Guilt-Free Holiday Eating — It’s OK to Throw Food Away

By Karl Ronn, First Mile Care CEO and Founder

‘Tis the season to overeat. We all do it even when we swear we won’t. But that’s OK. The First Mile Care Diabetes Prevention Program (DPP) is not about dieting. It’s not about self-denial. It’s about making small, incremental changes to your lifestyle to become more healthy, and learning to maintain those new habits you form over the year-long span of the program.

Here’s one change that can make a big difference to your health, not only during the holiday season but year round.

You are not the garbage can

What is tough at this time of year is that food is the centerpiece of festivities and is often offered as a token of love and friendship and neighborliness. Or you may have a fridge bursting with leftovers after your guests depart.

Most of us were brought up to clean our plates and finish leftovers. We have a lot of guilt associated with food waste. One of our DPP participants said he felt guilty for throwing food into the trash bin, but he also felt guilty if he ate foods he knew weren’t healthy, simply because he didn’t want to waste them. Guilt associated with both choices! Finally he realized, “The food goes into the garbage can or it goes into me — and I am not the garbage can!” He now allows himself to say “no” to friends and family and to throw food away, guilt-free.

First Mile Care Coach Sandra Huskey likes to tell the story of when she went to a Houston-area summer festival with her mother. They bought a giant cupcake to share. They each took a couple of bites and it was delicious, but neither wanted to finish it. Sandra pointed to the trash can but her mother refused. It took a painful couple of minutes before she could bring herself to throw it away. In Sandra’s view, they each had derived their enjoyment and satisfied their sweet tooth. They’d gotten their money’s worth. But in her mom’s opinion, they had wasted good money if they threw away uneaten food.

I have learned to overcome my own guilt feelings at throwing away french fries. I love them but know I can’t eat all the fries and have the drink that comes as part of the meal. So when I fill my cup, I throw away half the fries, right then. I know if I take them to the table, I won’t be able to stop, so I eliminate the temptation. And in that way, I still get to enjoy tasty fries rather than turning them into a forbidden food.

Another First Mile Care participant has a similar practice. When she orders a restaurant meal, she immediately requests half to be put into a takeout container, so that she avoids the temptation to overeat.

Trial and error

It’s important to keep in mind that lifestyle change is a process that requires time and commitment. The DPP hinges on behavior modification through a full year of integrated advice and support along many vectors. You are guided in making a personal plan, trying it, and probably failing. For some people, finding time to be active is difficult. For others, what’s key is identifying stress triggers or learning to recognize a healthy portion of food. Then you make a new plan and iterate, learning what works for you. Because if you don’t like it, you’re not going to do it in the long term. The group reinforcement and professional coaching will help you to surmount your challenges and sustain you after the novelty wears off.

The holidays are a busy and stressful time for most people, even if they are also full of joy. Allow yourself a little slack. You will probably eat more and exercise less. Give yourself permission to fail. The important thing is to keep trying and not become discouraged.

Take it easy

A First Mile Care DPP graduate who is a self-professed perfectionist said, “One of the things I learned from Coach Karalyn Cass is to give yourself a bit of grace. I think that’s something I need to have in front of me all the time. It’s really been a wonderful lesson for me to remember from this class.”

So, during the holiday season, when you’re confronted with tempting foods and drinks, remember that the garbage can is your friend. If you can, take leftovers to the office or your church or otherwise give it away, but don’t feel guilty if it goes into the trash bin. You control what you eat and how much. And you are not the garbage can.

Check out other articles on the First Mile Care blog for helpful advice on coping with the challenges you may experience around the holiday season:

As you can read in our DPP participant testimonials, change may come slowly and incrementally and you may regress at times, but it IS possible if you persevere. Sustainable lifestyle change is within your grasp.

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!


Perseverance Leads to Incremental Habit Changes and Healthy Weight Loss

By Juliana Ronn, First Mile Care Director of Operations

Regina Hasan joined the year-long First Mile Care Diabetes Prevention Program (DPP) at the beginning of 2021. She is a managing executive officer at the nonprofit organization Unlimited Visions Aftercare in Houston, Texas, where she has worked since 2004. UVA provides comprehensive substance abuse treatment services to adult men, women, adolescents and families, so Regina knows a thing or two about coaching people to identify behavioral triggers, stop bad habits, and create a healthy life balance.

But despite her self-awareness regarding lifestyle change and her success in surviving her own addictions since 1986 through 12-step programs, Regina found it challenging to lose weight to improve her health. That is, until she joined First Mile Care and made small, incremental changes to her eating behaviors and physical activity levels. As a result, she has lost 30 pounds and feels better than she has in years

Regina was never specifically told that she had prediabetes or that her blood sugar level was abnormal. But as an overweight Black woman in her 60s, with long-time high blood pressure, high cholesterol, and a glaucoma diagnosis, she knew she presented the risk factors for type 2 diabetes. She was also frequently out of breath and had painful knees due to the excess weight she was carrying.  

One day Regina looked at her lab results after a medical appointment and was shocked to see her body type described as “obese.” She knew she was overweight but had never considered herself as obese. It was a real wake-up call.

This description was still in the back of Regina’s mind when she received a phone call from First Mile Care Coach Shavon LeBlanc on behalf of her regular health care provider at the Pucillo Family Practice (part of Privia Health) in Sugar Land, near her home, inviting her to join a small local group starting the National Diabetes Prevention Program (DPP). Regina felt it was a sign from on high — “a God thing” in her words — that she should try again to make the changes necessary to lose weight and improve her health. 

Putting herself in control

Regina had attempted dieting, trying other weight loss programs in the past. She found some success with Weight Watchers but had gained the weight back. “I just didn’t look forward to counting those points for the rest of my life. And I didn’t like other diets like Jenny Craig that were about buying prepared meals or supplements,” she said.

She knew she could control her eating habits for a short period of time, as every January she participates in a fast organized through her church. The challenge was in making true, sustainable changes that she could continue long-term, rather than simply giving up something in the short-term.

“I don’t want to be tied to anything. I want to be able to control what I eat by doing little things, instead of practicing self-denial. I gave up smoking cigarettes, so my goodness, I want to enjoy something if it’s not going to kill me. I was at the point where I resented people who can eat and not gain weight. That made me mad,” she chuckled.

Encouragement to persevere

As someone experienced in group therapy, Regina knows the value of coaching and group support. “Coaches are like cheerleaders. In recovery coaching, it’s very important for someone who is trying to overcome drugs or alcohol or even a mental health issue to have a coach to ‘walk’ with you on the journey. So I was very open to the whole First Mile Care concept of sharing with the group. Just the opportunity to share progress each week and get encouragement was really helpful. Coach Shavon motivated me in the first few months when my progress was slow, and later when I plateaued. The camaraderie of the group was important.”

Regina actually gained a few pounds after starting the First Mile Care program, but her coach pointed out that it was probably due to building muscle mass. After a few months of up-and-down weight, she started regularly dropping pounds in early summer and eventually lost 30 pounds — although it took a couple of frustrating months to lose that last pound that brought her to a round 30. She is now able to fit in clothes she hasn’t worn in years, dropping two or even three sizes, from size 18 or 16 to wear size 14 and even size 12. Instead of wearing a size XL, she now often wears medium-sized tops. And she’s not done with her weight loss just yet.

There are five tactics to which Regina attributes her success in sustaining her weight loss:

  1. Regular movement. Regina faithfully gets the 150 minutes of moderate activity per week recommended by First Mile Care as a tenet of the CDC’s National Diabetes Prevention Program. Her 55+ senior community has a gym in which she works out regularly. She not only walks on the treadmill for an hour, she also gets plenty of exercise by walking her dog 2-3 times daily.
  2. Eating in moderation. A tip that Regina picked up in her First Mile Care class was to eat only half of what she orders in a restaurant, and to ask for the other half to be put in a takeout container. She does this when she first orders her meal, to avoid the temptation to eat more than she should.
  3. Calorie tracking. Regina downloaded the Lose It! app at her coach’s recommendation and started keeping track of her calorie intake. She no longer uses it regularly as she’s quite aware of the calories of her normal meals, but she has it on her phone so “it’s there when I need it.”
  4. Intermittent fasting. Regina practices fasting for 16 hours daily as she finds it’s helpful. While fasting is not a mandate of the First Mile Care DPP curriculum, coaches encourage participants to develop a personalized set of goals and try a combination of tactics to find what works best for them.
  5. Coach support. Regina also credits her success to Coach Shavon, who was not only persistent in her outreach to join the DPP but never gave up encouraging and supporting her. Shavon made Regina aware that type 2 diabetes is preventable, which persuaded her to join the First Mile Care program.

Regina also found her coach’s presentation on the connection between sleep, weight, and diabetes to be helpful, and is trying to practice better sleep hygiene along with moderate exercise and eating.

“I like eating good food and I want to be able to enjoy that. I’m not starving. It’s not about deprivation. If I want dessert, I eat dessert. But I don’t eat a whole package of Oreo cookies. I eat wisely and in moderation.”  

She added, “I know the goal of First Mile Care is not weight loss alone, but diabetes prevention. But I’m the type of person who needed to see results from the program beyond not becoming diabetic. And I have. And it just feels wonderful.”

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!


Fewer fees, obstacles for Medicare diabetes program in 2022. Is it enough?

Think Local

The virtual approach has its limits, says Karl Ronn, founder and CEO of First Mile Care, a chronic care company that provides the program for both Medicare and non-Medicare patients. Ronn thinks that whether or not virtual is permitted, the best approach to the program is “hyperlocal” — that is, to draw members of each cohort from within the same zip code or similar geographical cluster.

Read the full story via Decision Health’s Part B News


16 Best Menlo Park Wellness Startups – The Future of Events

The Startup Pill lists First Mile Care in their top picks for the best Menlo Park based Wellness companies. These startups and companies are taking a variety of approaches to innovating the Wellness industry, but are all exceptional companies well worth a follow.

See the full list here


Q&A with DPP Participant: Lifestyle Change, One Step at a Time

By Juliana Ronn, First Mile Care Director of Operations

Mike Kowis wrapped up the year-long First Mile Care Diabetes Prevention Program (DPP) in September. He is happy to share his First Mile Care success story with other people battling against  prediabetes. Below is an interview with him about the results he’s experienced with the DPP and his tips for leading a healthier lifestyle.

  1. Thanks for sharing your story, Mike. Could you tell us how the First Mile Care Diabetes Prevention Program has changed your life?
  • I feel more energetic overall, because I make an effort to be active every single day. I’m closing in on 300 days straight of surpassing my daily goal of 10,000 steps.
  • I lost about 10 pounds within the first couple of months of the program. That’s not a lot, but I’ve been able to keep it off for over a year now and am confident I won’t gain it back. Even if the weight starts to come back in the future, I now have the tools needed to take it off again. 
  • My waist is a little smaller and my abdominal area is flatter, to the point that I now have to wear a belt with my trousers and shorts to keep them from slipping! Guess it’s time to go shopping.
  • The blood work from my last medical checkup showed definite improvement, especially with lower triglycerides (fat) in my blood and a slightly lower cholesterol level.

 

  1. Tell us a little about yourself.  Did you have an active or sedentary lifestyle before joining First Mile Care?

I’m a 51-year-old senior tax attorney at Entergy Services, LLC. In other words, I’m a tax geek and spend a lot of time working on the computer. I live with my wife (our kids are grown) in Conroe, Texas, which is approximately 40 miles north of Houston. In my spare time, I’ve written several nonfiction books on various topics including tax trivia and have been an adjunct faculty member at Lone Star College-Montgomery for 20 years. So, I’m a pretty busy guy and have limited time for fitness. However, I’ve tried to stay fit through yard work and working out in my company’s gym two or three days a week. But I didn’t exercise as regularly and as intentionally as I do now.

 

  1. What has been your experience with diet and fitness programs?

I was fairly successful with the low-carb South Beach Diet several years ago. My triglycerides and cholesterol levels improved, and I was able to reduce my cholesterol medication to the lowest daily dose. But I like chips, pizza, and bread,  and at some point I just got tired of the self-denial. I stuck with it for three years, but couldn’t make a forever change. I slowly introduced a few more carbs into my diet, and then a few more, and eventually I wasn’t following the program anymore. And so the weight came back.

I had a Fitbit health monitoring device for a couple of years before starting with First Mile Care. Since I’m a numbers geek, I was good about observing my daily steps. Before this program, I typically walked 10,000 or more steps a day for three or four days each week, but I didn’t think about it in terms of burning calories. And I occasionally participated in fitness challenges at my day job where I walked 10,000 steps daily for a certain number of weeks to win a prize. I would commit to that activity for the period of the competition, and then go back to my occasional walks. It just wasn’t a priority for me to maintain the activity and make sustainable changes.

 

  1. How did you hear about First Mile Care as a treatment option for your prediabetes?

I was invited to join the program by Dr. John Walker of Highland Woods Health in The Woodlands, Texas (part of Privia Medical Group). I have a history of diabetes in my family and watched my grandmother prick her finger often to test her blood sugar levels. At that time, I recall thinking that I didn’t want to go through that if there was any way to avoid it. Over the years, I have tried to stay healthy and did not consider myself at high risk for developing the disease. When I learned I was considered in the prediabetes stage, it was a real wake-up call. My current physician, Dr. Christopher Prihoda, was quite pleased with my results after a few months of participating in the First Mile Care DPP.

  1. What do you like most about the First Mile Care program? Why do you think it has worked for you?

I realized there were really only two things that my coach asked me to do. One was to measure my steps, which I was already doing through my Fitbit. And the second one was to use the MyFitnessPal app or something similar to track my calories. So I downloaded the free app and linked it up with my Fitbit. Then everything was right there on my phone and incredibly easy to track. The tools have made me more mindful of what I eat and how much I exercise.

One of the things that attracted me to this program is that there is no “bad” food. As my First Mile Care coach, Sandra Huskey, explained, the program advocates balance and moderation. I have to be mindful of what I eat and if I go over my daily calorie target one day, I simply compensate for it the next — but I can eat what I want as long as I do enough exercise to burn off my calorie intake. That makes it much easier to follow the program. I feel confident I’ll be able to stick with it, versus the South Beach Diet where I had to swear off foods that I loved because of the carbohydrates. That’s really hard to do for the long term.

I found the First Mile Care program empowering because I could instantly see the effects of my food choices (which I entered in the app) and the value of my steps (which are automatically counted on my Fitbit). At any point in the day, I could check my calorie intake and see how much I had left of my daily calorie allotment. For example, the two tablespoons of peanut butter that I spread on toast every morning is 200 calories. That knowledge hasn’t made me stop eating peanut butter, but I am more careful. Maybe I only have one piece of toast with peanut butter instead of two. And if I want to eat more, all I do is take an extra walk around the block or shoot some hoops on the basketball court to burn off those extra calories. It’s within my control to change those numbers so I don’t have to feel guilty about having that extra dessert. That is probably my favorite aspect of the DPP — feeling in control.

  1. First Mile Care emphasizes in-person, neighborhood-based DPP groups. Did you find this helpful?

I didn’t know the other people in my group, and yet I could relate to them. It was reassuring to know that we were all based in the same area, used the same doctors, ate at the same Tex-Mex restaurants, and shopped at the same supermarkets. It built a sense of camaraderie just knowing that we were all local and facing the same health challenges together.

I was also inspired by my group members. All of them were older than me and retired. When I saw how committed they were to making sustainable lifestyle changes and how much weight they were losing, it made me think, hey, if they can do it, I can too.  I had no excuses because I was younger and generally healthier than the other participants. It was motivating to see those folks working so hard and making real gains.

One of the most rewarding parts of the program, besides feeling better and losing weight, was getting together with Coach Sandra and the other participants and telling them about meeting my goal of walking 10,000 steps every single day. My wife is tired of hearing me talk about it, so it was great to join the meeting and get a pat on the back from the group. It also felt great to be encouraged by people who sincerely cared about my success and were happy for me. I miss that benefit now that the program has finished. However,  I’ve been able to get  “attaboys” from some of my work colleagues  who see me occasionally post my daily step updates on our employee social network.

 

  1. What role has your coach played in your success?

I viewed our group coach, Sandra Huskey, as a personal life coach rather than just a group facilitator or trainer. From day one, Coach Sandra took a sincere interest in everybody. She didn’t tell us what to do, but helped each person to develop our own action plans. She’d ask, “Are you going to start walking more steps than you did before, or more consistently? Are you going to find another form of exercise or maybe start playing basketball?” She would encourage us to improve our activity levels and offer helpful advice. Sometimes it’s just common sense, but it really helps to have someone talk to you about it and encourage you to be more mindful. I liked getting her perspective on my progress and knew she had my best interests at heart.

When you see your doctor once or twice a year, you expect him or her to tell you to lose a few pounds or to be more active. Even if you tell them that you’ve been active and have lost weight, there’s always room for improvement. But with Coach Sandra, she was always excited at even small improvements, and was encouraging even if you plateaued. She emphasized that progress is incremental. She asked me to keep in touch once I’d finished the program to let her know when I’d hit my activity milestones. 

  1. What surprising thing did you learn about yourself in the program?

I learned from Coach Sandra to be mindful of habits. For example, when I sit down in the evenings to watch TV, I usually have a snack like popcorn or ice cream. After our discussion of triggers and habits in a First Mile Care session, I started to think about why I eat in the evenings. Sometimes you eat due to emotions, but sometimes it’s just boredom.  I realized that I eat at night because it’s just what I do as a routine. It’s not always because I’m hungry. It’s usually just a habit, and it’s triggered by turning on my favorite talk show. So I have learned to stop myself from opening the refrigerator or cupboard and instead ask myself, am I really hungry? Maybe I don’t need that popcorn or ice cream. If I am hungry, then I consider the calories of my available food choices before deciding which snack to eat. And so that was something surprising that I learned out of the program that has contributed to my overall health.

