Thank you for your willingness to participate in my obesity survey.  The questionnaire enclosed will be used for a small Social Psychology Research Paper.  The paper is not meant to represent a broad detailed account of obesity in America.  Rather it will encompass general experiences of the participants involved.  All questionnaires will be kept confidential.  If you are quoted in the research paper you will be assigned an assumed name.  The final paper should be finished by March, at this time I will be glad to email each participant a copy of the paper.
There are many aspects of obesity.  This paper will attempt to briefly zero in on society’s reaction to obese and non-obese people.  The paper is not specific to Bariatric surgery patients.  Rather than focusing on the surgery experience, I hope to focus on the weight loss experience.
You may submit your completed questionnaire to my mailbox on the Vertical Sleeve Talk website- or you can send it to Miss_April_Sue@yahoo.com

Thank you again for your willingness to participate.  There are no wrong answers.  This questionnaire reflects your personal experiences and opinions.  

GENERAL

Surgery Date:
Start Weight:                    
Current Weight:
Goal Weight:
Age:
Geographic Location:  (The answer can be general ie:  your state or region of the country): 

Marital Status:

GENERAL SOCIAL INTERACTION- Encounters one has in everyday life, going to the post office, the bank the grocery store.  Interacting with people in your community with which you have no personal or professional relationship.

True/False
__ Since losing weight I have noticed a difference in the way strangers treat me.
__ Before I lost weight, I was uncomfortable or embarrassed to try and shop in a “regular” size store.
__  I have noticed a change in the amount of attention I receive from the opposite sex.
__ Sales clerks were not as helpful or courteous to me before I lost weight.
__ People hold doors more often for me since I have lost weight.
__ In the past, strangers have made negative comments about my weight.
__ There was a time when I would become nervous, due to my size, when I would have to try and fit into theater seats, airplane seats or amusement park ride seats.
__ I have had problems finding clothing that would fit me because of my size.
__ When I was heavier I felt invisible.
__ I have been uncomfortable eating in public because of my weight.
__I enjoy being in public more now that I have lost weight.
__When I was obese and would buy healthy food- store clerks would comment on my food selection.
__ Since I have lost weight, when I buy healthy food store clerks comment on my food selection.
__ Strangers are friendly to me since I have lost weight.
Comments:  How has your general social interaction changed since you have lost weight?

THE WORK ENVIRONMENT: Encounters with coworkers , supervisors, clients, customers.

True/False
__ I feel that I am more respected at my job now that my exterior has changed.
__ I can notice a positive difference in the way I am treated at work.
__ I am more confident and successful with my work since losing weight.
__ Coworkers have said mostly positive comments to me regarding my weight loss.
__ Coworkers have said mostly negative comments to me regarding my weight loss.
__Clients and Customers have noticed and commented on my weight loss.
__ I feel that I have been passed over for promotions in the past because of my weight.
__ When I was obese I would avoid eating at office functions.
__Since losing weight, I receive unsolicited advice from coworkers concerning my diet and exercise.
__Before I lost weight, I would receive unsolicited advice from coworkers concerning my diet and exercise.
 __I feel that some of my coworkers attempt to sabotage my diet.
__ Some coworkers that I considered to be my friends before I lost weight, do not like me now.

Comments:  How has your work life changed since you have lost weight?

INNER CIRCLE:  Encounters with immediate and extended family, along with close friends and casual acquaintances. 
True/False
__ Some of my Friends/Family treat me differently since I have lost weight.
__Some of my friends/family react to me in a more positive way since I have lost weight.
__ Some of my Friends/Family are jealous of my weight loss.
__ My Friends/Family have said mostly positive comments to me regarding my weight loss.
__ My Friends/Family have said mostly negative comments to me regarding my weight loss.
__ I have the same circle of friends that I had before I lost weight.
__ I have more friends since I have lost weight.
__ Most of my friends are overweight.
__ Before losing weight would avoid eating, or eat very little at family functions for fear of being ridiculed because of my size.
__Since losing weight, I receive unsolicited advice from friends/family concerning my diet and exercise.
__Before I lost weight, I would receive unsolicited advice from friends/family concerning my diet and exercise.
__Since I have lost weight, and I am dedicated to my diet program, I find it difficult to eat at family functions for fear of ridicule.
__I feel that some of my friends/family attempt to sabotage my diet.
__ I look forward to family functions and gatherings with friends more since losing weight.
__Before losing weight I would dread family functions and gatherings with friends.
__ Some friends I had before I lost weight no longer like me.
__I am not as close to some of my family since I have lost weight.

Comments:  How has your interaction with family and friends changed since you have lost weight?

Personal Changes:  Changes in how you perceive yourself.
True/False
__ I dress in a different style of clothing now that I have lost weight.
__  I wear makeup and fix my hair more often since I have lost weight.
__ I find that I like to encourage those around me to lose weight.
__ I enjoy buying clothing now that I have lost weight.
__ I am more confident now than I was before I lost weight.
__ I am proud of the way I look.
__ I go out of my way to talk to people that have not seen me before I lost weight.
__ I am friendlier since I have lost weight.
__ I find that I like to talk about diet and exercise most of the time.
__I become frustrated with other obese people, I want to help them follow my lead.
__I think obesity is a choice.
__ Obese people should seek help.

Comments: How has your personal life/opinions changed since losing weight?