Are you obese?

You are a...

• Female
• Male

What is your age-group?

• 10 - 17
• 18 - 25
• 26 - 30
• 31 - 40
• 41 - 60
• over 61

What is your weight?

• 150 - 200 pounds
• 201 - 300 pounds
• 301 - 400 pounds
• over 401 pounds

Do you regularly engage in any of the following exercises?

Please select all that apply.

• Walking
• Running
• Swimming
• Biking
• Cardio-Fitness
• Weight-Lifting

Do you like to workout at the gym?

• Yes
• No

If not, why?

Please select all that apply.

• I do not like working-out at a gym.
• I do not have time to workout at a gym.
• I am too embarrassed because I am overweight.
• People look at me and I feel they are judgmental.
• There isn't any gym in my residential area.
• Gyms are too expensive.

Do you usually take any meal-replacement bars?

• Yes
• No

Are you a smoker?

• Yes
• No

What would take you to workout?

Please select all that apply.

• Loose weight.
• A gym where I would feel comfortable.
• A gym nearby my home / working place.
• A gym where I would find friends.
• A gym where I would find weight-management advice.