Eating Habits

Do you eat late at night?

Please select all that apply.

• yes
• I have odd hours due to work or school and have to eat late
• no
• sometimes

Do you eat breakfast?

• sometimes
• no
• yes

What is the portion size for meat (beef, pork, chicken etc.)?

Please select all that apply.

• 1/2 of a dinner plat
• Size of a deck of cards or what fits on 1/4 of a dinner plate
• what I get in a restaurant

Do you eat snacks?

Please select all that apply.

• healthy snacks
• unhealthy snacks
• yes
• in controlled portions
• no

Do you eat three meals a day?

• most of the time
• one meal
• yes
• only two

What is the recommended amount of daily fiber?

Please select all that apply.

• 36-40 grams
• 10-19 grams
• 5-10 grams
• 20-35 grams
• 41-50 grams

How do you describe what you eat?

Please select all that apply.

• I eat everything
• corn free
• no beef
• Mediterranean diet
• South Beach diet
• vegan
• gluten free
• macrobiotic
• Other
• Weight Waters diet
• vegetarian
• dairy free
• metabolic diet
• food allergies or intolerance

How many 1c. servings of vegetables should you get in a day?

Please select all that apply.

• 4-6
• 7-9
• 1-3

Do you drink high calorie beverages?

Please select all that apply.

• smoothies
• other
• juice
• energy drinks
• soda pop