Are you ready for weight loss? Free Self- Assessment!
isabelsince1994
Posts: 3 Member
Hey you guys, I wanted to share a self- assesment from my health class book. I took the class this summer and remembered wanting to share it with you guys 
It's composed of 6 parts, the first is just about your history, so there's no score but the other 5 have scores underneath it's section. Hope you guys get something good out of this!!! :]
Part One: Diet History
A. How many times in the past year have you been on a diet?
*0 times *1-3 *4-10 times *11-20 times *more than 20
B. What is the most weight you lost on any of these diets?
*0 lbs *1-5 lbs *6-10 lbs *11-20 lbs *more than 20 lbs
C. How long did you stay at the new lower weight?
*less than 1 month *2-3 months *4-6 months *6-12 months *over 1 year
D. Put a check mark by each dieting method you have tried:
* skipping breakfast *counting calories *increasing regular exercise *using meal replacements such as slim fast
*inducing vomiting *skipping lunch or dinner *cutting out most fats *taking weight-loss supplements
*taking prescription appetite supppressants *taking over-the counter appetite suppressants *cutting out most carbohydrates
*cutting out all snacks *taking laxatives *other
Part Two: Readiness to Start a weight-loss program
If you are thinking about starting a weight-loss program, answer questions A-F
A. how motivated are you to lose weight?
1. not all motivated 2. slightly motivated 3. somewhat movtivated 4. quite motivated 5. extremely motivated
B. How certain are you that you will stay committed to a weight-loss program long enough to reach your goal?
1. not at all certain 2. slightly certain 3. somewhat certain 4. quite certain 5. extremely certain
C. Taking into account other stresses in your life (school, work, and relationships), to waht extent can you tolerate the effort required to stick to your diet plan?
1. cannot tolerate 2. can tolerate somewhat 3. uncertain 4. can tolerate well 5. can tolderate easily
D. Assuming you should lose no more than 1 to 2 pounds per week, have you allotted a realistic amount of time for weight loss?
1. very unrealistic 2. somewhat unrealistic 3. moderately realistic 4. somewhat realistic 5. very realistic
E. While dieting, do you fantasize about eating your favorite foods?
1. always 2. frequently 3. occasionally 4. rarely 5. never
F. While dieting, do you feel deprived, angry, upset?
1. always 2. frequently 3. occassionally 4. rarely 5. never
Total your scores:
from questions A-F and circle your score category
6-16: This may not be a good time for you to start a diet. Inadequate motivationa nd commitment and unrealistic goals could block your progress. Think about what contributes to your unreadiness. What are some of teh factors? Consider changing thses factors before undertaking a diet.
17-23: You may be nearly ready to begin a program but should think about ways to boost your readiness.
24-30: The path is clear- you can decide how to lose weight in a safe, effective way.
Part Three: Hunger, Appetite, and Eating
Think about your hunger and the cues taht stimulate your appetite or eating and then ansqer questions A-C
A. When food comes up in conversation or in something you read, do you want to eat, even if you are not hungry?
1. never 2. rarely 3. occasionally 4. frequently 5. always
B. How often do you eat for a reason other than physical hunger?
1. never 2. rarely 3. occasionally 4. frequently 5. always
C. When your favorite foods are around the house, do you succumb to eating them between meals?
1. never 2. rarely 3. occasionally 4. frequently 5. always
Total your scores:
from questions A-C and circle your score category
3-6: You might occasionally eat more than you should, but it is due more to your own attributes than jto temptation and other environmental cues. Controlling your own attributes toward hunger and eating may help you.
7-9: You may have a moderate tendency to eat just because food is available. Losing weight may be easier for you if you try to resist external cues and eat only when you are physically hungry.
10-15: Some or much of your eating may be in response to thinking about food or exposing yourself to temptations to eat. Think of ways to minimize your exposure to temptations so you eat only in response to physical hunger.
Part Four: Controlling Overeating
How good are you at controlling overeating when you are on a diet? Answer questions A-C.
A. A friend talks you into going out to a restuarant for a midday meal instead of eating a brown-bag lunch. As a result, for the rest of the day, you:
1. would eat much less 2. would eat somewhat less 3. would make no difference 4. would eat somewhat more
5. would eat much more
B. You "break" your diet by eating a fattening, "forbidden" food. As a result, for the rest of the day, you"
1. would eat much less 2. would eat somewhat less 3. would make no difference 4. would eat somewhat more
5.would eat much more
C. You have been following your diet faithfully and decide to test yourself by taking a bite of something you consider a treat. As a result, for the rest of the day, you:
1. would eat much less 2. would eat somewhat less 3. would make no difference 4. would eat somewhat more
5. would eat much more
Total your scores:
from questions A-C and circle your score category.
3-7: You recover rapidly from mistakes. However, if you frequently alternate between out-of-control eating and very strict dieting, you may have a serious eating problem and should get professional help.
8-11: You do not seem to let unplanned eating disrupt your program. This is a flexible, balanced approach.
12-15: You may be prone to overeating after an event breaks your control of throws you off track. Your reaction to these problem-causing events could use impovement.
Part Five: Emotional Eating
Consider the effects of your emotions on your eating behaviors, and answer questions A-C.
A. Do you eat more than you would like to when you have negative feelings such as anxiety, depresion, anger, or loneliness?
1. never 2. rarely 3. occasionally 4. frequently 5. always
B. Do you have trouble controlling your eating when you have positive feelings (i.e., do you celebrate feeling good by eating)?
1. never 2. rarely 3. occasionally 4. frequently 5. always
C. When you have unpleasant interactions with others in your life or after a difficult day at work, do you eat more than you'd like?
1. never 2. rarely 3. occasionally 4. frequently 5. always
Total your scores:
from questions A-C and circle your score category
3-8: You do not appear to let your emotions affect your eating.
9-11: You sometimes eat in response to emotional highs and lows. Monitor this behavior to learn when and why it occurs, and be prepared to find alternative activities to respond to your emotions.
12-15: Emotional ups and downs can stimulate your eating. Try to deal with the feelings that trigger the eating and find other ways to express them.
Part Six: Exercise Patterns and Attitudes
Exercise is key for weight loss. Think about your attitudes toward it, and answer questions A-D.
A. How often do you exercise?
1. never 2. rarely 3. occasionally 4. somewhat frequently 5. frequently
B. How confident are you that you can exercise regularly?
1. not at all confident 2. slighly confident 3. somewhat confident 4. highly confident 5. completely confident
C. When you thin about exercise, do you develop a positive or negative picture in your mind?
1. completely negative 2. somewhat negative 3. neutral 4. soemwaht positive 5. completely positive
D. How certain are you that you can work regular exercise into your daily schedule?
1. not at all certain 2. slightly certain 3. somewhat certain 4. quite certain 5. extremely certain
Total your scores:
from questions A-D and circle your score category
4-10: You're probably not exercising as regularly as you should. Determine whether it is your attitude about exercising of your lifestlye that is blocking your way, then change what you must and put on those walking shoes!
11-16: You need to feel more positive about exercise so you can do it more often. Think of ways to be more active that are fun and fit your lifestyle.
17-20: The path is clear for you to be active. Now think of ways to get motivated.
REFERENCE: Health The Basics by Rebecca J. Donatelle, Second Custom Edition for East Los Angeles College
It's composed of 6 parts, the first is just about your history, so there's no score but the other 5 have scores underneath it's section. Hope you guys get something good out of this!!! :]Part One: Diet History
A. How many times in the past year have you been on a diet?
*0 times *1-3 *4-10 times *11-20 times *more than 20
B. What is the most weight you lost on any of these diets?
*0 lbs *1-5 lbs *6-10 lbs *11-20 lbs *more than 20 lbs
C. How long did you stay at the new lower weight?
*less than 1 month *2-3 months *4-6 months *6-12 months *over 1 year
D. Put a check mark by each dieting method you have tried:
* skipping breakfast *counting calories *increasing regular exercise *using meal replacements such as slim fast
*inducing vomiting *skipping lunch or dinner *cutting out most fats *taking weight-loss supplements
*taking prescription appetite supppressants *taking over-the counter appetite suppressants *cutting out most carbohydrates
*cutting out all snacks *taking laxatives *other
Part Two: Readiness to Start a weight-loss program
If you are thinking about starting a weight-loss program, answer questions A-F
A. how motivated are you to lose weight?
1. not all motivated 2. slightly motivated 3. somewhat movtivated 4. quite motivated 5. extremely motivated
B. How certain are you that you will stay committed to a weight-loss program long enough to reach your goal?
1. not at all certain 2. slightly certain 3. somewhat certain 4. quite certain 5. extremely certain
C. Taking into account other stresses in your life (school, work, and relationships), to waht extent can you tolerate the effort required to stick to your diet plan?
1. cannot tolerate 2. can tolerate somewhat 3. uncertain 4. can tolerate well 5. can tolderate easily
D. Assuming you should lose no more than 1 to 2 pounds per week, have you allotted a realistic amount of time for weight loss?
1. very unrealistic 2. somewhat unrealistic 3. moderately realistic 4. somewhat realistic 5. very realistic
E. While dieting, do you fantasize about eating your favorite foods?
1. always 2. frequently 3. occasionally 4. rarely 5. never
F. While dieting, do you feel deprived, angry, upset?
1. always 2. frequently 3. occassionally 4. rarely 5. never
Total your scores:
from questions A-F and circle your score category
6-16: This may not be a good time for you to start a diet. Inadequate motivationa nd commitment and unrealistic goals could block your progress. Think about what contributes to your unreadiness. What are some of teh factors? Consider changing thses factors before undertaking a diet.
