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TUESDAY, JULY 12, 2011




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Rates of obesity are climbing in Hong Kong


Crush hour





Jeanette Wang

Welcome wheels Ebenezer New Hope School for the visually impaired in Pok Fu Lam has a new van, donated by the Hong Kong Sanatorium & Hospital. The HK$740,000 raised from the “Walk for Vision” charity walkathon in 2009 paid for the van, which has had a wheelchair platform fitted and was given to the school last week. It will be used for commutes between home and school, trips to outdoor learning activities and medical emergencies. “This new van is a godsend to our teaching staff, students and their parents,” says Shirley Cheung Yuetmei, the school’s principal.

Better red than dead If you’ve not been working out, knocking back some red wine could be good for you. A new study published in The FASEB Journal suggests that resveratrol, an ingredient in the tipple, may prevent the negative effects of a sedentary lifestyle. Tests were done on rats, which underwent simulated weightlessness to mimic space flight. Those fed daily oral doses of resveratrol did not develop insulin resistance or a loss of bone mineral density, as did the control group. Dr Gerald Weissmann, the journal’s editor-in-chief, says: “Resveratrol may not be a substitute for exercise, but it could slow deterioration until someone can get moving again.”

Seven billion That will soon be the number of people on earth, United Nations Secretary General Ban Ki-moon says in his message for yesterday’s World Population Day. “Later this year, a seven billionth baby will be born into our world of complexity and contradiction. We have enough food for everyone, yet nearly a billion go hungry. We have the means to eradicate many diseases, yet they continue to spread. We have the gift of a rich natural environment, yet it remains subjected to daily assault and exploitation. All people of conscience dream of peace, yet too much of the world is in conflict and steeped in armaments. Overcoming challenges of this magnitude will demand the best in each of us.”

An egg a day … … keeps the doctor away? Perhaps. Researchers at the University of Alberta have found that two raw egg yolks have almost twice as many antioxidants – which may help fight cardiovascular disease and cancer – as an apple. However, frying or boiling them reduces the antioxidants by about half, and cooking in a microwave reduces them by a little more than half.

Kitchen creations Want healthy and delicious family meals? SOL Wellness is offering a series of classes for domestic helpers with a range of nutritious recipes, including breakfasts (July 21), finger food for children (July 28), desserts (Aug 4), and a three-course Italian meal (Aug 11). Classes are HK$500 each and held at 10am on Graham Street in Central. Tel: 2581 9699

Q: This is sort of an embarrassing question. Recently I found something unusual just outside my anus. It has grown like a pea. When I touch it, it is sort of hard but smooth, and it hurts a bit. What should I do? Is this some kind of cancer? A: There is really nothing to be embarrassed or worried about. Cancers are usually hard and irregular, and the smooth nodule you are feeling is more likely to be a haemorrhoid. Haemorrhoids come from natural structures consisting of connective tissue and blood vessels, and are similar to your lips. Irregular bowel movements, straining to go to the toilet, ageing and pregnancy may predispose you to forming haemorrhoids. If they become swollen or inflamed, there may be pain or bleeding. Haemorrhoids may be external or internal. Internal haemorrhoids may remain inside the rectum or prolapse outside. They are graded by the degree of prolapse: where grade I is a haemorrhoid that remains inside, grade II is one that prolapses but spontaneously reduces, grade III is one that prolapses and requires manual reduction, and grade IV is one that prolapses but cannot be manually reduced. You probably suffer from an external haemorrhoid or prolapsing internal haemorrhoid. If the haemorrhoid is asymptomatic, you can ignore it. If there is pain, itching or bleeding, treatment may be necessary. You should keep stools soft and regular, and minimise the time spent sitting on the toilet. Treatment options include rubber-band ligation, injection of a sclerosing agent, cautery (an instrument is used to burn, sear or scar tissue) and surgery. Dr Wayne Hu is a specialist in gastroenterology and hepatology and a member of the Health Post advisory panel


Planner more fun than a calendar in helping women keep track of periods ...................................................... Sasha Gonzales Period Plus by Flatcracker Software Free Rating 8/10 If, like most women, you don’t have time to keep track of your period the old-fashioned way – using a wall calendar and a red felt marker – this app was designed for you. No more figuring out when your next period is due, if you’re late – and if so, by how many days – and your average cycle length. Period Plus can even predict your ovulation and fertile days for the next three months. The information is presented on a calendar, using colour-coded legends, so you can view it all at a glance. Setting up is easy. Just enter the date and duration of your last period, and the app does the rest. What’s especially cool about

Period Plus is that it keeps track of common period symptoms. Rate your breakout or breast tenderness level, period flow and cramp intensity on a scale of one to five, and the app will create charts and reports based on your entries. Over time, you will be able to tell if your symptoms have improved or worsened. I could chart my weight, so I knew those extra kilos were due to bloat. You can even record your sexual activity, which is handy. Once the information has been charted, you can e-mail the reports to yourself too, if you want. Period Plus was pretty accurate – it estimated my next period to arrive between June 20 and 24, and I got it on the 23rd. Knowing exactly when you can expect your next flow makes it easier to plan holidays, outings and outfits. If you’re like me and you get all crabby and emotional just before your period, this app also helps put things into perspective. The day

before my last flow began, I remember feeling despondent, though I had no idea why. When I saw that my period was due, I felt relieved knowing that my feelings were probably hormonal. There are also fun period polls to take part in. Do you prefer pads or tampons? Do you take medication for cramps? Which is your worst PMS symptom? Submit your reply and view the overall results. You don’t have to worry about privacy because Period Plus is password protected. So even if your iPhone ends up in the wrong hands, you can be sure your data is safe.

Track dates and take part in some enjoyable polls

> CONTACT US Culture Editor: Janelle Carrigan Health Post Editor: Jeanette Wang General inquiries: Advertising: tel: 2565 2435; e-mail


Always tired? Mind your Bs ......................................................

mistakenly attack and destroy the cells in the stomach that make a protein, known as intrinsic factor, that helps absorb vitamin B12. Since a healthy liver has more than three year’s supply of vitamin B12, symptoms can take years to manifest. Common ones include fatigue, headache, loss of appetite, nausea, constipation, tingling and numbness in hands and feet, and weight loss. If left untreated, vitamin B12 deficiency can cause permanent damage to other organs and the nerves. Patients with pernicious anaemia have a higher chance of developing stomach cancer. To overcome the lack of intrinsic factor, the replenishment of vitamin B12 by injection is needed, as this bypasses the gut, Wong says. When Chan was first diagnosed at age 55, he required a B12 jab in his arm every other day for a week, and then once a week for four weeks. When the B12 levels in his blood normalised, it was once a month. “Once the store of vitamin B12 is built up in the liver, this can supply the body’s needs for several months,” Wong says. “An injection is then only usually needed every three months to top up the supply.”

Wynnie Chan Working 24/7 was something that Chan Wai-man was accustomed to. Tiredness came with the job, but the constant and painful tingling in his hands and feet was starting to get in the way of his work and his family life. His tongue was so sore that every meal was torture. After a visit to his doctor and several blood tests, Chan was diagnosed with megaloblastic anaemia. “Anaemia is a condition that occurs when there is a reduced number of red blood cells,” says Dr Lily Wong, a general practitioner in Central. Megaloblastic anaemia is characterised by immature and abnormally large oval-shaped red blood cells. These megaloblasts can’t function as normal red blood cells and are unable to deliver enough oxygen to the body tissues. These malformed cells are produced in the bone marrow when vitamin B12 or folate levels are too low. This can be caused by certain diseases, infections or medications that decrease absorption of these nutrients from food. A vitamin B12 and a folate blood test showed that Chan had pernicious anaemia, a condition caused by an impaired uptake of vitamin B12 from the gut. His illness was the result of an autoimmune disorder, where antibodies

Illustration: Angela Ho


Therapy turns up heat ...................................................... Tian jiu therapy is an ancient technique for treating allergic rhinitis and asthma, considered “winter” diseases in Chinese medicine. It’s a mix of Chinese herbal medicine and acupuncture theory, but there are no needles involved. Based on the formula in General Medicine According to Master Zhang, printed in 1695, and the result of clinical trials, eight carefully selected, stimulative Chinese herbs are ground into powder and mixed with ginger extract to form a pellet, which is then applied on specific acupoints according to the individual’s condition. The medication acts on these acupoints, stimulating the meridians and harmonising the visceral system (heart, liver, intestines and other internal organs) for prevention and treatment of diseases. Chinese medicine believes in treating winter diseases in summer, and tian jiu therapy (tian jiu coming from the characters for sky and moxibustion) is performed on three designated dates each year so as to achieve the best effect. These are known as “Three Dog Days”, which are the hottest in summer. The treatment dates with the strongest yang qi are chosen according to the Chinese calendar. For 2011, the first, July 14, is 30 days

after the summer solstice, or xiazhi. The second is July 24. Finally, the third, August 13, is 10 days after the start of autumn, or liqiu. The treatment takes one hour for adults and 20 minutes for children under the age of 16, and it’s advisable to complete the course of treatment. Yang is related to situations such as heat, brightness and synergy. Thus, the medicine will be absorbed and drive away the phlegm and cold inside the body. Similarly, it’s best to shower with warm water on the day of treatment to help efficacy. With allergic rhinitis and asthma on the rise, the Hospital Authority for Chinese Medicine Centres for Training and Research started in 2009 to systematically organise tian jiu therapy as an alternative treatment. Literature has been reviewed to evaluate its safety and effectiveness. It’s suitable for patients above the age of two. But it’s not advisable for those with acute asthma, fever, pharyngitis, tuberculosis, severe cardiac or pulmonary diseases, diabetes, and skin or drug allergies, or for pregnant women. Information provided by the Hospital Authority. Tian jiu therapy is available in all of the Hospital Authority’s 15 Chinese Medicine Centres across the city. See or call 2300 6699 for more details.

Annual blood tests are now routine for Chan. “I know that I need my shots until the day I die, but that’s alright because I never have any side effects,” he says. Sometimes, vitamin B12 deficiency is diet-related. In these cases, Wendy Ma, a senior dietitian at Hong Kong University’s SPACE Dietetic Clinic for Teaching & Research, recommends dietary supplements of B12 after initial treatment with injections. Large doses of vitamin B12 can also be administered either as a nasal gel or in sublingual forms. Since B12 is bound to protein in foods, eating adequate protein and green leafy vegetables, both of which contain iron and folate, helps. Ma suggests liver, meat (especially beef and pork), eggs, and milk and milk products as other good sources. Fermented soya bean products such as tempeh and miso, and seaweed and algae are said to contain B12. But Ma cautions: “It is not certain if humans can utilise this form of B12, so these should not be relied on as sole sources.” If you are unusually tired, it’s worth checking if you’re anaemic – most causes are easily treatable.


Balloon goes up on One out of every two Hongkongers is now overweight, a recent survey has found. Eileen Aung-Thwin looks at a global epidemic and its effect on public health


t 1.7 metres tall and 100kg, Jackson Lee, a freelance consultant has a Body Mass Index (BMI) of 34.6. That means he is morbidly obese. Studies show that such a high BMI puts Lee (real name withheld for confidentiality reasons) at very high risk for life-threatening conditions such as diabetes, cardiovascular diseases, gall bladder disease, and gastrointestinal cancers. He could also suffer from other ailments such as sleep apnea, back pain, arthritis and infertility. Worryingly, Lee is not alone. A recent study of some 30,000 people by The Family Project – an initiative sponsored by the Hong Kong Jockey Club Charities Trust in collaboration with University of Hong Kong’s School of Public Health – found that one in two Hongkongers is either obese or overweight. The survey is the largest of its kind in Hong Kong, says Professor Lam Tai-hing, director of the School of Public Health and the project’s principal investigator. It’s also unique because trained surveyors were sent to about 20,000 households to conduct interviews and obtain the data. Most other studies rely on participants to selfreport, which may be less accurate. There are no equivalent studies against which to compare the

Project’s data. But looking at the Centre for Health Protection’s Behavioural Risk Factor Survey of April 2009, in which 38.7 per cent of people aged 18 to 64 were overweight or obese, the latest statistics suggest a marked increase in weight issues in the territory. “If you look at the overall figure, it is very alarming,” says Lam. Hong Kong’s growing obesity epidemic is part of a worldwide trend. According to the World Health Organisation, obesity is the fifth leading risk of death in the world. It is considered a chronic but preventable disease. Obesity also carries a cost to society. Dr Gary Ko Tin-choi, vicepresident of the Hong Kong Association for the Study of Obesity (HKASO), wrote in the Medical Bulletin last year that obesity and its related conditions contributed an estimated 15 per cent to hospital admissions. Its related expenditure is expected to rise 47 per cent over five years. The latest numbers reveal that more men (54.6 per cent) are overweight and obese than women (50.8 per cent). Dr Daniel Ho Sai-yin, assistant professor with the School of Public Health, says women are under tremendous cultural and social pressures to be slim. Studies have found that young males, on the

other hand, prefer to have a larger physique and hence are likely to eat more and be at greater risk of being overweight. From the age of 25, the figure for overweight and obesity in men nearly doubles, from 25.8 to 48.5 per cent. Women, though, are more likely to pile on the weight later – after age 35. Lam suggests the timing of weight gain may be linked to different life stages. For instance, when young men leave school and start working, they have the means and the opportunity to choose their own food – this new-found freedom may contribute to poor food choices and weight gain. On the other hand, women’s priorities often change after

The drastic changes are in lifestyle, not genetic background. Chinese people do not generally have a propensity to be fat DR CHOW CHUN-CHUNG, HKASO PRESIDENT

marriage and childbirth, and watching their waistline becomes less important. Men’s weight gain also corresponds to the time their careers and work demands ramp up. A recent US study by researchers at the Pennington Biomedical Research Centre blames the changing – less physically demanding – workplace as a factor in obesity. It found that workers were expending 120 to 140 calories less a day compared to 50 years ago, which matched America’s weight gain over the same period. Marcus Chan (real name withheld for confidentiality reasons), 32, says that he turned to food to take the edge off stress at work. His weight ballooned from 80kg to 89kg in just half a year, raising his BMI to 29.1. “The obesity phenomenon in Hong Kong is a relatively new problem that has surfaced in the past 10 to 15 years,” says Dr Chow Chun-chung, president of HKASO. “The drastic changes are in lifestyle, and not genetic background. Chinese people generally do not have a propensity to be fat.” Ho says: “In the past when the population was poorer, the diet was mainly vegetable-based and you enjoyed meat or fish only on big occasions. Now, meat is served at

COVER STORY 5 Almost four out of five Hongkongers do not eat enough fruit and vegetables, and many eat out at least five times a week and do too little exercise. Experts say little changes – such as commuting on foot and climbing stairs – can make all the difference

obesity problem Weighty issue Percentage of Hongkongers who are overweight or obese 100%

Percentage of whole population Male 54.6% Female 50.8%

Obese Overweight

80 60


40 20

28.1 15.2

8.7 10.6 9.2 Male Female 15-24

Body Mass Index (BMI):

26.6 14.6




M F 25-34


M F 35-44

43.6 38.2













M F 45-54

M F 55-64


Less than 18.5

18.5 – 22.9

23 – 24.9

25 – 29.9

30 and over




Obese (moderate)

Obese (severe)

Sources: The Family Project, HKU School of Public Health

almost every meal.” Almost four out of five Hongkongers fail to eat enough fruit and vegetables. The problem is linked to dining habits. Many people still eat out at least five times a week for breakfast (30.2 per cent) and lunch (51.5 per cent). Affluence has fuelled growing appetites. “People, including children, simply eat too much,” says Chow. And the combination of


bigger portions of all the wrong foods is a double whammy. Recreation has changed and now involves more kicking back than kicking a ball. A survey by the Education Bureau found that only half the students had any regular physical activity outside of school. But almost half spent four hours every day in front of a television or computer screen.

The scenario for the adult population is worse – three in four people do not engage in any form of regular physical activity. Experts say legislation is crucial to the fight against fat. Laws for nutritional labelling on prepackaged food, which took effect two years ago, are not wide enough, some say.

A lack of standardisation in how nutritional information is presented may confuse the public and hence limit its usefulness in helping people make healthy choices, says Lam. Ho suggests an alternative. “In addition to the nutritional information, we might want to use a simple ‘traffic light system’ where a red label is a warning, yellow is OK and green is good. That will make it easy for the public to choose,” he says. Advertising for unhealthy food could also be banned, he adds. Lam wants tougher laws that stop the food industry misleading the public. “How healthy are the ‘healthy drinks’ you see on the shelves? How much vegetable is in that vegetable biscuit?” he says. “You need to have regulation that only allows the food manufacturers to claim their product is healthy if they can prove it.” The Health Department’s Eatsmart campaign, which started in schools in 2006 and included restaurants in 2008, has had an impact. The department says its survey in 2008 found that there were “significant increases” in the proportion of students who chose healthier food compared to 2006. “It takes at least 10 years to see the results of such programmes,” says Chow. “Hopefully, we will see a drop in obesity by 2015.”

As for physical activity, experts say that increasing the energy output can be achieved easily, by commuting on foot and climbing stairs. “Small changes can be very effective,” says Chow. “Get off the bus a stop earlier, or walk to a restaurant 15 minutes away.” The government can help by ensuring the connectivity of pedestrian walkways throughout the city. “Make sure the streets are safe for walking, that they are properly lit at night, that people can easily walk to their destinations,” Ho suggests. “Build lots of bicycle trails.” Chow thinks that infrastructure needs to be built to properly support the obese. “There needs to be a team of professionals to properly assess and treat obesity and its related conditions,” he says. “We need a dedicated obesity centre.” Ultimately, experts agree successful weight loss boils down to perception and motivation. Some people still think that obesity is mainly a cosmetic concern. Says Chow: “Obese people need to accept that obesity is a chronic disease like hypertension or diabetes that needs to be treated as one. Instead, the overweight turn to commercial weight loss centres that lure them with gimmicks and promise quick and easy results.”


One index that doesn’t fit all ...................................................... Eileen Aung-Thwin

BMI does not measure body fat percentages and fails to distinguish between muscle and fat

Hong Kong defines overweight and obese people as those with a Body Mass Index (BMI) of more than 23 and 25, respectively. A recent study published in the Canadian Medical Association Journal, however, questioned the validity of the recommended Asian thresholds. Researchers from Taiwan and the US found that Chinese men and women with a BMI of 24 to 25.9 – overweight by Hong Kong’s definitions – had the lowest risk of death. For Caucasians, it was 22.5 to 24.9, which is well within their “healthy” threshold. Various other studies are making it clear that defining the weight and health status across different populations isn’t as straightforward as taking weight in kilograms and dividing it by the square of height in metres. The fact is, BMI is almost 200 years old and was never designed to gauge fatness. Belgian polymath Adolphe Quetelet, who invented the formula in the 1800s, found it was a reliable statistical tool to study the physical characteristics of the normal or average man. When American scientist Ancel Keys revived the formula’s use for population studies in 1972 and coined its modern-day moniker, he thought it useful for widespread studies of diet but not for diagnosis of obesity. BMI’s simplicity and relative reliability in gauging total body fat have boosted its popularity as an assessment tool in recent decades. While there are other methods to more accurately measure fatness, they require the use of specialised equipment operated by trained professionals. In the 1980s, the World Health Organisation (WHO) adopted BMI as the standard index of obesity. But it has been a subject of

disagreement and confusion. For instance, the National Institutes of Health in the US first defined obesity as 27.8 for men and 27.3 for women in 1985. But in 1998, the thresholds were consolidated and changed to 25 for overweight and 30 for obesity to align them with international standards, and millions of formerly “healthy” Americans suddenly found themselves booted into the unhealthy range. Yet a 2005 study found that BMIdefined “overweight” people had a mortality risk similar to that of “healthy” people. In 2000, the WHO, the International Association for the Study of Obesity and the International Obesity Task Force jointly proposed to revise the definition for non-Caucasian populations to 23 for overweight and 25 for obesity, based on observations that risk of obesityrelated diseases occurred at lower BMIs in some Asian populations than in Caucasian populations. But the revision was criticised for being too radical. Then in 2002, the WHO released a report recommending that the original standards of 25 and 30 be retained as international definitions, but with 23, 27.5, 32.5 and 37.5 added as additional points of concern for Asian populations. Each country could decide what cut-off point it wanted to use to define obesity for its population. While it may indicate total body fat, BMI does not measure body fat percentages and fails to make

important distinctions between muscle and fat. Hence, a fit but extremely muscular athlete could be categorised as obese. Yet for the elderly, who have lost muscle and bone mass, their body fat percentage – and associated health risks – could have crept up without any significant weight gain. BMI also does not tell you anything about the distribution of fat. Central fat, or fat concentrated around the abdomen, is a proven indicator of increased risk of diabetes, cardiovascular disease and even death. Experts say waist circumference, which measures central fat, should be used with BMI to better assess one’s obesity-related health risks. An Asian man’s waist should be less than 90cm around, and an Asian woman’s less than 80cm. However, this also has its critics. Dr Daniel Ho Sai-yin, assistant professor at University of Hong Kong’s School of Public Health, disagrees that a single waist circumference measurement should apply to people of different heights. Studies have found that waist-tostature ratio, which divides a person’s waist circumference by height, better predicts one’s risk of cardiovascular and metabolic diseases. It’s even simpler to measure and calculate than BMI, and its recommended threshold of 0.5 (waist not more than half height) is easier to remember than the many – and confusing – figures associated with BMI. Even the WHO does not claim BMI to be a definitive measure of obesity in individual assessments. It recommends doctors consider other measurements such as waist circumference, the patient’s medical history and presence of other risk factors. But, regardless of the methods and numbers bandied about to define obesity, the harder task is figuring out how to help individuals bring down the number on the weighing scale.


Winning the battle? Tape it the right way ...................................................... Alison Johnson Losing inches from your chest, thighs, arms, hips, waist and buttocks is a clear sign of fat loss and fitness progress. So that you can efficiently take note of your successes – and failures – here’s how to use a tape measure correctly: Use a plastic tape measure Cloth varieties can stretch out over time and give you distorted measurements. Position the tape correctly Don’t pull the tape in tightly to get a smaller measurement. “Make sure the tape is snug, does not compress

your skin and is parallel to the floor,” says Maria Kinirons, director of food and nutrition for Weight Watchers North America. Wear thin fabrics – or better yet, nothing at all. Breathe normally Don’t suck your breath in or exhale forcefully when measuring your waist or chest.

Take monthly measurements Don’t measure too often: readings can change from day to day, or even during a single day, based on what you eat and drink. Pick one day a month and measure yourself first thing in the morning. If you’re female, don’t schedule this just before or during your period, when you tend to be more bloated.

Look straight ahead Stand tall with your feet together – or slightly apart if you’re measuring your thighs – preferably in front of a full-length mirror so you can see the tape’s position. Don’t slouch down to look at your reading. For the most accurate results, ask a family member or friend to help.

Measure at the right place For your chest, measure around the largest spot, generally at the nipple line. Waist: just above your hipbones, roughly at your belly button. Hips: the widest part of your buttocks. Arms: about 7.5cm above your elbow, at the largest point. Thighs: the biggest part of your upper legs. McClatchy-Tribune

Chart your weight loss with a tape measure when you get up in the morning


Fab food ideas for trim teens Andrew Dembina Summer is upon us, and teenagers are on the loose. As they are away from their school canteens or parent-selected meals, they have more freedom to eat. It’s likely their nutritional choices for the six-week break will range from fast foods lacking in dietary value to snacks laden with salt, sugar and fat. But arming kids with ideas for quick, tasty and healthy food fixes might help wean them off those unhealthy dietary habits. Vicky Cheng, executive chef at Liberty Exchange Kitchen & Bar, has a message for teenagers who have never attempted much in the kitchen. Cheng says they should not worry about how the food turns out. “Experiment,” he says. “I used to enjoy doing that when I was growing up, without worrying about the result. In Hong Kong, there are lots of wet markets with a lot of ingredients that are quite inexpensive. They are good to experiment with. “And if you’re interested in cooking, there’s nothing wrong with failing once or twice. Your parents will probably eat it all up for you, anyway.” For those with a sweet tooth, even sweetness can be healthy. David White, executive pastry chef at Grand Hyatt Hong Kong, recommends going for sorbets or chilled fresh fruit. “Or you can mix the two,” he says. “Blend a fruit like pineapple, add vanilla for extra flavour, strain and chill it and pour that over fresh berries. It’s very quick, tastes great and is good for you. If you want to get more ambitious, try home-made granita, which is a very simple and crunchy sorbet.” Getting young people to eat more healthily is a pressing need in Hong Kong. Gordon Cheung, a practising clinical dietitian and president of the Hong Kong Nutrition Association (HKNA), says some of these bad dietary habits are having a marked effect. “The prevalence of [those classified as] overweight and obese among Hong Kong secondary school students rose from 16.4 per cent to 17.7 per cent in the 1997-98 school year to 22.2 per cent in 200809,” he says. Childhood obesity is caused by multiple factors. But there are some major causes, such as physical inactivity and a high energy intake, says Sally Poon Shi-po, a registered

dietitian who is also on the HKNA’s health promotion subcommittee. “The traditional Chinese diet is generally high in carbohydrates and low in fat. So Hong Kong children consume less fat than their Western counterparts. But 30 per cent of their energy is derived from total fat. This is higher than that found in a traditional Chinese diet, which is about 14 per cent,” Poon says. “The main sources of total fat are meat, bread, cakes, milk, eggs, dim sum, fast food and fish. Dim sum is one of the most common food choices for breakfast and lunch. The total fat, saturated fat and sodium content of some dim sum is relatively high, while calcium and fibre content is low,” she adds. Poon says that it is the same story for teenagers’ favourite snacks – with potato crisps, sweets and chocolates scoring highly in secondary polls. Both Poon and Cheung note that overweight children are at risk of illnesses such as cardiovascular disease, hypertension, sleep apnoea and type-2 diabetes. “Overweight” is defined by the World Health Organisation as having a Body Mass Index (BMI, or weight in kilograms divided by the square of height in metres) greater than or equal to 25, and “obese” is defined as more than 30. For children, there are conflicting theories over whether this definition even applies, as they grow at such varying individual speeds. But overweight and obesity are the fifth leading risk for global deaths, says the WHO, so it makes sense to try to avoid entering adulthood bearing either of those two labels.

STEAM UP, VEG OUT Five healthy eating tips from chef Vicky Cheng of Liberty Exchange Kitchen & Bar: 1. Eat raw foods; keep cooking to a minimum and enjoy the natural taste of food. 2. Spend a little more money on good-quality olive oil instead of using butter. 3. Steaming doesn’t have to be boring; it’s a great technique after a good simple marinade. 4. I like to have crunchy cereal instead of chips for snacks. 5. I like instant noodles, but I always add veggies and egg to get more nutrients and make it more interesting.

Don’t be afraid to experiment, says chef Vicky Cheng. Photo: Dickson Lee

Vitamin-packed salad makes for easy pickings If you are looking to keep a meal light, and even if you regularly enjoy munching a salad, the idea of a meal consisting mostly of tomatoes might raise a sceptical eyebrow. This one genuinely has a wow factor, though. It’s all about the quality of the ingredients used – selecting the best tomatoes is key, as they are the star of this dish. Tomatoes are a nutritious package: they are a good source of vitamin A and C, and they also have decent fibre. They also contain lycopene, which supplies the red pigment and also serves as a powerful antioxidant. Ceviche is normally raw seafood marinated in seasoned lemon or lime juice. Here, tomatoes sit in the zesty, vitamin C-rich marinade to absorb the citrus juices. Combined with fragrant basil (loaded with vitamins A and C), crunchy toasted sesame seeds (vitamin B1 and lots of good minerals) and a bit of mozzarella, it becomes a very tasty, wholesome dish. Vicky Cheng – executive chef at Liberty Exchange Kitchen, where this ceviche is on the menu – says it’s not only top-tier supermarkets and organic produce suppliers that stock quality tomato varieties. You can find them in wet markets, too.

Heirloom tomato ceviche Serves 4-6 Ready in 20 minutes For the marinade 1 cup yuzu juice (or lime juice) ½ cup orange juice 2 cups extra-virgin olive oil 1 tsp sugar 1 tsp salt ¼ tsp fresh, cracked black pepper For the tomato salad 500g ripe heirloom tomatoes, sliced 2-4 balls buffalo mozzarella, wedged 1 small bunch fresh basil

1 orange, segments peeled ¼-½ cup toasted sesame seeds For the vinaigrette dressing ½ cup good-quality Japanese soy sauce 2 tsp Dijon mustard ¼ cup toasted sesame oil ¼ cup rice wine vinegar 1 cup olive oil Whisk marinade ingredients in a bowl. Marinate tomatoes for at least 15 minutes. Combine with rest of the salad ingredients. Whisk vinaigrette ingredients in a bowl. Drizzle over salad and serve. Andrew Dembina

Photo: Dickson Lee



Plunge into exercise and stay focused ...................................................... Suzanne Harrison Keeping children active is not just a healthy and fun approach to family life that can stave off obesity and future problems such as cardiovascular disease and diabetes. It can also help children perform better at school. Research on the cognitive benefits of keeping children active is increasingly being reported around the world. At the universities of Leeds and Aberdeen in Britain, researchers found that children who did moderately intensive exercise scored significantly better in concentration tests than those who didn’t. “It also raises the question of how much the often-reported decline in children’s attention spans in modern-day life stems from a lack of physical exercise,” says Dr Justin Williams, a senior lecturer in child and adolescent psychiatry at the University of Aberdeen. Last year, the Beckman Institute for Advanced Science and Technology at the University of Illinois did a study of nine- and 10-year-olds using magnetic resonance imaging. After determining their fitness levels with a treadmill test, they were given a cognitive challenge. Fit children were found to have larger basal ganglia, the part of the brain that aids in keeping attention and the

ability to co-ordinate actions and thoughts crisply. Recent figures indicate that youngsters in Hong Kong aren’t exercising enough. The University of Hong Kong reported that 35 per cent of those aged 13 to 20 suffered from spinal disc degeneration, of whom 93 per cent had lower back pain. And 20 per cent of children between six years old and 18 years old were overweight or obese in 2008-09, according to the Health Department. Heather Thomas Shalabi, Pilates instructor and co-director of Flex Studio, says posture problems and a lifetime of back pain can be avoided if parents take action beforehand. “Engaging in regular physical activity as a child usually means you will have good habits for life. Plus, it’s fun and helps them let off steam. This sets them up for a healthy, happier future,” she says. A family effort is ideal. Davide Butson-Fiori, founder of Circuit25 outdoor training, says: “It’s time parents became an example to their children. They need to get physical and get outside together.” With the holidays here, it’s the perfect time to try these activities. English Schools Foundation (ESF) Sports Programme, tel: 27111280 Held after school in 20 locations, the programme oversees 4,000 children

Take a dip in the pool and beat the heat; exercise stimulates children’s minds, too. Photo: Robert Ng participating in weekly activities such as swimming, tennis, tae kwon do, gymnastics, basketball and netball. Non-ESF students may join in. For the holidays, there are camps that allow children to try a range of sports, and sports clinics that build on basic skills such as running, jumping, catching and kicking. Treasure Island, tel: 2546 3542 Its Surf Camps for children are an ideal way to get moving, learn a new skill, make friends and build confidence in the water. Held at Pui O Beach, Lantau, the safe and gentle

waves are suitable for all levels, but participants need to be competent swimmers and comfortable in the water. The day camps run from Monday to Friday, and include daily surf lessons and activities such as surf safety, ocean awareness and beach games. Flex Studio, tel: 2813 2212 Its summer camp for pre-teens and younger children combines exercise with creativity. Instructors will teach singing, dancing and acting, yoga and Pilates, which develop physical and social skills, and confidence. The camp is designed to provide a

basic foundation across these disciplines, giving children the tools to explore further. Circuit25 Families, tel: 2501 0922 Bond with family members through 90 minutes of play-based activities that will not only provide a full-body workout, but also promote camaraderie and emotional grounding. The trainers will go to you on the day and time of your choice, to provide a personal programme to suit the fitness level of your family. Every class can fit up to three families of five members each.


Meat substitutes fail to fulfil carnivorous cravings ......................................................

Photos: Nora Tam

Jeanette Wang

Birds Eye Vegetable Fingers HK$28 for 10, City’super Here’s an easy way to get your children to eat – and enjoy – their peas, carrots and corn. Pop the fingers straight into the oven from the freezer, bake for 15 minutes to a golden brown, then tuck in with a good dollop of ketchup. The batter is thin and crunchy, with just the right amount of saltiness. Verdict: no replacement for fish, but a healthier alternative to fried junk food.

Quorn Sausages HK$26 for four, City’super Developed in 1967 to deal with the possible threat of a global food shortage, mycoprotein – made from fungi – has found its way into the mainstream diet in Britain and Europe. These low-fat, low-cal, high-quality meat-free sausages had a texture of a really lean sausage and tasted like pork chipolatas. Verdict: could pass as a real dog, until you realise there’s no grease.

Linda McCartney Vagetarian Burgers HK$36 for four, City’super I guess if I were a vegetarian and craving a burger, this might actually satisfy, since my taste buds wouldn’t compare it to meat anyway. But I’m not a vegetarian and these patties were dry and crumbly – similar to soggy cardboard – and had an overpowering onion taste. Verdict: pass on this and indulge in a juicy quarterpounder. Or you’ll regret it.


Shape up over the short haul ...................................................... Dorene Internicola Five-kilometre races and running/ walking events offer exercisers the chance to support a favourite charity without too much wear and tear on out-of-shape joints. But experts say for anyone who really wants to kick-start a fitness regimen, lose weight or just change their sedentary ways, training for a five-kilometre run may be the shortest distance from couch potato to easy runner. “It’s a better first step than just setting a goal to lose weight,” says

Matt Fitzgerald, a coach and editor at Competitor magazine. “Human beings are natural game players. We like having a goal, a game plan. There’s no game in losing 10 pounds [4.5kg].” And there’s no glory to be had just staring at a scale, either. “The magic of crossing the finishing line is what hooks people,” says Fitzgerald, who is based in San Diego, California. “It’s life-changing ... Event organisers push 5K because of the accessibility of the distance. Marathons are not for everyone. The 5K is a lot easier to host.” A healthy adult can get in shape

Some get so excited, they jump straight up to a half-marathon. Others find their niche in the 5K MATT FITZGERALD, COACH

for a five-kilometre race in just 10 weeks. “Most people can walk a 5K distance right now,” Fitzgerald says. “Just try to get to a point where you can jog the whole way.” Pete McCall, an exercise physiologist with the non-profit American Council on Exercise, says a top distance runner can knock out a five-kilometre run in 14 or 15 minutes. For beginners, 30 minutes is a moderate and accessible target. But be prepared to walk before you run. “Walk three to five minutes, then run three to five minutes, then gradually increase the amount of time you run,” McCall says. “It’s all about setting goals and giving your body time to adapt.” He said any realistic plan should also involve flexibility and at least three days per week of corestabilising exercises. Also, to avoid overuse injuries, runners should refrain from doing too much too quickly, and McCall recommends that the novice invest in a shoe designed for running.

“A running shoe has a different design and structure to a training shoe, which is wider with a different type of foot bed,” he says. But anyone aiming for a more challenging race than five kilometres should find a trainer. “From what I’ve seen, the 5K gets people more involved in running,” McCall says. “You establish a goal and train for it. When you see your time drop from, 30 minutes to 28, you say, ‘Yes, I can do this.’” He says even if a person’s sights are set on the marathon, the first goal should be five kilometres. Fitzgerald says while some use the distance as a stepping stone to longer races, others stick with the short and speedy run. “Marathons are really not for everyone,” says Fitzgerald, who has run 14 of them. “Some people get so excited, they jump straight up to a half-marathon, but no one should feel compelled.” He says many find their niche in the 5K running race. “After all, you can go to the Olympics with a 5,000-metre run,” he says. Reuters

UPCOMING 5Ks IN HONG KONG AVOHK adidas 5km Series 2011 This four-race series, organised by the Athletic Veterans of Hong Kong, spans six weeks and tours Hong Kong Island. Details: All races take place on Saturdays at 4.30pm. August 27 (Tai Tam Tuk Reservoir); September 10 (Bowen Road); September 24 (Wan Chai Gap Playground); and October 8 (South Bay). Entry fee: HK$110 per race or HK$400 for all four. Sign-up:; tel: 9038 5460.

RAMP Challenge Series 2011 The Hong Kong Multisports Association organises this three-race series to promote a sporting lifestyle and friendship, and also raise funds for the Hong Kong Pain Society. It kicks off with a 5km race, then progresses to 6km and 10km. Details: Sunday, September 11, 9am, Tai Po Road to Kowloon Reservoir. Entry fee: HK$120 plus optional donation. Sign-up:; tel: 8119 4312.

Kenenisa Bekele won the Beijing Olympics 5,000 metres in 12:57.82, but beginners can aim for 30 minutes. Photo: AFP


Friction over fiction as novelists’ trysts of the trade seen as threat to women ...................................................... Agence France-Presse It’s all innocent stuff: square-jawed boy meets doe-eyed girl, they fall in love, encounter a few rocky moments but ultimately seal their union with a kiss or a hint of sex. Wholesome yarns like this form the heartbeat of romantic fiction, a genre that has been in existence since the mid-18th century and today sells by the bucketload. But according to a debate launched by a medical journal in Britain, romantic novels are a potent threat to women’s sexual and emotional health. A commentary blasts these formulaic books for failing to promote safe sex and encourage patience in achieving female orgasm. It also criticises the books’ defining the success of a relationship as the ability to crank out babies.

“If readers start to believe the story that romantic fiction offers, then they are storing up trouble for themselves,” says British author and relationship counsellor Susan Quilliam. “Sometimes the kindest and wisest thing we can do for our clients is to encourage them to put down the books and pick up reality.” Quilliam, writing in the Journal of Family Planning and Reproductive Health Care, says that, according to a survey, only 11.5 per cent of romantic novels make any reference to condom use. When they do, it’s not usually useful: “Within these scenarios, the heroine typically rejected the idea because she wanted ‘no barrier’ between her and the hero,” she says. Even the steamier offerings of romantic fiction are dismal failures when it comes to sexual health, Quilliam contends. The typical bodice-ripper, the term used for racy romantic fiction,

ends “with the heroine being rescued from danger by the hero, and then abandoning herself joyfully to a life of intercourse-driven orgasms and endless trouble-free pregnancies in order to cement their marital devotion”. In fairness, says Quilliam, romantic fiction today has broadened its spectrum. Standard characters such as the brutal count and apple-cheeked maid have been supplemented by single mums, sensitive men, partners who each have to juggle daily jobs or cope with addictions, disabilities and even instances of domestic violence. Even so, these books fail miserably when it comes to sexual pleasure. They also fail to positively depict the ups and downs of relationships, she says. “We want women to be aware of their own desires rather than be ‘awakened’. We aim to reassure our female clients that their first time

may not be utterly joyful and that they may not gain reliable orgasms through penetration, but that they themselves are nonetheless existentially valid and that, with affection and good humour, things can improve immensely. “We warn of the stresses of pregnancy and child-rearing, and we discourage relentless babymaking as proof of a relationship’s strength.” According to figures cited by Quilliam, romance accounts for nearly half of all fiction bought, and some fans read up to 30 titles a month. For all its popularity, the genre’s influence over its readers has only rarely been explored, says Quilliam. But she suspects that it could have massive clout. “What we see in our consulting rooms is more likely to be informed by [romantic book publishers] Mills and Boon than by the Family Planning Association,” she says.

Illustration: Martin Megino



Winning tale of a binge battle ...................................................... Sasha Gonzales When I was 27, I consumed a large pizza, a medium lasagne and half a cheesecake in one sitting. My monstrous meal lasted 40 minutes, and when I was done, I chugged a bottle of cola and cried. It was one of the hundreds of food binges that occurred in my life between the ages of 16 and 36. Food ruled my life for two decades, but I was completely oblivious to the fact that I was slowly gorging myself to death. I didn’t even know there was a name for what I had – binge eating disorder, or compulsive overeating not followed by fasting, excessive exercise or purging. My problems began at 15, when I started reading fashion magazines. Looking at thin models made me feel horrible about my pudgy body. I began to think that if I, too, was slim, then perhaps I would be as beautiful and as loved. So for a week, I consumed nothing but coffee and crackers. I lost so much weight, I looked almost skeletal. At university, I endured several more bouts of anorexia and punished myself with insane amounts of exercise. For a while, I

also abused laxatives. They kept my weight down, and I liked that feeling of emptiness after a purge. It was like not having eaten at all. Over the following years, I grew increasingly obsessed with food. My publishing job was stressful, and bingeing became my coping mechanism. By age 30, I was 15kg overweight and constantly fatigued from a lack of nutrition. I tried every crash diet, from the Atkins to the Zone, but my food addiction was so powerful, I eventually gave up. Socialising was torturous, too. At parties, I had to avoid the food completely to stop myself from eating it all. I was a secretive binge eater. I’d stash snacks in my office cupboards, and then demolish them behind closed doors. Eating in secrecy was how I managed to hide my problem for two decades. Even my best friend had no inkling of my food struggles. Bingeing satisfied me for as long as it took to swallow the food. Then I’d be overcome by guilt, which gave way to disgust. To console myself, I’d eat again, renewing the cycle. Early last year, I decided to quit my job and focus on my health. I was near breaking point, physically and emotionally. I knew I had to make permanent changes to my lifestyle if I was going to get better.

I planned a move to Hawaii. When I visited Hawaii for the first time, at 22, it was like I had come home. Being there had a positive effect on my mind and soul. I felt like I could do anything. So it seemed like the best place to embark on my healing journey. Once in Hawaii, I devised a meal plan and drew up an exercise schedule that included different activities so I wouldn’t get bored. I began power-walking and swimming. I later added hiking and Pilates to the mix. Within weeks, my clothes were hanging off me. In five months, I went from 100kg to 80kg, and my fitness level soared. With no worries about work, deadlines, meetings or staff, I could focus on my goals. I had no problem sticking to my plans because I was really determined to change. Walking uphill and swimming long distances were challenging at the start because they left me winded. But I didn’t let that stop me from carrying on. I also met people who embraced the healthy lifestyle I’d envisioned for myself. One of my first friends was a personal trainer who became my walking buddy. Another friend got me into tennis, surfing and stand-up paddling. Whenever we went

I want to fall so deeply in love with myself that I will never abuse my body that way again shopping together, we’d walk to the mall instead of taking the bus. After dark, we’d hit a club and dance the night away. I found every excuse to break into a sweat. It was reading an article that made me realise I had binge eating disorder. I spoke to a doctor, who told me I’d checked all the boxes for the disorder. Had I known earlier that I was suffering from it, I probably would have sought medical help. Unfortunately, the disorder is difficult to diagnose because it is not as defined as anorexia or bulimia. But the disorder is believed to be more prevalent than either anorexia or bulimia. Studies suggest that people with the disorder have trouble dealing with their emotions – anger,

boredom, depression, stress and worry are thought to be triggers. It’s been 10 months since I arrived in Hawaii, and I still have 15kg to lose. I started running recently and have my sights set on next year’s Honolulu Marathon. Getting over the disorder has taught me how to deal with my feelings in less destructive ways. Now when I’m emotionally battered, I talk to a friend instead of stuffing my face with a bucket of fried chicken. My approach to food has changed. I’m no longer neurotic about it. If I want potato chips, I just eat a few, not the whole bag. Exercise has also become a major part of my life. I work out for at least an hour each day, and I keep my sessions fun so I don’t fall into a rut. I have no doubt that being in Hawaii has helped my healing process. For two decades, I grappled with an addiction, without knowing that I had a disorder. I’m thankful to be on the road to recovery, and I’m sure that I will keep moving forward. Ultimately, I want to be able to look in the mirror and be very proud of what I see. I want to fall so deeply in love with myself that I will never abuse my body that way again. I believe I’m almost there.

2011 07 12 Health Post #8  
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