NOTE :  Yellow Boxes to be filled by user.

NAME *

AGE *

Sex *

Male Female

Female Pregnant Female Lactating

HEIGHT (Cms) *

BODY WEIGHT (Kg) *

WRIST CIRCUMFERENCE (Cms) *

BODY FRAME

IDEAL BODY WEIGHT (Kg)

MODE OF WORK *

NORMAL CALORIE REQUIRED

CLINICAL CONDITION

CALORIE TO BE INTAKEN

BODY MASS INDEX (BMI)

CLASSIFIED OBESITY DEGREE

BLOOD CHOLESTEROL (AFTER MEALS) *

STANDARD BLOOD CHOLESTEROL (AFTER MEALS)

BLOOD CHOLESTEROL (FASTING) *

STANDARD BLOOD CHOLESTEROL (FASTING)

AMOUNT OF NUTRIENTS TO BE CONSUMED (gram/day) : Refer Below
(If cooking, the nutrients should be weighed and then cooked)

NATURE OF FOOD *

GRAINS

LENTILS

SKIMMED MILK ( ml / day )

SKIMMED MILK POWDER (if not consuming milk)

DAIRY PRODUCTS

NUTS & OILSEEDS

EGGS

MEAT AND FISH

VEGETABLE OIL

GREEN LEAFY VEGETABLES

OTHER VEGETABLES

ROOTS AND TUBERS

FRUITS

WHITE SUGAR, BROWN SUGAR, JAGGERY

SUGAR PRODUCTS

SODIUM OR SALT

MULTIVITAMIN  MINERAL TABLET ( One / Day )

TYPE OF NUTRIENTS TO CONSUME / NOT TO CONSUME:

WHOLE GRAINS AND PRODUCTS

TO CONSUME

Rice, Wheat, Oats, Corn, Bran, Whole grain, Brown rice, Grits, Rice kanji, Wheat flour or any grain flour, Biscuits (from any grain), Brown bread, Parched rice, Wheat noodles, Muffins from wheat flour.

NOT TO CONSUME

Refined wheat flour, White bread, White Noodles, Macaroni, Semolina, Vermicelli, Puffed rice, Rice crispies, Sago, Cream biscuits, Oily biscuits, Cookies made with butter and oil

LENTILS

TO CONSUME

Whole green gram, Split green gram, whole black gram, Split black gram, Whole chick peas, Split chick peas, Dry field beans, Dried peas, Garbanzo beans, Red lentils, Soybeans, Sprouts (from any lentils).

NOT TO CONSUME

Lathyrus peas.

SKIMMED MILK AND SKIMMED MILK POWDER

TO CONSUME

Fat free cow’s milk or goat milk. If not consuming milk, use skimmed milk powder instead.

DAIRY PRODUCTS

TO CONSUME

Cottage cheese from skimmed milk, Fat free yogurt or low fat yogurt, Buttermilk, Tea & coffee from skimmed milk, Low fat and skimmed milk products.

NOT TO CONSUME

Full fat milk, Full fat milk products like cream, cheese, butter, ice creams, condensed milk, yogurt, buttermilk, Tea and coffee made from full fat milk.

NUTS AND OILSEEDS

TO CONSUME

All to be avoided. However at times, limited amounts of poppy seeds, sesame seeds and fresh coconut can be consumed if restricting the intake of vegetable oils and fats.

NOT TO CONSUME

Peanuts, Peanut butter, Dry coconut, Coconut milk, Almonds, Cashew nuts, Pistachios, Walnuts.

VEGETABLE OILS AND FATS

TO CONSUME

Olive oil, Sunflower oil, Groundnut oil refined, Corn oil, Sesame seed oil, Grape seed oil.

NOT TO CONSUME

Coconut oil, Palm oil, Mustard oil, Ghee, Dalda, Vanaspathi, Butter, Mayonnaise, Margarine, Lard, All fried foods like chips, fritters, etc.

GREEN LEAFY VEGETABLES

TO CONSUME

Amaranth, Cabbage, Cilantro (Coriander leaves), Curry leaves, Drumstick leaves, Fenugreek leaves, Lettuce, Mint, Spinach, Kale, Collard greens, Celery leaves, Parsley, Mustard spinach, Cress, Chard, Endive.

OTHER VEGETABLES

TO CONSUME

Ash gourd, Bitter gourd, Eggplants, Broad beans, Cluster beans, French beans, Double beans, Cucumber, Cauliflower, Broccoli, Asparagus, Drumstick, Kohlrabi, Green plantain, Ridge gourd, Snake gourd, Bottle gourd, Tomato (green and red), Bell peppers (Capsicum).

NOT TO CONSUME

Okra, Yellow pumpkin

ROOTS AND TUBERS

TO CONSUME

Onion, Potato, Beetroot, Carrot, Radish, Sweet potato, Yam, Turnips.

NOT TO CONSUME

Colocassia, Tapioca.

FRUITS

TO CONSUME

Gooseberry, Apple, Grapes, Guava, Pear, Tangerine, Musambi, Orange, Water melon, Ripe papaya, Pine apple (limit), Pomegranate (limit), Peaches, Grapefruit, Cantaloupes, Apricots, Nectarines (limit).

NOT TO CONSUME

Figs, Prunes, Raisins, Banana, Plantain, Custard apple, Dates, Jackfruit, Ripe mango, Plum, Chickoo, Tender coconut water, Fruit juices (if consuming whole fruits, no fruit juices are allowed).

SUGAR, JAGGERY AND SUGAR PRODUCTS

TO CONSUME

Brown sugar, Jaggery, Molasses, Honey (limited).

NOT TO CONSUME

Candy, Soft drinks, Syrups, Jams, Jellies, Artificial sweeteners, White sugar, Puddings, Desserts, Custard, Chocolate, Honey.

MEAT AND FISH

TO CONSUME

Small portions of chicken without the skin, Lean meat. Meat should be boiled, steamed or baked without butter and not fried. Fresh and salt water fish to be boiled, grilled, steamed or baked with oil and without butter and not fried.

NOT TO CONSUME

Red meats like pork, beef, lamb, goat. Organ meats like liver, heart, brain, and kidney. Processed meats like salami, sausages, hot dogs, pepperoni, bacon, and ham. Shell fish like crabs, prawns, shrimps, oysters, lobsters. Avoid fried meat and fish.

EGGS

TO CONSUME

Hens egg preferably egg white.

NOT TO CONSUME

Ducks egg, Egg yolk.

SODIUM OR SALT

TO CONSUME

10 – 15 grams per day of iodized salt.

MULTIVITAMIN MINERAL TABLET

TO CONSUME

One tablet per day rich in Vitamin B1, B2, B6, B12 and minerals. Should contain iron in ferrous (Fe2+) form. Iron in the ferrous form is better absorbed by the body than the ferric form (Fe3+).

NOT TO CONSUME

Avoid all weight reducing drugs and tablets. Instead moderate exercising is a good remedy for reducing obesity. For example, walking 3 miles a day will expend about 300 calories.