Checklist: Are You Susceptible to Sugar Addiction? by Joan Kent, PhD

This questionnaire is meant to help you clarify your responses when you eat sugar.

FAMILY HISTORY (Check all that apply to your family.)

                                                                                       MOTHER                                FATHER                             SELF

Hypertension                                                             ________                                ________                             ________

Diabetes                                                                      ________                                ________                             ________

Heart disease                                                             ________                                ________                              ________

Obesity                                                                        ________                                ________                              ________

Alcoholism                                                                 ________                                ________                              ________

Hypoglycemia (low bl glucose)                             ________                                ________                               ________

Partiality to starches                                               ________                                ________                               ________

                  (pasta, bread, potatoes)

Binge-eating disorder                                             ________                                ________                                ________

Depression                                                                ________                                ________                                ________

Which of these behaviors do you exhibit with respect to sugar? (Check all that apply.)

Sugar cravings  ______________________________________________________________________

Preoccupation with sugar             __________________________________________________________

Compulsion to eat sugar                __________________________________________________________

Loss of control over how much sugar you eat    _____________________________________________

Unsuccessful efforts to quit sugar   ______________________________________________________

Purging (self-induced vomiting; use of laxatives; excessive exercise)      _________________________

Missing important events             __________________________________________________________

Self-isolation      _______________________________________________________________________

How often do you catch colds per year?                 _____________________________________________

Your body shape:              Apple     ______________________           Pear        _________________________

For an analysis of the results of this questionnaire, visit www.LastResortNutrition.com and request your free Empowered Eating Consult.

Brought to you by Dr. Joan Kent, best-selling author of Stronger Than Sugar.