Dear Diary, Today I ate . . .

Catrina Lankenau, 27, of Latham, New York, was always the big girl in school, her weight topped 220 lbs. in college on her 5’ 4” frame. She had a kind of weight-loss epiphany trying on plussize Halloween costumes. “It was just really emotional for me,” she recalled. “The next day I threw out everything that was junk food or bad for me. I bought a journal and I wrote down all of my food. I bought books about clean eating.”

As anyone who has tried to lose weight knows, determination and education are only the first steps. If the process of losing weight were as simple as the formula — more calories out than calories in — losing weight would be easier for everyone. But ridding ourselves of pounds involves more than arithmetic. It involves changes in our behavior. One element of a weight-loss program that may be helpful is keeping a food diary.

There is evidence that the simple practice of recording your food intake can have a dramatic effect on eating behavior and weight. Every one of 15 studies on self-monitoring dietary intake that were included in an in-depth review sponsored by the National Institutes of Health and published in the Journal of the American Dietetic Association “found significant associations between self-monitoring and weight loss.” This was certainly Catrina’s experience.

A tale of two Catrinas: before and after her dramatic weight loss

In a report from one of the largest and longest running weight-loss and maintenance trials ever conducted, researchers at Kaiser Permanente’s Center for Health Research and their colleagues throughout the country found that people who regularly kept food diaries lost about twice as much weight as those who didn’t. The more food records participants kept, the more weight they lost.As she began acting on her determination to lose weight, Catrina started keeping a food diary. She knew about recording what she ate from watching weight-loss shows and reading diet books. After losing 40 pounds on her own, she hired a trainer who urged her to keep journaling about her food. “I realized the days I wasn’t writing down what I ate were the days that I wasn’t staying on plan,” she said.

Keeping a food diary can be as formal as maintaining a notebook or journal, but it doesn’t have to be. Catrina kept a paper diary for years, but now she uses an app on her smartphone. (See Telediatetics and Weight Management below.)

When Catrina first started using the diary, it was more like a private journal where she would write about her feelings. “As I got into it more and as it became more a lifestyle of eating healthy, I did switch over to an app and ultimately I used My Fitness Pal probably the most,” Catrina said. “When I was working at a job, sometimes I would plan what I was going to eat the next day, write it all down and have it packed and ready the night before. As I’ve gotten into it more, it’s my lifestyle now, and I write it down at the end of the day as a way of checking on myself.”

Catrina credits keeping diaries with changing her relationship to food by making herself accountable. “When you track everything, you can see if your weight stops moving, whether there is more coming in than you are putting out,” she said. “I learned that a lot of my eating was emotional or stress related. Then I learned how to replace those habits and how to make foods that I crave in different ways, like making homemade pizza with a whole wheat or quinoa crust and topping with a sauce that doesn’t contain added sugar and topping it with veggies and light cheese or skipping the cheese all together.”

She also found that writing it down had the effect of making better food choices: “When you have to write down something unhealthy it doesn’t make you feel good,” she said. “You see it in black and white and you know what you’re doing is not good.”

Ultimately, Catrina lost 70 pounds and has kept it off. Of course, everyone could see that she was doing something that was working and asked her advice. She has since become a personal trainer certified by the National Academy of Sports Medicine and uses food diaries with her clients. “The number one thing I tell my clients is that it’s all about loving yourself and holding yourself accountable,” she said. “I can give you the information and write down every workout, but if you only apply it that one hour a week you’re with me, all those other hours of the week that you’re by yourself and making your own choices are going to determine your success. To be accountable, they have to find the motivation within themselves to proceed towards their goal.”

Lora Burke, professor of epidemiology at University of Pittsburgh Graduate School of Public Health and lead author of the literature review mentioned above, presented a paper at the 2015 American Heart Association Scientific Sessions showing how people were more adherent to self-monitoring with an electronic diary than with a paper diary. “However, in my experiences over several years, it does not matter what you use,” she said. “What is important is that you self-monitor.”


Telediatetics and Weight Management


Catrina’s switch to recording on an app is certainly at the forefront of technology. An emerging technology called teledietetics also allows for a different kind of intervention for people watching what they eat or working at weight loss.

Teledietetics uses smartphone technology to enable people to apply nutritional knowledge from consultations with a dietitian to the balanced diet and portion size information of the foods they are eating. According to a January 2014 article in Telemedicine and e-Health, “By recording their patients’ dietary intakes into a programmed system, dietitians can promptly analyze their food energy and nutrients. The program can then use the data to generate instant and individualized evaluations via online reports. These reports can educate individuals on how to modify their diets and gradually change their behavior to encourage healthy eating. Seeing the factual data on food energy and nutrient values establishes a mindfulness effect, helping the individual to change.”

In a study in Hong Kong, researchers compared one group that used a paper diary and another that used an electronic diary to a control group. Each group got the same nutrition education, but the paper diary group received comments from dietitians online and the electronic diary group received detailed calorie and nutrient information online. Both diary groups lost weight and reduced their BMI, but the electronic group lost only body fat while the paper diary group lost both fat and lean muscle mass, which eventually can make losing weight more difficult. The researchers concluded that the participants who used the electronic dietary records had a better understanding of healthy eating.

This information is provided as a resource to our readers. The tips, products or resources listed have not been reviewed or endorsed by the American Heart Association.


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