Survey

My name is Christine and I am a medical student at the UNMC. I am currently doing a community health research project on the resources available to people trying to loose weight and I am trying to determine if our community needs to do a better job! We are trying to assess different weight loss methods and the options people have etc. through a survey that should take about 2 min to complete. Would you be willing to fill out this survey? Thanks for your help. Please e-mail me the results at [email protected] The following is a survey compiled by medical students from the University of Nebraska Medical Center. The objective of the survey is to gain insight into adult obesity and weight loss treatments for individuals in the Omaha metropolitan community. The information gathered from this survey will be used to identify strengths and weaknesses in the community that individuals encounter when trying to lose weight. All of the information you provide will be confidential. Thank you for your time and participation. Height ______ Weight ______ 1) How long were you unhappy with your body weight before you decided to take action to try to lose weight? _________________________________________________________________________ 2) What other methods of weight loss have you tried? (Circle all that apply). a) Over the Counter Medications b) Prescription Medications c) Exercise d) Diet e) Starvation f) Purging g) Organized Diet Programs (Weigh****cher, LA Weight Loss, etc.). h) Joining a Gym, Workout Facility i) Weight-Loss Support Groups j) Surgery k) Other. Please specify. ____________________________________________________ 3) Which weight loss methods are you interested in trying, but have never tried? a) Over the Counter Medications b) Prescription Medications c) Exercise d) Diet e) Starvation f) Purging g) Organized Diet Programs (Weigh****cher, LA Weight Loss, etc.). h) Joining a Gym, Workout Facility i) Weight-Loss Support Groups j) Surgery K) Other. Please specify. ____________________________________________________ 4) For the above methods that you have not tried, what were your reasons for not trying them? (Circle all that apply). a) Financial b) Time c) Accessibility d) Motivation e) Current Health Problem f) No interest g) Other. Please specify. ____________________________________________________ 5) Which method of weight loss has been the most successful to you? ____________________ Why did it work? _______________________________________________________________ 6) What made you decide to try to lose weight? (Circle all that apply). a. Appearance b. Physician recommended c. Quality of life d. Health e. Family f. Other. Please specify. _______________________________________________ 7) How have you learned about different methods of weight loss? (Circle all those that apply). a) Physician's office b) Word of Mouth (friend, neighbor, co-worker) c) Television d) Radio e) Magazines f) Radio g) Internet h) Other. Please specify. ________________________________________ 8) Has a physician of other medical professional provided guidance or counseling to you about ways to lose weight? __________________________________________________________ 9) How much weight would you like to lose? _________________________________________ 10) Do you feel there are adequate resources in your community to help you lose weight? Why or why not?_______________________________________________________________________ 11) What community resource do you feel is lacking that would help assist you in your weight loss? _____________________________________________________________________