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Are you normal weight?

	Normal, within a few pounds
	5 to 15 pounds overweight
	More than 15 pounds overweight
	3 to 10 pounds underweight
	More than 10 pounds underweight

Which of the following most closely describes your current state of health:

	Generally healthy, a few points to work on
	Healthy but stressed, notice a wear and tear trend that needs improvement
	Feel like health is slipping, symptoms are becoming problematic and hard to change
	Health is a struggle, multiple issues or a major problem

Can you eat little and still not lose weight?

	I struggle to lose weight even when eating 1200 or fewer calories per day
	I eat moderately and still can't lose weight
	Not an issue

Describe your snacking pattern:

	Seldom snack, mostly three meals a day.
	Three to four snacks per week
	Average one snack per day
	Average two or more snacks per day

Do you eat a large meal within three hours of bed?

	My largest meal of the day is always close to bed
	I generally have a larger meal within three hours of bed
	Not very often

Do you overeat at night, continuing to eat or munch after dinner is over?

	I regularly eat too much food after dinner
	I sometimes eat or snack after dinner
	I must eat something before bed in order to fall asleep or stay asleep
	Seldom eat after dinner

Describe your appetite:

	Must eat a lot to feel satisfied, like to be really full
	Prone to overeating if not careful
	Normal appetite, moderate food intake
	Smaller meals due to digestive problems
	Poor appetite

Do you spend too much time thinking about food?

I am constantly thinking about food or my next meal

My life revolves around food too much

No

Do you experience periods of binge eating, stuffing yourself full of food?

	I excessively consume food two or more times a week
	I binge eat one to two times per month
	Seldom or never

Do you succumb to food cravings, eating what you know you shouldn't?

	My willpower is easily overcome by hunger or food cravings
	I sometimes give in to eating the wrong things
	No

Do you develop a hyper-uncomfortable feeling, rapid heart beat, or trembling feeling when you get hungry?

Yes

Sometimes

Not an issue

Do you slur words, feel mentally sluggish, or have trouble connecting thoughts when you haven't eaten?

	Yes, this happens three or more times per week
	Yes, this happens three to six times per month
	Sometimes, but doesn't happen often
	Not an issue

Describe your use of sweeteners:

	Must add sugar or artificial sweetener to foods or beverages
	Occasionally add sugar or artificial sweetener to foods or beverages
	Seldom or never add any sweetener

Do you eat in response to stress?

Yes

Sometimes

I lose my appetite in response to stress

Not an issue

Are you currently under considerable stress?

	I am currently experiencing an emotional trauma or severe strain
	General life stress is quite high and feels out of control
	General life stress is quite high and is barely manageable
	General life stress is high, but is managed well
	Moderate stress
	Low stress

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*These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease.
Note: the asterisk mark following a paragraph and linking to the above FDA disclaimer applies to any or all statements in that paragraph.

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Weight Loss News

Take the Leptin Quiz!

Leptin Diet Basics

Leptin Diet® Supplements

Books

Leptin Diet® Success Stories

Connect

Leptin Diet® Q&A with Byron Richards

Weight Loss News

Leptin Diet^® Supplements

Leptin Diet^® Success Stories

Leptin Diet^® Q&A with
Byron Richards