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How old are you ? 

How old are you (13 - 15) (16 - 18)
 
13 - 15
 
16 - 18
 
 
 
Would you say the media has held any impact on how you currently view your body?
 
Yes
 
No
 
 
 
Do you read fashion magazines/women's magazines ?
 
Yes
 
No
 
 
 
I compare my body to to the bodies of people in magazines
 
Agree
 
Disagree
 
 
 
How important to you is your appearance ?
 
Very Important
 
Moderately Important
 
Slightly Important
 
Not Important
 
 
 
Would you say the pressures of body image (looking a certain way) affects you?
 
Yes
 
No
 
 
 
What do you think is the biggest cause of your body image concerns?
 
My own perception of my body
 
Peer pressure
 
Pressure from family
 
The ideals of the Media (magazines,TV, etc)
 
Other
 
 
 
 
Against whom do you most often compare your body?
 
Actors/Actresses
 
Athletes
 
Friends
 
Modes
 
Other
 
 
 
 
Have you ever gone on a diet to change the way you look?
 
Yes, to loose weight
 
Yes, to gain muscle
 
No
 
Other
 
 
 
 
Which feature(s) of your body are you most dissatisfied with? SELECT A MAXIMUM OF TWO.
 
Arms
 
Breasts - too small
 
Breasts - too big
 
Chest
 
Height - too hall
 
Height - too short
 
Hips
 
General weight - want to loose weight
 
General weight - want to gain weight
 
Legs
 
Musculature (want to gain muscle)
 
Shoulders
 
Stomach / Abs
 
Thighs
 
Other
 
 
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