1
Do you eat privately, afraid that someone will know just how much you eat?
Yes
No
2
Do you label foods as "good" and "bad?"
Yes
No
3
Do you severely limit your food intake?
Yes
No
4
Are you constantly thinking about food, weight, or body image?
Yes
No
5
Do you "graze", having no planned meals but eating a large amount of food throughout the day?
Yes
No
6
Do you feel shame about being fat or obese?
Yes
No
7
Do you vomit after eating and/or use laxatives or diuretics to keep your weight down?
Yes
No
8
Do you count calories every time you eat or drink?
Yes
No
9
Does the number on your scale determine your mood and outlook for the day?
Yes
No
10
Do you eat as a way of nurturing yourself?
Yes
No
11
Do you exercise more than 45 minutes, five times a week with the goal of burning calories?
Yes
No
12
Have you tried many different ways to lose weight, such as fasting programs or weight loss programs, diet pills, prescription weight loss medications, laxatives, or diuretics?
Yes
No
13
Do you feel that you can never get enough to eat?
Yes
No
14
Do you eat when you are bored?
Yes
No
15
Do you feel a tremendous amount of guilt and fear about not being able to stop eating?
Yes
No
16
Do you "binge", eating an excessive amount within a two-hour period?
Yes
No
17
If you see yourself as thin, do you still obsess about your stomach, hips, thighs, or buttocks being too big?
Yes
No
18
If you eat a "bad" or forbidden food do you berate yourself and compensate by skipping your next meal, purging, or adding extra exercise?
Yes
No
19
Do you eat for relief or comfort?
Yes
No
20
Is it difficult for you to eat in public?
Yes
No
21
Do you eat when you're afraid?
Yes
No
22
Do you feel "out of control" when it comes to food?
Yes
No
23
Do you worry about what your last meal is doing to your body?
Yes
No
24
Do you feel you're "not good enough"?
Yes
No
25
Do you have compulsive behaviors involving food and eating?
Yes
No
26
Do you chronically diet only to regain the weight after going "off" the diet?
Yes
No
27
Is it difficult to concentrate on the daily tasks of studying or work because of food and weight thoughts?
Yes
No
28
Do you plan the next meal while you're eating the current one?
Yes
No
29
Do you eat when you're lonely?
Yes
No
30
Do you eat when you're stressed?
Yes
No
31
Do you weigh yourself several times a day?
Yes
No
32
Will you exercise to lose weight even if you are ill or injured?
Yes
No
33
When others tell you that you are too thin, do you still feel fat?
Yes
No
34
Do you experience guilt or shame about eating?
Yes
No
35
Do you eat when you're sad?
Yes
No
36
Do you punish yourself with more exercise or restrictions if you don't like the number on the scale?
Yes
No
37
Do your eating behaviors interfere with your daily functioning?
Yes
No