Lunch hour is sacred when you're a steelworker who does 12-hour shifts.
So it's somewhat remarkable to see a group of Tampa Bay Steel crew members file into the breakroom each Wednesday, step on a scale — work boots and all — and swap stories about fat grams and weight loss.
Initially, 13 men and three women signed on for 16 weekly meetings and a year of monthly follow-ups with coaches from the Tampa Metropolitan YMCA. They were picked because they fall into the swelling population of pre-diabetics: people very much at risk for developing Type 2 diabetes.
The 10 who have made it so far don't heat up Lean Cuisines or eat salads during this 60-minute lunchtime sojourn. Chow is leftovers and Swanson pot pies, homemade sandwiches and, yes, Cheez-Its washed down with Mountain Dew.
Instructor Maureen Chiodini doesn't pass judgment, even now, three months into the class. Instead, she reminds them to consider portion size or possibly changing to diet soda. And she applauds the small steps. After all, this is a group that seriously discusses the social stigma of drinking 55-calorie beer at a barbecue, and uses the term "fat boy" as an endearment.
This comfortable setting helps them share successes that in other places could seem insignificant. Larry walked about 16 miles during the week. William has worked up to 30 minutes on the treadmill at the Y. Shane walked his dog a couple of times, though the dog "wasn't happy about it," he says and laughs.
This program sets realistic goals, challenging them to lose 7 percent of their body weight, and increase physical activity to 150 minutes per week for a year or more. Doing these two things can cut the risk of a diabetes diagnosis by more than half, the research behind this national education program shows.
More than 90 percent of the nation's 26 million diabetics are Type 2, in which the body stops producing enough insulin or simply resists the effects of the hormone critical to regulating your blood sugar.
"This is about lifestyle change, not about fitting into your bathing suit," says Ann Albright, director of the Centers for Disease Control and Prevention's division of diabetes translation. No one meal plan, no one exercise regimen can improve the health of the estimated 79 million Americans with pre-diabetes, she says.
"There's no magic bullet … it's all about balance," Albright says of the 2-year-old program, now offered at 283 CDC-sponsored sites, and through YMCAs nationwide, including at 27 Tampa Bay-area branches.
This kind of creative attack on pre-diabetes is triggered by the massive number of Americans with it, and the roughly 25-million diagnosed Type 2 diabetics. The alternatives, experts say, is to put your health at serious risk of blindness, kidney failure, neuropathy, cardio vascular disease and limb amputation.
Although some diabetes is spurred by genetics, many people discover they struggle to produce or process insulin after a gradual weight gain that could have been avoided, says Henry Rodriguez, clinical director of the Diabetes Center at the University of South Florida.
"It's insidious. Many times people have complications before they have been diagnosed with diabetes or even know it," he says.
The Tampa Bay Steel class members laugh with each other through the meetings and during their shifts. But ask why they're counting fat grams, and they get serious. They're motivated by other friends and families living with Type 2 diabetes and its complications.
"Both of my parents are insulin dependent … and it has killed most of my family," Paul Smith says. "None of the men in my family, other than my father, made it into their 70s."
The YMCA-sponsored pre-diabetes program launched in 2010. The Y reports that 4,000 people nationwide have attended at least one class and one-third completed the 16 weekly sessions and monthly follow-ups. Of those who finished, the average weight loss was 4.6 percent, short of the 7 percent goal.
The low-retention rate points to the real challenge, say Chiodini, associate vice president for membership and programs for the Tampa Metropolitan Area YMCA. Sticking to a plan for 16 weeks is manageable. Keeping the weight off is hard, for all of us.
"How do you stay on track?" she says. "From now on, it's about problem-solving."
The UnitedHealthcare insurance company is such a proponent of the diabetes prevention program, it paid for Tampa Bay Steel, the city of St. Petersburg and other clients to launch employee programs. It is rolling out a similar program for Medicare customers.
In the St. Petersburg pre-diabetes program, the 50 participants saw a collective weight loss of 330 in their first eight months, officials said at a recent diabetes forum. One of them, water maintenance mechanic Steve Milliron, still gets to his YMCA four times a week for tai chi and a workout. Maintenance is hard, but eating better and exercise has become a habit.
"You start balancing … and see where you can go off-track," Milliron says. "You start saying (on your own), 'This is not a good choice.' "
Steelworker Spencer Parker says he's grateful he came back to the program after co-workers gave him grief for missing two classes. Despite his absence, he says he found himself paying attention to how much food he ate and trying to go on long walks with his fiancée.
He and co-worker Larry Mccrimmon agree accountability at work makes staying on the program easier. Outside the plant, there are constant pressures to eat and drink with friends and family.
"I did some bad things. … I ate some good food," Mccrimmon confessed to his classmates after a recent trip to a family funeral.
Winn-Dixie pharmacist and diabetes consultant Kenneth Lanier says cultural factors are an enormous challenge for overweight patients. He's constantly asked about sweets, flour tortillas and fried foods, basic foods in many homes.
"They say, 'I can't connect with my family if I can't have these things,' " Lanier says.
The only way to slow down the number of new diabetes cases is to be reasonable, says Kathy Macuhly, a diabetes educator and chairwoman of the Florida Alliance for Diabetes Prevention and Care.
It took a long time for our nation to be so overweight and at risk. Be patient and realistic when encouraging people to improve their health, she says.
"Let's be honest, an occasional cookie on a special occasion won't hurt. It's the day-to-day behaviors to worry about."
Diabetes prevention is the focus of special programs offered by groups such as the Hillsborough County Health Department and Tampa Bay area YMCAs. The programs are either free, covered by private insurance or include nominal fees. Contact the programs directly for information.
Hillsborough County Health Department diabetes self-management and diabetes prevention program: Uses registered dietitians and lifestyle coaches to implement long-term eating, physical activity and stress management strategies for people identified as having pre-diabetes. Call: (813) 307-8071
Hillsborough County Health Department GIFT (Get into Fitness Today) weight management program: A free group activity that lasts six to 12 weeks. Almost 4,000 local residents have participated in the past five years. Call: (813) 307-8071
Tampa Metro YMCA diabetes prevention program: Lifestyle coaches provide food, exercise and behavior guidance to qualified participants attending 16 weekly sessions and monthly support meetings for a year. Contact: Shera Goode at shera
.firstname.lastname@example.org or (813) 416-6834
St. Petersburg YMCA diabetes prevention program: Lifestyle coaches provide food, exercise and behavior guidance to qualified participants attending 16 weekly sessions and monthly
Are you at risk?
Think those love handles might be a sign of pre-diabetes? Answer yes to more than two of these questions, and you might want to consider having a conversation with your health-care provider.
Are you overweight (BMI greater than 25) or obese?
Is your blood pressure 140/90 or higher, or have you been diagnosed with high blood pressure?
Are you physically active fewer than two times a week?
Do you have a sibling or parent with diabetes?
For women: Did you have gestational diabetes during pregnancy or give birth to a baby weighing more than 9 pounds?
Are you 45 years old or older?
Are you part of any of the diabetes high-risk racial or ethnic groups? (African-American, Hispanic/Latino, American Indian, some Asian Americans and Pacific Islanders)
Sources: YMCA Diabetes Prevention Program; Centers for Disease Control and Prevention.