Please fill out the following as completely as possible. Your responses are entirely anonymous and confidential. Age: Male Female Current Weight: pounds Current Height: feet inches Highest Weight Ever:      When was that (month/year)? Lowest Weight at Current Height: Desired Weight: Freshman Sophomore Junior Senior Graduate Student I am not a student, but I am a Stanford affiliate. I am not affiliated with Stanford. Ethnicity: Do you participate in athletics at any of the following levels? Intramural Varsity/Intercollegiate Recreational Please choose a response for each of the following statements: Always Usually Often Sometimes Rarely Never N/A I am terrified about being overweight. I avoid eating when I am hungry. I find myself preoccupied with food. I have gone on eating binges where I feel that I may not be able to stop. I cut my food into small pieces. I am aware of the calorie content of foods that I eat. Always Usually Often Sometimes Rarely Never N/A I particularly avoid food with a high carbohydrate content (i.e. bread, rice, potatoes, etc.) I feel that others would prefer if I ate more. I vomit after I have eaten. I feel extremely guilty after eating. I am preoccupied with a desire to be thinner. I think about burning up calories when I exercise. Always Usually Often Sometimes Rarely Never N/A Other people think that I am too thin. I am preoccupied with the thought of having fat on my body. I take longer than others to eat my meals. I avoid foods with sugar in them. I eat diet foods. I feel that food controls my life. Always Usually Often Sometimes Rarely Never N/A I display self-control around food. I feel that others pressure me to eat. I give too much time and thought to food. I feel uncomfortable after eating sweets. I engage in dieting behavior. I like my stomach to be empty. I have the impulse to vomit after meals. I enjoy trying rich new foods. In the past 3 months, how often have you... Never Less than 1 time per month 1 to 3 times per month Once a week 2 to 6 times a week Once a day More than once a day gone on eating binges (eating a large amount of foods while feeling out of control)? made yourself sick (vomited) to control your weight? used laxatives to control your weight or shape? exercised to lose or to control your weight? Have you ever been treated for an eating disorder? Yes No If you have been treated for an eating disorder, was it through a: (check all that apply) Counselor Medical Doctor Nurse Psychiatrist Psychologist Nutritionist or Dietician Support Group Have you recently thought of or attempted suicide? Yes No When you have completed the form, please submit your results. The EAT-26 questionnaire is copyright David M. Garner and Paul E. Garfinkel, 1979, and David M. Garner, et al, 1982. Used with permission.