Allergy & Asthma Medical Associates
Keeping a record of your daily food intake will help you stay on track when trying to lose weight or maintain a healthy weight and activity levels. It also will give your doctor or health care provider a quick way to check your progress.
|How Much||What Food
||Time||Where||Alone or with Whom||Activity||Mood|
|3||Chocolate Chip Cookies||3:25pm||Office||Alone||Working on a report||Bored|
|1||Cheeseburger||6:15pm||Burger King||Claire & John||Talking||Happy|
|1||Regular Vanilla Shake||"||"||"||"||"|
|1 cup||Haagen Dazs Ice Cream||10:00pm||Kitchen||Alone||Watching TV||Tired|
How much: In this space indicate the amount of the particular food item you ate. Estimate the size (2" x 1" x 1"), the volume (1/2 cup), the weight (2 ounces) and/or the number of items (12) of that type of food.
What kind: In this column, write down the type of food you ate. Be as specific as you can. Include sauces and gravies. Don't forget to write down "extras," such as soda, salad dressing, mayonnaise, butter, sour cream, sugar and ketchup.
Time: Write the time of day you ate the food.
Where: Write what room or part of the house you were in when you ate. If you ate in a restaurant, fast-food chain or your car, write that location down.
Alone or with someone: If you ate by yourself, write "alone." If you were with friends or family members, list them.
Activity: In this column, list any activities you were doing while you were eating (for example, working, watching TV or ironing).
Mood: How were you feeling while you were eating (for example, sad, happy or depressed)?
If you have any questions, call your doctor.
Reference: American Academy of Family Physicians
Last updated May 2017