Fat Screener

Your Name (optional):
Age:
Sex: Male Female

Think about your eating habits over the past year or so. About how often do you eat each of the following foods? Remember breakfast, lunch, dinner, snacks and eating out. Check one radio button for each food.

Meats and Snacks 1/MONTH
or less		 2-3 times a
MONTH		 1-2 times a
WEEK		 3-4 times a
WEEK		 5+ times a
WEEK
Hamburgers, ground beef, meat burritos, tacos
Beef or pork, such as steaks, roasts, ribs, or in sandwiches
Fried chicken
Hot dogs, or Polish or Italian sausage
Cold cuts, lunch meats, ham (not low-fat)
Bacon or breakfast sausage
Salad dressings (not low-fat)
Margarine, butter or mayo on bread or potatoes
Margarine, butter or oil in cooking
  1/MONTH
or less		 2-3 times a
MONTH		 1-2 times a
WEEK		 3-4 times a
WEEK		 5+ times a
WEEK
Eggs (not Egg Beaters or just egg whites)
Pizza
Cheese, cheese spread (not low-fat)
Whole milk
French fries, fried potatoes
Corn chips, potato chips, popcorn, crackers
Doughnuts, pastries, cake, cookies (not low-fat)
Ice cream (not sherbet or non-fat)