The challenge holding back the diabetes prevention program

“So why aren’t more doctors prescribing the DPP to their patients with prediabetes? Perhaps it’s just not available to enough people when and where they need it. In addition to complex regulatory requirements and low reimbursement rates for providers, there’s the changing reimbursement rules for online classes versus in-person ones.”

Read more from First Mile Care founder and CEO, Karl Ronn, via Medical Economics >

Dealing with Lapses — How to Avoid Falling Into Old Habits

By La Tonya Allen-Brown, First Mile Care DPP Coach

We’ve all been there. You change your eating, exercise, and other lifestyle habits to achieve positive results. Perhaps your goal is weight loss, building muscles and improving flexibility, lowering blood pressure and/or blood sugar, improving the quality of sleep, or lowering stress. Maybe all of it! You feel GREAT. 

But after a while, you lose momentum. You start falling short of your goals. You “go off the rails.” Perhaps the weight loss slows, or the weather is inclement for exercising outdoors, or a pulled muscle prevents a trip to the gym. Maybe it’s vacation or a work project that requires longer-than-normal hours. “I’ll skip my workout today, but will make it up tomorrow,” you tell yourself.  An occasional glass of wine once again becomes a daily one. Yoga class seems like too much effort. Too busy to plan meals for the week and go to the market? There’s a strip of fast-food restaurants conveniently located on your drive home. And because of your schedule, you’re not getting seven-plus hours of sleep every night.

And just like that, you start slipping out of your new healthy habits back into an old, comfortable, less-than-healthy routine.

Yes, we’ve all been there — but we don’t have to stay there! It’s common to backslide. At some point, everyone has lapses – small slips, moments, or brief periods of time when they return to an old habit.

Getting back on track with your eating and activity goals after a slip-up is an important part of creating healthy habits that stick

Nip lapses in the bud

The First Mile Care Diabetes Prevention Program (DPP) recognizes that an occasional lapse or detour on your journey to a healthier lifestyle is perfectly normal.

A lapse is not a big deal unless you let it become one. But a lapse left unchecked can grow into a relapse, a chain reaction resulting in a return to previous eating and activity habits. A relapse usually results from a series of several small lapses that snowball into a full-blown relapse. The most effective way to prevent a relapse is to identify the lapses early and deal with the triggers before they turn into a relapse.

It’s possible to break the pattern of success, lapse, relapse. Whatever you do, don’t give up! You fall off the bicycle; you get back on. It’s important to have a growth mindset and not become discouraged. In a recent article on the First Mile Care blog, Coach Jina Berro explained how to stay positive and successfully vanquish the six types of negative thinking that can derail you on your path towards lifestyle change.

Planning your comeback

Part of successful lifestyle change is having a plan to deal with your high-risk situations (emotional, routine, social, or other) that could interfere with your progress, so that they do not turn from lapses into relapses. Develop a plan.  Write it down. Look at your plan when you find yourself faced with a high-risk situation, or in the middle of a slip.

Think about when you’re most at risk for going off-track in terms of your healthy eating habits, your physical activity habits, and other healthy habits that may require self monitoring (e.g., food journaling).

There are five steps of problem solving to address lapses:

  1. Describe your problem. What is the bad habit or habits that’s interfering with your progress towards your lifestyle change goals? Can you identify a root cause for the reason you “fell off the wagon”? Was it a special occasion? If so, is it likely to happen again soon? Did you eat because of social pressure? Did you skip physical activity because you were too busy with other things, or because of work and family pressures?
  2. Come up with options. How can you break the bad habit? What should you be doing instead to address the root cause of the problem? What are the pros and cons of each option?  If your challenge is food-related, you might want to eat mindfully and track your intake for a while, if you had quit doing it. You could budget fewer calories or increase your physical activity for a few days to make up for your lapse. If you had quit formal meal planning, you could try doing it again for several days, or several meals.
  3. Choose the best options that are most likely to solve your problem. Make your new routine easy and the old one harder to follow.
  4. Make an action plan. You want to regain control of your eating or physical activity at the very next opportunity. Getting back on track without delay is important in preventing lapses from becoming relapses. Write down what you’ll do, when, for how long, possible challenges, and ways to overcome the challenges. What negative thinking might get in the way, and what positive thoughts can help you keep going?
  5. Try it! And if it’s not working, switch things up. Iterate.

When you find that you have lapsed, focus on all the positive changes you have made. Lifestyle change is a journey, with lots of small decisions and choices that you make every day that add up over time. Remind yourself that a short period of overeating or skipped physical activity will not erase all of your progress. Reach out to your support group — your DPP coach, another First Mile Care participant, or friends or family members who will lend a sympathetic ear.

Most importantly, be kind to yourself. How you think about your lapse is the most important part of the process. If you give up and stop trying to make changes, then you are at risk for a true relapse. But if you treat your brief lapse as a learning opportunity, you will succeed.  And build in a healthy reward for when you get back on track!

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!

Accentuating Your Positive Thoughts

By Jina Berro, First Mile Care DPP Coach

Lifestyle change, whether deliberately undertaken or thrust upon you by circumstances, is not easy.  We tend to want to fall back into old habits. Even if the change is one you really want  — for example, following an intervention program to prevent the development of diabetes — it can feel very challenging at times.

Life is finally taking on a “normal” sheen after two-plus years of disruption, anxiety, loss, and separation. As we return en masse to in-person celebrations, indoor restaurant dining, crowded events, airline travel, school classrooms, and shared office space, you may find that managing the way you eat and drink, your activity level, and even your sleep are affected. The new habits you have developed are subconsciously struggling with your old ingrained behaviors. Life can feel challenging at times. 

Good health results from consistent behaviors. Making lifestyle changes that endure can be a slow process, but a rewarding one that pays big dividends. In the First Mile Care Diabetes Prevention Program (DPP), coaches work with participants to determine a set of realistic goals and an action plan that works because it’s tailored to each person — and within your control.

Did you know that your mindset towards change can make it easier — or harder? By replacing negative thoughts with helpful thoughts, you can stay on track to achieve better health outcomes. To quote one of Johnny Mercer’s many entries to the Great American Songbook:

“You got to ac-cent-tchu-ate the positive

E-lim-i-nate the negative

And latch on to the affirmative

Don’t mess with Mr. In-between.”

Now, it’s easy to say, “think positive thoughts” but how do you do it?  The key thing is to recognize that not all negative thoughts are the same. The DPP identifies six types of negative thinking that can derail you on your path towards lifestyle change.

  1. All or Nothing. You see only the extremes; for example, “I can never drink wine if I want to lose weight.”  But denying yourself something you really enjoy isn’t a sustainable solution. Instead, find the path of moderation. Allow yourself to have a glass of wine when you’re with other people, or allow yourself one bottle of wine a week. 
  2. Excuses. You blame situations, things, or other people for your choices. Haven’t we all said, “It’s too hot this week to go for a walk,” or “I can’t lose weight because my roommate is always making desserts.”  Instead, take a walk outside at a cooler time of day, or exercise in an air-conditioned room. Share recipes for healthier dessert alternatives with your roommate.
  3. Filtering. You focus on your failures instead of your successes. You’re downcast that you went off your healthy eating plan during vacation and gained two pounds. Did you have a good time while doing it? Then don’t stress about it. Instead, remember that you stuck to your nutrition plan five days out of seven, and focus on how many pounds you’ve lost since you started the DPP. Talk with your friends or DPP coach about how to stay on track in the future.
  4. Self-Labeling. You belittle yourself and your efforts towards long-term lifestyle change. “I’m in terrible shape and I’m a lousy cook.” Instead, think about what exercise you do now or dishes you make that you didn’t used to be able to do. Can you climb stairs without huffing and puffing? Do you walk a mile without stopping for rest? Are there a couple of easy recipes that you have added to your repertoire?
  5. Comparing. You compare yourself with other people and find yourself lacking. This is truly dangerous thinking, as every person’s journey towards lifestyle change is different. Instead of feeling disheartened by the progress made by other DPP participants, be encouraged. If they can do it, so can you! Ask them for tips. Discuss your action plan with your coach and see if you should adjust it, or try a different type of physical exercise.
  6. Pessimism. You assume the worst. “I’ll gain weight on vacation so what’s the point of sticking to my action plan?” Or, “I know I’ll hurt my back using this machine, and then I won’t be able to work out.” And worse, “I’ll get type 2 diabetes because my parents had it, so there’s no point in trying to reverse my prediabetes diagnosis.” Instead, undertake different types of activities that you can do safely. Get in movement during vacation that balances out the meals you eat.  And remember that you probably know a lot more about how to prevent type 2 diabetes than your parents did.

Once you identify the negative thoughts affecting your progress towards change, call a timeout on them instead of dwelling on them. Some people imagine a big red stop sign or a referee blowing a whistle. Ask yourself about triggers for negative thoughts in terms of timing, causes, routines, and even people. What new routines can help you pause your negative thoughts and guide you to more positive, helpful thoughts?

“You got to spread joy up to the maximum

Bring gloom down to the minimum …”

When negative thoughts enter your mind, it’s important to remember how well you are doing and how far you have come on your journey to prevent type 2 diabetes. You have the tools to replace those negative thoughts with helpful messages.

Here are some additional tips to manage negative thinking:

  • Practice helps. Practice recognizing negative thoughts and substituting positive ones.
  • Be realistic. Make sure your action plan for healthy lifestyle change  is do-able, specific, and flexible.
  • Laugh at yourself. Keep a sense of humor about your progress to lifestyle change — or lack of it. Rome wasn’t built in a day.
  • Spoil yourself. Practice self-care by managing stress, getting enough sleep, eating right, and staying active.
  • Maintain perspective. There are ugly, divisive things happening in the world that can bring your mood down, but there are even more acts of beauty and love.
  • Find your tribe. Be around people who practice helpful thinking and support you in your choices.
  • Reward yourself. Celebrate your progress towards your goals.

