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Free Guide to Healthy Weight Loss
Fill out this free worksheet that will help you establish your weightloss goals

Why Do You Want to Lose Weight?

___To feel better and stronger

___To feel more energetic

___To look more attractive

___To get healthy and stay that way

On a scale of 1 to 10 (ten being the highest) my desire to lose weight is:

____(Fill in a number from 1 to 10)


Why Are You Having Trouble Anyway ?
There are four basic reasons that people have trouble controlling their weight:

Heredity, Hidden Fat and Calories, Stress Eating and Portion Control, and Lack of Physical Activity. Read about these factors on the following pages then check each one that applies to you:

__ Heredity

__ Hidden Fat and Calories

__ Stress Eating and Portion Control

__ Lack of Physical Activity

At rest you burn about __________ Cal/day. I am going to give you a meal replacement and portion control eating plan that provides ________ Cal/day. Therefore, you will lose about _____ lb. per week.

According to your body composition analysis, you have about _____ % body fat. The normal range for women is 22 to 28 percent and for men is about 15 to 20 percent. Using these guidelines and your age your ideal body fat is ______% body fat which you will achieve at a target weight of _______ lb.

If this target weight seems to high to you then you have more muscle than the average person of your height. I would like you to try to maintain the extra muscle by doing weight lifting as well as aerobic exercise. You may be someone who likes to exercise. You need to eat about 0.5 grams of protein per pound of lean body mass each day. You lean body mass is _____ lb. and you need about ______ grams per day. If this target weight seems too low then you may have been inactive due to an injury or illness, or you may have eaten too little protein on previous crash diets. Since each pound of lean body mass burns about 14 Cal/day, you may need to build up your muscle through weightlifting to increase the number of calories you are burning. For example, if you built 10 pounds of muscle over one year, your metabolism would increase by 140 Cal/day from __________ Cal/day now to __________ Cal/day. If you have had a lot of trouble losing weight even when you stick to a diet, this may be an important strategy for you.


Great Genes in the Wrong Place

Heredity: Many of us come from families where being overweight or obese is common. Up until this

century, mankind struggled to have enough food to survive so having genes that help you hang onto fat and calories was an advantage at one time. Now with our modern food supply and lifestyles, these same genes can bring out obesity, but not in everyone. It depends on how many of the other factors below apply to you whether you will be overweight.

Is Heredity an issue for me ?

Yes _______ No _________

Genetics determines the potential for overweight and obesity, but diet and lifestyle determine whether and to what extent that potential is realized.


Hidden Fat and Calories
The most popular foods in our society, such as french fries, are manufactured to exact specifications much like your car. Specific amounts of specific fats and oils are added to foods to enhance taste. As consumers became aware of hidden fats in the last decade, over 1000 different fat-free foods which were not calorie-free were produced. So while fat is still the most important source of extra calories in the typical American diet, it is possible to eat so-called fat-free foods full of sugar and still maintain your weight. Do you find that you canít eat "just one" of any of the following trigger foods or that they stimulate your eating when you arenít hungry ?


The High Calorie, High Fat Culprits
Think about the foods listed below and check off all those that may be your Trigger Foods:

__ Nuts, chips, sunflower seeds, peanut butter

___ Cheese and Cheese Pizza

___ Salad Dressings including so-called "non-fat"

__ Mayonnaise, Margarine, Butter

__ Red Meat: Veal, Beef, Pork and Lamb

__ Fatty Fish: Salmon, Trout and Catfish

__ Non-Fat Frozen Yogurts and Ice Cream

__ Cakes and Pastries


Are Hidden Fats in Trigger Foods a problem for me?

Yes _____ No _____


Stress Eating and Portion Size
Even if you are eating the right foods most of the time, you may be eating too much food too often. If you are a stress eater, you may be eating too quickly to taste your food. You may also be eating portions that are too large, or having seconds too often. If you eat when you are not hungry or snack too often between meals, you may be a stress eater.

Meal replacements (such as Ultra Slim-Fast*) and portion-controlled meals (such as Healthy Choice, Lean Cuisine, and Weight Watchers) can help you to control your eating habits. Research shows that using a meal replacement leads to more significant weight loss than simply cutting back on your favorite foods. When you try to count calories, research shows you will usually underestimate your calorie intake for the day by up to 25%.

Your doctor will give you a specific meal replacement plan for your level of calorie burning per day. When you use meal replacements and portion-controlled meals according to these plans, you are ensuring that you are giving your body the fuel it needs to function properly. You are also controlling your total calories more carefully than with calorie-counting so that you eat fewer calories than you burn - the most important requirement for losing weight.

Are Portion Control and Stress Eating a problem for me ?

Yes _____ No _______

*Ultra Slim-Fast is the most widely available over-the-counter meal replacement in the U.S. and the one which has been utilized most in research and patient care at UCLA. However, you can use other meal replacements if they have a similar nutritional profile to Ultra Slim-Fast. Please ask your doctor or diet counselor about the nutritional value of other products you may be considering before you use them.


Exercise, Fitness, and Physical Activity
Research shows that people who include physical activity such as walking in their weight loss program are more likely to keep the weight off than people who only change their diet. See where you can fit more fitness into your daily activities of living. Walking stairs instead of taking the elevator, and walking on a treadmill for thirty minutes every day are just twoexamples of activities you can try.

Is too little physical activity a problem for me ?

Yes _______ No _________


Your Body Weight and Body Mass Index

Body Mass Index (BMI) is a method used to estimate body fat. While more accurate assessment methods exist, this approach is most practical in our office setting. BMI is a direct calculation based on height and weight, but it does have some limitations. For example, it may overestimate body fat in people who are very muscular, and it may underestimate fat in people who have lost muscle mass. A person is considered overweight if the BMI is between 25 and 30, and obese if the BMI is 30 or above. Your risk for developing certain diseases can be determined by your BMI.

Click here to check your Body Mass Index with the BMI Tool



Body Mass Index and Risk of Co-Morbidities

BMI (kg/m2)
Weight Class
Risk of Co-Morbidities
Normal weight
Grade I
Grade II
Very High
> 40
Grade III
Extremely High








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