KUESIONER PENELITIAN
GAMBARAN POLA MAKAN DAN STATUS GIZI REMAJA PUTRI YANG
MELAKUKAN DIET UNTUK MENURUNKAN BERAT BADAN DI SMA
NEGERI 7 MEDAN TAHUN 2014
I. Identitas Responden
1. Nama responden :
2. Kelas :
3. Umur :
III. Pertanyaan
B1. Bagaimana upaya atau cara anda dalam melakukan diet menurunkan berat
badan ?
No Upaya diet Ya Tidak
1 Latihan fisik/olahraga rutin
2 Mengurangi frekuensi makan setiap harinya (tidak sarapan
pagi, makan malam, dll)
3 Mengurangi konsumsi makan yang mengandung
karbohidrat
4 Mengurangi konsumsi makanan manis (cake, permen, kue,
dll)
5 Mengurangi makanan yang berlemak
6 Memperbanyak konsumsi sayur dan buah
7 Tidak makan sama sekali/ berpuasa (diluar ibadah)
8 Tidak meminum susu
9 Memuntahkan kembali makanan yang telah dimakan
10 Mengkonsumsi produk pelangsing (seperti WRP, slimming
tea, minuman berserat, dll)
11 Mengkonsumsi pil diet (pil pelangsing, pil peluntur lemak,
dll)
Nama responden :
Hari ke :
URT gr
Pagi / jam
Siang / jam
Malam / jam
No Responden :
Lauk hewani
a. Daging
ayam
b. Ikan
c. Telur
Lauk nabati
a. Tahu
b. Tempe
Sayur
a. Kangkung
b. Daun
singkong
c. Sawi
d. Sayur sop
e. Sayur lode
Buah
a. Pisang
b. Jeruk
c. Apel
d. Pepaya
Susu
a.
Siang / jam
Malam / jam
MASTER TABEL
1= BENAR 1= BAIK 1= OBESITAS 3 = NORMAL
0= SALAH 2=KURANG 2= GEMUK 4 = KURUS
NAMA RESPONDEN
Valid Cumulative
Frequency Percent Percent Percent
Valid 40 41.7 41.7 41.7
ade dwi pertiwi 1 1.0 1.0 42.7
albia hanum 1 1.0 1.0 43.8
anggun gabriella 1 1.0 1.0 44.8
annisa aprilia 1 1.0 1.0 45.8
annisa mowita 1 1.0 1.0 46.9
aulia hasanah 1 1.0 1.0 47.9
aulia husna 1 1.0 1.0 49.0
aura islamiyani 1 1.0 1.0 50.0
baby prena 1 1.0 1.0 51.0
defani syahara 1 1.0 1.0 52.1
deli maharani 1 1.0 1.0 53.1
dermawati siahaa 1 1.0 1.0 54.2
dian kristi 1 1.0 1.0 55.2
dina aprilia 1 1.0 1.0 56.3
dina wahyuni 1 1.0 1.0 57.3
dini aprilia 1 1.0 1.0 58.3
dita rismananda 1 1.0 1.0 59.4
elisa susilawati 1 1.0 1.0 60.4
emilia balqis 1 1.0 1.0 61.5
enique felicia 1 1.0 1.0 62.5
evlin 1 1.0 1.0 63.5
fadhila adani 1 1.0 1.0 64.6
grace virginia 1 1.0 1.0 65.6
hasanah dewi 1 1.0 1.0 66.7
jeny new fanry 1 1.0 1.0 67.7
kristina naiboho 1 1.0 1.0 68.8
lulu angelina 1 1.0 1.0 69.8
lya anggreini 1 1.0 1.0 70.8
marisi putri 1 1.0 1.0 71.9
KELAS RESPONDEN
Cumulative
Frequency Percent Valid Percent Percent
Valid 1 35 36.5 62.5 62.5
2 21 21.9 37.5 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
UMUR RESONDEN
Cumulative
Frequency Percent Valid Percent Percent
Valid 14 9 9.4 16.1 16.1
15 31 32.3 55.4 71.4
16 15 15.6 26.8 98.2
17 1 1.0 1.8 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
STATUS GIZI
Cumulative
Frequency Percent Valid Percent Percent
Valid obesitas 1 1.0 1.8 1.8
gemuk 4 4.2 7.1 8.9
normal 47 49.0 83.9 92.9
kurus 4 4.2 7.1 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
SKOR PENGETAHUAN
Cumulative
Frequency Percent Valid Percent Percent
Valid 2 3 3.1 5.4 5.4
3 4 4.2 7.1 12.5
4 10 10.4 17.9 30.4
5 5 5.2 8.9 39.3
6 7 7.3 12.5 51.8
7 13 13.5 23.2 75.0
8 5 5.2 8.9 83.9
9 6 6.3 10.7 94.6
10 3 3.1 5.4 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
KATEGORI PENGETAHUAN
Cumulative
Frequency Percent Valid Percent Percent
Valid BAIK 39 40.6 69.6 69.6
KURANG 17 17.7 30.4 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
MAKANAN POKOK(NASI)
Cumulative
Frequency Percent Valid Percent Percent
Valid >1xsehari 44 45.8 78.6 78.6
1xsehari 11 11.5 19.6 98.2
4- 1 1.0 1.8 100.0
6x/minggu
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