It can take time to replace negative thoughts with positive ones. But keep practicing and it will become a new habit! The First Mile Care DPP provides the coaching you need to self-manage your behaviors and create healthy habits that stick for the long term.


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!

Guidelines to Power Napping

By Karalyn Cass, First Mile Care DPP Coach and Program Coordinator

Many people are not fully aware of the important role that sleep plays in maintaining a healthy weight. In the First Mile Care Diabetes Prevention Program (DPP), coaches emphasize the basics of good sleep hygiene. As I explained in an earlier article and webinar on sleep habits, sleep is closely connected to both weight gain and loss, as well as how your body reacts to insulin, the hormone that controls your blood sugar. 

Your body repairs, recovers, and restores many functions during sleep that influence how much energy you have during the day. Sleep affects two hormones — ghrelin, which tells your body when you need to eat, and leptin, which tells your body that you’re full. When you’re sleep-deprived, your body will end up with too little leptin and too much ghrelin. Your brain will tell your body to stop burning calories and that you need to eat. You’ll feel hungry even when you don’t really need food. 

The general recommendation for a healthy amount of  sleep is 7-9 hours a night. Sometimes, though, you can use a brief period of sleep during the daytime to re-energize the body. Napping can help with drowsiness, relaxation, mood improvement, better concentration, a sharper memory, and creativity — hence the nickname “power nap.” 

In some countries, especially ones with hotter climates, napping is part of the traditional culture. (Noel Coward wrote an entire patter song about it.) While nap rooms have become a popular benefit in some larger companies for employees working odd hours, for most people with an 8-5 job, “siesta time” is a luxury to indulge on weekends, during vacations, and after big holiday meals.

Forty winks

It’s best to avoid frequent or excessive napping. The ideal nap is a short one in which you fall asleep quickly and wake feeling refreshed. 

  • Timing is everything: Napping before 3pm will take advantage of your natural sleep-wake cycle and be less likely to interfere with nighttime sleep. 
  • Keep it cozy: There are people who can nap anywhere, but a quiet, comfortable place will contribute to drowsiness.
  • Make it quick: Avoid napping for more than 10 to 20 minutes — set an alarm to avoid falling into deep sleep. Some power nappers can sleep as little as five minutes and still feel a benefit. Anything longer may hinder the five stages of sleep and leave you feeling groggy.

If you’re getting the recommended amount of sleep each night, you probably won’t need a nap on a regular basis. For people with erratic work schedules or who know they will be temporarily losing sleep (e.g., taking an early or late flight, vacation, etc.), a nap is helpful to recoup those lost zzzzzz. But naps aren’t for everyone, as some people find it easy to glide into a quick midday siesta while for others, it’s challenging to enter and leave a state of unconsciousness. And napping is not a long-term solution for people who suffer chronic insomnia.

Getting your shut-eye

An occasional nap of 10-20 minutes is not bad for your health. If you are sick, you may need to nap to aid your recovery, and for longer periods. Babies and young children also take long naps to give their body time to develop.

But if you’re an adult and need frequent naps, poor sleep at night is most likely the root cause. Consider frequent napping as a warning sign and reflect on what you can do to improve your sleep in terms of quality as well as quantity. 

Paying attention to your sleep patterns and trying to establish good sleep hygiene is key. Here are a few things to consider:

  • Scheduling: Establish a consistent sleep schedule that ensures the recommended amount of sleep, even on weekends.
  • Relaxation: Create a relaxing sleep environment: bed, pillow, temperature, etc. Reserve your time in bed for sleep and sex only, and avoid eating, working, or other activities. 
  • Movement: Get the recommended amount of exercise during the day. Physical activity can reduce stress and settle your mind, helping you to fall asleep faster and improve sleep quality.
  • Limitations: Avoid the following in the evening hours before bedtime:
    • Large meals
    • Large amount of fluids
    • Caffeine in coffee, teas, sodas, and chocolate
    • Alcohol
    • Use of electronics less than 30 minutes prior to bedtime

If you’re getting the recommended 7-9 hours of sleep each night yet are still feeling sleepy during your normal day, that could be an indicator of a hidden health problem. A recent study published by the American Heart Association found a link between older adults who napped and a higher risk of high blood pressure and stroke. Yet, experts recognize that the nap itself may not be the problem, but a symptom of poor nighttime sleep or other health factors. Make sure to talk to your physician about any underlying health issues that could be interfering with your sleep.

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 Steps to Healthy Aging

By Gray Jessiman, First Mile Care DPP Coach

September is designated National Healthy Aging Month in the U.S. to encourage healthy lifestyle behaviors among older adults. It’s also about raising awareness of the prevention and management of chronic health conditions like high cholesterol, high blood pressure, and obesity, which are often linked to the development of prediabetes and heart disease.

According to the Centers for Disease Control (CDC), more than one in three American adults have prediabetes, but 80 percent are unaware of the condition and the risk it poses for developing into type 2 diabetes. Compared to 2025, by the year 2060, U.S. rates of type 2 diabetes are expected to jump by nearly 40%, per a study published in the Journal of the American College of Cardiology in August. 

Luckily, prediabetes is reversible, so you have the chance to take control of your health by improving your eating habits, becoming more physically active, and lowering your blood sugar levels to avoid becoming a statistic.

The best time to prevent type 2 diabetes is NOW. If your doctor says that your blood sugar is in the range for prediabetes, or that you have other risk factors based on family history, consider the diagnosis as an early warning sign — like an indicator light on your car dashboard. The First Mile Care Diabetes Prevention Program (DPP) teaches participants with prediabetes to make small adjustments in habits that add up to sustainable, healthy lifestyle change in eating, activity, sleep, and stress management. You have time to fix this! 

The glass is half-full

The idea of Healthy Aging Month gained traction in the early 1990s when the first members of the Boomer Generation began turning 50. It spread the message that it is possible to celebrate life and the positive aspects of growing older by adopting a healthier lifestyle at any age. It encourages people to focus on their physical and mental health and take precautions to help them mature gracefully. 

It’s often been a challenge the last few years to look on the brighter side of life events. The world has sometimes seemed to be spinning out of control. And as you age, your physical and mental health as well as dietary and social needs, may change over time. But your life is still within your control. You can take charge of your physical and mental well-being by incorporating habits around exercise, healthy food, and adequate sleep. You’ll find it’s possible to age healthfully and gracefully and see the glass as half-full instead of empty.

Here are 10 habits you can start today to reduce your risk for diabetes and related chronic illnesses and to improve your ability to stay healthy into old age. 

  1. Be proactive about prevention. It’s important to have annual physical exams and regular checkups by your physician —  and don’t skip your eyes and teeth. Your health insurance may entitle you to proactive healthcare screenings, tests, and immunizations based on your age and gender. Your doctor may recommend tracking important health indicators at home with tools and smartphone apps, such as a continuous blood glucose monitor for learning how food affects the body, or an arm or wrist band for checking blood pressure range.
  2. Manage stress levels. Chronic stress can be associated with fatigue and depression, which can cause people to become less active and lead more sedentary lives. Stress can also interfere with sleep and increase your appetite, so it’s critical that you find ways to de-stress regularly. Stress-relieving activities should be calming and leave you feeling more grounded afterwards. Finding what works best for you to reduce and manage stress can play a crucial role in healthy aging.
  3. Practice good sleep hygiene. Your body restores many functions during sleep that play a role in how much energy you have. Sleep enhances mood, reasoning, problem-solving abilities, coping mechanisms, attention to detail, and memory. It also affects two hormones that tell you when you’re hungry and when you’re full, so it has a strong effect on weight loss (and gain). You want both the right quantity of sleep — at least seven hours — as well as good-quality sleep, so practice a healthy bedtime routine. Regular physical activity is a foundational element of sleep hygiene, as research shows that exercising can help you fall asleep faster and improve sleep quality.
  4. Eat in moderation. Using food as “medicine” is key for promoting a healthy and vibrant lifestyle. First Mile Care recommends a diet high in fruits and vegetables, with the ideal meal about 50% produce, 25% starches and fibers, and 25% protein, along with some fats essential to brain health and satiety (e.g., nuts, seeds, avocados, coconut or olive oil, etc.). It’s important to balance the recommended amount of each food group with daily recommended calories, which varies with age, sex, and physical activity level. As you age, you may need fewer calories, and can learn to eat mindfully and manage calorie intake through portion control, meal timing, and healthy food swaps. The National Institute on Aging offers dietary guidelines for older adults on its site, Healthy Eating As You Age
  5. Choose liquid refreshment wisely. Hydration becomes even more important as you age. Instead of sugar-sweetened drinks, consume water, sparkling water, tea, or coffee. Fruit and herbs add flavor that turns plain water into something special. Alcohol should be taken in moderation; ideally, no more than one drink per day. You can also make your own delicious smoothies at home with healthy ingredients.
  6. Get on your feet. Exercise actually slows down the process of aging. It is not only good for physical fitness, it also stimulates the growth of new brain cells, releases endorphins that boost your confidence, and improves sleep quality. The First Mile Care DPP says adults should aim for at least 150 minutes of moderate-intensity physical activity each week to help maintain a healthy weight and lower blood pressure, cholesterol, and sugar levels. Make your physical activity something you truly enjoy doing, alone or with a friend — swimming, cycling, dancing, running, yoga, walking, dancing, etc. Every step counts when it comes to reducing diabetes risk and maintaining a healthy heart. Recent research shows that walking for even two minutes after a meal can make a world of difference.
  7. Practice strength and resistance training. Muscles atrophy or shrink as part of the aging process, resulting in poor leg strength and balance that are a common cause of falls in older adults. Strength training is about maintaining muscle mass by building strength progressively through movement repetition and increased resistance through weight lifting. It can change your body composition by decreasing body fat and increasing coordination, power, and metabolism. Practicing strength training two times a week with either resistance bands or weights helps build strong bones and muscle, and improves balance and coordination, which is especially critical as you age.
  8. Stimulate your brain. As you age, your brain shrinks in size, slows down, and becomes less adaptable to change. Therefore, you need to exercise your brain regularly just as you stretch other muscles. This can include reading, writing, art, music, skills, crafts, languages, and all types of brain teasers, puzzles, and games — whatever involves concentration, analysis, problem solving, and memory.
  9. Maintain social connections. Remaining active and engaged with others is a gift to yourself. The emotional support you receive from being part of a network — friends, family, church, alumni groups, volunteer organizations — is part of the bigger picture in helping to keep your mind and body well. Human support eases stress when times get tough, as was reinforced during the last few years of COVID-enforced isolation and separation.
  10. Keeping a positive outlook.  The power of positive thinking shouldn’t be underestimated. The Journals of Gerontology: Series B published research that being pessimistic about growing old can become a self-fulfilling prophecy, leading to a faster deterioration in both overall health and wellbeing. The reverse can also be true. Technology puts pressure today on emotional well-being; increased screen time can affect sleep quality as well as mental health. Setting limits for your tech devices can reduce your exposure to negative news and influences, and therefore the risk of creating anxiety, stress, and depression.

You’re as old as you feel, the saying goes. By developing the right lifestyle habits, you’re going to look and feel younger, no matter your age.

“I am so thankful for the health that I have,” said Jeannie Lawson, a Houston-area septuagenarian who completed the First Mile Care DPP in 2021. “A lot of my friends have had surgeries and other kinds of health problems. First Mile Care has played a big role in my journey to good health and my ability to stay healthy. It is helping me to lead an active, vital life that makes me happy.”

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!

Considering Calories

By Taylor Winkel, First Mile Care DPP Coach and Registered Dietitian

Calories, calories, calories. People sometimes obsess over them. A calorie is a unit of energy in food and drink. We use calories to describe or measure how much energy your body could get from eating or drinking something. When you consume more calories than you expend in energy, your body stores the excess as body fat, which can result in weight gain over time. 

When someone talks about following a diet and counting calories to lose weight, the first thing that comes to mind is sustainability. Most trendy diets are attractive because they offer a short-term fix, yet weeks or months later the weight returns because adopting a diet of too few calories and too many rules is not practical and sustainable in the long term. This is why the First Mile Care Diabetes Prevention Program (DPP) emphasizes identifying behavioral triggers to make small, incremental changes to eating, physical activity, and other healthy habits that result in lifestyle improvements. 

The DPP promotes eating for health, not for short-term weight loss. First Mile Care coaches encourage participants to keep food journals to become more self-aware of eating habits. The DPP curriculum includes guidance on how to reduce calorie intake by controlling portion sizes and frequency of eating, and by swapping healthier foods for unhealthy items.

In addition to what you eat and drink, effective stress management, ample shut-eye, and regular exercise all play a role in lowering blood sugar and blood pressure levels, which can reverse prediabetes and reduce the risk of heart disease, along with other health benefits.

The calorie-energy connection

The ideal number of calories varies for each person. The Academy of Nutrition and Dietetics recommends calorie needs for adult women range from 1,600 to 2,200 per day, while for men it’s 2,000 to 3,200 per day. A person who rarely exercises and has a sedentary lifestyle would likely be at the lower range of calorie needs, whereas a very active person might be at the higher end. 

The factors that determine how many calories an individual adult needs is based on total daily energy expenditure (TDEE), or the number of calories you burn throughout a 24-hour period from all the types of physical activity your body does to keep you alive, from brain functions to exercise. 

TDEE reflects a combination of four calculations:

1) Basal metabolic rate (BMR) is the minimum number of calories your body needs to survive at rest, including breathing, organ function, and other body processes. BMR can change from person to person based on sex, height and weight.

2) Exercise activity thermogenesis (EAT) is the amount of energy needed for intentional activity or planned exercise that exert effort, such as running, lifting weights, swimming, cycling, etc.

3) Non-exercise activity thermogenesis (NEAT) is any energy required when not intentionally exercising. This can be doing chores around the house, cooking, cleaning, or pacing on the phone.

4) Thermic effect of food (TEF) is the energy required by the body to digest and absorb foods, and changes depending on what you eat.

To put it simply, sex, height, weight, activity level, and even the things you eat can affect the amount of energy or calories you burn, and ultimately need to survive. A professional athlete and a breastfeeding mother have vastly different caloric intake requirements than an office worker, as they expend energy differently. 

Al Cisneros, who successfully completed the DPP in the Houston area, said, “The First Mile Care program doesn’t require me to give up anything, only to get enough exercise to offset my caloric intake. I’ve found food journaling to be extremely helpful, and have continued to practice it even after the required period ended. I now realize there are so many easy forms of movement that burn calories and count towards my fitness goals.”

The dangers of not enough calories

We’re usually concerned with avoiding the consumption of too many calories. But what happens when you don’t get enough?

When you eat enough and have extra calories, specifically from carbohydrates, your body preserves glucose and stores it into the liver and muscles as glycogen so it can be utilized at a later time. Similarly, when you eat fat in excess, your body stores that in your adipose tissue.

If you do not eat enough, your body will start to slow down its metabolism so it can conserve energy, while also trying to make its own energy. To make your own energy (gluconeogenesis), your body will first pull that glycogen from liver and muscle stores in order to fulfill energy needs. Eventually, when the body is low on glucose or glycogen, fat tissues get broken down and the body makes energy from them. 

If your body goes through this process over and over and does not have enough fuel to power it, it not only slows down metabolism as described above, but it may lead to things such as nutrient deficiencies, mental fatigue, gallstones, etc. Basically, if you don’t eat enough calories, your body doesn’t convert enough energy and then goes into starvation or survival mode. 

Paying attention to your hunger cues

DPP is about becoming more aware of the foods you eat and what they do for you, rather than the latest fad diet, protein powder, or Instagram-famous supplements. If you’re fixated on weight loss, rather than on adding quality ingredients and calories to promote wellness, you’re more likely to indulge in disordered eating and develop an unhealthy relationship with food. 

One of the best ways to know if you are — or are not — eating enough calories is by getting in touch with your hunger and fullness cues. When you start to feel weak, shaky, sluggish, irritable, constantly hungry, experience frequent headaches or brain fog, or are struggling to sleep at night — these might be signs you are not eating enough.  And those are only short-term effects. If you restrict yourself too much for too long, you might notice hair loss, anemia, bone loss, and many other health complications. 

Good health results from consistent behaviors. Weight loss is a natural side effect of eating for health. Making lifestyle changes that endure can be a slow process, but a rewarding one that pays big dividends.

“As a result of the First Mile Care program, I’ve developed the habit of tracking calories and making healthy choices even when I’m eating away from home,” said Houston-area resident Jeannie Lawson. “It’s become a behavioral pattern and is always in the back of my mind. Tracking food intake, calories, and activity helps me stay on track and recover when I slip up. I know the choices I am making and how to reconcile them.”

Estimating your calorie needs

It’s always a good idea to talk with your primary care physician or meet with a dietitian one-on-one who can accurately assess your calorie needs. There are also online tools that can provide an estimate. The MyPlate Plan from the U.S. Department of Agriculture (USDA) bases estimates on height, weight, age, sex, and activity level. The Body Weight Planner from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) considers the same factors and is a bit more comprehensive.

Jeff Millhouse has also completed the First Mile Care DPP. He said, “Food tracking is important, just as it was in the other fitness programs I did. What is distinctively different is that the First Mile Care program takes a more holistic view about addressing the many intertwined factors that affect your physical health and mental well-being. It’s about learning how to make smart choices so that you don’t fall back on old behaviors.”

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!

Tempting Your Tastebuds with Herbs and Spices

By Jenny Fowler, First Mile Care DPP Coach

The First Mile Care Diabetes Prevention Program (DPP) teaches participants to make small adjustments in habits that add up to sustainable, healthy lifestyle change in eating, activity, sleep, and stress management.

While the DPP does not label foods or behaviors as “good” or “bad,” we recommend eating a diet high in fruits and vegetables. The ideal balance of a meal is about 50% produce, 25% starches and fibers, and 25% protein. It’s also essential to include some fats in the form of nuts, seeds, avocados, coconut oil, and olive oils, as they help you to feel satisfied.

Throughout the year-long DPP course developed by the Centers for Disease Control (CDC), we encourage participants to try new recipes, explore restaurants, and discover new ways to prepare food. In fact, one of the benefits of the First Mile Care DPP is our emphasis on sharing neighborhood-centric information with other participants in the group, who all live in the same ZIP codes as their coach. 

A diet focused on produce doesn’t have to be simple or plain.  Most Asian cuisines emphasize vegetables, yet their combinations of herbs and spices make for interesting flavor profiles. Experimenting with herbs and spices can jazz up your meal and even your beverages.

What’s the difference?

The dictionary definition distinguishing herbs from spices is that herbs are leafy things (e.g., basil, tarragon, thyme, cilantro, etc.) and spices are whole or ground seeds (e.g., coriander, cumin, anise etc.). But the division between leaves and seeds can be a bit messy.

Quite a few spices, like cardamom, cumin, and tumeric, come from plants that are botanically herbs — seed-producing plants that die down at the end of a growing season. Ginger (from a root) and garlic (a bulb) can generally be found in the spice aisle when in their powdered form, as can saffron (from a flower stigma) and clove (from a flower bud) which, like cinnamon bark, comes from a tree. And in the case of a number of plants, both leaves and seeds are used in culinary creations. The main thing is that, whatever their origin, they all add variety to the taste of your cooking.

Whether it’s an herb or a spice or simply something everyone thinks of as a spice, it’s important to remember that freshness really, really matters. People often say they don’t like a spice or don’t see its value, but that’s because they’ve tasted old dried stuff that sat in a kitchen cabinet for years.

