Food Diary Journal Sample ( , )

Food Diary Journal Sample (Day #2, #5, #94)
Today’s Date
Meal
Plan
Food
Qty
Actual
Cals
Breakfast
Sitting? Y N
Smoothie
2 cups
200
Time
Alone?
Toasted bread with butter
1 slice
120
Place
Total
Calories
320
Y N
Sitting? Y N
Time
Alone?
Place
Total
Calories
Mood*
Hunger
Level**
Lunch
Sitting? Y N
Salad
1 ½ cups
20
Time
Alone?
Rice noodles
1/16 cup
25
Place
Total
Calories
Mood*
Hunger
Level**
Crumbled bacon
¾ tbsp.
33
Flavored almonds
½ tbsp.
20
Fat free French dressing
1 tbsp
20
Cheese
1/8 cup
55
Packaged lunch meat
2 slices
25
Boiled egg
½ large
38
Toasted bread with butter
1 slice
120
Y N
Y N
Snack
Sitting? Y N
Time
Alone?
Place
Total
Calories
Mood*
Hunger
Level**
Granola bar (Curves or Special K)
1 bar
100
Dinner
Sitting? Y N
Spaghetti noodles
¾ cup
165
Time
Alone?
Chunky marinara sauce
3/8 cup
60
Parmesan cheese
2 tsp
20
Green beans
½ cup
13
Garlic toast with butter
1 slice
130
Fresh strawberries
½ cup
25
Light whip topping
1 tbsp
22
Bite size candy bar
1
50
Place
Total
Calories
100
435
*Mood Codes
H = Happy
C = Content
R = Rushed
A = Angry
B = Bored
L = Lonely
E = Excited
S = Stressed
X = Anxious
F = Frustrated
T = Tired
D = Depressed
O = Other (write it in the
box)
**Hunger Level Codes
1 = Not Hungry
2 = Barely Hungry
3 = Somewhat Hungry
4 = Quite Hungry
5 = Very Hungry
Y N
Y N
Mood*
Hunger
Level**
Snack
Sitting?
Y N
Time
Alone?
Y N
Place
Total
Calories
Mood*
Hunger
Level**
50
Cals
Mood*
Hunger
Level**
Snack
356
Qty
Day's Total
1261
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