Healthy Living Program (Page 4 of 5) in pdf

Healthy Living Program Page 4

Healthy Living Program ---

MMC (305) 348-2401 Ext. 5

Name: __________________

Panther ID#:__________________

Date: _____________

Food Journal: Please record your food intake for 2 weekdays and 1 weekend day & submit

your forms to shsdiet@fiu.edu or the Healthy Living Program office at least 3 days before

your appointment. Below is an example of a food journal to help guide you. Use the image

below to estimate food portions. Include all drinks (juice, milk, alcohol etc.)

Weekday 01

WHAT & HOW MUCH?

WHERE?

WHY? (Triggers, etc.)

HUNGER LEVEL?

(Rate from 1-4)

Breakfast

1 cup oatmeal w 1 tsp sugar

Time:

1 banana & ½ c blueberries

Home

Knew I had to eat

8 AM

2 cups coffee with 2 T cream

1 tsp sugar and 1 cup OJ

Lunch

Steak burrito with 4 oz steak,

Time:

Lettuce, tomato, ¼ cup sour

School

Very hungry

1:30 PM

Cream, cheese, ¼ c guacamole

12 oz Pepsi

Dinner

1 cup black beans

Time:

2 cups white rice

Home

Tired, made by family

10 PM

Grilled chicken size of palm of

Hand

2 cups water

All Snacks

McDonald’s

Times:11

Chicken Snack Wrap

Looked good

AM, 11 PM

Chocolate Chip Cookie – 2

Home

Craving sweets

Healthy Living Program Page 4

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