Childhood Diabetes

Hello, everybody. Welcome to Health Chatter. Today's show is on childhood diabetes, which, you know, from my perspective, is kind of sad that we actually have to talk about childhood diabetes. But we're seeing increased numbers, and we'll get into that in just a moment. We have great guests with us today that can really shine some insight into the whole concept concept of childhood diabetes. Stay tuned for that. We've got a great crew that always makes our podcasts successful. They include Maddy Levine-Wolf, Erin Collins, Deondra Howard, and Sheridan Nygard, who do our background research for all of our shows. And by the way, for our listening audience, all the research that we have for our shows is made available on our website. Sheridan Nygaard also does marketing for us. 
And then, of course, we have Matthew Campbell, who's our production manager and gets all the shows out to you, the listening audience, with nice music attached on the front and back, etc. So look forward to hearing this show next week. You'll hear it in about a week. In addition, Clarence Jones is my colleague today. who helps co-host this show. He's a great great colleague provides community input and perspective on this. And also today we have Dr. Barry Baines, who's our clinical advisor that'll provide some insight from the medical point of view as well. So thanks to everybody. Finally, Human Partnership is our community sponsor. I suggest that you check out their website at humanpartnership.org. It's a great community organization that does wonderful things in the health arena. 
So thank you to them. So today, as I said, we're going to be talking about childhood diabetes. We've got two great guests. Actually, I should say colleagues of mine who I've worked with in the past. And they're really, really great guests. great colleagues and friends. Teresa Ambrose manages the Diabetes and Health Behavior Unit at the Minnesota Department of Health. And she guides efforts to prevent diabetes and improve lives of all the people that are involved with diabetes, whether you're a caregiver or an actual person. Her career is focused on well-being and the prevention of chronic disease in health systems. schools, early child care work sites, community settings, etc. She's a registered dietitian. We've had Teresa on the show previously talking about nutrition, and I encourage you to listen to that show as well. 
So thank you, Teresa, for being with us today. Also, Julie Dalton, who I also had the pleasure of working with. She always has a great smile when she does all of her work. And She's the diabetes prevention planner at the Minnesota Department of Health in the Health Promotion and Chronic Disease Division. Currently, she oversees strategies to implement and spread and sustain evidence-based family-centered childhood obesity interventions as it relates to diabetes and has quite a long history, over 15 years of public health practice and experience. These are really experts in the field. And I'm sure that you, the listening audience, will enjoy hearing from them. So thank you, Teresa and Julie. Thank you for being with us today. So let's start this whole thing out by focusing on, first of all, when you say diabetes, it's one thing. 
When you say childhood diabetes, What are we really referring to? How do you define that age category of childhood? So thanks for having us. We're really excited to be here talking to Stan and Clarence and Barry. So when you think about diabetes, a lot of times people think of type 1 diabetes, which isn't what we're focusing on here, which is a condition that, you know, has consequences. complex origins, but type 2 diabetes used to be referred to as adult-onset diabetes. So when I started my career many years ago, we called it adult-onset diabetes. And then I started seeing children in a clinic that I was working in, children with severe obesity, starting to be diagnosed with type 2 or adult-onset diabetes. And it was really, really concerning. 
This is a type of diabetes that is considered largely preventable, and it has multiple factors that contribute to it. It's a very complex condition, but it is related to how our lifestyles, cultures have shifted, at least partially. And that's a type of diabetes that we want to talk about and how we can work to prevent it. Yep. Yeah, and I'd also like to add that, you know, if we talk about type 2 diabetes, we also have to mention prediabetes. And according to the CDC, one in five adolescents and one in four young adults are living with prediabetes. And that is staggering. And so prediabetes is a serious health condition where blood sugar levels are higher than normal. but not high enough yet to be diagnosed as type 2 diabetes. 
And this is something that we want to spend time discussing and also working on prevention and interventions. So let me ask you something. When we talk about childhood, can you have diabetes at birth? We'll leave that question to Dr. Baines. I see. I don't, you know, again, you know, I don't know whether or not, you know, as, as we define this category of childhood, we're talking about birth onward, or are we talking that nine, 10 onward? What, what do we, what, what's the parameter for childhood? So when we think about prevention of childhood obesity, we start thinking about gestation and what pregnant women are, doing because there is something called gestational diabetes, which means the woman's blood sugar is above a healthy level temporarily during their pregnancy, which can affect the infant in utero. 
And that can contribute to higher risks of diabetes for that child after they're born. And after that, you know, really focusing on encouraging breastfeeding, which is also associated with health, better health for the infant and mother. and reducing risks for future diabetes. Dr. Baines, do you want to add anything? Only that I agree with you 100%. And it's very complex and multifactorial. And things begin even before children are born in terms of that environment that might predispose them to both obesity and certainly to diabetes as well. So it's one of these things that's with us. It's also very genetic because I know as Teresa and Julie probably can talk about, there are certain populations that have a very high prevalence of diabetes that probably has a significant genetic link as well. 
I want to ask a question. I know that we've known about type type 1 diabetes, type 2 diabetes, but the state has really made us a effort now to really take a look at this issue of childhood diabetes, like, you know, with this grant and stuff like that. What was the tipping point? I mean, what came up that caused the state to say, like, okay, we have to deal with this? That is an excellent question. So we really need to focus at both the prevention level as early as possible and then, you know, the higher risk level of treatments and interventions for folks with prediabetes, children and adults with prediabetes. But what we know is that the earlier we can prevent obesity, the more likely we are to achieve good health. 
It's really hard to reverse obesity. when you already have it. And investing in prevention early in childhood is really the game changer for making a difference. I've heard one National Institute of Health leader, expert in the field, say if he had all the money in the world, he'd invest in prevention of childhood obesity. But the game changer, like for our diabetes program at the state, we are funded through the Center for Disease Control and Prevention. And they define the areas of work that we are paid to focus on. So until this last grant opportunity, we didn't have resources allocated to focus on childhood obesity and type 2 diabetes prevention in children. So we were thrilled to see that it was added and we're thrilled to be working on it. 
Julie, do you want to add? Yeah, I'd just like to add that I feel like at the national level, we're starting to see the concerning trends that are happening with childhood obesity, prediabetes, and type 2 diabetes. And I read a statistic recently, and it said if we do nothing, current projections are that 3 in 5, or 59% of today's children, will have obesity at the age of 35. And then 85% of 12-year-olds with obesity will still have obesity at age 35. And so really prevention is key. If we want to improve health, the health of our children, then we need to start early. You know, when we talk about all of these, the chronic diseases that we have on Health Chatter, we usually focus on three components, prevention, acute treatment, and then disease management. 
So I know that the Department of Health really focuses on prevention, and we'll get into that a little bit more in a second here. Clarence, you had a comment. Yeah, I did. I wanted to kind of follow up because when I take a look at, you know, I look at old videos and things like that, and all the people that I see on those old videos are real fans. I shouldn't say not all of them, but for the majority of the part, they're real, real fans. So what is the cause of this pandemic? increase in, uh, in diabetes and weight and obesity. What's going on that, that we have to really look at it now? I mean, you know, in 20, 30 years i mean that's we're not some major issues. 
Yeah, that's a great question. So I've had this bird's eye view as my career has been long. Um, and you know, when i started my career in the mid-1980s childhood obesity just started to escalate. Like obesity rates just started to climb after 1980 dramatically. And type two diabetes tends to follow about 10 years behind at a population level. So when people are talking about these small increases in the last 10 or 20 years, we start to think that it's just inevitable that type two diabetes is inevitable and 40% of people are going to have it in their lifetime. And people are going to live shorter lives than their parents. And we start to accept these to be inevitable. And it's not because we know that in the 1970s, four times less kids, less people had diabetes, type 2 diabetes and obesity. 
So we can reverse these trends. And to the cause, it's really complicated because there is a genetic component, but there's really an environmental component that kind of makes it harder for some people not to gain weight. it's often been referred to as a toxic environment that contributes to obesity. So if people who kind of, you know, grew up in those eras and can think about the differences, you know, advertising and marketing and screen time and our food environment, let's just share. I'm sure everybody's got really great examples of what they've seen. Barry, you see. Yeah. So, yeah, I wanted to, I'm just trying to think back, what started to change in the late 70s and 80s? And a lot of it is from the nutritional perspective. 
