High School Students & Athletes Eating Habits Survey (RD)

The purpose of this survey is to determine the prevalence and types of disordered eating habits in high school students and athletes. Please answer all questions to the best of your ability. Your responses will remain confidential and anonymous. You may opt out at any time. Thank you for your time.

1 What is your gender?

2 What grade are you currently in?

3 What is your race/ethnicity? (Choose all that apply)

4 Are you an athlete?

5 How often do you exercise (including practice, games/events/meets, exercise outside of practice, activities, etc.)?

6 Have you ever exercised for more than 60 minutes a day to lose or to control your weight?
Required answer

7 What is your current height?

100 characters remaining

8 What is your current weight?

100 characters remaining

9 Have you lost 20 pounds or more in the last 6 months?

10 Have you ever used laxatives, diet pills, or water pills to control your weight or shape?
Required answer

11 How many times a day do you eat?

12 Please answer the following according to your particular eating habits:

I eat breakfast daily
I eat lunch daily
I eat dinner daily
I snack daily
I experience feelings of hunger during the day
The meals I eat are well balanced (includes at least 3 of the following food groups: starchy vegetables/grains, meat/poultry/fish/meat alternative, non-starchy vegetables, fruit, oils/fat, dairy/dairy alternative)

13 What meal would you consider to be your main meal of the day (the meal where you consume a majority of the nutrients you need)?

14 Do you have any particular food allergies and/or sensitivities?

15 Have you been avoiding some foods for health and/or athletic reasons?

16 Please answer the following which best applies to you:

Some times
I am terrified about being overweight.
I avoid eating when I am hungry.
I find myself preoccupied with food.
I have gone on eating binges where I feel I may not be able to stop.
I cut my food into small pieces.
I am aware of the calorie content of food I eat.
I particularly avoid foods that are high in carbohydrates (ex. bread, rice, potatoes)
I feel that others would prefer if I eat more.
I vomit after I have eaten.
I feel extremely guilty after eating.
I am preoccupied with the desire to be thinner.
I think about burning up calories when I exercise.
Other people think I am too thin.
I am preoccupied with the thought of having fat on my body.
I take longer than others to eat my meals.
I avoid foods with sugar in them.
I eat diet foods (foods labeled fat free, reduced fat, sugar free, diet).
I feel that food controls my life.
I display self-control around food.
I feel that others pressure me to eat.
I give too much time and thought for food.
I feel uncomfortable after eating sweets.
I engage in dieting behavior.
I like my stomach to be empty.
I have the impulse to vomit after meals.
I enjoy trying new rich foods.