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Steve’s story: losing weight the hard way

Janet Webb
BSc(Hons) RGN
DiPN(Lond)
Practice Nurse
Lindum Medical Practice
London

Steve is 27 years old and a nonsmoker of 6' 2" with a body mass index of 36. He is employed at an electrical shop, fitting cookers and other appliances in people's homes. His story started with the break-up of his long-term relationship, when he decided to take himself in hand and lose weight.

Steve's first course of action was to look on the internet for slimming pills. They are readily available in various forms and price ranges; he chose an American product (Fenphedren), which promised to lift his mood as well as producing rapid weight loss.

Worryingly, he bought them at a reduced price as a special offer as they were going to be taken off the market. It never ceases to amaze me how people will readily pay good money for the risk of damaging their health. Since the days of travelling purveyors of miracle cures, people have willingly taken all manner of "remedies" without any concern about the contents.

Steve took the pills, as well as eating virtually nothing apart from cereal bars, for about three days. He suffered from headache, abdominal cramps and powerful flatulence, and became so argumentative that his family and friends begged him to stop. After that he became constipated, so took four Senokot tablets on two consecutive days. These still left him feeling bloated so he bought some Wind-Eze tablets, which helped.

Steve then decided to try a meal replacement plan, and bought a supply of milkshake-type drinks. Wanting instant results he replaced all his meals with these for about a week; but possibly still suffering the effects of the aperients, he had diarrhoea and managed to lose about 4 lb in weight. After this, he thought he would give the slimming pills another try.

Around this time he took up an offer of free gym membership for a trial four-week period, and at the first visit had his blood pressure taken – it was 166/92. He was advised against exercise on that occasion, but to see his GP for assessment. Instead, he used his friend's gym equipment in his garage – a variety of weights, exercise bike and a rowing machine.
Naturally, he used all of the equipment until he felt exhausted and, of course, he was still taking the slimming pills and the meal replacement drinks. From here, he went into town to buy new trainers and gym clothing, and fainted in the shop.

In my room, Steve's blood pressure had settled to 136/76. I took blood for coronary heart disease and diabetes screening, and a full blood count because of his recently disastrous dietary history.

When Steve gets an idea, he obviously goes with it, and if only his impatience for instant results could be toned down a bit, his vibrant enthusiasm might see him persevering more productively! We needed to find ways of harnessing his energy while keeping his interest …

He clearly likes to use the internet and to spend money as a problem-solving strategy. I talked about healthy eating in terms of energy supply and fuel. I explained fast-burning and slow-burning fuels providing different energy resources; about stored energy being converted to fat and about the added vitamins and minerals that come naturally with energy sourced from food. I showed him the Eatwell and British Heart Foundation (BHF) websites (see Resources); I am a huge fan of the BHF booklet So You Want To Lose Weight … For Good, and gave him a copy of this.1

Having started with the positive messages of what to do, I went on to suggest that diet pills obtained from the internet may not be safe, and together we looked again at the information on Fenphedra, its ingredients being described as stimulants and a substance related to marijuana. I suggested the stimulant may have caused his raised blood pressure, especially after he had admitted taking double the recommended dose!! Steve denied taking any street drugs; he had never smoked and drank alcohol only at weekends – no more than four pints of lager in total – since his job depended upon his driving license.

I realised I still hadn't got him to spend any money, and reasoning that this might encourage his commitment I suggested going back to buy trainers and gym clothing, giving the free gym membership another go and then starting a clothing fund, for when the weight reduction meant his current clothes didn't fit.

He seemed happy with this, and to like the BHF booklet (as I've found is usually the case) and said he'd got the message about energy and healthy sources of it. We arranged another follow-up to talk about blood results and check that motivation levels remained good. I had high hopes for Steve, convinced he had the determination needed to sustain lifestyle change.

When I saw him two weeks later, he felt confident he must have lost some weight. He denied any dalliance with internet quick fixes, talked enthusiastically about his new healthy eating regime and reported that not only had his new energy intake made him feel better, but he was also sleeping better than he had in years. He had gone back to the gym, his BP had remained within normal limits and he had been assigned a personal trainer who had given him a cardiovascular routine and encouraged keeping his fluid intake up. We were both disappointed then to find his weight had increased by 4 lb.

So it was back to the drawing board. I asked him to bring a diet diary the following week. It was exemplary, using portion sizes and food-group combinations from the BHF booklet. He had only listed the amount of fluid though, rather than the content of it. On further investigation, he had used his technique of spending as problem-solving, related to my (supposedly!) inspired talk on "energy" to buy high-energy drinks from the shop at the gym, and drank about a litre a day at work! I had omitted to relate energy to calories; I rang the gym who told me that their recommended energy-boost drink contained 28 calories per 100 ml. Coupled with the 1,800 calories he was taking from his now healthy diet, this 2,080 calorie total contrasted sharply with the dismal calorie intake he'd been having just before his first visit. 

Steve's on the straight and narrow for now. I'm looking forward to his next review when I'm confident I can discharge him to self-manage. Given his boundless enthusiasm, he'll probably be running his own weight-loss programme by then!

Reference
1. British Heart Foundation (BHF). So You Want To Lose Weight … For Good. London: BHF; 2005.

Resources
Food Standards Agency
Eat well, be well: helping you make healthier choices
W: www.eatwell.gov.uk

British Heart Foundation
W: www.bhf.org.uk