Do you find yourself distracted by thoughts of food? *

Yes

No

Are you adamant about losing weight? *

Yes

No

Does weighing yourself upset you? *

Yes

No

How often do you think about your body shape? *

All the time

Often

Sometimes

Never

How often do you feel guilty when you eat? *

Every time

Often

Sometimes

Never

Do you have a lot of self-imposed rules about food? *

Yes

No

Do you cut foods you love from your diet to save calories? *

Yes

No

Are you comfortable eating in a group? *

Yes

No

Do you try to keep an empty stomach to impact your weight? *

Yes

No

Do you limit your food often? *

Yes

No