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BODY IMAGE QUESTIONNAIRE

Male

Female

Whats your age?


14-15
15-16
16-17
17-18
18-19
1. Are you happy with the way you look?
Yes

No

2. If you could, what would you change about your appearance?


Face

Body (parts of it)

3. Is the others opinion about your appearance important for you?


A lot

A little

Not at all

4. Have you ever felt discriminated because of your physical


appearance?
Yes

No

5. Have you ever gone on a diet or are you doing it now?


Yes

No

6. If yes, who advised you?


A doctor
Yourself

a friend

the media (internet, magazine, TV)

7. Are you satisfied with the results?


Yes

No

8. If not, are you determined to go on?


Yes

No

9. What do you think makes a person attractive?


Slimness

Beauty

Character/Manners

10. Have you got a model you wish you were like?
Someone in your family
intellectual

Actor (-tress)

Top model

11. Do you think the medias representations of male/female are a


healthy image to follow?
Yes

No

12. After reading a magazine or watching a program full of beautiful


models, how do you feel about yourself?
Good

Indifferent

Frustrated

13. Do you think that the medias representation of teenagers


encourages young people to have a positive self-esteem?
Yes

No

14. Does happiness depend on physical appearance?


A lot

Partly

Not at all

An

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