Food as a Problem

This survey seeks to learn from the experiences of people who have food-related problems, how they have tried to resolve them, and what has worked. It is being conducted by a group loosely affiliated with the ACORN recovery group and includes a section near the end addressing ACORN experiences. No ties to, or even familiarity with, ACORN are necessary to successfully complete the survey. YOU MAY SKIP ANY QUESTION YOU WISH. Some of the information may be published in a future book about food addiction. The survey’s final section allows you to set the terms under which your data may be used in such a book or any other public use. Your experience is valuable, even if you decline to be identified in print in any way. The survey takes an average of 20 minutes to complete. If you have any questions, you may call 941-735-1732, or send e-mail to foodaddictionsurvey@ fisherblue.com. If you know others who would like to take the survey, please pass this Web link; a paper copy of the survey can be provided for those who prefer that method. Colleen Hillock, Medicine Hat, Alberta Michael Prager, Arlington, Mass. Phil Werdell, Sarasota, Fla.

W E I G H T

Have you thought of yourself as having a weight problem?

2	IF YES, at what age did you first become aware of it?

Have you gone to a professional or medical weight-loss program?

4	IF YES, for how long?

5	What is your highest adult weight? (If you don't know, give your best estimate.)

6	What was your lowest adult weight? (If you don't know, give your best estimate.)

7	What is your weight now? (If you don't know, give your best estimate.)

8	What is your ideal healthy weight?

9	How tall are you?

Comments

D I E T I N G

Have you ever dieted?

12	IF YES, at what age did you first try?

13	IF YES, about how many have you tried?

IF YES, check all the diets you have tried:

	Atkins
	Cambridge liquid diet
	California Diet
	Counting calories
	Diet Center
	Diet Workshop
	Fasting
	Health foods
	Herbalife
	Jenny Craig
	L.A. Weight Loss
	Liquid diets
	Medifast
	Moderate meals
	Prescribed weight loss medication
	Richard Simmons
	Skipping meals
	Slimfast
	South Beach Diet
	Stillman
	Suzanne Somers
	Weigh Down
	Weight Watchers
	The Zone
	Other (please specify)

15	IF YES, estimate the total amount of money you have spent on dieting:

Was elimination of all addictive foods an integral part of any of your diets?

Comments