Meal Planner Form

 

 

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Date

h

h

h

h

h

h

h

Nonfat Dairy

h

h

h

h

h

h

h

Lean Protein

h

h

h

h

h

h

h

Vegetable

h

h

h

h

h

h

h

Fruit

h

h

h

h

h

h

h

Starch

h

h

h

h

h

h

h

Extra Calories

h

h

h

h

h

h

h

Pedometer Distance

h

h

h

h

h

h

h

 

 

 

 

 

 

 

 

 

 

 

Directions: Each day, plan your meal and snacks according to the number of food exchanges allotted for this particular week, and record them with a tally mark (e.g. I 11) each meal. Make sure to ingest the exact volume specified for each food exchange. At the end of each day, record the distance of your pedometer. Turn this form in each Tuesday at noon.

 

 

Journal of THE AMERICAN DIETETIC ASSOCIATION  May 2001