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8/17/2019 Weight Control Diary
1/16
Managed
Weight ControlDiary
Start:
8/17/2019 Weight Control Diary
2/16
DAY 1
Morning.
Foods Eaten H ow m uch
C om m ents
Afternoon.
Foods Eaten H ow m uch
C om m ents
Xenical™ Yes N o
Xenical™ Yes N o
8/17/2019 Weight Control Diary
3/16
Evening.
Foods Eaten H ow m uch
C om m ents
Physical Activity
A ctivities H ow long
C om m ents
Stool Index
0 1 2 3 4
Xenical™ Yes N o
0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool
8/17/2019 Weight Control Diary
4/16
DAY 2
Morning.
Foods Eaten H ow m uch
C om m ents
Afternoon.
Foods Eaten H ow m uch
C om m ents
Xenical™ Yes N o
Xenical™ Yes N o
8/17/2019 Weight Control Diary
5/16
Evening.
Foods Eaten H ow m uch
C om m ents
Physical Activity
A ctivities H ow long
C om m ents
Stool Index
0 1 2 3 4
Xenical™ Yes N o
0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool
8/17/2019 Weight Control Diary
6/16
DAY 3
Morning.
Foods Eaten H ow m uch
C om m ents
Afternoon.
Foods Eaten H ow m uch
C om m ents
Xenical™ Yes N o
Xenical™ Yes N o
8/17/2019 Weight Control Diary
7/16
Evening.
Foods Eaten H ow m uch
C om m ents
Physical Activity
A ctivities H ow long
C om m ents
Stool Index
0 1 2 3 4
Xenical™ Yes N o
0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool
8/17/2019 Weight Control Diary
8/16
DAY 4
Morning.
Foods Eaten H ow m uch
C om m ents
Afternoon.
Foods Eaten H ow m uch
C om m ents
Xenical™ Yes N o
Xenical™ Yes N o
8/17/2019 Weight Control Diary
9/16
Evening.
Foods Eaten H ow m uch
C om m ents
Physical Activity
A ctivities H ow long
C om m ents
Stool Index
0 1 2 3 4
Xenical™ Yes N o
0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool
8/17/2019 Weight Control Diary
10/16
DAY 5
Morning.
Foods Eaten H ow m uch
C om m ents
Afternoon.
Foods Eaten H ow m uch
C om m ents
Xenical™ Yes N o
Xenical™ Yes N o
8/17/2019 Weight Control Diary
11/16
Evening.
Foods Eaten H ow m uch
C om m ents
Physical Activity
A ctivities H ow long
C om m ents
Stool Index
0 1 2 3 4
Xenical™ Yes N o
0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool
8/17/2019 Weight Control Diary
12/16
DAY 6
Morning.
Foods Eaten H ow m uch
C om m ents
Afternoon.
Foods Eaten H ow m uch
C om m ents
Xenical™ Yes N o
Xenical™ Yes N o
8/17/2019 Weight Control Diary
13/16
Evening.
Foods Eaten H ow m uch
C om m ents
Physical Activity
A ctivities H ow long
C om m ents
Stool Index
0 1 2 3 4
Xenical™ Yes N o
0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool
8/17/2019 Weight Control Diary
14/16
DAY 7
Morning.
Foods Eaten H ow m uch
C om m ents
Afternoon.
Foods Eaten H ow m uch
C om m ents
Xenical™ Yes N o
Xenical™ Yes N o
8/17/2019 Weight Control Diary
15/16
Evening.
Foods Eaten H ow m uch
C om m ents
Physical Activity
A ctivities H ow long
C om m ents
Stool Index
0 1 2 3 4
Xenical™ Yes N o
0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool
8/17/2019 Weight Control Diary
16/16
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