My Personal Plan Worksheet

What is your target weight? _________________________________________________________

Why do you want to weigh this amount? List your motives:

1. ___________________________________________ 3. ___________________________________________

2. ___________________________________________ 4. ___________________________________________



Make a list of every bad eating habit you have that will keep you from achieving this goal:

1. ___________________________________________ 4. ____________________________________________

2. ___________________________________________ 5. ____________________________________________

3. ___________________________________________ 6. ____________________________________________


What plan have you decided to use? List the details below:

___________________________________________________________________________________________

___________________________________________________________________________________________


What do you need to do to start this plan? (Buy a scale, purchase the book, gather information on calories
and grams of foods) Be specific:

____________________________________________________________________________________________

____________________________________________________________________________________________


Make a list of the situations where you find yourself overeating (i.e., family gatherings, out shopping--fast food,
restaurants, watching TV, snacking while reading). What is your plan for dealing with each of these situations?

1.__________________________________________________________________________________________

My Plan:___________________________________________________________________________________

___________________________________________________________________________________________

2._________________________________________________________________________________________

My Plan:___________________________________________________________________________________

___________________________________________________________________________________________

3._________________________________________________________________________________________

My Plan:___________________________________________________________________________________

___________________________________________________________________________________________

4._________________________________________________________________________________________

My Plan:___________________________________________________________________________________

___________________________________________________________________________________________

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Permission granted to print out for personal HOME use only.