Intermittent Fasting AssessmentIntermittent Fasting Assessment Which IF approach is right for me?Like many other styles of eating, intermittent fasting (IF) is simply one way to help you reach a specific goal.The principle of “Sometimes you eat; sometimes you don’t” applies differently to different people.This assessment can help us decide if IF is a fit for you (and, if so, what type might work best). Once I’ve identified which version of IF might match your needs, goals, and lifestyle, we can talk about how to help you succeed.Take the assessmentAnswer the following questions based on your current circumstances. Please read all questions and scoring options carefully, as they are not all the same.Full NameEmailDeep health dimension #1: Physical1. I exercise or work out fasted (i.e., on an empty stomach).– Select –NeverRarelySometimesVery OftenAlways2. My main goals include improving my exercise or sport performance.– Select –AlwaysVery OftenSometimesRarelyNever3. I use exercise as a reason to eat unhealthy and/or large amounts of food.– Select –AlwaysVery OftenSometimesRarelyNever4. I make sure to get plenty of restful sleep.– Select –NeverRarelySometimesVery OftenAlwaysDeep health dimension #2: Emotional5. If I miss a meal, I tend to just get back on schedule and eat normally.– Select –NeverRarelySometimesVery OftenAlways6. If stressed, anxious, or unhappy, I can cope well without eating or drinking too much.– Select –NeverRarelySometimesVery OftenAlways7. I have a healthy relationship with food.– Select –NeverRarelySometimesVery OftenAlways8. I manage my personal and professional stress levels well– Select –NeverRarelySometimesVery OftenAlwaysDeep health dimension #3: Mental9. I get overwhelmed and/or distracted by making decisions about food each day– Select –NeverRarelySometimesVery OftenAlways10. I make poor decisions around eating/drinking due to how busy and stressed I feel.– Select –NeverRarelySometimesVery OftenAlways11. I find it difficult to plan and prepare multiple meals per day.– Select –NeverRarelySometimesVery OftenAlwaysDeep health dimension #4: Existential12. I struggle to see the point of traditional “eat less” calorie/portion control types of diets.– Select –NeverRarelySometimesVery OftenAlways13. I feel I have purpose and direction in my life.– Select –NeverRarelySometimesVery OftenAlwaysDeep health dimension #5: Relational14. Sharing foods and/or drinks with other people is important to me.– Select –NeverRarelySometimesVery OftenAlways15. Eating and drinking with others is an important part of my job.– Select –NeverRarelySometimesVery OftenAlways16. I have a supportive network of people who care about me and my health.– Select –NeverRarelySometimesVery OftenAlwaysDeep health dimension #6: Environmental17. I find it easy to go long stretches of time without eating or drinking.– Select –NeverRarelySometimesVery OftenAlways18. It’s difficult for me to make “healthy” food choices at restaurants, events, and parties.– Select –NeverRarelySometimesVery OftenAlwaysGeneral questions19. How old are you?– Select –below 1818-70above 7020. What is your sex / gender?– Select –FemaleMale– Select –PregnantBreastfeedingPerimenopausal 21. How much moderate to strenuous exercise activity do you do each week?– Select –Minimal to none1-3 hours per week4-7 hours per week7+ hours per weekAthlete in training or competition season 22. How much sleep do you get on average each night?– Select –below 6 hours per night6-7 hours per night7-9 hours per nightabove 9 hours per night23. How are your stress levels and coping skills?– Select –My stress is pretty low and I do great when faced with most stressorsAlthough sometimes taxing, I stay relatively calm and focused.I struggle with stress and sometimes feel on the brink of a breakdown.24. Have you ever been diagnosed with an eating disorder, such as anorexia nervosa, bulimia nervosa, or binge eating?– Select –YesNo25. Do you have any history of disordered eating? (E.g., frequent dieting, an all-or-nothing mindset associated with food, rigid food rituals, feelings of guilt or shame associated with eating, laxative or diuretic misuse, or the use of diet pills.)– Select –YesNo26. Are you a Type 1 diabetic?– Select –YesNo27. Are you required to take food with any prescribed medications?– Select –YesNoSubmit
