1. I assess my body, in the mirror, by how my clothes fit, or by the number on a scale, and that assessment shapes how I feel about myself for the rest of the day.
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Yes
No
2. There are several foods I consider off limits because I can't trust myself around them.
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Yes
No
3. I restrict what I eat during the day and then find myself eating much more than I intended later.
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Yes
No
4. I prefer to eat certain foods or certain amounts only when no one is watching.
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Yes
No
5. I try to avoid certain social situations because of the food that will be there.
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Yes
No
6. I base how I feel about myself on my weight.
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Yes
No
7. There is a weight that I feel is correct for me and one that I feel is incorrect.
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Yes
No
8. I have days when I don't want to leave the house because I am so ashamed of how I look.
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Yes
No
9. I use external tools or rules, measuring, tracking, portioning, to control how much I eat because I don't trust myself to stop on my own.
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Yes
No
10. Sometimes I eat when I'm not hungry.
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Yes
No
11. Sometimes I don't eat when I am extremely hungry.
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Yes
No
12. I feel guilty after I feel that I've eaten too much.
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Yes
No
13. When I feel I've eaten too much, I write off the rest of the day and either restrict afterward or keep eating because the damage already feels done.
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Yes
No
14. I only allow myself a certain number of calories, points, or macros per day.
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Yes
No
15. If I go over my allowed calories, points, or macros I compensate by eating less the next day.
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Yes
No
16. I bargain with my hunger, skipping meals or holding off eating so I can justify having something I've labeled as bad later.
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Yes
No
17. When I am unhappy with my weight my first instinct is to restrict what I eat.
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Yes
No
18. I often don't eat until I am full.
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Yes
No
19. A significant amount of my mental energy on any given day goes toward thinking about food, what I ate, what I will eat, what I should not have eaten, or how to compensate for what I did eat.
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Yes
No
20. I have been on a diet at one or more times in my life.
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Yes
No
21. My weight fluctuates, often by 10 lbs or more.
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Yes
No
22. I have created a very rigid eating plan for myself.
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Yes
No
23. I eat differently in front of others than I do in private.
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Yes
No
24. I am afraid to listen to my body and trust my appetites.
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Yes
No
Email
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Full Name
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