Latest / Nutrition Connection by Dr. Kristen Hicks-Roof / 45: Dr. Su-Nui Escobar DCN, RDN, LDN, FAND - GLP-1 / CLINICAL
Transcript
- Kristen Hicks-Roof PhD, RDN: Welcome back to Nutrition Connection, the show where science meets storytelling. I'm your host, Dr. Kristin Xroof, dietitian, researcher, and lifelong advocate of the role of nutrition, health, and wellness. Each episode, I get to sit down with dietitians and nutrition experts all across the food and healthcare landscape. Leaders whose work touches nearly every aspect of our lives. So whether you're a student, a seasoned professional, or someone simply curious about food, nutrition, and health, this podcast is just for you. The views, thoughts and comments on this podcast do not reflect those of my employer nor the employers of my guests. So let's go ahead and get connected. I'm excited to bring on today's episode. We actually have one of my former doc students when I was at the University of North Florida. We have Dr. Sui Nui Escobar. She is a weight management specialist. She does everything. I'm telling you, she's a dietician. She's a doctor of clinical nutrition. She is also the co-author of the GLP-1 Kitchen. So welcome to the show. Su-Nui: Thank you, it's a pleasure having been here. Kristen Hicks-Roof PhD, RDN: It is going to be so awesome to talk and you wear so many different hats really focused on weight management. And I know I've seen you present at today's dietitian and other conferences really about what's the role of the dietitian in weight management, especially in the era of GLP one. So I can't wait to really dive in and you telling all of our listeners like what kind of jobs and side gigs and speaking opportunities you have. let's bring it all the way from the beginning. So what really inspired you and made you want to become a nutrition professional. Su-Nui: People, really I enjoy helping people at very different levels. And ⁓ the way I decided to study nutrition is kind of like crazy. I I do a year off from college. I was living in Europe, in Italy specifically, and working at cruise ship. And in Italy, it was very interesting because in college to keep my weight down in a healthy range, I had to work out for days a week. I had to like have a very restricted diet. And that's what I thought, right? That's what I knew back then. I was not on a nutrition major. I was in a different major. So when I was in Italy, I was very surprised that I did not, I was not in control of what I ate because we were fed whatever we were fed, lots of fish, veggies, but also like whole milk and... pasta and risotto and you know, I ate so many things that I would have never dared to eat back in college and by then I was living in the States. So I was very intrigued by that fact. How everybody in Italy seems to be like a very good way while like we all struggle to keep our weight down. And then when I started working on the cruise ship, I could see that in a place where food is unlimited. and the food was really good, how people react different to the food offerings. So next thing I knew, I was doing my master's in nutrition. Kristen Hicks-Roof PhD, RDN: That's so interesting. I've had, you know, friends who've worked on cruise ships before. And what a cool opportunity I feel like as a dietitian in training and or dietitians to be able to be in these experiences and emergence. I know every time I go on cruises, I always gain weight because I'm like, ⁓ I want to try this and I want to try this. This is a unique flavor profile. So I'm probably not the best person to go on those things, although we are going on one this summer and I can't wait. So Let's talk about your journey then. What kind of roles have you had once you decided to become a dietitian? How have you navigated that path and ultimately to being a co-author of your own book, cookbook? Su-Nui: I have an disclaimer to make. I have a DHT and you know that we like having 20 projects going on at the same time, right? And I always had two passions. One, I have a very clinical brain where I love complex cases and for that I actually work three days a week in a very clinical role and that you're gonna love. You're gonna love the physicians based on the research that you have done in the past. So for that I trained in the ICU. At some point I did ⁓ liver transplants and then, you know, my current role. And then the fun part of being a dietitian ⁓ is being mostly about weight management, although not at the beginning, but I've been a spokesperson for MILK, the Academy of Dietetics and Nutrition. And now I speak in conferences and... I just learned that I was speaking of fancy. Kristen Hicks-Roof PhD, RDN: Yay, congratulations. have also I just found out we got our session too. So I'm so excited. Su-Nui: Yay! What session are you doing? Kristen Hicks-Roof PhD, RDN: It's going to be on LinkedIn and how to use LinkedIn as a networking platform. Su-Nui: Amazing. And I guess to get there, it's just like I keep saying yes to different opportunities, you know, and I really don't a lot of things, but one thing leads to another. And one thing depends more on my understanding of, of especially weight management. So the next thing I do, I know more about it than I might get different opportunities because, know, I'm so, you know, I have learned. teach and write about the topic. So I know it, I know it very well. Kristen Hicks-Roof PhD, RDN: So how, for people who are listening, how do you land those partnerships with groups? How do you land these speaking engagements? Do you have any like tips or strategies of what you've learned, especially as a clinical dietitian, how do you expand beyond that role? Su-Nui: I think I start spending from the beginning, my first year in practice. And this is like really funny. I was in a health fair and then I met the person. I start talking to that person because that's what I do, And ⁓ I was also in a group that we were working to fight childhood obesity. And one of the dieticians there recommended to me to the person that I have met in the health fair. ⁓ And she was working in a PR firm and I became the spokesperson for ⁓ meal life, the former got milked. So it was, it's all like you're working here, you're talking to people and like you getting to know everybody. And when they think about someone that can deliver a specific topic, you, you land on those roles. ⁓ especially I guess in this last years, I have become, I don't know how to say it, but like, I've been up to the trends. started doing ⁓ management for GLP-1 for weight loss back in the day when it was not popular. And I guess that put me in a different level because then they knew that if they needed to know about GLP-1, I was a dietitian to do that. And one person invited me and then someone in that conference will invite me to another thing. it was kind of like, you know, like, connections there, networking, and at the same time, I volunteer ⁓ for organizations for the Academy in different, like throughout the years, different places from the local Academy to national levels. And I'm doing now the weight management DPG. And through that weight management DPG, I had the opportunity to do GLP-1 Meetup, which I got to like be more involved with other dietitians in this space. And we're doing another one in Ivo's, which it's going to be really cool because it's going to be GLP ones, but from a perspective of clinical practice and my role is going to be I'm using now GLP ones and I'm going to talk about it. ⁓ So, so that way we'll combine the science with what it is the day to day. So there's no one way I think it's just being open, talking to people. Don't be afraid of doing something that might look very difficult, but at the end of the day, sometimes you will realize that you know more than you think you do. Kristen Hicks-Roof PhD, RDN: What I love how kind of like your red thread throughout this is saying yes to opportunities and because what I've seen throughout my career too is when I'm giving a presentation, it almost always will lead to something else, whether that's a webinar, another presentation, another connection. And then the snowball just like kind of slowly gets bigger and bigger every time you do opportunities. So I think, you know, really figure out what your your passion is and what your expertise is. And you found that GOP1s was like early that was your passion and weight management. so it's like kind of find that passion and then find opportunities, whether that is at your clinical facility and giving a talk with all the medical providers or it's external, like you said, in your local community. Because I know, I mean, I remember when we were ⁓ planning an event over in Miami and I was like, GOP1s, ⁓ I know Sunui is like the perfect person for it, right? Because I've seen you talk about it and that is where slowly we almost build like an old school Rolodex of people who we can count on or who we know is an expertise. So let's talk about what you do in your current role, which is mini hats. So I want you to dive a little bit like what is the GLP-1 kitchen? What other sorts of activities do you do beyond clinical? Su-Nui: Yes. Yes. So in that fun sign, I always call it like that because I've never bore. Right now, I just finished completing some presentations. I'm giving some talks about a very unique topic is ⁓ the use of CGNs in weight management, which of course, I knew about it. I have been using it with some of my patients, but now I'm presenting about it. And I think that's going to be the next big trend. ⁓ And we're pairing it up with GLP-1s. ⁓ So it's like MySpace, but at add-on. And the GLP-1 kitchen is a cookbook that I developed with another, a couple of very well-known dietitians. And it's just like, I thought we needed a cookbook for people who are on GLP-1s. And ⁓ I use it all the time for my patients. And it's just like, you know, the foods that we... tell them to eat, but at the end of the day, we eat foods, we don't eat nutrients. And then of course, what else? It's just so much, but, but again, it's not like you do it all at the same time, right? Like you write the book, now I'm finalizing a meal plan for that. ⁓ I was invited to write a chapter in obesity for ⁓ state ⁓ care manual. So I just finished that. So it's fun, you know, I take it project by project and this year I'm focusing a lot more on growing my audience. So all the products that I have, I can sell and actually make more revenue. ⁓ Kristen Hicks-Roof PhD, RDN: Yeah, well, you know what? And I think that's something that for many dietitians who are like, that sounds really cool, right? You you talk about your fun projects, but at the end of the day, they need maybe a stable income, they maybe need a certain threshold of an income. And I think that that uncertainty is both exciting and exhilarating for some and also terrifying for others, right? And I think it all depends on who you are and what your situation is. If you have the capacity or abilities to be able to do this ⁓ that you just never know. And again, one door might open to another, which may eventually down the road lead to another full-time employment in an arena where you would have never expected as well. So I do think that there is opportunity there that if we say yes and when we say yes, it can just open more doors. So I want to talk a little bit about scientific evidence and data, and especially in your cookbook, I'm curious if you're able to like integrate this in because I mean, I'm a scientist and I love science, but I also love being a science communicator. And I think that is hard for many dieticians. And it's something it's a skill that we are constantly building. So how does scientific data and evidence fuel what you do in your day to day from clinical to all your fun activities? Su-Nui: ⁓ I leave. I feel like I never left grad school because I use evidence-based practices every single day. If I'm writing something, if I'm writing a blog, if I'm the book, whatever I'm writing, whatever I'm presenting, I need evidence-based to communicate that either to the public, to my patient, or to dieticians that I train. ⁓ going back to what you were saying, that people are scared of leaving their full-time job. I do have three days a week, I do work on ⁓ part-time job with benefits. So, you know, like I was able to find out what worked really well for me. So I have that security of like income and then, you know, I can play and be okay doing other things and having... you know, income that sometimes is high and sometimes is not. like that is really good. But like in that, in that role, I have to use evidence-based all the time and it's in a field where it's very cutting edge. ⁓ So we're learning every single day. And then whatever I gather there, I use it in other places. I know you want to know what it is because you're going to like it. ⁓ Kristen Hicks-Roof PhD, RDN: Yeah. I want to know. Tell me more. It's a perfect time. Give us details. Su-Nui: So I work as a dietician in a multi-organ transplantation team. I think that most transplant, that most organs that ⁓ our lead surgeon had done is seven in one person. ⁓ So it's really nice because like the doctors there know so much about nutrition. Kristen Hicks-Roof PhD, RDN: Wow. Su-Nui: And you're such a valuable member of the team that you never work. You always feel validated. always enjoy there because you're a ⁓ real team and we take care of the patients from the moment they start the evaluation for the transplants and the rest of their lives. And we have some that ⁓ the GI doctor, she can calculate the PM like this. She transplanted people as kids and now we see them and they're 34 years old. Kristen Hicks-Roof PhD, RDN: That's fascinating. And I love how you talked about like, you're right. You were like, you were setting the stage for me because I love physician, dietician collaborations. And I love really elevating the role of dieticians on clinical teams. know, during my time at University of North Florida, I mean, was my research for well over 10 years. So, and it is, it's so powerful when that connection is built and you are. Su-Nui: We will. Kristen Hicks-Roof PhD, RDN: such an integral part and you're validated, you're respected, you have autonomy, right? And I think that's, I was just giving a webinar the other day and I was like, it all starts with as simple as an introduction. If you're sitting at a nurse's station and you look left and you look right and you don't know those health professionals, introduce yourself. What's your name? What is a dietician? What do you do? How do you help the patient? Like a 30 second elevator speech to every single person that you meet in the clinical space and it sounds silly. Su-Nui: Mm-hmm. Kristen Hicks-Roof PhD, RDN: But all of a sudden they're like, oh, did you know we have this person called a dietitian on staff? Like they can help with anything nutrition and then you get referrals and then people know of you. And it all starts from an introduction. So I love that you talked about that and that you feel valued and respected because it just, it's such a feel good. And I think more dietitians deserve that feeling. Su-Nui: I 100 % agree because I think that is one of the most, the complaints I hear more often. Like, oh, I, you know, I write notes all day and nobody sees me. Well, you know, if they don't find a way for them to see you. Kristen Hicks-Roof PhD, RDN: Totally. Well, and one of the things that I was talking on the webinar I was giving the other day is all communications with health professionals should be bi-directional. So what I used to see in my research all the time is they would refer. So a physician, for example, would refer to a dietitian, but very rarely was the dietitian actually talking back to the physician. Yeah, they'd write their note, but like a physician doesn't know our lingo. They don't know what some of our terminologies are or what the complaints are. So Yes, a note is imperative for billing and reimbursement purposes, but we need to figure out strategies of how do we communicate a top line. Here's the issue with the patient. I recommend physical therapy and they can only do well in physical therapy if they have adequate nutrition status, right? Like there's so many layers to this. So I could talk all day. Don't get me on a soapbox or do it. Su-Nui: going. I can too. Kristen Hicks-Roof PhD, RDN: So what has been your most favorite or what you're most proud of so far in your career? Su-Nui: ⁓ I think I have so many great moments, but lately I feel that, ⁓ the impact that I made in GLP once early on was, was great because at that time that patients did not have the direction that we now have. And this field is not all right. It's only like a few years old, but it's feel, it feels like a lifetime. And I was speaking, ⁓ based on what I learned from my patients and, you know, borrowing from, ⁓ other. areas like a bariatric surgery, metabolic surgery. And I was able to really help dieticians understand what GRP wants where. And I was really spot on. Once the guidelines came out, yes, it was that because of course I had taken everything from the evidence that we had available. it was kind of that I'm very proud. And now that I wrote the chapter in obesity, that is like... wow, I mean, I cannot believe like I'm doing this. And when they asked me, I'm like, but no, I'm sure there's other people that know more than I do. But when I sit down and write, I had written so many blog articles, I had written so many guides, I had written so much and communicate so much that it was time consuming, but I was able to understand that if the editor actually likes it. It will be a way to communicate the modern way in which we treat obesity now because the death field has evolved so much in the last five years that we need a refresher. Kristen Hicks-Roof PhD, RDN: I feel imposter syndrome creeps upon all of us, right? Even, I mean, you're a doctor of clinical nutrition. You worked really hard for that degree of those credentials. So there is a lot of value behind that. But I think imposter syndrome is scary. You're like, there's got to be someone else who knows more. And I think it's that is something so prevalent across our profession is like no one knows nutrition as much as we do. They really don't. Su-Nui: Thank Kristen Hicks-Roof PhD, RDN: And so it's our job. We have to take the reins there and say, yeah, I could do that. I'm confident. And I'm sure you've built that confidence over time. And if you're an early career dietitian or nutrition expert listening, like you will continue to gain those strengths and that confidence and those skills. And sometimes you just do things when you're like, well, someone else trusts me enough to do it. So I know I can do it even if I actually don't think I can. Su-Nui: Yeah, I'll do my best, that's all I can do. Kristen Hicks-Roof PhD, RDN: It's going to be great. know that. So what suggestions or tips would you have for someone who's interested in a role like yours? And I would love for you to talk about a role that you can balance both the clinical side and the fun side. how what tips would you give them to be able to do that? And how do you even find a part time gig with benefits? Like, that's awesome. Su-Nui: ⁓ I asked for it. I was not afraid that when I saw that position, I thought that I was going to like it. ⁓ The doctor has a bad reputation among some dieticians because she's really hard, but she's the best doctor. One of the best doctors that I have met. ⁓ Kristen Hicks-Roof PhD, RDN: Nice, see? Su-Nui: So, like seeing what she did, I'm like, hmm, this I can do, I like it. And I interview and I mean, right now there's not that many dieticians and not many with the experience that I had. you know, I told them I can only come here if I get benefits ⁓ and they say yes. Kristen Hicks-Roof PhD, RDN: I mean, I think that's the biggest thing though. Like that's something I know even as a former faculty member, like we don't train students on negotiations, you know, and how to do that both in elevating your role, elevating benefits, increase salary, all these other things. So how did you bolster the confidence or did you learn or get mentorship from anyone to be able to do that? Or were you just playing Frank? Like I'm not doing this without X. Su-Nui: Well, the biggest thing is that I knew that I needed benefits. Like it was no other way around. I needed the benefits and either it was that role or not or something else. So I guess ⁓ when you're hungry, you have to do whatever it takes, right? And sometimes it's ask. But I guess like I had some good mentors ⁓ in terms of like asking more money because we, I mean, we should value ourselves, right? I mean, we... We are asked to do nutrition lectures for free so often or for very little money. And everybody's asking our advice for like, you know, for free. Well, I mean, who goes to the dentist and doesn't pay the dentist? Or if we sell a book, let's... get enough money so we can live ⁓ a life that is comfortable so we can give our kids what they need because you know those like extra school activities they're very expensive. ⁓ So I guess it's just like day to day you have to gather the confidence to ask for what you're worth. Kristen Hicks-Roof PhD, RDN: Yeah, I mean, I think it's really good feedback. Sometimes I think it's easier said than done, but it's a muscle that we can constantly build because you're right. mean, I will say for me personally and professionally, like there are some things where I'm like, OK, I may not get paid for it, but I know it's going to lead to future opportunities. And there's others that I'm like, this would be great. I don't know how much added value this is going to give me personally and professionally. So I need a, you know, Su-Nui: Yeah. Kristen Hicks-Roof PhD, RDN: some sort of honorarium or there has to be an income associated with it. So I try and balance those with what I think like, what's the reason that's the what's the reason I'm going? Who may I meet? What's the audience? How much time is it going to take me? And then I kind of like manage all those factors to then ultimately make a decision whether it's yes or no. And I'm a yes person, which is like to a fault. So I need to scale it back and I have slowly scaled it back because you really do have to have prioritization, especially when you're contracting and consulting work. I'm sure you've had this where you end up having multiple projects that are at the same time. Su-Nui: Yes, I mean, you and also depending on the season of your life you are right. But if you're going to write something that is a guide and you know that they're going to make a lot of money with that, why you're not getting like, you know, some money from that. And you sometimes ask and they're going to say no, and you might have to pass or they will tell you this is our budget or, you know, like, no. But in in also What are the goals for the year? If your goal is to grow as a speaker, you might want to take more speaking engagements even if they're not paid. But if your goal is to grow your business because you need to spend a lot of time in social media and connecting in other ways, then you cannot say yes to those opportunities. Kristen Hicks-Roof PhD, RDN: I really like that you're centering it back into the goals because I think sometimes we say yes and it may not align with like where we're going personally or professionally. So I think that's a really good tip and advice and a nugget of information that if you're walking away from this episode, really be thinking of how do we be strategic and what we're going to be doing, especially when you wear a lot of hats and you have a lot of expertise and you're maybe pulled in different directions. How do you make sure it's aligned with what you're looking for? Okay, well, you kind of alluded to it. I love the continuous glucose monitors that you talked about earlier. was just on a ⁓ on an in-person event the other day and it was for people with diabetes, but I was questioning them. I'm like, well, could we use this to measure ketones or could we use this for people with mate management? Because there's you get so much data from continuous glucose monitors that yes, I know things are like maybe you're in the normal, right? But what happens if you know that certain foods spike you more than others? Because every human is so different. So I think that's really interesting. And I don't know if this is your response, but if you had a crystal ball, Sunui, what do you think is coming next in nutrition? Su-Nui: I don't know if you really need a crystal ball because I feel the future is here. With technology and CGMs are one technology, right? But there's tons of different technology, especially with AI and everything that can be built using AI. ⁓ That is gonna allow us to do more personalized nutrition because you're right. I mean, you get a lot of information. So you're not like giving them a meal plan or an education that you think is gonna work, you're working with data. So you know what works or not. And then the patients are getting the feedback on that moment to where they're like, no, I need to go for a walk because every time I don't walk, my sugar is gonna spike. And like you said, as you said, not only for diabetes, but in terms of weight management, we know now and we're paying more attention to the fact that insulin resistance impacts weight management or obesity, and then obesity or excess weight impacts ⁓ insulin resistance. So now we're seeing a lot more of ⁓ this type of ⁓ correlations. So I think hormonal health, that is coming, well, not is coming, it's here again. ⁓ we're treating, I mean, I'm talking about with management because of course that's what I know, right? ⁓ But we're seeing obesity as a chronic disease that is multifactorial. And just because we're seeing it different, we are not treating it at the level of exercise, nutrition, but sleep, ⁓ stress, hormones. So that is, I think we're gonna change a lot in the way we are. nutrition and how we personalize it and the technology that we ⁓ will be using. And of course, with GLP-1s, crazy things are coming up. Triple agonists and phew. Like there's like a hundred like GLP-1s on the market and some that are not GLP-1s, but they're gonna also help us ⁓ with the food noise. Kristen Hicks-Roof PhD, RDN: I mean it almost- I I agree with you. It is so fascinating. If you are in research and you're looking at what's in phase one, phase two, phase three clinical trials, mean, some of these are just remarkable of the success they can have. But I love what you talked about of this is multifactorial, right? Yes, nutrition is a piece of the pie, but there's also a lot of other pieces. It almost reminds me back when I feel like I was an undergrad and they were like, Labs are so important in nutrition. We have to be able to read and interpret labs. And sometimes I feel like we get away from that, maybe not as much in the clinical space, right? But in many other spaces. But I think the opportunity with medications and weight management or comorbidity management, we're going to continue to use labs of many different sizes. It's not just your standard lipid panels anymore. you're gonna start seeing, right, whether it's continuous glucose monitors or HOMA-IR for insulin resistance or sleep in and metabolic regulation. Like there's so many other markers that the science and technology have, I wouldn't say fully caught up. I don't think we're all the way there, but I think we're getting there. And I think it's really an exciting opportunity for dieticians to come in at this pivotal spot to be able to interpret. all these different types of labs and have curated personalized nutrition. Is that what you are? That's kind of what you're, you're saying you think is the future. Su-Nui: Yes, and talking about the labs, mean, now you can walk into a lot of labs and get actually nutrition panels that now that additions we can use. So yeah, we can personalize nutrition to a much deeper level than we have ever done. Kristen Hicks-Roof PhD, RDN: Yeah, it's going to be really interesting. So, man, it was such an awesome episode. I'm so glad I was able to have you on. It's always great when I get a reconnect. And I know we've connected over the years, but it's always great to reconnect with my students and just see what incredible careers they've built. And I think you're doing an awesome work in the GOP one space. So if you need a GOP one expert, Sunui is the go to. So definitely reach out to her if you have any questions. But if you enjoy the episode, make sure you like, subscribe, leave a review. But most important, Check out the next episode because every episode I bring on a different dietitian and nutrition expert to tell their story and give you tips and advice of how to be successful in that career.