Changing long-established habits takes hard work and commitment on your part. So take a few moments to learn more about your relationship with food and how it affects you.

1. How many attempts have you made to lose weight in the past? None
1-5
5-10
10 or more

2. How many minutes does it take you to eat your dinner meal? 5-15 minutes
16-20 minutes
20 or more minutes

3. When you eat, do you have internal signs of hunger like stomach pangs or headaches, or do you usually eat because you are tempted by something external, like a smell or craving? External Signs
Internal Signs
Both

4. Do you associate certain people with food or wanting to eat? Yes
No

5. Do you associate certain places with food or wanting to eat? Yes
No

6. Do you associate certain times of day with food or wanting to eat? Yes
No

7. Do you associate certain activities with food or wanting to eat? Yes
No

8. Do you have any “forbidden” foods? Yes
No

9. How often do you eat foods high in fat and sugar such as french fries, muffins, pastries, cookies, deli meats, or fast foods? Several times per day
About once per day
A few times per week
Once a week
Rarely or never

10. If you overeat one day or at one meal, are you able to get back on track the next day or at the next meal? Yes
No