Quick Screening

Eating, Exercise and Body Image Quick Assessment
If you’re wondering about your own eating, exercise, or body image habits, consider answering the questions below. Check the box if the statement is true or mostly true for you.

Emotional Well-Being
I find myself feeling depressed easily.
I am very tense when it comes to food and eating.
I am anxious about how people perceive and judge me.
My self-esteem is based mostly on my weight and appearance.
Being dissatisfied with my weight, I am moody and easily irritated.

Eating Behaviors
I try very hard to control my eating.
I skip meals.
I am constantly on a "diet" to lose weight or gain weight.
I eat to make myself feel better.
I am willing to try any method that will help change my weight.
Sometimes I eat more than I should and I cannot control my eating.

Physical Health
I get tired easily.
(For women only) My periods have not been regular.
I have stomach aches and/or digestive problems.
I have headaches and body aches.
I take supplements, diet pills or laxatives to manage my weight.
In spite of undesirable side effects, such as moodiness and fatigue, I continue to use supplements, diet pills, or laxatives, or cannot take myself off of a strict diet.

Physical Appearance
I am dissatisfied with my body size and shape.
I have low confidence in how I look.
I wish I could change some parts of my body.
I don't see myself physically as attractive as others.

Physical Activities
When I exercise, all I can think about is either losing weight (women) or bulking up (men).
I have to work out a lot in order to feel in control of my weight.
I avoid social gatherings when I don't feel good about my body and myself.
I feel upset or worried if I’m not able to exercise
I exercise even if I am injured or too tired

I feel frightened at the thought of gaining weight.
I am unhappy with my current weight.
I want to significantly change my weight.
My weight has not been stable.

Academic Concerns
I am preoccupied with thoughts of food and thus find it very hard to concentrate on school work.
I get tired easily and do not have the energy needed for school/work.
I worry about getting less than perfect grades.

This questionnaire is not intended to be used for diagnostic purposes. If you answered yes to any of these questions, you may benefit from talking with a professional. For information, assessment, consultation or referrals, contact Counseling and Psychological Services (CAPS) (812- 855-5711), IU Health Center Medical Staff (812-855-7688) or Health & Wellness Dietitians (812-855-7338).