Yale Food Addiction Survey v9.0
Rudd Center for Food Policy & Obesity
Yale University
PO Box 208369
New Haven, CT 06520-8369

Gearhardt, Corbin, Brownell, 2009

For information about this survey click here

For video about this survey click here

 

There are no right or wrong answers.  Please respond to every question.
If you are uncomfortable answering any question a "decline to respond" option is provided.

 

[FrontPage Save Results Component]

 

Question #

IN THE PAST 12 MONTHS:

Response
1.  - I find that when I start eating certain foods, I end up eating much more than I planned.

     

2.  - I find myself continuing to consume certain foods even though I am no longer hungry.      
3.  - I eat to the point where I feel physically ill.      
4.  - Not eating certain types of food or cutting down on certain types of food is something I worry about.      
5.  - I spend a lot of time feeling sluggish or fatigued from overeating.       
6.  - I find myself constantly eating certain foods throughout the day.      
7.  - I find that when certain foods are not available, I will go out of my way to obtain them. For example, I will drive to the store to purchase certain foods even though I have other options available to me at home.      
8.

 - There have been times when I consumed certain foods so often or in such large quantities that I started to eat food instead of working, spending time with my family or friends, or engaging in other important activities or recreational activities I enjoy.

     
9.  - There have been times when I consumed certain foods so often or in such large quantities that I spent time dealing with negative feelings from overeating instead of working, spending time with my family or friends, or engaging in other important activities or recreational activities I enjoy.      
10.  - There have been times when I avoided professional or social situations where certain foods were available, because I was afraid I would overeat.      
11.  - There have been times when I avoided professional or social situations because I was not able to consume certain foods there.      
12.  - I have had withdrawal symptoms such as agitation, anxiety, or other physical symptoms when I cut down or stopped eating certain foods. (Please do NOT include withdrawal symptoms caused by cutting down on caffeinated beverages such as soda pop, coffee, tea, energy drinks, etc.)      
13.  - I have consumed certain foods to prevent feelings of anxiety, agitation, or other physical symptoms that were developing. (Please do NOT include consumption of caffeinated beverages such as soda pop, coffee, tea, energy drinks, etc.)      
14.  - I have found that I have elevated desire for, or urges to consume, certain foods when I cut down or stop eating them.      
15.  - My behavior with respect to food and eating causes significant distress.       
16.  - I experience significant problems in my ability to function effectively (daily routine, job/school, social activities, family activities, health difficulties) because of food and eating.      
17.  - My food consumption has caused significant psychological problems such as depression, anxiety, self-loathing, or guilt.       
18.  - My food consumption has caused significant physical problems or made a physical problem worse.     
19.  - I kept consuming the same types of food or the same amount of food even though I was having emotional and/or physical problems.     
20.  - Over time, I have found that I need to eat more and more to get the feeling I want, such as reduced negative emotions or increased pleasure.     
21.  - I have found that eating the same amount of food does not reduce my negative emotions or increase pleasurable feelings the way it used to.     
22.  - I want to cut down or stop eating certain kinds of food.      
23.  - I have tried to cut down or stop eating certain kinds of food.      
24.  - I have been successful at cutting down or not eating these kinds of food.     
25.  - How many times in the past year did you try to cut down or stop eating certain foods altogether?

    

26.

Please check ALL of the following foods you have problems with:

Ice Cream  Chocolate Apples
Doughnuts Broccoli  Cookies 
Cake Candy White Bread
Rolls Lettuce Pasta 
Strawberries Rice Crackers
Chips Pretzels French Fries
Carrots Steak Bananas
Bacon Hamburgers Cheese Burgers
Pizza Soda Pop None of these foods
27.

  Please list all other foods that you have problems with that were not listed above:
 

 
28.

Questions? Suggestions? Comments?
Please enter here

if you would like a reply enter your email address here

 


 

About You

Please respond to every question.  
If you are uncomfortable answering any question a "decline to respond" option is provided.
Please enter 0 [zero] where numeric data is requested and you do not wish to respond.

What is your gender?
What is the 4 digit year you were born?
Please enter 0 if you do not wish to respond
What is your height?
Please enter 0 if you do not wish to respond
Feet  Inches
What is your weight in pounds?
Please enter 0 if you do not wish to respond
Weight in Lbs
check if stripped weight
Tobacco use in last year including smokeless or e-cigarettes
Alcohol consumption in last year

 

Check all of the following that apply to you.

     I decline to respond to any of these questions
     I was admitted to hospital within last year
     I am under the care of a doctor
     I was told by a doctor within last year I was overweight
         but not obese
     I was told by a doctor within last year I was obese
     I have type II diabetes
     I have high cholesterol 
     I have heart or vascular problems
     I have vision problems
     I have had a stroke
     I have high blood pressure unless it is controlled by medication
     I have had one or more amputations
     I have or have had cancer
     I have an allergy to peanuts
     I have an allergy to gluten
     I have a food allergy other than peanuts or gluten
     I have renal (kidney) problems
     I have none of the above problems

Please enter any other medical conditions you may have,
particularly if these may be diet related

 

Thank you for participating in the survey!

 

 

{scoring and evaluation of instrument goes here}

  13-Jan-14 17:20
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