CASE HISTORY

Case history

PUBLISHED : Tuesday, 14 August, 2012, 12:00am
UPDATED : Tuesday, 14 August, 2012, 1:09pm

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At 33, Mark Teng was riding high. He had a successful business, a loving and supportive family, a romantic relationship and many friends.

Teng (whose name has been changed for patient confidentiality reasons) had an appetite for life that was mirrored in his appetite for food. Weighing in at 127kg, he would eat four to five large meals a day. It was no surprise that his childhood nickname was fei jai (fat boy).

But Teng received some sobering news when his family doctor told him he had a fatty liver, marginal blood glucose and hypertension that required medication to control.

Other than a brief dalliance with a weight-loss drug with temporary results, Teng had never tried to slim down. But now his health was on the line, he knew he had to shape up. His doctor referred him to Flavia U, senior dietitian at the Hong Kong Sanatorium and Hospital.

Teng hated the idea of seeing a dietitian because he thought he would be told only about the things he could not eat. In the two weeks before his appointment, wanting to get a head start, he went on a crash diet and ate only fruit and vegetables. He shed 4.5kg.

When he finally saw U and proudly reported his success, he was surprised when U expressed concern. "I was worried that he was not getting enough nutrition, and that would affect his metabolism in the long run," she says.

She explained that a diet that was too low in calories could result in fatigue, headaches and mood swings. Teng admitted that in those two weeks, he had suffered extra thirst, fatigue and headaches.

Aside from the immediate discomfort, a very low-calorie diet could also train the body to get used to the reduced intake and start to conserve energy as best it can. When the person eventually starts to eat more or eat normally, the body will absorb more nutrition and hoard the calories so that it will be even harder to lose weight in the future.

Furthermore, an unbalanced diet will result in a lack of coenzymes, organic substances that usually contain a mineral or a vitamin that helps balance the metabolism.

Teng weighed 119.3kg and was 1.76 metres tall. This gave him a body mass index of 38.5, well over the ideal Asian BMI of 23. (Many Asian countries adopt a lower ideal BMI than the American standard of 25 because studies show that Asian physiques tend to carry more fat.) He was classified as being severely obese. More importantly, his body fat was 38.9 per cent, almost double the ideal of 20 per cent or less for males.

U took a careful account of what Teng's typical food intake had been before the drastic two-week diet. In a typical day, Teng would start with breakfast at a cha chaan teng where he would eat rice noodles and pork chop macaroni. Lunch was a plate of rice with pork chop and sauce but no vegetables. Afternoon tea was a must, and sweet confections were favoured. Dinner often consisted of two bowls of rice and at least 11/2 bowls of meat. The day wasn't done until he had had instant noodles or some other pre-packed frozen meal for supper.

U estimated that Teng ate an average of 3,000 calories a day and sorely lacked fruit and vegetables. She asked about his lifestyle, preferences and food aversions, and found that, in addition to his recently discovered health woes, he frequently had diarrhoea, especially after meals. He also often suffered from colds and flu.

U devised a 1,900-calorie plan that enabled Teng to feel sated as well as give him healthy choices that he could easily access. He could still eat meat but in smaller portions, such as eight slices of roast pork. He could still eat at the cha chaan teng, but he had to pick healthier non-fried options such as ham instead of pork chop or luncheon meat.

He had to eat plenty of fruit and steamed vegetables, which he eventually grew to enjoy. Two or three times a week, he could indulge in a dessert. Teng had to be vigilant about the amount of sauce he used, however, as gravy contains a lot of fat and salt.

U encouraged him to enjoy one "free" day a week where he could eat as he pleased - this helped him to stay motivated and kept him from feeling deprived. She says that controlling a diet too strictly frequently leads to cravings and a failure to sustain weight loss. It can even result in eating disorders such as anorexia and bulimia.

Teng was astonished by the "generous" diet plan, but more astounding was the weight loss that followed. The tweaks in his diet led to an unexpectedly rapid weight loss of about 6kg a month. His chronic diarrhoea disappeared, as did the frequent flus and colds. His blood glucose normalised, and the fatty liver and hypertension abated. He no longer needed medication. At the end of six months, he reached his target weight loss of 36kg and his body fat dropped to a healthy 19 per cent.

Buoyed by his remarkable - and relatively painless - success, Teng became a poster boy and enthusiastic advocate of a dietitian-guided weight-loss plan. He started recommending everyone in his family and circle of friends to see U. In all, he sent about 60 people to her. His girlfriend lost 13kg.

His campaign for healthy eating did not end there. Teng influenced his business associates to eat healthier during business lunches. He also created a healthier work environment for his staff by stocking his office pantry with low-fat options such as non-fried noodles, soda crackers and sugar-free drinks.

U says that healthy, sustained weight loss is possible if people have a realistic and workable plan and learn to make gradual changes.