1. Do you have a reason for wanting to lose weight?
I know why I want to lose weight at this time.
I don't have specific reasons for losing weight; I just believe that I should.
I haven't thought about specific reasons for losing weight.

2. Do you think you can achieve your weight goals?
I feel in control of whether I achieve the weight I desire.
At times, I do not feel in control of whether I achieve the weight I desire.
I never feel in control of whether I achieve the weight I desire.

3. How do you best describe your dieting process?
I think that losing weight will take time and will not always be easy.
I think it is possible to shed my unwanted weight quickly, without problems.
I have not thought in detail about the dieting process.

4. How do you view your relationship with food?
I enjoy the foods I choose to eat.
I feel like I'm cheating if I enjoy food too much.
I do not enjoy food.

5. What are your attitudes toward exercise?
I know how I will incorporate exercise into my life (or have already done it).
I know that I should be physically active, but am unsure how to incorporate it into my life.
I have not thought about my exercise plan.

6. How would you describe your feelings about yourself?
Overall, I like myself.
I do not have many positive feelings about myself.
Overall, I do not really like myself.

7. Do you have a support system in place to help you achieve your goals?
I have a good support system of friends, family, and/or professional help that I can talk to about my weight issues.
There are a few people in my life that support me in my weight-loss efforts, but I wish I had more.
I don't feel there is anyone I can talk to about my weight-loss concerns and goals.

8. Do you feel that your life is "in order"?
My work and personal lives are stable enough for me to make my weight management goals a high priority.
Because of my work and personal lives, it is often difficult to make weight management a priority.
My work and personal lives make it seem impossible to focus on weight management now.

9. How will you track your weight loss progress?
I will keep a record of my progress toward my weight-management goals.
I'm not sure if keeping a record is really necessary.
I'm not interested in keeping a record of my progress toward my weight management goals.

10. How committed are you?
I can reach a healthier weight and maintain it.
I hope to reach a healthier weight, but feel I could fail.
I privately doubt that I can reach and maintain a healthier weight.

Source: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, National Institutes of Health, National Heart, Lung, and Blood Institute, 1998.