IN-CLASS WORKSHEETS
IN-CLASS WORKSHEET NUTRITION WORKSHEET PHASE 1 (Weeks 1-4) Instructions: The Budokon Optimal Nutrition program is divided into 3 phases – each phase is 4 weeks long. At each stage, you’ll make small changes step-by-step. In the manual, we clearly describe which foods to remove from your diet and which foods to add. As you move forward, you will continue to abstain from those foods that don’t support your good health, while continuing to add those that do. This gradual change will give you a comfortable way to learn about and experiment with making better food choices. To help keep you on track, you will be responsible for keeping a daily food diary during each phase. You will use this diary as a reference to see what areas you are doing well in and what areas can be improved upon. Your food diary will help you calculate the percentage of dietary intake of each of the 7 food groups outlined in your manual. You will also be responsible for tracking your progress by calculating your weight, body mass index, energy level, mood, and overall physical health during each phase using the worksheet below. 1. List 3 goals you’d like to achieve by the end of the Budokon Optimal Nutrition program (i.e. to lose weight, to have more energy, etc).
2. Beginning Weight (Record your start weight on Day 1 of the program):____________________
3. Body Mass Index (Body Mass Index or BMI is a measure of body fat based on height and weight that applies to both adult men and women. Calculate your BMI online at http://www.nhlbisupport.com/bmi/ and record your score:_____________________________
4. Body Mass Index (BMI) Category (Circle One): Underweight
Normal Weight
Overweight
Obese
IN-CLASS WORKSHEET NUTRITION WORKSHEET PHASE 1 (Weeks 1-4) 5. At the beginning of Phase 1 (the first day of week 1) in the Budokon Optimal Nutrition Program, rate yourself on a scale of 1-5 in each of the categories below by circling the appropriate number. 1=Poor, 2=Fair, 3=Good, 4=Great, 5=Excellent Overall Energy Level: 1
2
3
4
5
Overall Mood / Emotional Health: 1
2
3
4
5
4
5
Overall Physical Health: 1
2
3
6. The pie charts at the end of each phase in the Budokon Optimal Nutrition guide are intended as a visual guide to the volume of food you should strive to eat in each category in each phase of the program. The chart is different in each phase, showing how the ratio of vegetables to meat, for example, will shift as you progress through the program. You do not have to weigh your food to follow these charts or the recommendations in this guide. At the end of Phase 1 (the last day of week 4), use your food diary as a reference to roughly calculate the percentage of dietary intake of each of the following food groups. The left column illustrates the goal % for each food group in Phase 1. The right column is where you will record the actual % of food you consumed in each category over the course of the 4 weeks.
Phase 1 Goal %
Phase 1 Actual %
Vegetables:
Vegetables:
40%
______%
Whole Grains: 20%
Whole Grains: ______%
Meat:
10%
Meat:
______%
Fruits:
10%
Fruits:
______%
Dairy:
10%
Dairy:
______%
Legumes:
5%
Legumes:
______%
Nuts & Soy:
5%
Nuts & Soy:
______%
IN-CLASS WORKSHEET NUTRITION WORKSHEET PHASE 2 (Weeks 5-8) 1. Beginning Weight (Record your start weight on Day 1 of week 5 of the program):_____________ 2. Body Mass Index. (Calculate your BMI online at http://www.nhlbisupport.com/bmi/ and record your score):_____________________________ 3. Body Mass Index (BMI) Category (Circle One): Underweight
Normal Weight
Overweight
Obese
4. At the end of Phase 2 (the last day of week 8) in the Budokon Optimal Nutrition Program, rate yourself on a scale of 1-5 in each of the categories below by circling the appropriate number. 1=Poor, 2=Fair, 3=Good, 4=Great, 5=Excellent Overall Energy Level: 1
2
3
4
5
Overall Mood / Emotional Health: 1
2
3
4
5
4
5
Overall Physical Health: 1
2
3
5. At the end of Phase 2 (the last day of week 8), use your food diary as a reference to roughly calculate the percentage of dietary intake of each of the following food groups. The left column illustrates the goal % for each food group in Phase 2. The right column is where you will record the actual % of food you consumed in each category over the course of the 4 weeks. Phase 2 Goal % Vegetables:
Phase 2 Actual % 40%
Vegetables:
______%
Whole Grains: 20%
Whole Grains: ______%
Meat:
5%
Meat:
______%
Fruits:
15%
Fruits:
______%
Dairy:
10%
Dairy:
______%
Legumes:
5%
Legumes:
______%
Nuts & Soy:
5%
Nuts & Soy:
______%
IN-CLASS WORKSHEET NUTRITION WORKSHEET PHASE 3 (Weeks 9-12) 1. Beginning Weight (Record your start weight on Day 1 of week 9 of the program):_____________ 2. Body Mass Index. (Calculate your BMI online at http://www.nhlbisupport.com/bmi/ and record your score):_____________________________ 3. Body Mass Index (BMI) Category (Circle One): Underweight
Normal Weight
Overweight
Obese
4. At the end of Phase 3 (the last day of week 12) in the Budokon Optimal Nutrition Program, rate yourself on a scale of 1-5 in each of the categories below by circling the appropriate number. 1=Poor, 2=Fair, 3=Good, 4=Great, 5=Excellent Overall Energy Level: 1
2
3
4
5
Overall Mood / Emotional Health: 1
2
3
4
5
4
5
Overall Physical Health: 1
2
3
5. At the end of Phase 3 (the last day of week 12), use your food diary as a reference to roughly calculate the percentage of dietary intake of each of the following food groups. The left column illustrates the goal % for each food group in Phase 3. The right column is where you will record the actual % of food you consumed in each category over the course of the 4 weeks. Phase 3 Goal % Vegetables:
Phase 3 Actual % 45%
Vegetables:
______%
Whole Grains: 20%
Whole Grains: ______%
Meat:
0-5%
Meat:
______%
Fruits:
10%
Fruits:
______%
Dairy:
10%
Dairy:
______%
Legumes:
5%
Legumes:
______%
Nuts & Soy:
5%
Nuts & Soy:
______%
IN-CLASS WORKSHEET NUTRITION RESULTS WORKSHEET END OF PHASE 3 1. Did you lose any weight during the 12-week program? Circle One: Yes
No
2. If yes, how much weight did you lose?________ 3. Did you gain any weight during the 12-week program? Circle One: Yes
No
4. If yes, how much weight did you gain?________ 5. If you experienced a weight loss or gain, did these results favorably meet any of the goals you outlined in Phase 1?
6. Did your Body Mass Index score change during the course of the program? If yes, by how much?
7. If your Body Mass Index score did change, did it affect your overall BMI category (underweight, normal weight, overweight, obese)? Was the category change favorable? Please explain.
8. By the end of the program, did you feel a positive increase in your overall energy level, emotional health, and physical health? Circle the most appropriate number for each category below. 1 = Strongly Disagree, 2 = Disagree, 3 = No Difference, 4 = Agree, 5 = Strongly Agree Overall Energy Level: 1
2
3
4
5
Overall Mood / Emotional Health: 1
2
3
4
5
4
5
Overall Physical Health: 1
2
3
IN-CLASS WORKSHEET NUTRITION RESULTS WORKSHEET END OF PHASE 3 9. Did you achieve any of the goals you outlined in Phase 1? Please explain in detail below.
10. If you did not achieve your goals, what things prevented you from achieving these goals and what measures can you take to find success in the future?
