Name: _____________________________
Seven Day Food Record
A seven day food and physical activity record is intended to get a precise description of your typical daily diet and physical activity. Since this record will be used to help you make appropriate dietary and activity changes it is important that you try not to change your usual eating or activity patterns for these three days. Please try to be as accurate as possible by recording all of the foods and beverages you eat and drink. Rate your hunger/fullness cues on a scale of 1-10 by how your stomach feels before and after you eat (1 = famished, starving; 3 = stomach grumble; 5 = neither hungry nor full; 7 = politely full; 10 = painfully full). For example, if you feel your stomach grumble and you decide to eat, record a 3 for hunger. If you eat until you feel politely full record a 7 for satiety. Recording this information can help you identify external or emotional cues to eat. Record your physical activity in the column titled, “location/activity”. Be sure to state the type of activity and the duration.
In order to get an accurate representation of your diet, record your food intake for 7 days
Day 1 Food Record Date: 11/12/22
Time
Food & Beverage Description
Amount eaten
Hunger/
Fullness
Location/Activity/Feelings
9am
Coffee, orange juice
1 cup each
7/10
home
Bacon
3 strips
7/10
Home
Scrambled eggs
3 eggs
7/10
home
1pm
Sandwich turkey
1
5/10
home
apple
1
5/10
coke
1
7pm
Coke
1
Chicken/ pasta
½ plate
7/10
home
Sierra mist
Day 2 Food Record Date: 11/13/22
Time
Food & Beverage Description
Amount eaten
Hunger/
Fullness
Location/Activity/Feelings
8:30am
Apple juice
1 cup
5/10
Home/ full
Ham
2 slices
6/10
home
Egg omelet
3 eggs
7/10
Home
Apple slices
1 full apple
7/10
home
10:40 am
Walk with baby
Around park
12pm
Apples
1 apple
7/10
home
Sandwich
1 full
7/10
Home
coke
1 can
6/10
Home
5pm
Pork chops
1/3 plate
7/10
Moms house
White steamed rice
1/3 plate
7/10
Moms house
Coleslaw
1/3 plate
7/10
Moms house
7up
1 can
7/10
Moms house
8pm
Walk with baby
30 mins
Around park
Day 3 Food Record Date: 11/14/22
Time
Food & Beverage Description
Amount eaten
Hunger/
Fullness
Location/Activity/Feelings
7am
Egg omelet with ham/cheese
2 eggs
6/10
home
French toast
1 slice
7/10
home
banana
1 full
7/10
home
Orange juice
1 cup
6/10
home
9:30am
Walk
30mins
Around apt complex
12pm
Chicken salad sandwich
1
5/10
home
7up
1 can
7/10
home
cheeseburger
1
6/10
home
6pm
Turkey
½ plate
7/10
Home
White rice
1/3 plate
7/10
home
Sierra mist
1 cup
7/10
home
8pm
walk
30mins
Day 4 Food Record Date: 11/15/22
Time
Food & Beverage Description
Amount eaten
Hunger/
Fullness
Location/Activity/Feelings
8:30 am
Egg omelet with mushroom
3 eggs
6/10
Home/ full
banana
1
5/10
Home/ full
Orange juice
1 cup
6/10
Home/ fill
10am
walk
30 mins
Great/ calm
1pm
Chicken salad
1 plate
7/10
Fast food/ full
coke
1 can
6/10
Fast food/ full
1:30pm
walk
30 mins
Great and calm
5pm
Pork ribs
½ plate
7/10
Home full
Mexican red rice
½ plate
7/10
Home full
coke
1 can
7/10
Home full
Day 5 Food Record Date: 11/16/22
Time
Food & Beverage Description
Amount eaten
Hunger/
Fullness
Location/Activity/Feelings
8:30am
Banana bread
1 slice
5/10
Home/ full
Frosted flakes/ whole milk
1 plate
6/10
Home/ full
Eggs scrambled w/potatoes
3 eggs
6/10
Home/ full
Coffee/ coffee creamer
1 cup
6/10
Home/ full
10am
Walk
30 mins
great
12:30pm
Chicken breaded
2 slices
6/10
Home
Coke
1 can
6/10
Home
French fries
½ plate
6/10
home
2:00pm
Walk
35mins
Around home
6pm
pizza
2 slices
6/10
Fast food
coke
1 can
6/10
Fast food
Day 6 Food Record Date: 11/17/22
Time
Food & Beverage Description
Amount eaten
Hunger/
Fullness
Location/Activity/Feelings
9am
Kellogs/ frosted flakes
1 bowl
6/10
Home/ full
bagel
½ slice
5/10
home
11:00am
walk
30 mins
great
1pm
Pork chops
½ plate
7/10
Home/ great/ full
beans
½ plate
7/10
Home/ full
mushrooms
1/3 plate
6/10
home
Pepsi
1 cup
6pm
Cup of noodle soup
1 cup
7/10
home
Coke
1 cup
home
Day 7 Food Record Date: 11/18/22
Time
Food & Beverage Description
Amount eaten
Hunger/
Fullness
Location/Activity/Feelings
8am
Bagel
1 slice
5/10
home
Avocado slice
1 slice
5/10
home
Apple juice
1 cup
home
10:30am
walk
30 mins
Around park
1pm
salmon
3 slices
6/10
Full/ home
Mexican red rice
½ plate
7/10
Home/ full
Cranberry juice
1 cup
2pm
walk
30 mins
Around home/ great
6pm
cheeseburger
1
Fast food
French fries
Fast food
coke
1 cup
Fast food