THE COPE CLINIC
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CHILD & YOUTH PSYCHOLOGY
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CHEAT
First Name
Email
Last Name
Date
Instructions: Please select the word that best applies to the statements below.
1. I am scared about being overweight.
Never
Rarely
Sometimes
Often
Usually
Always
2. I stay away from eating when I am hungry.
Never
Rarely
Sometimes
Often
Usually
Always
3. I think about food a lot of the time.
Never
Rarely
Sometimes
Often
Usually
Always
4. I have gone on eating binges where I feel that I might not be able to stop.
Never
Rarely
Sometimes
Often
Usually
Always
5. I cut my food into small pieces.
Never
Rarely
Sometimes
Often
Usually
Always
6. I am aware of the energy (calorie) content in foods that I eat.
Never
Rarely
Sometimes
Often
Usually
Always
Continue
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