NAME___________________________________________

Women’s Health 3

Class Time, Day___________________________________

Diet Analysis

Personal Data

 

Weight_______________             Age: ________________

Height:_______________             Activity Level: _________

BMI: ________________             Body Fat %:___________

Meals Per Day:_________            Meals Eaten Out Per Week:____________

 

                                                            3-Day Diary

     Nutrients                           RDA                            Actual Intakes         

               

 
RDA
Day 1
Day 2
Day 3
Calories        

CHO       Calories / Grams

                      (60% of total calories)

        

Sugars     Calories / Grams

                       (10% of total CHO)

        

Protein    Calories / Grams

                       (15% of total calories)

        

Fat           Calories / Grams

                  (25% of total calories)

        
   Sodium          
Calcium        
FiberWater        

 

Complete Daily Diaries Attached

 

Liquids I drink other than water

              Liquid                                              Amount Per Week

1._______________________________________________________                                                                 

 

2. _______________________________________________________                                                   

 

3._______________________________________________________                                                    

 

4._______________________________________________________                                                                                             

 

5. _______________________________________________________                                                                 

 

6. _______________________________________________________                                                   

 

 FAVORITE Foods I eat that are more than 25% fat calories

              Food                                                % Fat Calories

1. _____________________________________________________         

 

2. ______________________________________________________                       

 

3._______________________________________________________          

 

4. _______________________________________________________         

 

5.________________________________________________________          

 

6.________________________________________________________          

  

Foods that would increase complex carbohydrates in my diet

 

1._________________________________________________________________          

 

2._________________________________________________________________          

 

3._________________________________________________________________          

 

4. _________________________________________________________________         

 

5._________________________________________________________________          

 

6.__________________________________________________________________          

 

Reasons why I should not or cannot change my diet right now

 

1. _________________________________________________________________         

 

2.___________________________________________________________________                      

 

3.____________________________________________________________________         

 

4. ____________________________________________________________________         

 

5______________________________________________________________________.          

 

6._____________________________________________________________________          

 

Ten ways of loving myself other than food

1.______________________________________________________________________          

 

2.______________________________________________________________________          

 

3._______________________________________________________________________          

 

4_______________________________________________________________________.                        

 

5.________________________________________________________________________          

 

6.__________________________________________________________________________          

 

7___________________________________________________________________________          

 

8. _________________________________________________________________________         

 

9.___________________________________________________________________________         

 

10.___________________________________________________________________________        

 *****Star the Healthy ones******

Additional daily vitamin supplements I take

1. __________________________________________________________________         

 

2.______________________________________________________________________

 

3.______________________________________________________________________

 

 Nutritional analysis of my 20 favorite foods...........Attach  Results

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CHOOSE 20 OF YOUR MOST FREQUENTLY EATEN OR FAVORITE FOODS AND DO A SPECIFIC NUTRITIONAL ANALYSIS (separate page)

Use the websites on the "Online Nutrition Resources" Page to find the information needed