17-23: You may be nearly ready to begin a program but should think about ways to boost your readiness.
24-30: The path is clear- you can decide how to lose weight in a safe, effective way.
Part Three: Hunger, Appetite, and Eating
Think about your hunger and the cues taht stimulate your appetite or eating and then ansqer questions A-C
A. When food comes up in conversation or in something you read, do you want to eat, even if you are not hungry?
1. never 2. rarely 3. occasionally 4. frequently 5. always
B. How often do you eat for a reason other than physical hunger?
1. never 2. rarely 3. occasionally 4. frequently 5. always
C. When your favorite foods are around the house, do you succumb to eating them between meals?
1. never 2. rarely 3. occasionally 4. frequently 5. always
Total your scores:
from questions A-C and circle your score category
3-6: You might occasionally eat more than you should, but it is due more to your own attributes than jto temptation and other environmental cues. Controlling your own attributes toward hunger and eating may help you.
7-9: You may have a moderate tendency to eat just because food is available. Losing weight may be easier for you if you try to resist external cues and eat only when you are physically hungry.
10-15: Some or much of your eating may be in response to thinking about food or exposing yourself to temptations to eat. Think of ways to minimize your exposure to temptations so you eat only in response to physical hunger.
Part Four: Controlling Overeating
How good are you at controlling overeating when you are on a diet? Answer questions A-C.
A. A friend talks you into going out to a restuarant for a midday meal instead of eating a brown-bag lunch. As a result, for the rest of the day, you:
1. would eat much less 2. would eat somewhat less 3. would make no difference 4. would eat somewhat more
5. would eat much more
B. You "break" your diet by eating a fattening, "forbidden" food. As a result, for the rest of the day, you"
1. would eat much less 2. would eat somewhat less 3. would make no difference 4. would eat somewhat more
5.would eat much more
C. You have been following your diet faithfully and decide to test yourself by taking a bite of something you consider a treat. As a result, for the rest of the day, you:
1. would eat much less 2. would eat somewhat less 3. would make no difference 4. would eat somewhat more
5. would eat much more
Total your scores:
from questions A-C and circle your score category.
3-7: You recover rapidly from mistakes. However, if you frequently alternate between out-of-control eating and very strict dieting, you may have a serious eating problem and should get professional help.
8-11: You do not seem to let unplanned eating disrupt your program. This is a flexible, balanced approach.
12-15: You may be prone to overeating after an event breaks your control of throws you off track. Your reaction to these problem-causing events could use impovement.
Part Five: Emotional Eating
Consider the effects of your emotions on your eating behaviors, and answer questions A-C.
A. Do you eat more than you would like to when you have negative feelings such as anxiety, depresion, anger, or loneliness?
1. never 2. rarely 3. occasionally 4. frequently 5. always
B. Do you have trouble controlling your eating when you have positive feelings (i.e., do you celebrate feeling good by eating)?
1. never 2. rarely 3. occasionally 4. frequently 5. always
C. When you have unpleasant interactions with others in your life or after a difficult day at work, do you eat more than you'd like?
1. never 2. rarely 3. occasionally 4. frequently 5. always
Total your scores:
from questions A-C and circle your score category
3-8: You do not appear to let your emotions affect your eating.
9-11: You sometimes eat in response to emotional highs and lows. Monitor this behavior to learn when and why it occurs, and be prepared to find alternative activities to respond to your emotions.
12-15: Emotional ups and downs can stimulate your eating. Try to deal with the feelings that trigger the eating and find other ways to express them.
Part Six: Exercise Patterns and Attitudes
Exercise is key for weight loss. Think about your attitudes toward it, and answer questions A-D.
A. How often do you exercise?
1. never 2. rarely 3. occasionally 4. somewhat frequently 5. frequently
B. How confident are you that you can exercise regularly?
1. not at all confident 2. slighly confident 3. somewhat confident 4. highly confident 5. completely confident
C. When you thin about exercise, do you develop a positive or negative picture in your mind?
1. completely negative 2. somewhat negative 3. neutral 4. soemwaht positive 5. completely positive
D. How certain are you that you can work regular exercise into your daily schedule?
1. not at all certain 2. slightly certain 3. somewhat certain 4. quite certain 5. extremely certain
Total your scores:
from questions A-D and circle your score category
4-10: You're probably not exercising as regularly as you should. Determine whether it is your attitude about exercising of your lifestlye that is blocking your way, then change what you must and put on those walking shoes!
11-16: You need to feel more positive about exercise so you can do it more often. Think of ways to be more active that are fun and fit your lifestyle.
17-20: The path is clear for you to be active. Now think of ways to get motivated.
REFERENCE: Health The Basics by Rebecca J. Donatelle, Second Custom Edition for East Los Angeles College
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