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Lifestyle Patterns Quiz
Quiz Directions
Read each statement and then place a check next to the answer that best reflects your level of agreement. Record your current
feelings and behaviors (not how you used to feel or act).
*
Indicates required field
1. If I "cheat" on my diet, I feel guilty afterward.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
2. If there’s food around me, I’ll probably eat it.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
3. I’m someone who regularly skips meals.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
4. Most meals are take-out or eaten in restaurants.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
5. Fruits and vegetables are my least favorite foods.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
6. I rarely eat fresh foods or home-cooked meals.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
7. Hungry or not, I snack on foods at home.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
8. Given a choice, I seldom choose fruits and vegetables.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
9. Hungry or not, I snack on foods brought into the workplace.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
10. I eat a fast-food meal most days of the week.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
11. I eat little during the day and am most hungry at night.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
12. I have two eating styles: the “good” one I show in public and the “bad” one I use in private.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
13. I rarely take the time to plan my meals.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
14. I eat most of my food in the evening, at dinner and after.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
15. I never feel full until it’s too late.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
16. I have difficulty controlling my portion sizes.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
17. Eating is always a battle between what I would like to eat and what I think I should eat.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
18. I really don’t know the first thing about how to get started with an exercise program.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
19. I exercise regularly but I may be in a rut because my routine doesn’t vary much.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
20. It hurts when I exercise.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
21. I want to exercise but have little time to devote to being more active.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
22. I’m too embarrassed by my body to go to the gym.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
23. I have physical limitations that make it difficult for me to be active.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
24. Being physically active has never been one of my priorities.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
25. I limit my exercise because I fear injury or stress on my heart.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
26. I don’t exercise because frankly I don’t like it.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
27. I alternate between being sedentary and working out excessively.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
28. Once my week-to-week exercise routine is interrupted, I find it very hard to get back on track.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
29. I’m someone who has never exercised and will need direction.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
30. My heightened awareness of other people’s and my own body size and shape prevents me from exercising.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
31. If I can’t do my full workout, I typically do nothing at all.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
32. I have been doing the same workout for the past 3 months or more.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
33. Despite trying, I can’t seem to fit exercise into my hectic schedule.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
34. I don’t usually vary the type, intensity, length, or frequency of my exercise routine.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
35. I do a lot to help others but not enough to help myself.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
36. Negative self-talk makes me my own worst enemy.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
37. My pace of life is out of control and I don’t know how to slow it down.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
38. I feel ashamed of my body.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
39. I know I need to lose weight, but I keep putting it off and can never seem to get started.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
40. I find myself eating instead of expressing my emotions.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
41. I avoid social situations because of my weight.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
42. My own high expectations lead me to feel disappointed even when I’m making progress.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
43. I am usually doubtful that a new weight loss program will work for me.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
44. I often find myself eating when I’m stressed, lonely, anxious, or depressed.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
45. I’ve had a high degree of success in my work and home life and expect the same of my weight loss.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
46. I feel like I’m juggling too many things at once and have little time for myself.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
47. I often put myself last on my “to do” list.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
48. I’m doubtful that I will ever find someone who can help me lose weight.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
49. I spend more time thinking about what I need to do to lose weight than actually doing something about it.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
50. Food is my trusted friend and comfort source.
*
Not me at all.
This is true some of the time.
This is me most of the time.
That's me!
First Name
*
Adapted from Dr. Kushner’s Personality Type Diet. Copyright 2009 Robert Kushner, MD.
Quiz may be distributed for patient education.
Submit
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