Embed Size (px)
Citation preview
How to use Mood Food Diary:• Everyday fill in the food diary by stating what you ate and
how you felt an hour after eating• Please record your mood, energy and stress in relation to
Tilda’s numerical grading's (page 4) for example feeling grumpy you would write ‘1’ in the corresponding box
• Mood, energy and stress must be recorded an hour after eating every meal in order to evaluate impact of eating certain foods
• If there are external factors affecting your mood please state what. It is important to differentiate between food and external factors which affect mood
• Please enter data digitally• Please find an example of a Mood Food Diary entry on the
following page
Time of meal:
Food consumed:
Mood – 1hr after eating
Energy - 1hr after eating
Stress - 1hr after eating
Happiness - 1hr after eating
If outside factors affected mood,
please tick box and detail.
Breakfast 09:30Porridge and 1 banana
10.30 am3
10.30 am2
10.30 am1
10.30 am1
Alarm clock and no hot water didn’t go off so running late for work which has put me in a bad mood
Lunch 13:00Chicken sandwich with salad.X1 packet salted crisps
14:004
14:004
14:002
14:002
Dinner 19:30Steak, chips and broccoliYogurt, blueberries and strawberries
20:302
20:304
20:302
20:303
Still no hot water and plumber can’t fix until tomorrow so feeling slightly moody
Snacks X1 appleX1 chocolate bar (35g)
12:30pm4
12:30pm3
12:30pm3
12:30pm3
Drinks X4 pints of waterX2 tea with milkX1 can of Diet Coke
10:30 – 314:00 – 420:30 – 313:30 -3
10:30 – 314:00 – 220:30 – 313:30 -4
10:30 – 114:00 – 220:30 – 213:30 -4
10:30 – 114:00 – 220:30 – 313:30 -3
Name
Age
Location
Telephone
Job Title
Height & Weight
Male or Female
To be completed before meal plan
How would you rate your default mood on a scale of 1 to 10. 1- representing super happy all the time! 5- average levels of happiness and contentment and 10- a depresses state of mind.
Does your mood fluctuate through the day? Can you give any insight into this if so - when, to what extremes and why you think this might be?
Does your mood affect your day, if so please give examples of how
How many portions of fruit and vegetables do you eat a day?
How many litres of water do you drink a day?
Are you an energetic person? Do you generally move around or are you sedentary?
Do you exercise? How many times a week? What do you do?
Do you have low energy despite having eaten sufficiently?
Can you tell us about your current eating habits e.g. do you have a sweet tooth or do you snack frequently, do you have three meals a day or eat little and often?
Ratings
1 Grumpy, no energy, very stressed, miserable
2 Bad mood, little energy, stressed, not happy
3 Neither grumpy/good mood, neither high/low energy, neither very/not stressed, neither happy/miserable
4 Good mood, energy boost, little stressed, happy
5 Exceptional mood, energetic, no stress, extremely happy
Time of meal:
Food consumed:
Mood – 1hr after eating
Energy - 1hr after eating
Stress - 1hr after eating
Happiness - 1hr after eating
If outside factors affected mood,
please tick box and detail.
Breakfast
Lunch
Dinner
Snacks
Drinks
Time of meal:
Food consumed:
Mood – 1hr after eating
[Please input time]
Energy - 1hr after eating
[Please input time]
Stress - 1hr after eating
[Please input time]
Happiness - 1hr after eating
[Please input time]
If outside factors affected mood,
please tick box and detail.
Breakfast
Lunch
Dinner
Snacks
Drinks
Time of meal:
Food consumed:
Mood – 1hr after eating
[Please input time]
Energy - 1hr after eating
[Please input time]
Stress - 1hr after eating
[Please input time]
Happiness - 1hr after eating
[Please input time]
If outside factors affected mood,
please tick box and detail.
Breakfast
Lunch
Dinner
Snacks
Drinks
Time of meal:
Food consumed:
Mood – 1hr after eating
[Please input time]
Energy - 1hr after eating
[Please input time]
Stress - 1hr after eating
[Please input time]
Happiness - 1hr after eating
[Please input time]
If outside factors affected mood,
please tick box and detail.
Breakfast
Lunch
Dinner
Snacks
Drinks
Time of meal:
Food consumed:
Mood – 1hr after eating
[Please input time]
Energy - 1hr after eating
[Please input time]
Stress - 1hr after eating
[Please input time]
Happiness - 1hr after eating
[Please input time]
If outside factors affected mood,
please tick box and detail.
Breakfast
Lunch
Dinner
Snacks
Drinks
Time of meal:
Food consumed:
Mood – 1hr after eating
[Please input time]
Energy - 1hr after eating
[Please input time]
Stress - 1hr after eating
[Please input time]
Happiness - 1hr after eating
[Please input time]
If outside factors affected mood,
please tick box and detail.
Breakfast
Lunch
Dinner
Snacks
Drinks
Time of meal:
Food consumed:
Mood – 1hr after eating
[Please input time]
Energy - 1hr after eating
[Please input time]
Stress - 1hr after eating
[Please input time]
Happiness - 1hr after eating
[Please input time]
If outside factors affected mood,
please tick box and detail.
Breakfast
Lunch
Dinner
Snacks
Drinks
