42 THE PROGRAM

H E A LT H R I S K A S S E S S M E N T Q U E S T I O N N A I R E

A LI ST Q UE ST IO NS

Do you smoke or use other forms of tobacco? YE S  ! NO !

Do you drink more than one to two glasses

of alcohol per day on average? YE S  ! NO !

B LI ST Q UEST IO NS

Is your blood sugar level above normal? YE S  ! NO !

Is your cholesterol level above normal? YE S  ! NO !

Is your blood pressure above normal? YE S  ! NO !

Do you need to lose more than ten pounds

to be at your ideal weight? YE S  ! NO !

Do you feel your stress level is too high? YE S  ! NO !

Do you feel you suffer from depression or anxiety? YE S  ! NO !

Do you skip your daily thirty minutes of exercise

more than you get it in? YE S  ! NO !

C LIST Q UE ST I O NS

Do you eat junk food (cookies, chips, candy,

soft drinks) most days? YE S  ! NO !

Do you feel fatigued much of the time? YE S  ! NO !

Do you feel your diet is lacking in fruits,

vegetables, and high-fiber grains? YE S  ! NO !

Do you have trouble getting seven to nine hours

of good-quality sleep every night? YE S  ! NO !

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 Getting Started 43

Scoring
A List: For every yes, assign 3 points.
B List: For every yes, assign 2 points.
C List: For every yes, assign 1 point.

Add up the points to get your total score. Total score ____________

Interpretation
0–2 points: Generally, your health habits are excellent.
3–5 points: You have good health habits, but they could be improved.
6–9 points: Your health habits need improvement.
10–13 points: Your health habits fall into a high-risk profile.
14–24 points: Your health habits fall into a very-high-risk profile.

In addition to taking the Health Risk Assessment, I encourage you to enter the
results of your most recent blood tests or physical examination in Health Stats
on page 370 in the Appendix so that you can compare your “before” and “after”
results upon completing The Program.
Now it’s time to create your health goals. Choose up to three long-term health
goals you would like to accomplish. They may be related to weight loss, stress
management, higher energy, greater fitness, better sleep habits, healthier eating
habits, improved blood pressure, cholesterol or blood sugar, or any other health
issue that concerns you. Keep it manageable. Pick no more than three. Make sure
your goals are realistic for the twelve-week time period. Don’t aim for the impossi-
ble. You can always take things to the next level once you reach your initial goal.
Remember, you don’t have to do it all at once. In fact, you are more likely to
succeed if you approach your goals slowly and gradually.

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