"*" indicates required fields Name* Age*Weight (kg/lb)*Please enter recent measurement Weight unit (kg/lb)*kg or lbkglbHeight (cm/ft)*Please enter recent measurement Height unit (cm/ft)*cm or ftcmft Please read each statement and select from the multiple choice options the answer that indicates the frequency with which you find yourself feeling or experiencing what is being described in the statements below.1. When I smell a delicious food, I find it very difficult to keep from eating, even if I have just finished a meal.* Definitely false Mostly false Mostly true Definitely true 2. I deliberately take small helpings as a means of controlling my weight.* Definitely false Mostly false Mostly true Definitely true 3. When I feel anxious, I find myself eating.* Definitely false Mostly false Mostly true Definitely true 4. Sometimes when I start eating, I just can’t seem to stop.* Definitely false Mostly false Mostly true Definitely true 5. Being with someone who is eating often makes me hungry enough to eat also.* Definitely false Mostly false Mostly true Definitely true 6. When I feel blue, I often overeat.* Definitely false Mostly false Mostly true Definitely true 7. When I see a real delicacy, I often get so hungry that I have to eat right away.* Definitely false Mostly false Mostly true Definitely true 8. I get so hungry that my stomach often seems like a bottomless pit.* Definitely false Mostly false Mostly true Definitely true 9. I am always hungry so it is hard for me to stop eating before I finish the food on my plate.* Definitely false Mostly false Mostly true Definitely true 10. When I feel lonely, I console myself by eating.* Definitely false Mostly false Mostly true Definitely true 11. I consciously hold back at meals in order not to weight gain.* Definitely false Mostly false Mostly true Definitely true 12. I do not eat some foods because they make me fat.* Definitely false Mostly false Mostly true Definitely true 13. I am always hungry enough to eat at any time.* Definitely false Mostly false Mostly true Definitely true 14. How often do you feel hungry?* Only at meal times Sometimes between meals Often between meals Almost always 15. How frequently do you avoid “stocking up” on tempting foods?* Almost never Seldom Moderately likely Almost always 16. How likely are you to consciously eat less than you want?* Unlikely Slightly likely Moderately likely Very likely 17. Do you go on eating binges though you are not hungry?* Never Rarely Sometimes At least once a week 18. On a scale of 1 to 8, where 1 means no restraint in eating (eating whatever you want, whenever you want it ) and 8 means total restraint (constantly limiting food intake and never “giving in”), what number would you give yourself?*12345678HiddenCognitive Restraint ScoreHiddenUncontrolled Eating ScoreHiddenEmotional Eating ScoreHiddenTotal ScoreEmail* Phone numberCommentPlease check me Δ