THE BODY IQ QUESTIONNAIRE

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THE BODY IQ QUESTIONNAIRE

The Body IQ questionnaire explores the different areas of your lifestyle that influence your
health, body shape, and daily performance. It measures the likelihood of you achieving (or
not achieving) your health, energy, weight management, and performance goals based on
the 6 critical pillars of women’s health.

For each of the statements below select the response the best characterises how you feel
about the statement,

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Email *

Phone number *

0 = never, 1 = sometimes, 2 = usually and 3 = always.

SECTION 1

Never = 0

Sometimes = 1

Usually = 2

Always = 3

I often bring work home at night

I check emails or social media accounts at night in bed, and first thing in the morning

I feel like there are not enough hours in the day to do all the things I have to

In order to get the job done it is easier to do it myself I find it difficult to relax

I don’t find it easy to let trivial things or annoyances slide

I experience unexplained mood swings, difficulty making decisions, and can be forgetful

I don't feel as if I have support from my family, friends and loved ones when I feel scared, angry, upset or anxious

I take prescribed medications that are related to stress or a psychological disorder

I get sick often - I seem to catch colds and illnesses easily

Never = 0

Sometimes = 1

Usually = 2

Always = 3

I often bring work home at night

I check emails or social media accounts at night in bed, and first thing in the morning

I feel like there are not enough hours in the day to do all the things I have to

In order to get the job done it is easier to do it myself I find it difficult to relax

I don’t find it easy to let trivial things or annoyances slide

I experience unexplained mood swings, difficulty making decisions, and can be forgetful

I don't feel as if I have support from my family, friends and loved ones when I feel scared, angry, upset or anxious

I take prescribed medications that are related to stress or a psychological disorder

I get sick often - I seem to catch colds and illnesses easily

Clear selection

SECTION 1: Please add up your score for this component and note it down here and on a notepad - you will need it later

SECTION 1: Your score *

SECTION 2 *

Never = 0

Sometimes = 1

Usually = 2

Always = 3

I have trouble getting to sleep at night

I wake up during the night and I can be a light sleeper On average I get 6 hours of sleep per night or less, or I find I sleep for more than 10 hours per night

I fall asleep on the couch in the early evening but then find I have a second wind so stay up late (e.g. after 10pm)

I hit snooze on my alarm multiple times in the morning before getting up

I take medication to get a better night sleep

I drink coffee to help me through the day (more than 3 cups)

I don’t seem to have a stable bed time; I go to bed at different times throughout the week and weekend

I go to bed after 10 pm

I wake up feeling tired, and as if I need more sleep

Never = 0

Sometimes = 1

Usually = 2

Always = 3

I have trouble getting to sleep at night

I wake up during the night and I can be a light sleeper On average I get 6 hours of sleep per night or less, or I find I sleep for more than 10 hours per night

I fall asleep on the couch in the early evening but then find I have a second wind so stay up late (e.g. after 10pm)

I hit snooze on my alarm multiple times in the morning before getting up

I take medication to get a better night sleep

I drink coffee to help me through the day (more than 3 cups)

I don’t seem to have a stable bed time; I go to bed at different times throughout the week and weekend

I go to bed after 10 pm

I wake up feeling tired, and as if I need more sleep

SECTION 2: Please add up your score for this component and note it down here and on a notepad - you will need it later

SECTION 2: Your score *

SECTION 3 *

Never = 0

Sometimes = 1

Usually = 2

Always =3

I have a job that is requires me to be seated

I sit for long periods of time without standing for a break (e.g. more than 60 minutes)

On an average day I would struggle to walk at least10,000 steps (or 60 mins of accumulated walking)

I sit whilst going to and from work each day (e.g. bus, car, train)

Overall, I am not pleased with the condition of my body

I watch TV or am on a device more than 2 hours of per day whilst sitting (outside of work time)

I am not satisfied with my current energy levels

When I’m really tired, I go to the gym or participate in exercise even though I would benefit from doing something less intense

I feel as if I have to do certain exercises to ‘burn calories’ a certain number of calories in my workout

I have work related injuries such as RSI, Overuse Syndrome, sore neck, shoulders +/or lower back issues

Never = 0

Sometimes = 1

Usually = 2

Always =3

I have a job that is requires me to be seated

I sit for long periods of time without standing for a break (e.g. more than 60 minutes)

On an average day I would struggle to walk at least10,000 steps (or 60 mins of accumulated walking)

I sit whilst going to and from work each day (e.g. bus, car, train)

Overall, I am not pleased with the condition of my body

I watch TV or am on a device more than 2 hours of per day whilst sitting (outside of work time)

I am not satisfied with my current energy levels

When I’m really tired, I go to the gym or participate in exercise even though I would benefit from doing something less intense

I feel as if I have to do certain exercises to ‘burn calories’ a certain number of calories in my workout

I have work related injuries such as RSI, Overuse Syndrome, sore neck, shoulders +/or lower back issues

