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Please answer the following questions about your eating habits.

I deliberately take small helpings as a means of controlling my weight.

Definitely true Mostly true Mostly false Definitely false

When I feel anxious, I find myself eating.

Definitely true Mostly true Mostly false Definitely false

When I feel blue, I often overeat.

Definitely true Mostly true Mostly false Definitely false

When I feel lonely, I console myself by eating.

Definitely true Mostly true Mostly false Definitely false

I consciously hold back at meals in order not to weight gain.

Definitely true Mostly true Mostly false Definitely false

I do not eat some foods because they make me fat.

Definitely true Mostly true Mostly false Definitely false

How frequently do you avoid "stocking up" on tempting foods?

Almost never Seldom Usually Almost always

How likely are you to consciously eat less than you want?

Unlikely Slightly likely Moderately likely Very likely

On a scale of 1 to 8, where 1 means no restraint in eating (eating whatever you want, whenever you want it) and 8 means total restraint (constantly limiting food intake and never "giving in"), what number would you give yourself?

1 2 3 4 5 6 7 8

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