Shireen:  We're speaking to Barbara Moschitta . Barbara has practiced nutrition for over 25 years as a registered dietitian. She's practiced in federally qualified health centers, outpatient medical offices. She specializes both in pediatric and adult weight management, diabetes treatment and prevention programs. She currently works for posology health, based out of Hilton Head, South Carolina, and her goal is to bring best practices to a community that is in need of access to a dietitian, regardless of income and other barriers. Welcome, Barbara.

Right off the bat, I'd like to jump into your background, I'd like to learn more about your interest in becoming a registered dietician and learning more about your experience.

Barbara: Well, I actually decided to become a dietitian when I was 15 years old when I was in my biology class. And my instructor mentioned that there was such a career when I was at a draw to food science. So that was the beginning of my path. So I had such a passion for food and nutrition anyway, and had no idea that it's such a career path. So I left high school early, went to college a little early and got started right away and just fell in love with the whole profession. And I think it served me well and I had served others as well during my journey, and continue.

Shireen: Now, in your bio, it mentions that you've worked at federally qualified, qualified, excuse me health centers. Can you speak to me a little bit about your experience there and then your current experience in Bluffton, South Carolina? What is it? 25 minutes from Savannah correct?

Barbara: Around 25-30 minutes.

Shireen: Okay, so tell me more about that.

Barbara: Okay, so when I started out, I had a wonderful mentor who found me when I was doing my grad program. So we worked at the migrant farm worker camps in Orange County in New York, which is the black dirt region for onion, farmers and other produce. So we did hypertension screening and diabetes education, one on one for all the migrant farmworkers at that time, they would leave Florida and Mexico and come up north to work the fields and packing houses. So I did my thesis there. And ever since then, I had abroad a federally qualified health centers because it was a grant funded program. I went into private practice and WIC and all these other positions, but then full circle, I turn 40 plus years old and end up back in a federally qualified health center under that same dietitian, who has mentored me for years and has given me that gift to work with the underserved, seeking a better quality of life for myself, no the north and I found that there was a lot of long term care physicians here but not really anything that would fit what I wanted to do here. And I fell into a wonderful group practice that is promoting health and wellness in the community from fitness levels to massage therapy and acupuncture and they really honor dietetics, and it is really impressive to me that dietetics was one of their primary focuses as well. And there is such a need in this community because there's one or two other outpatient dieticians in the area, but for the hospital doesn't have one on Hilton Head and I'm not so sure about some of the other foods. So people actually have to go to Charleston or Savannah or look online. And that's the one thing we want to create is a better access to dietetics here in the Hilton Head blocked in Buford County area.

Shireen: So you mentioned there’s not a lot of dietitians there. So tell me more about how many residents are we talking?

Barbara: Well, Bluffton is a suburb of Savannah and Charleston. It’s a small, beautiful city, that's a resort area for most, but most of us that are living here are trying to make a living. So it's about 23,000 and growing. And so with that the infrastructure has to grow the housing, the transportation, so it kind of reminds me of Orange County back in the 80s. But it's having a multiple level of growth with housing now. But fordable housing is really a barrier right now because people who work on the island may not necessarily be able to afford to live on the island. And so that's what the Lieutenant Governor is trying to create is better transportation and better access for living.

Shireen: The 23,000 residents about one or two dieticians serving all 23,000?

Barbara: Well, there is a hospital dietitian for impatient and there's another hospital overview for. So they're probably taking care of me and patients. And then like I said, if you look online on Google or Google business or health process like to, besides me, other than that, you go to Charleston.

Shireen: Well, okay. And so tell us more about these residents, what what kind of industries are the in what are they doing.

Barbara: So we have a retirement group, who are here enjoying this wonderful weather for golf and recreation, we have beaches, we have hiking trails, then you also have hospitality. And retail is very key here, we have tangier outlets, we have many grocery stores and more building, more houses are being built, more people are coming down. So for young people, it's a little more challenging, because they may have college degrees, like my daughter and can barely find something other than retail. But we have found medicine that has medical practices opening up and so a lot of our young people are actually seeking employment in medical fields.

Shireen: Speaking about diabetes, specifically, what is the prevalence of diabetes? Or what sort of challenges do you see in the community when it comes to diet related chronic illnesses, even via diabetes or heart disease?

