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This survey is completely voluntary and anonymous.
 
 
 
Are you:
 
a. Male
 
b. Female
 
 
 
What grade are you in?
 
a. 9th
 
b. 10th
 
c. 11th
 
d. 12th
 
 
 
Do you belong to a gym?
 
a. Yes
 
b. No
 
 
 
How many days I week do you exercise?
 
a. I never exercise.
 
b. 1-2
 
c. 3-5
 
d. everyday
 
 
 
Have you ever tried dieting or skipping meals to lose weight?
 
a. Yes
 
b. No
 
 
 
How often do you weigh yourself?
 
a. Never
 
b. Sometimes
 
c. Often
 
d. Very often
 
 
 
How confident are you in your overall appearance?
 
a. Not at all
 
b. Fairly
 
c. Indifferent
 
d. Confident
 
e. Extremely confident
 
 
 
How often do you compare yourself (in terms of appearance) to your friends, family members, or other peers?
 
a. Rarely
 
b. Sometimes
 
c. Often
 
d. Very often
 
 
 
Do ever feel embarassed or self-conscious to eat lunch at school or in public?
 
a. Never
 
b. Sometimes
 
c. Often
 
d. All the time
 
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