Binge & Emotional Eating Signs

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Binge Eating Definition A feeling of being out of control during the binge eating period, clients frequently report an ‘out of body’ experience

Binge Eating Is:
– Eating far more quickly than normal
– Eating until feeling uncomfortably full
– Eating large amounts of food when not actually hungry for food
– Eating alone or secret eating (including night eating)
– Experiencing significant feelings of shame, disgust, guilt, frustration and anger/hatred of self
- You are a ‘Serial Dieter’ and/or often compensate for binge eating by restriction/dieting, but do not purge.

Do you experience regular episodes of Binge Eating, according to the definition above?

YesNoOther

How long have you been struggling with food and/or your body image?

How would YOU describe your problem?

If you could wave a magic wand, how would you like to look in 12 months' time?

Have you sought help with this before?

yesno

If you answered "yes", can you tell me what type of help, for how long, and if you felt it helped

And if it didn't help, why do you think it didn't?

How motivated are you now to truly tackle and overcome this issue?

	1	2	3	4	5	6	7	8	9	10

1 is Not motivated, 10 is Highly motivated

What would it mean to you to overcome your struggle with food, emotional eating and body image and move on with your life, free of all of the stress associated with this issue?

Is there anything else you would like to share with KKW about your journey and struggles?

Would you like to speak to KKW about our 1:1 hybrid licensed program that incorporates education and recovery from binge eating with a licensed professional using the Eating Freely program at KKW?

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