1. Do I eat when I’m not hungry, or not eat when my body needs nourishment?
| Yes | No |
2. Do I go on eating binges for no apparent reason, sometimes eating until I’m stuffed or even feel sick? | Yes | No |
3. Do I have feelings of guilt, shame, or embarrassment about my weight or the way I eat? | Yes | No |
4. Do I eat sensibly in front of others and then make up for it when I am alone? | Yes | No |
5. Is my eating affecting my health or the way I live my life? | Yes | No |
6. When my emotions are intense—whether positive or negative—do I find myself reaching for food? | Yes | No |
7. Do my eating behaviors make me or others unhappy? | Yes | No |
8. Have I ever used laxatives, vomiting, diuretics, excessive exercise, diet pills, shots, or other medical interventions (including surgery) to try to control my weight? | Yes | No |
9. Do I fast or severely restrict my food intake to control my weight? | Yes | No |
10. Do I fantasize about how much better life would be if I were a different size or weight? | Yes | No |
11. Do I need to chew or have something in my mouth all the time: food, gum, mints, candies, or beverages? | Yes | No |
12. Have I ever eaten food that is burned, frozen, or spoiled; from containers in the grocery store; or out of the garbage? | Yes | No |
13. Are there certain foods I can’t stop eating after having the first bite? | Yes | No |
14. Have I lost weight with a diet or “period of control” only to be followed by bouts of uncontrolled eating and/or weight gain? | Yes | No |
15. Do I spend too much time thinking about food, arguing with myself about whether or what to eat, planning the next diet or exercise cure, or counting calories? | Yes | No |