Mindset assessment for losing your final 15 pounds and keeping it off
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Group ID
Rate from 1 – 10
2. I can commit to doing 15 minutes or more of exercise daily.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
3. with food serving size matters, therefore controlling serving size is a key to healthy a weight management strategy.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
4. A healthy serving size is the size of a medium size Apple.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
5. Traditional Breakfast foods are often filled with Carbs and fat
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
6. I should only eat when I am not hungry.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
7. Eating until I feel full/stuffed if i am really enjoying the food
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
8. Eat while I am watching Tv, driving, talking on the phone, or working on my computer is ideal.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
9. When eating with others it ok to be the first one to begin eating and the first one to finish.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
10. Its good to eat everything on your plate, because that’s what you were taught as a child?
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
11. working out is a drag, so not doing it is ok.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
12. It is better to eat fresh fruit rather eat sugary treats.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
13. It ok to smoothed my vegetables, especially potatoes, with butter and salt.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
14. Snacking on nuts and nut butter daily is a healthy thing to do?
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
15. Changing my lifestyle by losing weight through diet and exercise can improve my health condition.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
16. Weight management is importance for improving and maintaining overall health.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
17. There are few, if any exceptions, to the weight related chronic diseases.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
18. Sweet related consumption related Diabetes can have a devastating and life changing impact.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
19. The number of calories fat, salt and sugar in restaurants and fast-food meals are overly high.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
20. Discipling yourself to not have multiple servings of foods that you enjoy is a healthy thing to do?
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
21. Having the right mindset and self discipline are critical for achieving and maintaining good health.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
22. Emotional eating is often out of control eating.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
23. Maintaining a heathy dietary and staying active can be a challenge.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
24. Having food or drinks in your home that you know are not healthy is a set-up for unhealthy consumption
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
1. The goal of losing 15 pounds at a time is manageable and achievable.
*
Strongly disagree
1
2
3
4
5
6
7
8
9
Strongly agree
10
1 is Strongly disagree , 10 is Strongly agree
Submit
Should be Empty: