Welcome to the Therapy for Black Girls Podcast, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves.

I'm your host, doctor Joy hard and Bradford, a licensed psychologist in Atlanta, Georgia.

For more information or to find a therapist in your area, visit our website at Therapy for Blackgirls dot com.

While I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional.

Hey, y'all, thanks so much for joining us for session four twenty six of the Therapy for Black Girls Podcast.

We'll get right into our conversation after a word from our sponsors.

Today, doctor Fatima Cody Stanford joins us for a compassionate conversation about weight, health and healing.

We're exploring why obesity should be understood as a chronic disease and not a moral failing, and discussing new treatment options like GLP one medications that are changing lives.

Doctor Stanford brings both scientific expertise and deep empathy to this work.

She's an obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School.

What makes our perspective so valuable is that she understands the unique experiences of Black women navigating weight and health in a world that often judges us harshly as one of the few black women leading research in this fields.

Please how chronic stress, systemic barriers, and generational trauma show up in our bodies, and ways that traditional medicine has often overlooked.

During our conversation, we talk about the science behind weight regulation, how new medications actually work, and why it's time to move beyond VMI as the only measure of health.

Most importantly, doctor Stamford reminds us that seeking help for weight related health concerns isn't giving up or taking the easy way out.

Is taking care of yourself with the same compassion you'd show a loved one.

If something resonates with you while enjoying our conversation, please share with us on social media using the hashtag TVG in session, or join us over in our Patreon channel To talk more about the episode.

You can join us at community dot therapy for Blackgirls dot com.

Here's our conversation.

Thank you so much for joining us today, doctor Fatima.

Well, it's a delight to be here.

Thank you.

So you have done so much incredible work around obesity, medicine, health disparity.

You know a lot of your work in your clinical research has been around why obesity really should be classified as a chronic health condition.

Can you say more about why you think that shift needs to happen?

Absolutely, and I'm actually going to change it from being a condition to a disease specifically, and I'm going to tell you why a disease is opposed to condition.

So when it's classified as a disease, we actually treat it with the wherewithal that it needs.

So when it's a disease, we have different forms of therapy from lifestyle to medication to surgical interventions that we might utilize to treat it.

And we actually have those full gamut of things that we can actually use to treat obesity.

So let's talk about different things.

We have bariatric surgery or what we call metabolic and bearatric surgery that treat it for patients that have the most severe disease, process pharmacotherapy for those with kind of moderate disease, and then lifestyle forms of therapy which may fall in the diet, physical activity, and behavioral strategies which may be working with our psychologists and psychiatrists and things of that sort.

And so when we recognize it for the disease that it is, and we can get into that a little bit in terms of talking about its origin points, which are in the brain and the atapost tissue out of post is a fancy word for fat, but that is actually an organ and people don't realize that that is a metabolically active organ that has targets.

And so when we can target these organs within our body, the brain, the fat mass, we can actually treat it for the disease that it is and give it the wherewithal that it actually needs.

So, Asima, I am not a physician, so I feel like some of these things I will definitely not understand, but I got you.

I do want to understand, Like why has this been missed in the field, Like why are we just now kind of understanding obesity as a condition of our disease of the brain in fat as opposed to like a wheel pop kind of being.

I think it comes down to it being a visual disease, right.

We judge the book by its cover.

We look at a person.

If someone happens to carry more excess weight, we assumed that they just did something wrong, right, they didn't get up and exercise this morning, or they ate too much, they didn't push away from the table, so we assume that it's their fault, right, that they caused this for themselves.

Most diseases that people have aren't ones that are visual in nature.

You can't see if someone's blood pressure is high, right.

You can't necessarily see if someone has diabetes unless they've developed indoor and damage from the diabetes.

Maybe they've lost some of their limbs, maybe they developed blindness, maybe they've developed kidney disease and are having to go to dialysis or something.

Similarly, with some of the types of cancers, you don't necessarily see that they have cancer unless they've started to lose their hair or things of that sort.

You don't really know that someone has cancer.

Most things you don't really know unless you're the doctor and you have the patient chart.

And the chart isn't usually a physical piece of paper any more, rights on a computer and I can read it and I say, oh, well, you have this, you have asthma, or you have this or you know, these diagnoses that you can actually read.

But unfortunately, obesity is very visual, and so we as humans we start to judge the book by its cover, and we start really early in life we actually start to demonstrate signs of bias towards individuals that carry excess weight.

I'm going to tell you the age we start to really judge people.

Three years old.

That's when we really start to judge people.

So it starts on the playground, it starts in preschools.

It's when we say, that person is larger than me, and so I'm going to hooke fun at that person and assume that they did something wrong.

And we are getting those messages from the people around us, the adults around us that are saying, oh, there's something wrong with that kid, there's something that's not right.

And you can imagine that as we get older, we just begin to do more and more of that.

Those persons that happen to carry more weight become the laughing stock.

We turn it into comedy.

It's an acceptable form of laughter that we have.

It's no longer acceptable to do that towards someone because of their race or their ethnic background, or for other reasons.

But if someone happens to be larger in size, it's acceptable, and we are just given a pass to talk about them because of their size.

And so, because of all of these things, people, and I'm going to put doctors on the chopping block here, doctors, nurses, exercise physiologists, physical therapists didn't take the time to really learn the pathophysiology about the disease because they too assumed that it was just a matter of eating less and exercising more.

So, can you talk a little bit more about, like some of the science behind why OBCD should now be classified as a disease, what is actually happening in the brain and in.

The ved Absolutely, I'm so glad you've asked me to do that.

So there's two really pathways around the brain that tell us how much to eat and how much to store.

So there's a particular part of the brain called the hypothalamus.

It's a really small part of the brain, but there's two pathways, and one pathway is our anorexigenic pathway.

You know, when we hear anorexia, people are told not to eat right or told not to store fat.

Mask and that part of the brain is the fancy word I'm going to throw out there, don't worry about it.

It's called the palm sea or the propium milaniportant pathway.

And so if we travel down or we signaled out down that pathway, you can imagine we're going to be leaner in appearance.

Right, We're gonna store very little fat mass.

For those people that travel down that pathway, they have high levels of something called B D and F which stands for a brain derived neurotropic factor.

So they have high levels of that, they have lean appearance.

Okay, So they signal down that anal rexogenic pathway.

Now I exclusively treat patients with obesity, and they don't signal so well down that pathway.

They signal down a different pathway called the A g r P pathway, which stands for the agoty related Peptie pathway.

Now we talk about anal rexogenic, there is the opposite of that, which is called orexogenic orexigenic.

You express more fat mass and you have low levels of BDNF.

Okay, So when you have that, you are stimulated to eat and you're stimulated to store more fat mass.

So that's what's going on in the brain.

Okay, so that's the brain piece of it now talked about is a metabolically active organ right, So it actually is metabolically active.

And when it's being metabolically activated, if I'm stimulating that anorexogenic pathway, you can imagine I'm not storing as much fat mass.

But if I'm going down the other fat pathway, I'm storing more fat mass.

And there's things in our environment that can cause us to store more or less.

Right, So if we have more stress in our bodies from external stress or stress orders, whether it be chronic stress, you can imagine that I'm going to store more fat mass and actually activate more of that old rexogenic pathway.

And that's really important for us to note.

So I think it's really important, particularly as a black woman who's drawn to this, to recognize that chronic stress and stress ors can activate that pathway.

So let's take us back to something that all of us remember and that all of us were affected by, and that was COVID nineteen.

And so during COVID nineteen, regardless of who you were, where you were, I think we can all agree that we underwent stress.

Some of us had more or less stress.

But I think that we universally experienced stress, and so during that time we may have noticed some weight changes during that time that we can't maybe account for.

Because what was very interesting also is that there was an increase in physical activity and sometimes even healthier eating because a lot of us were at home.

We weren't going out to eat, we weren't doing all of these things.

So what was it?

What was the universal thing that was across all of us.

We had an increase in stress, and we had an increase of stress.

We have an increase in storage of ada posts.

What is ada posts?

That mass because our body thinks something bad is happening, and something bad was happening, it was a whole pandemic, and it thinks it needs to store to protect us from what else is coming.

So hopefully that helps us understand a little bit about this kind of disease process.

It gets more and more complicated from that, and we can go down different pathways and other things.

But that's some of the basics surrounding why obesity is in ded a disease process.

Thank you so much for that explanation.

That is very helpful.

I appreciate it.

Yeah, so you know something else I definitely want to talk with you about.

Is the rise in GLP ones we are seeing lots more attention there medications like ozimpic and we gob and manjaro, lots of different options.

And are those medications the ones that you were talking about, Like, if we classify this as a disease, now we have a whole arsenal of pharmacy, kinds of medicines that can be used to actually take care of this disease.

Yeah, but you know what's really interesting.

I'm glad you brought those up, but I want to talk about historically, we've actually been using medications to treat obesity since nineteen thirty three.

So my maternal grandmother was born in nineteen thirty three, and I'm going to say that you and I were both not quite around since then.

So the FDA has been approving medigations to treat obesity since way back then.

Now, I'm gonna say that a lot of those medications were problematic.

But let's talk about the gop ones, which everyone is talking about these days, and let's go back to that pathophysiology we just learned about.

So the way these medications work is they actually stimulate that anorexigenic pathway, that pathway of the brain that tells us to eat less and store less.

So for patients that go on these medications, they'll tell you, you know what, I'm really hungry.

I A so may not even be thirsty because it's stimulating that anorexigenic pathway.

Not everyone responds to these medicines.

These are not a cure for the disease of obesity.

I will repeat that again.

These medications are not a cure for obesity.

They are a treatment amongst treatments for the disease of obesity.

Okay, actually, don't repeat it a third time.

These medications are not a cure for obesity.

But for those patients that are responders, they stimulate that anorexogenic pathway.

And so for those that are listening that may be one of these that are responders, they'll be like, yeah, you know, it does seem to stimulate that pathway.

Wow, I do feel different.

For those that use kind of more layman's terms and terms that I wouldn't use per se, but they'll say it quiet's this food noise.

And I'm putting that in quotes on purpose because they may be preoccupied with this idea of like what's my next meal?

Not only was my next meal, what are the mills for the rest of the week or the next two weeks.

Like there's a preoccupat pation of like, gosh, I need to be thinking about that.

I need to be mil prep, I need to be doing this, I need to be doing that.

But it turns down that noise.

Think about like turning up the volume or whatever your favorite music is, and then all of a sudden it's on mute and you're like, well, look at that.

My patients may ask established Eaver, is this what you feel all of the time?

And I'm like, I guess, Oh, I don't know, because I don't that's not something that I sense, but I understand what they're talking about.

So it stimulates that pathway and then it down regulates that other pathway, that O rexygenic pathway that they may have been struggling with for quite some time.

It downregulates that.

So this is how those medications work.

That Ozimpic and will govy ozempic wigov are the semaglatide.

They are the exact same drug, Ozimpic as the trade name for patients with diabetes with govy for patients with obesity.

Manjaro is a dual agonis a combination of two different drugs, a gop one.

Gop one stands for lucagon like peptide one, and then it has another agent in it, what's called a GIP or glucose insulin tropic polypeptide.

Two medicines brought together all of these things.

However, I need this to know.

Gop one is in our body.

Okay, let me repeat that again.

Gop one's all of us that are human.

I don't know if there's any ai robox work walking around yet, but all of us that are human have gop ones in our body.

For those of us that have more gop one on board, we have a leaner phenotype because it's stimulating that anorexogenic pathway.

So we don't need to administer a SHOP because we already have it on board.

GIP, the dual agon is this on board.

We also have GP in our body.

GOP stands for glucos insulinentropic polypeptide.

So they combined these two things.

It is more powerful than the gop one alone.

Okay, It helps work together to stimulate even more total body weight loss by helping to regulate these pathways and our brain in our gut.

So hopefully that helps us understand that in order for us to have targets, there has to be some disease process to target right for us to work on.

And so I appreciate you sharing because I did not know that there were other medications that were designed specifically to help with the disease of obesity.

But my understanding is that the golp ones, of course, were originally designed to or they found that they worked with diabetes management, right, and so is the weight loss an off label impact that they found?

How did we realize that golp ones also could be used for obesity?

Absolutely, So let's go back to twenty years ago when these medications were first approved for the treatment of type two diabetes, and that was a drug called exenotite was is still called axenotype bieta, And when they were doing those first trials that were published, they started to notice a secondary benefit from these medications.

They were noticing that the patients going on these medicines, patients with type two diabetes, were getting a secondary benefit with weight being a positive response.

Most of the medications used to treat type two diabetes at the time were drugs called safana aureeas and like glipizide, glameaparide, these types of medications.

Unfortunately, those medications typically cause weight gain, and so they were noticing, Wait a minute, what's going on here.

We're noticing some weight loss, so we're getting dual benefits.

It's also important to note because I always hear this argument, oh, we're taking medications from patients with type two diabetes.

Let's get something straight.

People, eighty percent of patients with type two diabetes also have obesity.

So are we really taking it away?

Are we just treating the same people?

First, Let's get that, let's get that into wraps.

And we must also note that when we're looking at these medications.

Now, these medications are approved in both patient populations.

They're proved for patients with type two diabetes, and notice and capital A, N and D they're proved in patients with obesity.

Okay, so two patient populations, but notice there is a strong overlap between those two patient populations.

Patients with type two diabetes unfortunately often half obesity conc currently.

Okay, So they noticed when they looked at those trials and trial after trial after trial, they were noticing some weight benefit.

Now, when you look back at that initial gop one that was approved that we just talked about exanotide or bieta, it was a much weaker gop one, So that's why you weren't hearing about it so much.

And there was no social media anyway back then, so you aren't going to probably hear about it in the same way.

But as they started to refine and they moved over to drugs like dula glutide or loraglatide and et cetera, et cetera, they started to continue to see this so much so they were like, hm, particularly Novo Nordisk, who was the first to get an agent out and approved for obesity.

They said, okay, well, let's just get something approved specifically for obesity, and that was loraglatide that was a once daily injection under the trade name of sex Cinda after Victoza was approved, so once daily injection, and they were like, let's see, let's look at this both in adult patients and in pediatric patients.

And hence the first medication gets across the finish line specifically to treat patients with obesity.

Now, I can tell you that a once daily injection was not quite as popular as a once weekly injection, and as we also saw the percentage of weight loss not quite be the same as what we saw with semaglatides.

So semaglatide is that ozempic and mongovi we started to see fifteen percent total body weight loss.

Now that created some interest from the greater population and from doctors.

But not only the total body weight loss.

It was the resolution of comorbid conditions.

And what do I mean by that.

We started to see a reduction in things like major adverse coronary events like heart attacks and strokes, improvement in things like obstructive sleep, apnea improvement, and kidney outcomes improvement and heart failure.

All of these things we started to see that really increased the interests of doctors.

I will say that from the general population, I think it was the total body weight loss that really increased the interests.

Got it.

And so now we are at the stage where there's been more development in the GLP ones and now has led to the interest and kind of the excitement that lots of people are expressing in terms of being able to use these exactly.

I think that just more so, let's look at that true zeppetite, that dual agonist.

Right, we saw the fifteen percent and some maglati.

Now we're seeing numbers of like twenty two percent in that particular medication.

So people are like, what twenty two percent?

This is average?

Okay.

So for those that are listening averages averages, think about when you're in school and you got the average score and some people got a higher score and some people got a lower score.

Average is average.

So we just have to be aware that not everyone is an average responder or above average responder.

And that's really important, which is why I made that comment earlier.

It is not a cure right on, everyone is going to respond.

There are going to be some high responders and some low responders.

And by that it's not just in terms of like I told you that weight loss, looking at the resolution of obesity relay, disease improvement, and metabolic profile like things like your liver numbers or your cholesterol numbers or blood pressure, these things that we really care about in terms of improving your overall health.

Waste circumference, right, how much way you're hearing around the mid section, which we know predispose this to things like stroke and heart attacks.

These are really important things when I'm working with my patients that we go over how well does that blood sugar improve?

Are we seeing that come down?

Those are things to really really pay attention to.

Got it, And you're giving us the perfect segue into some of my next questions around if somebody is thinking like, hey, maybe this will work for me, what kinds of things should they be thinking about, and maybe what kinds of conversations should they have with their physicians if they're considering GLP one.

So I think it's really important to think about is this a disease they actually have.

I don't want you going on this medication.

Oh I just need five pounds.

I need to look five pounds because I want to look cute for that winning I'm going to be in, you know, and you know I want to look cute because I'm going on a cruise and you know, I really want to look cute in my biking.

This is not no, I'm not This is not what this is about.

This is for treating disease.

Okay, So a lot of people have gotten into this idea of doing this for vanity.

This is not that conversation.

I know a lot of people, not patients I treat.

But I've heard in the ethers in the social media community, whether it be ig or TikTok, that people are doing this for vanity reasons.

This is not that conversation, and I really hope people are taking this seriously because when you go want a medication of this kind, this is a long term commitment.

We're treating a chronic disease.

If this medication or medication class works for you, you are to use it indefinitely and definitely means for the rest of your life, because if it works, you need to use it for the rest of your life.

If you take the medication away and it worked for you, you will regain whatever you lost.

So if that was fill in the blank number of pounds, forty fifty whatever, I don't know, you will regain that.

And then you might know, well, how do you know that, because we've done studies.

We've done studies that demonstrate this true fact.

And it's not just about regaining the weights.

Also, whatever health benefits you've gleaned from being on the medication, unfortunately, those things will go away also.

So this isn't like I said, a vanity conversation.

This is about looking at the overall health benefits.

Now, I think that's a very important conversation to have.

One of the key issues, however, with these medications is the access piece.

These medications can be very pricey if not covered by your insurance.

Now, if you have the best insurance plan, maybe you have the Rose Royce Bugatti insurance plan.

Okay, if you got that, what Rick Ross I've rolled up?

You know, might Begotti, right, that's what he says.

Okay, So if you rolled up in that, then you have the insurance plan, then that's great.

That means you're playing like a thirty dollars copay a month and you're like, I got this great, fabulous for you.

Then this is a moved conversation.

I'm happy for you.

This is a non conversation.

But let's say you don't have that, then these medications can be very, very pricey out of pocket.

What are we talking about here in the US compared to our friends in Canada or in the UK.

We're talking one thousand plus a month.

That is a lot right now.

I can tell you that Eli Lilly, for example, has discounted their prices to three hundred and fifty to five hundred a month.

That's still a lot a month for these medications.

So just be aware that if we're talking a price point and you don't have coverage, these medications can be out of reach.

And we're hoping that for example, Ela Lilly has an oral that may be coming on the market at some point and then you're Beary in your future, and we're hoping that will drop the price point for an oral medication, not just an injectible or a daily oral, that will make it accessible to more individuals because the price point is so high.

We know that patients that have medicare this medication is not covered at all if you have obesity.

It's only covered for patients with type two diabetes.

We know in certain states with Medicaid not covered.

If you happen to live in Massachusetts, it is covered.

So it just depends on which state you are in.

How well have your legislators the lawmakers govern everything that happens, and if we're not seeing that in today's world, I think that we are living under a rock.

But the legislators are governing coverage, and so I think that these are important considerations to be having.

I think go over sign effects with these medications right, this key side effects.

I always tell my patients the number one, the number two.

The number three side effect is nausea.

Okay, got that number one, number two, number three.

After that, we have issues with constipation.

These medications do slow movement through the GI track.

I know this kind of sounds like a smelly conversation to have with your doctor, but this is a really important conversation.

You would have a good bowel regimen.

If you're like a have a I you know, had a bowel movement once every five or six days.

That is not normal.

Okay, that is just not normal.

This is something that you really need to be working with your doctor.

You need to be hydrating.

We need to be doing things to improve that bowel regiment because we don't want things to get stuck.

I would say other things that we want to think about, things like fatigue.

You know, are you have running into issues with fatigue with these medications?

Are you running into more serious side effects which could be things like pancreatitis where we would need to stop the medications, or are you losing weight so rapidly developed gallbladder issues if we if you've already had your gallbladder out, not such an issue if you're on the medications.

If we need to take your gallbladder out, that's not necessarily a problem.

You can develop issues with your gallbladder surrounding wrap up weight loss from just lifestyle modification, or with surgery or with other conditions.

It's just something that we need to be mindful of.

Partricularly started developing certain types of pain.

So these are conversations I think you should be having with your doctor if you're on these medications.

More from our conversation after the break, I want to go back to the conversation around the cost of the medication, doctor Fatima.

So is the cost reflective of it kind of being a newer drug and like there's no real generic and so of course it's more expensive.

Or is it a case of you know, the field not really recognizing OBCD as a disease that can be treated and then it's feeling like a luxury like kind of medication as opposed to like, know, this person needs this to kind of be I'm going to say it's.

Both, and let's talk about that.

So Number one, these companies, these medications haven't turned into generic yet.

And so when they haven't turned into generic, that means that there can't be any competition yet for these medications.

Now I'm going to give a caveat because unfortunately there are compounded versions that existed for these medications.

These medications have now been ruled to be illegal in the country.

But this has only happened within the last few months.

With some people that may be listening to what I'm talking about them maybe, well, I get my compounded drug.

So there have been strategies I think that some compounders have used to develop a drug that's cost effective.

And I'm doing air quotes because these are not the actual drug.

And the reason why I never prescribe compounded medications in this field is that they've never undergone in any research trials.

So how we're prescribing them to whomever, Jane or whomever, I don't know any of the safety data for that specific agent compared to the trials that were performed on the seventeen thousand that were in some magnetide or whatever.

And so I believe in giving my patients the best possible treatment and something that I will want for myself or my siblings or my parents.

And if I don't feel comfortable in giving my patients exactly that then I won't prescribe it.

So I will not use the compounded because I can't give you the paper that shows you this is what we can see.

Oh, we're going to see forty five percent nausea, and then we're going to see you know, this is what I'm expecting.

So that's an issue.

Now the compound it will say, oh, well, we're going to give it to you at this cheap price.

But it's like you're going to get something from the makeshift store and you're like, I don't know if that's going to really tastes like I wanted to taste it, may or may not go bad.

It's kind of something like that, and we unfortunately saw several deaths last year and over nine hundred hospitalizations from some of these compounded drugs.

So from a safety perspective, I think we just need to be well, now I'm not saying that you won't have something from the actual agent, but at least we know what to expect, and if you were to go to the hospital or whatever, we know what agent we need to respond to you.

What are we looking for?

Kind of like it was able to roll off.

What are these adverse events that we can anticipate.

I know what to look for, but if you're giving me some type of combat, I don't what am I I don't know what it is really like, what is it?

I don't know?

M thank you so much for it.

Yeah, for breaking that down like that.

So one of the things that has also been a large part of the conversation is this idea of something called the ozimbic face right that people's faces start to look different after using the medication.

Is this accurate and if so, is there a way to prevent or avoid this?

So this idea ozimpic base, ozempic butt, all the things, is it really specific to ozimpic or any of the compounds.

Whenever someone loses weight or a large amount of weight, we have fat stores.

So we have bat stores in our face, we have fat stores in our butt.

I e ad a post right that we've talked about, and so you can imagine that if you lose a lot of weight, you don't selectively choose where you lose weight, right, like you can't be like you know what, I feel like this is like a going back to like my childhood and it's like zap here, you know, like you and that from this particular area is you just lose all over it, and so people may feel like they're kind of more gaunt if they lose and they lose so much from their whole body.

So what I've heard from some of my dermatology colleagues or my facial plastic surgeon colleagues is people may do I don't even know all the terminologis and not this like fillers and different things, because they feel like they may have lost more if they lose.

They are high responders to these medications, but it's not specific, like I said, to just these medications.

If they lost a lot with diet and exercise, if they lost a lot from surgical interventions, whatever it might be.

It's so it's not specific to the medications.

Got it.

What are some of the other big misconceptions you think about gop ones?

Like I said, I think people think these are miracle drugs, like they're just magically going to work, and that's not true.

Like I said, there are some high responders.

I think that patients presume that if they come off that they'll just completely stay the same and that they won't regain the weight.

A large majority of patients will, and I think that it's important to recognize that because these are working so prominently on how the brain sees weight, I think that people think that they're the easy way out.

I don't see these as per se, the easy way out for a lot of people that have struggled their whole life, or maybe they've struggled after they had children, or maybe they struggle post menopause or whatever the reason of why they ended up developing obec It doesn't matter what it is.

This may be a tool in the toolkit that helps them to achieve a healthy weight.

And so this idea that it's someone that's just you know, going the easy way out, I don't see it as that.

So I think these are all misconceptions surrounding the use of gop ones.

The doctor of Vitiama, I know a lot of your work has also been around like the black community and like talking about obesity and like how that may be connected to like culture and like food and those kinds of things.

What are you seeing or do you feel like this is promising, like the advances that we are seeing with gop ones and other medications in terms of what it looks like to have obesity management in the Black women community.

Yes, you know, I see very large percentage of black women and men, but mostly women.

For my guys, I don't know if you're listening out there.

And I think the reason why that is is because when you see a black woman in the space doing this, I think you feel comfortable going to see a black woman.

The first person I saw this morning was a black woman, and I think we sense comfort in seeing each other.

I think that we identify with each other's stories.

We're not all of the same, We're not like this monolithic person, right.

We are all different.

We all have different experiences, but we unfortunately have shared trauma, and a lot of how we end up with developing this disease disproportionate to our counterparts, has to do with our trauma, something we call allostatic load.

We take on more in society than I think any other group.

We're always having to prove ourselves in every space, and that stress, that chronic stress, whether it's in our families, whether it's in work, I think contributes to us having the highest OBESI rate of any different group, particularly here in the US.

When you're able to come in and see someone like me and not have to validate who you are and explain that piece.

Well, let me let me explain.

Well, you know, as a black woman, you don't have to do that with you.

I understand that because I had I live that each and every day, and I fill that each and every day.

And so when we have tools, whether it's surgery or medication or all the life stules or putting any of this, I can at least say, okay, yeah, I got that, I live that piece.

Let's talk about what we're going to do about it now.

Okay, whether it's in this family as because I take care of a lot of families of black women, but let me help take that burden off of your table, and let's try to find what works for you.

Recognizing that works for you, maybe there's a different than what works for your sister or your daughter or whatever it is.

And I think that these tools are helping to alleviate some of that burden, but recognizing that that there's other stressors.

I'll give one example that helps maybe people understand of just the different types of people.

I might see one of my patients who's been with me for twice the time she does happen to be on a GOP one.

We did her telemedicine visit last week, and she was voting clothes in the laundromat while we were on the telemedicine visit.

Now, I don't know how her if she had a white doctor, how that would have gone.

But I was like, wait, manut, you're not voting that sheet right, and she was like, I got this doctor standford.

But you know what she was dealing with.

She had just lost something with section eight at the same time she was in the laundromat.

Actually, it wanted to her to go to surgery.

She wanted to go to surgery, but the psychologist, who happens to be person that's not like us, denied her from being considered for that therapy.

Thankfully, she was a high responder to gop one and so no longer needed surgery.

But we're able to have this dynamic that allows her the space and place to be wherever she needs to be to conduct that visit.

And she's done very well.

She's lost over thirty percent of her total body weight on therapy with me, and it just feels easy and that encounter.

But here she is at Master General Hospital, this very prominent institution where I'm sure that when she walks into certain spaces, she's not treated in the same way that our interaction is such that she could conduct that visit while she's folded her sheets at the laundromat and still get the respect and dignity that she deserves.

So she's able to have great health outcomes.

And I think that's the interaction that I want all people to have, but particularly Black women that face so many barriers all day every day.

So hopefully that helps you understand kind of what they actually look like.

Yeah, and I want to link back to an earlier conversation we were having around like accessibility, right and like the price of these medications, and we already know there are often so many disparities in the field in terms of access for the black community.

Are you concerned that GLP ones and the medications is going to be just another area where we are priced out or cannot get the services that would be really helpful.

Yes, I do think that this is an area of significant concern.

So let's use this particular woman I was talking about.

So, I happen to live in a state where Medicaid, which is called mass health, has decided to cover these medications, but it was only in twenty twenty three, that these medications have come under the umbrella for coverage for Medicaid, which are patients with lower socio economic position, so much so that my patients with Medicaid have better coverage than a lot of my patients that are insured patients under private insurance employer sponsored insurance.

For example, Blue Cross Bool Shield of Massachusetts, which is one of the largest insurers of the state, has decided as of January first, twenty twenty six, they will not cover these medications at all for any patients with obesity.

You can imagine that a lot of them are like, wait a minute, I would love to get on mass Health because hey, I'm want to be covered, and you know, you're putting patients in a really tough predicament.

Some of these patients have been covered, they've been, you know, under this Blue Cross Willshield of Massachusetts plan.

And now as they're scrambling, they realize January first is coming fast, and it's coming furious.

What will they do?

My mass Health patients will likely retain coverage.

It took us a long time to get them to coverage.

But here again this access issue is as a major issue.

What will happen will patients health revert.

And I'm concerned that definitively this will be a major issue.

And I'm just using Massachusetts as an example for the rest of the country.

I will say that our state tends to have better coverage than most states.

I was born and raised in Atlanta, Georgia.

I know that Atlanta tends to not to have not just Lanta, let's use Georgia as a model, tends not to have great coverage for these medications, whether under the private insurance model, employer's sponsor insurance models, compared to where I currently live.

And so if I'm talking to family and friends there and trying to guide them, they're like, gosh, I wish I were there with you.

And I'm kind of luck I wish you were here too, But it's unfortunate.

This goes back to what's happening at the legislative level.

What are we advocating for, Going back to the question you asked me earlier.

Is it because we don't truly recognize this as a disease.

Yes, and there's so many people that have the disease that it becomes a very expensive burden.

What if we reduce the price point for these drugs and use like a Walmart based model, right such that anyone that walks through that door can walk out with something without feeling strapped for cash.

And I really wish that it were something accessible in that way, mean the gop ones.

Yeah, And do you anticipate that as it exists longer and there are generics available, that it is something that becomes more accessible.

I really do, And particularly because we are going to have more players into the space, meaning more drug companies.

Right now there are only two players.

We have Novo Nordisk and Eli Lilly, two big drugs to magnetide intracepatite under the trade names of zempic, Wagovi, monduro zep Bound, which is the name we haven't heard until just then.

That's all we have, right, That's period the end.

Nothing else in terms of kind of what we consider the second generation or more highly effective medications.

But we have a lot of companies that have things in the pipeline, and if you if you knew all of the things in the popline, we would be here for another hour going over all of the names.

But that means that we have more things coming into the pipeline.

That means we potentially can reduce the pists because there's more Competitors's kind of like if you were to go to the drug store now and go to the lotion aisle, right, there's going to be all these differs, right they you know, maybe there's some premium lotion, right, but you probably have to go to Sax withth Avenue or and even Marcus to get that.

But you have all these ones and you're going to be able to pick and they have to price accordingly, right, because they have to compete in that market.

Similarly, I think that we'll see this drop and price because they have to compete against each other.

Now, this may be a little bit beyond like your specific area of expertise, but it sounds like there's also some exciting research coming out around golp ones and their impact on things like addictions.

I wouldn't say anything.

About I got yeah, so what's going on there?

So we talked about gop one receptors, we talked about the brain, we talked about the gut, but we're finding that GOLP one receptors are found throughout the body.

What's very interesting about that, particularly as you asked about addiction, is we're finding that these medications seem to be effective for a variety of conditions.

We saw these and mice models, So keep in mind these medications are often tested often, let's just say, always test in mice before they make it over to human models.

So in mice we saw that these were effective in looking at things like tobacco use, alcohol use, other things.

But we're seeing in humans similar things happen.

So patients might say to me, you know what, doctor Stafford, I haven't wanted to drink I can't even remember when I wanted to drink glass.

We think it's acting on some of the similar pathways for alcohol use disorder, similarly for tobacco use disorder.

But some of my physician colleagues that work specifically in alcohol use disorder are saying that it seems to be more effective than anything they currently have FDA approved for the treatment of alcoholism.

Now, I will tell you that, as you know, we're in a milieu where medical research is not being valued in the same way as someone who conducts research and has published over two hundred and seventy five papers.

I can tell you that I feel that directly.

So a lot of the studies that were set to start have been halted surrounding not only looking at addiction, but also other diseases and conditions like Alzheimer's disease, parkinsonism, issues like rheumatoid arthritis and gout.

I mean, we're seeing so many potential use case scenarios because what these medications seem to do is reduce inflammation throughout the body, and so we're seeing other potential use case scenarios, not just in the addiction realm.

And I think that if we have a different regime that allows us to consider actual science, that we potentially can begin to learn more and more of the potential benefits for these agents across a wide range of things, including addiction, which we're already seeing at the point of clinical care.

Thank you for this.

So I'm hoping that we do eventually fee this research take off, right because it sounds really important, right, Like these are answers that people have been looking for.

It sounds like for a long time.

Yes, absolutely, So what do you feel like is.

Missing from the way that media and social platforms really talk about things like GLP ones I.

Really want to get away from just like I said, just thinking about weight wait wait, wait, wait, And I don't think it's just about the number and the scale.

I think it's about the quality of weight loss.

I see this with my patients all the time.

They're hyper focused on what is the number?

Show?

What is the number?

Show?

What is the number?

Show?

It's more about overall health benefits.

And so I would hope we shift away from just like b AMI, when number am I supposed to be?

That's a very common conversation that I have with patients.

They're like, well, am I the right number?

And I'm like, have I ever given you a target number?

So I never give my patients to target weight.

I do give them target waste orcumferences, because if we can get that waist circumference down, then we're going to reduce their risk of things like strokes and heart attacks and things of that sort.

And so I would have shift away from this hyper focus on BMI, which was never meant for us, and move them into a more holistic consideration of looking at not only what the weight status is, but how does that weight status correlate to their blood sugar and their cholesterol and their liver function tests and things of that sort.

I think this is a much more holistic manner of looking at things.

I think it's important for us to realize that when people go on gop ones, we do lose not only fat, but we lose muscle, and so we need to be thinking about what are we eating and how does our physical activity regimen look like.

On these medicines, I see that patients aren't doing exactly what I need to them to be doing to retainly muscle.

I need them to be eating appropriate protein fiber, and I need them to be engaging in a significant strength training regiment to really retain as muchly muscle as possible.

I would say that both men and women don't do enough strength training.

But when I mentioned strength training to women, they are worried about they're going to turn into the next bodybuilder to go on Muscle and Fitness hers magazine, And I'm like, that's not going to happen unless you start taking some substances to really make you look a certain way.

But you're not gonna turn into a man overnight.

I promise more from our conversation after the break.

So you mentioned that your patients are sometimes looking like for a particular weight or you know, like, oh, what number should I be at?

There is something in the field that talks about like set point theory, right, like this idea that your body like enjoys being at a particular size.

Can you talk about that?

Yeah, so set point theory is a really valid phenomenon.

So basically, let's look at it this way.

Let's just pick a number.

Let's say your weight has gotten to two hundred and thirty pounds, okay, and you notice that no matter what you do, you always kind of come back to that number.

Like you may, you know, eat during the holidays, and let's say you may go to forty and after the holidays you kind of come back to to thirty.

Maybe you go on a diet, but remember diet is in the word diet, that's what you're going to diet, So we don't want to go on a diet, right.

But you go on a diet and you go on an exercise plan, maybe you get down to two twenty five, but somehow you come back up to you to forty.

