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    Motional Ating Uestionnaire: Are You An Emotional Eater?

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    Demna Benusa
    The document is an emotional eating questionnaire that asks patients to reflect on how their emotions influence their eating habits. It provides 18 statements across 6 categories of emotional eating - depressed, anxious/stressed, angry, bored, lonely, and happy - and asks patients to check any statements that are true for them. The goal is to better understand a patient's tendencies towards emotional eating so a plan can be developed to help them cope with emotions without using food. Patients are also invited to describe their overall relationship with food on the back of the questionnaire.

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    © All Rights Reserved
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    Motional Ating Uestionnaire: Are You An Emotional Eater?

    Uploaded by

    Demna Benusa
    89 views1 page
    The document is an emotional eating questionnaire that asks patients to reflect on how their emotions influence their eating habits. It provides 18 statements across 6 categories of emotional eating - depressed, anxious/stressed, angry, bored, lonely, and happy - and asks patients to check any statements that are true for them. The goal is to better understand a patient's tendencies towards emotional eating so a plan can be developed to help them cope with emotions without using food. Patients are also invited to describe their overall relationship with food on the back of the questionnaire.

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    Emotional-Eating-Questionnaire-SG

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    The document is an emotional eating questionnaire that asks patients to reflect on how their emotions influence their eating habits. It provides 18 statements across 6 categories of emotional eating - depressed, anxious/stressed, angry, bored, lonely, and happy - and asks patients to check any statements that are true for them. The goal is to better understand a patient's tendencies towards emotional eating so a plan can be developed to help them cope with emotions without using food. Patients are also invited to describe their overall relationship with food on the back of the questionnaire.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    89 views1 page

    Motional Ating Uestionnaire: Are You An Emotional Eater?

    Uploaded by

    Demna Benusa
    The document is an emotional eating questionnaire that asks patients to reflect on how their emotions influence their eating habits. It provides 18 statements across 6 categories of emotional eating - depressed, anxious/stressed, angry, bored, lonely, and happy - and asks patients to check any statements that are true for them. The goal is to better understand a patient's tendencies towards emotional eating so a plan can be developed to help them cope with emotions without using food. Patients are also invited to describe their overall relationship with food on the back of the questionnaire.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    EMOTIONAL EATING QUESTIONNAIRE

    Patient Name Date of Birth MRN

    Are you an emotional eater?


    Once we know the specifics of your emotional eating habits, we can develop a plan to help you cope
    with your emotions without using food. The statements below are examples of the most common types
    of emotional eating: depressed eating (items 1 – 3), anxiety/stress eating (4 – 6), angry eating (7 – 9),
    bored eating (10 – 12), lonely eating (13 – 15), and happy eating (16 – 18). We will discuss this in greater
    detail at one of your upcoming appointments.

    To gain a better understanding of your emotional eating tendencies, read the statements below and
    check the statements that are true for you.

    1. When I am feeling “down” or “blue” a 10. I look forward to eating something


    little snack will lift my mood. when I’m bored.
    2. When I’m depressed I have more desire 11. I eat more than usual when there is
    to eat. nothing to do.
    3. If someone disappoints me I want to eat 12. If time is passing slowly, I look forward
    something. to having a snack.
    4. When I am pressured or working under 13. Being alone increases my appetite.
    a deadline I have the urge to snack.
    5. I eat more when I am stressed than 14. I am less likely to eat when other people
    when I am calm. are around versus when I’m by myself.
    6. If I am worried or afraid of something, I 15. Eating makes me feel better when I am
    tend to eat. lonely.
    7. When people irritate me I want to get 16. I celebrate with food when I’m in a good
    something to eat. mood.
    8. I have had something to eat “just to 17. If I’m feeling really good, I don’t worry
    teach him/her a lesson”. about my diet.
    9. When I get angry, eating will make me 18. When I’m happy, having a favorite snack
    feel better. makes me feel even better.

    How would you describe your relationship with food? (Please feel free to use the back side of this paper as
    needed):

    Appointment Date:

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