Part 1 of 12

What you want

Start with the good part. There are no wrong answers here, and nothing you pick commits you to anything.

What would you most like to change in the next year?

Pick up to 3.

Lose weight or body fatGet strongerMove more easily (less stiffness, better balance)Have more energyBetter blood pressure, blood sugar, or cholesterolEat betterSleep betterKeep up with my kids or grandkidsBe consistent with what I already know to doLook and feel better in my clothesSomething else

Please answer this one so we can plan well.

Of those, which matters most right now?optional

Please answer this one so we can plan well.

Why now? What is the real reason you would want this?optional

A sentence is plenty. This is the part that keeps people going when motivation fades, so it helps me to know it.

Please answer this one so we can plan well.

Is losing weight one of your goals?

YesNoNot sure

Please answer this one so we can plan well.

Which describes you best right now?optional

I am actively trying to lose weight right nowI am mostly trying to keep from gainingI am thinking about it for the next few monthsNot right now

Please answer this one so we can plan well.

Part 2 of 12

Where you are now

Honest is more useful than impressive. Everything here is a starting line, not a grade.

In general, how would you rate your health?

ExcellentVery goodGoodFairPoor

Please answer this one so we can plan well.

In a usual week, on how many days do you do at least 10 minutes of activity that makes you breathe harder?

A brisk walk, yard work, dancing, exercise, a physical job all count.

0 days1–2 days3–4 days5 or more days

Please answer this one so we can plan well.

Do you exercise regularly? (Planned activity, 3 or more times a week, enough to breathe harder.)

Yes, and I have for more than 6 monthsYes, but for less than 6 monthsNo, but I plan to start in the next 30 daysNo, but I plan to start in the next 6 monthsNo, and I am not planning to right now

Please answer this one so we can plan well.

Do you do any strength exercise now? (Weights, bands, or body-weight moves like squats or push-ups.)optional

NeverOnce in a whileAbout 1 day a week2 or more days a week

Please answer this one so we can plan well.

Which of these can you do today?

This only helps me make sure activities are made to fit every body. Pick all that apply.

Pick all that apply.

Get up from a chair without using my handsWalk 10 minutes without stoppingClimb a flight of stairs without stoppingGet down to the floor and back up by myselfWalk 30 minutes at a brisk paceNone of these right now

Please answer this one so we can plan well.

Does pain in a joint, your back, or your feet limit how you move?optional

NoA little, I work around itQuite a bit, it limits walking or stairsIt limits most of what I do

Please answer this one so we can plan well.

Have you had a fall in the past 12 months?optional

NoOnceTwo or more times

Please answer this one so we can plan well.

If you would like to share it, your current weight rangeoptional

Completely optional. It only helps me plan for the range of bodies in the room.

Under 150 lb150–199 lb200–249 lb250–299 lb300 lb or morePrefer not to say

Please answer this one so we can plan well.

Part 3 of 12

Your habits today

Just frequency, no judgment. This is where the biggest easy wins usually hide.

On an average day, how many sugary drinks do you have?optional

Regular soda, sweet tea, juice, energy or sports drinks, sweetened coffee drinks.

None or less than 1About 12–34–56 or more

Please answer this one so we can plan well.

In a usual week, how many meals come from fast food, fried food, or takeout?optional

None1–23–45–78 or more

Please answer this one so we can plan well.

On an average day, how many servings of fruit or vegetables do you eat?optional

A serving is about a fist-sized amount.

Hardly any1–23–45 or more

Please answer this one so we can plan well.

How many evening meals a week are cooked at home?optional

0–12–34–56–7

Please answer this one so we can plan well.

How would you describe yourself in the kitchen?optional

I do not really cookI can put simple things together (sandwiches, rotisserie chicken, microwave)I cook basic mealsI cook most days and enjoy it

Please answer this one so we can plan well.

How many hours of sleep do you usually get?optional

Less than 66–77–8More than 8

Please answer this one so we can plan well.

How often do you eat because you are stressed, bored, or tired rather than hungry?optional

RarelySometimesMost days

Please answer this one so we can plan well.

How much do you feel you know about calories, portions, and how weight actually changes?optional

Almost nothing, it is confusingA little, bits and piecesA fair amount, I just do not always apply itA lot, I could teach it

Please answer this one so we can plan well.

What would you want to learn about?optional

Pick up to 3.

How calories and weight really workReading food labelsPortions and protein without countingSimple meals on a budgetEating out and church mealsStrength basics, safelyStretching, balance, and moving with joint painSleep and stressHow to build a habit that sticksNothing right now

Please answer this one so we can plan well.

Part 4 of 12

What has happened before

Most people have tried something. What stopped it is one of the most useful things you can tell me.

Have you tried to lose weight or get fit before?

Never really triedTried, it worked, and I kept the resultsTried, it worked for a while, then slid backTried, but never really got going

Please answer this one so we can plan well.

What made it stop?optional

Pick all that apply.

Life got busyResults came too slowlyGot hurt or sickThe plan was too strict or complicatedLost motivation doing it aloneCostTravel, holidays, or a season of lifeFelt judged or embarrassedOne bad day turned into quittingSomething else

Please answer this one so we can plan well.

Honestly, what is the hardest part for you?optional

StartingKeeping going after the first couple of weeksFood, not exerciseExercise, not foodWeekends and social eventsNighttime eatingFinding the timeNot knowing what to doNot sure

Please answer this one so we can plan well.

Part 5 of 12

Your life and schedule

This decides when and where things happen. Pick what is real, not what sounds good.

Which best describes your schedule?optional

Regular daytime hoursShifts or irregular hoursWork from home or flexibleRetired or not workingStay-at-home parent or caregiverStudent

Please answer this one so we can plan well.

Do childcare or caregiving duties limit when you could do something?optional

NoSometimesMost days

Please answer this one so we can plan well.

How far do you live from church?optional

Under 10 minutes10–20 minutes20–40 minutesMore than 40 minutesI mostly join online

Please answer this one so we can plan well.

Which days could you realistically give 20–30 minutes?

Pick all that apply.

SundayMondayTuesdayWednesdayThursdayFridaySaturdayIt changes every week

Please answer this one so we can plan well.

What times of day work?

Pick all that apply.

Early morning (before 7)Morning (7–11)LunchtimeAfternoonEarly evening (5–7)Later evening (after 7)Right after Sabbath service

Please answer this one so we can plan well.

Where would you most likely actually do it?optional

Pick up to 2.

At homeAt churchMy neighborhood or a parkA gym I already belong toAt workFollowing a video online

Please answer this one so we can plan well.

What could you realistically spend per month on this (food changes, a gym, equipment)?optional

Nothing extraUnder $25$25–75More than $75

Please answer this one so we can plan well.

Part 6 of 12

The kind of help you would actually use

This is the heart of the survey. I genuinely do not know yet whether people want a coach, a partner, a teacher, a cheerleader, or to be left alone with a plan. Tell me.

Which of these would you actually use?

Pick all that apply.

A workout or walking partnerA small group (4–8 people) doing it togetherA weekly group walk or class at churchSomeone who checks in on me every weekEncouraging texts during the weekShort teaching (5–10 minutes) on food and exerciseMeal ideas and recipes that fit my lifeGrocery and label helpA trainer-style plan that tells me exactly what to doA prayer partner for thisFriendly challenges or competitionsI would rather do this on my own

Please answer this one so we can plan well.

Of those, which one would make the biggest difference?optional

Please answer this one so we can plan well.

Which fits you better?

An in-person groupAn online or video groupOne partnerOn my own, with someone checking inA mix

Please answer this one so we can plan well.

Would you want to do this alongside someone you already know (spouse, friend, family)?optional

Yes, and I know whoMaybe, if you paired me with someoneI would rather be matched with someone newI would rather not partner

Please answer this one so we can plan well.

Who at home would be for this change?optional

EveryoneSomeNo oneI live alone

Please answer this one so we can plan well.

How would you want your wins recognized?optional

Privately, just between usIn my small groupIn the group chat, with everyoneI do not want recognition

Please answer this one so we can plan well.

