This inventory will give a general idea of your family’s typical eating and physical activity habits.
1) Read each statement and think about your family’s eating and physical activity habits.
2) Circle the words that best describe your family’s habits over the past few weeks.
3) After completing the Inventory, check your Habit Inventory score.
Healthy Eating and Physical Activity Score
____ 3 points for each Always
____ 2 points for each Most of the Time
____ 1 point for each Once in a While
____ 0 points for each Never
Now enter grand total here: Total: ________
If your score is:
More than 25 You’re charged up and going strong!
15-25 You’re taking charge but could use some help
Less than 15 You need recharging and you came to the right place to Take the Challenge!
Is there one thing discussed above that you would like to change in the next month?
Answer the following questions for your child (ask the child to complete them, or read the questions to your child and record their answers):
| In the past week I ate because I was bored | Often | Sometimes | Rarely |
| In the past week I ate because I was tense, sad, or angry | Often | Sometimes | Rarely |
| In the past week I ate a lot and then felt guilty | Often | Sometimes | Rarely |
| I think about food a lot of the time | Often | Sometimes | Rarely |
If these questions are answered “often,” please talk to your healthcare provider about them. They may indicate increased risk for an eating disorder.
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