Eating Habits

1. I am on a diet _____ .
   almost always
   about once a month
   3-6 times a year
   around the holidays or for special events
   never
   

2. I consume most of my food in 1-2 meals during the day.
   Most of the time
   Sometimes
   Rarely
   Never
   

3. I drink ________ glasses of water daily.
   none
   1-3
   4-5
   6-7
   8 or more
   

4. I eat breakfast ______ .
   every day
   4-6 times a week
   2-3 times a week
   once a week
   almost never
   

5. I eat my largest meal at night ______ .
   rarely
   1-2 times a week
   3-6 times a week
   every day
   

6. I eat something just before going to bed at night _______ .
   rarely
   1-2 times a week
   3-6 times a week
   every day
   

7. I eat whole grains (brown rice, wheat bread, etc.) instead of processed grains (white bread, refined sugars, etc.) ______ .
   most of the time
   sometimes
   rarely
   never
   

8. I have _____ caffeinated drinks (coffee, soda, tea) every day.
   4 or more
   3
   2
   1
   none
   

9. I snack on fruits and vegetables _____ .
   more than once a day
   every day
   2-3 times a week
   once in a while
   never
   

10. I snack on junk food (candy, cookies, ice cream, etc.) _______ .
    rarely
    1-2 times a week
    3-6 times a week
    every day
    more than once a day
    

11. I take my time while eating.
    Most of the time
    Sometimes
    Rarely
    Never
    

12. My food intake varies from day-to-day and week-to-week.
    Most of the time
    Sometimes
    Rarely
    Never