When you miss a few days, what helps you most?optional

A friendly check-inBeing left alone to restart on my ownA reminder of why I startedA smaller, easier plan to restart withNot sure

Please answer this one so we can plan well.

Part 7 of 12

What you want from me

I am figuring out my own role too. Be direct.

What would you want from me as the leader of this?

Pick all that apply.

Teach us the basics in plain languageOrganize groups, partners, and eventsCheck in with me personallyKeep everyone encouragedShare your own journey openly, including the hard weeksHold me accountable to what I said I would doHelp make church meals and events healthierPray with us about thisSet it up, then mostly let us run

Please answer this one so we can plan well.

Would healthier options at church meals and events (water, fruit, lighter dishes) help you?optional

YesSomewhatNoI do not usually attend those

Please answer this one so we can plan well.

How often would you like to hear about this at church (announcements, bulletin)?optional

WeeklyMonthlyOccasionallyNever, keep it low-key

Please answer this one so we can plan well.

Would you be willing to help lead, host, or encourage others?optional

YesMaybeNot now

Please answer this one so we can plan well.

Anything you could bring?optional

Pick all that apply.

Fitness or coaching experienceNursing, medical, or dietitian backgroundCookingHosting a groupTech help for othersEncouraging peopleLeading a walkSomething else

Please answer this one so we can plan well.

Part 8 of 12

Tracking and your phone

I want the tracking part to take seconds, not minutes, and to fit the phone you already have.

What phone do you use?

iPhoneAndroidA basic phone (calls and texts)I do not use a cell phone

Please answer this one so we can plan well.

How comfortable are you using apps on your phone?optional

Very comfortableSomewhatNot veryI would rather not use apps

Please answer this one so we can plan well.

Do you have any of these?optional

Pick all that apply.

A smartwatch or step counter I wearA bathroom scaleNeither

Please answer this one so we can plan well.

Which would you be willing to record most days for 3 months?

Pick all that apply.

Steps (from a phone or watch)Minutes of activityWeight, once a weekWhat I ate (a photo or a few words)WaterSleepOne tap: "I did my habit today"Nothing, I do not want to track

Please answer this one so we can plan well.

If you could only track one thing, which would it be?optional

Steps (from a phone or watch)Minutes of activityWeight, once a weekWhat I ate (a photo or a few words)WaterSleepOne tap: "I did my habit today"Nothing, I do not want to track

Please answer this one so we can plan well.

How would you like to check in or get information?optional

Pick all that apply.

Text messageA group chat (WhatsApp, GroupMe, iMessage)An app or websiteA paper card at churchA phone callIn person at church

Please answer this one so we can plan well.

How often would reminders be welcome?optional

Daily2–3 times a weekWeeklyOnly when I ask

Please answer this one so we can plan well.

Which language do you prefer for materials?optional

EnglishSpanishEither

Please answer this one so we can plan well.

Part 9 of 12

What gets in the way

These are reasons people commonly give. How true is each one for you?

"My days are so full that I do not think I can make time for activity."optional

Very trueSomewhat trueNot very trueNot true at all

Please answer this one so we can plan well.

"I am just too tired after work or the day to exercise."optional

Very trueSomewhat trueNot very trueNot true at all

Please answer this one so we can plan well.

"I want to, but I cannot seem to make myself stick to anything."optional

Very trueSomewhat trueNot very trueNot true at all

Please answer this one so we can plan well.

"I am embarrassed about how I would look exercising with others."optional

Very trueSomewhat trueNot very trueNot true at all

Please answer this one so we can plan well.

"I am afraid I might hurt myself or that it is not safe for me."optional

Very trueSomewhat trueNot very trueNot true at all

Please answer this one so we can plan well.

"It is too expensive. You need a gym, a class, or equipment."optional

Very trueSomewhat trueNot very trueNot true at all

Please answer this one so we can plan well.

Which of these would most likely knock you off track?optional

Pick up to 3.

Being tiredA busy weekDoing it aloneBad weatherStressGetting sick or hurtTravelHolidays and celebrationsWeekendsLate nights

Please answer this one so we can plan well.