 

  1. What kind of changes have you made as a result of the First Mile Care DPP?

First Mile Care has counseled me on how to develop good habits that I can control. I’ve learned how to use information from digital tools, like my Fitbit and the MyFitnessPal app, so I can determine the activity level I need to reach to burn off whatever I’ve eaten. I’ve developed a personal fitness and diet plan that is easy to adjust and maintain. There’s so much information out there; First Mile Care helped me see how to combine it in a way that works best for me, without having to give up my favorite foods.

I’ve also learned to make substitutes. As I mentioned, I like to eat a snack in the evening while watching TV. After questioning myself why I’m craving it, and if I still want something salty and crunchy, I might substitute a raw carrot stick and sprinkle on a tiny amount of salt. I’m still getting that salty taste that I crave, but am also eating a healthy snack with vitamins instead of the empty calories in popcorn. It might sound weird to substitute carrots for popcorn, but it works for me!

The biggest thing for me, of course, has been working towards my goal of one year of over 10,000 steps per day. At first I only wanted to hit 100 days. Then I thought, why not go for 200 days. And now I’ve set 365 days as my goal. I’ve been able to do it so far, but even if I were to fall behind one day, I’m confident that I’ll just pick up the next day and start over. I like the way I feel now, and that is partly due to this steps commitment.

  1. Now that your year-long DPP course has finished, how are you sustaining the changes you’ve made?

I work out at home at least two or three times a week. During the early months of the COVID shutdown, I wasn’t exercising regularly and didn’t feel healthy. I wasn’t energetic, and my body wasn’t responsive and flexible. Since I joined the First Mile Care DPP and got back into a consistent activity routine, I feel great. I shoot baskets in my backyard even if it’s only for 20 minutes on hot days, to get in some extra steps. Santa brought me a weight bench and equipment for my garage, so I can exercise with weights two or three times a week as I used to do when I could use my company’s gym pre-COVID.

I’m totally committed to hitting more than 10,000 steps a day. It’s become such a habit now that even when I was travelling out of town for my daughter’s college graduation last May and checked into the hotel late at night, I went outside for a walk just before midnight to make sure I hit my daily goal. Tropical Storm Nicholas blew through and I still went outside for a daily walk. In the past, I’d never have considered walking in the rain to get exercise. Instead, I’d just sit inside and watch TV or work on the computer.  But since I started the First Mile Care program, I’m more mindful now of my activity level and have become committed to my daily steps. I now feel confident that I’ll stick to it, and I’m happy about that.

While I tracked my calorie intake for about six months, and found it easy to do this with the MyFitnessPal app, I no longer do this. During the summer, my wife and I took a vacation trip to Montana, and I stopped tracking during that time. I did get in a ton of walking in the national parks so didn’t see any ill effects. When I got back from vacation, I was busy with work and used that as an excuse not to log my food intake. But I have found that my weight only fluctuates up or down by a couple of pounds because I am keeping up my activity level and eating the same foods. At this point, I’m so accustomed to what I’m eating — a lot of the same foods in the same quantities —  that I have a pretty good idea of what the calories are when planning meals.  As Coach Sandra often said, the app is there on my phone should I ever need it. If I see my weight go up, I can easily start tracking again. 

First Mile Care taught me good habits that sustain my lifestyle changes. The program opened my eyes to different tools and practices for enabling a healthy lifestyle, and helped me discover things about myself that I could change. I’ve been able to combine my new knowledge and the tools with a growth mindset to create new habits that really work for me. I appreciate how the program, my coach, and my classmates helped me on my path to good health  — while allowing me to remain in control.

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!


Why a fitness tracker won’t stop diabetes

Prediabetes can be reversed — but it requires time, support, and lifestyle changes IRL that apps and smartwatches can’t supply.

For decades, November has been the designated national awareness month for diabetes in the U.S. And for decades, national diabetes rates have continued to climb. The Centers for Disease Control (CDC) reports that 88 million American adults — more than one in three — already have prediabetes. Sadly, that number is also growing, and we shouldn’t look to technology for solutions.

Read more from our founder and CEO, Karl Ronn, via Medical Economics


After Your Workout: Dos and Don’ts

By Shavon LeBlanc, First Mile Care DPP Coach

Exercise is a critical component of the CDC-proven National Diabetes Prevention Program (DPP). At First Mile Care, we encourage DPP participants to set a minimum goal of at least 150 minutes of physical activity each week to keep strong and fit.

If weight loss is part of your goal to become healthy, exercise is essential, along with eating a healthy diet. Studies have shown the benefit of resistance training three or more days a week in lowering the risk of chronic illnesses such as type 2 diabetes. Just as important, cardiovascular exercise three to five days per week strengthens your heart, stimulates the immune system, contributes to weight loss, and provides a mental health boost.

First Mile Care Coach Kathy Gregory previously shared her tips for preparing for your workout — getting the right types and amounts of fuel, hydration, and sleep. But your post-workout routine is equally important. 

Keep stretching

Making movement a daily priority is essential to good health. It is important to  vary the intensity of exercises to develop strength gradually and incrementally, whether exercising alone at home or with a coach in a gym. Consistency will lead to change in body composition and strength. After your workout, I recommend lower-intensity activities involving flexibility, stretching, mindfulness, and meditation to reduce the risk of injury and improve the recovery process. 

Before and after your workout, stretching prepares your muscles to exercise and assists in releasing post-workout tension. Static stretching — holding a stretch for at least 30 seconds —  lengthens muscles and increases muscular relaxation. For a deeper stretch, contract the opposing muscle that you are stretching. For example, if stretching your quadriceps (the front of your leg), engage, contract, and squeeze your hamstrings (the back of your leg) for a deeper stretch. When stretching, avoid bouncing, and do not stretch to the point of pain.

I recommend stretching at least 10-20 minutes post-workout, as well as days in between heavy workouts, as a method of recovery. Rest and recovery are important tools in building strength, preventing injuries, and improving performance between days of resistance training and cardiovascular exercise. For example, after a heavy lifting day, the next day’s activities should be at a lower intensity, involving light cardio and/or flexibility exercises. 

Maintaining hydration

Water is essential before, during, and after a workout — especially if you’re exercising in hot and humid climates. Dehydration can limit your recovery and performance. Water should be your hydration replenishment of choice for short exercise routines. When exercising at a higher intensity or longer than one hour, electrolyte-filled drinks can provide carbohydrates and water to replace glycogen stores. Protein shakes can also serve for nutrition supplementation after resistance training.

During an intense workout session longer than 60 minutes, you should immediately rehydrate with 1 cup (8 oz) of fluid. Then drink 4-6 cups of water continuously for the next 1-2 hours after your workout. 

My suggestion is to avoid consuming alcoholic beverages prior to exercise. Alcohol leads to dehydration and lowers blood flow to the muscles. If you decide to drink, wait 1-2 hours after your workout. Calorie intake management is important when working toward health goals, so indulge in  alcohol beverages sparingly if weight loss is important to you.

Replenishing energy

Food is fuel, so after-exercise replenishment is important to recovery. The type of exercise will determine the fuel you choose for your post-workout replenishment. Carbohydrates serve as the energy source for vigorous exercise, contracting muscle and providing fuel to your brain. Carbohydrates are processed within the body to be converted to glucose, the primary energy source for many body processes. Glycogen stores carbohydrates in the muscle and liver so that they can be accessed to provide energy to muscles during prolonged exercise. 

Low-intensity exercises like gardening, light walking, and tai chi are replenished with easy-to-digest carbohydrates and water. Moderate-intensity exercise like bicycle-riding, aqua aerobics, and tennis games should be replenished with carbohydrates and protein. High-intensity workouts or resistance training need protein as fuel to build lean muscle and improve performance. 

As soon as possible after exercise, you should begin refueling to rebuild and replenish muscle. Within the first 30 minutes after exercising, consume easy-to-digest carbohydrates in fruits and vegetables, electrolyte replacement beverages, or protein shakes. Consuming protein and carbohydrates together improves recovery time and increases glycogen stores. Supplement your carbohydrate intake with 15-25 grams of protein to assist in muscle growth and protein synthesis. 

If you’re exercising to lose weight, fill your plate with vegetables and fruits that are lower in calorie content and higher in fiber and nutrients. Your post-workout meals should include lean protein, complex carbohydrates, and a small amount of healthy fat. Some yummy and healthy snack examples include scrambled eggs with sauteed spinach, ground turkey and avocado, apples with peanut butter and granola, protein shakes or protein bars, yogurt with granola and fruit, or wheat toast with avocado, egg, and salsa.

Today’s media-heavy environment floods us with advertisements that build cravings for delicious processed foods. Avoid heavily processed snack foods and unhealthy drive-through options, as they do not benefit post-workout refueling. Fried foods, salty chips, and sweet sodas provide simple carbohydrates but not the nutritional support to satisfy your hunger, which leads to overconsumption and does not assist in the rebuilding of lean muscle. 

Prioritizing sleep

Quality sleep is an essential component of a post-workout regimen, as a healthy sleep and recovery pattern leads to greater mental and physical performance. Tissue repair, muscle strength, stimulation of the immune system, and production of growth hormones occur during sleep and are essential to rebuilding a strong body. From a type 2 diabetes prevention perspective, lack of sleep can lead to higher blood glucose levels as it impairs the activity of insulin.  

Set a sleep routine to get your body in a rhythm to promote healthier sleep. An hour before bedtime, refrain from exercising, using your mobile phone, and consuming caffeine, which prevent restful sleep. You should also avoid alcohol before bedtime due to its dehydrating effects. And of course, choose a quiet and dark sleeping environment that is comfortable and conducive to rest.

Building change

Building strength and working out is important to your well-being and in preventing type 2 diabetes. Developing a good post-workout regimen will help you maximize your fitness.

At First Mile Care, we advocate steady, incremental lifestyle change to prevent diabetes. By taking the time to prepare your body for exercise and to allow it to wind down from a workout, your muscles can recover, rebuild, and strengthen. You’ll reduce the risk of injury while following your goal to sustainable change. 

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!


Maintaining Healthy Habits After Completing the DPP

By Juliana Ronn, First Mile Care Director of Operations

Katherine Dowling finished the year-long First Mile Care Diabetes Prevention Program (DPP) in early 2021. She is happy with the improvements she has made in her A1C level and weight loss, and agreed to share how she is preventing regression and maintaining her healthy lifestyle.

Katherine is a 75-year-old retired kindergarten teacher who lives with her husband of 52 years north of Houston in Conroe, Texas. She joined the Diabetes Prevention Program offered by First Mile Care in the beginning of 2020, at the recommendation of her physician, Dr. David S. Cos of Physicians’ Group of The Woodlands (part of Privia Medical Group).

By her own admission, Katherine has “probably tried every harebrained scheme for losing weight in my lifetime,” losing 20 pounds at least five times in her adult life, by her estimation. Each time she has gained it back as soon as she returns to what she calls “Katherine habits” of making unhealthy choices and eating too much and too often. At one point, she even served as a Weight Watchers leader for a couple of years between the births of her two sons, but gave that up as she felt uncomfortable doing it once she started regaining weight.

Katherine has inherited hypertension and has been on blood pressure medication for many years, although her cholesterol levels have always been in the normal range. But her doctor watched her weight fluctuations over the years and warned about her climbing A1C number. She said he explained its link to type 2 diabetes, and that “it’s what you eat and how much you move, but you don’t have to develop it. You can take care of this. You’ve got to get more active and you’ve got to lose weight.”

She said she knew she was in a “danger zone” when her A1C hit 5.9, but she wasn’t really familiar with the exact term “prediabetes” until she received a letter from her doctor inviting her to join the First Mile Care Diabetes Prevention Program, at no cost to her.

A neighborhood focus

Initially, the First Mile Care DPP classes were held in-person at a CVS pharmacy in The Woodlands, just a mile from Katherine’s home. “If you have to drive a long distance to go to a meeting, that’s going to be a recipe for deciding not to go sometimes. But if it’s close, that’s do-able. First Mile offers classes close to where people are. I think that’s helpful,” she said.

When COVID-19 hit, classes switched to Zoom. “Our group was less than 10 people, and became very congenial and comfortable with each other. Our coach, Karalyn Cass, did an extraordinary job of reaching out for an update from each person at each meeting. So we got to know and encourage each other, and to share suggestions of tactics and foods and parks to walk that we were each trying.”

Katherine added, “I probably helped other people because I don’t think there’s a single vegetable I won’t eat,” whereas some of the men in her class were vegetable-averse.  “I’m just excited to learn things about food that I didn’t know, like how to cook eggplant that a friend brings me from his garden so that it tastes yummy.”  It was rewarding for her to see other class members start to enjoy produce with her encouragement.

“We had one member who lost 100 pounds in our class! Even though we were not actually in a room together, I looked forward to class just so I could visit with my friends in the First Mile Care program. And all of us living in the same area to share recommendations seemed to me to be quite important,” she said.

Takeaway lessons

One of the biggest lessons Katherine took away from the DPP is that “you’re in charge of what you put in your mouth. And if you do the wrong thing, then you’re going to pay for it. That’s just a given.”  

The lessons in the First Mile Care DPP program were simple enough for Katherine’s classmates to understand and talk about in the moment. She learned to look at food labels in a new way, paying more attention to sugar content. “Whoever is doing the grocery shopping should be studying that, especially if you’re buying something that is pre-made. It’s a way to keep yourself on the straight and narrow with the program.”

One of the reasons Katherine believes the First Mile Care program works for her is its emphasis on behavioral change.  “Coach Karalyn was an incredible coach, very positive and knowledgeable. There were several places in the program where we talked about behavioral change, which was a major focus for her and exactly what I needed to hear.” Katherine learned to identify her eating triggers, dealing with sugar cravings and learning to eat her snack popcorn very slowly and mindfully.

Katherine liked the steady, constant pace of the class, with weight loss happening over time. “Quick weight loss is not appropriate for anybody’s body, in my opinion. I should know, I’ve done it many times. But the First Mile Care DPP really worked because it was slow and steady. And I believe that was exactly what I needed. That and the behavioral change that Coach Karalyn was so good at explaining. I felt like those two things were the best help for me.”

As a self-described perfectionist, Katherine used to be hard on herself for gaining weight, and became easily discouraged. The First Mile Care program has taught her to have a growth mindset and view lifestyle change in incremental steps. If she gains weight one week, she needs to persist and have the confidence she will succeed in keeping her goals.

Katherine said, “First Mile Care really focuses on your success in making slow and steady progress. I’ll still go out to dinner and I’ll still eat something I’m not supposed to have, but I get right back to work. That’s something I’ve learned that First Mile has helped me with achieving.”

She added, “One of the things I learned from Coach Karalyn is to give yourself a bit of grace. I think that’s something I need to have in front of me all the time. One of these days I am going to cross-stitch it on a pillow I’ll see each morning as I leave the bedroom. It’s really been a wonderful lesson for me to remember from this class.”

Weight loss and lower A1C

In the final meeting at the end of the program, Katherine learned she had lost 13.3% of her body weight over the course of the year, a statistic she had never been given in past weight loss attempts.  Nine months after finishing the program, she has kept her 20 pounds off. Her A1C stands at 5.0, down from 5.9, delighting her doctor. She gave away all the clothes that no longer fit after taking in the waistbands where possible. She is confident she will not need them again and uses how her clothes fit as a cue to pay more attention to her eating and activity levels.

“Your friends notice when you’ve lost 20 pounds in a year. Everybody asks me, how did you do it? I’ll say, Well, I was in a program that my doctor encouraged me to do. There are lots of diets out there. But the First Mile Care Diabetes Prevention Program really worked for me because it’s not just a diet. And all the lessons were helpful. You learned to look at the information in a different way.”

Maintaining change

The food journaling and daily weigh-ins that Katherine began under First Mile Care continue to be successful tactics for maintaining change, as she is an organized person and likes to see things tracked and written down. “I still record everything I eat. That was not something that was brand new to me, but I started again when I joined First Mile Care.” She would send her coach her weight and activity minutes by every Thursday even when classes no longer met on a weekly basis.

Katherine now allows her weight to fluctuate by three pounds, depending on how much she has eaten or if she drank wine with a meal. “The scale is my friend. I put that number on the diary that I use for eating. I see the number and say, well, I need to eat more salad or be careful to drink more water today. I look at breakfast, I look at lunch, and say, what can I have for dinner that’s not going to upset the applecart? I know pretty well now what not to do. But I forgive myself for my occasional lapses and I just get back to work.”

Katherine exercises more than in the past, but does not play any organized sport. She tries to swim laps for up to 30 minutes at her local YMCA twice a week.  She also walks with her dog for a mile in the morning on average, leaving her house before sunrise to avoid exercising in Texas heat and humidity.

“I will be very surprised if I can’t sustain the behaviors that I’ve learned because this is the longest I’ve gone without going back to old eating habits. And I think that’s wonderful! I’m very excited about it. First Mile Care is a good program and I hope that it will get even more popular, because it has certainly helped me.”

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!


10 Tips for Navigating the Grocery Store

By Kathy Gregory, First Mile Care DPP Coach

At First Mile Care, we place a great deal of emphasis in our National Diabetes Prevention Program (DPP) classes on the planning and preparation of healthy meals. That starts in the grocery store, where you learn to make more conscious purchases.  

As part of the First Mile Care “Diabetes Prevention in Action” webinar series, I played tour guide in my local supermarket. Due to COVID-19 restrictions, my classes couldn’t all go to the market together, so I brought the market to participants via Zoom.  

We know that making action plans, whether it’s for exercise, eating, managing stress, or sleeping, helps you to be more successful in meeting your goals. I recommend you try different stores and test a variety of brands to find the healthiest choices available that you enjoy which are also within your budget. 

Here are my 10 tips for navigating your grocery store.

 

1. Keep to your list. By planning your menus in advance, it’s easier to buy only the items that you need rather than giving into temptation and making spontaneous purchases of items that perhaps you shouldn’t eat. In addition to keeping on track, you may also save money by not over-buying .

 

2. Shop on the edges. Stay on the perimeter of the grocery store as much as you can because that’s generally where most of the whole, fresh foods are found.  Processed foods satisfy your taste buds momentarily but are not nutritiously dense, which means your body will be asking for more food within a few hours. 

 

3. Balance your shopping cart. A healthy plate should be about 50% fruits and vegetables, and your cart should reflect that. When you get to the checkout line, at least half — if not more — of your grocery cart should be filled with fresh, whole foods and in a rainbow of colors and varieties.

 

4. Buy seasonal produce. When you’re planning your menus, do a quick internet search every month to see what’s in season. In general, in-season produce should be cheaper because it’s more plentiful. And by shopping for what’s in season, you may be inspired to experiment with new recipes for fruits and vegetables that you haven’t tried before.

 

5. Consult the experts. The Environmental Working Group (EWG) issues consumer guides to shopping for produce that are useful to bookmark on your smartphone and consult before selecting produce. The EWG Dirty Dozen of fruits and vegetables have the highest levels of pesticide residue. There is a companion list, the Clean 15, with the lowest pesticide residue.

 

6. Read labels. The rule of thumb for labels is five ingredients or less, if possible. They should be words that you recognize instead of dyes, fillers, preservatives, and chemicals. Obviously, you also want to look at levels of sugars, salts, fats, carbohydrates, and calories. Some First Mile Care participants find it helpful to use a smartphone app called Lose It! to read barcodes and get label information.

 

7. Choose proteins wisely.  If you’re going to splurge, do it in the meats section — it’s really an investment in your health. Chicken, turkey, beef — whatever animal protein you eat, make sure it’s a lean cut and preferably grass-fed, as many conventional farm meats and cuts are from animals that have been fed antibiotics and hormones. But not all protein is animal-based; you can get plant-based proteins in many vegetables, as well as beans, nuts, and seeds. 

 

8. Question product placement. Companies pay for eye-level product placement. If you look at the higher and lower shelves, you may find worthwhile brands to compare with the better-known names on the middle shelves. And bending and stretching can be part of your workout!

 

9. Make your life easier. The key to starting a new good habit is making it easy for yourself. And if something that holds you back is the effort involved chopping fruits and vegetables as part of your meal prep, buy pre-cut items. It’s easy to find bags of pre-cut carrots, onions, and herbs, along with pre-mixed salad greens and fruit salads. Buying a cooked rotisserie chicken in your market to de-bone at home can be a great time-saver and ensure you’re getting lean protein in your meals.

 

10. Make food shopping part of your activity routine.  When I go to the market, I dress in my exercise gear and wear comfortable sports shoes. I take water to stay hydrated. I make sure I’ve eaten before I go, so I don’t make impulse purchases because I’m hungry. And because I’m following a list, I walk more briskly and efficiently. I might even do a loop around the store before I begin shopping to get in extra steps.

 

In addition to the produce and meat sections I discussed above, I also visited the dairy section to talk about butter, milk, and yogurt. And I ventured into the inner aisles to look at salad dressings, oils, pastas and pasta sauces, broths, breads, granola, and even chips and peanut butter. 

 

Watch the video below and join me as I walk around my local supermarket. There are occasional video jumps and sputtering due to WiFi connection hiccups inside the store. Please note that if I make recommendations on certain products by name, this is strictly my opinion only. Neither First Mile Care nor I have any relationship with those brands. I hope you’ll find my “tour” useful and that you can apply my shopping tips the next time you go to the market.

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!


Q&A with DPP Participant: My Success with the First Mile Care Program

By Juliana Ronn, First Mile Care Director of Operations

Jeannie Lawson recently completed the year-long First Mile Care Diabetes Prevention Program (DPP). She agreed to talk about why she joined, the results she has seen, and her tips for leading a healthier lifestyle.

1. Don’t keep us in suspense. What results have you seen from the First Mile Care Diabetes Prevention Program?

First Mile Care is helping me to lead an active, vital life that makes me happy. I like to travel, especially overseas, and I have to be in pretty good shape for that. Traveling is important to me, and it’s what I want to continue to do until I absolutely can’t — and I want that to be a long time from now. I’ve learned some good healthy strategies through the First Mile Care program which will support me in my long-term travel goals.

Besides my general feeling of good health and well-being, I’ve seen several measurable benefits: 

  • My blood sugar level in my recent A1C test was 5.6, in the average range. This has been consistent since I joined First Mile Care. I’ve been able to stop taking cholesterol medication as my cholesterol level is now in the normal range.
  • I’ve lost — and kept off — 12 to 14 pounds, depending on the day. I have not lost as much weight as some people in my group, but I didn’t have as much to lose at the start of the program. 
  • I’ve lost inches. I now consistently wear a medium instead of a large. I’ve dropped at least one numerical clothing size and sometimes two, depending on the item. 

2. Tell us a little about yourself. What were your health challenges before joining First Mile Care?

I’m a retired educator — high school English and later, head librarian.  I live in The Woodlands, Texas, on the northern outskirts of Houston. I’m 74 years old. Over the past several years, I have gradually lost weight through a variety of efforts, but it was not having a positive impact on my blood glucose. My doctor became concerned that I was in the prediabetes range, and it wasn’t improving despite my weight loss. I was also taking medication to control both blood pressure and cholesterol.

3. Did you know what prediabetes was before your doctor diagnosed you?

While diabetes doesn’t run in my family, I do have an in-law who is a type 1 diabetic, so I have been very aware of the disease.  For years, every time we looked at the numbers, my doctor, Thimos (Tim) Paschalis of Physicians’ Group of The Woodlands, told me I was in the range for prediabetes. But I like carbs and love sweets, and wasn’t really motivated enough to do anything about it. 

