How Much Do You Weigh?

  1. Your gender:
    • Female
    • Male
  2. Your age:
    • teen
    • 30s
    • 20s
    • 40s or older
  3. You exercise for at least a half hour
    • Rarely
    • Once a week or less
    • A few times a week
    • Almost every day
  4. How often do you eat fast food?
    • Once a week or less
    • Rarely
    • A few times a week
    • Almost every day
  5. How often do you weigh yourself?
    • Once a week or less
    • A few times a week
    • Almost every day
    • Rarely
  6. How many fruits and vegetables do you eat each day?
    • Do french fries count?
    • 3 or 4
    • 1 or 2
    • 5 or more
  7. Does anyone in your family have a weight problem?
    • Everyone does
    • Both of your parents do / did
    • One of your parents do / did
    • Not really
  8. When you eat at home, you:
    • Have someone else cook for you
    • Cook something for yourself
    • Heat up frozen food
    • Get take-out / pizza
  9. How often do you eat dessert?
    • After most dinners
    • A couple times a week
    • Only as a very special treat
    • Every dinner and sometimes lunch too
  10. Compared to other people of your age and gender, how easily do you gain weight?
    • Extremely easily
    • About average
    • Pretty easily
    • It's probably easier for you to stay thin
  11. When it comes to protein, you get it mostly from:
    • Fried chicken / fast food
    • Red meat / cheese
    • Lean meats
    • Tofu, beans, and nuts
  12. When you go out to eat at a restaurant you:
    • Order an entree and eat the whole thing
    • Order an appetizer and entree, and eat the whole thing
    • Order an entree and eat some of it
    • Order something small or a salad
  13. What do you drink the most of?
    • Sports drinks
    • Diet soda / diet drinks
    • Water
    • Soda

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