When is it hardest for you not to overeat?optional

Pick up to 3.

When stressed or anxiousWeekendsWhen tiredWatching TVLots of tempting food aroundChurch meals and gatheringsLate at nightIt is not hard for me

Please answer this one so we can plan well.

Part 10 of 12

How ready you are

Two quick 1-to-10 questions and a few about commitment. Honest numbers help more than high ones.

How important is it to you, right now, to get healthier?

12345678910

Not importantThe most important thing

Please answer this one so we can plan well.

If you decided to, how confident are you that you could keep one small change going for 3 months?

12345678910

Not confidentCompletely confident

Please answer this one so we can plan well.

How long could you see yourself staying with something like this?

A few weeks, to try itAbout 3 monthsAbout 6 monthsThis is a life change, I am in for the long haulNot sure yet

Please answer this one so we can plan well.

If something started, when would you be ready to begin?optional

Right awayWithin a monthAfter the holidays or a particular seasonNot sure yet

Please answer this one so we can plan well.

Which sounds more like you?optional

Start tiny and build. One small change at a time.A steady, moderate plan from day one.Go all in. I want a real challenge.Not sure, I would want advice

Please answer this one so we can plan well.

Part 11 of 12

Keeping it safe for you

I am not a doctor and will never give medical advice. These are the standard questions used before any activity program. They are optional, they never exclude anyone, and they only help me make activities safe for every body in the room.

Has a doctor ever said that you have a heart condition or high blood pressure?optional

YesNo

Please answer this one so we can plan well.

Do you feel pain in your chest at rest, during daily activities, or when you are active?optional

YesNo

Please answer this one so we can plan well.

Do you lose your balance because of dizziness, or have you lost consciousness in the last 12 months?optional

YesNo

Please answer this one so we can plan well.

Have you been diagnosed with another chronic condition (for example diabetes, asthma, arthritis, kidney disease)?optional

YesNo

Please answer this one so we can plan well.

Are you currently taking prescribed medication for a chronic condition?optional

YesNo

Please answer this one so we can plan well.

Do you currently have, or have you had in the past 12 months, a bone, joint, or soft-tissue problem that could be made worse by becoming more active?optional

YesNo

Please answer this one so we can plan well.

Has a doctor ever said you should only do medically supervised physical activity?optional

YesNo

Please answer this one so we can plan well.

Are you pregnant, less than 6 months postpartum, or recovering from surgery?optional

YesNo

Please answer this one so we can plan well.

Do any of these apply to you?optional

Optional. It helps me know which activity versions to prepare.

Pick all that apply.

DiabetesHigh blood pressureHeart disease, heart failure, stent, or pacemakerStroke or TIAAsthma, COPD, or another breathing conditionKidney diseaseOsteoporosis or a fracture after age 50Knee or hip arthritisBack problemsJoint replacement or surgery in the past 12 monthsTaking a weight-loss medication (Ozempic, Wegovy, Mounjaro, Zepbound)Something elseNone of these

Please answer this one so we can plan well.

In the last 6 months, have you lost weight without trying, or lost your appetite?optional

NoYesNot sure

Please answer this one so we can plan well.

Anything else about your body or health that you want me to keep in mind?optional

Please answer this one so we can plan well.

Part 12 of 12

About you

Last part. Name and phone are optional. If you leave them blank, your answers are anonymous.

Your age

18–2930–4445–5960–7475 or olderPrefer not to say

Please answer this one so we can plan well.

You areoptional

A womanA manPrefer not to say

Please answer this one so we can plan well.

Anything else? What would make you say "yes, I am in"?optional

Please answer this one so we can plan well.

Can I follow up with you about this?

Yes, text meYes, email meYes, talk to me at churchNo, keep my answers anonymous

Please answer this one so we can plan well.

Your nameoptional

Please answer this one so we can plan well.

Phone number or emailoptional

Please answer this one so we can plan well.

By sending, you agree that the program leader may use your answers to plan this effort. Nothing is shared with the congregation.

Your answers save on this phone as you go, so you can close this and come back.