Self-monitoring by recording eating behaviors and associated thoughts and feelings in daily food journals is basic to nutrition counseling and to Cognitive Behavior Therapy (CBT) in the treatment of eating disorders. In nutrition counseling, self-monitoring is beneficial for both nutrition counselor and patient. For nutrition counselors, food journals provide detailed descriptions of eating patterns and the circumstances of eating problems and is a concrete way to assess progress. For patients, self-monitoring increases awareness of eating problems and precipitating events. Food journals are a way for patients to communicate about their experiences between sessions and to help identify and differentiate between eating situations that are difficult or manageable. Some patients may have exaggerated the extent of their eating-disordered behaviors, and self-monitoring provides a more realistic picture that is reassuring.

I often say that “Food journals solve mysteries and suggest solutions.” For example, when a patient’s weight is not responding as expected, food journals can help determine the cause. Food journals provide information about the patient’s food patterns and about which foods are acceptable to the patient. They also provide undeniable evidence that restrictive eating increases the likelihood of binge eating. 

There are lots of ways to do a food journal. A number of my patients have created their own food record formats. Other patients have had success just recording foods and amounts consumed over the course of a day in a discrete pocket-size notebooks. More often than not these days, my patients are using phone apps to chart food behaviors. Most of the apps allow sharing of records via email or allow selected providers to view records. Some of my patients use Fitness Pal, but it is designed for calorie counting and weight loss and may be triggering for someone with an eating disorder. Next week I will review two new apps designed specifically for patients with eating disorders, Recovery Record and Rise Up.

Marcia

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze, 2007, Marcia is also author of the recently published Nutrition Counseling in the Treatment of Eating Disorders, Routledge, 2013.

 Copyrighted by Marcia Herrin and Nancy Matsumoto.

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