Well-Being Questionnaire

Different aspects of life can undermine health or support and enhance it. Certain physical factors or psychological strains like an unhappy relationship increase susceptibility to illness. You can increase your resilience by identifying these traits and making the necessary changes in your life. These may be in the realm of "Body," such as diet or exercise, or "Mind," for example finding ways to handle stress or difficult emotions. This questionnaire is designed to enable you to find out more about the different aspects of well-being. The colour histograms, displayed upon completion of the questionnaire, provide a more general assessment of your overall health.

How to Fill in the Questionnaire
Go through the entire questionnaire checking the coloured boxes that apply most to you. Once you have answered all pertinent questions, your overall score will appear. A General Guidance indicates the significance of the questions you have answered for each individual section.
Editor's Note
The information and recommendations in the Well-Being Questionnaire are for reference and education only. They are not intended as a substitute for a physician's diagnosis and care.

BODY
Physical Well-Being A=Usually B=Sometimes C=Never
  A B C   A B C
General Guidance

Physical fitness helps all the body systems function at their best and is important for the prevention of major diseases. It also boosts energy, helps reduce stress, and benefits emotional well-being. Obesity results from a lack of exercise as well as overeating, and places you at the risk of developing diabetes, stroke, arthritis, and other diseases.

1- Do you feel well and energetic? 5 -Do you exercise at least 20-30 minutes three times a week?
2- Are you physically fit enough to do the things that you want to? 6- Do you give yourself time to warm up and cool down before and after exercising?
3- Are you free of unexplained physical symptoms? 7- Are you comfortable about your weight, shape and physical condition?
4- Do you get all the sleep you need? 8- Given a choice do you walk or use the stairs?

Risk Taking A=Never B=Sometimes C=Frequently
  A B C   A B C

General Guidance

Taking unnecessary risks can endanger not just your life, but those of others and it increases stress and emotional problems.

1- Do you smoke? 5 -Do you smoke in bed?
2- Do you use potentially dangerous recreational drugs? 6- Do you carry a weapon?
3- Do you have more than 3 alcoholic drinks a day if a man, 2 if a woman? 7- Do you take part in dangerous sports?
4- Do you take risks when driving (such as drinking alcohol, speeding, not wearing a seatbelt)? 8- Are you careless when working with toxic or flammable substances?

Nutrition A=Usually B=Sometimes C=Never
  A B C   A B C

General Guidance

What you eat and drink provides energy for cell growth, maintenance, and repair, and for physical and mental activity. A diet low in fats and high in fiber, fruits, and vegetables can protect against disease. Junk and processed foods are low in fiber and high in fats, added sugars, and chemical additives. Fad diets may take weight off, but are difficult to maintain and pounds lost are quickly regained.

1- Do you eat a well-balanced, low-fat diet with high-fiber foods and plenty of fresh fruits and vegetables? 6- Do you rarely skip meals?
2- Do you keep your daily fat intake below 30 percent of calorie intake? 7- Do you resist eating when not hungry?
3- Do you keep your salt and sugar intake down? 8- Do you avoid junk food and processed food?
4- Do you eat poultry and fish rather than red meat? 9- Do you refrain from following diet fads?
5- Do you drink enough fluids to keep your urine pale yellow? 10- Do you minimize your caffeine intake (coffee, tea, cola)?

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