Respond to each item by using the following scale:
Never = 0
Sometimes = 1
Often = 2
Always = 3
1. I dislike seeing myself in mirrors.
2. When I shop for clothing‚ I am more aware of my weight problem‚ and consequently I find shopping for clothes somewhat unpleasant.
3. I am ashamed to be seen in public.
4. I prefer to avoid engaging in sports or public exercise because of my appearance.
5. I feel somewhat embarrassed by my body in the presence of someone of the other sex.
6. I think my body is ugly.
7. I feel that other people must think my body is unattractive.
8. I feel that my family or friends may be embarrassed to be seen with me.
9. I find myself comparing my body with other people to see if they are heavier than I am.
10. I find it difficult to enjoy activities because I am self-conscious about my physical appearance.
11. Feeling guilty about my weight problem preoccupies most of my thinking.
12. My thoughts about my body and physical appearance are negative and self-critical.
Source: Strong‚ B.‚ & Sayad‚ B.W. (1999). The resource book: A teacher’s tool kit to accompany Human Sexuality by Bryan Strong‚ Christine DeVault‚ and Barbara W. Sayad (p. 209). Copyright 1999 Mayfield Publishing Company. Reprinted by permission of The McGraw-Hill Companies.