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Determine Your Nutritional Health

The Warning Signs of poor nutritional health are often overlooked. Use this Checklist to find out if you or someone you know is at nutritional risk.

Read the statements below. Circle the number in the "yes" column for those that apply to you or someone you know. For each "yes" answer, score the number in the box. Total your nutritional score.

Please select your age range.

Please select 30 and below 31-40 41-50 51-60 61-70 71-80 81 and above

1. I have an illness or condition that made me change the kind and/or amount of food I eat.

Yes No

2. I eat fewer than 2 meals per day.

Yes No

3. I eat few fruits or vegetables or milk products.

Yes No

4. I have 3 or more drinks of beer, liquor or wine almost every day.

Yes No

5. I have tooth or mouth problems that make it hard for me to eat.

Yes No

6. I don't always have enough money to buy the food I need.

Yes No

7. I eat alone most of the time.

Yes No

8. I take 3 or more different prescribed or over-the-counter drugs a day.

Yes No

9. Without wanting to, I have lost or gained 10 pounds (4.5 kg) in the last 6 months.

Yes No

10. I am not always physically able to shop, cook and/or feed myself.

Yes No

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