1. Eating Habits
Which of the following best describes your eating habits?
a. I eat on the run–fast food, sodas, snacks–whatever is quick and convenient.
b. I skip breakfast, grab a quick lunch and have a big dinner.
c. I eat several mini meals throughout the day. I eat three balanced meals a day.
2. Weight management
How much weight (if any) would you like to lose?
a. None, I'm already at my ideal weight.
b. Just a few pounds.
c. 10 to 30 pounds.
d. 40 to 100 pounds.
e. More than 100 pounds.
f. None, I want to gain weight.
3. Shape management
Where do you tend to store your excess weight?
a. Mostly around my waist and in my upper body.
b. Mainly in my lower body.
c. All over.
4. Snacking
Which of the following best describes you?
a. I'm a snacker–especially late at night.
b. I tend to snack mid-morning/mid-afternoon.
c. I rarely snack.
5. Activity Level
Which of the following best describes your activity level?
a. I sit, stand and/or drive for most of my day.
b. I am minimally active with housework and other projects, but don't have a formal exercise program.
c. I occasionally work out and try to go for a long walk a couple of times a week.
d. I exercise regularly three or more times a week for at least 30 minutes at a time.
6. Digestive Health
Do you suffer from constipation and/or indigestion?
a. Often.
b. Sometimes.
c. Rarely.
7. Stress
How stressful is your life?
a. Very stressful.
b. Somewhat stressful.
c. Not stressful.
8. Energy
How would you describe your energy level?
a. I'm usually raring to go.
b. I get by, but I could use more.
c. I usually feel like I'm running on empty.
9. Heart Health
How concerned are you about heart health?
a. Very concerned.
b. Somewhat concerned.
c. Not concerned.
10. Anti-aging
How concerned are you about the visible signs of aging?
a. Very concerned–I see more wrinkles every time I look in the mirror.
b. Somewhat concerned–I'd like to age gracefully.
c. Not concerned.
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