Nutritional questionnaire Please answer the nutritional questions below. Name * First Name Last Name Email * Which bariatric operation have you had and when? * Do you have any medical conditions? Briefly describe how you are going, are you happy with your progress or have you been struggling in any way that you would like to discuss? * On a scale of 0 (flat/tired) to 10 (bouncing off the walls), how are your energy levels? * What supplements are you taking? (please be specific with brands, doses and consistency) * What medications are you taking? Have you been having issues with * Regurgitation/vomiting Dumping (loose bowels, hot flushes, sweats, rapid heartbeat, stomach pain , bloating) Constipation N/A Select which of these mindful eating techniques you are using at each meal * 20 chews 20 second pause between mouthfuls Ending meals at 20 minutes if not before None at the moment Please describe your portion size in general. * Are you eating three meals each day, skipping meals, or having snacks in between meals? * What do you eat on a usual day for breakfast, lunch and dinner? * What carbohydrates are you eating if any daily/weekly? * 1. Carbohydrates (bread, wraps, rice, pasta, cous cous, potato/kumara/corn, chips, crackers, scones, muffins). 2. Fruit. 3. Sweet foods/drinks (ice cream, lollies, fizzy drinks, chocolate). How much fluid are you managing to drink each day and what do you generally choose? * Are you drinking any alcohol, and if so, how often and volume how much? * Thank you!
