I, as Agent for the "Person in the Mirror," agree
to perform everything as to complete the following weight loss
Weight Loss Goal for this Agreement: __________
Target Weight: _________
hereby commit to starting today to achieve the weight loss that
I know I want and need to feel good about myself. I hereby take
sole responsibility for my weight and am willing to make permanent
changes in my diet and exercise habits.
this day forward I will no longer be denied the success I deserve.
This is an important day in my life, the day I make a final
commitment to do what needs to be done, to consistently focus
on my goal and eat healthy, every hours, every day, every week
from here forward. I will no longer make excuses or justify
my current unhealthy diet and lifestyle.
understand that my weight loss goal is going to be reached by
developing new healthy habits overtime. I understand that I
will not have to settle with my current weight. I have the power
to change my relationship with food to one that supports my
desire for a new healthy lifestyle.
Signature of Commitment
As I sign this contract. I understand that
my future is my
responsibility and I recognize I am capable of achieving
as Agent for the "Person in the Mirror," upon the
completion of this goal accept congratulations and realize that
I can do anything that I want and be anything that I want. I
have succeeded in setting and achieving one the most important
life goals - a healthy weight.
have taken a major step toward being the person I want to be.
I take great pride in knowing that I have successfully planned
and reached my weight loss goal.
am one large step closer to my final target weight goal. Reaching
my final target weight is a series of successful smaller goals.
Agent for the "Person in the Mirror"
of pounds Lost: __________
Current Weight: __________
Final Target Weight Goal: _________