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Body Image Survey

 

Please answer the following questions as honestly as possible.

 

Age       

Weight (in lbs.) 

Height     feet   inches

I feel like I have to do everything perfect.       

I berate myself for mistakes.       

I obsess about my body.       

I obsess about food.       

I exercise regularly.       

I obsess about exercising.       

Most of the time I am preoccupied with my weight.       

I feel like I'm fat even though others tell me I look fine.       

I look at other bodies and compare them to my own.       

If I were thin I'd like myself better.       

I am satisfied with my current weight and size.       

I'm afraid that if I'm not thin I won't be as successful.       

I'm afraid that if I'm not thin I won't be as likeable.       

My friends and family have talked to my about my body image.       

My friends influence the way I feel about my body.       

If yes, is that influence positive?       

My friends/family have concerns about my eating habits.       

I feel guilty after eating.       

I think about calories when I eat.       

I count calories in my meals often.       

I tend to restrain myself from eating and the binge (eat an excessive amount in one sitting).   

I have been on a diet before.       

If yes, at what age did you go on your first diet?       

I diet often.       

I use laxatives or diet pills to control my weight.       

I use another method to control my weight.       

If you use another method not mentioned please explain what that is.   

I have sought help for eating issues.       

I have felt concerned that I might have an eating issue.       

I feel that society pressures women to be thin.       

I feel that there is a certain image that women are expected to live up to.       

If yes, do you feel like you live up to that image?       

I feel like I'll never live up to that image.       

I feel like media impacts the perspective women have about their bodies.       

After watching TV, I feel more self-conscious about my body image.       

After reading a magazine I feel more self-conscious about my body image.       

I feel that the media portrays the average female body correctly.       

 

Other comments about the survey or your thoughts about body image and the media.