Body image questionnaire

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Age

13-15


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16-18

19-21

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21+

Weight

Height

Clothes size

*BMI CHART*

Current BMI

Relationship status

Single

Married

Long-term relationship

Ethnic group

What do you feel is the most attractive part of your figure?

Why?

What do you feel is the most attractive part of your best friend's figure?

Why?

What do you see as your least favourite part/parts your figure? (please choose the one you worry most about)

Arms

Bum

Stomach

Thighs

Hips

Other (please state)

All of the above

On an average day, how long would you say you spend thinking about your negative features?

Mins or

Hrs a day

On a scale of 1-5, with 1 being the worst and 5 being the best, how much do you feel your features are currently 'ugly', 'unattractive' or 'not right'?

1 - Very Ugly

2 - Markedly unattractive

3 - Moderately unattractive

4 - Not particularly concerning

5 - Not unattractive

Again on a scale of 1-5, how much time do you spend trying to improve these features (eg. Attending the gym/working out)?

1 - Very often (three times a week or more)

- Frequently (1-3 times a week)

- Occasionally/when it crosses my mind

- Rarely

- Very rarely

If you are in a relationship, how much would you say your features have an effect upon it? If you are not in a relationship, how much would you say it has an effect on dating or developing a relationship?

Majorly

Markedly

Moderately

Slightly

Not really

Not at all

If so, how do you find it affects your relationship/ability to develop relationships?

How much do you feel it affects your existing/potential sexual relationships?

Majorly

Markedly

Moderately

Slightly

Not really

Not at all

If so, how?

Please specify the 3 features you are most concerned about: rate on a scale of 1-4

I hate this part of my body

I dislike this part of my body

I can live with this part of my body, but am not fond

I don't mind this part of my body

I hate this part of my body

I dislike this part of my body

I can live with this part of my body, but am not fond

I don't mind this part of my body

I hate this part of my body

I dislike this part of my body

I can live with this part of my body, but am not fond

I don't mind this part of my body

How do you think these areas of your body compare with others of the same age, gender and ethnic group?

FEATURE 1

Really badly. My features are much more abnormal/dominant

Badly. I feel my features are notably unattractive in comparison with others ]

Could be improved. Some people have more attractive features than me

OK, I think my features are average

Well, I think my features are attractive

FEATURE 2

Really badly. My features are much more abnormal/dominant

Badly. I feel my features are notably unattractive in comparison with others

Could be improved. Some people have more attractive features than me

OK, I think my features are average

Well, I think my features are attractive

FEATURE 3

Really badly. My features are much more abnormal/dominant

Badly. I feel my features are notably unattractive in comparison with others

Could be improved. Some people have more attractive features than me

OK, I think my features are average

Well, I think my features are attractive

Is there anything you do because of the way you feel about your features? Read the situations below and in the second column rate the degree to which you currently avoid each situation on a scale of 1-4 (one being all the time and 4 being never.)

I avoid going to parties or social gatherings due to my features I avoid exercising in a gym/playing sport due to my features

I avoid/worry being physically close to someone due to my features

I avoid intimacy due to my features (or only under certain conditions, e,g. lights off)

I avoid certain types of clothes due to my features

I avoid looking in magazines or at TV due to my features

I avoid having my photo taken due to my features

I avoid seeing my reflection in the mirror due to my features

I avoid being centre of attention due to my features

I avoid/feel uncomfortable being naked due to my features

I avoid having relationships due to my features

I obsess over my features and avoid most of the above

I often check my features in the mirror

I often weigh myself

I often find myself comparing to other people my age/sex/ethnicity

I often compare myself to women in the media

I have a role model in the media who I aspire to look like (please specify)

I always apply make-up before leaving the house

I seek reassurance about whether my feature is noticeable

It takes me ages to find an outfit to cover my features

I diet or restrict my food often to improve my features

I use diet pills/laxatives or have tried alternative methods of weight loss

I work out and go to the gym more than I would like to improve my features

Others, please specify:

Can you please draw a portrait from your mind or impression you have of your body. Don't worry if you are not artistic: it would just be really helpful. You do not have to participate in this.

Now, look at a picture of yourself or look at yourself in the mirror. Do you still feel this picture is accurate? No/Yes

Now, compare the picture of you to some of the pictures in the media. Do you feel that you look healthy or how you should? If not, please specify:

Do you feel that the models used in the media and fashion are good to aspire to?

Why?

What size is the minimum that you would class as 'plus size' for a person of average height?

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