NAMA : _________________________________________________

CLASS : ________

Weight : _____________ Height : ____________

1. What is your BMI rate? Circle the category of your weight.

A) Underweight (≤18)
B) Normal (Healthy) (19 to 24)
C) Overweight (25 to 29)
D) Obese (30 to 39)
E) Extremely Obese (40 and above)

2. What meal that you often skip? Why?

3. Do u love to eat snacks? If yes, how often you will eat it?

4. How many hours you will sleep everyday?

5. You prefer to eat home-made food or restaurant food? Why?

6. Your food contains

A) More sugar B) Less Sugar C) More Salt D) Less Salt E) Both sugar and salt in
the less amount
7. What is your common,

Breakfast - ___________________________________________________________________

Lunch - ___________________________________________________________________

Dinner - ___________________________________________________________________

8. Are you active in physical activities?

A) Yes B) No

9. How many times in a week you will involve in physical activities?

10. Do you want to change your lifestyle to make it more healthier? How? Give three suggestions.