Depression Shame Grief Frustration Masculinity Lack of Satisfaction Sexual Issues Fear Romance Abandonment Anger Happiness Anxiety Relaxation Loneliness Loss Embarrassment Sadness Boredom Punishment Other

Lunch Breakfast Dinner

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Sweet foods Savory foods Fresh fruit Fresh vegetables Starchy foods Fatty foods

Stop over-eating / Portion control Stop drinking alcohol Stop eating junk foods Stop snacking between meals Stop drinking sweet drinks Do more or start exercise program Other

Dad Mom Bother Sister

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

YES NO

Yes No

1 2 3 4 5

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No