Healthy Eating Questionnaire

It has been said many times “you are what you eat” and hence healthy eating forms the foundation of healthy and disease free living. In this context healthy eating questionnaire is a series of questions which are designed to analyze food habits of individuals. It may also be used to assist people achieve their particular fitness goals like weight loss or muscle gain.

Healthy Eating Questionnaire Sample

Name:               __________________________________________________________________

Age:          ________________________        Sex:          ________________________

Height:              _______________________

Waist:               ________________________        Hips:         ________________________

  1. Enter your average meal timings

a)    breakfast :         _______________

b)    morning break:   _______________

c)     lunch:                        _______________

d)    evening snacks:  _______________

e)    dinner:                      _______________

f)      other:


  1. How would you describe your job? :

a)    sedentary

b)    some activity

c)     active

  1. Do you skip your breakfast often? If yes then how many times a week? If no then what do you have in breakfast?


  1. What would you have in your morning break?

a)    coffee / biscuits / chocolate bar

b)    cold drink / colas / chips

c)     fruits / salads / oatmeal cookies

  1. How many servings of fruits and vegetables do you have each day?


  1. What do you prefer as a drink while you are on the go?

a)     soft drink

b)     fruit juice

c)     water

  1. While going for team lunch with your office colleagues you are most likely to have

a)    bacon sandwich, coffee and donut

b)    pizza with chicken and cheese

c)     grilled chicken with potatoes

d)    If any other, please mention

  1. Your daily intake of water in liters :               ____________________________

Category: Health Questionnaire

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