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Your Relationship With Food
Use this to build awareness of your habits, beliefs, and triggers.
1. Your Definition of a “Good Diet”
What does a “good diet” mean to you?
Where does that definition come from?
How close are your current habits to that definition?
Score 0–10.
Score
Have you followed diets before?
Yes
No
If yes: which ones — what helped, what didn’t, and why?
2. Eating Habits
3 helpful habits I already practise
3 habits I’d like to improve
When are you most likely to overeat? (tick all that apply)
Evenings
Weekends
Social occasions
Stress
Boredom
When I’m alone
Other
How you usually eat
Portion awareness
I eat until my plate is cleared
I eat until I feel comfortably full
Speed
I eat slowly / mindfully
I eat quickly / on autopilot
Timing
I mostly eat when I feel hungry
I mostly eat by routine / when I have time
Attention
I give my food my attention
I often multitask while eating (TV/phone/work)
Hunger & fullness
Before I eat, I usually notice (tick all that apply)
Physical hunger (stomach cues)
Cravings / taste desire
Food noise / constant thoughts about food
Routine / “it’s time”
Emotions (stress, boredom, comfort)
Other
When I stop eating, I’m usually…
Satisfied / comfortable
Quite full
Overly full
Physically full but mentally want more
Confidence recognising hunger/fullness cues
Score 0–10.
Score
Notes on hunger/fullness (optional)
3. Triggers & Preferences
Any foods you’re sensitive to (bloating, discomfort, congestion)?
Yes
No
Any “trigger foods” that are hard to stop once you start?
Yes
No
If yes: which foods and what happens?
If yes: which foods?
Favourite foods
What usually drives you to eat? (tick all that apply)
Hunger
Stress
Boredom
Reward
Habit / routine
Social settings
Notes (optional)
How often do you eat past “comfortably full”?
Select
Select…
Never
Rarely
Sometimes
Often
Very often
How do you respond to cravings?
4. Lifestyle Patterns
How often do you shop for food?
Select…
Weekly
Every few days
Rarely / as needed
How often do you cook at home?
Select…
Daily
A few times per week
Rarely
How often do you eat out / get takeaway?
Select…
Once a month or less
A few times a month
Once a week
A few times a week
Most days
Sleep & stress (key appetite drivers)
Average sleep (weekdays)
Sleep quality
Select…
Poor
OK
Good
Stress level most weeks
Select…
Low
Moderate
High
When stress is high, my eating tends to… (tick all that apply)
Eat less / forget to eat
Eat more / graze
Crave sweet foods
Snack more often
No major change
Other
Notes (optional)
Social environment & support
Who do you live with?
Select…
Alone
Partner
Family
Housemates
Other
Do people around you support your goals?
Select…
Yes
Sometimes
No
Biggest social challenge right now
Select…
Eating out / takeaways
Family meals
Workplace snacks / office food
Weekends
Alcohol
Social pressure / comments
Other
Notes (optional)
5. Emotions & Beliefs
What emotions most often drive your eating? (tick all that apply)
Stress
Comfort
Reward
Boredom
Joy / celebration
Anything else?
What food messages did you grow up with?
Food rules I follow (spoken or unspoken)
Common and normal — the aim is awareness, not judgement.
“I can’t eat carbs after a certain time.”
“I have to earn food with exercise.”
“I should always finish what’s on my plate.”
“If I eat one ‘bad’ thing, I’ve ruined the day.”
“I should avoid a whole food group (e.g., carbs/fats).”
Other
Notes (optional)
Do you feel guilt or shame around food choices?
Yes
No
If yes: when does it show up?
What would you like to feel more of around food?
What would you like to feel less of around food?
6. Reflection
One pattern or insight I notice is…
One small change I’m willing to try this week is…
Clear
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