MAKANAN POKOK(JAGUNG)
Cumulative
Frequency Percent Valid Percent Percent
Valid 4- 6 6.3 10.7 10.7
6x/minggu
1- 13 13.5 23.2 33.9
3x/minggu
1x/bulan 37 38.5 66.1 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
SAYUR KOL
Cumulative
Frequency Percent Valid Percent Percent
Valid >1xsehari 3 3.1 5.4 5.4
1xsehari 3 3.1 5.4 10.7
4-6x/minggu 6 6.3 10.7 21.4
1-3x/minggu 13 13.5 23.2 44.6
1x/bulan 31 32.3 55.4 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
SAYUR (SAWI)
Cumulative
Frequency Percent Valid Percent Percent
Valid >1xsehari 8 8.3 14.3 14.3
1xsehari 3 3.1 5.4 19.6
4-6x/minggu 5 5.2 8.9 28.6
1-3x/minggu 18 18.8 32.1 60.7
1x/bulan 22 22.9 39.3 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
SAYUR (SOP)
Frequency Percent Valid Percent Cumulative Percent
Valid >1xsehari 13 13.5 23.2 23.2
1xsehari 6 6.3 10.7 33.9
4-6x/minggu 7 7.3 12.5 46.4
1-3x/minggu 16 16.7 28.6 75.0
1x/bulan 14 14.6 25.0 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
BUAH(PISANG)
BUAH (JERUK)
Frequency Percent Valid Percent Cumulative Percent
Valid >1xsehari 8 8.3 14.3 14.3
1xsehari 10 10.4 17.9 32.1
4-6x/minggu 12 12.5 21.4 53.6
1-3x/minggu 14 14.6 25.0 78.6
1x/bulan 12 12.5 21.4 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
BUAH (APEL)
Frequency Percent Valid Percent Cumulative Percent
Valid >1xsehari 1 1.0 1.8 1.8
1xsehari 2 2.1 3.6 5.4
4-6x/minggu 5 5.2 8.9 14.3
1-3x/minggu 8 8.3 14.3 28.6
1x/bulan 40 41.7 71.4 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
BUAH (PEPAYA)
Cumulative
Frequency Percent Valid Percent Percent
Valid >1xsehari 4 4.2 7.1 7.1
1xsehari 6 6.3 10.7 17.9
4-6x/minggu 6 6.3 10.7 28.6
1-3x/minggu 11 11.5 19.6 48.2
1x/bulan 29 30.2 51.8 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
BUAH (MANGGA)
Cumulative
Frequency Percent Valid Percent Percent
Valid 1xsehari 2 2.1 3.6 3.6
4-6x/minggu 5 5.2 8.9 12.5
1-3x/minggu 12 12.5 21.4 33.9
1x/bulan 37 38.5 66.1 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
SUSU SAPI
Cumulative
Frequency Percent Valid Percent Percent
Valid >1xsehari 3 3.1 5.4 5.4
1xsehari 10 10.4 17.9 23.2
4-6x/minggu 6 6.3 10.7 33.9
1-3x/minggu 7 7.3 12.5 46.4
1x/bulan 30 31.3 53.6 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
ASUPAN ENERGI
Cumulative
Frequency Percent Valid Percent Percent
Valid 582 1 1.0 1.8 1.8
595 1 1.0 1.8 3.6
741 1 1.0 1.8 5.4
745 1 1.0 1.8 7.1
758 1 1.0 1.8 8.9
787 1 1.0 1.8 10.7
797 1 1.0 1.8 12.5
844 1 1.0 1.8 14.3
858 1 1.0 1.8 16.1
876 1 1.0 1.8 17.9
885 1 1.0 1.8 19.6
902 1 1.0 1.8 21.4
915 1 1.0 1.8 23.2
924 1 1.0 1.8 25.0
932 1 1.0 1.8 26.8
933 1 1.0 1.8 28.6
949 1 1.0 1.8 30.4
956 1 1.0 1.8 32.1
962 1 1.0 1.8 33.9
990 1 1.0 1.8 35.7
996 1 1.0 1.8 37.5
998 1 1.0 1.8 39.3
1011 1 1.0 1.8 41.1
1022 1 1.0 1.8 42.9
1035 1 1.0 1.8 44.6
1037 1 1.0 1.8 46.4
1076 1 1.0 1.8 48.2
1101 1 1.0 1.8 50.0
1108 1 1.0 1.8 51.8
1147 1 1.0 1.8 53.6
ASUPAN PROTEIN
Cumulative
Frequency Percent Valid Percent Percent
Valid 44 2 2.1 3.6 3.6
45 7 7.3 12.5 16.1
46 4 4.2 7.1 23.2
47 5 5.2 8.9 32.1
48 6 6.3 10.7 42.9
49 4 4.2 7.1 50.0
50 6 6.3 10.7 60.7
51 6 6.3 10.7 71.4
52 4 4.2 7.1 78.6
53 1 1.0 1.8 80.4
55 6 6.3 10.7 91.1
56 4 4.2 7.1 98.2
57 1 1.0 1.8 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0
CARA BERDIET
Cumulative
Frequency Percent Valid Percent Percent
Valid SEHAT 11 11.5 19.6 19.6
TIDAK 44 45.8 78.6 98.2
SEHAT
EKSTRIM 1 1.0 1.8 100.0
Total 56 58.3 100.0
Missing System 40 41.7
Total 96 100.0