Abstract Introduction : Diet and nutrition play a significant role in many chronic non-communicable diseases. Therefore dietary changes occupy a prominent position in prevention and treatment of such diseases. A number of literature has been described the effectiveness of nutrition counseling in changing the dietary habits. Moreover, nutrition counseling and education by using visual tools are believed to be more effective and more communicable. Therefore, the researchers have been developing various counseling and education tools to facilitate nutrition care process. Among them, the Food Exchange List was one of the best inventions by the nutrition researchers. It was originally developed the American Dietetic Association, the American Diabetes Association and the United States Public Health Service, in 1950. Methodology : This was an action research which was mainly carried by qualitative approach. The 2008 ADAs food exchange list was the initial starting point of this research. To make culturally sensitive food exchange list, foods that were inconsistent with Myanmar culture were removed after market research. Then the interviews were conducted 25 diabetic and-or obese or overweight patients to know most common foods consumed by this target population. The foods resulting from the interviews and suggestions from the experts were added to the list. The foods removed from the original list were fast foods, combination foods and other 158 items. The 47 food items were added including Myanmar traditional snacks and therefore the final list had 315 food items under the 9 food groups. Then the required nutrient values of the added foods were calculated according to the food groups. The nutrient information for 100 grams of foods was obtained from Asian and Myanmar Food Composition Tables. After calculating one exchange serving for each food, this amount in grams was expressed by using household utensils. When the full list was obtained, flashcards for one exchange serving for certain popular foods were created by providing carbohydrate, protein, fat and energy contents in the back of the cards. Then the research was evaluated by assessing user opinion. The individual depth interviews were done with 4 nutritionists and 6 patients. Then theme analysis was done their interviews. Result : The developed Myanmar Food Exchange List includes total 315 food items under the 9 food groups, namely starch, fruits, milk and milk substitutes, nonstarchy vegetables, sweets, desserts and other carbohydrates, protein, fats, free foods, and alcohol. According to the results of interviews, the developed tool was said to be useful in both nutrition counseling and education and beneficial for both nutritionists and patients. It was applicable, portable, visual, interesting and culturally sensitive. It could also be used by other health care professionals. Conclusion : The tool resulted from this research was effective in the communication between nutritionists and patients.