Is Your Child Overweight?

These questions will help you determine if your child may need help with his or her weight. If you would like a counselor to contact you for a free 15-minute consultation about strategies for addressing your child's weight, please supply your email address or phone number and check "yes" on the last question.

First name:		Last name:
e_mail		phone

Does your child pass the “Eyeball Test”? Assuming you don’t believe most models in magazine covers look healthy (the 6-foot stick figures who weigh 109 pounds), does your child look overweight?

	My child appears overweight.
	My child does not appear overweight.

If your child gets the urge to exercise, what does he or she do?

	Sits on the couch and waits until the feeling passes.
	Actually exercises usually

If you and your child had to run to catch a bus for two blocks, would your child be more out of breath than you?

	Yes
	No

Could your child run a mile in less than nine minutes?

	Yes
	No

Would your child’s food pyramid consist primarily of pizza, cheeseburgers, and French fries?

	Yes
	No

Does your child view salads and vegetables as something far more appropriate for rabbits than humans?

	Yes
	No

Would your child know that a plain donut has far fewer calories and fat than a sesame seed bagel with cream cheese?

	Yes
	No

Is your child teased by peers about his or her weight?

	Yes
	No

Is your child's body mass index (BMI), a measure of body fat based on height and weight, higher than normal?*

	Yes
	No

Has your child complained about his or her weight?

	Yes
	No

Would you like a Counselor to call you for a free 15-minute consultation about strategies for addressing your child's weight?

	Yes
	No

Upon submitting the results, a red X will indicate an answer that suggests an issue with weight and/or fitness. Scores will range from 0-100; the higher the score, the more factors associated with weight and fitness issues. If you would like a counselor to contact you for a free 15-minute consultation about strategies for addressing your child's weight, please supply your email address or phone number and check "yes" on the last question.