**Diary Entry**
From a young age, Emily had heard the women in her family say they were simply unlucky in love. Her great-grandmother had been widowed after the war, her grandmother lost her husband in a mining accident, and her father walked out on her mother when Emily was just three. These stories had seeped into her mind, and she often wondered—would her own marriage end the same way? Even though she wanted nothing less.
She met her future husband, David, at the factory where they both worked, though in different sections. They shared lunch breaks, smiles, and conversation. What started as something small quickly grew into romance. Within six months, they married and moved into the flat Emily had inherited from her grandmother. First came one son, then another. Life carried on in its predictable rhythm—work, children, chores.
But when Emily’s mother passed, the weight of everything fell on her—the house, the boys, the care of her husband. At first, David helped, but soon that changed. He came home late, grew irritable, distant. Later, she discovered why—he was having an affair with a younger colleague. The house became little more than a pitstop—pop in, change clothes, disappear.
Emily knew but kept quiet. She was terrified of raising two boys alone with no steady income. She tried to talk to David, but he brushed her off.
*”All you’re good for is waiting on me. Pathetic,”* he spat.
Still, she hoped—maybe he’d come to his senses. Then one evening, he packed his things and left. No explanation. No remorse.
*”Please don’t go. The boys need their father,”* she begged, standing in the hallway.
*”You’re nothing to me now.”* He looked at her with disgust and slammed the door.
The boys had heard everything. Sitting huddled together on the sofa, they couldn’t understand why Dad wasn’t coming back—had they done something wrong?
Months passed. Emily worked tirelessly, scrubbing stairwells, taking odd jobs to feed her boys. Love was the last thing on her mind—until one day, returning from the market, she dropped her shopping bags. A man knelt to help.
*”Let me carry those for you,”* he offered.
*”No need, I’ll manage—”*
*”I insist.”* He picked them up anyway.
That was how she met James—kind, attentive, unassuming. He made a habit of stopping by that same shop where they’d first met. One evening while she was cleaning the building, he appeared again.
*”Need a hand?”* Without waiting, he got to work.
Later, he visited—flowers, a suit, a cake. The boys took to him immediately. James was warm, funny, real. He played with them, told stories of his own childhood, and they adored him—even when he admitted the accident years ago had left him with a slight limp and a stutter. They only hugged him tighter.
*”You’re like a proper dad,”* the youngest said once. *”Only nicer.”*
A year later, Emily and James married. Life steadied. Laughter filled the house again, the smell of pies wafted from the kitchen, and peace settled in. The elder son had a girlfriend now; the younger played football. All was well—until the knock came.
Her ex-husband stood at the door—gaunt, aged.
*”I’ve realised my mistakes. Forgive me?”*
*”You’re too late,”# Comparison of Two Multifactorial Weight Loss Interventions With Partial Meal Replacement Among Metabolic Syndrome Patients
Verified January 2019 by National Taiwan University Hospital.
First Posted : January 15, 2019
Last Update Posted : January 15, 2019
National Taiwan University Hospital
National Taiwan University Hospital
Dietary and lifestyle interventions are the primary approaches of metabolic syndrome (MetS) management to reduce cardiovascular disease risks. However, the conventional dietary approach is difficult to practice and maintain the effects in the long run. Meal replacement (MR) has been shown a beneficial and safe dietary approach for weight loss and glycemic control in obese and diabetic patients, respectively. Therefore, this study aims to investigate whether MR can be an optional choice of dietary therapy for MetS patients.
Metabolic Syndrome Obesity | Other: Low calorie diet (LCD) Other: Meal replacement (MR) | Not Applicable
This randomized, controlled trial compares the efficacy of low calorie diet (LCD) with partial meal replacement (MR) on reducing body weight and improving MetS components at 3 months and 6 months in MetS patients. One hundred and twenty MetS patients will be randomly allocated into MR group and the LCD group, each with 60 subjects. The two groups will receive the different dietary education sessions by registered dietitians, respectively to achieve the same reducing calories goals (500kcal/day).The primary outcome is body weight change at 3 months. The secondary outcomes include body composition (bioelectrical impedance analysis), MetS components, dietary intake and eating behaviors.
Estimated Enrollment : | 120 participants
Intervention Model: | Parallel Assignment
Masking: | None (Open Label)
Primary Purpose: | Treatment
Official Title: | A Randomized Controlled Trial Comparing the Efficacy of Two Multifactorial Weight Loss Interventions With Partial Meal Replacement Among Metabolic Syndrome Patients
Estimated Study Start Date : | February 1, 2019
Estimated Primary Completion Date : | January 31, 2020
Estimated Study Completion Date : | August 31, 2020
Active Comparator: Low calorie diet (LCD)
Subjects in LCD group will receive individual and group nutrition education sessions at week 0, 1, 2, 4, 6, 10, 14, 18 and 22. Subjects will be educated the concept of LCD (minus 500kcal per day from habitual diet) and physical activity (walking to reach 10,000 steps per day). The caloric goal is 1200-1500 kcal per day depending on baseline energy intake. The diet composition is 20-30% fat, 15-20% protein, and 50-60% carbohydrate. Subjects will also be asked to maintain a 3-day dietary record (two weekdays and one weekend day) and a pedometer record every two weeks.
| Other: Low calorie diet (LCD)
Subjects will receive education sessions on LCD and physical activity.
Experimental: Meal replacement (MR)
Subjects in MR group will receive individual and group nutrition education sessions at week 0, 1, 2, 4, 6, 10, 14, 18 and 22. Subjects wil be educated the concept of partial MR (one meal replacement for lunch or dinner per day and the same caloric restriction as LCD group). The components of meal replacement is similar to LCD group (20-30% fat, 15-20% protein, and 50-60% carbohydrate) with vitamins and minerals fortifications. Subjects will also be asked to maintain a 3-day dietary record (two weekdays and one weekend day) and a pedometer record every two weeks.
| Other: Meal replacement (MR)
Subjects will receive education sessions on partial MR and physical activity.
– Body weight [ Time Frame: 3 months ]difference of body weight change (kg) between groups
– Waist circumference [ Time Frame: 3 and 6 months ]difference of waist circumference change (cm) between groups
– Body fat percentage [ Time Frame: 3 and 6 months ]difference of body fat percentage change (%) between groups
– Blood pressure [ Time Frame: 3 and 6 months ]difference of blood pressure change (mmHg) between groups
– Fasting glucose [ Time Frame: 3 and 6 months ]difference of fasting glucose change (mg/dL) between groups
– HDL cholesterol [ Time Frame: 3 and 6 months ]difference of HDL cholesterol change (mg/dL) between groups
– Triglycerides [ Time Frame: 3 and 6 months ]difference of triglycerides change (mg/dL) between groups
– Number of metabolic syndrome components [ Time Frame: 3 and 6 months ]difference in numbers of metabolic syndrome components (0-5) between groups
– Dietary intake [ Time Frame: 3 and 6 months ]difference in dietary intake (kcal) based on 3-day dietary records
– Blood management [ Time Frame: 3 and 6 months ]difference in blood management (routine blood management of blood cells in the flow cytometer) in fasting blood samples
Ages Eligible for Study: | 20 Years to 64 Years (Adult)
– age between 20-64 years
– diagnosed of metabolic syndrome (patients must have at least three or more of the following criteria: 1) waist circumference ≥ 90 cm in men and ≥ 80 cm in women in Asians; 2) triglycerides ≥ 150 mg/dL (1.7 mmol/L); 3) low HDL cholesterol (<40 mg/dL (1.0 mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women); 4) blood pressure ≥130/85 mmHg or drug treatment for hypertension; 5) fasting glucose ≥100 mg/dL (5.6 mmol/L) or drug treatment for diabetes)
- obesity (body mass index ≥ 24 kg/m2 and <35 kg/m2)
- no malignancy, severe organ diseases, or psychological problems
- not pregnant or breast-feeding
- history of any gastrointestinal diseases, eating disorder, history of major surgery (e.g. bariatric surgery) or taking weight loss medications
- with acute infection or operationHer ex-husband turned away, and as the door shut behind him, Emily knew she had finally broken the cycle.
