Diabetes Risk

Weight Management

    Please only complete this form if someone from the team as asked you to do so.

    Please also only complete this form if you do not have a diagnosis of Pre-Diabetes, Type 2 Diabetes or any other type of Diabetes.

    Your Name*

    Date of Birth:*


    Each answer has a number next to it. Add up the number next to each of your answers to get your total score.

    1. How old are you?

    49 or younger (0)50 – 59 (5)60 – 69 (9)70 or over (13)

    2. Are you female or male?

    Female (0)Male (1)

    3. What is your ethnic background?

    White British, European (0)Other Ethnic group (6)

    4. Do you have a parent, sibling or child who has Type 1 or Type 2 Diabetes?

    Yes (5)No (0)

    5. What is your waist size?

    Less than 90 cm (35.3 in) (0)90-99.9 cm (35.3-39.3 in) (4)100-109.9 cm (39.4-42.9 in) (6)110 cm (43 in) or above (9)

    6. What is your Body Mass Index (BMI)? Use the NHS BMI calculator if you do not know.

    Less than 25 (0)25-29.9 (3)30-34.9 (5)35 or above (8)

    7. Has your doctor given you medicine for or told you that you have high blood pressure?

    Yes (5)No (0)

    Total score:

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