| 1. |
Your age? |
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Less than 45 years old |
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45-54 years old |
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55-64 years old |
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More than 65 years old |
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| 2. |
Your Body Mass Index = body weight (in kilograms) divided by the square of your height (in meters).
Note: 1lb = 0.454 kg ; 1 inch = 0.0254 |
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Less than 25 kg/m2 |
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25-30 kg/m2 |
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More than 30 kg/m2 |
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| 3. |
Do you engage in sport or other physical activity in you leisure time of at work for at lease 30 minutes on most days of the week? |
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Yes |
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No |
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| 4. |
Waist circumference (in Centimeters) |
| | ...Men |
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Less than 94 cm |
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94-102 cm |
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More than 102 cm |
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| | ...Women |
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Less than 80 cm |
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80-88 cm |
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More than 88 cm |
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| 5. |
How often do you eat fruit or vegetables? |
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Everyday |
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Not everyday |
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| 6. |
Have you ever had to take medication for high blood pressure? |
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No |
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Yes |
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| 7. |
Has a doctor ever said that you have high blood sugar levels (e.g. in the course of a medical examination during an illness or pregnancy)? |
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No |
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Yes |
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| 8. |
Has diabetes ever been diagnosed in a member of your family? |
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No |
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Yes, grandfather, uncle, aunt, cousin, but not your spouse. |
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Yes, your father, mother, brother, or sister, or your own child. |
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| This information are extracted from Future - The Aventis Magazine (3/2002) |
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