Metabolic Flexibility Questionnaire

First name

Last name

Do you struggle to lose weight?

0

2

4

Have you been on multiple calorie restriction diets in your life?

0

2

4

Are the weight loss tricks you used to use, no longer working?

0

2

4

Have you been gaining weight even though you haven’t changed anything with your diet or exercise plans?

0

2

4

Did you gain belly fat when you went into menopause?

0

2

4

Do you get “hangry” if you go without food?

0

2

4

Do you need food when you first get up in the morning?

0

2

4

Do you need to eat every few hours to keep your energy up?

0

2

4

Do you get sleepy after you eat?

0

2

4

Do you get brain fog after you eat?

0

2

4

Do you crave sugar?

0

2

4

Do you crave carbohydrates?

0

2

4

Do you crave alcohol?

0

2

4

Do you forget to eat enough vegetables?

0

2

4

Have you been on more than 5 rounds of antibiotics in your life? (Yes = 4 / 1-5 times = 2 / Never = 0)

0

2

4

Have you taken the birth control pill for more than 2 years? (Yes = 4 / No = 0)

0

2

4

Have you been diagnosed with high blood pressure? (Yes = 4 / No = 0)

0

2

4

Are you on a statin for high cholesterol? (Yes = 4 / No = 0)

0

2

4

Are you currently taking one of the weight loss drugs?

0

2

4

Are you over 40 years old? (Yes = 4 / No = 0)

0

2

4

Are you postmenopausal? (Yes = 4 / No = 0)

0

2

4

If you have a cycle, is it regular? (Yes = 0 / Sometimes = 2 / Never = 4)

0

2

4

Is your HgA1C 5 or less (If you know this number)? (Yes = 0 / No = 4)

0

2

4

Is your fasting glucose <100 ng/dl (If you know this number)? (Yes = 0 / No = 4)

0

2

4

Key:

› <25: Metabolically Healthy

› 25-50: Moving toward a metabolic crisis

› 51-96: Metabolically Unhealthy

Please calculate your total and enter it in the total box below.

Total