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Part 1

Assessing Body Image
The following statements evaluate the way you think about yourself. Indicate your preference by either marking a 'Yes' or a 'No' against each statement. There is no right or wrong answer.
1. I feel confident about the way I look.
Yes   No
2. There are aspects about my physical appearance that I would want to change.
Yes   No
3. I find myself constantly comparing my appearance to others around me.
Yes  No
4. Do you think how you look affects your relationships with your friends?
Yes No
5. Is having a better physical appearance important for success at work?
Yes   No
6. I am very conscious about my weight.
Yes   No
7. Any weight gain is unacceptable to me.
Yes  No
8. The thing I most want to change most in my physical appearance is
  • Face
    Yes No
  • Weight
    Yes No
  • Shape
    Yes No
  • Hips
    Yes No
  • Height
    Yes No
9. I seek others' approval/opinion about the way I look.
Yes No
10. I am happy with my physical / facial appearance.
Yes No
11. Media's portrayal of beauty does not affect the way I feel about my body.
Yes No
12. I spend a lot of time daily trying to change my body by
  • Exercise
    Yes No
  • Dieting
    Yes No
  • Frequent visits to a Dietician
    Yes No
  • Seeking opinion of Doctors (Dermatologists etc)
    Yes No
  • Cosmetic usage
    Yes No
13. I wish I could change the way I look.
Yes No
14. I don't feel comfortable in my body.
Yes No
15. I want to be seen with good looking people.
Yes No

Part 2

Looks and Aesthetics
1. Interest in Cosmetic Surgery
If you could afford it, would you ever consider getting cosmetic surgery done to improve your looks or body, now or in future?
Yes No
2. Body Image : Self Attractiveness Rating
How do you feel about your body ?
  • I have a great body
    Yes No
  • I have a good body
    Yes No
  • My body is just okay
    Yes No
  • I find my body unattractive
    Yes No
3. Satisfaction with Weight
Are you self-conscious about your weight?
  • Yes, I'm too thin
    Yes No
  • I have a good body
    Yes No
  • Yes, I'm too heavy
    Yes No
  • No, I'm fine
    Yes No
4. Facial Satisfaction
Yes No
How do you feel about your face?
  • My face is very attractive
    Yes No
  • My face is nice/pleasant
    Yes No
  • My face is plain / okay
    Yes No
  • My face is unattractive
    Yes No
5. Appearance Investment: Mirror Checking
Be honest: approximately how many times per day do you check yourself out in a mirror?
  • Never
    Yes No
  • 1-3 times
    Yes No
  • 4-7 times
    Yes No
  • 8 or more times
    Yes No
6. Would you be embarrassed if somebody found out that you have had cosmetic surgery?
Yes No
7. Do you approve of cosmetic surgery as a reasonable option for improving appearance issues?
Yes No
8. Would you be okay if your partner wanted to undergo cosmetic surgery?
Yes No
9. Do you know of someone in your social circle who has undergone cosmetic surgery?
Yes No
10. Do you think looks matter in befriending people?
Yes No
11. Do you think looks matter in securing a good job?
Yes No
12. Would you suggest someone else to undergo cosmetic surgery?
Yes No
13. Do you think unfavourable looks can affect one's confidence?
Yes No
14. Would you opt for cosmetic surgery if it was made more affordable? EMIs ?
Yes No
15. Can cosmetic surgery improve your relationship with your partner?
Yes No

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