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Does obesity run in your family?
 
Yes
 
No
 
Unknown
 
 
 
Does diabetes run in your family?
 
Yes
 
No
 
Unknown
 
 
 
Has a doctor ever put you on a diet because of your weight or health?
 
Yes
 
No
 
 
 
Do you believe that eating fruits and vegetables will decrease your chances in becoming overweight.
 
Yes
 
No
 
Never really thought about it
 
 
 
Have you ever participated in a fitness class or work out with a personal trainer?
 
Yes
 
No
 
 
 
Regular physical activity will improve your heath.
 
True
 
False
 
 
 
There are certain foods that will lower or raise your blood pressure.
 
True
 
False
 
 
 
Do you have high blood pressure?
 
Yes
 
No
 
Unkown
 
 
 
How often to you weigh yourself?
 
Daily
 
Weekly
 
Monthly
 
Only when I go to the doctor
 
 
 
Do you care about your health?
 
Yes
 
No
 
It's complicated
 
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