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Survey

EATING HABITS QUESTIONAIRE

Class/group: ______ Gender: ______ Age: ______ Weight: ______

Weight on entry to college: _____

Please answer the following question. You can tick more than one (1).

1. How many main meals do you have?o1o2o

3o4

2. Tick the food types that best suite you or best describe you:Breakfast Lunch Dinner

oMee / Nasi lemak oRice with dishes o Rice with dishesoBread oSoup / mee soup o Western meal

(burger/ hotdog)

oHot drinks(milo, teh tarik, Nescafe)

oPorridge o Low calories food(cereal/ biscuits)

oCereal /biscuits /Oats oFast food(McDonald, KFC)

o Vegetarian meal(salads, coleslaw,

potatoes)

oOthersPlease specify:

____________________

oOthersPlease specify:

__________________

o OthersPlease specify:

________________

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3. How often do you have snacks in between the main meals?o Alwayso Sometimeso Never

4. If yes, what do you take?o Chipso Nutso Sweets/ chocolate/ cakeo Fruitso Others , please specify: ___________

5. How often do you eat salad or vegetables and fruits with lunch or dinner?o Alwayso Frequentlyo Sometimeso Rarelyo Never

6. What do you drink before, during or after a meal?oWateroCarbonated drinkoJuiceoTeaoOthers, please specify : _________________

7. How often do you eat at fast food restaurants? (Mc Donald, KFC, Pizza Hut, etc)o Nevero Once a montho 2 or 3 times a montho 2 or 3 times a week

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o Everyday8. Do you use food supplement like vitamins to complete your diet?o

YesoNo

9. Do you believe that your health is affected by good eating habits?oYesoNo

10.Do you practice good eating habits?o

YesoNo

11.What type of food do you think you should eat to have a balanced nutrition?oMainly meatoMainly vegetablesoMeat, vegetables, and other variety of foodsoTry to balance up a meal (include as many foods)oOthers, please specify: ___________________

12.Do you realize your health can be affected by diet?oYesoNo

13.What does a healthy diet means to you?oTake vegetables onlyoTake two main meals in a dayoTake meals according to food pyramido A healthy diet is one that helps maintain or improve healthoOthers, please specify: ___________________

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14.Have you gained weight during your stay at this college?o

Yeso No

15.If yes, what do you think are the causes?

16.Do you think that students in this college have good eating habits?o Yeso No

17.What are your recommendations to encourage students here to have good eating habits?

18.How often do you fall ill (sick) due to bad eating habits?oOnce a weekoOnce a monthoOnce in two monthsoPractically neveroOthers please specify

19.Does the amount of food you eat balance up with the rate at which you use that energy?oYesoNooSometimes

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oAlwaysoOthers please specify.

20.Is there any other part of your health that you think is essential to this study, anythingimportant?

THANK YOU...