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Nutritional Attachment Questionnaire

Nutritional Attachment Questionnaire

This questionnaire is intended to assess your nutritional adherence and it is important to answer it at least 1 week before your nutritional counseling. Please answer the answer that is closest to your nutritional behavior from your last appointment with the nutritionist to the present.

Please select the most appropriate response in relation to your behavior in the LAST 3 MONTHS

Full name

Do I "peck" or eat small portions of high-calorie foods (like peanuts, bread crumbs, etc.)?

Almost always

Frequent

Occasional

Never

Have I vomited or felt "choked" from eating too quickly or too much?

Almost always

Frequent

Occasional

Never

¿Cómo muchos alimentos con contenido alto de azúcares como pasteles, flanes, postres, etc?

Almost always

Frequent

Occasional

Never

Do I consume caloric drinks such as sugary water, juices, etc.?

Almost always

Frequent

Occasional

Never

How without hunger, just because of anxiety?

Almost always

Frequent

Occasional

Hardly ever

How fast or without chewing food properly?

Almost always

Frequent

Occasional

Never

In general, do I drink 2 liters (for men) or 1.5 liters (for women) a day?

AND

NO

Overall, how do you feel your nutritional program has gone?

Excellent

Very good

GOOD

Regular

Just

Overall, am I getting the recommended vitamins and minerals?

Yes, Every day

Yes, 3 to 5 times a week

Yes, 1 to 2 times a week

No

Overall, am I getting the recommended protein powder supplement?

Yes, every day

Yes, 3-5 times a week

Yes, 1-2 times a week

No

Thank you for submitting your follow-up questionnaire. This will be discussed at your next nutritional consultation. Have a great day. Sincerely, Obesity Health Bariatric Nutrition Team

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