Christian Wellness Assessment Form

Developed by a Dietitian

Christian Wellness Assessment form created by Lacy Ngo, who is a registered dietitian and one of the top experts in Christian Mindfulness and Nutrition.

 

All You Need to Develop Your Own Christian Wellness Approach to Life

This assessment is perfect for people trying to improve their health AND their strengthen their walk with God through Christian Mindfulness and Nutrition. 

 

This is one of my favorite of my nutrition posts. This is what I would call my anchor post. Below I have included an adaptation of the assessment I developed for my clients. I used this assessment to customize my own clients specific plan! 

The Peace of Mindful Eating

 Save/pin/bookmark this for when you have time to sit down, carefully read the whole post, take notes, and develop your own habits to implement. 

Disclosure: This site may provide affiliate links (See full disclosure)

 

How to Use This Christian Wellness Assessment and Develop Your Own Plan

Step 1

First, answer the questions! 

checklist photo

Step 2

After answering the questions, determine which areas you would like to improve in your life.

Step 3

Once you have determined which areas you would like to improve, you will need to brainstorm habits that would help you improve your life in these areas. You will find links in the parentheses beside each question that will help you brainstorm and pick helpful habits to incorporate into your life. Click on the links and pick the techniques that you feel will best help you find solutions. notepad photo

Step 4

You are getting close to determining the specific lifestyle habits you would like to add to your daily life. Now let’s narrow it down. Pick 3-5 ideas that will be part of your plan and write them down. You may want to keep your plan somewhere visible. Keep practicing your changes until they become second nature to you.

Things to Remember

  • Often times if you try to change too much at once, you will get overwhelmed so only add a few lifestyle changes at a time.
  • I encourage you to consider picking mindful eating as one of the habits to implement. Mindful eating is about enjoying your food and listening to your body. You can learn more about mindful eating here.
  • Understand that “mess ups” are part of the process. We are not perfect. We will mess up. That is part of the process in…well everything in life. 
  • Take a multivitamin. I wish we were all getting the nutrients we need, but most people, unfortunately, are not getting all the vitamins and minerals we need in our diets.
  • Give your plan a few weeks. If you are having trouble with one component of your plan, go back to the solutions and try something else. Or after implementing your plan, you may notice things you would like to change that you had not thought of before. Go back to the habit tips and find a habit that will help you with the issue you want to address. 

Sample Diet Assessment

 Still need a little help seeing how this will work? Let’s look at a couple of examples of barriers  and solutions:

Barrier 1: You see from your assessment that you have problems with portion control so you click on the suggested solution articles. You first look at the Portion Control Tricks blog to see if there is a strategy that can help you. You like the idea of pre-portioning and freezing your foods. Now you have a habit you would like to implement into your life.  

Barrier 2: After finishing the assessment, you discover you binge on afternoon snacks. Based on the suggestion in the link provided, you decide to focus on hunger cues and eat when you are hungry instead of waiting until you are famished in the afternoon.

Christian Wellness Assessment Form

Date                           .

Height:                  Age                   Weight                Usual Weight                           

What are your health and wellness goals? What about your mind, body, and spirit would you like to improve?

Have you recently gained or lost weight?                  If so, how much                       

Medical History:

Please list any of your medical conditions. (Please be sure to discuss your medical issues and treatment plans with a doctor).

Your Daily Routine 

How many meals do you eat per day?             Snacks per day?         

Do you eat breakfast?         

(If yes, what kinds of things do you eat? How do you feel after eating that meal? If you would like to focus on eating healthier at breakfast, click here to learn how to build a nourishing breakfast meal or click here to find a list of healthy on-the-go snacks.)

If no, do you tend to wait until you are starving and then eat until you are uncomfortably full? (Click here to learn how mindful eating and listening to hunger cues may help with portion control)

Or do you not eat just because you are not hungry in the morning? (That is fine, keep doing what you are doing)

Or are you hungry, but too busy to stop to eat? (if the answer is yes to this question, click here to find healthy on-the-go nourishing snacks.

Do you skip meals?         Why?

Do you find following a diet difficult because you always feeling hungry? (You may be ignoring your hunger cues, follow these Mindful Eating Steps and focus on mindfully eating when you are hungry)

Work Questions

Occupation                                           .

Describe how your occupation affects your eating and exercise                                                                          

                                                                                                                                                        

                                                                                                                                                           

Do your coworkers and you often order take out, go out for lunch, or get fast food together?                  (If work seems to be a barrier to your health goals then click on When my Work Environment Gets in the Way of My Health and Wellness Goals, and 26 Clever Hacks for Eating Healthy While Eating Out  to find ideas that may help)

Do you travel frequently for work?                  (If yes, see Healthy Eating Hacks for Vacations and Frequent Travelers  and 26 Clever Hacks for Eating Healthy While Eating Out to develop your diet plan)

 

Are snack foods always available at work or do you snack at work? If so, what kinds of snacks do you eat?               (If yes, see Snacking Hacks for Healthy Living  and When Your Work Environment Gets in the Way of My Health and Wellness Goals to develop your own diet plan.)

Dining Out Questions

How many times do you eat out per week?              

Do you eat out often or are you always on the go and never eat at home?         

Name the restaurants where you most frequently eat?                                                                                            

Do you have trouble with portion control or eat high-calorie, lower-nutrient foods when you eat out?

If eating out seems to be a barrier to your health goals, see Eating Out Tips.)

Meals at Home Questions

Who cooks your meals?                       .

How often do they cook per week?                     .

Are the majority of the meals you eat cooked at home?                .

Are you expected to cook meals or are you the main cook for your family?              (If yes see Meal Planning , Grocery Shopping Hacks , How to Make the Foods I Already Eat Healthier,)

Do you often cook less nourishing meals because it is easier, quicker, or because you can’t think of what else to cook or you don’t know how to make nourishing meals?                          (If yes see Meal Planning , Grocery Shopping Hacks , How to Make the Foods I Already Eat Healthier,)

Do you struggle with menu planning?          (If yes see Meal Planning, Grocery Shopping Hacks , How to Make the Foods I Already Eat Healthier,)

Who do you eat with?                           .

Do you feel like you can’t cook nourishing meals because your other family members won’t eat it?                  (If the answer is yes and you feel that you cannot control what types of foods you eat due to your family, then control how much you eat instead by using Portion Control Tips. You could also try cooking the same meals that your family always enjoys, only using the lower calorie versions, see How to Make the Foods I Already Eat Healthier,” for ideas.” Many times families think they won’t like lower calorie foods but they are just as good. Try a few lower calorie recipes to see what your family thinks.)

Does someone else cook the food and therefore you feel you do not have control over what you eat?                   (If yes, then you will have to control your portions instead of what types of foods you eat so see Portion Control Tips. The Prepackaged, Pre-portioned meals or Meal Replacement post may also work well for you temporarily)

Does living with others make buying and having healthy foods in your house difficult?                (If yes, see  Portion Control Tips.)

Do you have difficulty with wanting overeating past full meals?                      (If yes, see  Portion Control Tips.)

Do you feel like you always end up putting too much food on your plate?             (If yes, see  Portion Control Tips.)

Do you feel like you aren’t eating very much at meals? (Perhaps focus on what you are eating instead of how much, see  Meal Planning , Grocery Shopping Hacks, How to Make the Foods I Already Eat Healthier,)

Who does the grocery shopping?                    

Are there more empty calorie foods in your house than nourishing foods?                           .  (If yes, see “Grocery Shopping Hacks.”)

Do you often snack on “empty calorie” snacks?              (If yes, see Snacking Tips .)

Are you sometimes too busy to plan meals when you get home, so you just make something easy and quick?           (If yes, see “ Meal Planning Tips”, “Grocery Shopping for Weight Loss,” How to Make the Foods I Already Eat Healthier,) You can also learn how to quickly build a meal on the spot with The Nourishing Meal Builder

How often do you eat frozen meals per week?            (If you eat frozen meals or quick meals often and rarely cook, then the Pre-packaged, pre-portioned meals or Meal Replacement diet tips may work well for you.)

Do you only  to prepare meals for yourself?                      (If yes, the Prepackaged. Pre-portioned Meals, or Meal Replacement Plans Meal Planning Tips, How to Make the Foods I Already Love Healthier,.)

Where do you eat when you are eating at home?                  

Do you eat at different places other than the table?              (If yes, see “Snacking Tips, and Portion Control Tips.)

Is the TV on while you eat?                (If yes, see “Snacking Tips“, numbers 104 through 116, and  Portion Control Tips.)

Non-Meal Times, i.e. Snacking Questions

What time of day do you snack or nibble on anything other than your meals?               

