The diet prescription is generated using a software program developed by the author. The program is named as “Suwa Posha”. The program takes an input of 5 parameters. They are weight, height, age, sex, body size, activity levels, food preferences and the diet type. The diet types mainly used for this study are normal diet, diabetic diet, DASH diet, Mediterranean diet and very low calorie diet (VLCD). With this input the program writes a diet prescription which

1) Portion controlled meals
2) Sri Lankan foods
3) Freely available Sri Lankan foods
4) Many healthy eating patterns suggested by various authorities are incorporated (number of fruit servings, number of vegetable servings, regular and spaced out meals, calorie balance, nutritional balance)
5) Inclusions of user preferences
6) Changes of macronutrient compositions of meals – depending on the medical problems co-existing
7) Changes in the calorie deficits in the meals
8) Emphasis on 6 meals per day without skipping any meal
9) Incorporation of emerging evidence in dieting – mediterranean diet, OMNI heart diets
10) Avoidance of inappropriate food fads
11) Implementation of new findings on human nutrition into your meal plan right away :
a) new ideas of diabetes management – vegetarian diets, adding sugar and sweets witin daily calorie balance
b) new ideas about snacks’ sugar an salt substituted by fruits and starch servings within the daily calaroie balance
c) OMNIHEART diet concepts
d) MEDITERRANEAN diet concept

1) Identification of the client by the author – first consultation or the subsequent consultation
2) Required measurements are recorded by a trained practice nurse – for every patient in every consultation
3) The measurements taken are – height in centimeters, weight in kilos, neck circumference, arm
circumference and waist circumference in centimeters
4) In case of follow up consultations the same nurse records all the measurements again
5) Repated measurements of height is used to assess the accuracy of the other measurements
6) Also the changes in the anthropometric values are correlated with the patients’ perceptions
7) These are evaluated by asking the following questions :

a) Do you feel the less heavier than few weeks back – usually felt within 1-2 weeks
b) Do you feel the waistline of your dress getting loser
c) Do you feel the chest and back of the chest getting thinner as felt by loser T-shirts and jackets
d) Do you feel the neck getting thinner as felt by less tight collars and ties
e) Do you feel the upper arm getting thinner as felt by the shirts and jackets getting loser

The answers to these questions guide us as to the fat loss and weight loss more accurately than the weighing scale and waist line measurements – reasons for this are weighing scales are not  scientifically accurate, anyway there are day to day changes in the weight which is a common
thing particularly in females.

8) Prescription generation using the web based service of the hospital – a menu plan of foods for a day to be taken for a week is generated. See the appendix for a typical menu plan.
9) Patient is given the following instructions :

a) A menu plan for 1 week given
b) Advice on how to get a 300 ml cup and 15 ml tablespoon
c) All food measurements are for cooked foods
d) Preparation method irrelevant – prepare food tastily, advised to have a wholesome meal
e) Portion size emphasized
f) Same menu plan for 1 week emphasized
g) Every 1 week menu plan is changed and a new menu plan for next week given
h) Every 10 th visit threshold diets are prescribed to challenge the body adaptations
i) After 10th diet food substitution is encouraged based on the already prescribed diet sheets
j) Plateau break diets are prexcribed as and when necessary
k) Exercises are not a part of this diet service and actively discouraged in very low calorie diets
l) Exercises are necessary for many other health benefits

9) Appointment for follow up in week’s time (56) – patient is told the following facts – weight
reduction is achievable, fat loss is achievable, pre-diabetes and pre-hypertension are definitely normalized,
repeated follow ups until targets are essential, after several weeks a nutritional rehabilitation is taking place (see the appendix for definition of this nutritional rehabilitation), steps in food exchanges (Appendix)
10) Follow up targets – more than 3% weight loss, more than 3% fat loss, normalization of blood sugar in pre-diabetes, normalization of BP in pre-hypertension, achievement of target blood sugars  in DM, achievement of target BP in HT, achievement of any other patient directed targets
11) Nutritional rehabilitation emphasized

