The Biggest Loser Contest
The Biggest Loser is returning. During the 12-week competition, which starts in January, contestants will learn
about and practice proper nutrition and exercise to transform their lives.
A grand prize will be awarded to the person who loses the greatest percentage of weight. Other prizes will be
awarded.
The first step in the competition is having a resting metabolic rate test to determine the amount of calories
needed each day, and then developing individual diets. Contestants meet with a dietitian weekly to review
nutrition logs, and learn nutrition tips and new recipes.
Exercise is the second step. Personal trainers lead two group workouts every week, and participants also
exercise on their own. Contestants will have full access to the land aerobics classes, aquatics classes and fitness
gym at Great River Health Fitness.
The third step is weekly meetings during which contestants discuss concerns about weight loss and
management.
Contestants do not have to be Health Fitness members. Applications must include a written questionnaire
and five-minute video featuring applicants explaining why they should be chosen. Selection will be based on
contestants’ health concerns, such as high blood pressure, diabetes, and joint pain, and life concerns related to
being overweight.
The application deadline is Monday, Dec. 22.
Fifteen contestants will be announced Sunday, Dec. 28, in The Hawk Eye.
For more information, please call Chris Reed, Great River Center for Rehabilitation, (319) 768-4100.
The Biggest Loser Application
Applications must be accompanied by a five-minute video featuring you explaining why you should be chosen.
Name Date of birth
Age
Occupation Home address
q Male
Date
q Female
E-mail
City
State Zip
Weight (mandatory)
Optional statistics:
Blood pressure­­­________ Body-fat percentage_______ Cholesterol_______ Clothing size_______
What was your turning point that made you decide to enter “The Biggest Loser” contest?
What weight-loss successes have you had?
What would this lifestyle transformation mean to you?
If chosen, what would be your initial 12-week goals?
Health History
Are you under the care of a physician? q Yesq No
Date of last exam:
If yes, please explain in detail:
Physician name
Address
Phone
Are you taking any prescription or nonprescription medicine? q Yes q No
If yes, please list name, dosage and how often you take each:
Do you smoke or use smokeless tobacco? q Yes q No
If yes, how long have you used and how much per day?
Please check and date if any of these apply to you:
q Angioplasty date: _________
q Blood transfusion date: _________
q Congestive heart failure date: _________
q Coronary bypass surgery date: _________
q Coronary valve surgery
q Heart attack
q Pacemaker
q Stroke Please check and date if any of these apply to you:
q Anemia
q Angina
q Arthritis
q Back pain
Explain:
q Irregular heartbeat q Kidney disease
q Lung disease
q Injuries
Explain:
q Cancer
q Chronic cough
q Productive q Nonproductive
q Chronic headaches
q Diabetes
q Diagnosed osteoporosis q Dizziness when rising or standing q Dizziness, light headedness q Exercise or cold-induced chest pain
q Gout q Heart murmur q Hernia
q High/low blood pressure q H q L date: _________
date: _________
date: _________
date: _________
q Palpitations q Seizures
q Rheumatic fever q Shortness of breath
q At rest q With activity q Surgeries
Explain:
q Swelling of the feet or ankles q Thyroid disorder
q Varicose veins q Other
Explain:
Family History
If you do not know your biological family’s health history, leave this section blank and proceed to Lifestyle
History.
Is your father living? q Yes q No Age at death ______
If no, what was the cause of death? ______________________________________
If yes, how old is he? ______
Please list any medical problems (father):
Is your mother living? q Yes q No Age at death ______
If no, what was the cause of death? ___________________________________________________
If yes, how old is she? ______
Please list medical problems (mother):
Please check here if there is a family (parents, grandparents, siblings) history of:
Relationship Relationship
q Cancer _________________________________ q High blood pressure _________________________
q Diabetes ________________________________ q Stroke ____________________________________
q Heart disease ____________________________ Lifestyle History
How many days each week do you exercise? ______
How many minutes does each session last, on average? ______
What types of exercise do you enjoy?
q Aerobics classes
q Cross-training
q Dynamic stretching q Eliptical trainer
q Free weights
q Jogging/running q Plyometrics
q Pool exercise
q Road bike
q Rowing machine
q Stair climber
q Stationary bike q Swimming
q Track workouts
q Trail running
q Treadmill running
q Walking
q Weight training q Yoga/Pilates
Are you on a special diet? q Yes q No If yes, please explain:
Is stress a concern at this time? q Yes q No If yes, please explain:
I have reviewed and answered each question to the best of my knowledge. I authorize the release of this
information to my primary physician(s) if chosen as one of 15 Biggest Loser contestants. Information will
not be released without my written consent, but the questionnaire information may be used for statistical or
scientific studies with my right of privacy retained.
Participant signature OFFICE ONLY
Biggest Loser application notes:
Date: