Our Methodology

What the HRA is

The HRA asks 35 questions in six sections. Every question is answered on the same four-point scale, scored 0 to 3, where 0 is the lowest-risk answer and 3 the highest. The total is the plain sum of the answers, so it runs from 0 to 105.

There are no weights, multipliers or hidden coefficients. Every result can be traced back, question by question, to the answers that produced it, and the cut-offs that turn a score into a band are published on this page. The scoring is fixed and identical for every person. Personalisation happens afterwards, in the coaching programme, and never inside the measurement.

Four rules governed how each question was written. Each question targets a named physiological signal rather than a general impression of wellbeing. Questions ask about frequency and pattern (how often a meal is skipped, what most food is cooked in) rather than asking people to recall quantities they cannot estimate accurately. Where a condition progresses in stages, the options form a ladder and the respondent picks the highest step that applies. And options are ordered by risk, not by quantity, which matters for the one question where risk is not a straight line: protein intake, where both too little and heavy supplementation are scored as load.

The Six Sections

The sections are ordered for the person answering: everyday routine first, and the more sensitive questions about tobacco, alcohol and oral health last. Each section is banded separately, so your report shows where risk is concentrated rather than only a single number.

How a Score Becomes a Band

Sections have different maximums, so a raw point count would not mean the same thing from one section to the next. Every score is therefore read as a proportion of its own section's maximum, and one pair of cut-offs is applied identically to every section and to the total. A score of 8 is Amber in a 21-point section and Red in a 15-point section, because 8 out of 21 and 8 out of 15 are not the same finding.

In points, for version 3, that gives:

Measurements and Clinical Escalation

The band in your report is the product of three separate layers. Keeping them apart is what makes the result explainable.

A questionnaire that adds up symptoms will under-rate a person whose disease is confirmed but causing no symptoms yet, which is exactly the person preventive care exists to reach. The escalation rule corrects for that, and it is deliberately narrow:

• A confirmed finding moves the overall band up exactly one step: Green to Amber, Amber to Red. Red stays Red.
• One step in total, however many findings apply. Someone who is diabetic, on blood-pressure medication and clinically obese moves one step, not three.
• What counts: diagnosed diabetes; blood pressure or cholesterol that is being treated with medication; a diagnosed condition recorded on your file by your coach or doctor (fatty liver, heart condition, high lipids, hypertension, kidney condition, neuropathy, PCOS or thyroid disorder); a BMI of 25.0 or above; and a waist at or above 90 cm for men or 80 cm for women.
• What does not count: pre-diabetes, or a reading that was once high and returned to normal with lifestyle change. Pre-diabetes is the stage at which lifestyle change works best, so it is treated as a reason for optimism rather than for a longer programme.
• Escalation never lowers a band, and every escalation carries a plain-language reason that is shown in your report.
• Where your answers and the clinician's record disagree, the clinician's record decides, and the difference is raised with your coach rather than silently resolved.

Three findings also place a safety hold on the programme, separate from the band: weight loss over the past year that you cannot account for, a BMI below 17, and a BMI of 40 or above. A coach cannot publish a programme for that person until medical review of the finding has been acknowledged. Unexplained weight loss is a recognised warning sign whose causes (thyroid disease, developing diabetes, malabsorption, infection and others) are found by investigation, not by a diet plan.

Body Mass Index and Waist: Indian Thresholds

BMI is calculated from your height and weight and assessed against Indian clinical thresholds: the consensus statement for Asian Indians published by Misra et al. in the Journal of the Association of Physicians of India (2009;57:163-170), carried forward by the 2025 India Obesity Commission revision. Indians develop metabolic complications at lower BMI values than Western populations, so Western thresholds would understate risk here. These are the clinical consensus numbers, not the population-monitoring action points of 23 and 27.5 that some Indian dietary guidance uses.

Waist is asked as a trouser-size band, because a self-measured waist is unreliable, and it is stored as the lower edge of that band so that rounding can never trigger an escalation. Waist escalation is applied only where a published South Asian threshold exists for the person's recorded sex. We do not invent a cut-off where none has been published.

Versioning

The instrument is versioned. Every stored result records the version that produced it and is always scored and banded against that version's own maximum, so an earlier result is never re-read against a later scale. Because bands are proportions, a result keeps its meaning across versions.

Validation Status

There are two different claims here, and we keep them apart.

What is established. The relationships each section is built on are well supported by published research, most of it large, long-running and independent of us: that smoking, blood pressure, diabetes, abdominal obesity, diet, activity, alcohol and stress account for most heart-attack risk, including in South Asians; that eating patterns carry measurable metabolic information; that lifestyle change prevents diabetes in Asian Indians; that gum disease is associated with cardiovascular disease; that a person's own rating of their health predicts outcomes. The evidence table below sets this out, section by section.

What is not yet established. Good science behind the questions does not make the instrument validated. Whether this particular score, with these particular cut-offs, corresponds to findings a clinician can measure in the individual (blood sugar and HbA1c, lipids, blood pressure, inflammatory markers) has not yet been tested by anyone independent of Healthness+. Nor has the effect of our programme on those measures.

We are seeking independent validation of both: studies designed, run and published by investigators with no stake in the result, including a null result. The instrument would be frozen for the duration, with no question, option, score or cut-off changed. Until such a study reports, the HRA should be read as what it is: a transparent, structured screening instrument, not a validated diagnostic test.

Evidence Base

Read this table as a statement about the general relationship in each row, not about our instrument. None of these sources tested our questions, scoring or cut-offs.

References

1. Yusuf S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937-952.
2. Anjana RM, et al. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol. 2023;11(7):474-489.
3. Ramachandran A, et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006;49(2):289-297.
4. Misra A, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163-170.
5. Lentjes MAH, et al. Meal patterns and postprandial triglyceride and glucose concentrations: a cross-sectional analysis in the EPIC-Norfolk cohort. Nutrients. 2022;14.
6. McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med. 1993;153(18):2093-2101.
7. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21-37.
8. Sanz M, et al. Periodontitis and cardiovascular diseases: consensus report. J Clin Periodontol. 2020;47(3):268-288.
9. Fendrich R, et al. Validation of a gut-brain axis questionnaire in psychiatric disorders. Psychiatry Res. 2022;315.

The Four-Pillar Programme

Every Healthness+ programme, regardless of band, addresses the same four pillars, calibrated to the intensity your risk profile requires.

Our programme design is also shaped by ongoing input from our medical advisor, Dr. Prakash Biranje, BAMS, to ensure that wellness recommendations remain within safe boundaries and are consistent with current preventive-medicine guidelines. The instrument is designed and maintained by Healthness+ (Zadok Ventures India Pvt Ltd), Bengaluru.