Eating Self-Assessment Tool Welcome to your Eating Self-Assessment Tool Full Name: Your Email: Phone number: 1. Do you eat only “safe” foods, low in calories and fat? Yes No None 2. Have you developed rituals with food, such as cutting food into small pieces or measuring food? Yes No None 3. Do you spend more time playing with food than eating it? Yes No None 4. Have you felt the need to exercise excessively, after or before eating? Yes No None 5. Do you dress in layers to hide weight loss or weight gain? Yes No None 6. Have you been spending less time with family and friends? Yes No None 7. Do your eating habits interrupt your daily functioning, e.g. eating out with friends, or attending a social function? Yes No None 8. Do you spend a lot of time thinking about and planning what you can eat? Yes No None 9. Do you make trips to the bathroom after meals? Yes No None 10. Do you take laxatives or diuretics after meals? Yes No None 11. Are you eating faster than other people? Yes No None 12. Have you ever stolen or hoarded food? Yes No None 13. Do you perceive yourself as fat despite others saying otherwise? Yes No None 14. Is your self-confidence based on your weight? Yes No None 15. Do you weigh yourself constantly? Yes No None 16. Do you feel guilty after you have eaten? Yes No None 17. Is your BMI (body mass index) lower than 18? BMI = (weight) (height squared) Yes No None Time's up Leave a Reply Cancel replyCommentEnter your name or username to comment Enter your email address to comment Enter your website URL (optional) Save my name, email, and website in this browser for the next time I comment.
