Podcast Summary
Living with Clinical Obesity: A Conversation with Dr. Fatima Cody Stanford: Obesity is a complex disease that requires medical treatment, not a moral failure or a matter of willpower or motivation.
Obesity is a disease, not a moral failure. Lulu Garcia Navarro, host of NPR's First Person, shares her personal experience of living with clinical obesity and the shame and guilt that comes with it. She had a life-changing conversation with Dr. Fatima Cody Stanford, an obesity medicine specialist at Harvard Medical School and Massachusetts General Hospital, who helped her understand that obesity is a complex condition that requires medical treatment. Dr. Stanford has dedicated her career to treating obesity and researching its causes and effects. She emphasizes that obesity is not a matter of willpower or motivation, but a disease that requires medical intervention. As new weight loss drugs like semaglutide (Ozempic and Wegovy) enter the market, there is a cultural debate about who should take them and when. Dr. Stanford encourages a more compassionate and evidence-based approach to understanding and treating obesity.
Addressing obesity in underserved communities: Behavioral interventions for obesity in underserved communities show promise but lack sustainability. Medical education should prioritize obesity education to better equip doctors.
Behavioral interventions focused on diet and exercise for addressing obesity within certain communities, such as the black church community and lower socioeconomic status groups, have shown improvement during the intervention but often fail to produce sustainable results. Additionally, at the time, obesity was not a significant focus in medical education, leaving doctors like Dr. Stanford underprepared to effectively treat patients with obesity. These findings highlight the need for more comprehensive and sustainable approaches to addressing obesity within these communities and for integrating obesity education into medical curricula.
Physician's personal experience with obesity treatment: Despite recommended healthy habits, obesity treatment falls short. More comprehensive programs and physician education are needed for effective solutions.
The way obesity is treated in healthcare often falls short of providing effective solutions for patients. A physician shares an experience where he realized a patient was following all recommended healthy habits, yet still struggling. He then pursued further education in obesity medicine at Harvard and Mass General, but faced resistance from his attending physicians due to their lack of knowledge in this area. This highlights the need for more comprehensive obesity treatment programs and education for physicians to better support their patients. The current business model, which often outsources treatment to for-profit enterprises, places the financial and moral burden on the patient, rather than a collaborative approach between healthcare providers and patients.
Recognizing Obesity as a Disease: A Turning Point: Dr. Fatima Cody Stanford's efforts to change the narrative on obesity as a disease during her fellowship led to a pivotal vote in the medical community, acknowledging obesity as a chronic disease.
Obesity was not widely recognized as a disease in the early 2000s, despite the struggles of those suffering from it. Dr. Fatima Cody Stanford, an obesity specialist at Harvard, recounted her experience during this time when she tried to change the narrative but faced resistance from the medical community. During her fellowship, she was invited to give a talk at the American Medical Association about obesity as a disease, unaware that a pivotal vote on acknowledging obesity as a chronic disease was coming up the next day. The debate centered around the belief that obesity was a consequence of other diseases rather than a cause itself, and some argued that behavioral interventions like Weight Watchers could solve the issue. However, Dr. Stanford saw obesity as a disease of the brain due to the brain's role in regulating fat storage. The vote to acknowledge obesity as a disease went through the following day, marking a significant shift in the medical community's understanding of the condition.
Two primary brain pathways regulate weight: Environmental factors like diet, sleep, and screen time can disrupt natural weight regulation pathways, leading to obesity. A new drug, Wegovy, targets appetite-regulating areas of the brain and shows promise for weight loss.
The brain plays a crucial role in regulating weight through two primary pathways: the PAMC (proopio melanocortin) pathway, which signals to eat less and store less, and the AGRP (agouti related peptide) pathway, which signals to eat more and store more. Our organs, genetics, and environment can influence which pathway is signaled. The increase in obesity rates despite unchanged genetics suggests environmental factors are at play, including changes in diet quality, sleep patterns, and screen time, which disrupt our natural rhythms and increase fat storage. Despite efforts to treat obesity with medication, some drugs have been pulled due to safety concerns. However, a new drug, Wegovy, targets the appetite-regulating areas of the brain and has shown promising results for weight loss, although not everyone responds. It's important to remember that semaglutide, the active ingredient in Wegovy and Ozempic, is the same drug.
