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Eating questionnaire
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  • 1. Condition 1□ Condition 2 □ Eating Questionnaire Circle your gender: Male / Female 1. Do you eat five portions of fruit and vegetables a day? Yes/No 2. Do you emotions affect the way you eat? Yes/No 3. Is food a big part of your life? Yes/No 4. On average how many times do you eat fast food in a week? Never 1 2 3 4 5+ 5. Do you enjoy a balance diet? Yes/No 6. Do you calorie count? Yes/No 7. Have you ever dieted? Yes/No 8. Do you think your food preference has been influenced by your parents? Yes/No 9. Are you keen to try new foods? Yes/No 10.Do you comfort eat? Yes/No 11.Do you believe in the saying “You are what you eat”? Yes/No
  • 2. Condition 1□ Condition 2 □ 12.Do you buy/eat supermarket own brands? Yes/No 13.From the list below select what you are most likely to eat Crisps Apples Chocolate Sweets Popcorn Carrot sticks Dips (e.g. houmous) Biscuits Dried fruit & nuts Chips Burgers Cake Cereal (e.g. coco pops) Cereal (e.g. muesli) Oranges Grapes Yogurt Pizza Roast dinner Soup Mash potato Ryvita Cheese Pineapple 14.During times of stress I tend to eat More/Less 15.During times of stress I tend to eat Full meals / snacks 16.In your opinion, what is a healthy diet? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 17.What factors do you consider to have the greatest effect on your food choice? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________