Awareness Journal Directions

 

Thank you for taking your time to fill out an Awareness Journal.  I believe this is a necessary first step on the road to better health.  Please print off or copy as many pages as needed for a one week period of time.  The Journal must be filled out with complete honesty, or the information will not be useful.  It is not something that is graded or judged.  This is a tool for you to understand yourself and your eating patterns better.  Sometimes we know we want to change, however we are not sure how or what we need to change.  An Awareness Journal can bring to light areas to start making new habits in. 

Your Awareness Journal must be completed prior to your first appointment, so please set your appointment 7 days out.  If you have questions leave me a message at 1-800-384-6766 and I will get back with you.  Thank you!

Here is an example of how to fill out the Journal:

 

Date

Time

Food/Beverage

Amount

Where

Why

Feeling before ate

Feeling

after ate

9/9

2007

Time

Awake

6 am

 

 

 

 

 

 

 

 

 

 

 

Time

sleep

9:30 pm

6:30

 

 

 

 

10:00

 

 

 

 

 

4:00

 

 

 

 

 

7:00

Cup of coffee

 

 

 

 

Cup of coffee and donut

 

 

 

 

 

Potato Chips, Mountain Dew

 

 

 

 

Broiled cod with steamed mix vegetables with extra butter & salad

8 oz

 

 

 

 

16 oz / 3

 

 

 

 

 

Large snack size bag, 42 0z soda

 

Fist size fish, 2 cups veg.

Kitchen

Counter

 

 

 

Work

Meeting

 

 

 

 

Car while driving

 

 

 

Apple-

Bee’s

Tired, like reading paper with coffee

 

It was available and I forgot to eat breakfast

 

I was starving, didn’t have time for lunch

 

Spend time with Husband

 

Neutral, just woke up

 

 

 

Bored

 

 

 

 

 

Anxious to get home, stressed from confrontation at work

 

Little uptight, restaurant packed

Awake, but slow

 

 

 

Little tired,

Stressed

 

 

 

 

Took a short nap before husband got home

 

 

Went to bed

 

Expression/word samples:

 

Why:  hungry, breakfast time, lunch, dinner, snack time, food was available, social event, taste good, habit, free food, smelled good, sample…..

 

Feeling Before:  uncomfortable, “out-of-control”, lonely, stressed, threatened, fine, dizzy, tired, hungry, sad, depressed, happy, social, angry, frustrated, bored, unappreciated, afraid…..

 

Feeling After: tired, sick, gas, stomach hurts, cramps, lazy, sad, stressed, angry, too full, betrayed, alive, active, energetic, normal…..