How many times have you been on a diet? *

1-5 Times

10+

Never

How many years have you struggled with food and weight? *

Only a few years

10-20 years

20-40 years

40+ years

Do you eat when you’re not physically hungry? *

Sometimes

Almost all the time

Never

Do you find it hard to resist the temptation to eat sweets and carbs? *

Yes, I have a hard time saying “no” to sweets (and carbs)

No, I have self-control around sweets and carbs

Are you preoccupied with thoughts of food? *

I only think about food around mealtime

My mind occasionally wanders to food throughout the day

I think about food all day long

I am completely obsessed with food, day and night

How often do you eat until you're stuffed? *

I generally eat until I’m satisfied, but not stuffed.

I occasionally eat until I feel stuffed

I binge frequently

I am afraid to feel hunger and I stay stuffed most of the time

Do you wait until you’re alone to eat how you really want to eat? *

I don’t have a problem eating in front of others

I tend to wait to overeat until no one’s around me

I try to give an impression that I’m a healthy eater around others, but when I’m alone it’s a different story

I am very secretive about my food binges, no one knows how much I eat

Have you ever hidden food from family members so you could eat it yourself? *

I sometimes hide my favorite foods from family members so I can eat it myself

I usually have a private stash of food that’s just for me

I’ve never hidden food from others

Have you ever lied about what you’ve eaten? *

I can’t think of any time I’ve lied about what I’ve eaten.

I haven’t lied, but I haven’t voluntarily offered up information about my eating, either

I have definitely lied about how much I’ve eaten

Are you happy with your body size? *

Yes, I’m happy with my body size.

No, I often don’t feel good in my body

I am constantly nit-picking and finding fault with my body

I’ve spent most of my life hating my body

Do you own several sizes of pants because of fluctuations in your weight? *

Yes, I have at least 2-3 sizes of clothes to accommodate my weight changes

No, I always fit into the same size pants

Do difficult or unexpected events throw you off your healthy eating plan? *

No, I deal with stress in a healthy way

I often turn to food when life gets stressful

I’ve gained at least 5 pounds when going through a difficult time

I’ve never been able to stick to my healthy eating plan when something unexpected or stressful happens

After eating healthy for a while, do you sabotage your positive streak by trying to eat “just one”, and then quickly falling back into unhealthy eating? *

No, when I make a healthy eating plan, I stick to it

I have definitely fallen off my plan after trying to eat “just one”

I’ve blown my diet by eating “just one” too many times to count

What is your biggest challenge to overcoming this problem? *

Finding a plan that actually works

Dealing with emotional eating

Getting support and accountability to eat right

Understanding why I eat the way I do

All of the Above

On a scale of 1 to 10 how committed are you to ending this cycle?

Would you be willing (and able) to invest in getting the help and support necessary to have success? *

Yes - I'd be willing to invest if you could promise me I wouldn't be right back where I started a year from now

No - I’m not willing to invest in a solution

Great, where should we send your results?

First Name

Email *