In nutritional care, having clients have a photo food journal is one of the most powerful tools in coaching clients to long-term dietary change. Reviewing a client’s food logs will reveal important details about their dietary habits, portions and the nutritional quality of their meals. For dietitians, this information is invaluable in guiding clients towards realistic goals.

Despite food diaries being a useful monitoring tool, it is a common challenge for clients to consistently log their meals and accurately record their dietary intake.

To help improve both the consistency and accuracy of food journaling, Healthie uses a photo based food journal within the platform and mobile app. Photo food journaling allows clients to log images of their meals in real-time. As a more accurate form of food reporting, it’s then up to the nutrition expert to interpret, assess and discuss the nutritional quality of the meal with their client.

Even more, with a host of settings, the Healthie Food Journal also allows dietitians to customize the food journaling experience for each of their clients. Besides, the journaling process can be kept basic (ie. client can simply upload their picture) or more detailed (ie. client can log the meal, include a description, identify their pre/post-meal hunger and mood).

For Healthie providers, you can conveniently keep track of all of your clients’ food journal entries by logging into the dashboard of your Healthie account (or mobile app). When a client’s food logs appear in a feed, similar to Facebook newsfeed, for you to scroll through, review and comment on. Then see all of your clients’ most recent logs in minutes.

This article provides a deep-dive review of utilizing the Healthie platform to customize the Photo Food Journal setting with clients, including:

• Walk through of the Healthie platform and mobile version of the app
• Detailed review of each photo food journal setting that can be activated (or hidden) from your client
• How to introduce photo based food journaling to your clients as a valuable tool in achieving their nutrition goals
• How to interact with your clients through food logs, and best practices
• Setting boundaries with clients on engagement and food journal reviews
• Suggestions for how to package and price food diary reviews as additional income for your practice

Helping client’s make dietary changes via photo based food journaling

The Healthie Food Journaling tool is convenient for both clients and healthcare providers alike. With an intuitive mobile-app, clients’ can log their meals and providers can review and provide custom feedback in real-time. This added level of support and engagement helps clients successfully navigate their nutritional challenges, for sustainable long-term change.

Having client’s keep a photo food journal can help to provide a significant amount of insight about their dietary habits, including trends in: meal choices, portion sizes, mood, hunger cues and client perceptions of their intake. Also, armed with this information, dietitians can tailor counseling sessions and goals to help clients make specific changes that will greatly impact their overall dietary intake.

Photo based food journaling, more than any other style of journaling, can be used across all patient populations and even transcends language and cultures. The Healthie Photo Food Journal tool supports all counseling approaches and can be appropriate for:

• General population (adults and even children)
• Disease-specific clients, MNT counseling
• Eating disorder clients
• Intuitive eating and HAES practices

Healthie’s customizable food journal settings:

From your Healthie provider account, you can adjust the default settings for all of your clients and/or adjust journal settings for individual clients. To view adjust food journal settings for an individual client, click their client chart > click ACTIONS from top right tab > navigate to SETTINGS tool (located next to client info).

Each setting can be checked-off (visible) or unchecked (not visible) for clients.

Here is a step-by-step explanation of each setting and how to best implement it with your clients:  

1. Client can take pictures of food and comment

By default, this setting will be turned on (visible). Clients will be able to upload a photo from their photo library or take a photo directly through the app. It’s best to recommend clients to take a photo of their meal before they eat and then log it after the meal. After that, by using the “description” box next to the photo, client’s can free-text information such as details of the meal, portion they consumed and any other relevant information surrounding the meal.

Client’s will also have the ability to change the date of when the meal was consumed, but the time-stamp shows for when the journal entry was actually uploaded. After a client posts a meal, they will have the ability to go back and edit their image or description as needed.

As a Healthie provider, your client’s newly logged journal entry will show on the top of your dashboard newsfeed (showing the most recent logs first).

2. Meal healthiness

This setting prompts clients to select from a stoplight-style image, how healthy they perceive their meal choice to be. By allowing clients to share their perceptions, you can collectively work together to discuss the nutritional quality of the meal, and the healthiness for your individual client, so that a client over time can have better insights about their food choices.

• Thumbs down = not healthy
• Sideway thumb = moderately healthy
• Thumbs up = very healthy

As a provider, when you view your clients food journal entry, you’ll see a red, yellow or green bar on the top-right of their entry.

3. Meal hungriness

Monitoring trends in food choices and habits over time is incredibly powerful when helping clients to make lasting change. When clients log their meals, they can quickly indicate with one tap how hungry they were pre-meal.

• Not hungry
• Somewhat hungry
• Very hungry

As a provider, meal hungriness will show within your client’s post, below the image of their meal or snack.

An example case-use of this setting in nutritional counseling:

• Your client in general consistently indicates that they are very hungry at their lunch meal
• Looking at their food photo, they are choosing less-healthy meals, or large portions
• Scrolling back, it’s clear to see that they are not consistently logging or eating breakfast
• In session, you talk this through with your client: since they are skipping meals earlier in the day, they are over-hungry at lunch, and it’s undermining their food choices and portion control
• Goal: client will work on incorporating breakfast daily

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4. Pre-meal hunger and post-meal fullness

For even more detailed monitoring of hunger and fullness cues, you can add “pre-meal” and/or “post-meal,” hunger settings. This will show a sliding scale for both pre-meal and post-meal, to allow a client to prompt a client to be mindful (and in-tune) with their hunger/fullness cues.

