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Eating and dietary habits survey
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Please take a few minutes of your time to fill in the following survey.
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1
How many times a day do you eat?
2
Please answer the following according to your particular eating habits?
Yes
Sometimes
No
I eat a good breakfast
I experience feelings of hunger during the day
I eat meat
I eat vegetables
I eat fruit
I eat dairy
I eat sweets
3
What meal would you consider to be your main meal of the day?
Breakfast
Lunch
Dinner
Other (Please specify)
Other (Please specify)
4
What does your main meal consist of and how is it prepared?
Freshly home-cooked produce
Restaurant meal
Pre-cooked, microwave or TV dinners
5
What does your main meal on the weekend consist of and how is it prepared?
Freshly home-cooked produce
Restaurant meal
Pre-cooked, microwave or TV dinners
Other (Please state briefly)
6
Have you been avoiding some foods for health reasons?
No
Yes (Please write which one/s and why)
7
Do you have any particular food allergies?
No
Yes (Please write briefly which one/s)
8
What is your weekly food intake frequency of the following food categories?
Several times a day
Once a day
Several times a week
Less often
Never
Sweet foods
Salty foods
Fresh fruit
Fresh vegetables
9
What percentage of your regular diet consists of meat and meat products?
90% or more
75%
50%
25%
Less than 25%
10
How much of your diet consists of vegetables and non-animal products?
90% or more
75%
50%
25%
Less than 25%
11
Do you or have you ever had cholesterol problems?
Yes
No
I don't know
12
Do you know your current BMI (Body Mass Index) index?
Less than 18,5 (Underweight)
18,5-25 (Ideal weight)
25-30 (Overweight)
30-35 (Moderate obesity)
35-40 (Obesity)
More than 40 (Morbidly obese)
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