List the foods you snack on                                                                                              

Do you nibble or graze on things here and there throughout the day?     (See Snacking Tips and Grocery Shopping Hacks)

Do you sometimes grab a couple of bites while doing something else like working, cooking, watching TV, using the computer, studying, etc?          (See “Snacking for Weight Loss” and “Grocery Shopping for Weight Loss“)

Eating our Emotions Questions

Do you snack or “splurge” when you are bored?          

Do you snack or “splurge” when you are stressed?         

Do you snack or “splurge” when you are sad?              

Do you snack or “splurge” when you are tired?

Are you getting 7 to 8 hours of sleep most nights?        

Do you eat because you need a break from work or because you are procrastinating?             

(If you answer is yes to any of these, see  Emotional Eating )

Activity Questions

How often are you currently working out and what do you do?                             

Do you have trouble finding time to exercise?          

Do you enjoy exercise?          

When is the best time for you to exercise?           .

Do you get bored exercising?           

Do you have trouble balancing exercise with time with your children or do your children seem to take up all of your time?            

Do you often feel too tired to exercise?                  

Do you feel too embarrassed to exercise in public?                

If exercise is an issue you would like to explore, see (If no, see Developing an Exercise Plan”,  When you are Too Busy to Exercise, and Exercises you can do with Your Children)

Misc. Questions

Tell me what your day is like from morning to night including everything you do throughout the day and eat including condiments and serving sizes.                                                                                                                                                          

Do you feel worse during vacations due to overeating?            (If yes, see “ Healthy Eating Hacks for Vacations and Frequent Travelers“)

List the things you most often drink? (If unhealthy drinks are an issue, see Top 5 Tips for Reducing Liquid Calories)

Do you find yourself often overindulging in sweet sugary foods?                           (If yes, see 4 Ways to Lose Weight When You Have a Sweet Tooth)

Do you spend a lot of time out with friends or at social gatherings?             (If yes, see “Weight Loss Tips for Parties and Social Gatherings“)

Do you find that you tend to eat healthy until you get out of your routine, and then your healthy lifestyle falls away? In other words, do you find that you go from one extreme to the other when you diet? If this is a problem with you, you may want to focus on mindful eating. Some days you will eat more calories than others, but you will not lose control and overdo it. On days when you can’t follow your routine, if you mindfully eat, you can still joyfully eat a healthy portion of food. You may also want to see, What happens when your motivation and willpower to eat healthy runs out?

While answering the above questions, did you notice portion control or eating until you are overly full was a common issue? (If yes, then see  Mindful Eating and  Portion Control Tips“.)

After going over this questionnaire, pick 2 to 3 things you would like to address and change.    (Examples include afternoon time, stress, boredom, sweets, getting seconds, portion control, alcohol, snacking, grazing, TV watching time, work stress, social occasions, dining out, eating immediately after work, etc)?                                                                                      

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exercise photo
Photo by Fit Approach

Was This Helpful?

I want this plan to include everything you need to be successful; so it you find another tip that worked for you, please let me know. If the research backs up any recommended techniques, I will add it to the list.

Copyright © 2017 Mindfulness in Faith and Food.

You are free to retain any and all content here for personal use, but need permission to use it anywhere else on the internet.

 

Published by

Lacy Ngo

Lacy Ngo is a Registered Dietitian with a Masters in Human Nutrition. Lacy focuses on mindful eaitng and living and her blog provides over 400 nutrition and weight loss tips as well as inspiring faith stories

16 thoughts on “Christian Wellness Assessment Form”

  1. This is such an incredibly useful assessment form! Not only will it help future clients, but also something for ourselves too. Sometimes we don’t realize little changes (as you mentioned changing sweet tea to unsweetened tea) can make a big difference!

    1. Thank you for taking the time to comment! This works great with my clients, and I take the assessment myself when I realize I need to do my own re-evaluation!

    1. Thank you so much for taking the time to share your thoughts. I am so glad you found this information practical. Providing practical and truly helpful content is my goal.

    1. Thank you so much for taking the time to comment. It really does mean so much to me when I hear others find the information useful. It inspires me to keep writing and trying to provide helpful, detailed content.

  2. Wow~This is a great post with so many useful tips and strategies! I am currently working with a woman who wants to lose some weight, but is tired of *diets*, so we’re using a lot of the strategies you listed in your post. I think you’ve got every situation covered 🙂

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