Diet and Physical
Activity Diary
N ame:………………………………………………………

Diet Diary Example
Please record everything you eat and drink today from when you get up to when you go to bed
Name: .Melissa Brown.........................................................................
Date:.12/08/2010.................................
TIME Details/ description of food and drink consumed
APPROXIMATE SIZE AND
AMOUNT
(e.g. cereal bowl, small packet,
King-size, dinner plate, teaspoon)
IF ANY, HOW
MUCH WAS
LEFT OVER?
08:00 Warburton's wholemeal bread
2 x large, medium slice None
08:00 Flora light spread Thinly spread on 2 slices None
¼ glass 08:00 Fresh orange juice, with bits
08:00 Tetley's tea with semi-skimmed milk and caster sugar
12:35
12:35
Tuna salad sandwich with
Warburton's wholemeal bread, spread with flora light
Mineral water
1 small glass
1 medium mug, dash of milk,
1 teaspoon of sugar
1 small can of tuna in brine, 1 leaf lettuce, ½ tomato, 4 slices cucumber, 2 slices thick sliced bread, thickly spread flora light margarine.
250mls
None
¼
None
15:00 green apple 1 small apple None
19:30 Homemade chicken
19:30 curry
Basmati rice
20:00 Horlicks with semiskimmed milk standard portion (medium plate) standard portion (medium plate)
1 medium mug
2 heap table spoons of Horlicks
None
None
None

DAY 1 - FOOD DIARY
Please record everything you eat and drink today from when you get up to when you go to bed.
Name: ................................................................................................
Date: .................................
TIME Details/ description of food and drink consumed
APPROXIMATE SIZE AND
AMOUNT
(e.g. cereal bowl, small packet, King-size, dinner plate, teaspoon)
IF ANY, HOW
MUCH WAS
LEFT OVER?

Day 2
Please record everything you eat and drink today from when you get up to when you go to bed.
Name: ................................................................................................
Date: .................................
TIME Details/ description of food and drink consumed
APPROXIMATE SIZE AND
AMOUNT
(e.g. cereal bowl, small packet, King-size, dinner plate, teaspoon)
IF ANY, HOW
MUCH WAS
LEFT OVER?

Day 3
Please record everything you eat and drink today from when you get up to when you go to bed.
Name: ….............................................................................................
Date:
…..............................
TIME Details/ description of food and drink consumed
APPROXIMATE SIZE AND
AMOUNT
(e.g. cereal bowl, small packet, King-size, dinner plate, teaspoon)
IF ANY, HOW
MUCH WAS
LEFT OVER?

Day 4
Please record everything you eat and drink today from when you get up to when you go to bed.
Name: ................................................................................................
Date: .................................
TIME Details/ description of food and drink consumed
APPROXIMATE SIZE AND
AMOUNT
(e.g. cereal bowl, small packet, King-size, dinner plate, teaspoon)
IF ANY, HOW
MUCH WAS
LEFT OVER?

Day 5
Please record everything you eat and drink today from when you get up to when you go to bed.
Name: ................................................................................................
Date: .................................
TIME Details/ description of food and drink consumed
APPROXIMATE SIZE AND
AMOUNT
(e.g. cereal bowl, small packet, King-size, dinner plate, teaspoon)
IF ANY, HOW
MUCH WAS
LEFT OVER?

Day 6
Please record everything you eat and drink today from when you get up to when you go to bed.
Name: ................................................................................................
Date: .................................
TIME Details/ description of food and drink consumed
APPROXIMATE SIZE AND
AMOUNT
(e.g. cereal bowl, small packet, King-size, dinner plate, teaspoon)
IF ANY, HOW
MUCH WAS
LEFT OVER?

Day 7
Please record everything you eat and drink today from when you get up to when you go to bed.
Name: ................................................................................................
Date: .................................
TIME Details/ description of food and drink consumed
APPROXIMATE SIZE AND
AMOUNT
(e.g. cereal bowl, small packet, King-size, dinner plate, teaspoon)
IF ANY, HOW
MUCH WAS
LEFT OVER?

Physical Activity
Please fill in any physical activity you do and give an indication of intensity. This enables me to work our Calorie expenditure through exercise.
Day
Monday
Type of activity and length Intensity
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday