If you are in recovery from an eating disorder, you are probably familiar with the idea of keeping a food diary (also called a food record or food journal).
Food diaries can be extremely useful when working with eating disorders, however, they are not recommended for everyone (I’ll say more about that in a minute). The basic premise is that a client may be asked to keep a written record of the amount and type of food consumed throughout the day, listing what was ingested at every meal and snack. Some professionals ask their clients to record the number of servings or the portion size, some will just as for a general description of what was eaten (e.g., a hamburger and fries, a small coke and 1 medium size peanut butter cookie).
Psychotherapists (and dietitians as well) may also request/suggest that a client record the thoughts and feelings experienced by the client before, during, and after eating. This can be extremely useful in identifying automatic thoughts and “thought distortions” associated with eating situations. Other items for inclusion in the record may be if/when a client engaged in binge behavior, if/when a client purged after eating, and if/when a client felt compelled to exercise (or actually did engage in exercise) following food consumption. Clients may also record where they were at the time of a meal, who they were with and what activities in which they may have been engaged. Lastly, some professionals may also ask clients to gauge their level of hunger, satiety, and subjective satisfaction before, during, and after meals.
Keeping a food diary has its practical limitations for some. After all, it may be difficult for someone to record their food consumption in the middle of a business meeting. Thus, clients are generally advised to keep a record during a meal whenever possible, but to record as soon as it is feasible when the situation is otherwise restrictive. Some clients will keep a food journal on a collection of loose-leaf papers, some will use a notebook or pad of paper, others may be given a structured form to use (either to serve as a guide, or as a place to actually record their diary entries).
A food diary may serve many useful purposes. Some dietitians will want clients to monitor their food intake, so a diary is a practical means for doing so. Therapists may wish to use the diary as a homework activity, or as a means of exploring thoughts and feelings that are recorded by the client. Patterns can be discovered through food journaling that the client may not otherwise notice, such as specific situations that appear to serve as antecedents to binge bahaviors, or certain types of social interactions that appear to precede purge behaviors. Just one example: a client may binge at night and assume that it is because they have “no control” over their food; yet the food record may reveal that the client does not eat anything most of the day. Thus the binge may have less to do with control and more to do with the body’s reaction to food deprivation.
Health care professionals can collect food records from their clients and review them, being keen to look for patterns and associations that may not be verbally reported by their clients. If there are omissions in the record or the client reports difficulties with the task, this can be discussed and reasons can be explored with the client as well. Clients may self-censor their entries due to feelings of shame or embarrassment. Thus feelings can be processed, behaviors normalized and concerns addressed.
A note of caution, studies show that for some, the process of food monitoring is associated with an increase in eating disorders symptoms. This is especially true for those who severely restrict their food intake or who are preoccupied with counting calories (in fact, many professional discourage calorie counting by their clients, myself included – I’ll say more about that in a future post). For these clients, food diaries actually serve to intensify food preoccupation and restriction. Therefore, you will want to evaluate the usefulness of a food record with each individual client and avoid use with clients where the activity may be contraindicated. An alternative that is sometimes used with such clients is an “appetite record”, which can assist a person with recognizing the physiological and behavioral cues associated with hunger and satiety; cues that are often indiscernible to eating disorder patients. Likwise, another alternative is a “food & feelings diary” in which a client records his or her emotional reactions to mealtimes and food, but does not include a record of the amount and types of foods eaten.
Professionals have used many different varieties of food records: 3X5 Cards, spiral-bound notebooks, or structured forms. As an example, I have included one of several of the structured versions that was developed for use in my practice; you may feel free to use or modify it for personal use ({filedir_1}food_diary_sari_shepphird_ph.D_._.pdf).
Additional Reference:s Craighead, L.W. (2006). The Appetite Awareness Workbook: How to listen to your body and overcome binging, overeating, & obsession with food. Oakland, CA: New Harbinger Press.
Agras, S & Apple, R.F. (1997). Overcoming Eating Disorders: A cognitive-behavioral treatment for bulimia nervosa and binge eating disorder. New York: Oxford Press.