Type 2 Diabetes is a new and needless epidemic confronting our nation's youth.


What are your family's needs now? Start to answer this important question by taking a look at your family's behavior and attitudes.

Print and complete this survey for each child in your family;

1. My family eats __# of meals together, at home, each week

2. My child eats __# of meals at school or out of the house each week

3. My child eats __# of vegetables every day

4. My child eats __# pieces of fruit every day

5. My child gets __minutes of exercise per day

6. My child’s favorite activity or hobby is ___and they spend __hours a week doing it

7. My child spends __hours a day watching TV, playing video games or on the computer

8. Right now I believe Type 2 Diabetes is; 

                 __No big Deal


                 __Scary and depressing

                 __Unavoidable since it runs in my family

                 __Controllable with good health habits

9. Right now this is how my child feels;

                __They don’t believe they have or am at risk for Type 2 Diabetes.

                __They are wondering what they can do to take control of their


                __They have already started to make some changes,

                    like (this)________________________________________      

                __They believe they have the power to take control of Diabetes.

10. This is what bothers them about being diagnosed with (or at risk

         for T2DM__________________________________________

11. This is what I would like to change about my child’s health:


12. If my child and I had three wishes, this is what we would wish for:

1.    _________________________________________________

2.    _________________________________________________

3.    _________________________________________________

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