Significant health improvements beyond weight loss with semaglutide use: Semaglutide and similar drugs, initially approved for diabetes, can help eliminate diagnoses related to conditions like sleep apnea, arthritis, and diabetes when used for obesity treatment. Focusing on overall health and happiness, rather than a specific weight, can lead to improved metabolic health and quality of life.
The use of semaglutide and similar medications, like Ozempic, for treating obesity can lead to significant improvements in overall health beyond just weight loss. These drugs, which were initially approved for diabetes, can help eliminate diagnoses related to conditions like sleep apnea, arthritis, and diabetes. By focusing on helping patients reach their happiest, healthiest weight, rather than a specific target weight, doctors can improve their patients' metabolic health and quality of life. This approach aligns with the fat acceptance movement's goal of treating people with dignity and respect, although there is ongoing debate about whether obesity should be considered a disease. Regardless, recognizing obesity as a disease is seen by some as a necessary step towards addressing its health consequences and offering effective treatments.
Societal biases and misconceptions prevent 99% of eligible individuals from receiving obesity medications: Societal stigma hinders access to effective obesity treatments, impacting those with diabetes and contributing to supply chain issues
Despite the proven benefits of medication for managing obesity, only 1% of eligible individuals in the US are receiving these interventions. This discrepancy can be attributed to societal biases and misconceptions about obesity being a disease, rather than a vanity issue. The recent shortage of semaglutide, a medication used for both diabetes and obesity, highlights this issue, with some blaming overweight individuals for "stealing" the drug from diabetics. However, it's important to recognize that 80% of people with type 2 diabetes have obesity, and many use these medications for their dual benefits. Misuse of these medications for weight loss by those who don't need them further complicates the issue, leading to supply chain problems and concerns about long-term effects. We need to challenge these biases and recognize obesity as a chronic disease that requires appropriate medical interventions.
Understanding Wegovy's safety profile in diabetes patients informs its use in obesity treatment: Wegovy's safety profile from cardiovascular outcome trials in diabetes patients indicates its potential effectiveness and safety in obesity treatment. Societal attitudes towards long-term use of weight regulation medications need to shift for equitable access and improved health outcomes.
Wegovy, a medication used for weight regulation, has a strong safety profile based on extensive cardiovascular outcome trials in patients with type 2 diabetes, most of whom have obesity. This understanding gives us a good indication of how the medication would perform in patients with a lesser degree of illness. The conversation around the use of medication for obesity treatment is part of a larger one about the role of medication in our lives and the shifting societal attitudes towards it. While there has been progress in reducing stigma associated with the use of medication for mental health conditions, there is still pushback against long-term use of weight regulation medications. The recent approval of new medications for obesity treatment is seen as a tipping point, but there are concerns about equitable access and potential health disparities. As a doctor, I believe that the focus should be on improving health, and these medications can be effective tools for weight regulation and cardiovascular outcomes. I hope that as societal attitudes continue to shift, insurance coverage and access to these therapies will align.
Addressing obesity as a chronic disease: Systemic changes like equitable access to obesity treatments and better education for healthcare professionals are crucial to addressing the obesity crisis. Seek help if struggling and remember it's not your fault.
Addressing the obesity crisis requires systemic changes, including equitable access to obesity treatments through Medicare and better education and training for healthcare professionals. The speaker emphasizes the importance of treating obesity as a chronic disease and not just sending patients to specialists. For individuals struggling with obesity, the speaker encourages seeking help and reminds them it's not their fault. There are over 6,000 obesity medicine physicians in the country, but more education and resources are needed to reach the vast number of individuals affected by this condition. The production of "First Person" was mentioned, with thanks given to the team involved.
