pitseleh. (waitedupforyou) wrote in ed_ucate,
pitseleh.
waitedupforyou
ed_ucate

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Dear Ladies,
I am doing a research paper on obesity in American. Mainly comparing our eating
habits and nutrition awareness to that of other countries. If you have the
time, please fill out this survey. You can respond anonomously if you wish! Thanks for your time.

PS- please only fill out this survey if you have been diagnosed with Obesity
or you have a BMI of 25.0 or higher. [Or if you have overcome obesity] Thank you!


Age:
Height:
Weight:
BMI:
How Long have you had this eating disorder?:
Does the media/tv/advertisement affect how you eat?:
Are there outside factors that influence you to over eat?:
How does being over weight hinder daily activities?:
What are you limited in doing due to your weight?:
Have you been obese your whole life?:
If not, when were you diagnosed?:
If not, what caused you to become over weight?:
Why do you over eat? [i.e- coping with emotions/pleasure,etc]:
What is food to you?
How much of an emphasis is placed on food in your household?
Have you taken steps to reach a healthy weight?
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