1. What is your current height and weight? 5'9 252
2. If you were at an ideal weight now, what would that weight be? 175?
3. At what weight would you like to be at four months from now?
220
4. Why do you want to lose weight?
to feel better about myself, to beable to buy the clothes i want not based on what fits
5. Do you want to lose weight for a specific life event such as wedding or reunion? If so, when is that event? No, more self confidence
6. What obstacles could get between you and your weight loss goals?
temptations!
7. Why do you think that you now have a weight problem?
Iv been fat my whole life, past depression adds to it as well
8. What lifestyle changes do you think would help you lose weight?
being more active and making healthier choices and resisting temptation
9. Have you lost weight in the past? If so, what has worked in the past to help you lose weight? yes ;ast year i lost 50 lbs i went to group meetings and took things 1 step at a time. learned about readng labels and makng better choices and staying active
10. Why do you believe that you did not lose weight or you gained the weight back?
i stoped losing because the group was over, because i plataued then went back to old habbits when my hubby was home for winter
11. What, if anything, has not worked for you in the past in helping you to lose weight? Why do you think it did not work?
nothing really
12. Would you try writing down all food and drink consumed for a given period of time? i supose if i had to
13. Do you cook at home often? If so, what do you cook?
i eat allot of chicken boobs and salads
14. How often do you go out to eat? Where do you go? to often. family owned reastraunts and family dinners
15. What are your three favorite foods?....chocolate...cheese...and....sweets!
16. What are your three favorite restaurants? fast food? kfc, subway....NYF
17. What are three things you can do differently when it comes to food?
no eating out. no sweets and more water
18. If you woke up tomorrow and your body was exactly the way you want it, what would be different?
id feel better about myself
19. Do you eat when you are not hungry? yes
20. Do you binge eat (large amounts at a time)?yes
21. Do you hide your food or eat in secret? No
22. Do you eat when you are sad, nervous, or depressed?
i actually eat more when im happy
23. Do you eat as a reward? yes
24. Do you eat while watching TV or using the computer? Yes
25. What do you normally eat for a meal? chicken and salad now....
26. What type of snacks do you eat?
now i go fpor fruit and nuts it use to be cakes, sweets deserts...chips
27. In terms of exercise, what, if anything, are you currently doing? zumba, nootcamp, kickboxing
28. Where do you go for exercise? in town

outisde
29. What, if anything, are your three favorite types of exercise? riding my bike, and all of the above, i also enjoy hiking
30. What is your daily/weekly/monthly/yearly motivation to move towards your goals? thinking about how much better i will look, fitting into clothes, wering s bikini being more confident for my husband
31. Do you have rewards for certain goals?
um, eating something unhealthy? wellll trying to reward myself with smaller clothes now