Strategies for Managing Weight Assessment
Reflect on your habits and preferences to discover effective ways to manage your weight.
Full Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
What is your primary goal related to weight management?
*
Lose weight
Maintain current weight
Gain weight
Other
How often do you engage in the following habits?
*
Rows
Never
Rarely
Sometimes
Often
Always
Eat vegetables and fruits
1
2
3
4
5
Eat processed foods or snacks
6
7
8
9
10
Drink water
11
12
13
14
15
Exercise for at least 30 minutes
16
17
18
19
20
Get at least 7 hours of sleep
21
22
23
24
25
How confident are you in your ability to manage your weight?
*
Not confident at all
1
2
3
4
5
6
7
8
9
Extremely confident
10
1 is Not confident at all, 10 is Extremely confident
What are the main challenges you face in managing your weight? (Select all that apply)
*
Lack of time
Lack of motivation
Emotional eating
Limited access to healthy food
Medical conditions
Other
Which strategies have you tried or are interested in trying? (Select all that apply)
*
Tracking food intake
Meal planning
Joining a support group
Working with a coach or nutritionist
Increasing physical activity
Mindful eating
Other
How motivated are you to make changes to your current habits?
*
1
2
3
4
5
Would you be interested in receiving support or coaching for weight management?
*
Yes
No
Maybe
If you have any additional comments or specific goals regarding weight management, please share them here.
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