Barbara: Well, with diabetes, in our community, I'm just learning about what's happening. But a lot of the families, again, are working two jobs. You know, each household has two people working, they have one day off a week, if they're in retail, it's a very unpredictable day off the schedules are very unpredictable, or they might be in landscaping. Hospitality again. So the challenges are long hours, long work hours, unusual work hours, people who are well managed with diabetes, who are the retirees perhaps, and they have their medical providers up in New York, so they don't live here full time. They may have their medical care taken care of elsewhere. But there is no endocrinologist in this region. I shouldn't say region, I should say Bluffton Hilton Head. The nearest one is in Savannah, there's a couple of them, we lost our dietician in the hospital who was a diabetes educator. So there's not much support other than diabetes, people with diabetes, going to a doctor who might specialize a little more diabetes I'm hearing but for the most part, they're going to primary or traveling for the care. So it's challenging that way because if they're working so much, it's very hard for them to get to their appointments.

Shireen: So you've got this population of 23,000, most people are in retail, who thought

in addition to that you have no endocrinologist in the in that area. And limited dietitians, two to three inpatient and seems like you're holding the fort down on an outpatient basis, your dietitian services.

Barbara: It's starting and luckily, Medicare and Medicaid can cover diabetes, but the people with pre-diabetes, they're not covered. And the people with obesity who's going at a very high risk for diabetes are not getting that, you know, and some of the insurance companies in South Carolina are not putting dieticians on their panels, so people who can't afford it aren't going to come in.

Shireen: So what do you have in the small percentage that you are able to meet with? What do you normally recommend to them, given the lifestyle that they have? The food culture in the low country is

Barbara: The food culture in the low country is a lot of fried food and a lot of fast food. We have fine restaurants too, but right now they're closed. But as far as food challenges, getting past some of the food culture here and learning to embrace where people are at maybe reducing the portion sizes, especially the carbohydrates, certain cultures really enjoy or comfort food, if the carbohydrates which if the sugars are being channeled, that that may not be in someone's best interest, depending on where they're at their numbers. And if they are self-monitoring, some people are afraid to self-monitor their blood sugars. But as far as my recommendations is to limit the portion sizes, use a smaller plate. I always use my palm of my hand for measurement and suggest if it's larger than your hand, it might be too much depending on if you're trying to lose weight and you know, so there's little tricks that we can teach with the plate method. And it's fairly simple because I'm someone may not be willing to give up some of the foods that they like, and I understand that.

Shireen: I want to understand a little bit more about the ethnic breakdown of the folks out there, can you tell us a little bit about that? 

Barbara: Yeah, I don't have statistics. But we have a lot of Americans here that are either Hispanic from South America or Mexico, we have the world for makeup here of the early Gullah culture. And so they have food practices that are different. It's a melting pot in here, in a sense, because we have very good restaurants that accommodate all, we have Ecuadorian restaurants, we have Mexican restaurants. So I think the challenges with those foods is the volume I work with where they're at, if they're willing to make small changes, that's really what it's about. And then couple it with exercise, because the Diabetes Prevention Program, their real focus is really exercise and fitness level and just improving movement in Americans. And that works across the board with pediatric obesity prevention, maternal child health, if we have a pregnant woman with very high blood sugars that can impact the next generation or overweight. You know, there's a lot of research with digestive health and diabetes, and just wondering how to restore our immune system with a lot of healthy vegetables and plant-based foods. So it's kind of marrying different food cultures together. But looking at, you know, what's working out there for dietetics, and for health and longevity?

Shireen: So from here, I want to dive into the current state of affairs with COVID-19. And the implications that has had on your community at large and then specifically within diabetes and diet related chronic illnesses. So I'd love to learn a little bit more about what that has looked like. And I want to touch back upon when you had mentioned predominantly retail industry. Yeah, I'm sure there are stores, closed, limited hours, things like that in place currently. What are you seeing? And what has that been like?

Barbara: Well, we're seeing a lot of fear. And it's hitting home to me is I learned was people in the area now have tested positive. So now the reality is here in Bluffton, and we still have people trying to come down for spring break, because this is another destination for spring break. And the beaches are still open from what I understand our public parks are open, and they are sanitizing bathrooms. So they haven't closed that down. And as far as some of the stores have very limited hours are not open at all, grocery stores are open, and I praise all that are working at a grocery store right now. Because they're stressed, they're worried. And there's the recording going on. And that's again, our fear, there are some psychological issues that people need to solve. And that's, that's, you've got to have compassion for that too. But everybody's becoming much more neighborly and helpful.

Shireen: Can you speak a little bit about diabetes specifically, and the patients that you're seeing? What kind of impact Are you seeing all of this have on them?

Barbara: Well, another dietitian that I met, who moved down here not long ago, she works at volunteers and medicine to see the patients on a certain day of the week that need help and guidance with diabetes. And so I reached out to them and we started a support group, early January, and it's been very successful, at least nine people showing. And right now, they're close, and we're not having our fundraiser. It's postponed we're not having our groups in April making May. Not sure yet. And it's a support group open to the community for people with diabetes. But right now, we're not able to have it. But it was a nice support group for people to ask questions, and share. And I'm trying new recipes, we always provide a recipe. I too, have diabetes. So it impacts me because I am very responsive to stress and my numbers will go up so I can see that that's probably impacting a lot of people. Right now. It's just increased cortisol and stress. 

Shireen: With the limited interaction that patients are now having with doctors with you know, with a diet Titian like yourself, have you guys looked at a telehealth format? What, what has that experience been like?

Barbara: Well, I had a patient who had prediabetes who reached out to me and he didn't want to come in because he has immune compromised in different ways. And in addition, so we did a phone console with him and his wife the other day, and that was perfect. I felt like we engage. We embrace shared stories. So it was a good experience. And I felt like his answers were, his questions were answered, and I'm sending out a packet of materials that I normally would have given them in our session. So I know my office is looking at the actual telehealth format. I know other dieticians in the area across the state are working in their offices and just phoning the patients in the hospital. A friend of mine, it was out of the area is seeing patients at the VA but personally.

Shireen: So with that, and as people are staying indoors more what kind of resources can you share? And what kind of pearls of wisdom to have to share? 

Barbara: Well, I've been doing some YouTube yoga, and you can I did it a couple of weeks ago. This is pouring rain and you want to go out to class, but you can take walks you can play with your kids outside. hiking, biking, I'm seeing a lot more outdoor activity going on. But if you're still indoors, if you don't live in a safe neighborhood for some reason, I would recommend doing some anything you can do at home using light weights or resistance then some people will I've had patients use the stairs and just walk those stairs. There's DVDs walk around your house five miles in services are Gary Shriner. And he's has diabetes himself. And he wrote several books, six of them. One is called think like a pancreas. But he has a Facebook page and website for integrated diabetes services. And they have a dietitian, so he sends recipes. So that's a good online source. And his books are wonderful. And you can order on Amazon and Kindle and all that. So I also use Michelle Mae has a mindful eating, eat we love love with you eat with diabetes, and she has online newsletters that help people support with the emotional impact of nutrition and you know, we all love food. So it's helpful to realize that if you have diabetes, you don't have to give up the foods you love. It's just how you balance them and portions and and what foods is happening together with so there is also the American Diabetes Association and they have free materials online.

Shireen: That's great. And so we're we're nearing the end of the episode here. Barbara, I'd love to talk to you. I'd love for folks actually to learn a little bit more about how they can connect with you and learn more about your work.

Barbara: Oh, thank you. I have my own Facebook case, but I'm also linked with posology dot biz, pathology fitness and pathology how and that's in Hilton Head. Bluffton, South Carolina, and I have a health prop page I have almost Google business dieticians and blocked in. My last thing is a little hard to spell for email, but it's MOS ch AI TTA and it's Barbara. So Barbara magenta.at polypharmacy doctors.

Shireen: Well thanks so much for your time. Barbara really, really appreciate it.

Barbara: Thank you.

Shireen: Once again Barbara Misha and she's based out of Bluffton, South Carolina. Thank you.

Barbara: Thank you

Connect with Barbara!

Barbara’s Facebook page 

Barbara’s LinkedIn page 

Email: barbaramoschitta@pulseology.biz

Resources mentioned:

Yumlish

Blog – Barbara Moschitta 

Gary Scheiner Diabetes books

Mitchell May blog 

Other resources:

Healthy Meal Prep – Toby Amidor

The American Academy of Nutrition and Dietetics

American Diabetes Association

NIDDK National Institute of Diabetes and Digestive and Kidney Diseases

International Food Information Council Foundation

Center for Science in Public Interest