28 | One Family, One Meal: Fighting Prediabetes Together

In today's episode, we address the urgent link between childhood obesity and the looming threat of diabetes. Join host Colleen Sloan and esteemed guest Lucille Bessler, a seasoned Registered Dietitian, as they unpack the clinical pearls and practical strategies healthcare professionals need to reverse prediabetes and prevent diabetes in their young patients.

Childhood obesity can be a delicate subject, but it's one we tackle head-on with compassion and actionable guidance. We discuss how to foster a family-centric meal planning approach that ditches the quick-fix diets and instead embraces nutrient-dense, delicious meals everyone will love. 

Key Takeaways:

• 96 million adults have prediabetes, and 1 in 5 children aged 12 to 18 are at risk.
• Childhood obesity is the leading risk factor for prediabetes and subsequent diabetes.
• Approaching the topic of a child's weight requires compassion and positive reinforcement.
• Practical nutrition advice includes emphasizing a balanced meal pattern and high-fiber carbohydrates.
• The DASH diet is a simple and effective approach for promoting overall family health.
• Encouraging physical activity and addressing excessive screen time are essential for preventing diabetes.
• Sleep patterns and mental well-being are intricately connected to screen time, emphasizing its impact on overall health.

Plus, I share some of my favorite high fiber snack ideas that kids will adore, from avocado crackers to homemade fruit pops. So, grab your headphones and let's shape the health of our future generations.

Don't forget to link up with Colleen on Instagram @examroomnutrition for more nutrition tips and community support, as we strive to make our patients healthier, one exam room at a time.

Connect with Lucille:
Website: https://nutritionandfamily.com/

DASH diet Resources:
https://www.nhlbi.nih.gov/education/dash-eating-plan
https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(23)00577-6/fulltext

Transcript

Colleen: 0:00

96 million. 1 in 5. 20 percent. What am I talking about? Well, there are 96 million adults age 18 and over with prediabetes. According to the CDC, 1 in 5 children age 12 to 18 have prediabetes, and 20 percent of US children are suffering from overweight or obesity. Childhood obesity is the number one risk factor for prediabetes, which can lead to diabetes. Now, correct me if I'm wrong, but addressing a child's weight and its health consequences can be a tricky topic, right?

Colleen: 0:36

My name is Colleen Sloan. I'm a pediatric PA and registered dietitian, and this is the Exam Room Nutrition Podcast, where each week, I'm giving you the nutrition training you never got in school to help you guide your patients with compassion and confidence. Today's episode is full of clinical pearls to help you teach your families how to reverse prediabetes and therefore prevent diabetes. If you find yourself telling your patients they just need to eat less carbs and exercise more, then this episode is exactly what you need. You'll learn better ways to educate your families, what foods to focus on and my Tough Love Strategy for Discussing Screen Time. Stick around to the end, where I give you my favorite foods that are high in fiber and kid-approved. So get comfy and join me in welcoming a dear friend and mentor of mine, lucille Bestler, is with us Now. This woman holds a special place in my heart because I have known her for over 10 years and she was a monumental influence to my development and career as a registered dietitian. Now, if you don't know who she is, I have to sing her accolades because she is a pillar in the world of nutrition and I am just so excited that I can call her my friend and colleague.

Colleen: 1:50

Lucille Bestler is a registered dietitian, nutritionist, certified diabetes educator, author and entrepreneur. She is the president and owner of the Family Nutrition Center of South Florida. With over 300,000 children and adults served, family Nutrition Center has been a leading provider of nutrition evaluation and care since its establishment in 1991. Now, if you don't think you can learn something from her, that date alone should tell you something about how much experience she has. Lucille also has a bestselling book called Nurturing with Nutrition. It's been highly acclaimed by physicians and families for its valuable insights on feeding infants and toddlers. Lucille, I am so thrilled to have you here. I love working with you. I love learning from you. So welcome to the show, thank you, colleen.

Lucille: 2:36

I'm so excited to be here. I just enjoy working with you so much too. I'm not sure that I love hearing how long I've been in practice that's scaring me a little bit. But I just really enjoy being here and I'm so excited to be able to bring some really good nutrition information to other health professionals so they know what to do when they're talking to their patient.

Colleen: 3:02

Well, you are just a wealth of knowledge and I've been learning from you for over 10 years. I mean, you met me when I was just a wee college student, so it's just so fun to continue to be able to learn from you and have this relationship with you. So let's jump into prediabetes, because I don't really think it's on a lot of people's radar, and I think it should be right, because what does prediabetes lead to? Diabetes? So talk to me a little bit about why should clinicians care, what types of things should we be aware of, and how can we discuss this with our patients.