When organizing your spice cabinet, keep these tips in mind:

  • Write the purchase date on the jar cap or put a label on the bag. In this way, you’ll keep track of the age and know exactly how long that paprika has been on the shelf.
  • Ground spices lose flavor more quickly than whole spices. As a general rule, whole spices can last up to four years, ground spices up to three years, dried herbs three years, spice blends two years, and fresh spices only a week or so. While it’s more convenient to buy them pre-ground, you’ll get more flavor over a longer period, and more benefits from the essential oils, if you buy them whole and grind them as you use them — similar to coffee beans. 
  • Before using any spice or herb in a jar, take a deep whiff. The sell-by date is not enough for judging freshness. If the aroma isn’t pungent, the taste (and health benefits) won’t be, either. Time to toss it.

Here are just a few herbs and spices that I like to use in meals. You can also experiment with infusing fresh herbs like basil and lavender in water for a tasty, sugar-free drink.


Basil/mint. Many of the most popular culinary herbs are from the same mint family: anise hyssop, basil, lavender, lemon balm, oregano, rosemary, sage, savory, summer savory, sweet marjoram, and thyme. Basil contains antioxidants, vitamins and minerals, including vitamin A, vitamin K, iron, manganese, and calcium. Fresh or cooked basil is a delicious addition to salads and pasta dishes, and can even be a substitution for mint in a cocktail like a mojito.

Dill. The leaves of dill weed can be added like parsley to potato salad, tzatziki dip, and fish. The seeds are used as a spice to flavor foods like bread and pickles.

Lavender. Another member of the mint family, all lavender is edible, but some types have a higher camphor content so are better suited to soaps and bath products. What’s labeled as “culinary” lavender is a flavorful addition to vinegars, fruit, salads, and poultry dishes. Steep the seeds with black or herbal teas, or add them to ground coffee beans for an extra-soothing cuppa joe. 

Lemon grass. Its distinct citrusy flavor and aroma is a staple in South Asian cooking. It’s widely used in savory dishes and meat, poultry, seafood, and vegetable curries, especially when combined with coconut milk. The stems are also used in teas, pickles, and in flavoring marinades. It promotes digestion and is considered a diuretic.

Oregano. As a member of the mint family, oregano has a minty aroma as well as a peppery bite and can even dress up canned soup. It often appears in Mexican and Spanish dishes as it pairs well with tomatoes, pasta, and olive oil. Oregano has antibacterial properties and has been shown to have antiviral properties for certain viruses. You can get therapeutic amounts from oregano oil.

Rosemary. The rosmarinic acid in this herb is known to help with allergies, nasal congestion, and overall inflammation. Fresh or dried rosemary will flavor oils, vinegars, sauces, meats, soups, and stews.

Sage. Sage is very high in vitamin K, and it contains vital minerals like magnesium, zinc, and copper.

This herb is antimicrobial which may help reduce dental plaque from bacteria in your mouth. Several types of acidic compounds in it act as antioxidants, which has made it a popular traditional ingredient in bedtime infusions.

Tarragon. This aromatic, licorice-scented herb is frequently used in French cuisine as it adds flavor to any meat or vegetable dish as well as soups. You can make your own salad dressings and meat marinades by infusing vinegar with tarragon. It’s a source of vitamins A, B6, and C, and is considered a digestive aid.


Cardamom. The black and green pods and seeds are widely used in Indian, Middle Eastern and even Swedish cuisine. It’s a core ingredient of popular masala spice mixtures that season meat and vegetable dishes, baked goods, and even chai tea, coffee, mulled wine, hot cider, and eggnog. It has a range of antioxidant, diuretic, and digestive properties that make it a fixture in traditional medicine.

Cayenne Pepper. A dash of this spice adds flavor to soups, stews, scrambled eggs, and hummus. It adds heat to Mexican sauces, Asian curries, and Cajun dishes. A tiny pinch gives a kick to hot cocoa or even lemonade. It offers potential health benefits as an active ingredient is capsaicin, which is thermogenic, meaning it speeds up metabolism. Like other chili peppers, cayenne peppers are especially rich in provitamin A carotenoids and vitamin C.

Cinnamon. Obtained from the inner bark of the cinnamon tree, cinnamon adds flavor not only to candy, pastries, breakfast cereals, and snack foods, but to savory dishes, fruit, and tea as well. It has antioxidant, antibiotic, and anti-inflammatory properties.

Coriander/Cilantro. The seeds of the coriander plant are the coriander spice, while in the U.S. we call its edible plant leaves and stems “cilantro.” It’s a member of the parsley family, related to other lacy-leaved plants such as anise, caraway, chervil, cumin, dill, and fennel, and even vegetables such as carrots, celery, and parsnips. Coriander leaves and seeds are full of vitamin K, and it also acts as a diuretic. The seeds can be roasted, pounded, and included in meat rubs and marinades.

Cumin. A spice from the dried seed of a plant in the parsley family, it’s a staple in spice blends and is used in Mexican, Indian, African, and Asian cuisines. It has calcium, iron, and magnesium, and also contains antioxidants which may be linked to benefits such as promoting digestion.

