APPENDIX IV: FOOD AND ACTIVITY DIARY
Complete the following Food and Activity Diary to help
identify specific barriers that may be preventing you from making
successful changes. Print out copies and fill out the
daily diary for a minimum of two weekdays and one weekend day
each week, so that you can chart your progress. Be specific;
include information on how much, where and when you eat and
drink, and your mood on each occasion. Record the type of
exercise, intensity of exercise, and how much time you exercise.
Look for trends such as increased eating on weekend days and
lack of physical activity on workdays. For further weight
management guidance, contact a physician, registered dietitian
(RD), or other healthcare professional. Consider keeping this log
daily for two weeks before your next doctor’s appointment,
and bring the log along when you see your health care provider.
RECORD and BE SPECIFIC... Date:___________
| BREAKFAST |
| LUNCH |
| DINNER |
| SNACKS |
| ACTIVITIES |
