(1-D1-c) Baseline Evaluation – Questions

(Eval. 1AC) Level of Willpower Q1:

How often is your willpower so strong that you can easily and comfortably resist tempting foods, even when you are surrounded by them? (Or have a little without losing control.)

(Eval. 1AC) Level of Willpower Q2:

How often are you confident that you will be able to stay in control in eating situations? 

(Eval. 1AC) Level of Willpower Q3:

How often are you able to stay comfortably in control in eating situation?

(Eval. 1AC) Level of Willpower Q4:

How often is your willpower so strong that you can easily and comfortably stop eating after having “just enough” rather than “too much”?

(Eval. 1AC) Level of Willpower Q5:

How often can you feel comfortably ready to stop eating after having “just enough” rather than “too much”?

(Eval. 1AC) Level of Willpower Q6:

How often is your willpower so strong that you can eat just a little of a food you really like (like 1 or 2 small cookies) and easily and comfortably stop after just that much?

(Eval. 1AC) Level of Willpower Q7:

How often do you enjoy and prefer less food MORE THAN excessive amounts?

(Eval. 1BC) Difficulty Stopping Q1:

How often is it difficult for you to stop eating once you start? 

(Eval. 1BC) Difficulty Stopping Q2:

How often do you eat without reliably knowing where you will stop?

(Eval. 1BC) Difficulty Stopping Q3:

How often do you eat fast, like you’re in a rush?

(Eval. 1BC) Difficulty Stopping Q4:

How often do you keep eating something even when it doesn’t taste very good, isn’t satisfying or just to finish it off?

(Eval. 1BC) Difficulty Stopping Q5:

How often do you keep eating after the point that you intended to stop eating? (You intend to stop eating at a certain point but you keep eating after that point.)

(Eval. 1BC) Difficulty Stopping Q6:

How often do you eat “a little” too much?

(Eval. 1BC) Difficulty Stopping Q7:

How often do you eat “moderately” too much?

(Eval. 1BC) Difficulty Stopping Q8:

How often do you eat “much” too much?

(Eval. 1BC) Difficulty Stopping Q9:

How often do you eat whenever tempting food is available to you?

(Eval. 1BC) Difficulty Stopping Q10:

How often do you eat a lot while cooking or preparing foods?

(Eval. 1BC) Difficulty Stopping Q11:

How often do you eat much too much on holidays and special occasions?

(Eval. 1CC) Mental Stresses (Obsessions) Q1:

How often does your mind send you ideas, desires, urges, emotions, etc. to eat too much, even though you know it’s not good for you to eat so much?

(Eval. 1CC) Mental Stresses (Compulsions) Q2:

How often do you have persistent urges that compel you to eat too much, even though you know that it’s not good for you to eat so much?

(Eval. 1CC) Mental Stresses Q3:

How often does it seem like your mind is fighting your efforts to lose weight.

(Eval. 1CC) Mental Stresses Q4:

How often do you use excuses or rationalizations to eat excessively? (Such as you deserve to because you had a bad day.)

(Eval. 1CC) Mental Stresses Q5:

How often is it so difficult to control your eating behaviors that you don’t usually even try?

(Eval. 1DC) Quantities Q1:

How often do you eat full-size (average restaurant size) meals and snacks?

(Eval. 1DC) Quantities Q2:

How often do you eat meals and snacks that are larger than full size?

(Eval. 1DC) Quantities Q3:

How often do you have to eat a lot in order to feel satisfied?

(Eval. 1DC) Quantities Q4:

How often do you PREFER to eat large portions, rather than smaller, sensible portions?

(Eval. 1EC) Eating for Wrong Reasons Q1:

When something upsets you, how often does it trigger you to eat a lot of food?

(Eval. 1EC) Eating for Wrong Reasons Q2:

How often do you eat much too much when you are having fun or relaxing?

(Eval. 1EC) Eating for Wrong Reasons Q3:

How often do you eat when you are not genuinely hungry? (Or you don’t even think about whether or not you are hungry.)

(Eval. 1FC) Food Choices Q1:

How often do you eat much too much junk foods?

