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!