Archive for category: Podcast Transcripts

Transcript

Dr.  Wendy Slusser  00:03

You probably know someone who works in a hospital, a relative, a friend, a roommate, or you may work in a hospital yourself. Our nation’s heroes have been working at breakneck speed for the past year, and have faced countless challenges and hardships. Expert in resilience training and professor of clinical psychiatry and pediatrics at the David Geffen School of Medicine at UCLA, Dr. Brenda Bursch, has been at the forefront of addressing the mental health and emotional well-being challenges our frontline workers in the hospital are facing. In this episode, Brenda shares tips on how we can boost our own resilience and reveals the science behind storytelling as a way to integrate our emotions with our memories. Join us for a conversation about supporting our frontline workers, and build our own gratitude, empathy and finding glee in the future. So Brenda, it’s so great to have you join us today to chat about the challenges our frontline workers are facing. And I’d like to have a conversation about these challenges and how we should be thinking moving forward.

Dr. Brenda Bursch  01:11

Thank you for having me, I’m glad to be here.

Dr.  Wendy Slusser  01:13

Just such a privilege to have you here. Known you for over a decade, maybe two. You always have keen insights into so many different settings, and this setting that we’re talking about are the frontline workers. And that would entail not only health professionals, but also people that are keeping the engine going not only at UCLA, but across the country. So getting right into it. What do you think are some of the main challenges our frontline workers in the hospital are facing today?

Dr. Brenda Bursch  01:41

Well having just come through our biggest surge over the last year, I can say that many of our health professionals are utterly exhausted at this point in time. What they face has been unprecedented in their careers, even for people who’ve worked in the hospital for decades in terms of how much trauma, death, change in normal routines they’ve had to cope with. And even those providers who are not necessarily directly working with our COVID patients have really had to be flexible and change a lot in what they do as well. And many of those individuals feel a sense of helplessness too. So there’s almost like some survivor guilt for not having been on the front line for those who are not, you know, in those situations, in the emergency department or ICUs that really took the biggest brunt of the surge.

Dr.  Wendy Slusser  02:37

Explain to me what survivor guilt means, because I think other people, not even on the front lines, have a sense of guilt that they aren’t able to contribute. What does that mean?

Dr. Brenda Bursch  02:47

Right. So, you know, even this week, I was talking to someone who is, you know, working in our hospital setting with very, very ill patients, but still felt that there was more that he could have done to help his colleagues who were taking on so many COVID patients, and, you know, experiencing so many patient deaths, over and over and over again. And so what I mean by survivor guilt is just the sense of, you know, it should have been me, you know, it could have been me, I should have been able to do more. And so a sense of helplessness that comes along with that, as well as some guilt. So, you know, when I think about those, like the person I spoke to this last week, who feel like they’ve not done enough, you know, those who feel that it should have been them caring for COVID patients in the ICU, I sometimes think of a sports analogy. So for example, on a basketball team, you have starters, and you have bench players, and you have all of the professionals to support those players. And then you have the organizational and the league wide rules and requirements to kind of direct the overall direction of the activity of everybody else. To win a championship or to be COVID, we need all of these pieces to be operational and they ought to be coordinated with each other and they ought to be focused on the same goal. We tend to focus on those starters, you know, they’re the ones who are observably critical to the win. But you know, equally critical, even if they’re less observable, are the rest of the players and the support staff. If they weren’t doing their jobs and ready to fill in when asked to do so, like when someone became ill or injured, then we would have been in a much worse situation. They might have made different types of sacrifices, but it’s important that we recognize and value the sacrifices that they did make. Of course, you know, this analogy falls short in that our frontline professionals have been exposed to higher levels of stress and trauma than many others. But even given this, you know, no health professional or support staff has been unimportant to the efforts to combat COVID during the pandemic. And those people who still have some capacity and a desire to do more will play a profoundly important role during the recovery. And so what my biggest suggestion is, is to find ways to emotionally support your colleagues who have been on the front line. You know, we know from past epidemics and other kinds of disasters, that it is likely to take years for people to really, you know, process everything they’ve been through, there’s not been time to do that. And so there’s going to be after effects for quite a while, you know, certainly the next couple years. And not everybody really wants to hear those stories, or is able to hear the stories due to confidentiality. But if you have people on your team, or within your profession, who you know have gone through a lot, it can be quite helpful for them if you reach out and just ask them if they want to talk about what they’ve been through. And it’s really easy for the listener, because it’s not about problem solving. It’s not about trying to change anything. And the listener doesn’t have to do any kind of fancy techniques other than just listen and try to really, really understand what the emotional experience for the person has been. And to empathize with that. And that’s a very powerful intervention that is extremely helpful to people who’ve gone through something traumatic. To tell your story is very different than just thinking about it in your own head. And we know that to either journal about it, or to talk about it out loud, allows for the integration of your emotions with your memories, which allows you to process the information in a more efficient and effective manner. So it does help you get through it better, to be able to do that with somebody you trust and other health providers. And I mean, when I’m talking about health providers, I’m not talking just about doctors and nurses, but anybody who works in that healthcare setting, who interacts with health providers, or patients or their family members, those people are in a unique situation to really understand what it’s like. You know, I think many health providers feel that they’re almost living in a different universe than a lot of people who don’t have that type of a job. You know, a lot of people are protected from what’s gone on in the hospitals and so it’s hard for them to understand how difficult it’s been.

Dr.  Wendy Slusser  07:15

You said the word empathize, which I think is a really important distinction between that, practicing empathy versus compassion. Empathy is something that we all could practice, compassion is taking action on it. So what exactly does empathy mean or how do you practice it?

Dr. Brenda Bursch  07:31

Well I think in practice, what it means is communicating to somebody that you get it and not doing that by turning the story onto yourself and telling your own stories necessarily, although sometimes that can be helpful if someone knows you’ve been through the same thing. But it can be done in a very basic way, by just repeating something that someone has just told you, you know. “I am so depressed, this has been such a difficult thing,” you can just say, “Wow, this has been really difficult for you.” And that seems kind of silly in a way. It seems like, “Well, you’re just repeating what I just said.” But if you are speaking to somebody, it means that they’re paying attention to you. What they are able to say back to you what you’ve just said, it means they’re really paying attention. So at a very basic level, it’s communicating very directly, almost like a summary of what you’re hearing, especially paying attention to the emotional content of it. As opposed to any other kinds of memories or facts. I think that’s the easiest and most straightforward way. But of course, you’re also expressing empathy in how you are with your nonverbal communication and how engaged you are and how much you are focusing attention and not being distracted. If you have had a very similar situation, you know, it can be helpful to share that as long as you don’t take over the conversation if your goal is really to support someone else.

Dr.  Wendy Slusser  08:59

Well, that kind of practice probably could have been done or should have been done even before COVID. And if you think about, especially with a lot of our health care providers, knowing that there’s been huge burnout in general. And so how do you find the challenges of the pandemic, on top of what was actually already a condition that was happening in our health system relating to emotional well-being?

Dr. Brenda Bursch  09:24

I’m so grateful to you and to others who were able to support some of the work that I’ve done over the last five or six years on the topic of provider burnout and trauma, because we did have some programs in place already that we’ve been able to build upon, and hopefully we’ll continue to do that. But just to give a couple examples. We do have three locations right now where we have peer support programs. So, you know, in the emergency department and anesthesiology, and in one of our medical units, we trained about 15% of the providers in those areas on science-based ways to provide support in many, using many of the skills I just talked about. You know how to reach out to somebody after an adverse event, and provide them support, allow them to vent, give them some resources, if they want to be hooked up for additional education or services, and also just to provide education on what’s normal. And the feedback that we’ve gotten based on those programs, is that it really changes the culture. Even if people don’t want to chat about what they’ve been through, they really appreciate being asked, and it starts to really address some of the stigma associated with mental wellness. You know, we are in an environment where perfection is valued, you know, we want to be perfect for our patients. And because of that, it makes it really difficult to admit if you’re struggling, and you know, to make that more normal, to be able to talk about the fact that we all struggle, and especially among our leaders, to have our leaders share some vulnerability, really makes a huge impact on especially younger health providers who might feel intimidated by more senior people. And, you know, by hearing vulnerability more, having a program within your department that supports this type of communication, it really makes things a lot more transparent and helps people feel more comfortable that their leaders will have empathy for them if they struggle, and that it will be safe to bring it up. So I’ve been very grateful that we had some of that already in place. We’ve had some resilience training programs in place, we’d already developed an app to help our health providers assess how they are feeling, and to get immediate feedback, and coping skills, suggestions as well as connection to resources within that app. So all of those things were already in place, because we already had an issue with you know, burnout, as you know, as is true across the entire country. And then once we got hit with COVID you know, our health system quickly established a COVID mental wellness workgroup, led by Dr. Karen Miotto, and with inputs from professionals from the National Traumatic Stress Network by Pynoos and Melissa Brymer. And folks from our Staff and Faculty Counseling Center, and others from other locations within the health system that got pulled in specifically for this effort. And then we immediately started training mental health providers on disaster psychiatry interventions, so that we could start deploying our own mental health providers to specific units within the hospital and work groups and residency groups so that they could have a go-to embedded person who had some skills that could help them not only process as they go along some of the difficult things they’re facing, but also to hook them up with resources, and to develop resources as requested. So we’ve had quite a large group effort over the last year to do what we can to provide more immediate support for our health staff.

Dr.  Wendy Slusser  13:21

So Brenda, you’re pointing out the fact that in any disaster, you really had to be prepared. And you identified some of the areas that you had already been working on that really set the stage for preparedness and then was able to augment them and branch out according to this particular disasters, being the pandemic. You mentioned resiliency, and you’re a professor in the Department of Psychiatry and Biobehavioral Sciences and Pediatrics at the David Geffen School of Medicine at UCLA. And you’re an expert in training in resilience. What does that entail?

Dr. Brenda Bursch  13:56

Well, I’ll start with the definition of resilience, which is basically the degree to which one can adapt to and recover from difficult situations. Some of these skills are taught in our families as we’re growing up, there’s probably some biological contribution to it as well. But thankfully, you can also augment those skills. So we know that there are certain both individual skills and then also organizational efforts that could be made to try to improve one’s resilience. You know, what I’ve done mostly, is really focused on the individual. So you know, I know that the organization is also you know, looking at policies and procedures and resources and access to care and things like that, that are very important. My focus has been mostly on the individual and what the individual can do to try to boost their own resilience. You know, there are a variety of different types of skills that do that and you know, the idea from my perspective is to teach people some of those skills and to recognize that what will feel natural and normal and helpful to people will vary. And you know, some of them already get it, some of them, and like when I’m doing my training, if I can teach one skill that they haven’t seen or heard of before, then I’m very happy because we have a very resilient health force already. They’re beleaguered right now, but they’re very, very resilient at baseline. So it’s really trying to shore up any areas that could be shored up, you know, so at an individual level, ironically, one of the most important things is really to think about your support system. We know how incredibly important social support is, helpful social support, you know, because you might have a lot of friends or family and some of them might be really supportive, and some of them might not be, they might be more of a drain. So really thinking about who is it that helps me remember who I am? Who is it that helps me feel good and healthy, and lifts me up? And if I’m not having as much interaction with those people, right now, how can I make that happen, because that’s essential. And so for some people, it’s connecting with other people at work, who really understand what’s going on. And for some people, it also means connecting with people outside of work, so that you can have a break. And because we’re not being able to see each other as much, it might be setting up regular phone calls or Zooms, you know, in a way that you didn’t have to before because you would run into each other, or you would see each other socially. And then at an individual level, there are so many different things that can be helpful that range from just basically taking basic care of yourself, you know, am I still eating properly, have I figured out how to move my body even though I am working remotely, as an example. Just very basic, general health things, things that you can do to regulate your emotions better, to communicate better, to give your mind a break from thinking about difficult things all of the time. So for example, one of the skills that many people have gravitated towards in recent times are mindfulness types of interventions, and there’s so many different types you can do. The basic idea, though, is that you want to try to put yourself in a relaxed, calm state. And you don’t want to be thinking about things in the past or things in the future. So you know, if you think about things in the past, we often spend time criticizing ourselves about we could have done something better, or why didn’t I do it this way, or that person aggravated me. And if we’re thinking about the future, sometimes we’re thinking about, oh, I’ve got so much work to do. And when am I going to fit this in and will I hit this deadline, and I’m nervous about that. But if you can try to be present, and instead of using all of those thoughts, try to use your senses to perceive what is right before you, in a relaxed state, it gives your mind a break. And we know that mindfulness interventions have all sorts of physical and mental health outcomes that are positive. And you know, some people say, “Well, I can’t learn to meditate.” You know, they associate mindfulness with meditation. And you know, it’s something you have to practice but you don’t have to do a full on meditation practice to derive benefit from mindfulness type exercises. So there’s all sorts of other things like, you know, mindful walking, or mindful eating. It’s about focusing your attention using your senses, what am I smelling? What am I hearing? What am I seeing? And trying to be as present in the moment as you can. And then when you notice your mind going towards the future, the past, just bringing it back to what am I seeing, hearing, smelling, feeling right now? And so there are a variety of ways to do that. But that’s an example of a popular intervention that does not take that much time, which is really critical. If you’re talking about very busy health providers, you can’t say “Go to a yoga class,” they’ll laugh at you. I mean, they’re like, that’s not possible, it’s not going to happen. You have to figure out things that can be done within the workflow that have an outcome, even if you only have five or 10 minutes a day to do it. And that’s really what, you know, what we’ve tried to prioritize in terms of our skills training.

Dr.  Wendy Slusser  19:12

Brenda, that was really highly informative. And I’m just sort of trying to figure out, one, when you’re doing your educational or outreach, if a person can even identify one skill that they might not have known about, or to practice for resilience, that was a huge success. What skills have you noticed, have been the most common that people have identified as ways that they could build resilience?

Dr. Brenda Bursch  19:38

I think one of the things that’s been the most fascinating to me is that I’ve been in so many situations over the last year where I’m either teaching resilience or giving some sort of a processing space opportunity for people or I’m listening to Schwartz Rounds where our, you know, providers are telling their stories and I also do some work in the community and other settings. And so it’s not always just health providers I’m listening to, you know, I listen to people talk about their own family experiences, which the health providers have, as well. You know, family members who’ve, you know, had COVID, or who’ve died and their childcare challenges and like, there’s so many different things. And the thing that has really been notable to me is that no matter how difficult the story is that I’m listening to, by far, the most common spontaneous expression of a coping skill that I hear is almost invariably, somebody will spontaneously add something that they’re grateful for. They will talk about something and say, “But at least you know, I have a job, I am so grateful I have my family, I am so grateful that I have a place to live, I am so grateful for my colleagues, I’m so grateful to be working at UCLA.” I hear this over and over and over again. And I don’t know that people really realize what an important resilience tool that is. But kind of like I was talking about with mindfulness, attentional focus matters, what your brain is paying attention to impacts how you feel. And you know where most of us in the health care industry are problem solvers, all day long, we’re trying to solve problems. And because of that, we get into this, you know, we’re perfectionistic, we have to be for our jobs. So we’re always looking for problems. So it kind of puts you in this critical mindset, you know. This is a problem, we have to fix it problem, problem, problem problem. And so to counter that, it’s really helpful to spend some time with your brain focused on things that are good, and that you are grateful for, and that are going well and that are positive, to help balance your perception of reality. And, you know, we know from research that gratitude practices are very powerful. And so one of the interventions that I sometimes will recommend is that people spend, again, it can be three or five minutes a day, doing something to reinforce their focus on what they’re grateful for. So that could be sending emails to five people that day that they just really appreciate and just thanking them. It could be writing a list of three things that went really well today. It could be three things, three people you’re grateful for, it could be anything that kind of just reminds you about the goodness of what’s gone on, silver linings. And, you know, I think nobody had ever imagined in their lifetime, they’d be living through something like this. And so I think for many of us, we’re really much more appreciative for so many minor things that we never thought we’d lose before, like going to a restaurant. You know, never imagined that we couldn’t go to a restaurant for so long or, you know, visiting a family member or you know, so many things. And so finding gratitude or appreciation for some of those minor things, I am hoping, you know, once we are more opened up, that that appreciation will lead to feelings of glee as we’re able to be reintroduced all those things we miss right now. Well, that’s a perfect lead into my next question, which is moving forward, what are your recommendations for recovery from this pandemic? Well I think, you know, the first thing that’s worthy of saying, again, is that this is not going to be an on off switch in so many ways. The recovery is going to be in fits and starts, people are going to have different levels of comfort, and people have had different levels of trauma and loss. And so because of all of those things, it will also take different amounts of time for people to recover. And so I think the first thing is being patient with each other. And recognizing that this is going to take some time, and being compassionate towards ourselves. Maybe we can’t complete as many tasks as we normally can. Maybe we need to revise some of our goals and timelines so that they’re a little bit more realistic. But I think, in general, making space to tell those stories, is going to be an important part of recovery.

Dr.  Wendy Slusser  24:13

I hear storytelling a lot in your responses, and the power of storytelling is so profound in so many settings. What is it about the storytelling that is so important to you?

Dr. Brenda Bursch  24:25

Well as I mentioned before, telling one story is a much more effective and efficient way to process trauma than just sitting with it by yourself. Not only do you derive benefit from that social support, but it also allows you to integrate your emotions with your memories in a way that’s helpful and allows you to move forward. When you tell your stories and other people respond to those and you hear other people’s stories, you realize you’re not alone. We’re in this together. And that’s another theme that I hear very frequently, that, you know, even for people who are not telling their own stories yet, maybe they’re not quite ready to, they’re hearing others. It’s very reassuring. It’s like, oh, I’m not the only one struggling. So the more that we can really share all of that with each other, we’re creating a culture of support and safety for everybody.

Dr.  Wendy Slusser  25:23

I’m thinking, you know, a lot of people think, “Oh, you know, you want to be resilient before something bad happens.” But you can build resilience during the bad event as well. How does storytelling play into building resilience?

Dr. Brenda Bursch  25:37

When terrible things happen that you don’t expect, I think that, you know, you discover strengths and skills in yourself that you never thought possible. But we don’t have time. And we don’t make the priority to really think about that, and give ourselves credit for that, or understand it in a way that allows us to package it for future use. And I think that when you tell your stories, it’s a way that you can do that. You can honor you know, the strengths you found and better understand how they developed and how to use them again in the future. I think the other thing that happens with storytelling, especially if you’re storytelling, you know, with others, who have similar experiences to you, is that it, you know, it can remind you about, you know, why it is that you got into your profession to begin with. So, if you are a nurse, for example, and you’re talking to another nurse about everything that you’ve been through, and they understand, because they’ve been through the same thing, it’s really common that that conversation ends up evolving into a place of also remembering, you know, what it is that they went into nursing to accomplish, you know, what their fundamental values are and what their goals were. And, you know, I’m not saying it’s all roses in that, you know, there are times when people might feel like, “Oh, did I make a bad choice. I mean, this was really brutal,” like, “Who would want to live through this.” And that’s a normal feeling. You know, this was extremely disturbing for many, many people. But despite that, it’s remarkable how many people will also in the same storytelling, say that “I’m so glad I was able to do something, I’m so glad I was able,” and it might be small things sometimes too, because many times the care is futile. There are many instances where because of the nature of the disease itself, clinicians who are used to being able to regularly save patients had no tools at their disposal that they could use. The usual tools were either not available, or they just didn’t work. And so to find meaning and to find something where they felt like they were fulfilling their mission, as a physician, or a nurse, or a housekeeper or anybody in that role, means that you might have to switch in other places. So what might be facilitating the conversation with a loved one over, you know, an iPad and Zoom, because they couldn’t visit in the hospital, it could be, you know, trying to find a way to get a patient out onto one of our decks to see sunshine, you know, for a day. It could be a variety of other things, you know, helping getting them to windows, so they can see their dog outside. And, you know, finding meaning in those ways, which is very different than how they’re accustomed to finding meaning. And you know, through those stories, you can find those nuggets. And you can appreciate those moments whereas if you don’t stop and do that, the days, every day is so dense for so many of those micro moments, you never stop and really appreciate the impact that might have had on a patient or a family. And so I think, you know, by sharing the stories, there’s a higher likelihood that somebody will point that out if you’re not seeing it and that you will notice it if you hadn’t before.

Dr.  Wendy Slusser  28:55

You know, putting my white coat on, having you say what kind of advantage there is to tell a story, to build your resilience, makes it more likely that some people that are very sort of not going to dwell on the past and just move forward, it might bring people to the table to be more likely to do that, and then build their resilience more. Because there is something about our profession that makes you say, “Oh, you can’t dwell on the on the bad part, or you can’t feel bad. You just have to go forward and charge ahead,” right? And at least in my generation, so this gives it a purpose that might actually entice more people to participate.

Dr. Brenda Bursch  29:40

Right. Well, and we know that when leaders are a little bit more vulnerable, that younger faculty and trainees and other people who are more junior are more likely to reach out for help. And if it’s your very own leader, they might also be more likely to reach out to that leader for help because they’ll have increased confidence that that leader will understand. Whereas that leader feels like they always have to be the strong tough one, and they never share any of that, then there’s a wall that’s up. I mean, you know, and so it’s harder to approach that person, because you’re comparing yourself to them. And you have this false belief that they don’t struggle, and that they’ve never, they’ve never had some of the same feelings you have.

Dr.  Wendy Slusser  30:20

And that gets to what you were saying, that you had prepared a number of our departments already with the peer counseling, the peer-to-peer support, that helps break down that barrier.