4. Before joining First Mile Care, had you tried other lifestyle change or weight loss programs?

I had joined Weight Watchers in the past. It’s a good program, but I needed more structure than it offered me. I wasn’t very consistent. And some of the diet programs that require you to buy food can get very expensive. I also joined a gym and, later on, the YMCA. Since I was not someone who has ever particularly liked to exercise, I was just kind of plodding along. 

5. How did you hear about First Mile Care?

One day I received a letter from Dr. Paschalis introducing First Mile Care and the Diabetes Prevention Program. I contacted the physician assistant Lindsay Domangue, whom I’ve also known for several years, and she told me it was a great program and they’d recommended me for it. I thought about it for a while before committing, because I’m a methodical person and don’t just jump into anything. And it’s been so easy! It’s also amazing that it’s available at no charge to me.  I’m really grateful that they sent that original letter inviting me to join the program!

6. What do you like about the First Mile Care program? Why do you think it has worked for you?

The group encouragement and accountability was critical to me, and the valuable coach instruction and advice. We talked a lot about learning to read food labels. I used to track points in Weight Watchers, but now I track the calories and am shocked at the high calorie and fat content in most fast foods. It has made me very conscious of what I put in my mouth and has changed how I do my grocery shopping. Now when I am in the store, I use a smartphone app called Lose It!, which reads the barcode and tells me the label information. It helps me with tracking what I consume and deciding if I really want to buy that food item with high calorie or carbohydrate or salt count.

Tracking food intake, calories, and activity helps me stay on track and recover when I slip up. I’ve learned it doesn’t work to think you can eat crazy and then exercise like crazy, as what you eat is more important for losing weight than the exercise alone. It’s better not to eat crazy in the first place. I also learned that First Mile Care recommends getting a minimum of 150 minutes of activity each week. I knew movement was important, but it helps me to have a baseline number to hit. 

I used to not pay attention to what I ate when I traveled, but I travel a lot. And I’m very social, so I often dine out with friends. I might lose weight but then gain it back when I was socializing or traveling. Now, I’ve developed the habit of tracking calories and making healthy choices as a result of the First Mile Care program. I have the confidence that I can continue making healthy choices even when I’m eating away from home. It’s become a behavioral pattern.

For example, I was able to spend a week during the summer at a spa hotel in Mexico which has fabulous food. I’ve gone to that hotel several times over the years and have always gained at least five pounds because of eating desserts or not taking a morning walk. And then when I got home, I’d think, “Oh well, I’ve blown it.” But now, after being in the First Mile Care program, even though I didn’t actively track that week, it was always in the back of my mind. I knew the choices I was making and how to reconcile them. This time I only gained one pound — which I easily lost at home.

7. First Mile Care emphasizes neighborhood-based DPP groups. Did you find this helpful?

It was really important for me to participate in a group for motivation. In this program, because we were meeting every week and I knew that I would be speaking about my week, I always came prepared, and so did everybody else. We felt accountable to each other to take the program seriously. The sharing of their challenges helped me. It sometimes became pretty personal. A couple of the people in my group lost family members so we supported each other through those trying times.

Knowing we were from the same geographical area helped us become comfortable with each other. We were all in the same boat with our prediabetes and were united in wanting to improve our health. We knew the same restaurants and neighborhood places and could make recommendations to each other for where to buy certain items and how to fix healthy snacks. Even though we had to do Zoom meetings because of COVID-19 restrictions, I felt as if people were in the same room with me. We were able to meet in person a few times outside and also met with some of the other First Mile Care DPP groups. 

8. What role has your coach played in your success?

Coach Karalyn Cass was fabulous. I can’t say enough good things about her. She was approachable, knowledgeable, and very positive. Like any coach, she had a definite plan for each meeting which started and ended on time. She directed our conversations so everyone could share and be heard but not feel rushed. She added strategies and offered instructions at the end of our time together. I know she really listened because she would refer back to comments people had made in previous sessions. It was also helpful that she was a part of the local community, as she knew the places we walked, and how the weather was affecting our activities. That gave a personal touch which made people feel comfortable. Our group would have been dysfunctional without her facilitation. 

9. What kind of behavioral or habit changes have you made as a result of the First Mile Care DPP?

One of my weaknesses is sweet things. So I’ve learned in the DPP that when I go shopping, I just do not pick up cookies or other sweets. When I made Christmas cookies last year, I kept them at my neighbor’s house to remove the temptation. Instead, I keep fruit in my refrigerator for when I’m craving something sweet.

I have also become aware that one of my triggers for snacking is to sit for long periods of time. I can easily sit in my chair all evening, reading or watching TV and snacking. So I asked my children to chip in together to give me an Apple Watch for my combination birthday and Mother’s Day gift. I love it because it prompts me to get up every half-hour, and it’s kind of a competition because I want to see the circles close on the activity tracker. I would probably never have asked for the watch or used a digital tracker if not for what I learned through First Mile Care.

We also talked quite a bit about what Coach Karalyn called “sleep hygiene” and how it is connected to weight control and good health. So now I try to get ready for bed earlier and quiet myself so that I can go to sleep more easily.

10. Now that your year-long DPP course has finished, how are you sustaining the changes you’ve made?

The year I spent in the First Mile Care Diabetes Prevention Program has really built up my confidence. The material provided throughout the program has been invaluable to me. I have saved everything in a notebook and go back and refer to it. You can diet all you want to, but unless you learn some strategies to continue the changes you make, you slide right back as soon as you leave the program or stop the diet. Well, I’m not going to slide back! I know that I can make healthy lifestyle changes and continue them.  

One of the things I’ve learned from First Mile Care is that doing something with a group really helps keep me motivated. So now I have a small walking group. It’s just a few ladies walking almost daily inside our local mall when the weather is hot, or along The Woodlands waterway when it’s cooler. It’s been a great companion group to my First Mile Care class. I also do Zumba, chair yoga for seniors, and have even started weight classes at the Y.  First Mile has taught me to appreciate the value of the group.

I am so happy about — and thankful for — the health that I have. A lot of my friends have had surgeries and other kinds of health problems. I want to remain vital. And I think that First Mile Care has played a big role in my journey to good health and my ability to stay healthy.

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!