Men's Health Weight Management Survey
Please complete this survey to help us better understand men's health and weight management habits. Your responses are confidential and will be used for health improvement purposes only.
Your Age
*
Your Height (in cm)
*
Your Weight (in kg)
*
How would you describe your current weight status?
*
Underweight
Healthy weight
Overweight
Obese
Prefer not to say
How often do you engage in physical activity each week?
*
Rarely or never
1-2 times
3-4 times
5 or more times
Please rate your agreement with the following statements about your lifestyle.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I eat a balanced diet regularly.
1
2
3
4
5
I get enough sleep each night.
6
7
8
9
10
I feel stressed often.
11
12
13
14
15
I have support from friends or family to manage my health.
16
17
18
19
20
What is your primary motivation for managing your weight?
*
Improve health
Increase energy
Improve appearance
Doctor’s recommendation
Other
What challenges do you face when trying to manage your weight? (Select all that apply)
*
Lack of time
Lack of motivation
Unhealthy food availability
Work/life balance
Medical condition
Other
On a scale of 1 to 10, how ready are you to make changes to your lifestyle for weight management?
*
Not ready
1
2
3
4
5
6
7
8
9
Very ready
10
1 is Not ready, 10 is Very ready
How satisfied are you with your current weight management efforts?
*
1
2
3
4
5
If you have any additional comments or concerns about your health or weight management, please share them below.
Submit Survey
Should be Empty: