Do you wonder if you have an obsession with food, or if you are a food addict? You can find out by completing this self assessment survey form.

Do I Have an Obsession with Food?

Ask yourself the following 20 questions and answer them as honestly as you can.

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

 

If you have answered:

YES to any one of these questions, there is a definite warning that you may be food obsessed.

YES to any two, the chances are that you are food obsessed.

YES answers to three or more, is definitely consistent with food obsession.

 

*2. Congratulations on completing the twenty questions.

If you wish for one of our A Home Away counsellors to contact you for a free, personal consultation, please complete your contact information for how you wish to be reached.

NB: Your confidentiality is strictly respected; your information will not be provided to any outside person or agency.

 

Name:
 
Email:
 
Phone Number:
   
Address:
 
City/Town:
 
Province/State:
 
Postal Code/ZIP:

3. You deserve to get the type of help you need.
Are you ready to consider treatment at A Home Away?

Yes

No

What is the best time to call you?

4. What is your preferred method of contact?

Telephone

E-Mail

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