Wattana (not his real name) is not a regular drinker. But he really enjoys the greasy food and sweet treats that are largely to blame for his higher-than-ideal cholesterol and triglyceride levels.
People who gather more fat around their middle are at risk of metabolic syndrome and nonalcoholic fatty liver disease.
"I love fried chicken and chicken curry," said 41-year-old Wattana who now weighs 84kg. "Thai desserts are also my favourite as I simply find them irresistible."
Wattana admitted that his lifestyle has become increasingly sedentary over the years.
"I usually sit all day long for work, I have dinner in front of the TV," he said. "Well, I know I should do some working out. But you know, after a long and tiring day at work, it's not easy to do."
Two years ago, during a routine physical examination, blood tests showed up elevated levels of certain liver enzymes. After being made aware of the abnormalities he immediately sought a professional consultation.
"I was worried as I've learned that the liver is one of our vital organs, and someone I know had a liver-related death," he recalled.
After having additional tests and procedures, he received the unfortunate diagnosis that there was excess fat in his liver and fibrosis had started to form. To improve the condition, he has a weight loss regime under professional care.
"I think I'm lucky as I have a regular physical check-up. The condition shows no symptoms and I didn't know I had it," he said.
Wattana's condition is called non-alcoholic fatty liver disease (NAFLD). It's similar to alcoholic liver disease but NAFLD is present in people who don't drink alcohol or drink minimally.
Excess fat accumulates in the liver when diets contain more fat than the body can manage. The fatty tissue accumulates and is stored inside liver cells.
According to Assoc Prof Dr Sombat Treeprasertsuk from the Gastroenterology Centre of Bangkok Hospital, it's normal for people to have some fat in the liver. But when the build-up exceeds 5% of the liver's weight, it is classified as a fatty liver.
The problem becomes serious when it causes damage. It may bring inflammation and scarring of the liver, or cirrhosis, a condition where scar tissue or fibrosis form in the liver. Cirrhosis can be lethal as it prevents the liver from working correctly, and in the worst cases causes liver failure.
"Being overweight and obese is the risk factor associated with the development of NAFLD," Dr Sombat said.
According the Ministry of Public Health, some 17 million Thais are considered grossly overweight while there are about 4 million people with a tendency to be overweight or obese each year.
Also, NAFLD is most often present in people who are middle-aged and overweight or obese. These particular people often have high levels of cholesterol or triglycerides, insulin resistance, or a combination of those factors. This combination, also known as metabolic syndrome, increases the risk of development of cardiovascular diseases and diabetes.
It's estimated that between 37% and 90% of obese people and between 50% and 62% of people with diabetes are at risk of developing fatty liver.
Dr Sombat noted the number of patients with NAFLD has significantly grown in the past decade.
"The obvious reason for weight gain among modern people is they have convenient lifestyles, and they eat too much but do too little so they put on weight," said the expert.
A simple way to identify a weight problem is to measure your waist. According to Dr Sombat, an Asian woman's waist should be less than 80cm and a man's 90cm. And people who develop excess weight around the abdomen, or a rounder middle, are more susceptible to metabolic syndrome.
Dr Sombat noted that skinny people with "hidden obesity" are also at risk of the development of NAFLD.
"This should be a wake-up call for skinny people," said the doctor.
He explained that the fat present underneath the skin is called subcutaneous fat while that found around the inner organs is called visceral fat. Some skinny people may build up more fat around the inner organs than underneath in the skin. They may be considered overweight or obese if they have a high enough percentage of body fat on the inside.
As obesity on the inside is invisible to the naked eye, Dr Sombat is concerned that skinny people often assume that they have low fat levels and are healthy. Meanwhile, visibly overweight and obese people know that they have problems.
"Some skinny people are not aware of this. They eat whatever they want. They skip a physical check-up and do not exercise. Unfortunately, they may come to us when the condition is already advanced," the doctor said.
NAFLD is often silent. It produces no symptoms, particularly in the beginning. It may get noticed when people have medical tests and a doctor may see signs of fatty liver from blood tests.
When the condition progresses _ usually over many years or decades, people may experience fatigue, weakness, nausea and abdominal discomfort, particularly where the liver is located.
To determine the presence of fatty liver for sure, patients are advised to have a liver biopsy. Dr Sombat says this can assess the severity of the condition _ whether the liver is inflamed, how much fibrosis has been formed and whether cirrhosis has developed. However, it's an invasive procedure.
"I was a bag of nerves when my doctor advised a liver biopsy," Wattana recalled. "I watched a YouTube video about the procedure and it helped me keep calm."
Dr Sombat said: "A liver biopsy is usually done under local anaesthesia, and the procedure worries many patients. Well, it may not be a patient-friendly option."
There is a new procedure known as a Transient Elastography that offers a non-invasive and rapid option. This method is used to assess liver fibrosis and monitor the ups and downs of a patient's condition.The encouraging news is that NAFLD is reversible. The condition can be improved through a change of lifestyle, Dr Sombat said. For people who are overweight and obese, the doctor advised a safe weight-loss regimen through dietary control and increased physical activity. There is no fix-quick for permanent weight loss.
"I now watch my diet and go jogging in the park as often as I can, according to my doctor's advice," Wattana said. "I used to enjoy fried chicken many times a week, but now I allow myself to have it two times a month. The tricks do work for me as I lost 4kg over the past year. My cholesterol level has also gone down bit by bit and my fatty liver condition has also gradually improved. I've tried to keep it up."
Treatment is of paramount importance. It can not only help prevent the development of cirrhosis, but also reduce the risk of cardiovascular disease. NAFLD, according to Dr Sombat, is a predictor of coronary artery disease.
"Let's lead a healthy lifestyle that can ward off obesity, the risk factor of NAFLD," said Dr Sombat.
"In fact, it can help protect against many health issues, and to achieve the goal, a well-balanced diet and regular exercise is the key."