Dr. Brenda Bursch  30:33

That’s the feedback we’re getting. And it’s, you know, it’s something that is evolving nationwide. Joint Commission is interested in peer support programs, you know, the information, the data, you know, is growing over time. So my hope is that, eventually, that will be something that is rolled out across our whole health system, as well as all the other health systems in our country.

Dr.  Wendy Slusser  30:58

That’s excellent. Well, I’m in full support of that, kinda, let’s get our heads together.

Dr. Brenda Bursch  31:02

Alrighty, let’s do it.

Dr.  Wendy Slusser  31:05

So would you say there any silver linings that have come from this pandemic?

Dr. Brenda Bursch  31:09

I think, you know, we kind of been talking some about silver linings along the way, just things that people have been grateful for. I think that it will really be different for different people. Some people really have taken this event, this pandemic, to think about where they’re at in their life, am I on track where I want to be? You know, should I be changing something? So, you know, for some people, they might decide, you know, “I’ve been thinking I want to move back to where my family is, for years now. And this is really pointed out to me how important that is. And so I’m going to make that a priority” as an example. Or “I was waiting to retire to travel. But that seems silly. Like soon as I can, I should start traveling” or, you know, whatever, “I want to have a child,” Whatever major life goals that you have, it might put them into a different perspective than you had before. Some people might feel more confidence, you know, because they now have been through something that they never imagined they would be able to successfully endure. And so just having endured that may give them confidence. You know, we’ve had all sorts of innovation on the science front that has occurred that will forever change all sorts of approaches to medical problems. We’ve had a huge revolution in how we communicate with each other using, you know, electronic platforms for meetings. And, you know, we’ve seen that it’s in some sub specialties in medicine, it’s worked really well and improved access to care. You know, in my own department, in the Department of Psychiatry are no show rates have gone down. And people who normally have to drive for a very long way can just, you know, immediately be on Zoom. And so it doesn’t work in all situations. And it doesn’t have to be Zoom, it can be Webex or you know, another platform. But it does open up all sorts of opportunities in that regard, as well as having meetings without having to travel and recruitment for trainees and all sorts of other avenues that I can’t imagine we’re going to go back to exactly how we were before, because everyone is suddenly now skilled in these tools, whereas before we weren’t. And so it’s much easier now to set those meetings up and be assured that people can manage the technology. So I think that that’s forever transformed, you know, how we will be operating. And I imagine also that there’ll be more people working remotely on a more regular basis, because we’ve seen certain ways in which that can be very effective. You know, those are just a few. There’s so many. But I think, and I think just as I mentioned before, our level of appreciation, I’m hoping that we are able to maintain some of that. We’ll remember these days and maintain some feelings of like, oh, wow, I really am so happy I get to just go visit family or go to a restaurant or whatever it might be.

Dr.  Wendy Slusser  33:57

Well, if you think about the Great Depression of 1929, and how much impact it had on at least my parents generation, that was a long lasting impact.

Dr. Brenda Bursch  34:08

Very good point. I had not thought about that.

Dr.  Wendy Slusser  34:11

Well, to wrap up, what good do you think will come out of this pandemic?

Dr. Brenda Bursch  34:15

You know, this is my hope. You know, I, of course, it’s impossible for me to predict. But I do hope two things. One is, you know, I think that health systems in general, and certainly our health system, was aware of the, you know, importance of mental health and wellness of our workforce. I think there’s more and more data emerging that demonstrates that’s how you give good patient care, that when you have a healthy workforce, both physically and mentally, your patients do better. And this makes good business sense, to really pay attention to this aspect of the well-being of our health force. And I’m hoping that this might even accelerate some of those efforts. You know, I know that we’re already underway, but I’m hoping that some of those efforts will be accelerated. And then you know, as I mentioned before, I’m just hoping that we will live with a renewed sense of appreciation. And time will tell, we’ll see if that’s true.

Dr.  Wendy Slusser  35:10

That’s for sure. I mean, one thing about the need and appreciation of emotional well-being support, is the concern that there are not enough providers. What is going to change in that arena?

Dr. Brenda Bursch  35:24

Wow, you know, that’s a really difficult question to answer. And, you know, it’s an interesting thing, because I think it’s uneven. Right? I think in some areas, we have not enough providers. And then I know, we also have providers that are worried about job security too, because there’s some places in which utilization has gone down, or other models of care are being implemented that might reduce the need for some providers. So I think that there’s concern on both sides. And that means we need to work smarter and more efficiently, right. We need to make sure that everybody is working at the top of their license, that where you are training, I think the best example would be, you know, the peer support we’ve been talking about. Clearly, there’s not enough mental health providers for the need that we have. And so because of that, we have to be really smart, we have to prioritize. We know that, for example, if you have mild to moderate symptoms of anxiety, or depression, self help interventions can be helpful. Peer support interventions can be really helpful. So if we can better equip people to help each other and help themselves, then we can really save the mental health professionals for those who have the most severe problems, who really need that expert care. And, you know, that same model could be replicated in other areas as well, just really thinking about how do we empower people better, and then most strategically use the talent that we have for their talent?

Dr.  Wendy Slusser  37:00

Well, that’s an excellent way to end this talk. I want to thank you so much, Brenda, you are always just an incredible resource for all of us at UCLA and around the country. I know you do a lot of consulting and support for others outside of the health system, and you’re a real gem. And I don’t know if you have any final words that you’d like to share with us or wisdoms before we end this podcast.

Dr. Brenda Bursch  37:24

I’ll just say it’s a mutual admiration society. So I will thank you for your incredible support. You’ve always been a huge advocate and you know, put money behind that and networking. And it’s just, I can’t tell you how much I’ve appreciated that. And, you know, that’s a really good example of how we move forward in these partnerships. So thank you very much for having me today.

Dr.  Wendy Slusser  37:46

Thanks. Yeah, it’s always about the team.

Dr. Brenda Bursch  37:48

That’s right.

Dr.  Wendy Slusser  37:49

Thank you, Brenda. Thank you for tuning into UCLA LiveWell. For more information about today’s episode and the resources mentioned, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA LiveWell on Apple Podcasts, Spotify, or wherever you listen to podcasts. Get to know us a little better, and follow us @healthyUCLA. If you think you know the perfect person for us to interview next, tweet your idea to us please. Have a wonderful rest of your day, and we hope you join us for our next episode as we explore new perspectives on health and well-being.

Dr.  Wendy Slusser  00:03

In the United States, every other person over the age of 20 either has prediabetes or diabetes. Today we learn about the story behind this alarming statistic with diabetes expert Dr. Tannaz Moin. Dr. Moin graduated from the University of California, Irvine with a dual MD and MBA degree. She completed an internal medicine training and chief residency year at Yale University, followed by specialty training in endocrinology, diabetes, and metabolism at UCLA. She has quickly excelled in her field. Currently, she’s an assistant professor at UCLA and core investigator at the Center for the Study of Healthcare Innovation, Implementation and Policy at the Veterans Association, Greater Los Angeles, where her research focuses on comparing the effectiveness of different interventions for patients with diabetes and prediabetes. What exactly is diabetes? And what are the risk factors for it? What can you do if you are at risk, or have diabetes? Join us today as Dr. Moin unpacks these questions and shares what a successful diabetes prevention intervention looks like. Dr. Tannaz Moin, it’s so wonderful meeting you here and talking about this incredibly important subject, diabetes prevention programs and your record speaks for itself in terms of what you’ve accomplished over your lifetime, your short lifetime, I expect a lot more in the future. And also having someone as talented as you in so many ways, not just as a researcher and an accomplished physician, but also ability to really cross into other different departments and working with various different people with different skill levels, and educating them, and working with them, communicating. I think it really speaks for the well-roundedness that you are but also how you’re able to work in this field of diabetes, which really is requiring a large, multi-talented, multi-disciplinary group to accomplish your goal. What is your goal, actually, what is it? What would you say?

Dr. Tannaz Moin  02:13

Well, thank you. I’ll start by just saying thank you so much for having me here today. And it’s been an absolute pleasure working with you as well, and other folks across the campus who are thinking about prevention and healthier lives, and for our students, for our faculty, for our patients. So it’s really an honor to be here. And you know, in terms of my personal goals, I think, you know, I realized early on in my training here as an endocrine fellow, so I was studying diabetes in particular, that we have the opportunity to be proactive about a lot of things with respect to our health and well-being. But I think the way medicine is delivered in the US is often reactive. So we’ll be talking about prediabetes. And I think that’s a great example of us really trying to get ahead and empower our patients to lead healthier lives.

Dr.  Wendy Slusser  03:06

Right, working upstream.

Dr. Tannaz Moin  03:07

Yeah, absolutely. Instead of waiting, again, for bad things to happen, and then stepping in. And as an endocrinologist, you know, I sometimes get some slack, or I used to, why why are, you know, preventing the one thing you’re supposed to be treating? I would love that. Yeah, there’s a lot of really kind of bad things that we can’t prevent. But, you know, we’re learning more and more about the importance of prevention, and that even though I’m a subspecialist who focuses on diabetes, that is my passion. And I think part of that stems from seeing the negative impacts diabetes can have on my patients’ lives and their families’ lives. So really just using that as a motivation.

Dr.  Wendy Slusser  03:55

Yeah I mean, what you’re describing really is secondary prevention, right? Because primary prevention would be preventing even the prediabetes. Secondary prevention is taking someone with something that’s the harbinger.

Dr. Tannaz Moin  04:07

Right. And when we talk about prediabetes, so yes, we are trying to prevent diabetes. But you know, we’re still at a point where we’re, in technical terms, trying to prevent those bad things that can happen with diabetes, like heart problems, heart disease, strokes, MIs. And so in that respect, we’re still doing primary prevention of those kinds of negative side effects. So, yeah, this is something I feel passionate about. And I feel very lucky to be in sort of a university setting where folks are forward-thinking about these topics, including, you know, yourself. And we’re bringing together individuals from, as you said, different sectors. And all of us have, you know, something to contribute. And together, I think we can get a lot farther and be much more impactful than any of us sort of working alone.

Dr.  Wendy Slusser  04:59

For our listeners, can you give a bit of a background on what diabetes is?

Dr. Tannaz Moin  05:04

Sure, I’d love to do that. So diabetes, we can think about it broadly as a condition where blood sugars or glucose levels are higher than they should be in the body.

Dr.  Wendy Slusser  05:14

And what’s normal? What is higher?

Dr. Tannaz Moin  05:19

So a normal blood sugar, if you were to fast overnight, and we were to do a blood sugar test in the morning, normal is 100 or less. And so diabetes is when, you know, in the morning, if we were to do that blood test, is 126 or greater. And the reason that diabetes happens is that there’s dysregulation of a very important hormone called insulin, which controls blood sugar levels in the body. Insulin’s released by the pancreas, and it’s essential for life. We can’t live without insulin. And so there’s two types of diabetes. Type 1, where folks are usually diagnosed at a much younger age, and the pancreas stops producing insulin altogether.

Dr.  Wendy Slusser  06:03

Younger meaning less than 20.

Dr. Tannaz Moin  06:05

Yes, yeah. And you know, they can be toddlers and into the teen years. We do have cases of adults who are also diagnosed with Type 1 Diabetes. But what happens on a sort of a pathophysiologic level is the pancreas, the islet cells, stop producing insulin.

Dr.  Wendy Slusser  06:22

The Type 1?

Dr. Tannaz Moin  06:23

The Type 1. So folks who are diagnosed with Type 1 Diabetes, require insulin replacement therapy right after diagnosis. And the second and much more common type of diabetes is Type 2 Diabetes, which means that the body’s actually still making insulin. It just doesn’t know how to use it correctly. And that type of diabetes is usually diagnosed older, in adulthood. And individuals with Type 2 Diabetes are almost always started on oral medications. And with time, many of them also may need insulin therapy. So there’s an overview of the two different types of diabetes.

Dr.  Wendy Slusser  07:06

And what does it mean to have prediabetes?

Dr. Tannaz Moin  07:09

So what it means to have prediabetes is that the sugars are above normal, but not yet meeting the diagnostic threshold to be diagnosed with Type 2 Diabetes. So fasting between 100 and 125, is considered prediabetes. So less than 100 is normal. 100 to 125 is prediabetes, and 126 or more is considered diabetes. And there’s also another blood test, Hemoglobin A1C. So 5.7 to 6.4% is considered prediabetes, and 6.5% and above is considered diabetes. And so what it means to have prediabetes is that you’re on this spectrum of the sugars are a little above normal, but you don’t yet meet the criteria to be, you know, considered to have full-blown diabetes.

Dr.  Wendy Slusser  08:05

That sounds very clear. Thank you.

Dr. Tannaz Moin  08:08

You’re welcome.

Dr.  Wendy Slusser  08:09

The thing that, I think, has blown my mind away is this sort of statistic of one out of two over 20-year-olds in the United States are either prediabetic or diabetic. And I know people say one out of three are prediabetic, but to me, this other data point is even more profound. 50% of our population. One out of two, right? And tell me more about it, I mean, like, how have we gotten here? Like, it just blows my mind. As a pediatrician, it blows my mind.

Dr. Tannaz Moin  08:39

Well, as an adult endocrinologist, it also blows my mind. The statistics are really alarming.

Dr.  Wendy Slusser  08:45

And what data is this?

Dr. Tannaz Moin  08:47

This data? So there was a study published in the New England Journal of Medicine, one of the highest tier kind of journals that we have. And it comes from data and investigators from the CDC, Centers for Disease Control and Prevention, who have a really strong interest in diabetes prevention these days. And yeah, it’s absolutely shocking. And I think there are a lot of risk factors for diabetes and prediabetes. Obesity being one of the biggest, and we know those rates are continuing to increase as well. So you know, and it’s not that every person with prediabetes or diabetes is obese. We have different phenotypes or body types, but definitely higher risk. Also, lack of physical activity, we know is a risk factor for both prediabetes and diabetes, and our lives have become more and more sedentary. You know, we sit behind our computers or when we get home from a long day of work, we’re not doing as much physical activity as we should be doing.

Dr.  Wendy Slusser  09:53

Yeah. And why is that? Why is physical activity so protective?

Dr. Tannaz Moin  09:58

So there’s a lot, you know, we understand and there’s some things we don’t fully understand. So obviously, weight maintenance or prevention of weight gain is one very important thing about physical activity. So we know as individuals age, they gain weight. But folks who are more physically active are less likely to gain weight, they also tend to have more muscle mass, which, when we think about the balance between insulin and glucose, or sugar levels in the body, is a protective thing. And there’s all these other factors like stress, which we know, you know, sort of there are stress hormones. Stress levels can increase blood sugar levels in the body, and physical activity is protective in that way as well. You know, there are again, numerous other risk factors, the ones we’ve talked about so far are what we call modifiable. So these are things that every single person has the power to change. I can eat healthier, I can be more physically active. There are some things, though, that are non-modifiable. So that might be our family history. So a parent, a brother, or a sister with diabetes, will increase your risk. And certain racial and ethnic groups. If you’re African American, of Hispanic background, Asians, all have increased risk. And those are things, unfortunately, none of us can change about ourselves. So it’s very important to focus on the things we can. And I think, healthier lifestyle is really the key here.

Dr.  Wendy Slusser  11:26

I want to go back to two things that you said just earlier. I’d like to debunk a myth, in the sense that, yeah, I think, as you age, you can gain weight. But I don’t know. It’s like, everyone says, oh, you know, going through menopause, you’re going to gain weight.

Dr. Tannaz Moin  11:45

Yeah. So it’s not that you have to gain weight. But when we look at population-level data, and this is not just one study, I mean, numerous studies have shown this. And part of this is our metabolic rate actually does decrease as we get older. So that plays into it. And so even if you’re physically active and kind of eating the same things, with age, you’re at increased risk. So I think the better way to phrase it is, with age ourpropensity to gain weight goes up.

Dr.  Wendy Slusser  12:14

If you don’t modify your diet and listen to your hunger cues.

Dr. Tannaz Moin  12:18

Yeah, and obviously stay physically active. Absolutely. So all of those. Again, the things we can modify the things we have power to potentially sort of be proactive about, as opposed to wait until something happens and then react after the fact.

Dr.  Wendy Slusser  12:32

Yeah, because I feel that one thing that I feel is a myth is the fact that, you know, women who go through menopause are going to gain weight. Whereas what you could really be considering as not denying yourself food, but just listening and being more mindful of your hunger cues. Yeah,

Dr. Tannaz Moin  12:48

Yeah, I just read a study about children and hunger cues. So you know, parents say, eat more finish your plate. And how, you know, sort of culturally, that can be, you know, a belief or a personal family sort of tradition that, you know, people clean their plates. And that we should, as parents, stop doing that because you kind of suppress those cues. And we should be listening, because oftentimes, we’re eating much beyond that hunger cue, and that, again, puts us at risk for all kinds of health problems.

Dr.  Wendy Slusser  13:19

Yeah. Well, actually, there’s research that shown, out of Penn State, Leann Birch did a lot of research on parents who are controlling over their child’s intake actually backfires, ultimately, and especially with girls, Caucasian girls. The data shows that they will actually be much more likely to be overweight later in their 7, 8, 9, 10-year-olds, period of age.

Dr. Tannaz Moin  13:44

Yeah, and I think there’s even some data about, you know, sort of, especially women compared to men, that the more controlling parents might be around food and intake, the propensity to have eating disorders in young adulthood. And we see that in our patients with diabetes, too, who are transitioning to adulthood and might have had lots of do this, don’t do that, eat this, don’t eat that. And that can definitely backfire as they get older.

Dr.  Wendy Slusser  14:08

So when we’re talking about diabetes, when we say one out of two people are either prediabetic or diabetic, we’re talking about Type 2 Diabetes?

Dr. Tannaz Moin  14:17

Yes. So those statistics, when the CDC, Centers for Disease Control and Prevention pulls the statistics, they’re pulling from different data sources, and they try as much as possible to make sure that it’s Type 2 Diabetes and prediabetes. But as you know, there’s another type of diabetes, Type 1 , juvenile onset, insulin dependent. Because from the get-go, the body has stopped producing insulin. The pancreas, the organ that’s responsible for insulin production. But what happens, you know, and my work is in large data sets, when you’re trying to tease out Type 1 from Type 2 Diabetes, sometimes it’s not a perfect science. But yes, when we talk about those statistics, we’re talking about prediabetes and most patients with diabetes actually do have Type 2 Diabetes. That’s a much, much, more common form.

Dr.  Wendy Slusser  15:07

And so the other thing that you were mentioning which is non-modifiable are your genes. And that’s when you referenced certain ethnic or racial groups have a higher tendency, right. It’s really related to the genetic makeup. Now there’s also this belief, of course, which you’ve talked about modifiable behaviors. So you can have genes but they don’t have to be your destiny.

Dr. Tannaz Moin  15:30

Absolutely. I’m a wholehearted believer. But it does mean that if you have those certain risk factors you should be talking to your doctor a lot sooner. Typically we start screening for Type 2 Diabetes at age 40 or 45.

Dr.  Wendy Slusser  15:48

And how do you screen them?

Dr. Tannaz Moin  15:49

So there’s very simple blood tests. The one that’s most commonly used these days is called a Hemoglobin A1C test.

Dr.  Wendy Slusser  15:55

And what does that mean?

Dr. Tannaz Moin  15:56

Yeah, so what does that mean? So this test measures the amount of glucose on red blood cells. It’s sort of a very plain definition of what the test is actually doing. It reflects the level of glucose that’s circulating in the body over three months’ time on average. And so for prediabetes, it’s an A1C of 5.7 to 6.4%. 6.5% and above is considered diabetes. So it’s a very simple test. You don’t need to fast or do anything different with respect to your diet but your doctor could simply order the tests for you and so you could know. And if you do have some of these other risk factors, it’s better to get screened earlier.

Dr.  Wendy Slusser  16:41

Yeah, earlier meaning 40?

Dr. Tannaz Moin  16:43

At a younger age, yeah, absolutely. If you’re overweight, if you’re not that physically active, you may want to get tested sooner as well.

Dr.  Wendy Slusser  16:54

Even if you don’t have a relative, is that it?

Dr. Tannaz Moin  16:56

Yeah, so you know, depending on the patient and their risk factors, we would even screen teenagers. And we’re doing more and more of that because there are more individuals who are overweight and at risk. So those are the the national guidelines that, sort of, are phrased that way.

Dr.  Wendy Slusser  17:13

Well and even, correct me if I’m overstating, but from what I understand is, if you do run a higher blood sugar level when you’re a teenager, you’re much more likely to accelerate your expression of Type 2 Diabetes because of growth hormones and the other hormones that are circulating?

Dr. Tannaz Moin  17:30

Yeah, absolutely. And I’m by no means, you know, sort of a research expert in that area but definitely, I think we’re seeing the onset of what we would call dysglycemia or sort of abnormal glucose regulation and slight elevations in the glucose levels at earlier ages. So decades ago, it was very rare, I would say, for someone who’s a teenager to be diagnosed with Type 2 Diabetes. Now it’s a lot more. You know, sort of, we’re seeing more cases of it. So there’s definitely things that happen, usually 6 to 10 years before you’re diagnosed with diabetes is when we start to see lab changes, physiologic changes. So this is a very long, kind of indolent process that’s almost completely asymptomatic, so you wouldn’t otherwise know unless you had the conversation with your physician and thought about getting yourself screened for diabetes.

Dr.  Wendy Slusser  18:25

So with prediabetes, you’re describing that there are effects on your body, even that aren’t negative?

