Name:_______________________________ Grade and Section: _____________________

The Relationship Between Sleep Duration and Body Mass Index (BMI) Among
Students
Directions: Kindly provide the information needed. Simply fill in the blanks.
Please answer honestly and the information will be treated highly private. There are no wrong
answers, this is for research purposes only.

Age: _____
Weight (kg): _____
Height (cm): _____
Body Mass Index (BMI): ______ note: indicate in whole number

For the questions below, please shade the circle.

1. On average, how many hours of sleep do you get on school days?
O 3-4 hrs. O 7-8 hrs.
O 5-6 hrs. O 9-10 hrs.
2. Do you think that sleep duration can affect your body mass index?
O Disagree
O Neither agree nor disagree
O Agree
3. Do you think obesity among teens is a problem in the Philippines?
O Disagree
O Neither agree nor disagree
O Agree
4. Do you think that the relationship between sleep duration and body mass differ across age
groups?
O Disagree
O Neither agree nor disagree
O Agree