Paprika. This spice made from dried and ground red peppers is a common ingredient in spice blends and rubs, marinades, sauces, and stews. It adds a touch of color to hummus, waffle fries, deviled eggs, and cauliflower. Like cayenne pepper, it contains capsaicin, shown to have antioxidant properties and a range of health benefits.

Turmeric. A member of the ginseng family, turmeric is a frequent addition to Indian cuisine. In addition to giving mustard and curry their vibrant coloring, it also contains curcumin, known to have powerful anti-inflammatory effects. 

As you can see, there’s no reason you should ever consider your meal boring and tasteless! The website of the U.S. Department of Agriculture (USDA) has a wealth of information related to healthy eating, including recipes and meal plans based on the USDA’s Dietary Guidelines for Americans, 2020-2025. 

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!

AMA Health2047 Bullish on Innovation

“…the diabetes prevention program is ‘just remarkably effective. It far outshone the conventional behavior modification like Weight Watchers. It even outperformed diabetes drugs like Metformin.'”

Read the full story from Chicago Medicine (pg.22) >

Walking for Wellness

By Sandra Huskey, First Mile Care DPP Coach

A study published this month in Diabetes Care found that walking 10,000 steps per day can lower the risk of death in people who have trouble regulating their blood sugar. The researchers at the University of Seville examined data from the CDC on 1,700 American adults with prediabetes and diabetes. Walking for 2.5 hours a week can cut your risk of heart disease by 30%, according to Harvard Medical School research.

This isn’t really a surprise to participants in the First Mile Care Diabetes Prevention Program (DPP), who are asked to get a minimum of 150 minutes of moderate activity — which can include walking — per week as an element of the program. If 10,000 steps seems daunting, try taking it in chunks. People trying to start exercising often get caught up in “all or nothing” thinking, but even a few minutes throughout the day in small spurts of activity offers benefits. 

Walking not only burns calories but can strengthen your muscles, flatten your abdomen, lower your blood pressure, relieve stress, and lift your mood as endorphin levels increase. It’s a cardio exercise as it gets your heart rate up, as well as a weight-bearing exercise that engages all of your lower body muscles, plus your core and arms if you swing them lightly from your shoulders. Walking can also help prevent bone loss as you age, since bone is living tissue that, like muscle, grows stronger with exercise, according to the National Institute of Health.

Why walk?

Walking truly is the near-perfect exercise because it doesn’t require training, you can do it anytime — winter or summer, day or night, alone or with a partner or pet — and it’s free.  All you need is a decent pair of shoes that you check regularly for wear and tear to avoid uneven pacing that might lead to falls and hip, ankle, and back pain.

Even a tactic as simple as parking your car at the far end of a garage from the door can add extra steps to your day. If you have a sedentary desk job with a lot of virtual meetings, try using the time before or right after the meeting to take a short walk. If you’re working from home, do a “virtual commute” at the start and end of each day by walking around your house, yard, or neighborhood as if you were commuting to and from work. Walking meetings and phone calls are an easy way to get your steps in, as is using your walk to catch up on podcasts, whether for education or entertainment. 

Here are a few tips for getting more out of your walk.

Take smaller steps at a faster pace: Your walk will become a more challenging cardio workout if you walk faster, and swing your arms accordingly. Shorter strides help build your cadence and increase your speed (and you’ll hit that magic 10,000 marker more quickly).

Vary your route and scenery: If possible, get both flat and hilly terrain into your walk, or take in stairs. Determine multiple routes that help you reach your goal in terms of steps or time, and then vary them daily to keep your walk fresh.

Challenge yourself with intervals: Walk slowly for one minute, then quickly for one minute, and repeat. Or walk in five-minute blocks, where one minute is fast-paced and four are easier.

Keep going: The fewer breaks you take, the longer you’re keeping your heart rate elevated, so keep pacing in place while waiting to cross the street, or while checking out shop windows or the books in your neighborhood Little Free Library.

Aside from the physical benefits, walking gives you “me time” — preferably outdoors in the fresh air — to think, listen to music, catch up with a friend, or just to observe your surroundings and change of seasons in more detail. You may even make new acquaintances in your neighborhood. 

Mike Kowis, who completed the First Mile Care DPP in Houston in 2021, saw the value of tracking his daily steps on his Fitbit. “One of the most rewarding parts of the First Mile Care program was getting together with the other participants and telling them about meeting my goal of walking 10,000 steps every single day. It felt great to be encouraged by people who sincerely cared about my success and were happy for me.”

So start walking!

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!

CHPPR and First Mile Care Partner to Reduce Prediabetes Rates

“The DPP is a year-long, lifestyle change program clinically proven to stop the onset of type 2 diabetes. Less than 5% of Americans with prediabetes have a program within 10 minutes of home. We are committed to making the DPP more accessible by creating a nationwide network of First Mile Care DPP coaches.”

Read the full story from our partners at UT Health here >