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What sex are you?
 
Male
 
Female
 
 
 
Who/what do you think the idea of "the perfect body" is more influenced by?
 
Peers of the opposite sex
 
Peers of the same sex
 
The media via magazines, TV, etc
 
Other (please specify)

 
 
 
Do you compare your body to othes?
 
Yes
 
No

 
 
 
Against whom do you most often compare your body to? (Select all that apply)?
 
Actors/Actresses
 
Friends
 
Athletes
 
Models
 
Family Members

 
 
 
Have you ever gone on a diet to change the way you look? (Select all that apply)?
 
Yes, to lose weight
 
Yes, to gain weight
 
Yes, to gain muscle
 
No, I've been satisfied with my weight

 
 
 
How important is your apperance?
 
Extremely important
 
Very important
 
Moderately important
 
Slightly important
 
Not important at all
 
 
 
What are the some things that can relate to a negative body image?
 

 
 
 
Which feature(s) of your body (if any) would you change?(Select all that apply)?
 
Chest size( increase or decrease)
 
Thighs
 
Legs
 
Hips
 
Muscle increase
 
Stomach
 
Arms
 
Height( taller or shorter)