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POST Questionnaire Behaviour Modification

○ Part I Please answer the questions below




i. Your Height SPECIFY _______ (Centimeters)

ii. Your Weight SPECIFY _______ (Kilograms)

iii. Do you have any of the following diseases (you can tick all that is applicable)
o High blood pressure
o Diabetes
o High cholesterol
o Kidney disease – specify

iv. Do you take any regular medications ?
o No
o Yes – please list all medications you take regularly


○ Part II Please choose one, best choice according to you from the
options provided. No answer is right or wrong. It is how you feel about
it.

v. How many meals do you usually consume per day (not including small snacks)?
Please circle one answer

1 2 3 4 more than 4

vi. Can you differentiate between physical hunger meaning your body’s need for fuel
and your mental “desire” to consume food?
1. Yes
2. No
3. Don't know

vii. What is your trigger to consume food?


1. Hunger
2. Mealtime whether hungry or not
3. Other factors (temptations, influences from other people…)
4. Unable to identify
viii. Please identify your hunger spot on the diagram below by selecting the appropriate
number (1-5). Please choose only one number.

Write number here ________

ix. For the majority of time, do you base your food intake decisions mainly on your
cravings ​or ​other factors​ such as advertisement, smell or sight of food, people‘s
suggestions. Please circle one answer
1. Cravings
2. Other factors: advertisement, smell or sight of food, people‘s suggestions
3. Don’t know

x. Do you take into consideration your previous feedback after a similar meal,
specifically how you felt physically, mentally or emotionally?
1. Yes
2. No
3. Don’t know

xi. How long does it take you to consume an average meal?


1. Less than10minutes
2. 10-20 minutes
3. More than 20 minutes

xii. Are you able to have control over your food intake when you are stressed?
1. Yes
2. No
3. I am never stressed
xiii. Are you able to have control over foods you tend to consume quickly or have a
tendency to overeat?
1. Yes
2. No
3. Don’t know

xiv. When do you usually stop eating?


1. When you feel satisfied that you have had enough
2. When you become aware that you have overeaten
3. When every one else stops eating
4. When you have consumed the calories you are “allowed”

xv. Do you typically finish your plate when consuming a meal?


1. Yes
2. No
3. Don’t know

xvi. Do you usually experience any of these signs of overeating after your meal: so full
you can’t breathe, have to loosen your belt, can’t get off the chair
1. Yes
2. No
3. Don’t know

xvii. If you are not hungry or don’t wish to eat, are you able to consistently refuse food
offered to you by your ​close family members or significant other​ (wife, husband)?
1. Yes
2. No
3. Don’t know

xviii. If you are not hungry or don’t wish to eat, are you able to consistently refuse food
offered to you by ​other people​?
1. Yes
2. No
3. Don’t know

xix. Are you satisfied with your meal choices: specifically related to your ability to
balance your consumption of foods that are “healthy for you” and those that are “not
healthy for you”?
1. Yes
2. No
3. Don’t know

xx. Are you satisfied with your snack choices: specifically related to your ability to
balance your consumption of snacks that are “healthy for you” and those that are
“not healthy for you”?
1. Yes
2. No
3. Don’t know
xxi. Are you satisfied with your body weight?
1. Yes
2. No
3. Don’t know

xxii. Do you feel your current eating options and choices are restrictive?
1. Yes
2. No
3. Don’t know

xxiii. Do you usually feel uncomfortable after eating because of bloating, indigestion or
acid reflux?
1. Yes
2. No
3. Don’t know

xxiv. Do you usually experience guilt (feeling you should have avoided eating or not eaten
so much), regret or shame after your meal?
1. Yes
2. No
3. Don’t know

xxv. How many minutes are you exercising per week?


1. More than 110 min
2. 76- 110 min
3. 40- 75 min
4. Less than 40 min

xxvi. Are you still complying with the diet plan you have been trained on ?

1. Yes
2. NO
3. Don’t know

xxvii. Do you feel confident that you will be able to follow this eating methodology in the
long term ?
1. Yes
2. NO
3. Don’t know