For each item, record the scale number that best reflects your current lifestyle.

0 = Never

1 = Rarely

2 = Sometimes

3 = Often

4 = Almost Always

I try, but fail, to lose weight and keep it off.  _____

I feel out of control of my eating.  _____

I eat when I'm not physically hungry.  _____

I turn to food when stressed or upset.  _____

I use food as a source of pleasure or reward.  _____

I think a lot about food.  _____

I sabotage my weight loss efforts.  _____

I binge eat or graze eat.  _____

I feel ashamed of myself and my eating.  _____

Food helps me deal with feelings.  _____

TOTAL SCORE  _________

 Interpretation:

0 - 10  No or little emotional eating: Your weight management efforts should be relatively uncomplicated by emotional issues.

11 - 20  Mild emotional eating: You may experience difficulty achieving weight management goals due to emotional obstacles.

21 - 30  Moderate emotional eating: You will probably encounter emotional obstacles to healthy weight management and should consider counseling.

31 - 40  Severe emotional eating:  Significant obstacles exist to healthy weight management, and counseling is strongly recommended.