Switching from Diabetes Management to Diabetes Prevention

By Karen Karen Graham, RD, CDE posted in Healthy Living Professionals & Educators

DCN55img_2wgardenEating healthy foods is a combination of many things. It can be based on what we know about healthy eating and how we apply this knowledge. It is also based on our food security and the environment in which we live, and how this determines what foods are available to us.

According to Brian Wansink:

We believe we have all the free will in the world.  We believe we overeat if the food is good or if we’re really hungry. In reality, those are two of the last things that determine how much we eat…What really influences our eating, is visibility and convenience.

For more information check out www.mindlesseating.org or http://foodpsychology.cornell.edu/content/beating-mindless-eating

I’ve worked as a diabetes educator for almost 30 years. All of you that are also diabetes educators, will have seen all ages, all sizes and all personalities step through your doors. Being a diabetes educator is a rewarding career because we are able to provide people with immediate answers and help in a time of need (often at time of diagnosis or while managing life challenges or diabetes complications). This support may be in the form of quick answers to their questions, providing them with additional information such as handouts, a great website or a comprehensive diabetes book. Sometimes we provide emotional support to the person with diabetes or their family members. We all have stories of success that we can share − stories of people who make positive short-term and sometimes long-term lifestyle changes.

Yet there is a downside to diabetes education. This is that a significant number of the people that we counsel are unable to make the changes we suggest, even small changes. Sometimes the barriers to change are too large, and often these barriers are the overwhelming number of entrenched signals and factors in the environment that trigger an unhealthy lifestyle. For example:

  • jobs that are sedentary and/or require long commutes
  • excessive advertising of poor food choices and alcohol on television
  • rows of chocolate bars lined up in the box store or grocery store when you go with good intentions to buy fruit, or
  • corner stores, gas stations, vending machines and fast-food outlets at every corner, promoting fruit juice, pop, chips, chocolate bars, French fries and burgers, and rich coffees, donuts and super-sized muffins and bagels.

The need to make changes to the food and exercise environment is being recognized, yet significant policy changes are too often absent or slow, and the obesity epidemic is in contrast, moving quickly.

I recently switched from being a Manitoba-based Diabetes Educator to being a British Columbia-based Community Nutritionist. While the focus of a diabetes educator is to educate and support people to eat less and eat better, the focus of my new job is to help create an environment where unhealthy food is less available, and healthy food is more available, more affordable and the easiest choice. This requires networking and developing community partnerships with local governments, health care service providers, schools, workplaces and restaurants. Community Nutritionists help develop partnerships, policies, programs, local champions and resources related to healthy eating. They may work with their own governments to lobby for change, as success relies heavily on policy makers and government to mandate changes. For example, Cathy Richards, RD, a well known Community Nutritionist in BC, worked over many years for a policy to get healthier food choices in schools and in government vending machines (http://www.interiorhealth.ca/YourHealth/HealthyLiving/Pages/FoodEnvironment.aspx).

Community Nutritionists also help develop sustainable food systems, to help people have access to more local food, or grow and produce their own food. One example of this is the creation of Public Produce Gardens in Kamloops, BC, spearheaded by Laura Kalina, RD, a Community Nutritionist and author (http://www.lookkamloops.ca/kamloops_food_policy_council.htm) In these type of projects, unused land can be converted to community demonstration gardens. For example, a vacant lot (private donated land) in a downtown area converted to a community garden. In some cases, it could bring edible landscaping into the community design and planning as part of the city’s Municipal Plan. This type of initiative can involve the city, municipalities and community groups and is often managed by a Food Policy Group or Council. The whole community “owns” the vegetables and fruits, and anyone can go and pick! This is a cool diabetes prevention initiative because research shows that when people eat more fruits and vegetables their risk of diabetes goes down.

Managing the increasing number of people with diabetes will require a concerted effort between many players: diabetes educators and health workers, community nutrition initiatives that are multi-sectoral, as well as serious lobbying by non-profit food network organizations fighting against the powerful money-driven food lobby.

If you are wondering “As a Diabetes Educator, how can I take more of a preventive nutrition/Community Nutritionist approach?” then consider these things:

  • Promote your clients to plant gardens, join in a vegetable garden share group or community garden, and buy local fruits and vegetables at their farmer market.
  • Work with your local sports facilities and concessions to encourage healthier food choices for your clients and all that attend (http://www.stayactiveeathealthy.com/managers/modular_toolkit.html)
  • Is pop and juice being sold in your client’s workplace or school…can you lobby for change, or support a local champion to take on this cause?
  • Do you have your own children? Suggest to their school that they sell local vegetables or fruits instead of chocolates for a fundraiser (http://healthyeatingatschool.ca/resources/c/food-at-school)
  • Teach low-cost shopping and budgeting skills.
  • Facilitate home cooking that is nutritious, fast and easy, so people eat less in restaurants, and eat better at home. This might mean helping to establish cooking programs and community kitchens, or it might be as simple as recommending an easy and practical cookbook.
  • Encourage the “family meal” – eating together at a table, turning off electronics, and slowing down eating.
    • Finally, wherever possible work with your local Community Nutritionist to increase programming in your community that will help reduce everyone’s risk of diabetes.

A 2004 document by the Community Nutritionists Council of BC called Making the Connection – Food Security and Public Health gives a nice overview of food security issues as does the BC Interior Health website section on food security: http://www.interiorhealth.ca/YourHealth/HealthyLiving/FoodSecurity/Pages/default.aspx

About the Author
Karen Karen Graham, RD, CDE

Karen Graham, RD, CDE, is the author of two books The Complete Diabetes Guide (2011) and Canada’s Diabetes Meals for Good Health (2012 Robert Rose edition). Her books have life-size photos of everyday healthy meals in sensible portion sizes – making meal planning and cooking easy and fun. Her books are used by diabetes educators across North America as a teaching tool in diabetes clinics, and have sold almost a quarter of a million. If you have any comment on this article or would like more information about Karen’s resources, go to www.karengraham.ca or contact her at karen@karengraham.ca. By searching “Karen Graham” online at www.youtube.com you can also view her videos.