Personal Diet Analysis Guide by maclaren1

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									     Personal Diet Analysis Guide
•   Helps you gain helpful and accurate information of your overall dietary intake
•   You will be provided a detailed analysis of your diet
•   We will help you realize your strengths and weaknesses of your eating habits
•   You have the option to make additional appointments to provide you with healthy and fun recipes
    to encourage and motivate healthy eating
•   Upon further request we can provide you with additional help and information regarding your diet

    Elena C. Dan
    Nutritionist
    805-231-1517
    Tips on how to record your diet
•   For 3 consecutive days (including at least 1                      Example for how to record your diet
    weekend day), record everything you ate and               Correct way to record                   Wrong Way
    drank throughout the day.
                                                                                    Breakfast:
•   Record all food items, beverages (including water)
    and supplements consumed as you go throughout        11/2 cups cherrios                     bowl of Cherrios
    the day so that you do not forget what you ate.      ½ cup of 2% milk                      ½ cup of milk
•   Pay attention to the serving sizes you consume –     5 pc. Raw walnut halves                walnuts
    this is VERY important!!! Measure food items for     1 medium apple                         apple
    accuracy.
                                                         8oz. of brewed coffee                  coffee
•   Remember, in order to get an accurate analysis of
    your diet you need to be honest when recording       1tbsp of non-dairy creamer             spoonful of creamer
    food portions.                                                                    Snack:
•   Here are some tips on how to record correctly:       6 oz. Fritos chili cheese             2 handfuls of chips
    Enter the amount of the food in cups, teaspoons                                               corn chips
    (tsp), tablespoons (tbsp), slices/pieces, ounces,
    and other standard measures.                                                      Lunch:
    Specify if food is fresh or cooked, or if it was     2 slices of whole wheat bread                  Turkey and
    prepared from canned (if canned, specify if canned         Cheese
    in juice, water, or syrup.)                          3 oz. Muenster low fat cheese          Sandwich
    Was the food boiled, baked, fried, steamed,          3 oz. Turkey breast packaged
    broiled, or roasted?
                                                         Lunchmeat
    Include condiments like: mustard, ketchup, relish,
    mayonnaise, dressing, salt, etc.                     2 pc. Romaine lettuce
    What kind of bread? Whole wheat, sourdough,          1 tbsp. Dijon mustard
    white, rye, etc? Toasted or not?                     2 thin slices tomato
    Was the milk nonfat (skim), 1%, 2%, whole?           12 fl. Oz. Can of diet Pepsi           1 Diet Pepsi
                                                         ½ cup vanilla non-fat frozen yogurt   scoop of frozen yogurt
                                                    Client Information
Name:

Phone:

Email:

Age:           Gender M / F                  Height:

Current Weight:                        Desired Weight:
(Please talk to your personal trainer about your goals regarding weight gain or loss)


Activity level: sedentary lightly active active very active (please circle)

Sedentary – includes activities of daily living, without additional exercise. It includes housework, grocery shopping, walking the
     dog, walking to the bus, mowing the lawn.
Low active – Includes activities of daily living plus exercise that is equal to waling for 30 min at 4 miles per hour every day. For an
     adult of average weight, this amount of exercise wil burn about 120 additional Calories. Exercises with less intensity.
Active – Includes activities of daily living plus exercise that is equal to waling for 1 hour 45 min at 4 miles per hour every day. For
     an adult of average weight, this amount of exercise will burn about 410 additional Calories.
Very Active – Includes activities of daily living plus exercises that is equal to walking for 4 hours 15 min at 4 miles per hour every
     day. For an adult of average weight, this amount of exercise will burn about 1000 additional Calories.
3 Day Food Intake Record   Date:
Meals                      Day 1


Breakfast:




Snack:


Lunch:




Snack:


Dinner:




Snack:
3 Day Food Intake Record   Date:
Meals                      Day 2


Breakfast:




Snack:


Lunch:




Snack:


Dinner:




Snack:
3 Day Food Intake Record   Date:
Meals                      Day 3


Breakfast:




Snack:


Lunch:




Snack:


Dinner:




Snack:
Additional Comments or
       Questions:

								
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