Section 1: Goals and Attitudes
  1. Compared to previous attempts, how motivated to lose weight are you this time?

    1. Not at all motivated

    2. Slightly motivated

    3. Somewhat motivated

    4. Quite motivated

    5. Extremely motivated

  1. How certain are you that you will stay committed to a weight loss program for the time it will take you to reach your goal?

    1. Not at all certain

    2. Slightly certain

    3. Somewhat certain

    4. Quite certain

    5. Extremely certain

  1. Consider all outside factors at this time in your life (the stress you're feeling at work, your family obligations, etc.). To what extent can you tolerate the effort required to stick to a diet?

    1. Cannot tolerate

    2. Can tolerate somewhat

    3. Uncertain

    4. Can tolerate well

    5. Can tolerate easily

  1. Think honestly about how much weight you hope to lose and how quickly you hope to lose it. Figuring a weight loss of 1 to 2 pounds per week, how realistic is your expectation?

    1. Very unrealistic

    2. Somewhat unrealistic

    3. Moderately unrealistic

    4. Somewhat realistic

    5. Very realistic

  1. While dieting, do you fantasize about eating a lot of your favorite foods?

    1. Always

    2. Frequently

    3. Occasionally

    4. Rarely

    5. Never



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