Lucille: 3:32

So you know, I think that we should be very concerned. So what we really want to do is prevent Children from converting from lack of a better way to describe it from pre diabetes to diabetes, why let's think about their health if they become a diabetic in their teens or in their early twenties. What are we looking at in terms of co morbidities as they age? We're looking at heart disease, kidney disease, high blood pressure, and the list goes on. And the thing about diabetes and pre diabetes, as we always say, it's really self management. So what you mentioned is probably the biggest problem, and that is the state of overweight or obesity in our population, including in children.

Lucille: 4:26

Now, I've heard from many that this is a topic they don't want to talk about. Health professionals feel very Awkward talking about this, and then, of course, there's a movement healthy at any size, but I am going to probably not be popular to say if a child or adult is suffering from obesity and has other risk factors already, including Physical symptoms like that, a canthosis nigra cans, you see that in pediatric practice, that's something to look at. Look at that lab data, look at those hemoglobin a, one c's, order them and see what they are, and then we have to address. Wait, we do in a positive way, never in a negative way. But I think by really helping that family, focus on healthy eating, healthy exercise, good lifestyles, you can really make a difference.

Colleen: 5:28

Great points. Yeah, I love that and, honestly and truly, as clinicians, we cannot afford to shy away from encouraging patients to follow a healthy meal pattern and exercise daily. And it's not about not accepting them at a weight and really taking that language away from the weight per se, because, yes, it's true, we accept and approve of and appreciate and love all bodies. However, studies have shown over the years, over the decades, that excess weight leads to multiple comorbidities, including death, and so it is a serious thing. But I love that you said that we need to approach it with compassion and with sensitive language, because we're not trying to attack the child.

Colleen: 6:13

Their weight is a result of the poor food choices that they've had and a result of their lack of physical exercise. So there's no need to attack the child. There's no need to belittle or offend them. However, you can come alongside them and encourage them to just make small food swaps and healthier choices over time, because this is an act of love. We want the child to live and thrive and succeed well into adulthood and well into being an older adult, and you know, as pediatricians, it's our job to set that foundation for a healthy relationship with food. So let's talk a little bit about. What are those specifics. If you've got a kiddo who's in that pre-diabetic range, what types of things and nutrition advice can we as clinicians give in that routine wall check to not scare the parent or child and to give them helpful tips that they can incorporate?

Lucille: 7:04

So, colleen, I really love that you said don't scare them. So don't say things like oh you know, if you don't change your eating, you're going to have to take a needle because you're going to get a diabetes. Don't say things like that. Let's just be positive and say we want to keep you healthy, so we're going to get mom and dad and grandma to work with us on making some really good food choices. But parents need tools and they need advice, because they wouldn't just serve their child on healthy foods because they want to. They just don't know sometimes. So let's give them specific tools on how to prevent diabetes and give them healthy habits that could stick. So I have a couple simple and, I think, effective tips that I've used over the years. I always try to say hey, the whole family has to do this, because if I was sitting on the couch eating my apple, you better not be sitting next to me, colleen, eating your bed the potato chips, because I would be really upset, because I love the data chips, yeah. So I think that's really number one.

Lucille: 8:18

Number two I like to say no fad diets. Fad diets are silly. They're not going to work. They're not, you know, long term. We want simple but balanced meals. I know that's the difficulty. I always like to say to people let's make it simple. Every meal should have a vegetable, any kind. Any meal should have a lean protein. Every meal should have some kind of carbohydrate. Make it a high fiber carbohydrate. If you can Just make it simplistic let's not go into these very long explanations you lose people. They don't want to know the science. We know the science, so we could take that science and make it simple.

Colleen: 9:05

I love the first point that you made and I want to linger there a little bit because I also encourage this and I will tell my parents hey, it's one family, so there's one meal, so it just kind of takes the pressure off mom or whoever is the food preparer to not be a short order cook, because this also now will solve the issue if you've got a picky toddler and maybe an overweight teenager and maybe a husband who doesn't like his vegetables either.

Colleen: 9:33

So, hey, we're one family, we're eating one meal and we're going to enjoy it together and we're going to talk about our day together, because it's not just about the foods that we're eating, it's the environment that we're cultivating to. And I really love that you stress the importance of not following any fad diets, because I mean, even as adults who've maybe struggled with their weight, you know that fad diets do not last. You cannot sustain them for a long time. They are unrealistic and really just keeping it simple, simple, works. Drink more water, eat more fruits, eat more vegetables, try to stay away from the greasy foods and the really, really sweet stuff. Most of the time, right, keeping it very, very simple will work over time.

