Hello 
Pardon me everyone,
I'm a high school student trying to collect surveys from the network about dieting.
If you have time, can you please spare some of it and help?
Thank you very much.
Oh oh and I will delete this if anyone consider as a problem.
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Age:
1. How tall are you? ___ Ft ___ In
2. How much do you weigh? _____ Pounds
3. Are you satisfied with your current weight? If not, how much weight are you willing to lose?
Yes ? No ?
a. Less than 10 lbs.
b. 11 lbs. to 25 lbs.
c. 26 lbs. to 50 lbs.
d. More than 50 lbs.
4. Since when did you become aware of your body shape and weight?
a. less than age of 10
b. age of 11 to 14
c. age of 15 to 18
d. more than age of 19
5. Put the number to describe(s) the frequency of your behaviour.
sometimes = 1 often = 2 always = 3 never = 0
Avoiding eating between meals:
Exercising alone:
Dieting or exercising with a friend:
Dieting or exercising with a family member:
Avoiding eating breakfast:
Counting calories:
Selecting low-calorie foods:
Drinking water before eating:
Lying about the amount of food eaten :
Weighing self several times a day:
Smoking cigarettes :
Keeping busy to avoid temptation to eat:
Taking laxatives:
Self-induced vomiting:
Avoiding eating with family:
6. Do you consider certain qualities of your body most as an inherent result from your parents' genes rather than a developed result?
a. very likely
b. likely
c. possibly
d. unlikely
7. How would you rate your closeness of relationship with your parents?
very distant = 1 distant = 2 neutral = 3 close = 4 very close = 5
8. How aware are your parents of your diet? How is their opinion?
9. Are your parents aware of their body shape and weight as much as you do?
Yes ? No ? Maybe ?
10. How many siblings do you have? Specify their gender.
a. none
b. one M/F
c. two M/F M/F
d. three M/F M/F M/F
e. four or more M/F M/F M/F M/F M/F
11. How would you rate your closeness of relationship with your sibling(s)?
very distant = 1 distant = 2 neutral = 3 close = 4 very close = 5
12. How aware is/are your sibling(s) of your diet? How is her/his/their opinion?
13. Is/are your sibling(s) aware of her/his/their body shape and weight as much as you do?
Yes ? No ? Maybe ?
14. How would you rate your family meal? for what reason(s)?
excellent = 1 good = 2 average = 3 poor = 4 very poor = 5
Your reason(s) :
15. Are your friends aware of their body shape and weight as much as you do?
Yes ? No ?
16. Have you ever felt mistreated by your friends/peers because of your body shape?
Yes ? No ? Maybe ?
17. Do you consider yourself "less attractive" to opposite sex?
Yes ? No ? Moderate ?
18. How do you usually handle your hardships?
a. alone
b. family members
c. friends
d. others ______________
19. How many hours do you watch television per week?
a. less than an hour
b. an hour to five hours
c. five hours to ten hours
d. more than ten hours
20. How often do you read fashion- or celebrity-related magazines?
a. less than once a week
b. once or twice a week
c. three to five times a week
d. everyday
--------------------------------------------------------------------
Thank you!
any questions: inkyoho@gmail.com
Pardon me everyone,
I'm a high school student trying to collect surveys from the network about dieting.
If you have time, can you please spare some of it and help?
Thank you very much.
Oh oh and I will delete this if anyone consider as a problem.
--------------------------------------------------------------------
Age:
1. How tall are you? ___ Ft ___ In
2. How much do you weigh? _____ Pounds
3. Are you satisfied with your current weight? If not, how much weight are you willing to lose?
Yes ? No ?
a. Less than 10 lbs.
b. 11 lbs. to 25 lbs.
c. 26 lbs. to 50 lbs.
d. More than 50 lbs.
4. Since when did you become aware of your body shape and weight?
a. less than age of 10
b. age of 11 to 14
c. age of 15 to 18
d. more than age of 19
5. Put the number to describe(s) the frequency of your behaviour.
sometimes = 1 often = 2 always = 3 never = 0
Avoiding eating between meals:
Exercising alone:
Dieting or exercising with a friend:
Dieting or exercising with a family member:
Avoiding eating breakfast:
Counting calories:
Selecting low-calorie foods:
Drinking water before eating:
Lying about the amount of food eaten :
Weighing self several times a day:
Smoking cigarettes :
Keeping busy to avoid temptation to eat:
Taking laxatives:
Self-induced vomiting:
Avoiding eating with family:
6. Do you consider certain qualities of your body most as an inherent result from your parents' genes rather than a developed result?
a. very likely
b. likely
c. possibly
d. unlikely
7. How would you rate your closeness of relationship with your parents?
very distant = 1 distant = 2 neutral = 3 close = 4 very close = 5
8. How aware are your parents of your diet? How is their opinion?
9. Are your parents aware of their body shape and weight as much as you do?
Yes ? No ? Maybe ?
10. How many siblings do you have? Specify their gender.
a. none
b. one M/F
c. two M/F M/F
d. three M/F M/F M/F
e. four or more M/F M/F M/F M/F M/F
11. How would you rate your closeness of relationship with your sibling(s)?
very distant = 1 distant = 2 neutral = 3 close = 4 very close = 5
12. How aware is/are your sibling(s) of your diet? How is her/his/their opinion?
13. Is/are your sibling(s) aware of her/his/their body shape and weight as much as you do?
Yes ? No ? Maybe ?
14. How would you rate your family meal? for what reason(s)?
excellent = 1 good = 2 average = 3 poor = 4 very poor = 5
Your reason(s) :
15. Are your friends aware of their body shape and weight as much as you do?
Yes ? No ?
16. Have you ever felt mistreated by your friends/peers because of your body shape?
Yes ? No ? Maybe ?
17. Do you consider yourself "less attractive" to opposite sex?
Yes ? No ? Moderate ?
18. How do you usually handle your hardships?
a. alone
b. family members
c. friends
d. others ______________
19. How many hours do you watch television per week?
a. less than an hour
b. an hour to five hours
c. five hours to ten hours
d. more than ten hours
20. How often do you read fashion- or celebrity-related magazines?
a. less than once a week
b. once or twice a week
c. three to five times a week
d. everyday
--------------------------------------------------------------------
Thank you!
any questions: inkyoho@gmail.com
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