Obesity Meal Planner

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name: obesity-meal-planner
description: Step-by-step meal planning for a patient with obesity — from diet recall to calorie prescription to macronutrient targets. Use when a clinician asks "how do I plan a diet for my obese patient", "what calorie target for weight loss", "how many calories should I prescribe", "meal plan for obesity", "diet plan for overweight patient", or needs to build an individualised dietary prescription at the clinic.
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# Obesity Meal Planner — Step-by-Step

## STEP 1 — Diet Recall (What Is the Patient Actually Eating?)

Ask about a typical day's intake:
- Breakfast, lunch, dinner, snacks, beverages (tea/coffee with sugar, juices)
- Portion sizes (bowls, rotis, cups)
- Eating out frequency, fried foods, sweets

**Goal:** Estimate current daily calorie intake. This anchors the gap between current intake and the target you'll prescribe — and makes the deficit feel concrete to the patient.

> Example: A patient consuming 2,000–2,500 kcal/day needs to see that their "normal" lunch alone can be 900+ kcal.

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## STEP 2 — Calculate Ideal Body Weight (IBW) & Calorie Target

**IBW using Broca's Index:**
- Men: IBW (kg) = Height (cm) − 100
- Women: IBW (kg) = (Height (cm) − 100) × 0.85

**Calorie prescription based on activity level:**

| Activity Level | Daily Calorie Requirement |
|---|---|
| Sedentary (desk job, minimal exercise) | 20–25 kcal/kg IBW |
| Moderate (light exercise 3–4x/week) | 26–30 kcal/kg IBW |
| Strenuous (physical labour or daily intense exercise) | 31–35 kcal/kg IBW |

**For weight loss in obesity → use the sedentary range (20–25 kcal/kg IBW) regardless of actual activity**, to create a meaningful caloric deficit.

> Example: Height 155 cm male → IBW = 55 kg → Target = 55 × 20–25 = **1,100–1,375 kcal/day**
> (Round to ~1,200 kcal/day for simplicity)

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## STEP 3 — Assign Macronutrient Targets

Based on ICMR-NIN Dietary Guidelines for Indians 2024:

| Macronutrient | % of Total Calories | Grams (at 1,200 kcal) |
|---|---|---|
| Carbohydrates | 45–55% | 135–165 g |
| Protein | 20–25% | 60–75 g |
| Fat | 20–25% | 27–33 g |

**Approach: Balanced diet with calorie restriction** — not low-carb, not low-fat. This is the most sustainable strategy for long-term weight management.

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## STEP 4 — Quality of Macronutrients (What to Eat Within the Targets)

**Carbohydrates — prefer complex over simple:**
- ✅ Whole grains (ragi, jowar, bajra, oats, brown rice), dal, legumes, vegetables
- ❌ White rice in large portions, maida (refined flour), sugary drinks, biscuits, packaged snacks

**Protein — prefer lean sources:**
- ✅ Dal, legumes, sprouts, low-fat curd/paneer, egg whites, fish, skinless chicken
- ❌ Fried paneer, full-fat cheese, processed meats

**Fat — prefer unsaturated:**
- ✅ Small amounts of nuts (4 almonds + 1 walnut as snack), seeds, olive/groundnut oil
- ❌ Ghee in excess, butter, fried foods, coconut oil in large quantities

**The Indian Food Plate (visual guide):**
- ½ plate = vegetables (2 portions)
- ¼ plate = starch/cereal (1 portion)
- ¼ plate = protein (dal/legume/lean protein)
- + 1 portion fruit + 1 portion curd/milk

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## SAMPLE MEAL STRUCTURE (~1,100–1,200 kcal)

| Meal | Example (Indian) | ~Calories |
|---|---|---|
| Breakfast | Vegetable upma 1 bowl + curd 1 bowl | 248 kcal |
| Lunch | 1 phulka/¾ bhakri + dal 1 bowl + vegetable 1 bowl + curd 1 bowl | 388 kcal |
| Snack | 1 small fruit + 4 almonds + 1 walnut | 148 kcal |
| Dinner | Vegetable oats/1 phulka + salad 1 big bowl + vegetable 1 bowl + curd | 320 kcal |
| **Total** | | **~1,104 kcal** |

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## CLINICAL GUARDRAILS

- **Never prescribe below 1,000 kcal/day** without specialist supervision — risks micronutrient deficiency and muscle loss
- **Don't skip the diet recall** — patients frequently underestimate intake by 30–40%; the gap between their perception and reality is a powerful motivational tool
- **Use IBW, not actual weight** — calculating calories on actual obese weight sets the target too high and defeats the purpose
- **Protein is the most under-consumed macronutrient** in typical Indian vegetarian diets — explicitly counsel on protein sources
- **Snacks are often the hidden calorie bomb** — a plate of pav bhaji at snack time = 400 kcal, which is 35% of the entire day's budget

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*Source: CCOPM Module 3 — Practical Approaches to Lifestyle Management in Obesity. ICMR-NIN Dietary Guidelines for Indians, 2024. The Washington Manual of Medical Therapeutics, 37th ed., Wolters Kluwer, 2024.*