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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.

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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?

7

What is your current height?

8

What is your current weight?

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?

11

How many times a day do you eat?

12

Please answer the following according to your particular eating habits:

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: