Body Image

Please answer the following questions honestly. Your answers are completely anonymous. Thank you for your honesty.


A red asterisk (*) indicates required questions.

  1. I basically feel good about my body image.*
    Yes
    No


  1. I would feel better about myself if I could lose a few pounds.*
    Yes
    No


  1. I would feel better about myself if I could gain a few pounds.*
    Yes
    No


  1. If I looked "better" I would have more friends.*
    Yes
    No


  1. I know people who force themselves to vomit after they eat.*
    Yes
    No


  1. I have binged on food before. (Example, eaten an entire carton of chocolate ice cream by myself...)*
    Yes
    No


  1. I sometimes judge others by their physical appearance.*
    Yes
    No


  1. I think others may judge me by my physical appearance.*
    Yes
    No


  1. Do you think it is right to be judged by your physical appearance?*
    Yes
    No


  1. When I feel good about the way I look, my day seems to go better.*
    Yes
    No





Mrs. Stevens
Teacher
Birdville Center of Technology and Advanced Learning
N. Richland Hills, TX