The Healthier You

Jennifer Bianchi DTR

FORMS

Nutrition/Health History Questionnaire is a very important part of your nutrition analysis. This information helps me to know more about your health and eating habits which in turn helps to design a weight loss plan for your own personal needs. This in combination with the three day food recall will be a part of your complete Nutrition Analysis. You will be given the Nutrition/Health history questionnaire at your first appointment or mailed to you on request.
The three day food recall will be used for your initial analysis. Instructions for filling out the 3 day food record;
1. Choose "typical" days to keep your food record-- not special occasions or holidays!
2. Keep records for 3 complete days. Journal two week days , and one weekend day. Write foods down as soon as you eat them. We typically can only recall about 70-75% of the food we eat at the end of the day.
3. Record ALL foods and beverages consumed--from bites to binges!
4. Include portion sizes for all foods and beverages, and please, use standard serving sizes, refer to the sample portion sizes on the weight management link. Avoid terms like "bowl", "serving", "plateful", or "helping."
5. List all ingredients in dishes, sandwiches, soups, etc. whenever possible. Feel free to send along a recipe or food label to improve the accuracy of your analysis.
The more details you can provide the more accurate your analysis will be!
You will write down every food item you eat or drink for three consecutive days, please try to include at least one weekend day. Pick days that are around your normal eating patterns, try not to include a day that is a holiday, company lunch, family get togethers and so on. Please be as accurate as possible, if you have labels from food you are eating use them to write down the information such as type of food and portions eaten.
Food activity log is for you to use while in the weight management program. This form helps you to be personally accountable for everything that goes into your mouth. Keep these forms in a notebook, do not throw them out. You can have occasional calorie counts done on these forms to see if you are staying within your calorie level.