Resolve to Love Survey
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1
. Have you resolved to lose weight in 2012?
Have you resolved to lose weight in 2012?
Yes
No
2
. How many times have you made losing weight your New Year's Resolution?
How many times have you made losing weight your New Year's Resolution?
Once before
Twice before
More than three times
More than five times
5-10 times
More than 10 times
3
. Do you weigh yourself every morning?
Do you weigh yourself every morning?
Yes
No
4
. Do you experience anxiety if you can't weigh yourself on a regular basis?
Do you experience anxiety if you can't weigh yourself on a regular basis?
Yes
No
Other (please specify)
5
. Would you say that your confidence level is affected by the number you see on your scale?
Would you say that your confidence level is affected by the number you see on your scale?
Yes
No
Other (please specify)
6
. Do you feel you must be constantly vigilant in order to maintain your weight?
Do you feel you must be constantly vigilant in order to maintain your weight?
Yes
No
Other (please specify)
7
. Do you deny yourself certain foods in order to maintain your weight?
Do you deny yourself certain foods in order to maintain your weight?
Yes
No
Other (please specify)
8
. Do you experience anxiety at social events that involve eating?
Do you experience anxiety at social events that involve eating?
Yes
No
Other (please specify)
9
. How often are you satisfied with your weight?
How often are you satisfied with your weight?
Always
Most of the time
About half the time
Once in a while
Never
Other (please specify)
10
. How much of your time, money and energy are spent on weight issues?
How much of your time, money and energy are spent on weight issues?
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