I sort of remember the 70s and 80s is where the fast food boom took off. And again, that wouldn't win any healthy food awards, mostly with offerings and a lot more fried foods. coming in, more processed foods. I mean, so I actually have questions about that. Even though things are multifactorial for how this happened, it's sort of, can we sort out what are the big play? I'd like to hear what are the priority ones where then we could all sort of think about and work together to start making an impact. it's so complicated. We can't do it all. But if we could do something, then Clarence will, you know, will be more calm. I'll be more calm and Stan will be more calm. 
But that's one of the things is how can we also help to get the word out? But I wonder if you could just, you know, help us to understand sort of what that priority piece, what are the big players, you know, in this? Yeah, health affairs is, has run articles about some of these things. So one of the big players have been big changes that we've seen results with are changes in the WIC food packages, where instead of giving kids fruit juice, you're giving them whole fruits, for example. So the quality of the food and less processed foods, ultra processed foods are a huge factor. Sugary beverages have dramatically increased in consumption. Overall, and the trends are pretty parallel, and they're associated with increased rates of type two diabetes and cardiovascular disease and cavities. 
And so sugary drinks, you know, include things like sports drinks and lemonade and Kool-Aid. You know, these flavored waters that have even artificial sweeteners are associated with metabolic conditions. So trying to encourage consumption of water and milk, low fat milk. For children and adults, no sugary beverages are recommended before age five. And even if kids are going to consume them, you know, occasionally one eight ounce drink a week, like people are consuming far, far too much sugar. And that can make a big difference because when you consume sugary drinks, it doesn't satiate your hunger. You still feel hungry and you can eat a lot of food. So that is a huge change people could make. And some approaches to that are reducing access, right? 
Having policies in schools and childcare centers and sports teams so that those aren't available and water is. So how do you, you know, I keep thinking, I remember our son had his first, when he had his first birthday party. And of course we had a cake. And I think that was like the first, you know, taste of, and he went nuts when he first tasted it. So it's like, okay, going forward though, how do you define moderation? I mean, you know, these things are in our environment where we have these sugary cereals, we have these sugary drinks, we have things that are causing us to get obese. How is it from a prevention standpoint, We can work with people or communities on identifying moderation. 
Great question, Stan, because we know that overly restricting a child's diet will... Forget it. It's not good. Actually, you know, it's counterproductive. They're more likely to have eating problems or even eating disorders. Like, we do not want to do that. As a dietician, you know, I would... be very obvious. I love chocolate chip cookies. You know, it's not a horrible thing. It's good for your mental health can be enjoyed. And it's how often and how much not giving like special meaning or feeling like they're bad foods but focusing on just enjoying food and, and, you know, having a whole foods diet and role modeling, you know, so that it's not the norm to just have pizza and soda for every party. You know, if you're planning a school party for your kids, you can make really fun fruit kebabs. 
Kids can love, love those kinds of things and enjoy it. So it's not making one food good or bad, but but just putting more high quality foods in the environment and role modeling. Yeah. Better choices. Yeah. I would also add, I would also add when we talk about moderation, I think we also have to talk about education. Educating providers, healthcare providers, how to talk to caregivers about moderation, healthy foods, and access to healthy foods. And then using the MyPlate or foods from someone's background that contain whole foods and vegetables and fruits. And just learning how to plate your food. can be important to attaining moderation. Yeah, Clarence, you're on mute. That makes it better. Zula, let me ask you this question. What are your expectations or hope for the community with this project? 
I'll just give some background. In 2023, MDH received CDC funding to implement a new strategy that reduces type 2 diabetes risk among children most in need. And the intent of the strategy is to implement, spread, and sustain one CDC-recognized evidence-based family healthy weight program. And so what we are doing at this state is we are conducting a landscape analysis to understand what is happening in Minnesota, where is their most need, which communities don't have access to family healthy weight programs. And then from there, we will assemble a work group consisting of community leaders, health experts, and others that will select the best fit program based on community needs and resources. And then after that, we want to identify partners to implement the program for the identified communities. 
Now, we know that there are certain communities that have more disparities than others. And those are the communities that we really want to invest in. So once a program is selected, the Minnesota Department of Health Diabetes Unit will acquire the program, will work on training programs, the facilitators of the program. And then we also want to spend some time addressing social determinants of health that can affect individual and community health directly. We think that goes hand in hand with prevention. And then after that, our hope is that we can scale the programs and adapt as we go. And one thing that I really want to point out is that we know that one program cannot be the program for all communities. And so we want to make sure that we are listening to what the needs are and adapting the programs to best meet people where they are. 
So let me ask you, so the Department of Health, this is the State Department of Health in Minnesota, health chatter goes to, you know, a variety of different people around the United States. Are we seeing similar problems in different areas of of the united states and in different communities, or is it is what we're seeing for childhood diabetes pretty consistent nationwide as far as prevention oriented activities in order to help make a difference here? So is are we only talking about minnesota or can we generalize to the to the greater united States? Great question, Stan. The U.S. is seeing growing rates of both obesity and type 2 diabetes and in children, some alarming rates, especially in African-American youth. Minnesota is actually, you know, overall has slightly lower rates of diabetes and lower rates of obesity because there's a lot of really good things happening in our communities. 
Our community are stepping up. There's efforts to get healthier kids restaurant meals where every kid's meal isn't a fried food and a sugary drink. You know, we can make those kinds of policies as communities. And there's a lot of work going on with the statewide health improvement partnership, some of our hospitals and care systems and Organizations are working at the community level to make changes. There's a lot of community groups that are really concerned about this, trying to make it easier for people to make the healthy choice. So by influencing little p policies like will our faith based organization, you know, serve some fruit when we kind of congregate or, you know, there's a lot of a lot of different efforts going on. 
Yeah, and I can add that I think this is a national problem. And I think that's what CDC is seeing as well. And I think currently one in five children and teens between the ages of two to 19 have obesity in the United States. And that's four times the rate of obesity than in the 1980s. So yeah, we are working on building infrastructure to prevent obesity. childhood obesity so that we can then prevent prediabetes and type 2 diabetes for our children. I want to go back and ask this question. I think, Teresa, you mentioned the fact that artificial sweeteners was an issue. And I thought artificial sweeteners was really designed to address the issue. And it appears that that's some more fake news now for us. 
What's up? Yeah, everybody kind of assumed that, but the studies are showing that it really affects your metabolic health. So when we're talking about obesity or too much weight for height, what we're really concerned about is health. People come in all shapes and sizes and we want to avoid weight stigmatism or weight bias. But when we're looking at trying to address it and make healthier choices and reduce the sugar in our diets, turning to sugary drinks, even artificially sweetened sugary tasting drinks seems to affect our hormones, our gut microbiome. And we see higher metabolic health issues and the associations with chronic conditions, but especially for kids, they're growing, they're smaller bodies. We don't want to expose them to, um, chemicals that we really don't understand the long-term effects of. 
So it could give them a preference for sweeter foods and make them more likely to over-consume sweets. So really focusing on water and low-fat or skin milk is really the approach. So, you know, our illustrious crew put together some great research here. And I think maybe just to save a little time here, it might be useful for our listening audience to hear some of the symptoms of childhood diabetes. So you see things like increased thirst, frequent urination, increased hunger, fatigue, blurry vision, where they might be complaining about that, and also can even lead to frequent infections. Risk factors, we've kind of talked about a little bit here. Inactivity, diet, obviously. Family history, which I think we should maybe touch on a little bit. 
Race and ethnicity, which I really want to dive into deeper here. So let's talk about family history, first of all. So genetics, I guess, is maybe a way of putting it for our listening audience. Higher risk. Just because you're perhaps genetically predisposed? Yeah, definitely. If you have a family member who has had type 2 diabetes, you're going to be at higher risk of developing type 2 diabetes. As a child? At any age? At any age. So, yeah. Okay. All right. So let's... dive into some of these race and ethnicity issues. Unfortunately, and Clarence and I have had many chats on a variety of chronic conditions. And it really is unfortunate that we see that, again, diabetes in this case, we see higher prevalence in, for instance, the African-American population or American Indian population. 
Seems like just about any disease, fact disease, these communities are at higher risk. But for today, let's talk about diabetes and specifically the populations that it's really hitting hard. Yeah, definitely is hitting the African-American community and our American Indian community exceptionally hard. Other communities like Latinx community. and people of color in general. Asian communities sometimes will have like, will experience diabetes with less body weight. So at a lower body weight, they seem to be at higher risk. So there are definitely differences, but a lot of the differences are also associated with social determinants of health, where you live, work, learn, play. Yeah. Back to that toxic environment. You know, we look at our Minnesota Student Survey, people of color, communities of color, children of color are drinking more sugary drinks, a lot more. 
