SMART Goals for a Healthy Lifestyle – Adults (Checklist)

Set goals to help you make changes

1. Go over the following lists of healthy habits.

2. Place a 9 checkmark in the box for each healthy habit you want to work on.
3. Pick 1 or 2 habits you want to start with.
4. For each habit, use the last page of this handout to write a SMART goal.
5. After a few weeks of doing the new habit, decide if you are ready to make another change to your lifestyle. If
you are ready, then set a new goal.

Healthy eating

Based on Canada’s Food Guide:

‰ I will choose ______ servings of vegetables and fruit per day (7-10).
‰ I will choose ______ servings of grain products per day (6-8).
‰ I will choose ______ servings of milk and alternatives per day (2-3).
‰ I will choose ______ servings of meat and alternatives per day (2-3).

Eat three well balanced meals daily, with healthy snacks as needed:
‰ I will eat breakfast, lunch and dinner every day.
‰ I will plan my meals and snacks ahead of time.
‰ I will make meals and snacks at home more often.
‰ I will not skip __________________ meal.
‰ I will add a healthy snack of ________________ if my meals are more than 4 hours apart.
‰ I will increase my fibre intake by eating _________________every day.
‰ OTHER: __________________________________________________________________

Watch your portion sizes:

‰ I will decrease my portion size of ___________ from _________ to _____________.
‰ I will wait 20 minutes after finishing one serving before taking more food.
‰ I will stop eating when I no longer feel hungry. I won’t finish my plate just because “it’s there”.
‰ I will eat less other food so that half of my plate at lunch and supper will be vegetables.
‰ I won’t eat _________________out of the bag or container anymore. I will put a small portion on a plate or
bowl and put the rest away.
‰ I will not eat while watching TV or reading.
‰ I will serve food from the kitchen and stop putting large bowls of food on the table.

Reduce your sugar intake:

‰ I will limit my juice intake to _________ cups/mL per day.
‰ I will choose ___________________instead of pop and other sweet drinks.
‰ I will drink ______ cups of water or low calorie drinks per day.
‰ I will decrease sweets and treats like cookies/ice cream/chocolate to __________________times per week.
‰ OTHER: _________________________________________________________________
Developed by Registered Dietitians Nutrition Service
Reduce your fat intake:
‰ I will reduce my servings of added fats (margarine, salad dressings, oils, sauces and gravy) from _____ to
_____ tsp. per day.
‰ I will reduce my portions of meat and alternatives from _____to ____ per day.
‰ I will use baking, grilling and steaming as cooking methods.
‰ I will choose ________________ (fruit or vegetable) instead of ________________ as snacks.
‰ I will use milk in my coffee instead of cream.
‰ OTHER: ____________________________________________________________________

Reduce your salt intake:

‰ I will decrease my sodium (salt) intake by eating less _____________________________________.
‰ I will use fewer high salt foods (canned soup, ketchup, soy sauce, prepared salad dressings).
‰ I will not use the salt shaker to add salt to my food at the table or in cooking.
‰ OTHER: ___________________________________________________________________

Eating out:
‰ I will order________________ instead of_____________ when eating out at family dining restaurants.
‰ I will go through the drive-thru or eat “on the run” only __________ time per week.
‰ I will order ________________instead of _____________ when eating out at fast food restaurants.
‰ I will eat out less than three times per week.

Lifestyle changes

‰ I will write down what I eat and drink each day in a journal.
‰ I will eat at the kitchen table instead of _______________________________________.
‰ I won’t eat in my car or at my desk at work.
‰ I will read food labels to help me make better choices.
‰ I choose to take care of myself when I feel depressed or stressed by ____________________
___________________________________________________________________________.
‰ I choose to _____________________________________________________instead of eating.
‰ I choose to decrease the number of cigarettes I smoke to ____________ per day by___________date.
‰ I choose to quit smoking.
‰ OTHER: ____________________________________________________________________

Physical activity

‰ I will be more active daily by _______________________________________________.

‰ I will _________________________(activity) on _________________________ (days of the week) for
______________ (time).
‰ I will get __________________ steps each day on my pedometer.
‰ I will increase my weekly average of _________ steps to _________steps.
‰ I will take the stairs instead of using the elevator or escalator.
‰ I will do an activity that makes me breathe heavier and sweat for at least 20 minutes _________ times a week.
Staying on track

Write down the names of people you can ask to support the changes you are making.

______________________________________________________________________________

Write down things that could stop you from achieving your goal.

______________________________________________________________________________

______________________________________________________________________________

Now, write down some ideas for what you can do to keep on track.

______________________________________________________________________________

______________________________________________________________________________

Write down why you are making a healthy lifestyle change. Read this when you feel like giving up on your goal.

______________________________________________________________________________

______________________________________________________________________________

My first goal is:

Goal:

Specific
How I will do it?
Measurable
How I will measure it?
Achievable
Is this something I can do?
Rewarding
How will I feel rewarded?
Time Frame
When I want to achieve it?

Date: _____________ Signature: ____________________________________________

© 2005 Capital Health Authority Regional Nutrition and Food Service. Revised December 2006 RNFS—14-001
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without prior written permission of Capital Health. Direct correspondence to the Education Resource
Program Leader. This is not a rendering of specific nutrition advice by Capital Health, and individuals should seek individual dietary consultation.