Lucille: 10:12

You know what I tell them. I say listen, why don't you have once a week? You all get around the table and have a menu planning meeting. Everybody gets to pick their favorite food and you could always modify it. So if I say, oh, my favorite food is macaroni and cheese, so you could make macaroni and cheese with low-fat milk. You don't have to put butter in it, you could use whole grain pasta, but you could still make macaroni and cheese. So I kind of like that, because everybody gets their say on what they want to eat and I understand people don't have a lot of time for cooking. I truly do understand that Batch cook on the weekends. I always love that Batch cook and then you could have, you know, leftovers on Monday or Tuesday, so that'll help Some other things I like.

Lucille: 11:03

I like kids in the kitchen. I will tell you from a personal experience. My Italian grandfather taught me how to cook at five years old. Colleen, I've told you that before. I love kids in the kitchen. You could give them tasks that they could do. It gets them involved, it gets them excited and you could get them to eat foods that they might normally not eat. So again, give people. My feeling is, as health professionals, let's give them positive things, Get excited. You know, I think that I show a lot of excitement and passion. Show that because that could be, I think, contagious.

Colleen: 11:43

I totally agree with you and I too love kids in the kitchen and you know it doesn't have to be for every meal, you know, because, yeah, we're working parents. Sometimes I'm like, oh my gosh, I have 10 minutes to throw something together. I don't have the patience to sit here with a five year old trying to peel something, right. But maybe you can set aside time an hour, one day a week where you're like, ok, yes, this is the time I'm going to have the kids in the kitchen helping me.

Colleen: 12:07

And it's also a great time to just talk about those foods because, again, the more they engage, the more they interact with the food, the more likely they are to try it once it's put on a plate in front of them. So ask them hey, what color is this red pepper? Does it feel soft or is it crunchy? Is it cold or is it hot? How loud can you crunch it when you bite down on it?

Colleen: 12:28

Because you're getting them to look at it, you're getting them to learn colors, because maybe you've got a four or five year old who you're trying to teach these things to. You can have them count how many different little pieces of beans are in front of them, and it also gets them to touch the food, because how many times have you put down a plate in front of the kiddo and they won't even touch it? But now there's no pressure and they think they're just playing, so they've touched this food. So I cannot agree with you more how much I love kids in the kitchen. I'd love to hear other thoughts of what we can do as clinicians. What else do you have in mind?

Lucille: 13:01

I like to get to the root of what the meals should look like. So I did say you know, make it simple. But, as a health professional, do not ever say no carbs. Don't do that, please. There are important good carbohydrates and tell them about that good carbohydrate. You don't have a lot of time, but say make the plate simple, you need to include a high fiber carbohydrate and tell them that high fiber carbohydrates help to control blood sugar and can be very useful in helping to control appetite patterns.

Lucille: 13:37

I'd like to promote the dash diet, because the dash diet is not your fad diet. It is a great way of eating for all of us. It's culturally adaptable to anyone and it's that simplistic approach Eating more vegetables, eating fruit, whole grains, a little bit more fish, if we can. That's always a hard one. People either love fish or they ate fish, but a little less saturated fat, more beans and much less sugar. I think it's a really great approach because it can be helpful for any family member. It's simple and it would be a really great way for kids to eat healthier and to get healthier.

Colleen: 14:28

Totally agree, and I love the dash diet as well too, because it's more of just a meal pattern and it is just a healthy pattern that we all really should be following and it's appropriate for the entire family to follow. I'm going to go ahead and link to more information regarding the dash diet. So if you wanted to educate yourself so that you can properly educate your parents and patients, you can do that in the show notes below.

Lucille: 14:49

I also like to just say but what about, off the nutrition, but the lifestyle area? How about encouraging physical activity? How about screen time? And I know that might be just an awful thing to talk about, right? So that is limiting screen time. I don't know. Can you do it as a pediatric health professional, Colleen? Can you even broach that subject with caretakers and parents?

