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Food Diary - DOC

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					Food Diary
Week One Directions:

List every single thing that goes in your mouth.

This is your week to eat the way you want to eat

Do not try to be “good.” There is no value judgment on what you eat

Do not do anything differently. Don’t try to impress us.

Write down:
       • What you eat
       • How much you eat
       • Where you eat (in car, in bed, in movies, restaurant, kitchen, etc.)
       • Why you eat (bored, hungry, angry at someone, frustrated, time to eat)
       • With whom you eat (alone, with Hermione, with the dog)

And remember that whatever you have done, I have done. I have eaten a whole pizza, six
huge chocolate doughnuts, or a carton of ice cream all at once.
Day 1   When?   What?   How     Where?   Why?   With
                        much?                   whom?




Day 2   When?   What?   How     Where?   Why?   With
                        much?                   whom?




Day 3   When?   What?   How     Where?   Why?   With
                        much?                   whom?




Day 4   When?   What?   How     Where?   Why?   With
                        much?                   whom?
Day 5   When?   What?   How     Where?   Why?   With
                        much?                   whom?




Day 6   When?   What?   How     Where?   Why?   With
                        much?                   whom?




Day 7   When?   What?   How     Where?   Why?   With
                        much?                   whom?

				
DOCUMENT INFO
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posted:3/7/2012
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Description: Customizing handouts is the best way to reach patients, says Dr. Diane Batshaw Eisman in a March article in Medical Economics magazine. To get started with your overweight patients, provide them a food diary to begin a habit of mindful eating. This is just one template you can use.