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Follow-up Intake
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Follow-up Intake

Noom Questions to Use

My Ideas
Women who are in their 50s may need a slightly different strategy depending on their current lifestyle.
Which best describes you?
My diet and activity need a lot of work
I have some healthy habits
I mostly eat well and stay active

Which of the below best describes your current priorities?
I am only focused on losing weight
I'd like to gain some muscle while I lose fat
Gaining muscle is more important to me than losing fat

As a woman in your 50s, the specific combination of foods you eat can have a huge impact on your ability to burn fat.
Which of the following best describes your typical lunch?
I tend to eat sandwiches and/or wraps
Salad or mixed vegetable bowl
Protein with a side
Fast food
Other

What is your weight loss goal?

Lose 1-20 lbs for good
Lose 21-50 lbs for good
Lose over 50 lbs for good
Maintain weight and get fit
I haven’t decided yet

Have you noticed changes in your weight even though your diet has stayed relatively the same?
Yes, consistently
Definitely noticed a few
I’m starting to
Not sure
Not at all

How important is it for you to have more energy and feel healthier now and as you get older?
Very important
Somewhat important
Unsure
Not important
⁠
Do you think that a slowing metabolism is contributing to your current weight?
Yes, definitely
Yes, a little
Maybe
Not much
No, not at all


What’s your current weight?
We don't mean to pry, we just need to know so we can build a plan that's right for you.
lb.

What is your ideal weight that you want to reach?

lb.

What area do you want to focus on in your plan?
Nutrition
Physical activity
Building good habits
Other



Why are you uncertain about hitting your weight loss goal? (Check all that apply)
I haven’t had success in the past
Previous plans were too restrictive
Hitting a plateau
Losing weight and gaining it back
Losing motivation
Plan seems not realistic
Plan seems not aggressive enough
Other


As a woman in your 50s, your environment can play a major role in your ability to lose weight.
Which best describes the area you live in?
The country
The suburbs
A major city
Other

What area do you want to focus on in your plan?
Nutrition
Physical activity
Building good habits
Other

What is your main reason for wanting to lose weight? (Please choose what is most important)
Improve physical appearance
Engage more with family and friends
Become healthier
Feel better day-to-day
Other


This is your plan, designed to work at your pace. So knowing you, as only you can, which pace would you prefer?
As fast as possible
Slow and steady wins the race
Somewhere in between the two



Behavioral Profile:

I want to...

Reach a lower weight
Change my lifestyle to a healthier one
The biggest barriers to achieving my weight goals are...
External (e.g., temptations around me)
Internal (e.g., bad habits, low energy)
Weight loss/management is...
My ultimate goal
A means to a different health goal (e.g., lower blood pressure, less joint pain, etc.)
When it comes to working toward my weight goal…
I feel constantly motivated
My motivation goes up and down
A weight loss program...
Could teach me something new
Probably wouldn't teach me anything new about how to lose or maintain my weight
When it comes to weight loss programs...
I need one to reach my weight goals
I don’t need one and can figure out how to achieve my weight goals on my own

How long has it been since you were at your ideal weight?
0 - 6 months
6 - 12 months
1 - 3 years
More than 3 years

**Which of the following weight loss programs have you used in the past 12
months?**
Noom
WW (Weight Watchers)
Jenny Craig
Keto
Nutrisystem
Other
None

Have you attempted any of the following in the past to help lose weight?
Paid meal plans
Restrictive dieting
Gym membership
Prescription medication or procedure
None of the above

Are you currently subscribed to any of the following services? (select all that apply)
Gym Membership
Fitness App
Meal kit delivery
Meditation App
None

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