SECTION 3: Please add up your score for this component and note it down here and on a notepad - you will need it later

SECTION 3: Your score *

SECTION 4 *

Never = 0

Sometimes = 1

Usually = 2

Always = 3

After eating I experience abdominal bloating, pain or discomfort

I have irregular stool movements

I have gas and I burp or belch after meals

I find it difficult to drink 5 glasses of water a day (not including coffee/flavoured drinks) (

I consume diet drinks or sugar free products (such as Equal) at least once a day

I have known sugar allergies

There are days where I do not eat any vegetables at all

I eat out at least 5 times per week (including breakfast, lunch, snacks and dinner)

I eat each meal whilst doing something eg: at my desk, on my phone, watching TV

On an average week I have more days with alcohol in it then days without

Never = 0

Sometimes = 1

Usually = 2

Always = 3

After eating I experience abdominal bloating, pain or discomfort

I have irregular stool movements

I have gas and I burp or belch after meals

I find it difficult to drink 5 glasses of water a day (not including coffee/flavoured drinks) (

I consume diet drinks or sugar free products (such as Equal) at least once a day

I have known sugar allergies

There are days where I do not eat any vegetables at all

I eat out at least 5 times per week (including breakfast, lunch, snacks and dinner)

I eat each meal whilst doing something eg: at my desk, on my phone, watching TV

On an average week I have more days with alcohol in it then days without

SECTION 4: Please add up your score for this component and note it down here and on a notepad - you will need it later

SECTION 4: Your score *

SECTION 5 *

Never = 0

Sometimes = 1

Usually = 2

Always = 3

I have dieted or have been on some form of controlled eating plan more than 3 times in my life

I count calories, weigh food and/or track my intake (such as My Fitness Pal)

I often eat or drink when I am tired, stressed, upset, bored or lonely

I get stressed or concerned when I have to go out for dinner, and I don’t know what is on the menu

I am not happy with my body shape/size right now and I am concerned about it

I feel that I give way too much time and thought to food

I am preoccupied with having fat on my body

I find it difficult to enjoy a fabulous meal out or indulge in treats without ‘blowing it’ and without feeling guilty or disappointed

I feel as if I can’t rely on my body’s natural hunger cues

I have used or are currently using laxatives, diet pills or diuretics to control my weight

Never = 0

Sometimes = 1

Usually = 2

Always = 3

I have dieted or have been on some form of controlled eating plan more than 3 times in my life

I count calories, weigh food and/or track my intake (such as My Fitness Pal)

I often eat or drink when I am tired, stressed, upset, bored or lonely

I get stressed or concerned when I have to go out for dinner, and I don’t know what is on the menu

I am not happy with my body shape/size right now and I am concerned about it

I feel that I give way too much time and thought to food

I am preoccupied with having fat on my body

I find it difficult to enjoy a fabulous meal out or indulge in treats without ‘blowing it’ and without feeling guilty or disappointed

I feel as if I can’t rely on my body’s natural hunger cues

I have used or are currently using laxatives, diet pills or diuretics to control my weight

SECTION 5: Please add up your score for this component and note it down here and on a notepad - you will need it later

SECTION 5: Your score *

SECTION 6

Never = 0

Sometimes = 1

Usually = 2

Always = 3

I find it difficult to look at myself naked in the mirror

I have many negative thoughts about my body

I spend a lot of time comparing myself and my body to others – whether that is in real life or on social media

I avoid clothes shopping because I don’t like seeing myself in the changing rooms

I get annoyed or frustrated at myself for not having enough ‘motivation’ or ‘willpower’

I avoid participating in certain activities or going to the gym because I am worried about what others will think of me

If I was asked by a stranger to list my top 3 favourite parts of my body I would struggle to answer them

I often feel bad about myself because I don’t like my body

On many occasions I wish for my body to look different

I believe that I will only be happy when I have lost my weight or achieved my goal look

Never = 0

Sometimes = 1

Usually = 2

Always = 3

I find it difficult to look at myself naked in the mirror

I have many negative thoughts about my body

I spend a lot of time comparing myself and my body to others – whether that is in real life or on social media

I avoid clothes shopping because I don’t like seeing myself in the changing rooms

I get annoyed or frustrated at myself for not having enough ‘motivation’ or ‘willpower’

I avoid participating in certain activities or going to the gym because I am worried about what others will think of me

If I was asked by a stranger to list my top 3 favourite parts of my body I would struggle to answer them

I often feel bad about myself because I don’t like my body

On many occasions I wish for my body to look different

I believe that I will only be happy when I have lost my weight or achieved my goal look

Clear selection

SECTION 6: Please add up your score for this component and note it down here and on a notepad - you will need it later

SECTION 6: Your score *

SECTION SCORES

SECTION 1 *

SECTION 2 *

SECTION 3 *

SECTION 4 *

SECTION 5 *

SECTION 6 *

GRAND TOTAL SCORE : /180 Add up all of the six sections *

A copy of your responses will be emailed to the address you provided.

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