Question 1/10

Have you been told by a healthcare professional that you are overweight or obese?

Yes
No

Question 2/10

How often do you eat fast food or highly processed foods?

Daily
Weekly
Occasionally
Never

Question 3/10

How many servings of fruits and vegetables do you eat per day?

None
1–2
3–5
5+

Question 4/10

Do you feel that your weight impacts your overall health?

Yes
No
Unsure

Question 5/10

How frequently do you engage in physical activity?

Never
1–2 times per week
3–5 times per week
Daily

Question 6/10

Have you tried a weight-loss program or diet plan in the past?

Yes
No

Question 7/10

Do you have access to healthy food options?

Yes
No
Limited access

Question 8/10

Do you regularly drink sugary beverages?

Yes
No

Question 9/10

How much water do you drink daily?

Less than 4 cups
4–6 cups
7–9 cups
10+ cups

Question 10/10

Would you be open to consulting a healthcare provider about weight management?

Yes
No
Unsure