Life Quality Score Assessment

DOMAIN 1: DIET & NUTRITION

1. How many servings of vegetables and fruits do you consume daily?

0–1 servings — rarely eat veggies/fruits 2–3 servings — occasional veggies/fruits 4–5 servings — regular intake most days 6+ servings — consistently high plant food intake

2. How often do you consume ultra-processed foods? (fast food, packaged snacks, sweetened beverages)

Daily — multiple times per day Most days — at least once per day Occasionally — 2–3 times per week Rarely or never — less than once per week

3. How often do you eat home-cooked meals versus restaurant or takeaway food?

Almost always eating out or ordering in More often outside than home-cooked More often home-cooked than outside Almost always home-cooked meals

4. How many glasses of plain water do you drink daily?

Less than 4 glasses — severely under-hydrated 4–6 glasses — below recommended intake 7–8 glasses — near adequate hydration 8+ glasses — well-hydrated consistently

5. How would you describe your meal timing and eating pattern throughout the day?

Irregular — often skip meals or binge at night Inconsistent — miss 1–2 meals regularly Mostly regular — occasional missed meals Very regular — consistent meal times every day

DOMAIN 2: PHYSICAL ACTIVITY

1. How many days per week do you engage in at least 30 mins of moderate physical activity?

0 days — completely sedentary 1–2 days — low activity level 3–4 days — moderate activity level 5–7 days — high activity level

2. How long do you typically sit or remain sedentary without movement during a typical day?

8+ hours of continuous sitting 6–8 hours with minimal movement breaks 4–6 hours with some short movement breaks Less than 4 hours — regularly break up sitting

3. Do you engage in any strength or resistance training?

Never — no resistance training at all Rarely — once a month or less Sometimes — 1–2 times per week Regularly — 2–3 times per week or more

4. How do you typically get around for short distances? (less than 1 km)

Always use vehicle — never walk Usually drive — walk only if necessary Mix of walking and vehicle Walk or cycle for most short distances

5. How would you describe your overall physical energy and stamina for daily tasks?

Very low — exhausted by minor tasks Low — tire quickly with moderate effort Moderate — manage most tasks with some fatigue Good — handle daily tasks comfortably

DOMAIN 3: SLEEP QUALITY

1. How many hours of sleep do you typically get on weeknights?

Less than 5 hours — severely sleep-deprived 5–6 hours — below recommended 7–8 hours — within recommended range 8–9 hours — adequate to optimal sleep

2. How often do you wake up during the night and have difficulty going back to sleep?

Almost every night — severe sleep disruption Several nights per week — frequent disruption Occasionally — once or twice a week Rarely — sleep through most nights

3. How often do you wake up in the morning feeling refreshed and rested?

Almost never — always wake up tired Rarely — most mornings feel unrefreshed Sometimes — feel rested about half the time Most mornings — usually wake up refreshed

4. What time do you typically go to bed on weeknights?

After 1:00 AM — very late bedtime Between 12:00 AM and 1:00 AM Between 10:30 PM and 12:00 AM Before 10:30 PM — early, consistent bedtime

5. How often do you use screens (phone, TV, laptop) within 30 minutes of going to bed?

Every night — always use screens at bedtime Most nights — 5–6 nights per week Occasionally — 2–3 nights per week Rarely — almost never use screens before bed

DOMAIN 4: STRESS & WELL-BEING

1. How often do you feel overwhelmed, anxious, or unable to cope with your daily responsibilities?

Almost daily — constantly overwhelmed Several times per week — frequent stress Occasionally — once or twice a week Rarely — generally feel in control

2. Do you have any regular stress-management practices? (meditation, hobby)

None — no stress-relief practices at all Rarely — only in crisis situations Sometimes — a few times a week Daily — consistent stress-relief routine

3. How often does work, family, or financial stress lead you to eat unhealthy foods or overeat?

Very often — stress eating is a major issue Often — eat unhealthy when stressed Sometimes — occasional stress eating Rarely — stress rarely affects eating

4. How supported do you feel by family or friends in managing your health condition?

Not at all supported — facing it alone Minimal support — rarely get encouragement Some support — occasional help and understanding Well supported — family actively helps

5. How often do you feel hopeful or positive about your ability to manage and improve your health condition?

Rarely — feel hopeless about my condition Sometimes — mixed feelings about outcomes Often — generally positive with some doubt Almost always — confident and motivated

DOMAIN 5: EMOTIONAL HEALTH

1. How would you describe your overall relationship with food and eating on a daily basis?

Very stressful — eating causes guilt and anxiety Complicated — food is often a source of shame Neutral — mostly eat without strong emotions Positive — enjoy eating mindfully and guilt-free

2. How often do you experience positive emotions — such as joy, contentment, gratitude — during your week?

Rarely — most days feel heavy or joyless Occasionally — a few positive moments weekly Often — positive feelings on most days Daily — regularly experience positive emotions

3. Do you feel your chronic condition affects your self-image or confidence?

Severely — it strongly impacts my self-worth Quite a bit — often feel defined by my condition Somewhat — occasional self-image concerns Minimally — condition does not define me

4. How often do you eat in response to emotions like boredom, loneliness, sadness, or frustration?

Very often — emotional eating is a daily pattern Often — several times a week Sometimes — occasionally eat emotionally Rarely — generally eat only when physically hungry

5. How motivated do you currently feel to make changes to your diet and lifestyle for your health?

Not motivated — not ready to make changes Somewhat motivated — thinking about it Motivated — willing but need guidance Highly motivated — ready and committed to change

Almost done! Where should we send your results?

Your Name

Mobile Number