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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