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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.
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1
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Have you thought of yourself as having a weight problem?
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2
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IF YES, at what age did you first become aware of it?
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3
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Have you gone to a professional or medical weight-loss program?
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5
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What is your highest adult weight? (If you don't know, give your best estimate.)
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6
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What was your lowest adult weight? (If you don't know, give your best estimate.)
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7
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What is your weight now? (If you don't know, give your best estimate.)
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8
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What is your ideal healthy weight?
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12
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IF YES, at what age did you first try?
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13
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IF YES, about how many have you tried?
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14
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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 |
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15
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IF YES, estimate the total amount of money you have spent on dieting:
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16
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Was elimination of all addictive foods an integral part of any of your diets?
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