Nutrition Questionnaire
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3Assignment #1: Place a check mark in front of each sentence with which you agree. Respond quickly. If you have to think about it, you are trying to
convince yourself of the truth.
1.
I eat many different kinds of foods.
2.
I do not eat foods high in sugar such as soft drinks, candy, cookies, and cake.
3.
I do not eat salty foods such as chips and pretzels.
4.
I do not use the salt shaker at mealtimes.
5.
I do not eat foods high in fat such as fried or greasy foods.
I weigh just about the right amount – I am not underweight or overweight.
6.
7.
I eat only when I am hungry and I eat until I am full (if you sigh during a meal, it is a sign of being full). I never eat more than I need.
8.
I eat plenty of fresh fruits and vegetables. I eat at least four servings of them every day.
9.
I eat mostly whole- grain breads and cereals.
10. I eat cheese, yogurt, and ice cream or drink a glass of milk 4 times a day.
If you checked all of these sentences, your food habits probably need very few changes. If you have checked less than 5, you may be headed for trouble.
Review the dietary guidelines and then commit to making at least 1 change towards being healthy.
A.
MY DIETRY GOAL SELF- CONTRACT
I, ______________________________________, would like to change my food habits. The dietary goal I would like to reach is Goal # _____: which is :
________________________________________________________________________________________________________________________________.
I will begin working on this goal by taking this first step: _______________________________________________________________________________________.
Your signature ______________________________________________________
***AT THE END OF UNIT 2, AND AFTER YOU HAVE WORKED ON THIS GOAL FOR AT LEAST 7 DAYS, ANSWER THESE QUESTIONS:
-
How difficult was it following this guideline? Why?___________________________________________________________________________________
______________________________________________________________________________________________________________________________
-
What can you do to make meeting this goal more reaitstic?______________________________________________________________________________
-
Could you tell a difference when you followed this goal? Explain. ________________________________________________________________________
Assignment #2: Nutrient Dense – Empty Calorie Foods Comparison
Directions: Using the food charts with nutritive values, choose 2 foods from the nutrient dense side and 2 foods from the empty calorie side and
shade in the bar charts for each nutrient listed below the bar.
NUTRIENT DENSE FOODS: Food________________ Calories______ EMPTY CALORIE FOODS: Food___________________ Calories____
100
100
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
Fat
Chol
Sod-
Fiber
Prot-
Vit.
Vit.
Iron
Cal-
Fat
Chol
Sod-
Fiber
Prot-
Vit.
Vit.
Iron
Cal-
.
ium
ein
A
C
cium
.
ium
ein
A
C
cium
Food__________________ Calories__________
Food__________________ Calories__________
100
100
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
Fat
Chol
Sod-
Fiber
Prot-
Vit.
Vit.
Iron
Cal-
Fat
Chol
Sod-
Fiber
Prot-
Vit.
Vit.
Iron
Cal-
.
ium
ein
A
C
cium
.
ium
ein
A
C
cium
1-Which type of food (nutrient dense/empty calorie) has more amount of the bars shaded? ____________________________________
2-What does that say about the nutrient content?_____________________________________________________
3-Which type of foods have more fat and cholesterol? __________________________________________________
4-Explain the dietary guideline #1, ‘Adequate Nutrients within Calorie Needs :
#1 was followed: Discuss both days.
5. Look at Days 5 and 10 on your food record and analyze them for how the DG
6. ______________________ are the balance of calories remaining in a person’s “energy allowance” after consuming sufficient nutrient-
1
dense forms of foods to meet all nutrient needs for a day. Discretionary calories may be used in selecting forms of foods that are not the most
nutrient dense (e.g. whole milk rather than fat-free milk) or may be additions to foods (e.g., salad dressings)
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