My Bright Future - Physical Acitivity and Healthy Eating for Rural Young Women

Talking With My Health Care Team

My Starting Point

Ask a member of your health care team to fill in this page. It shows where you are now with your health, eating, and physical activity. It also has space for your health care team member to write down his/her advice for healthy changes you could make.

Tip: Save this page. Use it first to help set your goals. Then, have your health care team member fill it out again after you've made changes. Seeing how far you've come can help you stick with your healthy habits!

Date:
Height (inches):
Weight (pounds):
BMI:	(Circle chart at bottom of page where height and weight meet.)

Note: The body mass index (BMI) is an estimate of body fat based on height and weight (not just weight alone). A high BMI may mean you are overweight or obese and at a higher risk for high blood pressure, heart disease, stroke, type 2 diabetes, and other conditions. The BMI is valid for both men and women, but it does have some limits. It may overestimate body fat in athletes and others who have a muscular build. It may underestimate body fat in older persons and others who have lost muscle mass.

Other numbers to keep in mind:

Blood pressure:
Cholesterol level:
Waist/hip measurement:
Glucose level:
Smoking: Yes/No

Current Physical Activity Assessment:

On target
Recommend changes

Current Nutrition and Eating Habits Assessment:

On target
Recommend changes

Health Care Team Advice: Next Steps

Body Mass Index (BMI) Table
BMI Height	100 lbs.	110 lbs.	120 lbs.	130 lbs.	140 lbs.	150 lbs.	160 lbs.	170 lbs.	180 lbs.	190 lbs.	200 lbs.	210 lbs.	220 lbs.	230 lbs.	240 lbs.	250 lbs.
4’ 10	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese
4’ 11	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese
5’	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese
5’ 1	Below normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese
5’ 2	Below normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese
5’ 3	Below normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese
5’ 4	Below normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese	Obese	Obese
5’ 5	Below normal	Below normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese	Obese
5’ 6	Below normal	Below normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese	Obese
5’ 7	Below normal	Below normal	Below normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese
5’ 8	Below normal	Below normal	Below normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese	Obese
5’ 9	Below normal	Below normal	Below normal	Normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese
5’ 10	Below normal	Below normal	Below normal	Normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese	Obese
5’ 11	Below normal	Below normal	Below normal	Below normal	Normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese
6’	Below normal	Below normal	Below normal	Below normal	Normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese	Obese
6’ 1	Below normal	Below normal	Below normal	Below normal	Below normal	Normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese
6’ 2	Below normal	Below normal	Below normal	Below normal	Below normal	Normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Obese	Obese	Obese
6’ 3	Below normal	Below normal	Below normal	Below normal	Below normal	Below normal	Normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Over- weight	Obese
6’ 4	Below normal	Below normal	Below normal	Below normal	Below normal	Below normal	Normal	Normal	Normal	Normal	Normal	Over- weight	Over- weight	Over- weight	Over- weight	Obese

Below Normal

Normal

Overweight

Obese

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