Gender: Female Male

Age:

Height:

Weight (approx):

stones lbs

or 

kilos

or 

lbs

Target weight (optional):

Nationality:

Occupation (optional):
Professional
Administrative
Retail
Manual
Unemployed
Raising children
Housewife / househusband
Other (please specify):

 

 

1. Have you ever felt discriminated against because of your weight?

Yes

No

If yes, tick all that apply:

During school years
In the workplace
In a family environment
In a social setting

Comments (optional):

 

 

2. Do you believe people’s weight is becoming more or less of an issue in the following environments:

In society generally:

More No different Less

 

In the workplace:

More No different Less

 

Comments (optional):

 

 

3. Do you think the Government should legislate against fattism / discrimination based on a person’s weight?

Yes

No

Comments (optional):

 

 

4. Do you feel your weight has held back or hindered your career opportunities?

Yes

No

Comments (optional):

 

 

5. Do you feel employers should do more to accommodate staff who are overweight?

Yes

No

Comments (optional):

 

 

6. Do you feel being overweight is a disability that should be treated as such in the following environments:

In society generally:

Yes

No

 

In the workplace:

Yes

No

Comments (optional):

 

 

7. Do you feel work colleagues and associates undervalue your abilities because of your weight?

Yes

No

Comments (optional):

 

 

8. Have you ever been bullied, made fun of or negatively singled out in any of the following environments because of your weight:

Yes

No

If yes, tick all that apply:

At school
In the workplace
In a family environment
In a social setting

Comments (optional):

 

 

9. Do you think fattism / discrimination based on a person’s weight should be treated in the same way as sexism and racism?

Yes

No

Comments (optional):

 

 

10. Do you feel employers have a responsibility to implement schemes to help their staff maintain a healthy weight?

Yes

No

Comments (optional):

 

 

11. Do you feel society should do more to accommodate people who are overweight?

Yes

No

Comments (optional):

 

 

12. Do you feel being overweight is more or less accepted in today’s society than 10 years ago?

More No different Less

 

Comments (optional):