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Week 2 Behavior Change Contract (Signed)

Santa M Murtano is committing to losing 1 pound per week for 7 weeks through diet and physical activity. Her long term goal is to lower her BMI to 21. She identifies 3 obstacles as having odd work hours with no time for exercise, winter weather, and lack of home cooked meals. Her strategies are to do exercises between jobs, jog to work, and take stairs instead of elevators. She will use her spouse, a health course, a health center, and a nutrition textbook as resources. Her short term goals are to consume 1800 calories daily by 1/24/16, reach 10000 steps daily by 1/24/16, and 15000 steps 3 days a week by 1/22/16 with ice cream

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Milene Teja
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644 views

Week 2 Behavior Change Contract (Signed)

Santa M Murtano is committing to losing 1 pound per week for 7 weeks through diet and physical activity. Her long term goal is to lower her BMI to 21. She identifies 3 obstacles as having odd work hours with no time for exercise, winter weather, and lack of home cooked meals. Her strategies are to do exercises between jobs, jog to work, and take stairs instead of elevators. She will use her spouse, a health course, a health center, and a nutrition textbook as resources. Her short term goals are to consume 1800 calories daily by 1/24/16, reach 10000 steps daily by 1/24/16, and 15000 steps 3 days a week by 1/22/16 with ice cream

Uploaded by

Milene Teja
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DATE: 1/20/16

NAME: Santa M Murtano

Behavior Change Contract


DIRECTIONS: Choose a health behavior that you would like to change and fill out this behavior change
contract (a sample on the next page). Sign the contract at the bottom to affirm your commitment to
making a healthy change, and ask a friend to witness it.
My behavior change will be:

Losing 1 lb weekly for next 7 weeks through physical activity and diet
My long-term goal for this behavior change is:

Possibly until my BMI reaches 21


These are three obstacles to change (things that I am currently doing or situations that contribute to
this behavior or make it harder to change):
1.

Odd and long hours at job, no time for physical activities

2.

Winter and snow

3.

No time to prepare home-cooked foods, the food I eat are mostly takeouts

The strategies that I will use to overcome these obstacles are:


1.

Trying to do exercises every 1-2 hours at jobs

2. Jog or run and detour when going to my workplace


3. Taking stairs instead of escalator and elevator at work
Resources I will use to help me change this behavior include:
A friend/partner/relative:

My spouse who together will also lose weight

A school-based resource: This course


A community-based resource:

I live near a health center that offers free nutrition counsels

A book or reputable website: The textbook


In order to make my goal more attainable, I have devised these short-term goals.

Calories intake of 1800 daily


(short-term goal 1)

1/24/16
(target date)

(target date)

(reward)

1/22/16

15000 steps 3 days in a week


(short-term goal 3)

(reward)

1/24/16

10000 steps daily


(short-term goal 2)

Ice cream

(target date)

(reward)

When I make the long-term behavior change described above, my reward will be:

2/28/16
1 week off work
______________________________________________________________
Target Date: ____________________
I intend to make the behavior change described above. I will use the strategies and rewards to
achieve the goals that will contribute to a healthy behavior change.

Santa M Murtano
Signed: _____________________________

Kurniawan Teja
Witness: _____________________________

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