Food Diary

Illustration

To use this diary:

1. Print out a copy of this form.

2. Make seven copies (one for each day).

3. Record everything you eat for a week.

4. Record your preferences, how you feel, etc.

5. Use your answers to become conscious of eating patterns and positive and negative reactions to foods.

6. Use the information when planning changes to your diet.

Foods Consumed: Bread / Cereal Vegetable Fruit Milk Meat / Protein Added Sugar
Breakfast            
Snack            
Lunch            
Snack            
Dinner            
Snack            

My reactions to food I ate: Check or list all that apply.

Foods that made me feel good:

Foods that made me feel bad :

Foods I enjoyed eating include:

Foods I didn’t like include:

Foods I craved include:

My eating patterns: Check or list all that apply.

Times when I snacked:

How I felt when I wanted a snack:

Types of snacks I generally chose:

Number of times I ate in a restaurant or fast food establishment:

Convenience foods I used:

Fresh foods I ate:

Times I overate or binged:

Number of times I skipped a meal:

Number of meals I prepared at home:

Obstacles to preparing meals at home this week:

What I can do to improve my diet: