I try to avoid certain foods high in fat, carbs, or calories.

YES

NO

If I am craving a certain food, I don’t allow myself to have it.

YES

NO

I get mad at myself for eating something unhealthy.

YES

NO

I have forbidden foods that I don’t allow myself to eat.

YES

NO

I don’t allow myself to eat what food I desire at the moment.

YES

NO

I follow eating rules or diet plans that dictate what, when, and how to eat.

YES

NO

I find myself eating when I’m feeling emotional (i.e., anxious, sad, depressed), even when I’m not physically hungry.

YES

NO

I find myself eating when I am lonely, even when I’m not physically hungry.

YES

NO

I use food to help me soothe my negative emotions.

YES

NO

I find myself eating when I am stressed out, even when I’m not physically hungry.

YES

NO

I am not able to cope with my negative emotions (e.g., anxiety and sadness) without turning to food for comfort.

YES

NO

When I am bored, I eat just for something to do.

YES

NO

When I am lonely, I turn to food for comfort.

YES

NO

I have difficulty finding ways to cope with stress and anxiety, other than by eating.

YES

NO

I trust my body to tell me when to eat.

YES

NO

I trust my body to tell me what to eat.

YES

NO

I trust my body to tell me how much to eat.

YES

NO

I rely on my hunger signals to tell me when to eat.

YES

NO

I rely on my fullness (satiety) signals to tell me when to stop eating.

YES

NO

I trust my body to tell me when to stop eating.

YES

NO

Most of the time, I desire to eat nutritious foods.

YES

NO

I mostly eat foods that make my body perform efficiently (well).

YES

NO

I mostly eat foods that give my body energy and stamina.

YES

NO

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