Dr. Tannaz Moin  18:33

Yes, absolutely. So, you know, I like to think about normal blood sugar, prediabetes, and diabetes as a continuum. So we have sort of a slow progression throughout all of these different stages. It’s not like everybody knows, actually, about the bad side effects of diabetes: heart disease, you know, it’s the number one cause of kidney failure, blindness, preventable amputations in the U.S. and in the world. That’s sort of general knowledge. Most people are aware that diabetes is not a good thing, but it’s not like there’s an on-and-off switch, so you all of a sudden have this risk when your blood sugar reaches a certain threshold. In the prediabetes range, you’re still at risk, an increased risk, for those things.

Dr.  Wendy Slusser  19:16

And why is that?

Dr. Tannaz Moin  19:18

So we have yet to really fully understand the pathophysiology, I would say, of why increased blood sugars directly, you know, are related to cardiovascular events. But there’s some thought about glucotoxicity, so that the glucose itself is actually toxic, the sugar. And so in prediabetes, of course, your sugars aren’t as high as diabetes. That’s sort of by definition what it is. But it’s still above normal. And so all of those things that we worry about. Retinopathy, when vision is impaired by diabetes, also happens in prediabetes. The rate of it is lower, but it’s still a risk. So absolutely something to take seriously.

Dr.  Wendy Slusser  19:59

So one out of two over 20-year-olds are either prediabetic or diabetic in the United States. And I’m assuming that it’s less in the 20-year-old range and it’s sort of rises as people age?

Dr. Tannaz Moin  20:12

Absolutely. Because as you get above, sort of, in the fifth or sixth decades, so 50 to 60, absolutely, the prevalence even goes higher and higher. Because age, in and of itself, is actually a risk factor for diabetes. So as I was mentioning, most national, sort of, care guidelines would say, even in someone with absolutely no risk factors for diabetes, by age 45 they should have been screened for it, because age itself is a risk factor.

Dr.  Wendy Slusser  20:39

And another statistic that’s quite dramatic to me is the one out of ten do know. Only nine out of ten don’t know that they’re prediabetic or diabetic.

Dr. Tannaz Moin  20:51

Yeah so and this is where my work has focused, you know, sort of in the last five to seven years. I think it’s shocking. Every time I hear that, I’m not less shocked. I mean, it’s really alarming, especially because prediabetes is a time, I’ve always thought of it as, you know, the silver lining is even if you’re at risk you know that there are things, and we’ll talk about those, hopefully, but there are things you can do to prevent Type 2 Diabetes or at the very least delay the onset. Yeah, glass half-full is what I always tell my patients. But if you don’t know that you have this condition, how would you know to sort of do anything differently or to be proactive? And again, these statistics come from the CDC data, and they’re kind of now a decade old, so we’re hoping that with some of the national campaigns that are ongoing from the CDC, the American Medical Association, and I know when I give talks sort of anecdotally, I always ask people to raise their hand. There’s sort of more, I think, attention to the issue but yeah, I would say most patients and there are recent studies show that it’s maybe closer to 20 or 30% know. So we’re making headway, but that still means, you know, three-fourths of people have no idea.

Dr.  Wendy Slusser  22:11

Well yeah, you’re definitely making headway. I have a friend who, in her union, she got a newsletter this week that said one out of three Americans have prediabetes. So she couldn’t believe it. She, like, texted me, oh look at this, Wendy, and that’s what you told me and there it is! So I mean, that would be terrific, right, if our organizations that normally are dealing with other health and welfare issues could also telegraph this message.

Dr. Tannaz Moin  22:40

Yeah, absolutely. And I think you know, the old saying is knowledge is power. And so I think everybody has the right to know about their you know their health conditions, their risks. And some people may choose not to do anything about it. You know that’s not their priority right now. But I think giving folks the information to make those kinds of informed choices about their health is really important. And you know I have yet to meet a patient in all of my years of training and faculty that doesn’t care if they get diabetes. Yeah, who wouldn’t be motivated?

Dr.  Wendy Slusser  23:16

If they have had a relative that has had it.

Dr. Tannaz Moin  23:18

Yeah, so everybody you know most people are sort of, have some experience either through family or friend or colleague. And you know when we talk about prediabetes, if they’re at risk, again, I’ve yet to meet someone who says, oh that’s really not that important to me. Of course everybody’s motivated. And it’s interesting and it’s sort of a contrast to when I talk to patients about weight management. For some folks it’s not as important maybe to lose weight, or you know, but when we talk about in the context of diabetes prevention, it becomes a priority, usually.

Dr.  Wendy Slusser  23:50

Well I can understand that because it’s focusing on something that is a positive, you know, outcome that isn’t necessarily the values of how you look, which are different for different people. But your health, everyone wants to be healthy, right? Everyone defines it differently. That’s one of our Semel HCI values, you know. Everyone wants to be healthy but everyone might define it differently. So one thing that has struck me about this whole conversation about one out of two are prediabetic or diabetic, only one out of 10 know it, that we’ve known since 2002, a way to reduce your risk of developing diabetes if you are prediabetic. So tell me about that study from 2002. I mean, we’re almost two decades after.

Dr. Tannaz Moin  24:42

Yes, so well, that study, commonly referred to as the Diabetes Prevention Program or DPP study, was published again in that same New England Journal of Medicine, which is one of the highest tier journals, and was conducted in 27 centers in the US. Patients who had prediabetes and were overweight, were randomized to receive an intensive lifestyle intervention which we also now commonly referred to as the Diabetes Prevention Program or DPP, to metformin or to placebo, which was basically some informational flyers and “usual care.”

Dr.  Wendy Slusser  25:18

And metformin is?

Dr. Tannaz Moin  25:19

Metformin is an antiglycemic, it’s a diabetes medication.

Dr.  Wendy Slusser  25:24

The oldest one, right?

Dr. Tannaz Moin  25:25

Yeah. The oldest.

Dr.  Wendy Slusser  25:26

From the lilacs, from France.

Dr. Tannaz Moin  25:28

Yea, actually, it is. It’s derived from the French flowers. So it’s, yeah, and it’s one of the oldest, safest medications. And these days actually one of the cheapest, it’s pretty low-cost and low-risk. And so patients were randomized to these three arms and then followed over time, the intensive lifestyle intervention, metformin, or usual care.

Dr.  Wendy Slusser  25:56

And what was the intensive lifestyle intervention?

Dr. Tannaz Moin  25:59

So the intensive lifestyle intervention in this study was one-on-one, face-to-face weekly sessions over 16 weeks. And overall, these were conducted over 12 months’ time. So they could be, you know, biweekly, depending on the participant’s needs. And there were some very specific goals. 150 minutes of moderate physical activity. So everybody was aiming to do a minimum of that.

Dr.  Wendy Slusser  26:26

They could build up to it, though, right?

Dr. Tannaz Moin  26:28

Yeah, they could. And there was actually a run-in period of a couple of weeks before, to get folks sort of starting to be active if they’ve never been active.

Dr.  Wendy Slusser  26:35

So 150 minutes a week means 30 minutes a day for 5 days.

Dr. Tannaz Moin  26:39

Yes. And moderate means, you know, you don’t have to go run marathons. We’re talking about brisk walking. So you sort of can still carry on a conversation, but feeling a little bit, sort of, out of breath, but could still speak a full sentence.

Dr.  Wendy Slusser  26:55

It wouldn’t have to be all at the same time. It could be, like, ten minutes, ten minutes, ten minutes.

Dr. Tannaz Moin  26:59

Yeah, and it’s actually better.

Dr.  Wendy Slusser  27:01

Isn’t it also better to exercise after you eat? Or walk after you eat?

Dr. Tannaz Moin  27:07

So yeah, it’s great in terms of, you know, digestion. I think there’s some data about sort of being able to digest food. But also after you eat is when your blood sugar levels tend to rise and activity helps reduce blood sugar levels.

Dr.  Wendy Slusser  27:20

How does it do that?

Dr. Tannaz Moin  27:22

So activity, one, you’re burning calories, I think that’s a very sort of straightforward way of thinking about it. So you’re burning calories, and you’re burning kind of the food that you’re taking in. It’s one of the main ways, yeah. So those muscles are working, and they need glucose, right? They need to take it.

Dr.  Wendy Slusser  27:37

So the glucose will be out of the bloodstream. So the insulin doesn’t have to be doing it as much.

Dr. Tannaz Moin  27:43

Exactly. Well, the insulin helps, yeah. So when glucose goes up, insulin goes up. And when you don’t have diabetes, there’s sort of a perfect match of the insulin and glucose. So all that extra sugar is taken up. When you have diabetes, that balances off, so insulin may go up, but it’s not being used appropriately, and the sugar levels stay up. So 150 minutes of moderate physical activity a week, and then in the original trial, it was 7% weight loss. So the actual amount of weight loss varied at one year. It varied depending on the person’s starting weight, but it was to aim for 7%. And the third part of this intervention was really reduction of calories to be able to meet that 7% weight loss goal. So actually, they followed these participants for three years. But at the end of the study, they looked at, you know, weight loss in the first year, which was on average, about 5%.

Dr.  Wendy Slusser  28:41

On average, so some people lost ten percent, some lost one percent.

Dr. Tannaz Moin  28:46

Yeah. And what they found in this study was that that amount of weight loss, we’re talking about 5%, in those first 12 months, was correlated with a 58% relative risk reduction for progression to Type 2 Diabetes, as compared to the placebo arm. And the data we have on prediabetes that comes out of some studies that were done in China, is over the lifetime, prediabetes represents about a 70% risk of progressing to Type 2 Diabetes. So not every single person who has prediabetes is going to get diabetes, but you know, the lifetime risk is actually pretty high. And you know, so we talked about all these risk factors. And so you know, if someone’s overweight and doesn’t lose the weight, or if they are from certain racial or ethnic groups, their risk might even be higher.

Dr.  Wendy Slusser  29:41

Yeah. And so getting back to preventive medicine, which I think is really a unique characteristic of your work, because it is true as a specialist, even in this day and age, a lot of medical doctors are still not devoting the amount of time that they’d like to or they even have the skills for. So why is it so important for long-term health for your patients or our community overall? What’s driving you to focus on this?

Dr. Tannaz Moin  30:06

Yeah, I think for me personally, it really has been what I see in my everyday sort of clinical practice of with respect to diabetes, sort of the negative impacts. And so at the same time, so you see all of these negative things that can happen, and it’s physical, a whole change of life. Yeah, absolutely emotional. And, you know, living with diabetes is, you know, something that folks can do very successfully. But it’s a whole added bunch of thing you have to do. Check your blood sugar, you know, I mean, there’s a lot of other things that come with that.

Dr.  Wendy Slusser  30:39

What is it, what comes with it?

Dr. Tannaz Moin  30:42

Checking your blood sugars, medications that you’re taking. And in some instances, you know, usually we start with oral medications, but often, might be insulin, and that’s multiple daily injections that someone’s giving them. And so you can think about, we can think about the average working person and how much of a disruption something like this can be to their life. And so you know, if we’re in a position where we can, again, prevent, or at the very least, we can delay the onset by years, I think we’re doing so much for, you know, quality of life, really, more than anything else. And, you know, in terms of our healthcare costs, and from a societal perspective, prevention is key. As most of our healthcare spending happens, in a reactive fashion, people are hospitalized, you know, sort orf fo these diagnoses and complications from the diagnoses. So in the US, one out of every seven healthcare dollars goes to diabetes-related care and complications. One out of every seven.

Dr.  Wendy Slusser  31:44

Wow, what is our health care spending, do you know?

Dr. Tannaz Moin  31:48

So in terms of diabetes-related healthcare spending, we get great estimates from the American Diabetes Association, which are published about every five years. In 2017, the ADA estimated that we spent $327 billion on diabetes-related healthcare in the US. In comparison, in 2012, we had spent $245 billion. So in the span of just five years between 2012 and 2017, diabetes-related healthcare spending has increased by 26% in the US, so from an individual quality of life perspective, it’s critical that we try to prevent diabetes, but also from a societal and sort of big picture, also really, really important that we prevent.

Dr.  Wendy Slusser  32:39

Yeah. So what what are the makings of a successful diabetes prevention program?

Dr. Tannaz Moin  32:45

Sure, that’s a great question. And I think we’re fortunate that we are in a time that we have very clear guidelines about how to do diabetes prevention program delivery and how to do it well. And we have national guidelines on what the makings of a successful program are. And all of that is informed from the trials, the randomized control trials and all the studies that have been done over the last two decades. So critical things are that the program is vetted by and sort of recognized by the Centers for Disease Control and Prevention or CDC. There’s a national registry that’s publicly available, a website that you can go and look up programs by your city, by your state. So that’s key. And and the reason that’s key is all of the programs that are in that registry follows some very basic standards for delivery, based on the research. And the coaches are certifiedl they’re trained the curriculum.

Dr.  Wendy Slusser  33:48

And they don’t have to be college educated.

Dr. Tannaz Moin  33:50

Absolutely not. But they have some training to do what they’re doing. The curriculum is, you know, again, informed by the original research studies. And also, it’s an intense program that’s delivered over time. So we know the more sessions that are a part of the program, the better in terms of someone’s ability to lose weight. So the programs are all at least a year long, 12 months, and at least 22 sessions in those 12 months, and some programs offer more. And when we talk about those numbers, it can be a little overwhelming. It doesn’t mean that you have to come to every session. But the idea that, you know, when you’re making healthy lifestyle changes, it’s not overnight. You’re doing it slowly and over time, and that any of you do it in that way are more likely to succeed.

Dr.  Wendy Slusser  34:38

Well I remember, you said the sweet spot’s 10, right?

Dr. Tannaz Moin  34:41

So we know, sort of, 9 or 10 is critical, you know, dose and again, every sort of study that’s looked at this, the more sessions, the more lasting and the more the actual amount of weight loss. Yeah. Part of that is because more motivated, you know, individuals might be self-selecting. Yeah, but that session attendance and the number of sessions is highly correlated with weight loss, for sure.

Dr.  Wendy Slusser  35:11

Yeah. And so, tell me long-term outcomes, like you’re telling one year. What’s the sort of return on the investment, so to speak?

Dr. Tannaz Moin  35:21

Yeah, so the Diabetes Prevention Program study that was published in the New England Journal in 2002, you know, they’ve published their 10-year outcomes, their 15-year outcomes, and that cohort of patients is still being followed. So under sort of the auspices of NIH that sponsored the trial. And you know, so what it looks like is that the protective sort of risk-lowering effects of intensive lifestyle intervention, and also the m metformin, which was one of the other arms of the study, and

Dr.  Wendy Slusser  35:50

What was that reduced risk?

Dr. Tannaz Moin  35:52

So in the first three years, it was 31% relative risk reduction. But that protective effect, or the risk-lowering effect of both the intensive lifestyle intervention and metformin, are lasting to 15 years, so they decrease over time. But there’s still a significant degree of risk reduction. Even 15 years out where a lot of folks have regained the weight they lost in the original intensive program.

Dr.  Wendy Slusser  36:18

Their diet must have changed, or their activity levels.

Dr. Tannaz Moin  36:22

Yeah, what we know from this study is that, you know, again, even if you can do the intensive lifestyle intervention, or even with respect to the metformin, even if you did it for a period of time, it’s somehow protective for 15 years.

Dr.  Wendy Slusser  36:34

It gave your pancreas a break or something.

Dr. Tannaz Moin  36:36

Yeah, again, the pathophysiology is yet to be fully clear. That is the largest cohort of patients with prediabetes who’ve been followed over time in any, you know, study conducted anywhere in the world. But there are also large studies that have been conducted in China and Finland, where patients have been followed over time and showing, again, sort of this protective benefit that lingers even years after the trial is completed.

Dr.  Wendy Slusser  36:37

Well, you know what, it makes me wonder, and it’s something that I know you’re going to be looking at, in our groups that we are having here at UCLA. But I’m wondering, the sort of other secondary outcomes, not just related to the physiologic changes, but this social cohesion or social connectivity, that might be a result of these group classes, which were up to only 20 people in class.

Dr. Tannaz Moin  37:30

Right. So it’s sort of a small group environment is how the DPP is delivered. And again, that’s another aspect of a successful program to look for. You don’t want to be in an auditorium with 100 people trying to sort of take the course.

Dr.  Wendy Slusser  37:45

Are there some courses that are taught that way?

Dr. Tannaz Moin  37:47

I’m sure there are. They won’t be CDC recognized, but there are and so, you know, I mean, the day and age we live in, if you go onto Google and say, you know, diabetes, there’s a whole series of things that might come up. And not that sessions like that aren’t helpful and refer you to get more information and, you know, sort of an overview. I’m a big supporter of the more, sort of, information is a good thing. But in terms of the Diabetes Prevention Program, you know, we have some really kind of very clear guidelines on how to do that program and do it well, based on the research. So that’s important to sort of keep in mind. And in small groups, so we’re talking about 20 or fewer participants, and there’s a coach who shares information from the curriculum, but folks are coming together. And they’re supposed to share their shared, you know, challenges, and also their successes. And, you know, there isn’t a lot of data that we’ve seen in terms of when you bring people together around this topic of prediabetes. We know there’s group cohesion over time, right? So you’re meeting with the same people and the same coach. And you would think that that hopefully, is a motivating force for individuals. And in studies we’ve done and the VA particpants, the Veteran’s Association, talk about accountability. So I know when I’m going to my group, you know, I am accountable to myself for these promises to live a healthier life and be more physically active. But, you know, I’m also accountable to my group members. And that’s another form of social support. So, yeah, we’re really excited to look at these things and see, you know. We know quality of life improves with the DPP, an intensive lifestyle intervention that’s been shown, but it could be because of social support.

Dr.  Wendy Slusser  38:03

And how do you measure quality of life?

Dr. Tannaz Moin  39:40

So there are different survey instruments that can be used in studies and the original cohort of patients who was in that DPP study from the New England Journal is still being followed, as I’ve mentioned. Then they’ve had standardized assessments, measurements of how they rate their own quality of life. And with the folks who were in the intensive lifestyle intervention, they are rating higher quality of life, again, whether or not they were able to lose weight, whether or not they were able to stick with the intervention. Their quality of life over time seemed higher. We didn’t see that change with the metformin arm or with the usual care arm.

Dr.  Wendy Slusser  40:18

That’s very interesting and it will be interesting. Hopefully you’ll have some data for social well-being since we know that’s a big predictor of health and longevity in other studies around just aging Americans. You mentioned your work at the Veteran’s Association, and you mentioned earlier the diabetes prevention seems to be more motivating than weight loss. Your studies that you’ve published, too, have shown that kind of data or observation is played out.

Dr. Tannaz Moin  40:51

Yeah so I spend, you know, part of my time in the VA and actually some of my initial interests around diabetes prevention are based on work I did really many years ago with veterans. And part of the issue or the challenge with veterans is the rates of obesity are even higher than the general population. And the VA has always had what we would call a standard-of-care weight loss program known as the MOVE! Program that’s delivered actually at 150 VA medical centers everywhere. But it’s sort of delivered in different ways based on the site so we were really interested, now this is going back to 2012, to do a comparative effectiveness trial, to compare DPP, which is a much more intense diabetes prevention program, meaning more number of sessions and you know certified coaches, same group, that group accountability kind of cohesion we were talking about, to compare outcomes and patient experiences with the DPP as compared to MOVE!.

Dr.  Wendy Slusser  41:57

Which doesn’t have the same, like you don’t have to go to the same group.

Dr. Tannaz Moin  42:01

Right it’s sort of a come-as-your-schedule-allows, your goals are not, you know, the same. I might want to just be more physically active, you might want to just eat healthier. Whereas the Diabetes Prevention Program has standardized goals so everybody in the group is working towards the same goals. So we did this study, initially we started with just an in-person version of the DPP, which is the way it’s traditionally delivered, compared to MOVE!. And we saw that around six months there tends to be more weight loss with the DPP as compared to MOVE!.

Dr.  Wendy Slusser  42:38

Even though MOVE! was a weight loss program.

Dr. Tannaz Moin  42:40

It is. And this is a really active comparitor. We’re not comparing patients to usual care. And by 12 months, though, the weight loss seem similar between the two groups or it was approaching the same. And part of that is regained, so what happens is the program went from being very intensive to less intensive, the Diabetes Prevention Program. But patient satisfaction was much higher with the DPP. Participation tended to be higher so veterans were coming. They were more likely to come to a DPP session than they were to a MOVE! session and as this study started getting underway, we actually decided because at the time there was a lot of interest in technology and how we can deliver DPP differently, we actually added on an online or virtual group form of the DPP. And those results were really kind of interesting because then we were doing a three-way comparison and it seemed like online and in-person DPP, you know, they’re very similar in terms of the amount of weight loss that they resulted in. We’re talking about around four kilograms. And and the MOVE! participants were kind of hovering around the same weight over the 12 months.

Dr.  Wendy Slusser  43:54

They didn’t gain weight but they didn’t lose weight.

Dr. Tannaz Moin  43:56

Right and so, you know, it was really interesting to see that, you know, you could deliver a traditional face-to-face program, maybe using a web-based platform that might provide some convenience and flexibility.

Dr.  Wendy Slusser  44:10

So it’s another option that might be available and acceptable to some people. So the social learning aspect. Was that maintained in the online, like there were forums for the groups?

Dr. Tannaz Moin  44:24

Yeah. And online DPP is delivered in different ways and by different vendors. There’s a lot of them out there and, again, I would encourage our listeners to reference the CDC lists because they tend to vet the programs.

Dr.  Wendy Slusser  44:37

So just go to cdc.gov and search for “diabetes prevention program.”

Dr. Tannaz Moin  44:42

And you can see a registry. But yeah, usually the way online DPP programs are delivered is asynchronously, which means I can log in at 2am and you can log in at 12am, you know, or 1pm. It’s not a group time, it’s not like a Skype, you know, or a WebEx or something. There are programs that do it that way. But most are providing some educational materials and it might be through videos or other sort of interactive means. But I can sort of go through those materials at a time that works for me. And then I have sort of access to what’s happening with other people in my same group. So I log in and imagine kind of a Facebook group. And so I can see their pictures, they can see my pictures, they can see how I’m doing in terms of my goals, and I see how they’re doing. We have a coach, we can send each other messages, we can post to the group site, and we all have wireless scales. So we’re weighing ourselves instead of driving in for an appointment, you’re kind of doing that conveniently at home. So that’s a more multifaceted kind of way of thinking about online DPP.

Dr.  Wendy Slusser  45:53

So you could still get support, but in a non, like, live situation, or ideas from other people, because that’s what I find that social learning is so useful for people to say, hey, you know, I couldn’t fit in the walk.

Dr. Tannaz Moin  46:08

And that’s what we saw. We actually did a study where we looked among women veterans who tend to be more reluctant to participate in any of the in-person weight loss programs in the VA. I think the number was an average of 70 posts, you know, over the first couple weeks of the program. So it takes effort, you know, it was very interactive. And we did interviews with these participants and I was really surprised to find out that they still felt accountable to their group. And they felt like they were part of a group, you know. This wasn’t, you know, sort of a random set of people that they, you know, had no interest in getting to know, and some of them actually even formed, if they lived close together, were interested in forming walking groups. So again, there is that social component. And the coach, any successful online program should have a live coach, you know, there should be someone that you can talk to by phone, or would even call you if you haven’t logged in in a week to say, hey, is everything okay? And that’s a real important piece of success. We had that, and any program that, you know, someone’s looking to sign up for should have that.

Dr.  Wendy Slusser  47:18

And so if you were to say, a 40-year-old, you’re a specialist, so you wouldn’t see a 40-year-old that was just coming in for a checkup, but say you’re like supervising internal medicine resident in clinic, and there was a 40-year-old coming in who looked like they had a healthy weight and no family history of diabetes, what would you do? For a checkup?

Dr. Tannaz Moin  47:43

For a checkup? Yeah, it’s been a long time since I’ve done general primary care. There are other age, you know, appropriate screenings. I think I would talk with them, I would, you know, even if their weight was normal, I would talk about the importance of avoiding weight gain, because, as we talked about, as you get older, your risk of potentially gaining weight goes up. And I would also ask a lot of questions about the other potential risk factors. So in someone who’s 40, I would ask about, if they’re a woman, you know, how much weight they gained during pregnancy, if the baby was over nine pounds. That’s a risk factor for diabetes, and really try to make sure that we, you know, aren’t missing any other risk factor.

Dr.  Wendy Slusser  48:28

Even though they had a normal glucose tolerance test?

Dr. Tannaz Moin  48:31

Yeah. So baby over nine pounds at delivery is a risk factor for future diabetes development. So some women have a known diagnosis of gestational diabetes, where, you know, the glucose isn’t normal during pregnancy. But on a baby that’s large for the age or the mean, is also a risk factor.

Dr.  Wendy Slusser  48:53

Even though they pass their glucose tolerance test? Oh, that’s interesting. It’s not a perfect science, is it?

Dr. Tannaz Moin  49:00

Not a perfect science. And that’s why there’s great screeners, and that might be something else I would do or encourage our residents to do, share that information with patients. There’s nine questions and there are different versions of this screening, but it literally takes 30 seconds. And the questions are about your age, your physical activity or family history. You know, if you’re a woman, whether or not you had gestational diabetes, a baby over nine pounds, and it can give you a risk score.

Dr.  Wendy Slusser  49:26

Without having a blood test?

Dr. Tannaz Moin  49:28

Without having a blood test. And if your risk score is elevated, the data, the research and the national guidelines would say you should be thinking about being checked and participating potentially, in a DPP program.

Dr.  Wendy Slusser  49:42

So if you were, say, maybe you just want to prevent or you want to institute healthy lifestyle, and you are less than 40 and you’re not in any of the risk categories, what would you do? First of all, I think that the Diabetes Prevention Program, I’ve heard people really enjoy and totally talk about how it changed their life in terms of just socializing with their family and feeling better, and being able to hike and all this stuff. So I always like to sort of, I’m sure you do, to like gear people towards the positive and not like, oh, you have to give up this or that. But what’s your standard, kind of, coaching that you’d like to see people to do in their in their day-to-day life? Like, what would you recommend?

Dr. Tannaz Moin  49:42

So I think simple and small steps are really important. So obviously, I’m a huge proponent of the Diabetes Prevention Program, but that’s a big commitment and it’s hard, you know, for some folks maybe to commit to doing the program. But there are little things you can do, and goal-setting, and thinking about, you know, one thing you can change. I think, it’s something that’s reasonable, it’s feasible, it’s something you can do. You know, there are all these fad diets, and you go on these sort of crazy calorie restriction, but if it’s not something you can maintain, chances are, you’re going to do the sort of the yo-yo, the up and the down weight cycles that we try to avoid.

Dr.  Wendy Slusser  51:11

What happens if you are a healthy weight already, like, a 20-year-old? What would you say, not to give up or change? But what do you should be done? Where should people go, what direction?

Dr. Tannaz Moin  51:23

So one thing I actually do talk to patients, and actually friends and colleagues about is this concept of self-monitoring. So I think, especially with diet. We often aren’t thinking about what we’re eating, and not just calories, but the sort of the nutritional component. I think someone who’s at a healthy weight probably is doing that and obviously is lucky in terms of the metabolic rate and things like that. But I would encourage them, you know, to do a food diary, and you can do it with a good old journal and pen. But there are all these really neat apps and kind of things that are available. And to really take a look at the foods they’re eating, and both in terms of calories, but the nutritional component. And even if you’re a healthy weight, there’s always things that you might be able to improve in terms of your health. And then of course, physical activity is huge.

Dr.  Wendy Slusser  52:17

And walking. Just plain old walking.

Dr. Tannaz Moin  52:20

And walking. Just park a little farther. You know, so I think that’s something again, that we could all do more of. And it’s not easy. It’s hard to do, but something for folks to think about, yeah.

Dr.  Wendy Slusser  52:33

And so for, like, the foods that you would suggest are good foods, period, but also good if you are prediabetic. I know fiber, high-fibrous foods.

Dr. Tannaz Moin  52:44

Yeah. And we are, you know, learning more and more about the ideal dietary makeup for someone with prediabetes. It’s sort of relatively speaking, still a newer, you know, concept in the last decade or two, I think fiber and sort of complex grains are really important. We also are hearing more and more about the Mediterranean diet. So nuts and you know, sort of the olive oil and fish, and kind of staying away from heavy meat products, I think might be something else to think about. But the idea is to eat a balanced diet, try to avoid processed foods.

Dr.  Wendy Slusser  53:30

And sugar really sneaks into all foods, even mayonnaise has sugar.

Dr. Tannaz Moin  53:35

Everywhere. And that’s why I like these apps a lot. I mean, the one I’ve personally used is MyFitnessPal. But there’s a million out there, but it actually gives you, once you put in sort of the food item, it shows you everything, not just calories, but how much salt, how much sugar, you know, and that’s eye-opening.

Dr.  Wendy Slusser  53:52

And that’s much more important to me. I mean, I think carbohydrate content is much more important than the calories.

Dr. Tannaz Moin  53:59

Yeah. So it’s really amazing. And, you know, again, physical activity is so important. But, you know, I tell my patients, when I see them in clinic, you know, I can be on the treadmill for like an hour and I burn maybe 400 calories. In a minute, you can, you know, consume something and you’re just not even sort of thinking about it. So self-monitoring, you know, someone who’s at a healthy weight and has made lots of good decisions so far, I think that might be something they could do to see, gosh, you know, what am I eating?

Dr.  Wendy Slusser  54:31

Yeah, that’s been proven in both just healthy maintenance, but also weight loss.

Dr. Tannaz Moin  54:37

Yeah, absolutely.

Dr.  Wendy Slusser  54:38

Well, so from your perspective as an endocrinologist, what’s the number of grams of sugar that you would recommend a prediabetic, in percent of their caloric intake?

Dr. Tannaz Moin  54:49

Oh, that’s a tough question. Yeah. I don’t know that we have a prescription for something like that. You know, for our patients with diabetes, there’s been a lot, you know, more studies and I think if we follow the general guidelines for diabetes, they’re  about 60 grams of carbohydrates per meal. Not more than though, per meal, three meals a day. But that’s still, I mean, if you think a slice of bread is about 15 grams, if you had a sandwich, that’s half, and then you might have an apple, which is another 30 grams. So that’s generally the recommendations for someone with diabetes. For prediabetes, we don’t have clear, set guidelines like that, but that might be sort of a framework to think about.

Dr.  Wendy Slusser  55:30

So would you recommend for like a prediabetic, well, obviously diabetics do, but to actually, in terms of self-monitoring, monitor their carbohydrate intake?

Dr. Tannaz Moin  55:41

Yeah, so carbohydrate intake. And again, it’s not just about the calories and the carbohydrates, but making sure they’re getting balanced intake from sort of a nutritional perspective, too. So if we think about, you know, the My Healthy Plate, you know, the idea is half is coming from salads, and green vegetables and things. And so to be thinking along those lines of eating balanced meals, is really important. And of course, avoiding high-sugar drinks and kind of any sugar sweetened beverage, you know, eliminating that altogether.

Dr.  Wendy Slusser  56:19

Which includes sugared sodas. And also what about the sodas that are artificial flavors? Or artificial sugar?

Dr. Tannaz Moin  56:30

Yeah, so this is where, you know, I don’t want to say the jury’s still out. But I’m, you know, not a basic scientist, but there are basic science studies that have been done, you know, using animal models, showing that animals that are taking in high levels of these artificial sweeteners are more likely to be at risk for diabetes and weight gain.

Dr.  Wendy Slusser  56:54

And what’s the pathophysiology behind that?

Dr. Tannaz Moin  56:56

So, you know, it’s not one that I’m familiar with, but you know, in my own sort of thinking about this, I’ve thought it’s like, you taste sweet, but the sugar isn’t the sugar that your body’s expecting. So maybe there’s some kind of hormonal dysregulation, and that might be happening, but we don’t have human studies. We don’t have large trials that have been done, you know, in adults or obviously not kids that have looked at this. So the data about whether it’s good or not really comes from animal studies. And it’s hard to extrapolate that to humans, but there is some indication that, you know, maybe it’s not a healthier choice.

Dr.  Wendy Slusser  57:36

Right. And do you know anything about, I know, there’s herbs that are considered moderating, like cinnamon?

Dr. Tannaz Moin  57:46

Cinnamon, and actually tumeric is another one.

Dr.  Wendy Slusser  57:49

Sage?

Dr. Tannaz Moin  57:50

Yeah, not my area of expertise. But, you know, I do get patients who ask about this. And I’m always of the thinking that, you know, to try. A lot of these things are sometimes advertised as supplements and so it gets into this sort of gray area. But I think, again, thinking about what we’re consuming and why, is an important thing for all of us to be doing.

Dr.  Wendy Slusser  58:13

Right. And certainly, those particular herbs make things taste better. So that’s important.

Dr. Tannaz Moin  58:19

Right, so cinnamon’s a favorite and tumeric, we use a lot in, I mean, Middle Eastern foods. I think, yeah, try it and, you know, see how it works.

Dr.  Wendy Slusser  58:31

It’s good for your gut health, as far as the data that’s out there. So, to wrap up, I want to leave our listeners with some resources to go to if they’re seeking to improve their health and live a healthier lifestyle. Do you mind sharing some resources, both nationally, and within California? And even here at UCLA?

Dr. Tannaz Moin  58:53

Sure, so I’ll start nationally, I think there’s a lot of really incredible information on the CDC website. And those, again, you can just go Centers for Disease Control and type in “diabetes” or “prediabetes” on Google. And there’s really helpful information about what diabetes is and what prediabetes is, and, you know, even some questions about pathophysiology, but really national statistics, what the trends look like. And then the CDC also has, what we had mentioned, this national registry of DPP programs that are certified. So that would be one of the main sites I would send folks to to get more information about the clinical side, but also some potential resources.

Dr.  Wendy Slusser  59:40

And if you wanted to start a program on your university campus, you could also get information from them about that?

Dr. Tannaz Moin  59:50

Yeah, the standards for delivery. So the metrics that they expect if you’re going to deliver a program and that process, absolutely. And I think the American Medical Association also has a prediabetes STAT, which stands for a Screen Test Act Today site. And that also has patient-facing materials, it has provider-facing materials that are helpful for thinking about how to screen, who to screen. You know, it’s geared at both providers and healthcare organizations. So that’s a great resource. And locally, so obviously, we’re so proud to have our local campus, UCLA-based Diabetes Prevention Program, which is open.

Dr.  Wendy Slusser  59:55

One of the firsts, right, on a university campus.

Dr. Tannaz Moin  1:00:37

Yeah, which we’re really proud of, and it’s offered through Campus Recreation. And in addition to the Diabetes Prevention Program, our campus offers other classes and group-based weight management programs and things that folks would probably be interested to learn about. And that program, our UCLA DPP program, is now a model for the other UC campuses. So if someone’s listening, and they’re on another UC campus, there should be a DPP even closer to home that they can reach out to. So yeah, lots

Dr.  Wendy Slusser  1:01:12

Campus staff are able to use that for free. And here at UCLA, students as well.

Dr. Tannaz Moin  1:01:18

Yeah, absolutely. So it’s a program that would normally cost around six, seven, maybe, you know, $100. But it’s offered free for faculty and staff and students on the campus. That’s a huge benefit. Yeah. And hopefully more people learn about it. We do have waitlists. So I mean, we’re, again, very excited about the program.

Dr.  Wendy Slusser  1:01:18

Oh, we have waitlists now? Oh my goodness.

Dr. Tannaz Moin  1:01:43

Yeah, we have waitlists. So, we don’t want to turn anyone away. But you know, we are trying to accommodate.

Dr.  Wendy Slusser  1:01:51

We want to keep it at 20 participants.

Dr. Tannaz Moin  1:01:53

The smaller group, yeah, because you’ll get more out of the program in a smaller group. So yeah, we’re really excited about our campus leading the charge here.

Dr.  Wendy Slusser  1:02:04

Well, so we’ll end this with some questions. I haven’t covered anything. But also I’d love to know, like, what’s your home kitchen look like?

Dr. Tannaz Moin  1:02:12

Oh, well right now we’re in temporary housing, but my home kitchen is relatively small. But it often includes the kids and I cooking together, we sort of tend to do that as a family.

Dr.  Wendy Slusser  1:02:28

And how old are your kiddos?

Dr. Tannaz Moin  1:02:29

So I have a six and an eight year old, so they’re kind of stove-safe at this point. They  want to help. But you know, we’re really trying to do balanced meals at home. But you know, that can be challenging sometimes after school, and it’s a rush.

Dr.  Wendy Slusser  1:02:46

How do you overcome that challenge?

Dr. Tannaz Moin  1:02:50

Yeah, so some days are better than others, but, you know, even if it means, we’re rushed, even if it means taking some vegetables and doing a steam quickly and sort of having them on the side. We’re trying and I have help at home so that really does make it easier. The other thing I’m trying to do is, and this is a personal thing, less frozen stuff. We tend to like freeze everything. And I know in Europe, the refrigerators are smaller, and you’re trying to eat fresher, but that’s also challenging, so something we’re working on.

Dr.  Wendy Slusser  1:03:27

Well, frozen vegetables are considered to be almost even more nutritious.

Dr. Tannaz Moin  1:03:32

Absolutely. And I have a whole stockpile of them for sure. But yeah, trying to think about all of us. But no juice, you won’t find any juice in my house.

Dr.  Wendy Slusser  1:03:41

So making a healthy choice, the easy choice, right? And the less healthy choice the not-so-easy choice.

Dr. Tannaz Moin  1:03:47

Yeah. And that’s the way I sort of grew up too, you know. I don’t remember soda. I don’t remember chips, you know, in my household.

Dr.  Wendy Slusser  1:03:57

And you don’t make them forbidden foods. If they’re at someone else’s house, it’s not like oh, they can’t do that. Yeah. Yeah, that’s always the hitch in certain circumstances. It’s no question. Was there anything that we haven’t covered that you’d like to share?

Dr. Tannaz Moin  1:04:04

Yeah. And it’s not like, I mean, we definitely have our days when we will eat out. We have our days where things aren’t as ideal as I’d like them to be. But, you know, I think one thing is this hunger cue. And that’s something culturally for us and for my family. It’s always about like, finish your plate, you didn’t eat it. And you know, so that’s something we’re really trying to work on at home so that when you feel full, it’s okay to be excused. You don’t have to keep eating for the sake of eating. So that is something we’re trying to work on, with the grandparents especially. No, just thank you so much for this opportunity. Thank you for your leadership on the campus. I don’t think any of this, what we’ve accomplished with the UCLA DPP program, and a lot of other really exciting things that are happening on campus, would have been possible without you, Wendy.

Dr.  Wendy Slusser  1:05:05

Well, thanks Tannaz, we’ll stay tuned. We’re going to do more, onwards and upwards.

Dr. Tannaz Moin  1:05:10

Thank you.

Dr.  Wendy Slusser  1:05:11

Thank you so much. Thanks for your valuable time.

Dr. Tannaz Moin  1:05:14

Thanks so much.

Dr.  Wendy Slusser  1:05:14

On all of this work that you do. Thank you so much for tuning into Live Well. Today’s podcast was brought to you by UCLA Semel Healthy Campus Initiative Center. During these extraordinary times of the COVID-19 pandemic, UCLA’s Diabetes Prevention Program has transitioned online, and demonstrated that it is possible to create a strong sense of community virtually. Many participants have shared that this program has enhanced their current life in providing a strong social support network. We’re learning how to stay connected during this new normal and invite you to learn more about how you can become involved in the Diabetes Prevention Program. For more information on Dr. Tannaz Moin, and the DPP, please visit our website at healthy.ucla.edu/livewellpodcasts.

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Dr.  Wendy Slusser  00:03

What is the food print? And how does our diet impact our planet? In this second part of a two-part episode, UCLA Public Health doctoral student Hannah Malan shares her current research involving sustainable diets and Impossible meat. Keep listening to learn about how we can feed our planet sustainably and equitably. And how UCLA students reacted to Impossible meat. And what does nudge theory have to do with it? Okay, so explain to me and the audience, your project, your PhD.

Dr. Hannah Malan  00:41

Sure. Okay, this is fun. So I guess I’ll go back a little bit and talk first about how I was even exposed to the topic I’m working on, which is thinking about our food print. So in 2016, for Food Day, when I was working with Semel Healthy Campus Initiative, again, this is you know, working, collaborating with folks who are already doing things and expanding that work. But Professor Amy Rowat, who co-leads the Eat Well pod and Professor Jenny Jay, were talking about this idea of a food print. And when I say that I’m referring to the carbon footprint of food, that’s how we’re using the term. And so the carbon footprint of food includes everything in the life cycle of producing that food. So this includes the growing, harvesting, processing, and distributing of food all around the world. And so each step involves using resources and emitting greenhouse gases. So the carbon footprint of food. People often think of transportation and packaging as a big part of it but a large share actually comes in changes in land use. So cutting down natural ecosystems, forests, which are natural carbon sinks, and replacing that with often livestock, which are producing large amounts of greenhouse gases. So cows, I think many of us know now, produce methane, mostly through their burps.

Dr.  Wendy Slusser  00:48

And people think it’s the other end, right?

Dr. Hannah Malan  02:12

That, too, is part of it. Yeah, but…

Dr.  Wendy Slusser  02:15

The burps are more.

Dr. Hannah Malan  02:16

The burps are more. So the growing of the livestock, too, when they’re alive. But animal foods in general tend to have higher carbon footprints than plant-based foods, not just because of the emissions they produce by burping or other things, but also when you think about the feed efficiency conversion. So if you grow food and eat it directly, it’s a lot less resource intensive than growing food to feed animals. So that step in the process right there, compounds the environmental effects. The evidence demonstrates very clearly that plant-based foods have a much lower carbon footprint than animal based foods.

Dr.  Wendy Slusser  02:56

Yeah, I mean, I was reminiscing with you earlier, about 12 bushels of grain is equivalent to one pound of red meat.

Dr. Hannah Malan  03:04

Yeah.

Dr.  Wendy Slusser  03:04

I’m sure that equates, I learned that in college 40 years ago.

Dr. Hannah Malan  03:08

Right, and the data just keep getting more accurate and better. So if we think about moving a little bit down the food chain, a serving of beef has about five times the carbon footprint as the serving of chicken. But a serving of beef has 34 times the carbon footprint as a serving of beans or lentils.

Dr.  Wendy Slusser  03:27

Geez, that’s incredible.

Dr. Hannah Malan  03:29

Yeah, it really makes you think.

Dr.  Wendy Slusser  03:30

And also we know distribution is an issue, but just in terms of the impact on, the stress to the planet.

Dr. Hannah Malan  03:38

To the planet. Yeah, I mean, for me, learning about lifecycle analyses of food, and really quantifying environmental impacts this way has actually been really eye opening and empowering because it really reveals that you don’t have to participate in this elite food economy to make a difference. You don’t have to be shopping at Whole Foods and buying specialty green juices and you know, all organic and pasture-raised and all of that to make an impact. The data really demonstrate that the ingredients you choose matter more than the production techniques. So there are many other reasons to buy organic, buy local, to support your local economy and farmers, and support a food system or practices that you support. But if you think about it on the large scale and you really choose to shop and eat by the numbers, ingredients are the most important things you can do.

Dr.  Wendy Slusser  04:38

You mean by ingredients, meaning choosing the red meat versus the chicken or the beans.

Dr. Hannah Malan  04:44

Exactly, so whether you’re eating at McDonald’s on campus or preparing your food at home, choosing a lower impact option like a fish fillet or a chicken over a beef, choosing to do a bean burrito with veggies rather than a beef burrito. That makes a huge impact and a greater impact than choosing organic or something like that. So a planetary health diet is quite accessible in that way.

Dr.  Wendy Slusser  05:14

As a communicator, you know, educated by that wonderful institution, UC Santa Barbara, and your research in the focus groups of people wanting to see infographics, you developed something, right, that could help tell people this.

Dr. Hannah Malan  05:31

So another part of the qualitative research, an outcome of that was understanding how students learn. And we know at a place like UC Santa Barbara, too, but UCLA students have amazing access to academic courses. But two things that really emerged for me regarding food literacy were this experiential learning in the dining halls. So the food environment as a learning tool, and also using visuals, infographics, and really comparative information to help students understand the relative impacts of what they’re doing. So what we’re doing in my PhD work is informed by science that helps us understand how to capture people’s attention, how to translate information in a way that is intuitive and makes sense to people. So sort of two fields of research that I’ve been drawing upon are social marketing and nudge theory. So social marketing is really this theory of traditional marketing, but marketing socially beneficial behaviors and products, but connecting behaviors with desirable outcomes or things that people want. So if you think about Coca-Cola, they’re selling the idea of happiness or engagement. They’re not selling the idea of a product, maybe sometimes they are, but it’s more than that. So this exchange theory, which is often how we explain what’s happening, is we’re aligning a product or a behavior with an outcome that people want. So for my dissertation work, rather than discussing health or some other outcome like that, we’re really aligning the behavior change with fighting climate change. So we know that something that’s important to students, and this is important, I think, for public health practitioners to keep in mind is that not everybody makes decisions based on health. And I think when you work in public health for a while, you kind of forget that it’s not people’s priority. And so this culture of health becomes especially important, but also aligning healthy behaviors with outcomes that are aspirational, and are attractive to people. So for students, climate change is an issue that’s top of mind. It’s very timely, it’s important, feels good to participate in, not the changing of the climate but the mitigation of climate change. So we identified that as something to align our campaign with. At the same time using the principles, as I mentioned, from nudge theory, which is all about structuring choices in a way that makes the healthy choice the easy choice, or facilitates a socially desirable outcome. So this can be making a menu item stand out more on a menu, or using intuitive stoplight colors to help people understand the relative impacts of things rather than giving numbers. So we wouldn’t put calories on a menu because, and the evidence supports this too, people don’t really have a good sense of what that means. People aren’t paying attention to that type of thing. Only the nutrition elite, so folks who are highly educated and concerned about their weight, are likely to interpret those in a productive way. So it’s really thinking about how do we communicate ideas in a way that can capture people’s attention that can not require or put too much burden on them to process the message. So again, it’s making the healthy choice the easy choice. We’re exposed to so many messages and so much information. So thinking about how to present options or information in ways that that resonate, or that stick with people beyond that moment.

Dr.  Wendy Slusser  09:16

And then also on our campus, we don’t want to put calories up because we don’t want to, you know, focus on weight or stigma.

Dr. Hannah Malan  09:23

Right, absolutely. Yeah, I think that’s a big one and something I feel strongly about in my work too, is that it’s not about weight. It’s not about appearance, it’s about eating in a way that fuels your body for health and well-being in the long term, and eating in a way that supports the planet, that is enjoyable for you, that makes you feel good about what you’re doing, that you can optimize your life as a student, all of those things.

Dr.  Wendy Slusser  09:51

You have a great logo, what’s the logo that you used for your promotion?

Dr. Hannah Malan  09:54

So our slogan is “swap the meat, save the planet.” Yeah. So we’re really focusing on on the positive outcomes of behavior and not taking any options away. The project with Dining that I’m studying for my dissertation is introducing the new Impossible plant-based meat at one of their most popular to-go restaurants on the Hill. So the location was chosen based on its popularity with students. Students love this location and the quantity of meat that they sell. So they serve high amount of red meat, large quantities, I mean UCLA Dining does 6 million meals a year, and so this restaurant alone is doing hundreds of thousands of covers a year. And meat was the majority of entrees they were selling, with beef making up about 30% of the items, so it was a huge target and a really ambitious project to try to see what could we introduce to move the needle, as they like to say. So I think many folks have heard about Impossible meat but it’s a plant-based meat alternative. It’s scientifically engineered to taste like meat, to mimic the texture and some of those sensory qualities that people love about meat, the way it cooks and sizzles, it has heme iron in it which is intended to give it that meaty flavor, and it’s intended to be satisfying like meat. So in many ways to give people the experience of eating meat that we’ve come to know and love in American culture, so really a product that can help this shift towards lower meat diets. So in addition to introducing this product, we ran the social marketing campaign which was all framed around climate change, the “swap the meat, save the planet,” and some of these educational materials that are informed by the nudge techniques I mentioned, so providing students with intuitive stoplight-colored graphs that show the relative impacts of foods using icons.

Dr.  Wendy Slusser  12:05

On health, or I mean rather, on planet health.

Dr. Hannah Malan  12:08

On carbon footprint, yeah. So everything was about climate change and the carbon footprint of different foods.

Dr.  Wendy Slusser  12:15

And so tell us what you’re finding.

Dr. Hannah Malan  12:17

Sure, so this has been such an exciting project because it’s such a new area of research. And we keep hearing that these products are so popular and people love them and I really commend Impossible for their mission and to introduce a product that can compete with beef but the results are a little bit more nuanced than that. So the most surprising result that we saw was while animal based protein consumption did decrease, we also saw that Impossible cannibalized some of the other vegetarian options. So this is great for a company like Impossible, but we need to look a little bit more closely what that means for nutrition and health, and what that means for overall reductions in animal-based protein and carbon footprint. So unfortunately what it’s looking like at this point, just looking at comparisons from this fall to last fall, so this fall when we introduced the product compared to last fall, we saw that beef consumption only decreased about 2%. So it’s a small percentage but on scale it amounts to a large number of portions of beef so I’ll be crunching those numbers to calculate the carbon footprint savings. What surprised me and I think surprised the dining directors was that we saw more of a decrease in the medium-impact category foods, so poultry and cheese and pork, rather than in the highest-impact category which was beef. So while we did see increases overall in low carbon footprint items, which included Impossible, we didn’t see beef decrease as much as I had hoped. And then again, these shifts from folks who are choosing other vegetarian options to choosing Impossible, to me that’s an unintended consequence and something that we need to look at more closely and discuss.

Dr.  Wendy Slusser  14:17

And see whether was that consistent or was it just one time. Did the vegetarians continue to go back to Impossible, or were they just trying it because it’s a novelty?

Dr. Hannah Malan  14:26

Well, this is looking at data from the entire quarter. And this is looking at proportions of meals sold over the entire quarter so I was anticipating that, that maybe in the first few weeks we saw a lot of students come over and try it and then it dropped off. But it looked like Impossible actually continued to gain popularity throughout the quarter, so part of what I’m thinking is that students who maybe weren’t eating at this restaurant before started coming there because we saw an increase in covers as well.

Dr.  Wendy Slusser  15:02

Oh, you did.

Dr. Hannah Malan  15:02

So we have to look more closely at all the dynamics because there are more students living on the Hill this year than there were last year. And this is also a challenge of doing food environment research, is you have to think, did the clientele change? Or did the people who were eating here change their behavior? And that’s a really challenging question to understand. Because if we’re just having people come eat this food, who would have been eating vegetarian elsewhere, we’re not really having the intended impact. So folks who were eating beef are still eating beef, but other new people are coming to eat Impossible. We’re not really meeting the mission. But as I said, we did see decreases overall in animal-based protein, so about a 7% drop in animal-based protein sales, which at scale is huge.  That is huge.  That’s huge, yeah.

Dr.  Wendy Slusser  15:55

And what you’ve taught me about vegetarianism is that the cheese is a big impact on the environment.

Dr. Hannah Malan  16:02

Yeah, sorry to be a Debbie Downer on this one to all the cheese lovers out here, including myself, but it’s one of the shocking things to see is, yeah, so cheese has a higher carbon footprint than chicken. But that’s looking at it by weight. So you wouldn’t usually eat a 4-ounce serving of cheese. We found that actually, on the Hill, quite a few items do, like quesadillas, personal pizzas. So those very cheesy items can have up to 4 ounces of cheese. But again, and I think this is important for us to think about in general and I really want to emphasize this message, is that eating a planetary health diet doesn’t mean you have to become vegan. It doesn’t mean that you have to cut out all the food you love. And I think this moderation is important and conscious awareness is important. And just simply by reducing the frequency and the quantity of high-impact foods really makes a difference and the data support that that’s a viable strategy for staying within our planetary boundaries as well.

Dr.  Wendy Slusser  17:11

Yeah, I mean, I heard like if we all kicked out one serving a week, in the United States, of high-impact foods, which means red meat, like hamburgers and lamb, right? Just once a week, if you ate one less serving a week, we would meet the Paris agreement by 30%?

Dr. Hannah Malan  17:32

Yeah, we would get 30% of the way there. So just reducing one serving a week, that’s awesome.

Dr.  Wendy Slusser  17:39

And the average consumption in the United States currently is six times a week. That’s what I’ve heard.

Dr. Hannah Malan  17:45

Yeah, yeah. So it’s about 2.7 ounces a day, which is a little less than a serving. So that makes sense. Yeah, and just when we’re talking about reducing, I think it’s important to remember when you’re creating your meal that most Americans are eating far more protein than we need to be eating. So when you’re creating a meal, of course, you want to get enough protein to meet your needs and to help you feel full. But that doesn’t need to be your main goal every time you’re creating a plate. Most foods have protein in them. So even a bowl of oatmeal is going to give you protein. And throughout the day, if you’re eating a lunch of vegetables and grains, that’s going to be satisfying to tie you over.

Dr.  Wendy Slusser  18:29

So what I’m hearing you say, Hannah, is that we can reassure people that generally in the United States, our protein intake is actually well over the recommended daily recommendation. And that by having a planetary health diet, which would include no more than one serving, 4-ounces of a red meat, bovine meat, which is a cow meat or lamb meat, that you could spread over the week if you want, but no more than that a week. And then having protein in your diet every day is recommended. But it can come from plant-based proteins, like lentils, black beans, and that other animal-based proteins don’t have to be eaten every day to get your recommended daily amount of protein.

Dr. Hannah Malan  19:20

Right. And if you think about it on a population level, I mean, there are entire cultures of vegetarian eaters who consume no animal meat. And if we look at dietary patterns and health outcomes over time, vegetarians tend to do better than folks who eat a more Western diet. And pescatarian diet tends to be the most helpful for long-term health outcomes. Which is eating fish and plants. So small amounts of meat, in general we can say, and this is on a population level, it’s not to give individual advice about what to eat, but especially among Americans, we are eating too much protein. And so reducing protein overall, and eating more fresh fruits and vegetables and whole grains is a great way to improve your health and make a positive impact on the planet. I feel really, really optimistic for my generation. I mean, I think there’s so much more that we could be doing right now on a policy level. We have so many policy tools in our toolkit to be changing the incentives and the political will just doesn’t seem to be there. But I think it will be. I think our generation is really waking up to these issues. And that’s why I think communication is an important part of it at this point. Where we are in this transition is changing the culture around eating meat, and a university is a great place to start. So I feel really proud of UCLA for being at the forefront of that and for our Dining folks to be interested, as I said, in not only trying this but learning what happens when we do it too, being open and transparent with their data and sharing that with others. So I think this is how we all move forward, is trying new things, seeing what works. As I mentioned, I think Silicon Valley is amazing at coming up with quick solutions and being innovative and creating technologies that solve problems, but we do have to be honest about unintended consequences. And, you know, my dad used a phrase recently that really resonated with me, which is regretable substitution. And I’ve been thinking about that a lot with plant-based meat. And, you know, we don’t want to be creating new problems while we’re solving others.

Dr.  Wendy Slusser  21:43

Right. I mean, there’s that real challenge that you discovered as you were doing your plan with the Impossible Burger’s health versus planet health, individual health versus planet.

Dr. Hannah Malan  21:57

Absolutely. So Impossible meat is an ultra-processed product. It’s high in sodium and saturated fat. It has heme iron, which has some questionable linkage to colon cancer, and which regular meat has as well. So yeah, it’s possible that heme iron is one of the mechanisms by which red meat is detrimental to health. So there are still many questions about why red meat is associated with increased risk of diabetes and heart disease, and colon cancer, as I mentioned. We know over long-term studies that we see those patterns. But yeah, with Impossible meat, it’s hard to know right now. Like when my friends ask me, well, is eating Impossible meat better than eating red meat? And I say for your health, we don’t know. For the planet, absolutely. And so it’s been really valuable for me to work with the dietician on campus as we’re rolling all of this out, and to also be transparent about that as well. So all the nutrition facts for UCLA’s recipes are available online for students to see. This product is not being promoted as a healthy option. And we still have more questions than answers about the health implications of eating products like this. So, one of my hopes is that this research encourages others to do more studies, controlled feeding studies, or more long-term studies about the implications of eating processed meat alternatives.

Dr.  Wendy Slusser  23:34

Yeah. And one of the things that struck me when you described your study, that you said also is in the literature about how health messaging actually makes people find food not as tasty?

Dr. Hannah Malan  23:50

Yeah, so this is a really interesting field of research. Folks at Stanford and involved in the Menus of Change research group have have done quite a bit of work on this and I’m doing another experiment right now that’s finding similar results. But the way we describe food influences how people perceive it, how they anticipate their enjoyment of the food, whether they choose it, and how much they enjoy it. So it’s important and it’s looking like introducing the word “healthy” into the equation may reduce people’s enjoyment of the food and make them less likely to choose it. So health can have a negative connotation even though most people will tell you, eating healthy is important to me, I’m trying to eat healthfully. There are so many different priorities and values or so many different goals, I guess, we’re managing when we make a food choice, right? Especially for students. Is this gonna fill me up? Is going to get me through the next six hours of my day, or maybe the rest of the day if I can’t afford to eat another meal? Is this is going to be tasty? Is this going to nourish me and make me, you know, do well in class? Is this going to be something that is going to make me feel good? So we’re all doing, you know, every time we make food decisions, even though it’s a habitual behavior that we do multiple times a day, we’re managing these various goals. So health is one part of it, but can easily be trumped by other goals. We tend to prioritize short-term goals over long-term goals, right? So, often people will think of health as a sort of delayed goal or long-term goal, especially for young people. So emphasizing things like feeling good, or having a positive impact on something like the environment, which is quantifiable or immediate. Those things can be more impactful. So, yeah, I guess a message about messaging would be, don’t emphasize the healthiness of the food, emphasize other attractive attributes, which can include things like environmental benefit, which what I have seen does not detract from people’s enjoyment of food, and may actually bolster it.

Dr.  Wendy Slusser  26:10

It was really interesting, because what you’re describing, the word health in general is so interpreted by the individual. And I’m thinking, you know, our transportation director, as you know, Rene Fortier has used what she refers to as the health message, but it’s not really the health message. She refers to the fact that she was able to reduce single-occupancy car driving to the campus, commuting, significantly by sending out the message that you’ll lose 10 pounds in a year if you switch to active transport. Now, she didn’t say you’d be healthier, she said you’d lose. There was like a direct impact, sort of similar to what you’re describing about the planet health. So you’re driving people to health, like being more alert, but you’re not saying you’re healthier, but you’re going to be more alert, which is healthier. Yeah. That’s the outcome of good health.

Dr. Hannah Malan  27:05

Right, absolutely. I think short-term benefits are really important to communicate. Aspirational desires are important to communicate. Quantifiable outcomes, like you mentioned, with the 10 pounds, or an environmental impact is quantifiable. So we’re able to show the reduction in carbon footprint in that swap, right, a reduced relative risk of X percent over 20 years, you know, of heart disease is really hard to communicate to someone.

Dr.  Wendy Slusser  27:36

So abstract. Yeah.

Dr. Hannah Malan  27:36

So I think as communicators, we need to keep these things in mind and keep learning from the marketers who have been really good at selling stuff for a long time.

Dr.  Wendy Slusser  27:47

That’s for sure. Well that’s what you’ve done. You’re merging public health with one of your advisors from the Anderson School of Business here at UCLA. So you’re combining the two sciences, really.

Dr. Hannah Malan  28:00

Right. And I love working with her, because we think about food in such a different way, we think about human behavior in such a different way. And I think she’s a good reality check for me, too, when I’m imagining that everyone’s going through their day, you know, making food decisions a certain way. So again, that’s a good example of food being this topic that is so interdisciplinary and brings people together.

Dr.  Wendy Slusser  28:26

So you know, you started out this conversation describing how you really were raised defining your success by helping others. And so far already with your research with the focus groups you have by identifying a priority of our student body here at UCLA. And now we have a teaching kitchen. And that should make you feel good. It makes me feel good knowing that that happened. And I’m thinking that some of the pearls of of what an individual can do to help planet health and at the same time, your own personal health, were some of the following that I picked up from you, was 1) you don’t have to completely go vegetarian or vegan, you can just minimize your bovine meat-eating which would be red meat and lamb, I guess.

Dr. Hannah Malan  29:18

Yeah, ruminant meat. So, beef and lamb. And not only reducing that but really making an effort to replace that with nutritious whole foods. So plant-based proteins are a great way to do that, so lentils or black beans. Get creative with beans is an awesome way to do it. I mean, even doing a peanut butter and jelly sandwich is a really inexpensive and great way to eat a low carbon footprint meal. Rice and beans with guacamole, getting creative with veggie tacos and beans or lentils.

Dr.  Wendy Slusser  29:53

And your goal will be one a week of the red meat, if that.

Dr. Hannah Malan  30:00

If you can get to one serving a week of red meat, you are golden.

Dr.  Wendy Slusser  30:04

That will help all of us.

Dr. Hannah Malan  30:05

That will help all of us. And really, you’ll participate in this transition, which is not just changing your own behavior. But we have to remember that in capitalism, when you buy something, you’re voting. So you’re voting with your fork, you’re signaling to food companies what you want. And that’s really, really powerful. You need to vote on Election Day, always. But you have a lot of power as a consumer. And I hope that’s something that students realize, that Dining responds to what they want and what they’re choosing. And this will continue throughout your life as a consumer.

Dr.  Wendy Slusser  30:41

That’s very good advice for everyone. And one other piece, which you mentioned, the Menus for Change Research Collaborative that looked into, for instance, a burger being mixed with mushrooms. So perhaps even for those that really want to have two meals a week have some sort of burger-tasting meal, could just mix half their portion of burger one day with some mushroom and the other…?

Dr. Hannah Malan  31:09

I love this. You can, seriously, there are so many ways to do this. When I say eat it once a week, this is your 4-ounce portion that you get. So split that over four days and have a small amount mixed into a stir fry or, you know, blend the meat with something else. Yeah, find at UCLA, you can get the blended burger, which is beef blended with vegetables, to reduce the portion size. So we when we talk about how much you’re eating, it’s not only frequency, but it’s portion size. So, yeah, I think that’s another great way to think about it, is cutting your portion and having it twice a week instead of once.

Dr.  Wendy Slusser  31:50

Right. And that’s sort of the flip.

Dr. Hannah Malan  31:53

That’s the protein flip. Yeah, use meat as a condiment and a flavoring agent.

Dr.  Wendy Slusser  31:58

And we’re talking red meat, right? So people can still have their chicken and others. So practically speaking, 4 ounces of red meat a week is really what your aspirational goal should be if you want to really make a difference on Planet Earth and also for your own personal health.

Dr. Hannah Malan  32:19

Absolutely.

Dr.  Wendy Slusser  32:20

So, thank you so much. Is there anything else you’d like to add before we wrap this up?

Dr. Hannah Malan  32:26

No, I think just a thank you to you, Wendy, for being one of those mentors for me who made it possible to be here and for so many students you do that for, so.

Dr.  Wendy Slusser  32:40

Well, having having students like you as part of the family is really, you know, speaking of defining your success by helping others, that’s, like, a really great way to live and I’m really glad that to see you move forward and I can’t wait to see what you do next. You’ve forever happily surprised me.

Dr. Hannah Malan  33:03

Thank you.

Dr.  Wendy Slusser  33:03

Thanks so much.  Thank you for tuning into UCLA Live Well. For more information about today’s episode and the resources mentioned, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA Live Well on Apple Podcasts, Spotify, or wherever you listen to podcasts. Get to know us a little better and follow us @healthyucla. If you think you know the perfect person for us to interview next, tweet your idea to us, please. Have a wonderful rest of your day and we hope you join us for our next episode as we explore new perspectives on health and well-being.

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Transcript

Dr.  Wendy Slusser  00:03

When the COVID-19 pandemic broke out in the United States, the existing inequities and vulnerabilities of our food systems were starkly exposed. Join me as I chat with co-founder and chair of the Center for Good Food Purchasing, Paula Daniels, about how we can meet this moment to make transformative progress in our food systems. Paula, this is just such a pleasure to talk with you on our Live Well podcast. I’ve been waiting for the day to be able to interview you formally on this podcast.

Paula Daniels  00:37

The pleasure’s mine.

Dr.  Wendy Slusser  00:38

Oh, thanks. And we’re going to be talking about two very important reports that came out in the last month. One is the “Springboard for Equitable Recovery and Resilience in Communities across America” that you helped write. And then the Rockefeller Foundation report that you contributed to titled “Reset the Table: Meeting the Moment to Transform the U.S. Food System.” We’re going to talk about both of them, because it seems to me that in the area of food, and food security, and food systems, they have a lot of similar messaging, although the Rockefeller report, as we all know, is more focused on food. But I’d love to discuss with you, first of all, what was the impetus of both of these reports?

Paula Daniels  01:21

Yeah, well, both of the organizations that did these reports were very alarmed by what they were seeing happening in the food system, but you know, the long lines of people needing to get food. And then at the same time, you have that paradox this, you know, complete conflict and almost dissonance that you had a number of farmers that had food, but that weren’t able to get to the places of need. So it revealed a lot about the food system that a number of organizations were trying to draw some lessons from and to move forward and to think about how we can make changes so that this sort of thing doesn’t happen again. And for both, I mean, going through this effort, I think so many of us saw this, as well as all the other places that did news reporting. But the connecting-the-dots part that was very important through these processes of preparing the report for “Springboard” as well as Rockefeller was that these problems in the food system predated the COVID pandemic, and predated what was revealed. Because of the pandemic, the fissures in the food system, the fault lines became the earthquake that shook everything wide open, but these fault lines were already there. So many of the people who are working in the food system saw that this is what they had forewarned about the need to have a more resilient food system and the need to have more value-based relationships built into the food system. So these organizations embarked on an exploration of that. So the “Springboard” report which was done by the Well Being Trust, which is a mental health organization that’s affiliated with Providence Saint John’s, they combined with the CDC, the Center for Disease Control, and they did a paper on all the areas that have been impacted in this time. The economy, housing, governance, and food was one aspect of it, and which I did write that section. The Rockefeller Foundation had been making its entry into the United States. They’ve mostly been funding food issues on a global basis but started their U.S. initiative just last year. And so they had been examining how to engage with the U.S. food system, but also felt quite responsible once this crisis hit us and all these issues were revealed, to start trying to pull some initiatives and make some sense out of it. So for the Rockefeller Foundation, I helped facilitate two roundtables, they had quite a few roundtables. All told, they spoke with over 100 individuals from a select list representing every aspect of the food system, and in a diverse way as well, to get input. And that resulted in the paper called “Reset the Table,” which has a number of key recommendations.

Dr.  Wendy Slusser  03:56

So you talk about the food system and its fragility even before the pandemic. So in other words, they really weren’t prepared for this kind of a stress. That’s what you’re describing. So tell me, what makes you make that comment? What are you basing that on?

Paula Daniels  04:12

Well, the food system leading up to the pandemic was one that already was suffering from being fractured along these silos of production, distribution, and access. And there’s a lot of work that’s been happening in the last 10 or more years, some of which I’ve been a part of, to try to look at the food system in a more holistic way. It’s basically an economic system and has thrived in the last many decades based on economic incentives and disincentives that have been set into place by our federal government, largely to support lots of export and that’s the 20th century model. The Cold War imperative that came out of you know, post-World War 2 to compete with Russia and out-grain Russia, just you know, grow more grains, grow more of five key products in order to compete on the world stage. So that was how our system was built. But what that did was it left a lot of people out on the margin. It started shrinking out small business owners. So the consolidation into large companies, because of this competition, lends itself to kind of singular economic and linear approach to food system. Grow, distribute, eat. Grow, export, distribute, eat, it was just very linear. But what was lost in there was the aspect of health and also the aspect of supporting a smaller economy. And that’s been a problem for decades now. And that has been known for decades. And that’s why we formed the L.A. Food Policy Council in Los Angeles, this is trying to address those problems. Well, with the COVID system, just completely shaking up and disrupting and breaking the supply chain lines that moved on existing commercial relationships. That’s what broke, it revealed itself to be quite complex, but also quite fragile once it was shut down. So it’s like a spider web that you just break apart. And then the spider has to re-weave its connections. So the fact that there was a lack of connection, or a lack of a robust connection to the local food economy, to the communities that had need, is what was revealed. So a good example is with chicken, because we know that the chicken supply was disrupted because of a COVID outbreak in the meat processing plants. So that’s been on the march toward high consolidation since the beginning of the 20th century. And there are only now a few, there’s one main chicken supplier in the United States. It’s Tyson’s. There’s a handful of meat suppliers in the world. There’s six multinational companies that control all the meat supply, that means chicken and beef. So they have it consolidated into these very well-prescribed contractual relationships that are geared toward economics. But it’s not geared toward health. And it’s not geared toward serving certain communities. So all those relationships were disrupted, and the relationships where there was more of a direct connection to community are the ones that did thrive. So the farmer’s markets, the CSAs, meaning the direct sales where a farmer had a direct relationship with a restaurant or with a consumer already, those types of relationships went through the roof in terms of really supplying need. And they really showed how important it was to have a community relationship versus a purely commercial relationship, if that makes sense.

Dr.  Wendy Slusser  07:20

Yeah, it does. That last example makes a lot of sense. So let me understand the example about the chicken. So you’re saying because of the COVID outbreaks in the chicken centralized growing or processing site, that is what disrupted the distribution to the communities around the country.

Paula Daniels  07:40

Well, so because chicken is consolidated into the hands of six multinational companies, they’ve started consolidating to create economies of scale into a few processing plants. So for economies of scale, the more efficiencies you have in the system, the better, that’s what they always work towards. So efficiency means high production, it means less people, if they can manage it, like less labor to pay, like highly automating things so it’s cheap, and they can get as much profit as possible, right? That’s the business imperative. So meat processing has been consolidated into 15 meat processing plants, and there were very few that were local. So when there was a COVID outbreak in the meatpacking plants and they had to shut it down, that disrupted the meat supply chain, which is why they then went to the federal government and asked for an emergency declaration that this needed to keep working. But that’s to keep that existing model going. If you had local meat processing, some of the more local producers, so maybe some of the free-range chicken producer, some of the heritage poultry producers, some of the grass-fed-and-finished beef producers, might have had somewhere to send their meats for processing and that could have still supplied the local communities. In fact, there are places where there are local abbatoirs, like places that do process their own meat, and that send it to local communities. So those are the relationships that are more robust if they’re already geared towards supporting local economies and supporting local communities. That’s what we found was still working well.

Dr.  Wendy Slusser  09:05

What you’re describing is a situation where some of the solutions you have been thinking about for probably decades. And now during this time of stress, and there’s an opportunity to make a change and transform us to a more sustainable food system. And I know, in the “Springboard” paper you wrote, you detail how we should transform the U.S. food system. And I know there are three areas that you specifically focused on. One is what you’re just describing now, which is the coordinating for regional change, such as food hubs. And so I’d love to hear from you. What does that mean, you’ve described farmer’s markets and CSAs, which I think a lot of people are familiar with, but I don’t think a lot of people might understand what that means: food hub.

Paula Daniels  09:48

Yeah. So food hubs are an essential part of a local food system. And it’s something that many have been working toward for the last, I would say, 10 to 15 years or so. And food hub can sound, like, vaguely meaning it’s anywhere where you go to get food that’s been collected. So in some ways, some would think of a farmer’s market as a food hub because food’s been aggregated there from smaller farmers. But the way we’re thinking of it, the way it was recommended in these reports, is it’s a business that is intentionally mission-driven to support the regional food economy and to support community health. So it’s intentionally designed to support smaller farmers in the surrounding region, and also to provide healthy food to communities. So typically, the food hub that I’m thinking of and that we recommend here is not a for-profit enterprise. It could be, but part of what I’ve seen in some studies of food hubs, and then some of the information I’ve gathered from firsthand interviews, is that a for-profit enterprise starts needing to continue to make money and sometimes the mission of the enterprise drifts. So they start needing to make value-added foods, they start not being able to give as much time to the small farmer to help them with their food safety needs, whatever it is. So typically, a really successful food hub is either a nonprofit or some other form of business, so that they can devote themselves to the mission. And there’s a very well-known one that started in Pennsylvania called The Common Market. So it’s a nonprofit, and it provides support to the small local farmers in the region, particularly farmers of color. And they provide technical assistance, and they provide marketing assistance, they act as intermediaries for the farmers. And for smaller farmers, it’s a struggle to compete in that larger marketplace. So The Common Market, this food hub, would provide that cushion for them and just be able to aggregate whatever they’re selling, versus having the smaller farmer have to figure out their sales chain, other than through the direct sales of a farmer’s market or a restaurant. But to get to more volume, so you can get to more success, you need to sell to larger institutions. And the food hub can be that intermediary, because large institutions have very efficient ordering processes. So sometimes that doesn’t match with how the farmers growing, or what their capacity is in terms of fitting into that high-volume setting. So the food hub would be that very important intermediary, mission-driven. And the food hub will also make sure that the produce goes to certain communities, so school districts, but also communities of need, they often will work with food banks. So when COVID hit, the food hub Common Market in New York already had a number of relationships with the small farmers and relationships with the school districts and relationships with the food bank. So there wasn’t any disruption, they went directly from serving a certain stream and operating a certain way to, okay, now I know where the need is, and they could move everything to the need. Whereas the very large distributors didn’t have those relationships already. And you can’t make those relationships overnight. And you can’t make them in the middle of an emergency. So those relationship-driven and values-driven nonprofits are the ones that did really well, as well as the others that were more local. So there’s a number of food hubs from around the country that I think we’re hearing some similar success stories from.

Dr.  Wendy Slusser  12:55

It sounds like a really promising proposals. So how do these food hubs that are not-for-profit, how do they sustain themselves?

Paula Daniels  13:02

Yeah, really good question. So right now, a number of them are philanthropically funded. That’s not often a good long-term solution, because philanthropy has funding cycles. So a number of them do also have earned income. So The Common Market is a combination of philanthropic funding as well as earned income. But I believe, and this is one of the recommendations in the “Springboard” report, that this is a place for government support. So we recognized during the COVID crisis, that food is an essential good, and that food workers are essential workers. I mean, it was declared as such, because they’re allowed to continue working, but if we take that idea to a philosophical point, if you’re an essential worker, you’re providing a public service. This is a public good, there should be public investment in this. So it seems like a really good opportunity for local and state government, and particularly local government, to invest in food hubs to create economic development, funding streams and direct their economic development funding towards support of food hubs, so that that can be a more long-term solution and could maintain its viability with some public funding that’s durable. There could also be public finance arrangements. We pass a lot of bonds for water protection for parks and open space for transportation. Can you imagine if we were to pass some sort of a bond that would allow us to support food system infrastructure, so we could have a more robust local and regional food system and create a lot of jobs out of that. We know for a fact that there’s jobs in the food system. So if we were to make sure that they were supporting a more regionally resilient food system, and we could keep those jobs here, instead of some export line somewhere else, we’d really benefit the local food economy.

Dr.  Wendy Slusser  14:44

That’s a lot for me to think about. Because, you know, I remember trying to find, digging in to what resources are out there in terms of how people define food hubs, and like you said, it’s kind of a big umbrella for a lot of different structures like the farmer’s market versus this more Common Market model. Would you be able to direct the listener to a summary of these kinds of options? Or is it really something that is on your to-do list? You’re such a great writer.

Paula Daniels  15:14

Well, thank you. There was a really good report done by a USDA specialist. It’s about food hubs. And his name is James Barham. He did a study on food hubs and did quite a good analysis. And they came out around 2013, I would say.

Dr.  Wendy Slusser  15:31

Yeah, I remember reading that. That actually was the only paper that gave me any clarity, besides talking to you verbally. But I do think that there’s something to be said about the lessons learned that we’re coming out of with COVID in these kind of examples that you have just described in terms of The Common Market in New York. I feel that these kinds of models, would I think, inspire other municipalities, potentially, or local governments, just seeing how it works. So these are really important lessons that we’re all really trying to capture at this time. And I think these two papers that we’re discussing are the beginning, because it’s really sort of this first phase, like, hey, let’s not forget the lessons we’re learning, the hard lessons we’re learning, let’s, you know, be able to at least get something good coming from this real tragedy that we were confronted with today with the pandemic and continue to be. I think the food lines around the food banks and the students at UCLA have just exponentially gone up in terms of foods insecurity, as well, as we know, here in Los Angeles, all these families that have always been living sort of on the edge are now over the edge. So food hubs is one and I think this is interconnected with the next recommendation that you made in your paper for the “Springboard,” which was account for true food costs. What do you mean by that?

Paula Daniels  16:57

Yeah, this recommendation was in both papers, the Rockefeller Foundation as well, is true cost accounting in food. And it’s something to be taken into account by decision makers and buy businesses when they look at food. So what we know now is that our food is very cheap, we’re fortunate. It’s still hard for some folks to afford food, but by and large, when we look at it as a percentage of the average person’s budget, we’ve managed to keep food at affordable levels. But the reason it’s affordable is because some of the true costs are not embedded in the food product. And that’s because of government support in the production process and sometimes in other forms, like tax incentives, or other benefits. An example is if you were to look at the cost of, I’ll say, an organic strawberry, or the cost of a hamburger patty at McDonald’s. So a pound of ground beef, if it’s an industrially-produced beef, and it’s not grass-fed, is gonna be about the same as a pound of organic strawberries. Maybe organic strawberries might even be more. I know for sure, it’s the same as a cost of a pound of apples. So why is that? That you have this very large animal that takes up an awful lot of resources, that uses a lot of water, uses a lot of land in order to graze and then be maintained, and then its processing and transport emits an awful lot of greenhouse gas emissions. So why is it that it’s so cheap? It’s because all those consequences of producing the beef are either supported by subsidies, or they’re just not embedded in the cost of the food because of the economic efficiencies and the economies of scale.

Dr.  Wendy Slusser  18:29

Meaning the government. So people that are against government subsidies have to remember that their meat product is subsidized.

Paula Daniels  18:36

Highly subsidized. The water’s subsidized, there’s a lot of tax breaks that are given along the way, there’s a lot of different ways it’s subsidized. The growing of the corn and soy to feed the cows is highly subsidized. That’s where a lot of farm bill payments go. So those costs, those impacts, are called externalities. They’re external to the actual cost that you’re paying. But they’re not embedded in it so they’re not truly accounted for. Take that organic strawberry. It’s not subsidized, and you’re paying more for it, because it’s organic. So organic has a price premium. But what that means is that you’re also paying to not have the ground be polluted and to not have the farmworkers be exposed to one of the more toxic pesticides that strawberries are normally sprayed with, methyl bromide – very toxic. So it’s embedded in the cost of the strawberry when you pay that higher price premium, and it’s not pushed off on to the public. So the public, like the EPA, might have to clean up after some of the toxics that are emitted. That’s a public health consequence. If you’re paying for health care for somebody who’s been impacted by inhaling that methyl bromide, that’s an external cost that’s being borne by the public but not by you when you purchase the strawberry, so it’s embedded in it. Do you see what I mean?

Dr.  Wendy Slusser  19:47

Yeah, let me recap it, because really, in your paper, you do talk about true cost accounting, and I wanted to understand that in more detail. As I understand what you are describing is that there’s a lot of money costs in our food that the consumer doesn’t pay. Well, we end up paying for it indirectly, not directly, indirectly by our taxes that go to the farm bill that subsidize what appears to be many of the foods that you described early on would be part of the competitive commodities that we were focusing on post-World War 2, corn and soy and grain.

Paula Daniels  20:23

Yes, corn, wheat, rice, sugar, soy.

Dr.  Wendy Slusser  20:26

Much of that is exported. Is that correct?

Paula Daniels  20:29

Much of it is exported, yeah.

Dr.  Wendy Slusser  20:31

Okay. So that’s a cost that then goes through our taxes to support those foods that are then sold in the market externally. So we don’t even necessarily benefit from those foods that are subsidized that get exported, in a sense.

Paula Daniels  20:48

Not necessarily, yeah. And sugar is a really good example. So if you were to just take the cost of any sugary beverage, it’s not very expensive, let’s say it’s $1 for a can. But when you have lots of youth drinking lots of sodas every day and then experiencing obesity, as well as diabetes, then you have the public health costs of taking care of those children who had these cardiometabolic disorders. And that’s significant. And that public health costs of caring for the children or whoever else has those impacts is not borne by the cost of the product itself. So those are the negative externalities that we’re talking about, the negative impacts that aren’t in the cost of the food. So taking that into account, so that the idea of true cost accounting is to be aware of them, to assess them, and to make sure that we’re acknowledging that. So that if there’s a food product that has these negative externalities, and sugar is probably one of the best examples, that we’re aware of that. But also, as a decision maker, you can take that into account. A very, you know, blunt instrument for dealing with that is a tax. So when you’ve seen places where there’s been attacks on sugary beverages, and there was an attempt to do that in California in the city of Richmond, and in Mexico. They’ve done it in other places. That’s an attempt to cut level things out and to have the product then bear its true cost, it’s when you put a tax or a fee on it, that’s one way to do it. There’s other ways to do it. But that needs to be acknowledged, is what the impacts are of certain food products.

Dr.  Wendy Slusser  21:40

Well, in addition to the poor health outcomes of drinking sugar-sweetened beverages, which has been shown, two servings of sugar sweetened beverages increase your chances of getting diabetes by 26% and the billions of dollars, it costs in health care industry, or to us, ultimately, and the individual from all the lost work and pain and suffering that isn’t even accounted for. But we saw the cost to our environment. And experts call out that specific non-nutritive food as one of the methods to reduce the impact of our food system on the climate. So I think your point is really well taken in terms of we have to be looking at certain parts of our food system that not only are negative to the individual that we’ve seen with COVID. But overall in the future, I don’t think this is a sustainable step.

Paula Daniels  23:00

Yeah, that’s a really great example of, I mean, because we’re not going to be able to get this done without having corporate, you know, for-profit, nonprofit, university partnerships to solve these big challenges of our time.  Sorry, I just have one other quick example. So there’s a company, Danone, that’s based out of Europe, and they are beginning to do this. They’re beginning to be responsible about true cost accounting, and they are starting to add carbon into their financial balance sheets. They declared that as of last year, and they’re going to start doing it. So they’re being responsible corporate citizens, and and trying to implement true cost accounting in their financial frameworks, so a lot of ways to do it. And government, everybody.

Dr.  Wendy Slusser  23:40

And government. Exactly. And the third area that you cover is leveraging the power of public contracting. So explain to me what that means.

Paula Daniels  23:49

There’s an awful lot of money in food service that we learned about during COVID. We saw how much of a disruption rippled throughout the system. But the food service industry and institutional food is about 120 billion a year, it’s a lot of money. And of that, a large percentage of it is through public institutions. So school districts in particular are the largest food service provider in any given region, because they’re feeding tens of thousands, if not hundreds of thousands of students a day when they’re all in school and in the cafeteria. But we’ve also seen how important they are in terms of rising to meet the moment because they were quite heroic during the COVID crisis and regardless of the consequences to their budget, they just started feeding people. And it did cause a lot of them to lose an awful lot of money. LAUSD I think is in the hole for 30 million or something like that.

Dr.  Wendy Slusser  24:37

And they’re continuing to do that. No questions asked.

Paula Daniels  24:40

That’s right. Yeah, it’s quite heroic.

Dr.  Wendy Slusser  24:42

Largest food program in the country, L.A. Unified School District.

Paula Daniels  24:45

And New York is pretty big too. So New York and LAUSD are the top two so they have hundreds of millions of dollars that they spend so L.A. Unified School District was around $150 million, about 120 of that spent on food per year. So that’s a lot of money that can influence an economic system that we started talking about our food systems largely economic, in response to economic incentives and disincentives, primarily. So using those public purchasing dollars toward helping to build and create market demand, create market viability I should say, for regional food systems is really key. And that’s our theory of change. So we’ve been working with school districts and other municipal institutions to help direct their food purchasing dollars towards supporting local food economies and fair labor and community health. But the more institutions do that in any given region, the more likely you’ll really be able to build some robustness in those relationships that can be more resilient, more regionally resilient. So it can be a really key position, it’s a really key energetic lever toward developing a more regional food system because it creates the market demand for it. So if Mayor was to call for all large institutions serving over a certain threshold, let’s just say, I’m going to give an easy threshold, over 5 million of food purchasing in a year, to set aggregate targets to support the local food economy. Just think of how strong that would be in times of crisis. You’d already have those pipelines built, you’d already have those relationships in place for when there’s any sort of emergency such as in New York, there was Hurricane Sandy before there was COVID, where they had complete disruptions in service. And they’ve invested an awful lot into the local regional food economy there. So if we were to do that here in Los Angeles, if we were to do that in any region, to use aggregate purchasing targets, to say, we’re going to start creating this market relationship with our local food economy, and we’re also going to make sure we’re serving communities of need, and we’re also going to make sure everybody along that supply chain is well paid, then you start building that robust regional food economy. And it doesn’t have to replace the global system 100%. I don’t think that’s realistic, but if we were to get to a strong percent, like a 30% target, like we have with our renewable energy targets, then we’d start making a big difference in terms of supporting our original farming economy.

Dr.  Wendy Slusser  27:00

Okay so what you’re saying, actually, Paula, sounds like two important ingredients to this leveraging the power of public contracting. One is setting up what you’ve done. And I think you’ve been alluding to it, but we haven’t really specifically talked about it yet: your Center for Good Food Purchasing. And you’ve actually outlined what it would take to have something that you’re describing give people a roadmap to get to this kind of ultimate goal, which is really the best for everyone, right, this more regional kinds of food systems, at least some sort of hybrid of industrial and regional. Right now it’s just mostly all industrial. So we really need to have some sort of balance. But also setting goals. So maybe what would be great for us right now is hear a little bit about the history of your Center for Good Food Purchasing, where it started, and then some examples of how it’s really taken off in a significant way.

Paula Daniels  27:54

Sure, yeah. So the Center for Good Food Purchasing is an outgrowth of the Los Angeles Food Policy Council. We founded the L.A. Food Policy Council, oh, the work started back in 2009 with that idea of wanting to celebrate then the 30th anniversary of farmer’s markets by building on the idea. So farmers markets, when they were started in 1989, were intended to provide economic support to small struggling farmers, and then also to get food to low-income communities that didn’t have access to it because there weren’t enough supermarkets because of redlining. There wasn’t enough healthy food in their neighborhoods, just junk food in their neighborhoods. So it was intended to solve that problem. So taking the nub of that idea, the central philosophy of that idea, and saying, how do we then make that be bigger than an occasional Saturday market? How do you make that be a larger idea and have it really start making transformative shifts in this disaggregated system? So we founded the L.A. Food Policy Council and developed a food policy framework having Los Angeles be a leader in that region, which we saw is the 250 mile radius around L.A. So taking into account the 10 county farming regions around L.A. And among the key goals was to develop a procurement policy for large institutions so that we could support the direction of food service providers to buy food that would support the local food economy, as well as support fair labor and community health and environment, for sure. So the Good Food Purchasing Program does have those five values, and it has a rating program for large institutions. It works something like LEED certification works for buildings. In other words, we have the five very clear categories: local economies, environmental sustainability, fair labor, animal welfare, and nutrition. And it’s metric based. So when an institution enrolls in the program, they agree that their purchasing will be directed and rated on how well they’re doing in the five categories. So we get their purchasing information and analyze it. And because we give the direction and give a pathway for the institutions to know how to do it, it does make a difference right away. It might be something they’ve been trying to figure out, how to be environmentally sustainable, but they wanted to support local economies, perhaps, but hadn’t come up with a plan, etc. So we have the plan that we can give them and that they can follow. An example was L.A. Unified School District. So when L.A. Unified School District enrolled in our program, they had been thinking a lot about nutrition and making nutritional improvements. But I think you were part of a program, Wendy, they put salad bars in schools that was tremendously successful. So they’d been thinking about that for a while, but hadn’t focused as much on some of the other aspects. So once they enrolled in our program, they went from less than 10% local sourcing of produce, on average, to then an average of 60% local sourcing of produce. And that directed $12 million into the local food economy just in the first year, and it created 150 new jobs in food processing. So that is one example. Then their vendor, the person who was supplying them with the produce was also inspired by the program to start sourcing local and sustainable wheat for the bread products. And then that also had the ripple effect of then LAUSD looking at its meat contracts. So then they put a requirement that all poultry would have to be raised without the routine use of antibiotics. So those sorts of changes started happening. And LAUSD is now directing even more money into the local food economy, which is sustaining more jobs. So then we expanded after that, it got some national attention. So now we’re the Center for Good Food Purchasing. And we’re now in 20 cities around the country and 53 institutions. So we’re also in New York, and Chicago, and Boston, and DC public schools, and San Francisco, Oakland, Fresno, a lot of different places, and all these places, in aggregate, are making these shifts in the food system. So it’s not actually surprising, then, that we’re learning that the school systems have been a huge safety net, not just during pre-COVID but during COVID. In a way, you’ve actually enhanced that because of the nature of your local system that you’ve helped develop through Good Food Purchasing. That’d be an interesting look at, I mean, looking at the ones that you had the schools committed to your Good Food Purchasing to see how they played out compared to others. Well, yeah, I think that they deserve the credit on their own for being pillars of the community and for being very responsible and very interested in serving the public that they do serve. So they’re all very committed public servants and really want to do a good job by their community, which is why they were interested in our program to begin with.

Dr.  Wendy Slusser  32:23

Yeah, I totally agree. There’s no question. You know, there’s no i in team. So that, you know, I know, the Urban School Food Alliance, you were actively working with them, too, around this commitment to no antibiotics in poultry. And tell me has that impacted the industry itself? Based on that purchasing signal from the school districts in terms of more poultry being offered up with no antibiotic? Have you been able to determine that or…?

Paula Daniels  32:52

I think that a number of the large poultry producers are reformulating their product lines, for sure. And they are moving more toward trying to figure out how to develop poultry products that are raised without the routine use of antibiotics. So the school districts are a big market, and it can have quite a difference.

Dr.  Wendy Slusser  33:09

So in other words, just that one lever of that one purchaser or group of purchasers can really make a difference.

Paula Daniels  33:16

They definitely can.

Dr.  Wendy Slusser  33:17

How do you see the Center for Good Food Purchasing fitting into these recommendations in these two different documents we’re talking about?

Paula Daniels  33:25

Well, we’re happy to support all of the recommendations in the documents, and we definitely do have a path toward helping municipal and other institutions direct their purchasing. So if there’s an opportunity for folks to participate in our program, and use that to help set their aggregate purchasing targets, that would be terrific. Doesn’t have to be ours, they can move forward in any way that makes a difference. But we’re happy to offer what we have.

Dr.  Wendy Slusser  33:50

Well, to wrap up, what good do you think will come out of this pandemic? Or what do you want to see come out of it?

Paula Daniels  33:56

Well, I think it’s high time that every level of government understood and invested in the value of having a robust regional food system. And that means really not just talking about local, but putting some backing into that. So providing whatever economic development support they were able to provide to creating more of a renewable energy portfolio, taking that same level of effort and putting it into a local regional food system. I think it’s high time. And you can see that need arising in a number of places around the country. But for too long, we have depended on our federal government to be able to fund these strategies. I think it’s in the hands of local government to take it from here.

Dr.  Wendy Slusser  34:38

And so what would be the path that you would like to see happen to make that a reality?

Paula Daniels  34:43

I think there’s a suite of initiatives that any local government could embrace. So one would be to set aggregate purchasing targets in their region. And the other would be to, and I know how difficult it is when you’ve got a crumbling budget and you have to lay off government workers and put them on furlough and programs are being diminished. So I don’t say this lightly, but developing a regional food system can create jobs. And it can create local jobs. And it can create jobs that are long-term and actually quite satisfying for the workers. And that can be a good source of income and well-paid. So it’s an investment in the future of the region, if you can provide that economic development support, once you set the aggregate purchasing targets, to then back that up with all the capital infrastructure and the soft infrastructure. So the local processing, the local distribution, the relationship infrastructure, the technology infrastructure, all of that to make that local food system work well, and then to invest in the health of the communities at the same time. So that means having the capital infrastructure, the hard infrastructure of those access points, if it’s small markets, or however else, you’re going to be able to access it, and then invest in the people that make all these things happen.

Dr.  Wendy Slusser  35:56

That sounds like a win-win-win for everybody, locally, or even regionally, or nationally. To end, then, I guess, what keeps you up at night, Paula?

Paula Daniels  36:06

Oh, gosh, Wendy. I mean, we’re seeing all the behaviors of the past of our society coming to bear in a way that’s quite powerful and cataclysmic. So we’re seeing the consequences of climate change right now, in the heat, and the fires that are burning outside our doors in California. We’re seeing it throughout the world, we’re seeing the consequences of a 100-year pandemic, a lot of which has to do with how we manage our agricultural production and animal production. We’re seeing the consequences of a lack of investment in our healthcare systems. We’re seeing the consequences of our participation in democracy coming to bear. So there’s just so much here right now that I think we’re at a moment where we need to really show what we believe in and what we value. If we were to learn anything from this, it’s that we need to rethink our relationships to each other and to the world. And I think we’ve fallen into the trap of thinking that we could automate so much of all of that, and that we could attenuate it through commercial transactions or other transactions. But we need to rethink our relationships to each other and the world in this sense. We’ve not been in partnership with the world for a long time. But ages ago, we understood that we were but a part of the earth. And the Earth wasn’t separate from us and wasn’t a resource to merrily exploit. And I think what we’re seeing now, in this time, is that the Earth is pushing back and telling us you haven’t been a good partner. You’re not paying attention. We need to change how this works. So we need to rethink all those relationships and to work in all of our relationships with much greater respect.

Dr.  Wendy Slusser  37:48

I couldn’t say it any better. That’s so right. Mother Nature is raising her hand and telling us to slow down, put pause on our lives, and think about where we’re heading. Well, that’s a great way to end this conversation because clearly, your work, your commitment to creating a fair, equitable world through food is huge. I know you have other commitments as well. I think food is a great unifier. And also, it’s a necessity of life. It’s directly related to health and well-being in so many different facets. So thank you for all you do, Paula, every day, you think about it. You live and breathe it, you enjoy food. And I think you really are a great leader and I can’t wait to see some of this work continue to transpire and augment and multiply in our country and around the world as well.

Paula Daniels  38:47

Thank you so much, Wendy, and I can say it right back at you, all the change that you’re making.

Dr.  Wendy Slusser  38:56

Thank you for tuning into UCLA Live Well. For more information about today’s episode and the resources mentioned visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA Live Well on Apple Podcasts, Spotify, or wherever you listen to podcasts. Get to know us a little better and follow us @healthyucla. If you think you know the perfect person for us to interview next, tweet your idea to us, please. Have a wonderful rest of your day and we hope you join us for our next episode as we explore new perspectives on health and well-being.

Dr.  Wendy Slusser  00:03

Today I chat with Bruin alum Savannah Gardner about her amazing journey. As a change banker at UCLA and beyond. Struggling with food insecurity, Savannah began to see her struggle from a new perspective while taking a UCLA food justice class. Through the UC global food initiative Fellowship Program, Savannah, in turn, was able to take substantive steps to help other UCLA food insecure students. Keep listening to hear Savannah story and her insights on finding one’s path in college. So anyway, Savannah, thank you so much for being here. What a pleasure.

Savannah Gardner  00:40

Thanks for having me, Wendy.

Dr.  Wendy Slusser  00:41

Yeah,

Savannah Gardner  00:42

I’ve been on the side of the microphone. Yeah. Behind the scenes, right.

Dr.  Wendy Slusser  00:47

I mean, you’re the one who really helped kick off this podcast in the production side of things. So it only bodes well for the podcast that you get to be interviewed.

00:58

Dr.  Wendy Slusser  00:59

I hear that you’re also behind the original ideas. So I’d like to open up our conversation with your story of how you came to UCLA. I know you just graduated just about a year ago. And what was your journey, you know, to get here to this wonderful university?

Savannah Gardner  01:17

Sure. So I was born in New York from the Bronx. I moved here when I was nine. I went to public school on the east coast. My mom remarried and moved to Los Angeles, he moved to the San Fernando Valley. And I started in LAUSD, the highly gifted magnet, I moved to middle school in the valley. My mom separated from my previous stepdad. Then we moved to the west side of Los Angeles. And then I ended up going to a private school on the east coast to boarding school to Phillips Exeter. And then that was my first kind of taste of

Dr.  Wendy Slusser  01:54

How the heck did you get to Phillips Exeter, from the west side of Los Angeles?.

Savannah Gardner  02:02

You know, they came to this is like, why tracking is a real thing. The  Dean of a different private school came to our school just talked and, I could get out of science class, if I got a signed note from my mom saying that I could go to this dean of somewhere, you know? Yeah, I forged her signature, and I went to the Dean’s talk. And then I was like, Oh, this is like an interesting private school, I was kind of pursuing alternative high school options anyway. There’s like the Cal State LA program with you take your GED, essentially to skip most of high school. So that was an option for me, or maybe pursuing a non traditional route anyway. So then this kind of came up. And then I just picked a couple of schools applied, and ended up in New Hampshire. And then by the end of my time there, and I applied to colleges, I came back to Los Angeles, my family was a big pull, and that my mom and my three younger siblings. And then five years later, I’m here. I’m graduated, very thankful of everyone that got me here, including myself. And throughout that time, I kind of got involved in food justice and environmental justice and environmental racism and learning about my place in Los Angeles, really learning to appreciate the city for all its good and his bad. And being a change maker in that. So that’s how I’m here. And I’ve worked for HCI most of the time.

Dr.  Wendy Slusser  03:26

Right on so, you know, what were the challenges that you faced along in that journey? It sounded like one  was not a challenge that you just sort of landed on this opportunity that took you to New Hampshire and  to your high school years. But what what did you face that were facilitators or challenges?

Savannah Gardner  03:47

Sure. So I included my, the part of my life where I went to New Hampshire because I think that was a me being in boarding school, this very elite school coming from a low income background with a single mom and three younger siblings growing up on CalFresh, which is California food stamps. There was a lot of dissonance that I felt there, but I was kind of at a point where I really wanted to assimilate to this and kind of hide my where I came from. And then I came to UCLA and I was kind of carrying that. I always worked, I always helped support my family. And I took a food justice class here at UCLA where I learned more about the systemic reasons why families like my own end up in situations like my own and I think that gave me a lot of solace and empowerment and being able to feel like I was a Changemaker in my situation you know, as opposed to feeling like I had to hide that I supported my family or how to hide where I was from that if anything it made me more proud of myself for being there and proud of my mom and my siblings for going through so much with so little but still being on the other end of it

Dr.  Wendy Slusser  04:56

and being loving and a family.

Savannah Gardner  04:59

Yeah, and still doing are part within our community despite it. I think i needed kind of that juxtaposition in order for me to have really appreciated where i come from as opposed to think a lot of folks because of the situations where i’m like want to hide it or you don’t you know there’s a lot of shame associated with being poor, but through this  experience at UCLA, I was really able to kind of harness it and use it as something that makes me inexplicably me as opposed to a part of me that I’d rather change

Dr.  Wendy Slusser  05:31

And accepting of that. So it’s  interesting, I think you know of course during a developmental stage in high school everyone wants to belong right, and so you ended up in a situation where you were more different than some of the other people in your class or maybe not. Everyone might have been hiding something that was fit into  something that didn’t didn’t feel like it was assimulating in you know or being equivalent. So in  your sort of journey of this realization, how did find that? I mean it sounds like you learned about food justice through this great summer program right and we’re going to get to some of that what you’ve done with that which is so empowering and so admirable. In terms of that realization was it just like one moment it was an ah-ha? Or how did it  evolve? I know it’s it’s hard to know because it was in real time and then now it’s retrospective.

Savannah Gardner  06:36

I think that part of it did kind of originate in high school when you’re given a lot of autonomy in boarding school which is I think good and and bad and it can be very challenging

Dr.  Wendy Slusser  06:50

But you didn’t get kicked out no which is a huge badge of honor these days!

Savannah Gardner  06:58

Yeah, I’m very grateful for the opportunity because it gave me one of the opportunities was to really see myself in that space and find myself and like find friends that came from the same background and really finding solace in other people and other women there and having  mentors or femtors  that were really wanted us to graduate. That was having people that really wanted to cultivate for you, rooting for us, and having that when you’re away from your parents especially when my mom had a lot going on here you know she was having a newborn and a three and five year old or a four and six year old at that time. So that was I think kind of the first part of it for me where I really had people in my corner

Dr.  Wendy Slusser  07:39

to sounds like that would be a piece of advice you’d give others if they found themselves in the position you were in .

Savannah Gardner  07:46

Yeah, and I mean I’ve for a lot of reasons I’ve had the privilege of being trapped in my education of being like in a gifted program or being selected to go to the public school or got into UCLA. Those are the kinds of things where if you find your environment there and those people that do root for you there, it can make all the difference especially when you’re questioning you know your place there, if you have imposter syndrome or whatever it may be. I think that was a big part of it earlier on. I think a lot of it the challenges were associated with my socioeconomic background you know I worked at least 25 hours a week, I really had a kind of section of my life around how I could work, how I could support myself and support my family. Financial aid is great but there’s a limit to it. Rent is high here so there was kind of that necessity I had but also the essential part of my being here is also needing to embrace myself and me being a student and taking this time for me trying to find a balance of the two was one that took a really long–I’m still on that balance-but you know are trying to find that balance but I think that really happened here at ucla and being able to see that I can do what I need to do for me as well as my family and I could have both, like I could have my cake and eat it too even if I gotta pay bills you know. I think that I was really lucky that I had support systems and jobs that allowed that flexibility. So that challenge I think is probably going to be a lifelong challenge for me, but I think it really kind of crowned and I started to understand it more much more during my time at UCLA.

Dr.  Wendy Slusser  09:21

Well I had the chance to observe you and you really did do a great job balancing all of that and having first met you when you were in the food justice class and learning about the work you did with food forward, I feel that you really embrace and take on opportunities as they come your way and in a very, I think not only productive way, but imaginative. So I’d like you to give me a little bit of background or reflection on and explain what first of all the Global Food Initiative and  the fellowship that you did with them and what that led to. You identify that as a big turning point in your sort of own self realization of  acceptance.

10:08

Yeah, I really did kind of have a moment where like one class changed my life i had gotten a freshman year i had gotten an offer for an internship in dc for the summer but i didn’t get as much money as i had needed to be able to they could pay for like part time stipend and i couldn’t swing that um in order to send money home and i was kind of at this point where i was like oh god what am i going to do for the summer you know how can i kind of find that balance and further myself but also makes money and make sure I don’t have to worry about the fall and a friend just kind of a friend actually from Swipe Out Hunger which is a student group here that addresses food insecurity amongst students primarily but also just the greater LA community.

Dr.  Wendy Slusser  10:51

And tell me a little bit before you go on, what’s Swipe Out Hunger just so people  understand.

Savannah Gardner  10:55

Yeah, so Swipe Out Hunger is a national organization that started here at UCLA. Its primary goal is to address student food insecurity in a sustainable way primarily through using campus meal plans and repurposing the leftover meal plans that are already paid for for folks that need, primarily students in need so kind of a student helping student model. Our chapter here at UCLA also kind of did more traditional outreach of general awareness among the student body, helping in research we did  big events like Sandwiches for Smiles where we’d make sandwiches that would stock the food closet here on campus, which is a anonymous command come out exactly what it sounds a food closet you can just grab what you need.

Dr.  Wendy Slusser  11:39

So you were already involved in some sort of form of alleviating hunger for your peers and others?

Savannah Gardner  11:48

Yeadh and I really had a moment and kind of at the same time that I chose not to take this internship cause of my own financial security was kind of the same point where in Swipe Out Hunger, I had originally joined Swipes because I had been a part of working with people experiencing homelessness in high school, I thought it’d be a great thing for me to continue in college. I really loved it and made me feel like I was bridging a gap of the inequities that we have in society but on a personal basis, and I love that so i joined Swipes and Swipes really, although we went and worked at soup kitchens or worked with folks experiencing homelessness, it was really about alleviating student food insecurity and being able to name that you know move from Oh I’m serving someone to actually  the club is serving people like me. Like I’m going to the food closet and I’m receiving these meal vouchers that we collect was really difficult and they kind of happen at the same time where I was introduced to this food justice class and I was having this moment where I was like maybe I shouldn’t be in this club. You know like if this club is supposed to be serving people like me, why should I be here, why do I deserve a seat at this table? Obviously I stuck with it, I moved through that. End of freshman yea, I signed up for the class on food justice. They had a paid internship as part of the service learning class for this dual part model where you learn about an aspect of society or social inequity and then you also serve within it.  The Global Food Initiative under President Napolitano also paid the first cohort which is why I was able to do it. I’m very grateful for that.

Dr.  Wendy Slusser  13:22

That Global Food Initiative paid for three cohorts, three summers worth, not necessarily the paid internship part but the other the classes.

Savannah Gardner  13:32

Yeah I mean that was that was a perfect example like model for me later and that if you want people from a background that you’re serving, you have to incentivize and make it accessible for the people that you’re serving. So if you want food insecure people to take this class and learn about their own community in Los Angeles, then you have to take away the stress of applying for summer financial aid and  finding dual funding for this internship,  the class.  So I kind of at the crowning where I was learning, I was really trying to see whether or not I fit into Swipe Out Hunger. I felt like I fit, always fit, but it was hard feeling like I was questioning whether or not I was the person to do the work.  And then I took this food justice class and you know we’re learning about CalFresh and WIC and sustainable food systems and food apartheid and all sorts of stuff, and it was very interesting for me to finally feel like the situation was flipped you know? When we start to talk about food assistance and what people what access people have to food assistance in the city of Los Angeles, I can describe what WIC was to the class because my mom is on WIC which is for women with infants and children that’s like a select meal program for mothers with children under five and pregnant moms. So you know like being able to take that initiative around this table of 20 really bright people and being like oh god I know what it is, like this is what it is and these are the problems with it, you know, and I can now name that inequity, you know, like on WIC, you you don’t have a lot of autonomy, there are certain criteria of things you can buy, right? So you could buy like 24 ounce cereals, or in total 64 ounce of these certain types of cereals at the certain stores that accept WIC and being able to describe that frustration of not being able to buy the cereal my family would buy if we had the money to without WIC, and then being able to be given the space to talk about that in the circle. And also have other people build off and share their own experiences. Or have folks who never experienced that, ask questions about it, you know, and ask, why is this the way it is, was really a turning point for me and understanding, I’m great, because I made it here, and I deserve to be here. And I’m really grateful for having that experience much earlier on than a lot of folks do when they come to college, especially like first generation students.

Dr.  Wendy Slusser  15:54

And so tell me about your internship with Food Forward. Yes, which was the one with your food equity class that summer.

Savannah Gardner  16:01

I really wanted to work with Food Forward, but it was the farthest one I took the bus. So there was kind of that accessibility factor. I wasn’t sure but thankfully the person I was paired with had a car. And I just kind of made it work when I couldn’t get there with him. And we got paired. So it’s an LA based gleaning organization that centers around three main gleaning platforms, which involves using produce that would otherwise go to waste and we purposely get for folks in need. So there’s the backyard harvest program which gleans from local orchards, people backyards, really a community-centered. You have volunteers come to someone’s backyard to clean this 40 year old orange tree that’s been sitting in the middle of Brentwood since before the house was built, right. And so that that those ornages  don’t go to waste. Maybe that family doesn’t  have the capacity to eat 200 pounds of oranges, but  can’t have the capacity to clean them themselves. But you have volunteers come collect that and that goes to a local food insecurity reduction organization. Or you have the farmers market gleaning program, which is what I worked with, which goes to local farmers markets and has a relationship with farmers where the farmers donate their extra produce from the like two dozen farmers markets in Los Angeles.

Dr.  Wendy Slusser  17:08

I see you guys at the Brentwood one every Sunday.

Savannah Gardner  17:11

Yeah, we’re there. Then the last one is the wholesale produce market, which goes to kind of the big shop downtown at 3am, where Ralph’s would buy their produce from or in Vons, and gleans the excess produce from that, and that’s on a millions of pounds scale. The farmers markets are on anywhere from like 500 to 2000 kind of pound scale that gleans, so that we would collect it per bucket. And then the backyard harvest really depends. But it’s normally on a smaller scale, unless it’s like a larger gleaning of an orchard or something. But yeah, I got placed with Food Forward, and they needed help with their farm Farmers Market recovery program doing outreach. And I really loved their their model of being a middle person organization where they see this excess that would otherwise this produce that would either go back to compost for the farms, or go to waste, or go to like chicken feed. And then these people in Los Angeles that, you know, the city has a huge food insecurity rate and high social inequity. So being able to bridge that gap of the best produce that we could get in Los Angeles from these farmers markets and being able to give it to the people who would have the least access to it. And it’s a really wonderful experience, just go to the farmers market and talk to farmers and have them fill up some boxes and collect them and weigh them at the end. And then you get to see the organization’s pick them up at the end of the day. So I spent a summer interning with Food Forward and learning about the farmers market recovery program. And then I was approached by the Healthy Campus Initiative in conjunction with Cathy O’Brien, who ran the food justice class, asking if I would like to further this program and bring it actually to a campus that would be able to glean produce for food insecure students. And so this was also kind of like the situation where I was like, I could get paid to do something that I really like, awesome. I’ll take it. I don’t really know what’s going on. But I’ll take it. And it was a fellowship, it became a fellowship under the Global Food Initiative, which was President Napolitano’s initiative to feed the world sustainably and equitably, by 2050.

Dr.  Wendy Slusser  19:11

And we were starting in our own backyard, so to speak.

Savannah Gardner  19:14

Yeah. So the fellowship really focused, you know, people that were researchers that have been working on, like the effects of climate change and food for years, to people like me, you know, sophomore, students 19, that were just working on a local farmers market trying to feed families that they went to school with, and everywhere in between. And I’m really grateful for having that fellowship support me and not being able to be exposed either.

Dr.  Wendy Slusser  19:39

And you were in that fellowship for two years, right? Let’s Yeah, well, I think that you know, the example of you picking up your experience with the food justice course and really being responsive to the requests, you know, that we had for you through Semel Healthy Campus Initiative to really bring it to life over the course of now, four years really, it’s been tremendous. It’s a real asset because you identified something that was really useful. And then you partnered, as I remember with Tyler Watson and brought it to our graduate student housing and here to our food closet into a cafe 580, which is a nonprofit that serves our population here at UCLA and graduates as well. And one of the things that is striking to me that really came to light in your sophomore year was this myth that students in four year elite universities like, like UCLA, aren’t food insecure, that everyone is food secure. And the data rolled in early on in your sophomore year that showed that, indeed, there’s some real challenges that we have on our campus and across campuses in the United States. And it sounds like part of that might have been the fact that we didn’t know this is because people weren’t sharing. It sounds like but now, are you finding now  since that data rolled in and there’s more attention to this as a challenge that people are more open and less shameful of their experiences?

Savannah Gardner  21:17

I sure hope so. Yeah, yeah, I think that it is changing. Like the food closet here at UCLA started in 2009, kind of post recession, so did a lot of our other economic crisis response teams. The 580 cafe opened up at this turn where there were so many more students that no longer had support, possibly from their families, right, if they were going through some part of the recession. But that I think, brought to light that this is always been happening. And there’s always been food insecure students at elite colleges, and now that there, you know, are diversity initiatives or initiatives that get folks from different socio economic backgrounds or this slow buff up of financial aid, that more students started to come here and really make their own communities here. I think people have been talking about it, if they’ve had the support, to, you know? Food insecurity happens at higher rates, and different depending on what community you’re from, depending geographically where you’re from, it can look different. And I think people were sharing it, but not on a scale that it currently is, you know, now it’s, I think people have always been sharing about it with people that they felt comfortable and supported with, but now it’s, you know, you can have these high level meetings where someone’s like, yeah, I’m food insecure. And this is, or I have been, or I’m on CalFresh. And you’re talking about it with people that maybe you aren’t as comfortable with, because it is coming out more in the open, I think is the barrier that is being broken down after the food insecurity study come out?

Dr.  Wendy Slusser  22:43

Yeah, I mean, we here at UCLA, actually had a survey prior to the UC wide survey that I feel was helpful to us to then dive into more deeply a focus group sessions that really brought to light, sort of more personal experiences of food and security that Hannah Milan and Tyler Watson ran. And what’s striking to me is that, you know, when I shared it with the more senior administrators here at UCLA, like the VC of research at the time, was just so saddened by it, that he offered funding from further research to help support the understanding why this is occurring. And you know, what’s interesting is that the data, if you look at it, the majority of students are food insecure, probably associated with their economic circumstances, family circumstance. There is a percent though, and we found it also in the focus groups of students that probably are food insecure, because of not having the food literacy to prepare food, or even those that are food insecure, from a financial point of view, need that kind of component, which means, you know, learning skills to actually prepare healthy foods on a budget. And what’s your feeling about that?

Savannah Gardner  24:00

I think that both are really necessary in order to be able to see the entire spectrum of food insecurity and seeing that it doesn’t just look one way, it’s not about not having food, it’s about not having enough food, it’s not about the type of food you eat, it’s all of it, you know, it’s all of the above. It’s how to cook it. It’s everywhere from where you get it to how you dispose of it, like all of that encompasses someone’s food security. I think that the really interesting part that came out of those food focus groups that Hannah and Tyler did, was that students didn’t  necessarily feel supported in learning those skills here at the university, before the university, depending on where they came from, and didn’t really feel like they had an avenue that they could harness those if they wanted to.

Dr.  Wendy Slusser  24:47

Right, so thankfully, now we’re gonna have a teaching kitchen. It was something long and hard fought but we got it.

Savannah Gardner  24:55

Yeah, I think UCLA is doing a lot to ensure that we are kind of working on those short term and long term goals of addressing the whole spectrum of food insecurity.

Dr.  Wendy Slusser  25:05

Yeah. And you worked on that too, with your CalFresh initiative. So tell me a little bit about that.

Savannah Gardner  25:12

Sure. So the first year of my fellowship, under the Global Food Initiatve was specifically to really structure this program sustainably and efficiently per Food Forward program from the farmers market to student housing, or to students. And we actually had a roundtable with the Chancellor, where it had students primarily from the community itself, so food insecure students, but also food insecure students that were changemakers. In kind of these first conversations or large scale conversations about food insecurity on campus. So like students with dependents and students from Bruin shelter, which was UCLA’s first sponsored student run homeless shelter for other students in Los Angeles, came and really had a roundtable with their Chancellor, and we’re able to kind of share some of the things we’re working on. And it was a very enlightening for me in that moment, when we had that roundtable and made it really clear that I could be really, I could tell what we’ve done with the cleaning program bringing 1000s of pounds of produce to students with dependents and family housing and the food closet. But ultimately, this is a short term, if anything, the shortest term solution,  it’s really alleviation or a poverty alleviation or giving you some food. So we wanted to bring it to the next level, you know, like people are having their lights turned off, you know, or going to school and having to stay in the library because they don’t have heating, or they got an eviction notice, you know that there’s the oranges we bring on a Sunday, one Sunday a week, although they do a great job, they’re not addressing that disconnect. Right? So we started to move forward with enrolling students on CalFresh and having our CalFresh initiative,

Dr.  Wendy Slusser  26:50

So that’s the snap or the food stamp program.

Savannah Gardner  26:53

Yeah, so Supplemental Nutrition Assistance Program for the state of California. So students are able to qualify, it’s kind of like a sliding scale, depending on how many dependents you have and how much money you make. But students are eligible. And a lot of students knew that they were know that they’re eligible. There are of course, eligibility requirements. But we thought, one, the next step in really giving people the autonomy to buy what they eat, and having a longer term solution of food insecurity would be establishing CalFresh and working with Department of Public social services.

Dr.  Wendy Slusser  27:25

There was a really great article that featured you in the Daily Bruin here our daily UCLA newspaper. I want to say a quote about what you said in that article, you said, “if you were food insecure, not making ends meet CalFresh gives you the option where you don’t have to take loans out for food, or go to a place that’s too far from campus. We’re just trying to break the system and let students know that’s there. And it was only 1% of students are enrolled in CalFresh. at UCLA, even though 42% are reported to be food insecure throughout the UC system.” So that means that of course, 42% are necessarily eligible. But there is some need there that isn’t being met clearly.

Savannah Gardner  28:09

That was kind of our first step in really seeing, like, who would be eligible if we tried this on campus, you know, could people get $194 for food in a month, you know? Which may not sound like a lot, but when you’re already struggling to make ends meet, that could be the difference of more meals a week, that could be the difference of, you know, being able to cook something that’s  culturally relevant to you and what something you want to eat when you’re right before you study in the library all night. So we started having these kinds of CalFresh fairs on campus by word of mouth, I was helping enrolling students out of 580 Cafe, before we had this kind of really more established program. But we were working with  MSW or a Master’s in Social Welfare.

Dr.  Wendy Slusser  28:53

And where are we now in the percent of people? It was only 1% that were enrolled a couple years ago. So where do you do you know where we are?

Savannah Gardner  29:03

I’m not sure where we are now. That’s the UCLA CalFresh initiative has really grown exponentially in the last year and a half.

Dr.  Wendy Slusser  29:09

So we hope that it’s higher at least.

Savannah Gardner  29:11

Yeah, but we have you know, we have hundreds of people coming out to the fairs over the course of the year, are applying. And we have 40,000 people, right, on campus kind of across disciplines. And then we have 42% of them are potentially food insecure, right? So it’s about 20,000. And even if 5% of those food insecure people on campus, you’d have 2000 more food, secure people on campus, and that would mean healthier communities on campus and more people are eating,  more people want to be happy, more people  are eating what they want to eat,when they can would make this campus a better place for everyone and more equitable in that way. And I think that’s really why that was so important to our initiative.

Dr.  Wendy Slusser  29:57

Yeah, I mean, what strikes me so profoundly and I am going to do a plug for a TEDx talk that I featured your story because it really, to me, says so much about somebody who has the capacity to turn something that can be challenging into something so positive and working towards bettering not just your peers lives, but But you’ve had great impact, I think across  California being a real model for other students and other UC campuses. And I’m just curious, because in the TEDx talk, I talk about, like what it takes to perhaps have better well being, after graduation, citing this Gallup Purdue survey that identifies the people who find professors who care about them or a mentor who encourages them or engaging in an internship that allows you to apply what you’ve learned in the classroom. I feel like those kinds of features in your four years at UCLA you did all of that. You found like the Catho O’Byrne to inspire you and you did this internship. Did you ever think you would, and you would end up where you are now? If you were to look back in time, what were your expectations when you first arrived?

Savannah Gardner  31:23

Yeah, I thought I was going to be a marine biologist. And I thought I was going to work on a boat and dive with sharks. That was kind of my goal. So since I moved to California, I really fell in love with the Pacific Ocean. And having my course at UCLA really showed me that I have a different purpose, and that I really have the responsibility to address the inequities that we have for families that look like mine, or families that don’t look like mine, and being able to do that in a way that’s holistic and with love and care. And that’s where I am now. And I’m really grateful for that it took me a long time to get here.

Dr.  Wendy Slusser  31:59

But what were those challenges? You laughed?

Savannah Gardner  32:04

It’s something that I think we’re oddly told that, you know, from a young age like, well, you know, you’re asking something, I asked my little sister, like, what do you want to be when you grow up? And I’m like, she’s six, I don’t know what I want to do, why am I asking her? You know, we have this one track, or we’re taught to have this one track. And veering from this one track can be kind of hard, especially in college, when you’re like, you think your major is so important to what you do for the rest of your life, you know, or you’re wondering if this is this is it, you know, I had to make all these decisions right now is if you don’t have a lifetime ahead of you. God willing. So I think that was hard for me. And then also being able to kind of grapple like being a first generation student, especially from a low income background, like you have that expectation where you have your whole family to look up to, and so kind of grappling with like, okay, well, like I still want to buy my mom house, so that she doesn’t have to work till she can’t anymore, you know, for whatever reason. I want to do that in a way that is oriented and community justice. And that could be kind of hard sometimes. But making like seeing that those are my priorities. And just like I had to find the balance before I can find the balance, again, is really important to me.

Dr.  Wendy Slusser  33:08

And so what would you give your freshman self advice? What would be the advice you’d give yourself?

Savannah Gardner  33:15

Oh, my gosh, there’s so much advice I would give myself. I think I would tell myself to not worry so much.

Dr.  Wendy Slusser  33:23

About what?

Savannah Gardner  33:24

I think I spent a lot of times worrying whether or not I mean, rightfully so worrying or what worrying whether or not I had a place here, you know, whether or not what I was doing mattered by my family, of course. And I think that sometimes the university community  and just the way of life on a quarter system can allow you, you know, can kind of foster that worrying, you know, you got to test tomorrow, you got work the next day you got this and this to do. And I think I could have enjoyed a lot of that time a little bit more than I did, until I did start to find kind of my rhythm and my purpose. And that balance. I think I also would have told myself to ask more questions earlier on, just to people I admired. I think especially coming from that perspective, you’re like, you have this professor, that’s amazing, you have a like a mentor, that’s incredible, or you have someone that you haven’t met yet, but you want to and that could be kind of intimidating. And there are a lot of people that I lost opportunities to just being able to, like thank them or for talking or being able to ask them more questions that, you know, if I could have done that experience over, you know, ultimately, what time I got to lunch didn’t matter as much. Or whether or not I thought I should ask question didn’t matter as much, you know, to, to the kind of brains that come to this environment. I think I should have, I could have just done it more often and not worried about it.

Dr.  Wendy Slusser  34:45

There was more trying to be a little bit more assertive or brave in situations and not rushing around. Definitely taking a breath.

Savannah Gardner  34:56

Yeah, and I deserve that breath, you know that I was allowed to have and I was deserving of it.

Dr.  Wendy Slusser  35:03

That’s a good piece of advice for everyone isn’t it, and also to be more loving and forgiving to yourself.

Savannah Gardner  35:10

Mm hmm. Especially in post grad, I think I had such a purpose and intention on campus. I really had a community, I really had this thing that I was so heavily involved with, you know, with food insecurity on campus, or really basic needs on campus and ensuring that people had access to everything that they deserved, and the university that when I graduated, I was like, I wanted to take a step back from it, because I think I needed it. But I also lost my sense of purpose in that and you know, it changes from being at UCLA to who am I in the city of Los Angeles? Who am I in the state of California, who What am I doing as a citizen or as a person?

Dr.  Wendy Slusser  35:52

I’ts hard to manage that.

Savannah Gardner  35:53

It was. It’s really hard, it was really, really hard, especially because I mean, it’s not like a situation change, you know, I’m able to work more on it, because I don’t have class. But it’s not like I’m not, things don’t magically change once you graduate. Because graduating is so important, or was so important to me and my family that it was, I didn’t think much after it. I just knew I needed a break. And I deserved one. And I wanted to take one for myself. I farmed in Hawaii, I stayed at a farm in Hawaii for a month, on a coffee farm, which is awesome, but kind of, I think I’m kind of finally coming out of being in this point post grad that I wish I was taught a little bit more about or just kind of mentored a little bit more in and being like it can be confusing to not have as much of a purpose as you did when you’re a student, but that that’s also really necessary to find what you love to do.

Dr.  Wendy Slusser  36:43

So, as you transition, is there any challenge or problem that’s sort of hovering over you that you want to continue to really work on and grapple with? What is it that you’re going to take with you in terms of this food justice?

Savannah Gardner  37:01

My involvement in food justice, and community justice on campus and for students with families, was really pivotal for me, in order to be able to learn, you know, how things happen on a system wide level, or how things happen systemically, people don’t have access to food and isolation. You know, it comes with your basic needs and housing and your education opportunities. And, you know, your access to healthcare and tons of other things, transportation and whether or not you know, the city of Los Angeles is accessible to you, depending on can depend on whether or not you could afford a bus for an Uber, right? So I don’t think if I had as much time really sitting in food justice and being able to kind of see or learn about how food justice is social justice and community justice, and that they’re not really separable, and that they’re one in the same. It kind of gave me the knowledge I needed to want to pursue and learn more about other types of social justice, like environmental justice, or education justice.

Dr.  Wendy Slusser  38:03

Yeah, you’re really touching on the fact that food I mean, the food system itself has so many intersections with justice, starting from how it’s grown,  to prepared, delivered and, and eaten and then discarded. So which part of that sounds like you’re interested in a lot of points? Well, not too many, never too many, especially at your at your stage. I think at your stage, you know, you’ve got to sort of discover, right, this is the time and it is uncertain when you have this these sort of transitions. It’s common to feel that way. So I guess one question is where do you start seeing yourself hovering in that sort of line of food systems for justice? And then the other is, what kind of advice would you give others who are entering UCLA with, you know, interests in areas of wanting to do good, and make the world a better place?

Savannah Gardner  39:04

I think I see myself moving really in towards an environmental education lens, simply learning about CalFresh made me embrace the fact that my family was on CalFresh. And that knowledge empowered me to then be a change maker. And I think I have the responsibility to kind of pass that baton. So I see that as kind of maybe my next step, but also just learning my relationship with the Earth more. And that kind of comes from the production end of food justice or side of food justice. And that’s why I went to Hawaii and farmed, you know, I wanted to be able to see a food system, outside of urban farms in LA, really be able to see a community make their own food. And learning more about that

Dr.  Wendy Slusser  39:49

It had that feel being in that Hawaii farm land.

Savannah Gardner  39:53

It was amazing for a lot of reasons. I think it also showed me though, that there’s so much more I have to learn, you know. I’m gonna spend my lifetime learning and I think my advice to whoever wanted to do this work  is that they already can, they already have the ability to be a change maker whether or not it’s they’re initiating it, but also that they will also spend their lifetime learning things. So to, you know, embrace themselves and be humble, and ask questions and also get off campus.

Dr.  Wendy Slusser  40:29

What do you mean by that?

Savannah Gardner  40:31

You know, it just it becomes a bubble, it becomes kind of a self fulfilling prophecy, you go to school, you go to library or party, depending on what day it is. And then you go, you know, you go to the dining halls or back home to lunch, depending on if you’re commuting student or not. And I think, for me, it was really volunteering off campus and taking the bus in the city made me know that I had a purpose beyond I think that’s helping me postgrad knowing that like, I have a purpose beyond just university so that when they leave, they can see the university contextualized, like, within the wider community that we are UCLA, because we are of Los Angeles, and not kind of the other way around.

Dr.  Wendy Slusser  41:10

Right? Especially us, such a large urban, university and a larger, one of the largest cities in the country.

Savannah Gardner  41:20

Yeah, you don’t have to leave Westwood  if you didn’t want to right? But  I think you would have a skewed picture of the city and what it has to offer, and what it does, then if you didn’t, right?

Dr.  Wendy Slusser  41:32

Yeah, those are really good points. Well, you know, Savannah, it’s just such a pleasure, I have to say, knowing you and seeing you grow and talking to you and feel like you’re really continuing to be, you know, evolving into somebody who has and will continue to make a difference. Certainly have done it on campus and you see wide and I feel that I can’t wait to see your next chapter in your life. It’s going to be incredible.

Savannah Gardner  42:00

Thank you. Oh, my gosh, yeah, I think I’m really blessed to have had spaces on campus that have supported me like HCI has, or you know, like CPO as any other part of the Community Programs Office that is helping  people and spaces that have supported me, and given me kind of what I already had, was like the power of believing in myself and in the work that we do.

Dr.  Wendy Slusser  42:26

Right on

Savannah Gardner  42:26

Yeah, thanks Wendy.

Dr.  Wendy Slusser  42:34

Thank you for tuning into UCLA live well. For more information about today’s episode and the resources mentioned, visit our website at healthy ucla.edu backslash live well podcast. Todya’s podcast was brought to you by the Semel healthy campus initiative Center at UCLA. To stay up to date with our episodes. Subscribe to UCLA live well on Apple podcasts, Spotify, or wherever you listen to podcasts, get to know us a little better and follow us at healthyUCLA. If you think you know the perfect person for us to interview next, tweet your idea please. Have a wonderful rest of your day. And we hope you join us for our next episode as we explore new perspectives on health and well being.