Besides, this setting is particularly useful when working with clients on mindfulness, intuitive eating or clients that struggle with eating disorders. It allows a client to have more insight into their body’s signals, and to track their progress over time. Hunger and fullness will fluctuate throughout the day, but the goal is to help identify and avoid the extremes of the scale.

Using the 1-10 hunger scale to interpret cues:

1. Ravenous: Difficulty concentrating, low energy, headache, everything sounds good, past the point of comfortable hunger.
2. Over-hungry: Stomach growling, stomach may hurt, need to get food now, everything is starting to sound good.
3. Strong signals to eat, hungry: Thoughts about food increase, stomach starts to growl more, need to get something to eat increases.
4. Slightly hungry: Starting to think about food, deciding what sounds good to you, what you would like to eat, and maybe stomach gently growling
5. Neutral: not hungry or full
6. Slightly satisfied: will likely be hungry again in 1-3 hours.
7. Fully satisfied: Comfortably full, but would not want to eat more. Satisfied.
8. A little overfull: slightly uncomfortable, beyond full, stomach may feel really full but not painful
9. Stuffed: Past the point of comfort, full, stomach may hurt.
10. Sick, painful: uncomfortably full, feeling sick

5. Emotion surrounding meal

When this setting is visible for clients, they’ll be prompted to select a “mood” from a preset list of emotions. Clients learn how to distinguish between physical feelings (hunger pangs, nausea, headache, or difficulty concentrating) and emotional feelings. For more intuitive and non-diet based approaches to wellness, this setting can be an effective way to help clients achieve healthier eating habits, and a healthy weight over time.

If you enable this setting for your client, they will be able to select an emoji that reflect their mood at the time of logging.

Preset moods for clients to choose from:  

• Happy
• Stressed
• Tired
• Confident
• Anxious

6. Reflection on meal

For even deeper insights on emotions surrounding a meal, allow clients to provide a “Reflection.” These settings will prompt them to free-text any insights, thoughts or explanations surrounding the meal. In some cases, like with clients that have digestive issues, you may even want to use this setting as a way to document symptoms that a client experiences.

Default settings: eating disorders

When working with clients that have (or are recovering from) eating disorders, you can automatically set food journals to default to the “Eating Disorder” setting. Choose this as your default for all clients (ie if you work exclusively with eating disorders clients) or make it the default setting for an individual client. Client’s will NOT know or see that they are on an “eating disorder” default setting.

When turned on, this setting will:

• The following checkboxes in the “Food” section are turned on:
• Client can take pictures of food and comment
• Pre-meal Hunger and Post-meal Fullness
• Emotion surrounding meal
• Reflection on meal
• Turn off all “Metrics,” that are typically visible to clients (ie, weight, body fat)
• Turn off “Fitness” settings so that clients are not prompted to see or log workouts
  

Interacting with client’s via the Healthie photo food journal

As you scroll through food journal entries in your newsfeed, you’ll have two options to interact:

1. To simply mark a journal entry as “viewed,” you can click the glasses icon underneath the food picture. The glasses will become a darker blue color, indicating to both you and your client that you’ve seen it.
2. Comment on a journal entry to give specific feedback — comments can easily be made from the desktop or mobile app. Your client will receive a notification that there is a new “comment” for them to view, helping them stay informed of the feedback you’ve provided.

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Introducing Healthie’s photo food journal to your clients

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Setting expectations: how often will you review food journal entries?

One of the most important things to review with your client is how often you’ll be giving feedback. This expectation should be established based on your client’s specific needs, client load, philosophy and services.

Some guidelines to help you establish your practice expectations/policies:

• How often will you review food journal entries (every day, once a week, 2-3 times/week?)
• Will you leave comments on every food journal entry, or only as feedback is needed?
• Will you check the “glasses” icon on every food journal entry?
• How often will you expect your client to log their meals (every day? For the short-term or as a long-term commitment?)
• Does it cost extra for you to review food logs?

Generating income – including food journal reviews in your pricing

Reviewing food journals entries, especially if you have a higher client load, can be time-consuming. Many dietitians offer to review food logs with clients, but as this is not client-facing time, they don’t charge or bill for these services.

Many Healthie practitioners choose to include food diary reviews within their client packages. Through the platform, you can create and customize your service packages:

1. Include food journal reviews within a package (ie. 3 month Wellness package, including 1 initial session, 2 follow-up sessions and food diary reviews 2-3 times per week) → markup the rate for the additional time it will take you to review food logs
2. Offer food journal review as an add-on service (ie. you can offer a monthly subscription fee for regular food diary reviews)

Demonstrate how to use Healthie’s food journal with clients

Taking the time to walk client’s through how to log is best practice, even with your most tech-savvy clients. Show your client how to create a food journal entry (on mobile and/or computer). Walk through each of the features your client will see, and discuss how much detail you expect them to provide.

Many Healthie providers prefer to create a short video demonstrating how to use the Healthie app and photo food journal. Record your video on your phone and upload to YouTube or Vimeo. Copy the “share” link, and you can include this link in any of your intake forms or emails.

For Healthie members: here is our list of resources to support your wellness practice on the Healthie platform

Tracking Client’s Activity on Website and Mobile App

Best Practices for Client Logging

How to add a welcome video to share with clients