Nutrition Questionnaire (Page 3 of 3) in pdf

Nutrition Questionnaire Page 3

Healthy Dietary Guidelines include having breakfast

Assignment # 6 Your Breakfast

1. Did you have some breakfast this morning?

Yes

2. Do you usually eat breakfast?

Yes

3. If you do NOT eat breakfast regularly, why not?

a. Not hungry?

b. Not enough time?

c. Breakfast not prepared

d. Don't like food served

e. On a Diet

f. Don't want to gain weight

g. Other reasons List

4. If you did eat breakfast, which of the foods below were included in your breakfast?

a. Fruit or juice

b. Cereal with milk, cream

c. Bread, Toast, rolls

d. Butter or spread

e. Milk

f. Eggs

g. Meat

h. Pancakes, waffles

i. Coffee or tea

j. Cocoa or other beverage

k. Other foods List

5. List foods checked above under their food group as outlined in MyPyramid.

Grain

Vegetable

Fruit

Milk

Meat and Beans

Fats and oils

6. Did you eat a balanced meal?

Yes

7. If

not what would you need to have a balanced meal? (give 3 suggestions)

4. Look at Day 3, 6, &9 on your Food record. Did you eat breakfast? If so, are the foods you consumed good choices for a breakfast?

Nutrition Questionnaire Page 3