LifeSlim Questionnaire

The LifeSlim Questionnaire is designed to help you:

Find out what’s stopping YOU from losing weight and keeping it off.

The questions listed on the following pages are divided into categories to help identify YOUR likely individual cause(s). These categories/causes are considered by many weight-loss experts to be the most common reasons why people find it difficult to lose weight.

Complete the questionnaire by marking the YES box for EVERY question that applies to you.

Add up the ticked boxes for each section and then refer to the LifeSlim Scoresheet at the end of the page, to help you score and interpret your results.

** The LifeSlim Questionnaire is not designed to diagnose medical or health conditions. This needs to be done by a qualified health professional.

Insert Summary Scores Below

	Slow Metabolism
	Low Energy
	Sluggish Thyroid
	Diet & Nutrient Deficiencies
	Food Cravings
	Unstable Blood Sugar
	Insulin Resistance

To find out how you can overcome some of YOUR specific barriers to weight loss refer to the MultiSlim Weight-Loss Guide or MultiSlim Weight-Loss Pack (available from health food stores & pharmacies and online).

A score between 0-2 indicates that this cause is unlikely to be stopping you from losing weight.

A score between 3-5 indicates that this cause may be a mild problem for you. Some attention at reducing the impact of this cause is likely required.

A score of greater than 5 indicates that this cause is likely having a significant impact on your weight loss efforts. It is important that you direct your attention at modifying this cause.

Slow Metabolism
Yes
	1. Do you feel that you eat less than others but seem to put on weight easily?
	2. Do you drink less than 8-10 glasses of water a day?
	3. Do you believe that you have less muscle mass than most people your age?
	4. Are you over 40 years of age?
	5. Do you suffer from a thyroid condition?
	6. Do you skip meals (including breakfast) or go longer than 3 hours between meals?
	7. Do you suffer from high levels of stress?
	8. Do you exercise less than 3 times a week?
	9. Are you seated for most of the day?
	10. You don’t eat all of the following foods every day: fruit, vegetables, lean meat, good oils (unsaturated fats).
	Add the ticked responses and enter YOUR score here

Low Energy
Yes
	1. Do you find yourself easily drained at the end of the day?
	2. Do you find that your energy levels impact on your ability to complete every day tasks?
	3. Is lack of energy a common excuse for not exercising?
	4. You don’t take a multivitamin every day.
	5. Do you eat more than 4 serves of any of these foods each day: bread, pasta, fruit juice, cakes, biscuits, sweets and lollies?
	6. Are you physically drained after exercise?
	7. Do you need to take a stimulant in the morning (e.g., coffee) to get you going?
	8. Do you regularly complain about feeling tired?
	9. Do you wake up feeling as though you need more sleep?
	10. You don’t eat all of the following foods every day: fruit, vegetables, lean meat, good oils (unsaturated fats).
	Add the ticked responses and enter YOUR score here

Sluggish Thyroid
Yes
	1. Do you feel tired all the time?
	2. Do you suffer from poor memory and concentration?
	3. Do you consume a high intake of soy products and foods?
	4. Do you suffer from constipation?
	5. Have you experienced weight gain over the last 1-2 years?
	6. Do you suffer from regular headaches?
	7. Do you suffer from depression or mood swings?
	8. You don’t eat all of the following foods every day: fruit, vegetables, lean meat, good oils (unsaturated fats).
	9. Do you have a low sex drive?
	10. You regularly eat one or more of the following foods every day: broccoli, cauliflower, cabbage, brussel sprouts, turnips, spinach, radish, and horseradish.
	Add the ticked responses and enter YOUR score here

Diet and Nutrient Deficiencies
Yes
	1. Do you eat less than 2 serves of fruit and 3 serves of vegetables a day?
	2. Do you eat less than 3 meals a day?
	3. Do you skip meals including breakfast?
	4. Do you eat less than 1,000 calories (4,200 kilojoules) a day?
	5. Do you eat less than 4 serves of protein a day (e.g., beef, chicken, fish, legumes etc)?
	6. You don’t take a multivitamin every day.
	7. Do you eat a diet low in fibre?
	8. Are you always on a diet?
	9. Do you consume a diet high in saturated fat?
	10. Do you regularly complain about feeling tired?
	Add the ticked responses and enter YOUR score here

Food Cravings
Yes
	1. Do you eat even when you are not hungry?
	2. Do you snack between meals?
	3. Do you regularly eat after dinner?
	4. Do you have midnight snacks more than once a week?
	5. Do you regularly crave sweets?
	6. Do you eat chocolate or sweets every day?
	7. Do you eat when you are bored?
	8. Do you believe your emotions have a major impact on your eating?
	9. Do you only eat a few types of food every day?
	10. Do you constantly think about food throughout the day?
	Add the ticked responses and enter YOUR score here

Unstable Blood Sugar
Yes
	1. Do you often feel lethargic an hour after eating?
	2. Do you feel you need to consume sugary foods to boost your energy levels?
	3. Do you regularly eat high GI (glycaemic index) foods?
	4. You don’t regularly consume meals that contain a combination of protein, carbohydrate and fat.
	5. Do you skip meals or go for more than 3 hours without eating food?
	6. Do you suffer from regular headaches?
	7. Do you suffer from sleep problems?
	8. Do your concentration levels regularly waver?
	9. Do you suffer from mood swings?
	10. Are you overweight or do you hold a lot of fat around your abdomen?
	Add the ticked responses and enter YOUR score here

Insulin Resistance
Yes
	1. Do you exercise less than 3 times a week?
	2. Do you suffer from high levels of stress?
	3. Is there a history of diabetes in your family?
	4. Are you over 40 years of age?
	5. Do you suffer from high blood pressure?
	6. Have you struggled to lose weight in the past despite intense efforts?
	7. Do you regularly feel tired?
	8. Do you often feel like your mind is in a ‘fog’?
	9. Do you regularly feel agitated and jittery?
	10. Are you overweight or do you hold a lot of fat around your abdomen?
	Add the ticked responses and enter YOUR score here