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Eating Attitudes Fitness Test form
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Eating Attitude Test
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Full Name:
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First Name
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Last Name
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Mobile No:
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Email id:
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Date of Birth:
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Age:
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Gender:
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Female
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Height in feet and inces:
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Current Weight :
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Highest Weight (excluding pregnancy):
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Lowest Adult Weight:
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*
Please choose a response for each of the following statements::
Always
Usually
Often
Sometimes
Rarely
Never
Am terrified about being overweight
Avoid eating when I am hungry
Find myself preoccupied with food
Have gone on eating binges where I feel that I may not be able to stop
Cut my food into small pieces
Aware of the calorie content of foods that I eat
Particularly avoid food with a high carbohydrate content (i.e. bread, rice, potatoes, etc.)
Feel that others would prefer if I ate more
Vomit after I have eaten
Feel extremely guilty after eating
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Next
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Behavioral Questions: In the past 6 months have you:
Never
Once a month or less
Once a week
Once a day or more
Gone on eating binges where you feel that you may not be able to stop
Ever made yourself sick (vomited) to control your weight or shape
Ever used laxatives, diet pills or diuretics (water pills) to control your weight or shape
Exercised more than 60 minutes a day to lose or to control your weight
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Lost 20 pounds or more in the past 6 months:
Yes
No
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Comments:
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