Colleen: 15:20

It really is tough, especially the middle-aged teenagers, because you know they've really grown up with a device in their hand or in their face. This demographic just grew up with tech and so it is really really tough. But I'm not afraid and I do push the topic, because not only is screen time affecting their meal time behaviors but it's also affecting their mental status. You know, we know anxiety, we know depression has increased, especially in teen girls because of social media and their time on the screen, but also sleep patterns. I have so many kids who are on their phone in bed at 11 o'clock at night, scrolling or doing whatever they're doing, and they're not falling asleep until 2 or 3 am and then they're up at 5 or 6 for school and it's disruptive to their sleep patterns and we know that sleep also affects our weight and our overall health.

Colleen: 16:11

So I will push this topic and I'll actually ask the teenager hey, pull out your phone and let me see the screen time. Because you can't just say do you spend a lot of time on your phone? Because my definition of a lot of time on a phone is way different than a 16-year-old's definition of a lot of time on their phone. So when I make them go into this Settings app and look at screen time, you would be shocked, Lucille. I've had a teenager girl whose screen time was up to 15 hours a day 15 hours, and that's appalling to me. You've got to get off the screen and go outside, take a walk, go interact with people, right? There's so many other things that you could be doing, so don't be afraid to ask about their screen time. Have them pull out their phone and show it to you, because it's going to affect so many things in their life, not just their weight and risk for diabetes.

Lucille: 17:05

I think that's wonderful. I think that's so great that you do that. I'm going to use that. They're on their devices and they're eating. It diminishes their ability to know satiety, so they're just eating and eating and they don't know that they're full.

Colleen: 17:21

Lucille, I'm so grateful for the gift of your time. Thank you so much for being here with us. This topic was extremely important, so I hope my listeners that the next time you have an overweight teenager or even a child who you are concerned with, that they are at risk for pre-diabetes just keep in mind that they are now at risk for diabetes in the very near future and that you can provide them with one or two of these helpful tips that Lucille and I discussed. Lucille, I'd love to have you back. Thanks again for being here. Thank you, I really enjoyed it. All right, guys. Now it's time for my Nutrition Notes. In this section, I will leave you with a nutrition tip, an interesting case or an encouraging quote that I think might add value to your day Now.

Colleen: 17:59

In this episode, we briefly chatted about the importance of using compassionate language around weight and being cautious not to offend or poke fun of the patient, but in a previous episode you confided in episode 13, titled Do's and Don'ts of Weight Conversations with Kids. We discussed this in detail and provide you with the exact things to say. So you might want to go ahead and check that one out next. But for today's nutrition tip, let's talk a little bit more about fiber. We know fiber is helpful for constipation, but it is also so important for lowering cholesterol levels and keeping blood sugar stable. We talked a lot about childhood constipation In episode 19, titled the Scoop on Poop Managing Constipation in Kids. So if you wanted to go learn more about fiber and its role in constipation, you can listen to that episode Now. Adults need about 30 grams of fiber in a day and kids need anywhere between 19 and 25 grams of fiber daily. Now I have a simple way for you to remember this, and it comes from the American Dietetic Association. This suggests an age plus five rule. So, for example, a five-year-old needs 10 grams. They're five years old, so add five, so they would need 10. Here's a quick reminder of some examples of sources of fiber Whole grains, like brown rice, barley, whole wheat, quinoa and popcorn.

Colleen: 19:13

Fruit and vegetables. Nuts and seeds especially ground flaxseed and chia seeds, and beans and lentils. Okay, but kids won't eat a plate full of lentils and flaxseed. So here are some simple ideas you can suggest to your patients that the whole family will love. The first one I love is crispy broccoli. Steam up the broccoli a little bit, then dip it in a beaten egg and then cover it with whole grain breadcrumbs and then a little flaxseed sprinkle and then bake until crispy. The next one kids love is avocado crackers. Mash up avocados and spread on your favorite cracker. You can set out some sprinkles quote-unquote, like flaxseeds or chia seeds, for some fun. I also love homemade fruit pops so you can puree their favorite fruits and freeze it for a fun summer day, and then the kids can make their own popcorn, trail mix, mixing their favorite nuts, some different dried fruit that they like, maybe even a few chocolate chips to make it a little bit sweet.

Colleen: 20:07

But this turns out to be a really fun snack for kids. Obviously, just educate your parents on anything that could be a choking hazard for kids younger than five. All right, guys. Well, that's it for today. I'm so glad that you joined me on this important conversation and I hope that this topic brought you some value and some interesting tips that you can discuss with your patients moving forward in the clinic. If you have any questions for me or if you would like to connect with me, you can find me on Instagram at exam room nutrition. And, as always, let's continue to make our patients healthier, one exam room at a time. I'll see you next time.