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OUR PRIORITYYour Family's HealthJOURNEYJOURNEYJOURNEYWEIGHTWEIGHT LOSSLOSS WEIGHT LOSS NAME IC NO GENDER TEL NO ADDRESS MALE ( ) / FEMALE ( ) WEIGHTWEIGHTWEIGHT LOSSLOSSLOSS WEIGHT LOSSJOURNEYJOURNEYJOURNEYJOURNEY
Gender Low Risk Increased Risk (Asian Cut-off) High Risk (WHO Standard) Men <90 cm ≥90 cm ≥102 cm Women <80 cm ≥80 cm ≥88 cm 1. BODY MASS INDEX (BMI) ➡ For Asians, health risks (diabetes, heart disease) appear at 90 cm (men) and 80 cm (women).Reference: CPG_Management_of_Obesity_(Second_Edition)_2023 2. WAIST CIRCUMFERENCEOUR PRIORITYYour Family's Health 1
References: CPG_T2DM_6th_Edition_2020_13042021 CMSH Hypertension CPG 2018 V3.8 FACategory Fasting Plasma Glucose (FPG) 2h Plasma Glucose (OGTT*) Random Plasma Glucose Normal <6.1 mmol/L <7.8 mmol/L — Impaired Fasting Glucose (IFG) 6.1 – 6.9 mmol/L — — Impaired Glucose Tolerance (IGT) — 7.8 – 11.0 mmol/L — Diabetes (T2DM) ≥7.0 mmol/L ≥11.1 mmol/L ≥11.1 mmol/L + symptoms *OGTT = Oral Glucose Tolerance Test (measured 2 hours after 75g glucose load). ➡ Summary: Prediabetes = IFG (6.1–6.9 mmol/L) or IGT (7.8–11.0 mmol/L). Diabetes = FPG ≥7.0 mmol/L or 2h OGTT ≥11.1 mmol/L or random ≥11.1 mmol/L (with symptoms). 3. GLUCOSE 4. BLOOD PRESSUREOUR PRIORITYYour Family's Health 2
Date of assessment: Known Medical Co-morbidities: Occupation: INITIAL HEALTH ASSESSMENT Height : ................................ Weight : ................................. BMI : .................................. Classification of BMI: ...................... Blood Pressure : ................................. Heart Rate : ................................. SpO2 : ..................................1.Full Blood Count Total White Cell Haemoglobin Platelet2. Renal Function Profile Creatinine Urea Sodium Potassium Calcium Uric Acid Etc4. Fasting Lipid Profile Total Cholesterol Triglycerides HDL Cholesterol LDL Cholesterol5. HbA1c6. Urine FEME: ...................: ...................: ...................: ................... Blood Test:: ...................: ...................: ...................3. Liver Function Profile Albumin ALP ALT AST Etc: ...................: ...................: ...................: ...................: ...................: ...................: ...................: ...................: ...................: ...................: ...................: ................... 37. Vit D8. TSH: .................................: .................................: .................................: ..................................................................9. Others: ...................................................................................................
Measurement Midarm Circumference Breast Circumference Waist Circumference Buttock Circumference Thigh Circumference: .....................: .....................: .....................: .....................: ..................... Body Composition AnalysisOUR PRIORITYYour Family's Health Additional Notes: 4 Weight Loss GraphWeight (kg)Time (Weeks)W1W2W3W4W5W6W7W8W9W10W11W12W13W14W15W16W17W18W19W20Instruction Note to Physician: This form is a blank template for tracking progress. Please manually enter the numerical scale (kg) on the vertical axis, starting with the patient's current (first) weight and marking the Target weight. Plot a data point for each weekly check-in. Consistent tracking helps guide adjustments to the patient's weight.Target Weight:First Weight:
Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:WEIGHT PROGRESSION ASSESSMENT 5 Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:Minum 500ml air sebelum makan boleh meningkatkan kadar metabolisme sebanyak 30% selama sejam!Mulakan hidangan dengan sayur-sayuran (Suku-Suku Separuh). Serat membantu anda rasa kenyang lebih lama dan mengawal paras gula darah.Power of WaterFiber & Satiety
Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:WEIGHT PROGRESSION ASSESSMENT 6 Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:Fakta: Kurang tidur meningkatkan hormon Ghrelin (lapar) dan menurunkan Leptin (kenyang). Pastikan tidur 7-8 jam untuk kawal selera.Sleep & WeightFakta: Penurunan 5%–10% berat badan mampu menurunkan tekanan darah sistolik anda secara signifikan.Consistent BP
Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:WEIGHT PROGRESSION ASSESSMENT 7 Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:Tips: Berhati-hati dengan "Sos" dan "Kicap". Ia sering mengandungi gula tersembunyi yang boleh membantutkan penurunan berat badan anda.an menurunkan Leptin (kenyang). Pastikan tidur 7-8 jam untuk kawal selera.Hidden SugarOtot lebih tumpat daripada lemak. Jika berat anda statik tetapi baju terasa longgar, itu tanda anda sedang membina otot dan membakar lemak serentak!Fakta Otot vs Lemak
Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:WEIGHT PROGRESSION ASSESSMENT8 Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:Ukuran pinggang yang melebihi 90 cm (lelaki) atau 80 cm (wanita) meningkatkan risiko penyakit jantung dan kencing manis secara mendadak.Fakta Ukur Lilit PinggangPengambilan garam berlebihan boleh menyebabkan badan menyimpan lebih banyak air (water retention), yang membuatkan berat badan pada penimbang nampak statik atau naik.Garam & Water Retention
Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:WEIGHT PROGRESSION ASSESSMENT9 Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:Mengambil protein yang cukup (seperti telur atau dada ayam) semasa fasa penurunan berat badan membantu mengekalkan jisim otot dan membakar lebih banyak lemak.Protein untuk OtotOtak memerlukan masa sekitar 20 minit untuk menerima isyarat "kenyang" daripada perut. Makan dengan perlahan membantu mengelakkan pengambilan kalori berlebihan.Fakta Kunyahan
Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:WEIGHT PROGRESSION ASSESSMENT10 Date: BP : PR: Weight: BMI: Measurement : Midarm: Sleep Duration (hours): Breast : Medications: Waist : Buttock : Thigh : Notes: Exercise:Ujian HbA1c (seperti yang terdapat dalam senarai ujian darah di muka surat 3) adalah penting untuk memantau purata kawalan gula darah pesakit dalam tempoh 3 bulan yang lalu.Kepentingan HbA1cMencatatkan berat badan dan ukur lilit (seperti Midarm, Breast, Waist, Buttock, dan Thigh) secara mingguan membantu anda melihat perubahan komposisi badan walaupun angka pada penimbang tidak berubah banyak.Konsistensi Rekod
Your Family’s Health OUR PRIORITY