Self Assessment – Food Survey | A Home Away | Holistic Recovery Retreat | Wellness | Rehab

1. Have you ever wanted to stop eating and found you just couldn't?

Yes
No

2. Do you think about food or your weight constantly?

Yes
No

3. Do you find yourself attempting one diet or food plan after another, with no lasting success?

Yes
No

4. Do you binge and then "get rid of the binge" through vomiting, exercise, laxatives or other forms of purging?

Yes
No

5. Do you eat differently in private than you do in front of other people?

Yes
No

6. Has a doctor or family member ever approached you with concern about your eating habits or weight?

Yes
No

7. Do you eat large quantities of food at one time (binge)?

Yes
No

8. Is your weight problem due to your "nibbling" all day long?

Yes
No

9. Do you eat to escape from your feelings?

Yes
No

10. Do you eat when you're not hungry?

Yes
No

11. Have you ever discarded food, only to retrieve and eat it later?

Yes
No

12. Do you eat in secret?

Yes
No

13. Do you fast or severely restrict your food intake?

Yes
No

14. Have you ever stolen other people's food?

Yes
No

15. Have you ever hidden food to make sure you have "enough?"

Yes
No

16. Do you feel driven to exercise excessively to control your weight?

Yes
No

17. Do you obsessively calculate the calories you've burned against the calories you've eaten?

Yes
No

18. Do you frequently feel guilty or ashamed about what you've eaten?

Yes
No

19. Are you waiting for your life to begin "when you lose the weight"?

Yes
No

20. Do you feel hopeless about your relationship with food?

Yes
No

You're Done!

Congratulations on completing the twenty questions.

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Self Assessment – Food Survey

Do I Have an Obsession with Food?

You're Done!

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