Obesity Questionnaire


Obesity is one of the growing ailments in the world today that affects a large chunk of the population mainly in developing countries.. Obesity can be measured by a calculation of BMI( Body Mass Index) which equals a person’s weight in kilograms (kg) divided by their height in meters (m) squared. An obesity questionnaire can help you find out whether you are on the threshold to obesity or are already obese and how to overcome this disorder which can have far reaching consequences on your health.

Obesity Questionnaire Sample

Name:

Address:

Phone no.:

  1. Is your weight disproportionate to your height?

A)   Yes

B)    No

  1. Is your BMI( Body Mass Index) > 25?
  1. Do you undergo mood swings often?

A)   Frequently

B)   Rarely

C)   Moderately

  1. Do you eat in response to

A)   Anger

B)   Sadness

C)   Frustration

D)   Boredom

E)    All of the above

F)    None of the above

  1. Are you currently on any medication?
  1. If yes, name the medications u take.
  1. Do you have any of the following diseases?

A)   Diabetes

B)   Cushing’s syndrome

C)   hypothyroidism

  1. Please list any other conditions that you suffer from.
  1. How frequently do you eat?

A)   Every 2 hours

B)   Every 4 hours

C)   Every 6 hours

D)   Every 8 hours

  1. Does obesity run in your family? Give details.
  1. Do you binge on unhealthy high calorie foods?
  1. Describe your lifestyle.

A)   Sedentary

B)   Active

C)   Moderate

  1. Are you currently a smoker?
  1. What was the age for the onset of obesity?

A)   early teens

B)   late teens

C)   early adulthood

D)   late 30s

E)    middle age

Category: Medical Questionnaire

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