Food and eating habits survey
Dear Sir/Madam,
Please take a moment to fill in this short food and eating habits questionnaire.
1) In a typical day, how many times do you eat?
*
Once
Twice
Three times
Four times
Five times
Six or more times
2) What meal would you consider to be your main meal of the day?
*
Breakfast
Morning snack
Lunch
Afternoon snack
Dinner
Other:
3) What is your typical main meal on workdays?
*
Freshly home-cooked meal from high quality ingrediencies
Premium restaurant meal
Fast food meal
Ready meal
4) What is your typical main meal on weekends?
*
Freshly home-cooked meal from high quality ingrediencies
Premium restaurant meal
Fast food meal
Ready meal
5) In a typical day, how many of your meals include carbohydrates (bread, beans, milk, popcorn, potatoes, cookies, spaghetti, soft drinks, corn etc.)?
*
None
One
Two
Three
Four or more
6) In a typical day, how many of your meals include protein (meat, eggs, nuts etc.)?
*
None
One
Two
Three
Four or more
7) In a typical day, how many of your meals include vegetables?
*
None
One
Two
Three
Four or more
8) In a typical day, how many of your meals include fruit?
*
None
One
Two
Three
Four or more
9) Do you consume athletics food supplements?
*
Yes
No
10) Do you know your current BMI (Body Mass Index)?
*
Underweight (less than 18.5)
Normal weight (18.5 to 24.9)
Overweight (25 to 29.9)
Obesity (30 or more)
11) Do you have diabetes?
*
No
Yes
12) Do you have any particular food allergies?
*
No
Yes, these:
13) Have you or are you experiencing cholesterol related problems?
*
No
Yes
14) Do you follow a meal plan created by a nutritionist?
*
Yes
No
*
Answer required
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