Food Diary Sample- Back

 

Daily Food Diary             Woke At:                       Fell Asleep At:
Date:                                         Weight:
	Guidelines		BEHAVIOR CODE:	E= EXCITED		H=HAPPY/GOOD		T= TIRED
	Daily Calorie Goal:    1400-1500		A= ARGUMENTATIVE	F=FRUSTRATION		R=RESTAURANT		U=UPSET
	Daily Fat Gram Goal:		B= BORED	G=GATHERING		S=STRESS		W= WHINY
	Meal/Time	Food Offered	Amount Eaten	FAT	TOTAL	Calories	TOTAL	Behavior
	Breakfast
	Snack
	Lunch
	Snack
	Dinner
	Snack
	Water	(   ) (   ) (   ) (   ) (   ) (   ) (   ) (   )
			Total: