Week 1 Questionnaire

Part One

1. What is your age
2. Are you overweight now
3. How much
4. How long have you been overweight
5. List your overweight relatives
6. Have you been on other weight loss programs
7. What is the longest you have been able to maintain a weight loss
8. Do you exercise regularly
9. What kind of exercise do you like the most
10. What kind of exercise do you like the least
11. What are you hobbies
12. What started your weight gain
13. How do you handle emergencies

Part Two

Describe how you cope with:
• insecurity
• jealousy
• worry
• anger
• money problems
• fear
• joy
• put-downs by people you love
• rejections
• stress
• death of family member or friend
• grief
• sad feelings
• guilt
• sudden remembrances of painful memories