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Eating Behavior Survey
For the following series of questions, please indicate if/how often you engage in the following behaviors currently.
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Email
*
Your email
What is your age?
*
Your answer
What is your current height?
*
Your answer
What is your current weight?
*
Your answer
1. When you have put on weight, do you eat less than you usually do?
*
1) Never
2) Seldom
3) Sometimes
4) Often
5) Very Often
2. Do you try to eat less at mealtimes than you would like to eat?
*
1) Never
2) Seldom
3) Sometimes
4) Often
5) Very Often
3. How often do you refuse food or drink offered because you are concerned about your weight?
*
1) Never
2) Seldom
3) Sometimes
4) Often
5) Very Often
4. Do you watch exactly what you eat?
*
1) Never
2) Seldom
3) Sometimes
4) Often
5) Very Often
5. Do you deliberately eat foods that are slimming?
*
1) Never
2) Seldom
3) Sometimes
4) Often
5) Very Often
6. When you have eaten too much, do you eat less than usual the following day?
*
1) Never
2) Seldom
3) Sometimes
4) Often
5) Very Often
7. Do you deliberately eat less in order not to become heavier?
*
1) Never
2) Seldom
3) Sometimes
4) Often
5) Very Often
8. How often do you try not to eat
between meals
because you are watching your weight?
*
1) Never
2) Seldom
3) Sometimes
4) Often
5) Very Often
9. How often
in the evenings
do you try not to eat because you are watching your weight?
*
1) Never
2) Seldom
3) Sometimes
4) Often
5) Very Often
10. Do you take into account your weight with what you eat?
*
1) Never
2) Seldom
3) Sometimes
4) Often
5) Very Often
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