Name: _Lauren Merrill___

Eating Your Way to Health

Self-Report Sheet
Date: ___1/13/2015__________________

**This sheet is to be completed without assistance from books, internet, books, other people & any other
outside sources.

1. The 5 healthiest individual foods are & why?

a. __Chickpeas High in protein and nutrients
b. _Kinoa Same as above
c. __Spinach - Iron
d. _Grilled chicken - Protein
e. _Tomatoes Good for your skin
f. _Carrots Good for your eyes
g. _Broccoli High in nutrients
2. The 5 unhealthiest individual foods are & why?
a. _Donuts Sugar and fat
b. _Granola bars highly processed
c. Cereal Also highly processed
d. _Fast food cheeseburgers Greasy and fatty
e. Ice cream No nutritional value and a lot of sugar
3. Macronutrients are:
They are a substance needed in large amounts in living organisms
4. Micronutrients are:
An element required in trace amounts in a living organism.
5. Label the following foods as primarily either: fat (F), carbohydrate (C) or protein (P):
Eggs
___P_____
Olive oil
___F_____
Salmon
___P_____
Broccoli
___P_____
Black beans ___P_____
Celery
___P_____
Rice
___C_____
Milk
___F_____
Avocado
___P_____
Pork
___P_____
Coconut
___P_____
Blueberries ___P_____
6. Whenever I eat, I am cognizant of the composition of my food.
Strongly agree
Agree
Neither agree or disagree
Disagree - Yes
Strongly disagree
7. When purchasing foods I typically base my selections on: (rank the top three, 1=primary
reason)
_6__ Price
_3__Value
_1__Quality _2__Brand __4_Source _5__Labeling
8. I typically eat healthy foods.
a. Strongly agree
b. Agree
c. Neither agree or disagree Yes
d. Disagree
e. Strongly disagree
9. I typically pay little attention to the foods I consume.
a. Strongly agree
b. Agree
c. Neither agree or disagree
d. Disagree - Yes
e. Strongly disagree
10.If I had three foods + water to survive on for a year, I would select & why.
a. __Grilled chicken Its is high and protein and it tastes good

b. __Rice It is filling and goes well with chicken

c. __A baked potato with butter Is also filling
11.My most eaten three meals are & why? (E.g. cobb salad, peperoni pizza, chicken &
broccoli)
a. __Yogurt with granola Easy and tasty breakfast food___________________
b. _Broccoli alfredo pasta Its the best thing in the cafeteria at App
c. Grilled chicken sandwich It tastes good
12.My least eaten three meals that I believe I should eat, are & why?
a. _Spinach It is high in iron and nutrients
b. _Kinoa I have heard it is healthy but have never really eaten it so I should give it a
try.
c. Salads They get boring after a while
13.My food choices have little to do with my overall health
a. Strongly agree
b. Agree
c. Neither agree or disagree
d. Disagree
e. Strongly disagree - Yes
14.I typically eat unprocessed (natural form) foods.
a. Strongly agree
b. Agree
c. Neither agree or disagree
d. Disagree - Yes
e. Strongly disagree
15.Rank the top 5 factors which have the greatest impact on my overall wellness. (1greatest impact)
_2__ Food quality/intake ___ Water quality ___ The health of the environment in which I
live ___ Hygiene ___ Genetics ___ Air quality _1__ Activity levels __4_ My relationships
_5__ Degree of intellectual stimulation ___ Occupation _3__ Sleep quality ___ Spiritual
satisfaction ___ Income/wealth ___ Other _______________
16.Each week I exercise
a. Everyday
b. 5-6 days
c. 3-4 days - Yes
d. 1-2 days
e. Rarely/never
17.When I exercise, I typically do so at
a. A high intensity - Yes
b. Moderate intensity
c. Low intensity
d. Casually
e. None of the above
18.I rate my current health as:
a. Significantly above the average American of similar age
b. Above the average American of similar age - Yes
c. Similar to the average American of similar age
d. Below the average American of similar age
e. Significantly below the average American of similar age
19.Why?
__Although I do eat processed foods sometimes, I do not do it on a regular basis and I opt
for healthier options such as the grilled chicken sandwich instead of the fried one. And I
exercise a lot.
My goal for selecting this course is:
Learn about my eating and lifestyle choices when it comes to nutrition and lose weight.