(Eval. 1FC) Food Choices Q2:

How often do you neglect to include some healthy foods in your diet?

(Eval. 1FC) Food Choices Q3:

How often do you not really try to eat healthily?

(Eval. 1GC) Fear and Apprehension Stresses Q1:

How often are you afraid that you will have to give up some of the joy of eating in order to achieve lasting weight loss?

(Eval. 1GC) Fear and Apprehension Stresses Q2:

When you start eating, how often are you afraid that you will end up eating too much?

(Eval. 1GC) Fear and Apprehension Stresses Q3:

How often are you afraid that the way you eat could lead to serious health diseases (like heart disease, kidney failure, diabetes, etc.) or make them worse?

(Eval. 1GC) Fear and Apprehension Stresses Q4:

How often are you afraid that you may never find a solution to your weight problem (because nothing has worked permanently for you yet)?

(Eval. 1HC) Self Esteem Stresses Q1:

How often does your lack of eating control cause you to feel bad about yourself?

(Eval. 1HC) Self Esteem Stresses Q2:

How often does your excess weight cause you to feel bad about yourself?

(Eval. 1IC) Discomfort Stresses Q1:

How often do you eat so much that you feel uncomfortably full?

(Eval. 1IC) Discomfort Stresses Q2:

How often do you eat so much that you feel nauseous or sick?

(Eval. 1IC) Discomfort Stresses Q3:

How often do you feel uncomfortable in your clothes (or you have to wear loose clothes) because of your excess weight? 

(Eval. 1IC) Discomfort Stresses Q4:

How often do you feel uncomfortable while doing your daily activities, because of your weight or overeating? 

(Eval. 1JC) Health Stresses Q1:

How often does the way you eat pose a serious threat to your health? It could lead to (or worsen) serious health conditions, like heart disease, diabetes, liver or kidney disease, etc.

(Eval. 1JC) Health Stresses Q2:

How often do you experience heartburn, acid reflux or GERD after eating? 

(Eval. 1JC) Health Stresses Q3:

How often do you take antacids or other medications to help relieve symptoms of heartburn, acid reflux or GERD?

(Eval. 1JC) Health Stresses Q4:

How often do you have symptoms of low blood sugar? (If you don’t eat soon after you start to feel hungry, you begin to feel weak, shaky, light headed, headachey, or even sick.)

(Eval. 1JC) Health Stresses Q5:

How often does your excess weight make it difficult for you to exercise? 

(Eval. 1JC) Health Stresses Q6:

How often do you do things to try to counteract your excessive eating, like exercising, taking diuretics, fasting, taking drugs or stimulants, purging (vomiting), etc.?

(Eval. 1KC) Social Stresses Q1:

How often do you avoid social situations because of your weight?

(Eval. 1KC) Social Stresses Q2:

How often are you criticized, ridiculed or stared at in a negative manner because of your weight?

(Eval. 1KC) Social Stresses Q3:

How often do you feel that your excess weight affects your personal relationships in a negative way?

(Eval. 1KC) Social Stresses Q4:

How often do you feel that your excess weight deprives you of social or professional opportunities?

(Eval. 1LC)

Please list any PHYSICAL health conditions that you have. (For example, heart disease, high blood pressure, kidney disease, high cholesterol, high A1C, Type 2 Diabetes, hypothyroidism, difficulty moving, etc. – please number them.)

(Eval. 1MC):

Please list any MENTAL health conditions that you may have: 

(Eval. 1NC):

Please check ALL previous weight loss method you have tried, below:

(Eval. 10C):

Your current status regarding the use of GLP-1 weight loss drugs, such as Ozempic, Wegovy, Saxenda, Zepbound, etc.

(Eval. 1PC)

What is your current weight?

(Eval. 1QC): Certification of Truthfulness:

I hereby certify that I have truthfully answered all of the questions of this Evaluation to the best of my ability. (You may go back at this point and change any answer.)

(Eval. 1RC) Refund Eligibility:

I understand and agree that I may receive a full refund, for any reason, if I don’t proceed beyond this point. But I will not be eligible for a refund, once I open the next lesson (Lesson 5).