Weight Loss Survey
Gender
Please Select
Female
Male
Prefer not to say
Age
Please Select
less than 17
18-20
21-29
30-39
40-49
50-59
More than 60
What are your motivations to lose weight (multiple selection is possible)?
Improved health
Feel more attractive
Please others (family, friends, spouse)
Have more confidence
Fit into my favorite clothes
Ease joint pain
Other
What weight loss programs have you tried in the past (multiple selection is possible)?
Weight Watchers
Low carbs
Low fat
Paleo
South Beach
Swimming
Running
Walking
Crossfit
Other
What was your main reason while being in a specific diet?
I loved the food.
I had great support from others.
I had the right frame of mind.
I had a strong purpose for losing (like a wedding or other event).
I never felt hungry.
I had great accountability.
Other
What things are important to you in a diet (multiple selection is possible)?
Healthy food plan
Quick weight loss
Eat foods I love
Great support group
Not feeling hungry
Not feeling like I am dieting
Losing at a slow, healthy pace
Learning how to maintain the weight loss
Other
What are/were your greatest difficulties in dieting (multiple selection is possible)?
Healthy food plan
Quick weight loss
Eat foods I love
Great support group
Not feeling hungry
Not feeling like I am dieting
Losing at a slow, healthy pace
Learning how to maintain the weight loss
Other
What do you think is your biggest obstacle to losing weight?
1
Rows
Yes
No
I have a supplement plan designed by my doctor based on my lab results and weight loss needs.
2
3
I have had my prescription medications reviewed to see if any of them are preventing weight loss.
4
5
I have a personalized professional fitness plan, including strength and cardio, designed for me by a fit and qualified trainer.
6
7
I have a professional nutrition plan based on my BMR (basal metabolic rate) and activity level.
8
9
I have a recent detailed body composition study and know my body fat percent and metabolic rate.
10
11
I have had my labs drawn in the last three months to determine if there is any hormonal imbalance related to my weight gain.
12
13
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