Back in 1993, I was a high school runner with a warped understanding of nutrition, so much so that my parents sent me to a dietitian, who had me keep a brief food journal as part of our work. After analyzing my journal, she told me that I was not consuming enough fat (Hey, it was the 1990s, and being afraid of dietary fat was the in thing to do.), and we brainstormed ways in which I could increase my intake.
More than 30 years later, food journals remain commonplace in dietetic counseling, and tracking apps like MyFitnessPal have popularized and normalized the act of documenting one’s eating even outside of working with a dietitian. But just because we can does not mean we should. As with anything, keeping a food journal can offer benefits, as it did for 16-year-old me, but plenty of potential cons exist, which is why the vast majority of my patients never keep a food journal as part of our work.
For those of you who are unfamiliar with what food journals are, they typically involve the user recording what, when, and how much they have eaten. When I do suggest that a patient keep a food journal, it is usually for one of four reasons, the first of which is reassurance. Sometimes a patient wants to make sure their intake of a particular nutrient or food group is appropriate, and having objective data to point to – as opposed to solely my subjective opinion – helps to relieve their anxiety while also serving as a double check for me. Along those same lines, I have found that when people eat intuitively, their macronutrient intakes almost always fall within their estimated need ranges without them even trying to make that happen, and analyzing their food journals is a way to confirm this.
Other times, I might suggest a food journal in order to prove a point. The science of nutrition moves steadily at a glacial pace while the pop culture of nutrition is labile. Just as my predecessors spent a great deal of time teaching people like teenage me that dietary fat need not be feared, I am sometimes in the position of reeducating patients about what their nutrition needs actually are versus what social influencers have made them believe that they need. Some patients take my word for it when I tell them they are getting way more protein than they need, but other people need to see their food journal analysis showing that their protein intake is equivalent to what we would give to a third-degree burn victim fighting for survival in order for them to understand that TikTok and its ilk are questionable sources of nutrition information.
If someone’s medical condition makes us particularly interested in their intake of a particular nutrient or nutrients, a food journal can help us to take a focused look at their consumption. For example, if bone health is an issue, a food journal can enable us to better understand their calcium and vitamin D intakes.
The fourth reason that I might recommend a food journal is simply to get our foot in the door to discuss a particular subject. People have different communication and learning styles, which is totally fine. Some patients like to converse, ask questions, and share their own thoughts, while others do better with a data-driven approach. For the latter folks, sitting down together and looking at their food journal yields a more fruitful conversation than if we were just looking at each other.
Despite their upsides, food journals have their drawbacks, which is why I only end up recommending their usage to a small subset of my patients. One of my main concerns is the tendency for people to use food journals as a tool to be hard on themselves. Sometimes people rationalize that if they have to record an eating behavior of which they are ashamed, they will be motivated to change. The expectation, in other words, is that keeping a food journal will provide accountability, but in reality, I cannot remember a single instance of such an approach bringing about long-term behavior change or an improved relationship with food. The risk is that food journaling exacerbates feelings of shame and damages a relationship with food that is already fraught.
My second concern is that keeping a food journal can be a step in the wrong direction for people who are trying to redevelop their intuitive eating skills, which involves making decisions about what, when, and how much to eat based on one’s internal cues. In contrast to intuitive eating, tracking apps, points systems, and lists of foods to eat or avoid are all external systems that distance people from their intuitive eating cues. While food journaling has the potential to help with intuitive eating, as previously discussed, I have seen many instances in which they are more of a hindrance. Although I always explain to people that the estimated needs that I calculate for their intakes of various nutrients truly are merely estimates based on algorithms that are the best we have yet are still highly flawed, sometimes people have difficulty internalizing such nuance, especially if they have a history of an eating disorder or disordered eating. Put more simply, they view these estimated needs not as ballpark guidelines, but rather as rules of what they “should” be doing, and becoming an intuitive eater while holding onto such a belief is an uphill battle.
Related to my previous concern, keeping a food journal opens the door to getting too caught up in objective data. Numbers are cool – I have a degree in mathematics from Tufts, and I spent my first three years out of college working as an operations research analyst for the federal government – but we can lean on them too much. SMART goals have their place, but the further I get in my career as a dietitian, the less I believe that they belong in nutrition counseling, where subjective data carries more importance. The more that a given patient seems to care about numbers, the more cautious I am about recommending a food journal due to the risk of exacerbating what is already an overemphasis on the objective.
Lastly, keeping a food journal is hard work! The best practice is to record the foods eaten in real time, as trying to remember what one ate in the past increases the likelihood of mistakes, which means that the individual has to be willing to write down or input into a device the details of their eating at the time of consumption, which takes time and has the potential to be socially awkward. Recording the necessary level of detail – including product brands, produce varieties, quantities, and details of each component of a meal or snack – is tedious. Because of everything that goes into keeping a food journal, the most that I ever ask anybody to record is three days of eating, and even in this instance, the third day’s journal is typically sparser and vaguer than the preceding two. Food journaling is an exhausting endeavor, and if someone is unable and/or unwilling to put in the effort to go about it properly, the data could end up being virtually useless, meaning all their time and effort is for nothing.
Earlier, I briefly defined a food journal as one’s recording of what, when, and how much they have eaten because that is what they usually include, but sometimes they take on different forms. For example, a food journal could omit quantity but prompt the user to record data such as their hunger level at the start of the feeding, their fullness level at its conclusion, the environment in which they ate, their mental and/or physical state, and any noteworthy thoughts or feelings that arose before, during, or after the eating experience. Utilizing this latter type of food journal can sometimes – but not always – be a way of taking advantage of the upsides of food journaling while mitigating their downsides.
Looking back, I am grateful that my own dietitian suggested a food journal all those years ago, as it was a useful exercise for me to go through at that moment in time. Food journals have their place, but like any tool, sometimes they are better left in the toolbox.