But that's not because, you know, it's more environmental. And there's a lot more advertising targeted to people of color. African-American children see twice as many ads on TV. if you drive through certain communities, you'll see billboards and fast food restaurants for unhealthy foods. Um, so i'll pause there. I see Gary. Yeah, I just wanted to build on that and actually ask more uh more questions um because it seems that one of the issues is with, you know, the designated food deserts that in a lot of these communities There are no grocery stores, and the only grocery store is, I would say, 7-Eleven. You know, it's Speedway. It's, you know, Holiday. It's the gas stations and fast foods. You have lots of those, but not grocery stores. 
And then in addition, another area is that school lunches and breakfasts, too, would be an opportunity that oftentimes you know, a lot of students in schools are eligible for reduced or free lunches and they also get breakfast. And so I'm just, you know, wondering how significant, and I think it does play a significant role, but I haven't looked at the research. And so I'd be curious to hear from, you know, Teresa, both you and Julie about that issue. If you don't have access, because Julie talked about access to food. If you don't have access to healthy foods, you know, you know, you have to eat. And unfortunately you get lots of calories. Then, you know, there might be empty calories, but people do need, we need calories to carry on and function. 
And oftentimes these low nutrition calories tend to be the most affordable, which kind of gets you in this downward spiral and a trap of, you know, I got to feed my family. I don't have access to healthy food. So I just wonder if we could just, talk a little bit about that. I know we're not going to solve the world's problems on that, but understanding that, that always has been something that pops into my head as being a significant issue if we're going to make headway and do education. Do we deal with, like for the Department of Health, do they deal with food deserts? Yes. In my previous role as a nutrition planner, I worked With corner stores, we worked with local public health to try to increase access to healthy foods in corner stores and neighborhoods. 
Those food deserts are a real problem. Food insecurity is associated with obesity and type 2 diabetes. So we do need to address that. And we need to make sure people get good quality food. So there's a super shelf initiative that's really worked across the state with getting healthy, good quality food into food shelves. So when people visit, the first thing they see are fruits and vegetables. It's not taking away choice. It's encouraging. It's just making good appealing foods easy and accessible for everyone. So, you know, checkout lanes, we've all had that experience of seeing or having our own children nag us at the checkout lane. They want that treat. That's marketing. Marketing is product price, placement, promotion. They're putting it everywhere we are. 
And so we can have policies to try to limit that or work with stores to ask them to not have some of those things at the checkout lane or at least have some healthy choices there too. It's hard because there's a lot of economic forces working against that. Julie, I'll let you add what you want. Yeah, I'm so glad we're talking about this because health is closely linked to the conditions in which people are born, where they grow, where they live, where they work. worship and play and age. And that's all part of the social determinants of health. And so we need to recognize that not everyone has the same opportunities to make healthy choices. And in fact, it's unreasonable to expect that some people will change their behavior easily when so many other factors are affecting them. 
and their ability to make healthy choices. So I really liked what Teresa touched on, policy level, sharing resources to people about food shelves or access to a gym, a place where they can work out safely if they don't have sidewalks or if they don't feel safe in their communities. Things like that can help address social determinants of health. I think I agree with that. I think that I'm going to pile on with this. So I think there's some real systemic issues that we have in our state, in our country, that we need to be honest and try to address. And for me, it is the... That's why I asked you, Julie, about what are your hopes and expectations for the community? Because I think that there is a... 
this is a bi-directional kind of conversation that we have to have, you know, that people need to understand what are the risks they're taking for utilizing those corner stores and utilizing those foods, as well as we need to talk about why don't we have more access to grocery stores and things like that. Why do we have to travel? Why don't we have access to pharmacies anymore? I mean, you know, you've got, you know, we've got all these different things and these are all factors around health. And so the question for me always is, how can we have a honest conversation about what we really need to be doing? I think that there is a politically safe kind of conversation that we can have. 
But I think that there comes a time where we're starting to see this stuff is becoming so prevalent. In fact, I think, Teresa, we were talking about the fact that when we're talking to Diana Hawthorne, She was talking about a kid that was 13 years old came in. He was 300 pounds. And we couldn't find a coat for him. You know what I mean? So when are we going to sit down and have some real hard, hard, hard conversations where we don't feel attacked? You know what I mean? So that's what I'm asking about. The hope for this particular opportunity is can we just talk? I mean, can we talk and then really come up with some activities? So that's my comment. I'm finished. 
Yeah. There's so many things. And back to, you know, what Dr. Bain said as well, Clarence, and what you're saying is, you know, there's a childhood obesity interventions cost effectiveness study that Harvard has led. It's called the Choices Initiative. And you can look online, Google it, Choices and Harvard. But but they've identified the most effective interventions to address childhood obesity. And things like sugary beverage excise tax, you know, will really reduce health disparities. There's some, you know, some things like, you know, the policies that we have in schools about afterschool activity and play and making sure they're accessible to the populations experiencing the greatest health disparities. So kids have a place to play and move. and have access to healthy foods after school. 
There are some things that are really parent education oriented with text messages that come through the primary care provider to support parents as they're trying to navigate the remarkable pressures on their children to make unhealthy choices through, you know, they're exposed to so much advertising. Like if we had a policy at a federal level about advertising to children, that would have a huge impact. So And think about all the rural communities with the dollar stores moving in, the grocery stores moving out. Those communities are experiencing a lot of health disparities as well. So those are all policy level things that need to be discussed. Yeah, Julie. Yeah, I'd like to add that. Clarence, you brought up such a great question as far as how can we really sit down and talk about 
And I think we have started to do this work in August of 2023. The cardiovascular health unit and diabetes unit joined forces to co-write a state plan, which is a roadmap for how we want to address these chronic conditions moving forward through 2035. And we identified 10 outcomes through an extensive community engagement. process. And through that process, one thing that stood out to me is that the community wants a seat at the table from the very beginning. And so with this work that we're doing with childhood obesity prevention and also type 2 diabetes prevention, we are working to put together groups where we can listen to community voices so that we can choose programs that are a appropriate for the communities that we are wanting to serve. 
And so, and through that, you know, those conversations, we're going to have to talk about some hard things and we're going to have to pull in some other people to help us address some of these issues and inequities that communities are facing. I think, too, I appreciate that. I think that the, you know, I applaud that because That's what I would like, too. And I think that it's going to be important to bring in those voices that may not necessarily be kumbaya. Because we have to speak truth to a lot of these issues. And sometimes it's not it doesn't appear to be nice, but it's necessary. And so I just want to put that out there, too. So I've got a couple of 
of things that seem to be happening out there right now, I'm calling them the false sense of security. So let's talk about Ozempic, for instance, okay, where you, okay, you know, you can lose weight by just, you know, taking a medication. So I just wonder, you know, in these community conversations, it's just like, okay, I'm overweight, or I'm obese. take the pill, take an injection. Thank you very much. So these false sense of security, how are we addressing that going forward from a prevention standpoint? So that's a great question in the media all the time, Stan. The American Academy of Pediatrics recently came out with guidelines for best practices in addressing childhood obesity. And they recommended that these lifestyle behavior programs that family healthy weight programs that Julie just was talking about earlier. 
That's part of the focus of our grant is to make those proven programs available to communities experiencing the greatest disparities and figure out which ones make the most sense with those communities. And the medications, you know, we're going to have endocrinologists who specialize in this. There are some children who are having severe health problems. Their weight is so great that, you know, they're having spinal problems, their knees, knee problems, metabolic problems, that their lives are going to be, they're going to get things like kidney disease and blindness at much earlier ages and not have healthy lives. You know, for some of those kids, these medications are going to be really, really helpful, but they're not for cosmetic changes. And lifestyle change in and of itself has many, many benefits on affecting other health conditions like hypertension and dementia. 
So, you know, we can't kind of forget about that. There's not really a quick fix for health. It's not just about one pill. Yeah. You know, Clarence, maybe you can respond to this as well. It's like, you know, there are certain communities, there are certain races that have higher risk of many chronic diseases. How is it, and maybe this is part of this community conversation type of thing, how is it that we really get communities of people? It's one thing just to talk about it. It's another thing for them to own the issue, own the risk, own the problem. So certainly getting the conversations going is a start. But then how is it that we get them to own the problem? So I think that part of the key is identifying who the real messengers are going to be. 
Because anytime you start talking about money and funding, they're going to be those people that's going to come up with the big voices saying, look at what, you know, look at, we can do this, we can do that. I think to find, to go in and find out who are the people that have really been doing the work for a long time, who are the people that are really the influencers, To give them a chance at the table when they've been kind of excluded out is how we're going to really be able to make it. Because these are the people that are really making a difference. But their voice is not being heard because they're being overshadowed by others. So I know that that's a tricky thing with government because, you know, you can't be as selective. 
You know, and it's what I always talk about. It's like, you know, you got folks been talking about this stuff for 40 years. They ain't done nothing. So... I'm hoping that with, and I believe this is about you, Teresa and Julia, really I do. I really believe that you're going to try to find the real treasures in our community that can really help to elevate this conversation. But you have to be much more, I'm gonna use the term discriminatory in terms of some things that people don't like that word, but I chose this red shirt today versus my blue shirt. I was discriminating. No, so discriminatory is not always a bad thing. I'm just talking about trying to really, you know, make a difference in terms of the health of our community. 
We have to be a little bit more selective in who we have out there leading the charge. Yeah. So, Julie, you know, I know just because I've worked with you, you know, many, many years, I know that we've been involved in this prevention arena for a long, long time. Diabetes, we're in an arena, cardiovascular, Health and disease, another. So how do you know? Have you gotten a sense of how you know whether you're making a difference? Are we seeing changes or, you know, and this gets into this whole thing of measuring, you know, whether or not we're getting anywhere with this, which, you know, I know CDC really likes. On the other hand, there's part of me as a health professional that basically says, you know what, sometimes you just know it's the right thing to do and let's just keep going at it. 
Don't worry about the measurement. We know that these are good things to do and hopefully these things combined with many other hopefully positive things will have an impact. Regardless, what's your sense of measuring? Is there a way to measure this? That is a great question. And for me, I think it comes down to this deep knowing that not doing anything is not a choice. We have to do something. And change takes a long time. Adoption of healthy lifestyle changes doesn't happen overnight. It takes time. people need to hear the same messages about obesity, overweight, prediabetes, type two diabetes over and over and over before it finally clicks and they're motivated to make changes. So, um, you know, we have evaluation, um, measures in place, um, and that tells part of the story. 
And I think also hearing, um, from community, that's another part of the story. So when we put all these things together, I think that's when we know that we're making a difference because we hear it from community. Okay, yeah, my grandmother is taking, you know, so-and-so to the class and word spreads eventually. So this will take time for us to see a change, but we have to start. We don't have the option to not. You know, I agree with that. You know, you know, The positive measurement maybe will come from just anecdotal reactions where people will say, geez, you know, it's because of you that, you know, I personally changed my lifestyle. And you know what? That's great. You know, that's like a 100% increase, you know, as far as I'm concerned. 
I remember it took, God, 25 years or so to get... to convince people to put kids in child restraint seats and to wear seat belts, for God's sakes. I mean, these are things that take time. I'd be remiss to not bring this up. What effect do you think COVID had on addressing and being successful, hopefully, in getting information out to the public about diabetes? Because to be honest with you, maybe I'm wrong, but when COVID was here, still is, but not like it was a few years ago, that was heavy on everybody's minds. That was it. But on the other hand, we had other issues to deal with. People still had diabetes or were at risk of. So how did you deal with it during the COVID pandemic? 
So COVID, so we know People with diabetes and people with complications from diabetes had the most severe outcomes from COVID. It was really concerning, you know, really vulnerable populations. So really getting messages out for protection. But I think there's so much more work to be done here. One of the things, you know, I anticipated when that hit, because I've worked in childhood obesity clinics before, is, you know, over the summer months, kids tend to gain weight. They have less structure. School meals with the Healthy Hunger for Kids Act are really one of the healthiest sources of food kids get. And it's great that we have free school lunch for all now. I expect that's gonna have a beneficial impact on our kids. But we, I lost my train of thought and I totally lost it. 
COVID. COVID. So kids did gain weight. Kids were dealing with stress. You know, we saw more people out walking, which is really encouraging, but we know healthy lifestyles can be beneficial for reducing risks from things like COVID. So we need to do better. We need to do more communication. Yeah. Things happen like this, you know, and, and believe it or not, you know, for listening, I will have another pandemic somewhere down the road and hopefully there'll be lessons learned from it. Julie, go ahead. Yeah. So to answer, um, Or to add on to the COVID conversation, I think we saw increases in weight and definitely increases in food insecurity, which all leads to increased rates of type 2 diabetes. I saw a recent study that said visits to the food shelf have increased substantially in 2023. 
An increase of 1.8 million food shelf visits in 2023 with 7.5 million total visits. So I think, you know, food insecurity is something that we need to address as well. And on that note, we will be putting out community-based grants for community to lead the way in addressing food access-related issues to prevent and support people with diabetes. Because we know having nutritious, not just food security, but food and nutrition security, you know, having access to good, wholesome foods that are appealing, that are safe, that, you know, are culturally appropriate. We need to find better ways to make it easier to make the healthy choice. You know, the other community conversation that I was thinking of, and I was wondering if there's been some thought about it, is how is it that we can coalesce healthcare professionals? 
around good messaging. And so I can imagine having a conversation with some physicians, some public health people, some community health workers, some nurses, et cetera, in a room and say, okay, we are hopefully the trusted professionals that can provide useful information. How is it that we can all be on the same page when we do this so that we have a common denominator of knowledge that we can we can share with these communities out there so that they know that they're getting some good useful information has there ever been that kind of discussion about getting a grouping of health care professionals together health care providers are really one of the places where it's most appropriate to to talk about health and how weight's affecting a child's health because it's not just a cosmetic issue you know it shouldn't be approached as a cosmetic issue 
And providers don't feel comfortable talking about this often. We did some focus groups with providers and school nurses. This is a hard topic to talk about. So I think more training to support the health messages, how to approach it, not to contribute to disordered eating behaviors, for example, to not make the problem worse. So I think there's really important efforts that could go into helping. equip health professionals in supporting. I could see a group get together on just health messaging. Because many of these things overlap with cardiovascular disease or even cancer. I think it would be a very, very useful enterprise to do that. I'm taking a risk here, Sam. Go ahead. I have this very I tell you, I'm a looper. So I think I think way, you know, crazy stuff anyway. 
I didn't know that, Clarence. OK, I think what would be wonderful, just really quick, that when a patient visits a doctor, they walk away with a bag of healthy food, a little small bag. You know, the apple or orange or something like that. And and you just say like, hey, you know what? I want you to think more about this. Or a prescription to go to your grocery store to get vegetables. Yeah, because they'll take that home. I mean, you never know if they're hungry or homeless or anything like that, but they'll probably take it home to their little kids. And so instead of buying a McDonald's, you don't spend the money for that or whatever other program, they got an apple or orange because that's the better thing. 
So I just think a little bag, a little brown paper bag with like four or five different items in it saying, hey, take this home, this is healthy food. Might be a good way to promote that. Great idea. I love it. Food prescriptions are on the policy agenda for a lot of people to try to have healthcare coverage, to write a food prescription. Why wait until they get a chronic condition? Why not help somebody before that? The cost effectiveness of that and the studies that we're seeing are really, it's common sense to to use those types of approaches. Well, I know that there's a lot of complicated aspects to prevention, certainly of this particular chronic disease, diabetes, and it certainly overlaps with many of the others. 
I really applaud your efforts. I know that this is not an easy game to play, especially dealing with variety of different communities that need our help. But the public should know that your state health departments really work at trying to come up with some good creative ideas and work with you out there. So Teresa and Julie, thank you so much. I think as in other shows, we reserve the right to to call you back. Or, for that matter, for you circling back with us and say, hey, we have something really exciting to tell you and your audience. And all you have to do is contact health chatter and off we go. So, thank you for your expertise it's it's really good. Last comments. 
Clarence? You're on mute. Oh, okay. Thank you. Barry. In addition to the thank yous, I think this is a more of a beginning conversation. And I think getting the word out and getting people talking about this as an issue can also, I hope, create some momentum toward understanding and action. And this is just wonderful to certainly Teresa to reconnect with you and Julie to meet you and a topic that just is of such importance to our to all communities, but certainly in the Minnesota community. So thank you so much. Thank you to you. Thanks for our listening audience. And everybody, keep health chatting away.