Answer honestly. Don’t share your answers with anyone . Number your paper 1-25. You may write a Y or an N for Y

1. Do I Have a Negative Body Image?It’s important to recognize the signs of a negative body image. Once you recognize the problem, you can work on accepting your body. The sooner you address the problem, the more likely you are to overcome it.

2. Answer honestly. Don’t share your answers with anyone.Number your paper 1-25. You may write a Y or an N for YES or NO.

3. 1-Do you have a fear of appearing overweight or underweight?2-Do you think about food a lot when you are not eating and not hungry?3-Do you constantly (critically) compare your body with others?

4. 4-When you exercise, do you frequently think about how it may change your appearance?5-Do you say negative things about your body to other people?

5. 6-Do you say mean things about your body to yourself (in your head or out loud)?7-Do you think it is better to look good than to feel good?

6. 8-Do you feel bad about yourself or your body after looking at magazines or watching television?9-Do you judge others you see in the media, positively or negatively, based on how they look?

7. 10-Think of someone you think is very fit and healthy. Would it be OK with you if they did something unhealthy to help them appear fit and healthy? 11-Do you often feel guilty after eating a very high calorie meal?

8. 12-Do ever wish you could throw your food up after you ate it so the food would not be in your body and making you fat? 13-Do you avoid social activities because you think others will find you unattractive?

9. 14-Do you avoid eating around other people? 15-Do you wish you could change the way you look? 16-Are you jealous of others who look the way you would like to look?

10. 17-Do you often fantasize about changing your appearance or certain parts of your body? 18-Do you often deal with difficult feelings with food? 19-Do you lie or have you been secretive about your eating behavior?

11. 20-Do you go on eating binges that you felt you might not be able to stop? 21-Have you used vomiting, laxatives, water pills, and/or diet pills to control your weight?

12. 22-Do you participate in a sport that might encourage weight loss? (cheerleading – fliers, dance, gymnastics, or any sport with weigh ins) 23-Are you a perfectionist?

13. 24-Do you have difficulty coping with problems? 25-Do you feel that you have to constantly get the approval of others?

14. Add up the amount of times you answered YES.

15. IMPORTANT! • The results of this survey should be private and there is no need to share them with anyone in class.

16. 0-6: means you have a positive body image and self-esteem

17. 7-12 means you have an average body image and self-esteem

18. 13-18 means you have a negative body image and self-esteem. You should consider talking to someone about this issue, as you may have a slight risk of doing something bad to your body to change the way you look.

19. 19-25 means you have a very negative body image and self-esteem. You NEED TO speak to someone about this issue, as you run the risk of doing something unhealthy to change the way you look.

20. If you are concerned about the results, you should talk to someone who can help. Who could you or a friend go to if there is a concern?

21. Speak to a friend or relative, but eventually you should speak to a professional who can help. This would include a doctor, the school nurse, your guidance counselor, or a teacher.