Venice resident Frank Porter, 77, says he put on a few pounds over the years but didn’t think it was serious.
He and others still considered him a “tall and lanky person” who could eat whatever he liked.
“I was always sort of a clean-your- plate kind of person,” says Porter, who enjoyed hefty servings of po’ boys, potatoes and peanuts. “Weight had never really been a problem for me; I just ate what I wanted and never paid attention to all the nutritional things like calories and fats.”
Mary Chase works with 15 adults in a Diabetes Prevention Program at the Venice YMCA once a week for 16-weeks. Those who are enrolled attend the one-hour long classroom sessions, followed by monthly maintenance sessions. (August 19, 2014) (Herald-Tribune staff photo by Rachel S. O'Hara)
Last year, his doctor even told him that his blood glucose was a bit higher than usual — but not to worry; it wasn’t diabetes.
“He said I was sort of at the high end but he didn’t think I needed to do anything,” Porter says. “It wasn’t like he said something was wrong; he said it wasn’t a problem.”
Folks like Porter, whose blood glucose levels are higher than normal but not high enough to be diagnosed with type 2 diabetes have what is called prediabetes — a condition that affects 86 million Americans, according to statistics released this year by the Centers for Disease Control and Prevention.
Ignoring it is a bad idea.
People who have prediabetes and do nothing are 15 percent to 30 percent more likely to develop type 2 diabetes within five years, says the CDC.
To help spread the message to more doctors and their patients with prediabetes, the American Medical Association has launched a new pilot project with the Venice SKY Family YMCA and doctors who practice in Sarasota County — where prediabetes is prevalent because of the high median age here.
“Our experience has been, even though one out of three have prediabetes, only 11 percent know,” says Dr. Robert Wah, president of the AMA. “Part of it may be how we define people in the prediabetic community.”
Wah says the Venice YMCA is one of five sites selected in the country because it has an established diabetes prevention program based on the CDC’s national program, and is also participating in a similar demonstration project funded by the Center for Medicare and Medicaid Innovation.
What the AMA wants, Wah says, is for more doctors to screen their patients for prediabetes and refer those who have it to the program.
“We can reach from a national level down to the front lines through our network,” Wah says. “The YMCA is a great complement to the physician’s office.”
REMARKABLE EFFECT
Type 2 diabetes, which affects 29 million Americans today, is the seventh leading cause of death. Typically — although it’s not the case for everyone — people at risk of developing prediabetes are overweight, 45 years or older, have a family or genetic history of diabetes, do not exercise or have had gestational diabetes during pregnancy.
A blood glucose test is the only way to diagnose prediabetes, and some health experts think more patients should have one.
For those who do have prediabetes, moving more and eating less could nip it in the bud. Research shows people with prediabetes who achieve a 5 percent to 7 percent weight loss with exercise and diet can reduce or delay the onset of diabetes by 58 percent. Outcomes are even higher for people older than 60.
“There is a remarkable effect that occurs with modest weight loss; it’s more powerful and more effective than medication,” says Venice endocrinologist Dr. Robert Dubin. “I spend all day telling my patients to change the way they eat.”
Jennifer Tucker-Mogensen, Director of Health Innovation at the Venice YMCA, says the program focuses on two goals: two and a half hours of moderate exercise a week, and a weight loss of 7 percent. It’s open to anyone with prediabetes — testing can be done onsite at the Y — and is free for people with Medicare.
“We wanted to bridge the community gap and help medical systems that don’t quite fill their patients’ needs,” says Tucker-Mogensen. “This is evidence-based and clearly demonstrates that if the two program goals are attained, an individual can reduce their risk of developing type 2 diabetes by 58 percent.”
Those who enroll attend 16 weekly one-hour classroom sessions, followed by monthly maintenance sessions. There are weekly homework assignments, daily food tracking, exercise, and lots of talking and sharing. Small groups of 10 or fewer gather with a diabetes education instructor to discuss not just fat, calories and exercise, but also how to champion the day-to-day struggles many face when trying to lose weight — the messy emotional and social stuff that can derail even the most dedicated.
During a recent Monday morning class — the 11th week — class instructor Leslie Carlsen passes around some handouts on the day’s topic: Talk Back to Negative Thoughts.
“Today we’re talking about negative thoughts and how they can undermine our success,” says Carlsen, standing in front of a dry erase board, marker pen ready. “What are some of the negative thoughts you had last week?”
After a few seconds, the hands go up, people start talking and Carlsen starts writing: “I can’t do this.”
“I feel bad when I have a cheat day.”
“I feel guilty.”
“Why can’t I eat the way other people do?”
To counter this feeling, Carlsen says, “Turn it into a positive spin: I ate it; I own it; I will change what I am doing the rest of the day. Don’t beat yourself up.”
TRACKING IS KEY
The core component of the program — which starts right away and requires some getting used to — is tracking each day’s food intake, every morsel that passes the lips, and recording its caloric and fat content. Fat is the focus and the goal is to keep it at 42 grams a day.
“It’s such an eye-opening piece, and really is the pivotal cornerstone to the program,” says Tucker-Mogensen.
Carlsen says the program won’t work if you don’t track — but is also quick to remind the group that staying in the race is what that matters, not how fast you get there.
“Some people don’t reach 7 percent; they might reach 5 percent; but they have still reduced their risk greatly,” says Carlsen. “Even if you lose two pounds, you’ve just reduced your risk by 13 percent — that’s huge.”
Karen Borling of Englewood, 68, enrolled in the program with encouragement from her doctor.
She says the tracking was tedious at first, but it has become easier and helped her shed significant weight so far.
“I like the idea of eating better, and this teaches us balance and how to maintain weight loss. It’s something we can use for the rest of our lives,” says Borling, one pound shy of reaching her goal.
To help meet her exercise goals, she uses the free YMCA gym pass that she gets at the end of the class — you have to show up and stay the full hour to get one.
“You feel so much better after exercise,” Borling says. “When I come home from water aerobics I have so much more energy now; I don’t sit down anymore.”
Dubin, the Venice endocrinologist, has been steering patients to the program since its inception several years ago. Most of those who go, he says, have a success story to share.
“After three years, they come back to see me and they say, ‘Dr. Dubin, I still don’t have diabetes,’ ” he says.
Dubin likes to repeat a quote by Thomas Edison: “The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.”
“That’s what we’re starting to do right now,” he says. “I’m excited; my patients are excited. Having a program like the YMCA that really works and is evidence-based in our community is a remarkable opportunity. It really makes a difference.”
Although Frank Porter wasn’t referred by his doctor, he joined the program last year. He has lost 6.5 percent of his weight, he reports, and got his blood sugar down to a healthier level. He’s also completely off the blood pressure medication he had been taking for 20 years.
“Before, I was just totally ignorant of nutrition. I’m aware now,” he says. “You don’t need to sacrifice and give up things; just do things in moderation. I don’t just blindly throw down the peanuts now.”
