"I know that getting at least 60 minutes of physical activity a day is important for staying healthy but, with school and a part-time job, I don’t have a lot of time for it. My doctor told me that even small amounts of physical activity throughout the day make a big difference, and she gave me some ideas of things I can do. My favorite? Walking briskly through the mall with my friends! Who knew exercising could be so fun?"
Brenda
Baltimore, MD

GETTING STARTED

This section asks questions about your current level of physical activity and healthy eating. Check the box that best answers each question and/or write your answer on the line.

PHYSICAL ACTIVITY

1. How many days a week do you do physical activity? (for example: stretching, playing soccer, running, swimming, playing volleyball, dancing, walking, or other aerobic activities)

   7 days 5-6 days 3-4 days 1-2 days 0 days

   
   
2. How much time do you spend doing physical activity on a typical day?

   60 minutes or more 30-59 minutes 20-29 minutes Less than 20 minutes Once in a while Never

   
   
3. What activities do you spend the most time doing in your free time? Check all that apply.

   Homework Physical activities (for example: soccer, volleyball, hiking, dancing, gymnastics) Watching television/Using the computer Shopping Talking on the telephone Spending time with friends or family Babysitting/Working at a job Household chores (for example: cooking, cleaning) Napping Others______________________________

HEALTHY EATING

When answering the next questions, think about the variety of foods you eat from each of the food groups from the time you wake up until the time you go to bed. Include all foods and beverages that you eat and drink at home, school, restaurants, and from vending machines.

4. How often do you have foods from the milk group? For example, on a typical day how often do you drink low-fat or fat-free milk, add milk to your cereal, eat low-fat or fat free yogurt, or cheese?

   3 or more times a day Twice a day Once a day Less than once a day

   
   
5. How often do you eat foods from the meat and beans group such as lean hamburger, chicken, turkey, fish, pork, peanut butter, eggs, nuts, dried beans, or tofu?

   3 or more times a day Twice a day Once a day Less than once a day

   
   
6. How often do you eat fruit or drink 100% fruit juice?

   3 or more times a day Twice a day Once a day Less than once a day

   
   
7. How often do you eat vegetables or drink 100% vegetable juice?

   3 or more times a day Twice a day Once a day Less than once a day

   
   
8. How often do you eat foods from the grains group such as cereal, brown rice, pasta, breads (whole wheat and white breads), tortillas, couscous, bagels, pita bread, or crackers ?

   3 or more times a day Twice a day Once a day Less than once a day

   
   
9. How often do you eat candy, cakes, cookies, doughnuts, candy bars, or chips?

   3 or more times a day Twice a day Once a day Less than once a day

   
   
10. How often do you drink soda, soft drinks, pop, or sweetened teas?

    3 or more times a day Twice a day Once a day Less than once a day

    
    
11. How would you describe your weight?

    Underweight Healthy weight Overweight

    
    
12. Do you take vitamin, mineral, or dietary supplements?

    Yes No Don’t know If yes, what types of supplements do you take? Calcium Iron Folate Vitamin D Fiber Multivitamin/multimineral Others ________________

    
    

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"By the time I get home from school, I’m starving and can’t wait until dinner to eat! Last time I saw my doctor, she recommended some healthy foods that make good after-school snacks. Now, I ask my mom to buy raisins and apples for me to snack on. It keeps the hunger pangs away and my energy up while I’m doing my homework, too."
Shannette
Des Moines, Iowa