1) Weight loss
2) Waist loss
3) Normalization of prediabetes
4) Normalization of high blood cholesterol
5) Normalization of high blood triglycerides
6) Weight benefit loss for arthhritis, sleep apnnea syndrome, surgery and anaesthesia risks

Follow the steps below:

1. Carry out an online diet consultation at our website (http://digayu.com/cameosDieting.php)
2. Select the prescribed diet sheet from the product list (currently only VLCD Sri Lankan foods and VLCD American foods APPS only available)
3. Make the payments and download diet prescription
4. Follow the diet prescription for 1 week
5. Renew the diet prescription after 1 week
6. Repeat the steps 2 – 5 until the targets of weight management achieved
7. If yes exit the process. If no start from step 1 again. If after 6 weeks no response consults your family physician or endocrinologist

1) Serving sizes shown are for cooked foods and prepared meals
2) All the 5 meals have to be taken and they are to be equally spaced out in time
3) Your fat and oil consumption should be that of a average sri lankan cuisine
4) Same meal plan for the entire week
5) Come again after 7 days for the next diet plan
6) Only the foods shown in the meal plan to be taken – no other extra foods
7) Tea means tea or plain-tea in sri lankan terms – no milk unless otherwise prescribed
8) Buy a cup which measures 300 ml and a table spoon which measures 15 ml – cup or table spoons are not your cup at home nor spoons kept on your tables
9) You can drink water unlimited – BUT NO OTHER FOOD except those shown in the meal plan
10) These meal plans will achieve weight loss and waist loss both – during the dieting program sometimes weight is lost, sometimes waist is lost, sometimes both lost – but it surely will occur. We have achieved weight losses upto 40 kg with dieting alone
11) No need of exercise for weight loss during this dieting program –
12) Expected outcome – weight loss, waist loss, decreased pigmentation, regular menses, decreased abdominal girth, increased fitness and decreased fatigue
13) There are many other things to do during a course of dieting programs which help to achieve your goals they are :
Timers – 20 min meal time, eat slowly without gulping down the throat
Sleepers – avoid short sleep duration, normal sleep pattern essential
Yoga – mindfullness meditation helps responsiveness for inner body signals, so that more sensitive for meal taste, hunger and satiety signals
Eating pause – first pause after a meal is started to be noticed. Stop eating therabouts
Eating slowly – essential for GIT hormone action sensors
Chewing gum – in between meals’

Exercises
Habituation – habit formation for eating behavior => daily repetition => 66 days
Identify emotional eating – See in dietingebm.txt

1) Weight loss
2) Waist loss
3) Weight gain
4) To reverse prediabetes
5) To reverse prehypertension
6) To reverse early hypercholesterolemia
7) To reverse atherogenic dyslipidemia
8) To achieve diabetes control
9) To achieve hypertension control
10) To achieve hyperlipidemia control
11) Management of food allergy
12) Management of chronic kidney disease
13) Management of lactose intolerance
14) Management of food inntolereances
15) Weight loss prior to surgery
16) Management of arthritis
17) Management of sleep apnea syndrome
18) Management of high cardiovascular risks
19) Management of high cancer risk
20) To reverse cachexia of chronic diseases like cirrhosis, cancer, heart failure, chronic renal failure
21) Management of failure to thrive in childhood
22) Management of skin problems – acanthosis, eczema,
23) Management of asthma, COPD
24) Personal requirements

Please follow the the steps below for dieting using our eHealth services

1) Select the group to which you belong :
a) Healthy and fully functional
b) Diabetes
c) High cholesterol
d) High triglycerides
e) High blood pressure
f) Mixture of diabetes, cholesterol, triglycerides
g) Kidney failure
h) All the rest

2) If you are in any category other than “a” please do a initial diet consultation through our website
3) If you are in “a” make sure healthy means free of any known disease
4) If you are in “a” make sure you are fully functional – that means you are engaged in your day to day routines as expected
5) Check your weight in kilos and decide which category now you belong to :
6) Weight between 70-110 kilos and the rest
7) If you are in the 70-110 kilos you can follow our diet programs online without any supervision
8) All the others a diet consultation through our website OR Family Physician or Endcrinologist advice is required