8/17/2019 Weight Control Diary

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Managed

Weight ControlDiary 

Start:

8/17/2019 Weight Control Diary

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DAY 1

Morning.

Foods Eaten H ow m uch

C om m ents

Afternoon.

Foods Eaten H ow m uch

C om m ents

Xenical™ Yes N o

Xenical™ Yes N o

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Evening.

Foods Eaten H ow m uch

C om m ents

Physical Activity

A ctivities H ow long

C om m ents

Stool Index

0 1 2 3 4

Xenical™ Yes N o

0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool

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DAY 2

Morning.

Foods Eaten H ow m uch

C om m ents

Afternoon.

Foods Eaten H ow m uch

C om m ents

Xenical™ Yes N o

Xenical™ Yes N o

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Evening.

Foods Eaten H ow m uch

C om m ents

Physical Activity

A ctivities H ow long

C om m ents

Stool Index

0 1 2 3 4

Xenical™ Yes N o

0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool

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DAY 3

Morning.

Foods Eaten H ow m uch

C om m ents

Afternoon.

Foods Eaten H ow m uch

C om m ents

Xenical™ Yes N o

Xenical™ Yes N o

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Evening.

Foods Eaten H ow m uch

C om m ents

Physical Activity

A ctivities H ow long

C om m ents

Stool Index

0 1 2 3 4

Xenical™ Yes N o

0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool

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DAY 4

Morning.

Foods Eaten H ow m uch

C om m ents

Afternoon.

Foods Eaten H ow m uch

C om m ents

Xenical™ Yes N o

Xenical™ Yes N o

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Evening.

Foods Eaten H ow m uch

C om m ents

Physical Activity

A ctivities H ow long

C om m ents

Stool Index

0 1 2 3 4

Xenical™ Yes N o

0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool

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DAY 5

Morning.

Foods Eaten H ow m uch

C om m ents

Afternoon.

Foods Eaten H ow m uch

C om m ents

Xenical™ Yes N o

Xenical™ Yes N o

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Evening.

Foods Eaten H ow m uch

C om m ents

Physical Activity

A ctivities H ow long

C om m ents

Stool Index

0 1 2 3 4

Xenical™ Yes N o

0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool

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DAY 6

Morning.

Foods Eaten H ow m uch

C om m ents

Afternoon.

Foods Eaten H ow m uch

C om m ents

Xenical™ Yes N o

Xenical™ Yes N o

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Evening.

Foods Eaten H ow m uch

C om m ents

Physical Activity

A ctivities H ow long

C om m ents

Stool Index

0 1 2 3 4

Xenical™ Yes N o

0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool

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DAY 7

Morning.

Foods Eaten H ow m uch

C om m ents

Afternoon.

Foods Eaten H ow m uch

C om m ents

Xenical™ Yes N o

Xenical™ Yes N o

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Evening.

Foods Eaten H ow m uch

C om m ents

Physical Activity

A ctivities H ow long

C om m ents

Stool Index

0 1 2 3 4

Xenical™ Yes N o

0 = no stool today, 1 = normal stool, 2 = oily stool, 3 = soiling or leakage, 4 = loose stool

8/17/2019 Weight Control Diary

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