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After you answer all the questions, you will receive:
Please say whether the following statements are mostly true for you, or mostly false. If you're not sure, choose the option that's closest to how you feel. Please do not skip any questions.
Emotional Eating
1. I tend to graze all day long, rarely allowing myself to get hungry.True False
2. Sometimes when I'm alone, I eat in ways I wouldn't want anyone else to see.True False
3. I feel guilty when I eat foods thought of as "fattening" - I don't feel I have the right.True False
4. I feel like there are two of me - I'm constantly arguing with myself about food.True False
5. I sometimes eat so far past full that it hurts, and I can't stop myself.True False
6. I eat for reasons other than hunger (e.g. anxiety, anger, loneliness, boredom).True False
7. I've been on a million diets. If I lose weight, I gain it back.True False
Desperation To Be Slim
8. I have vomited, starved myself, or exercised excessively to lose weightTrue False
9. I think constantly about food - what I just ate, what I'm about to eat.True False
10. I spend a lot of time planning my next diet or weight loss strategy.True False
11. If I weigh myself and see I've gained a pound or two, it ruins my day.True False
12. I weigh myself frequently - usually once a day or more.True False
13. I think that if I only could lose weight, I'd be happy in my life.True False
14. If I could have one wish, it would be to lose weight and be slim.True False
Negative Self-Image
15. Being fat makes me feel safely invisible - no one expects anything of me.True False
16. Being fat makes me feel less vulnerable, harder to push around.True False
17. I blame many of the problems and failures in my life on my weight.True False
18. I put off dreams and goals for the day when I finally lose weight.True False
19. I have turned down invitations because I'm embarrassed about how I look.True False
20. I feel disgusting and unlovable because of my weight.True False
21. I'd feel pressure to perform and live up to higher standards if I were slim.True False
Lack of Self-Care
22. I feel like I should be able to solve my weight problem without help.True False
23. It makes me feel selfish and uncomfortable to ask for what I need.True False
24. I will attempt to meet the needs of others, even at my own expense.True False
25. When people are rude or put me down, I don't stand up for myself.True False
26. I don't bother much with clothes or grooming because of my weight.True False
27. Sometimes when I feel bad, and I have no idea what's bothering me.True False
28. I have health problems related to my weight.True False
Sexual Discomfort
29. I'm uncomfortable being touched.True False
30. I have been a victim of physical or sexual abuse.True False
31. I feel ashamed to be seen naked or in a swim suit.True False
32. I like my body, and feel sexy and attractive.True False
33. My weight makes me feel nonsexual - not masculine or feminine.True False
34. I have an active and satisfying sex life.True False
35. I'm afraid I'd be promiscuous if I were slim.True False