Body and Food Relationship Survey
Help us understand your experiences and perceptions regarding your body and your relationship with food.
What is your age?
*
What is your gender?
*
Female
Male
Non-binary
Prefer not to say
Other
How satisfied are you with your body image?
*
1
2
3
4
5
Please indicate how much you agree with the following statements about your eating habits.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I often eat when I am not hungry.
1
2
3
4
5
I feel guilty after eating certain foods.
6
7
8
9
10
I skip meals to control my weight.
11
12
13
14
15
I eat more when I am stressed or upset.
16
17
18
19
20
How often do you engage in the following behaviors?
*
Rows
Never
Rarely
Sometimes
Often
Always
Counting calories or tracking food intake
21
22
23
24
25
Avoiding certain foods completely
26
27
28
29
30
Binge eating
31
32
33
34
35
Exercising to compensate for eating
36
37
38
39
40
How would you describe your relationship with food?
*
Mostly positive
Neutral
Somewhat problematic
Very problematic
Other
What emotions do you most often associate with eating? (Select all that apply)
Happiness
Guilt
Anxiety
Comfort
Indifference
Other
Have you ever followed a specific diet or eating plan?
*
Yes
No
If yes, which diets or eating plans have you tried? (Select all that apply)
Low-carb (e.g., Keto, Atkins)
Low-fat
Intermittent fasting
Vegan/Vegetarian
Mediterranean
Other
What are your main motivations for changing your eating habits? (Select up to 2)
Improve health
Lose weight
Gain muscle
Manage a medical condition
Influence from friends/family
Other
Is there anything else you would like to share about your relationship with your body or food?
Submit Survey
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