Weight Control Test

This test takes approximately 20 minutes.
Please try to answer the questions as accurately as possible. This will ensure that the data we are collecting and the feedback you'll be getting are as accurate as possible.
Questions 1-19 are meant to give us an idea of who you are and what your experience with weight control has been so far.
Questions 20-38 represent our Weight Control Motivation Scale.
Please provide us with your comments and suggestions about this test, as well as your e-mail address (only if you want our feedback concerning your score), before you submit your answers.

Background Infomation

1. Are you Male or Female?

Female
Male

2. What is your age? years.

3. Nationality (country of birth):

4. Country, province/state, and city where you live:

Weight & Diet History

5. What is your weight in pounds? lbs.

6. What is your height in inches? (Write 69 if you are 5'9") in.

7. Are you currently on a diet?

Yes
No (Go to question 9)

8. If yes, specify the kind of a diet you are currently on, and then go to question 11.

9. If you are not currently on a diet, do you intend to go on one?

Yes
No

10. If yes, what kind of a diet do you intend to go on?

11. What was your weight (in pounds) one month ago? lbs.

12. What was your weight (in pounds) six months ago? lbs.

13. What was your weight (in pounds) twelve months ago? lbs.

14. What is the maximum you have ever weighed (in pounds)? lbs.

15. How many diets have you previously been on?

16. What is the largest amount of weight you have lost while on a diet? lbs.

17. At what age did your weight problem begin? years.

18. How much would you like to weigh? lbs.

19. How much weight would you like to lose in the coming month?

Weight Control Motivation Scale

20. RIGHT NOW, how important is it for you to succeed in weight control?
Not that important   1 2 3 4 5 6 7 It's the most important
compared to other                                               goal in my life
goals in my life

21. RIGHT NOW, how much physical pain is caused by your weight?
None 1 2 3 4 5 6 7 A great deal

22. RIGHT NOW, how much emotional pain is caused by your weight?
None 1 2 3 4 5 6 7 A great deal

23. RIGHT NOW, do you believe you will be healthier if you lose weight?
I do not believe 1 2 3 4 5 6 7 I believe I will
I will be any                                                     be much healthier
healthier

24. RIGHT NOW, do you believe you will be happier if you lose weight?
I do not believe 1 2 3 4 5 6 7 I believe I will
I will be any                                                     be much happier
happier

25. RIGHT NOW, how do you feel about having to deal with weight control and trying
to maintain healthy (eating and exercise) habits?
I totally resent it 1 2 3 4 5 6 7 I don't mind at all

26. RIGHT NOW, how much effort do you feel it will take to succeed in weight control?
A huge effort 1 2 3 4 5 6 7 A little effort

27. RIGHT NOW, how much effort are you willing to make to reach your desired weight?
Hardly any 1 2 3 4 5 6 7 Whatever it takes

28. RIGHT NOW, how confident are you that you will reach your desired weight?
I'm afraid I will fail 1 2 3 4 5 6 7 I'm sure I will succeed

29. RIGHT NOW, how confident are you that you will maintain the weight that you lose?
I'm afraid I will regain all of it 1 2 3 4 5 6 7 I'm sure I will maintain all of it

DURING THE PAST WEEK, how often did you do each of the following?
30. Imagined myself at my desired weight.
Many times per day
A few times per day
Every day
A few times
Once or twice
Never

31. Told myself that life is short and I deserve to please myself by eating whatever I want.
Many times per day
A few times per day
Every day
A few times
Once or twice
Never

32. Felt doubtful about succeeding in weight control.
Many times per day
A few times per day
Every day
A few times
Once or twice
Never

33. Thought about the benefits of losing weight.
Many times per day
A few times per day
Every day
A few times
Once or twice
Never

34. Felt regretful about all the things I must give up in order to lose weight
(e.g., foods I like, old and comfortable habits, favourite restaurants, parties, etc.)
Many times per day
A few times per day
Every day
A few times
Once or twice
Never

35. Reminded myself that I will reach my weight loss goals if I am persistent.
Many times per day
A few times per day
Every day
A few times
Once or twice
Never

36. Felt guilty about my weight (or my overeating).
Many times per day
A few times per day
Every day
A few times
Once or twice
Never

37. Thought that trying to lose weight was too big of an effort.
Many times per day
A few times per day
Every day
A few times
Once or twice
Never

38. What are the factors that you think have influenced your motivation when it comes to weight loss or weight control?

Comments & Feedback

Please provide us with your comments and/or suggestions regarding this survey.

Please provide us with your e-mail address if you would like our feedback on your answers to this survey.