Health assessment: Tania

We look at Tania's eating and exercise habits and give her some advice.

Subject

Tania is a 33-year-old mother of three who would be considered a normal Kiwi stay-at-home mum: except for the fact that most of the year she lives in Japan.

• Age: 33 years
• Height: 1.65m
• Weight: 77.5kg
• BMI: 28.5kg

Tania's goals

• Weight loss
• Improve fitness

While her husband works as a trainer with a rugby team in Korea City, Japan, Tania has a daily battle off the field with her little ones (aged 1, 3 and 5) and her weight.

Tania's current eating habits

• Breakfast: Cornflakes, milk and yoghurt or porridge, raisins and soy milk. Breakfast always includes a coffee (including milk and sugar).
• Morning tea: Usually nothing.
• Lunch: Often purchase noodle or rice dish (minimal vegetables) or cheese and ham on toast. Purchased rolls are also common and miso soup is often included.
• Snacks: Tania has sweet cravings: biscuits, chocolate or some of the kids' afternoon treats are common. Rice crackers are also a favourite.
• Dinner: Spaghetti bolognese (minimal vegetables), rice stir-fry with chicken or beef and vegetables, or roast dishes. Macaroni cheese is also a favourite.
• Dessert: A chocolate bar or ice-block most often.

In the past, Tania has gained a lot of weight when returning to New Zealand over the summer holiday break and has a self-proclaimed sweet tooth. She doesn't eat any fresh fruit and enjoys a small amount of milk each day (including soy). She drinks plenty of water and has a few alcoholic beverages each week.

She enjoys adding cheeses, dressings and sauces to her meals and buys takeaways a few times each week including Japanese meals (some of which are healthy) and the occasional burger, fries and soft drink as a comfort.

Tania's current exercise regime

Although she goes through sedentary periods, Tania does have a history of gym programmes. She has not done much exercise since before giving birth to her one-year-old baby. Her VO2 max is 30.25 ml/kg/min (fair).

She recognises she feels best – more mentally alert and positive – when she includes exercise in her weekly routine. Her best results have been when she exercises with others. But she faces a multitude of barriers to exercise including a reluctance to venture too far; being the main carer for her three children; and having a limited support network.

Tania's medical assessment

Tania underwent a medical assessment by a doctor in Japan and is cleared for exercise. Her check-up confirms she is physically healthy after the birth of her baby one year ago and her blood pressure is fine at 121/70.

Expert assessment

Kristen MacKenzie, health and nutrition consultant at Millennium Institute of Sport & Health, comments:

"Tania is only slightly overweight based on her BMI (over 25) but she has a history of putting on large amounts of weight. She is not feeling 100% because of her sedentary lifestyle. Tania is no longer breastfeeding so she is safe to undertake a weight-loss programme (excessive energy restriction is not recommended for a breastfeeding mother).

Japan has one of the lowest rates of obesity in the world, at just 2%. There are some obvious links to be made between this and the way the Japanese eat: they have a range of healthy foods available such as vegetables, fish, rice and noodles, soy-based products and fruit. However, Tania's diet includes minimal fish, minimal fruit and a lot of convenience or 'western' foods such as biscuits, cheeses, dressings and chocolates. She also eats large portion sizes. So it is no surprise Tania hasn't reaped health benefits from being in Japan. The typical Japanese diet is high in salt, but a higher intake of Japanese foods has not had a detrimental effect on Tania's blood pressure."

Recommendations

Food

Breakfast: Have a similar breakfast to the current one including porridge or cereal/bran plus (soy) milk and raisins.

Lunch: Include a low-fat protein and a range of vegetables every day. Many Japanese foods are suitable (eg soups, sushi and rice/ noodle-based dishes). She should include approximately 1 cup of rice or pasta or a few slices of grainy bread.

Low-energy snacks: Try small low-energy snacks between meals including green or herbal tea, miso soup or a piece of fruit. A good option for afternoon tea is yoghurt (soy if preferred). This is particularly good before or after exercise.

Limit takeaways and treats: Higher-fat takeaways should be limited to once a fortnight. Tania is advised to watch her snacking and higher-fat foods such as macaroni cheese, but she can have a treat occasionally. Helpfully, most restaurants in Japan have nutrition information, so she is given an estimate of the kilojoule amounts to aim for at each meal.

A balanced dinner: This should include 100-150g of lean meat (fish would be ideal 3 times a week) plus carbohydrate foods such as a small serve of noodles, rice or potato; and vegetables. Dessert could be fruit or dairy-based dishes, particularly if these have been lacking throughout the day.

Exercise

Some of the food changes are minimal; the key for Tania's improvement physically and mentally is exercise! She adds a gym session 3-4 times each week including: 25 minutes running on the treadmill; 20 minutes on the bike; 5 minutes on the rower; and some light weights. This will progressively rise. She gains support through her husband's rugby team from some of the other women who agree to join her at the gym and she gets a child minder a few times a week. In addition, she aims to include walking and other forms of exercise in the backyard with her children.

Tania's reaction

After 2 weeks

"I have tried to lose weight before, and had differing results. Surprisingly, emailing Kristen has been easier in some ways than face-to-face. It has meant I have had to take more responsibility and just be positive. I've had to make it happen for me: from receiving the information on nutrition from Kristen, printing out then reading everything, to kick-starting myself into gear. It almost felt like an assignment I had to research, as I didn't have someone in front of me dictating in simple terms. The benefits of the changes are already apparent. I feel better, more confident and am losing weight too!

I think one difference that affects eating habits in NZ is that we're used to having large dinner plates, but they don't even fit in the dishwasher here in Japan so we bought new plates that are smaller and have found we eat less as a result. Portions are like rules here, part of the way you live."

6 weeks later

Tania has had fantastic results! She now weighs 72kg, over 5kg less than where she started and almost in the healthy weight range at a BMI of 26.4. She is feeling confident as she has been the main motivating factor behind the changes and hasn't felt the changes were too hard to do for the benefits she has gained. Her weight loss is not slowing.

She has stuck to the recommendations well and although she has met some hurdles (such as the child minder not being available or finding fast food in an unfamiliar part of town), she feels she can continue on her path. She is looking forward to returning to New Zealand and feeling – and looking – great. She is more determined than ever that she will not put the weight back on. Her VO2 max is now 37.6ml/kg/min (an excellent rise of 7ml/kg/min) according to her trainer husband.