You know, your body just seems to always kind of teeter around it.

And so if you go and look at your weight chart over time that you seem to vacillate around a certain number.

Now you might say, well, back when I was filling the blank.

Age high school or college, you were at a different point.

But over time, what we'll notice is that our weight set point can shift, okay, up until about the age of sixty to sixty five, we'll notice it starts to decline.

And at that point people are like, oh, I'm losing weight, but not so fast.

You're losing muscle.

And the reason why you're losing weight at that age is usually not because you're losing the right kind of weight.

It's because you're losing muscle, okay.

And so this idea of point is your brain decides to defend this set point.

No matter what you do, you notice that you always kind of come back to this particular set point or range.

It's probably more of a range set range.

They set point is their actual terminology, and you can become very frustrated by it.

And this is why people get frustrated when they join gyms.

At the beginning of the year.

They're like, gosh, I did all of that and I lost three pounds.

Are you kidding me?

And so then they stop going to the gym in like by February twentieth, I don't know whatever date, because they're like, I just put in all that work, and I just can't see whatever I try, like, it just it just doesn't seem to work for me.

And so then they may need something that's a bit more focused on addressing the underlying disease pathology to change that set point.

Got it?

Okay, So that maybe what clients are wanting to work on as opposed to like big way.

Yes, yeah, but it's not like I said, I don't want It's not that I don't want them to focus on the number, because they will go in and look up there be a MI and they'll say, well, okay, well I'm three pounds from what it says I'm supposed to be, or I'm five pounds.

So if I give them a target number, let's say it tells them they're supposed to lose eighty seven pounds.

Let's just come up with this number, and let's say they lose sixty two pounds.

Let's just use that.

We could say that that's pretty great, right, But if they don't lose eighty seven, they're going to feel like a failure.

And let's say with that sixty plus pound weight loss, their blood pressure is now normal, their cholesterol is now normal, all of their living.

Everything's perfect in terms of like everything else, but they have hyper focused on losing this number.

I'm gonna say that was flawed in their thinking because they feel like they have to be this number defined by something that was never meant for us.

BMI was this concept that comes from Aldolph to Lay, who was a Belgium statistician that really sought to determine what was normal for Belgium white male soldiers.

I am not that you are not that, So why are we trying to force ourselves into a guideline that was never really meant for us to begin with?

Are there any advances in the field to move away from BMI, because I keep hearing people say that, but it feels like largely like the medical industry is still using BMI.

So are there alternatives?

Yeah, so the medical industry still largely uses that.

But I will tell you.

On January sixteenth of twenty twenty five, I had already happened.

The Lanta Commission, which included fifty eight commissioners, of which I am one of them, developed a new criteria to look at obesity.

We look at something called preclinical obesity and clinical obesity where we don't focus on BMI except for patients that do have severe obesity, so BMI of forty plus we kept and retained the BMI for patients that were under that.

We look beneath the hood.

We start looking at your waste circumference or waste to hip ratio.

We start determining do you have these obesity related conditions like type two diabetes, or like the thirteen cancer is caused by OBC or all these other things to determine more of a fuller picture of who you are instead of just relying on one number.

Got it?

Got man?

Well, thank you so much for all of that information, Doctor Fatima.

This has been so helpful.

Please let us know where can we stay in touch with you.

Do you have a website as well as any social media channels you'd like to share?

So my website is ask ask doctor dr Fatima dot com and all of my socials are also that so one IgM asked doctor Fatima dot com one x which I'd spend very little time there, but you've want to go hang out there and that's where you like to go is ask doctor Fatima.

I'm not on Facebook, don't plan on being there, so you guys can just go have fun and chat with each other there.

LinkedIn also ask doctor Fatima, So feel free to come and hang out with me.

And I usually try to post on ig and LinkedIn.

I would se those where I spend a lot of my times, and also my website and so.

Yeah, so I hope that you learned some things about obesity's disease, what's going on in the field.

The only thing I didn't really say is I still think biatric surgery is by far the most effective treatment for patients with severe obesity.

As I mentioned before, most of my patients with severe obesity still require multiple modalities of therapy, and most of them still do require the use of like a gop one in addition to so I just don't want to downplay that therapy, which I still think is a very useful tool for patients with obesity, and particularly for those with severe obesity, and I use it across the age spectrum, from my pediatric patients to my older at ault.

So we might a physician choose to maybe start with a golp one and see how that works versus like bary egic surgery.

Yeah, I think that gop ones are really great for patients with mild to moderate obesity.

So patients that may have evidence of clinical disease, they have evidence of clinical obesity, but don't have severe disease.

So once we get into that category of having severe disease, the best treatment, hands down, like I've mentioned, is bariatric surgery, and usually in the form of something we call a sleeve gas strectomy.

What does that mean?

We cut out about seventy to eighty percent of the stomach.

But before we actually think that's the reason why you lose weight, it's not.

The surgeons will tell you that at this wrong grellin, which is the key hunger hormone, is housed in the fundest region of the stomach that's cut out, and so you will be in this honeymoon period in that first six twelve months post surgery.

But grell and that key hunger hormone is cut out, and you're like, gosh, I'm never hungry, this is great, this is delightful.

Grellan's also housed in the brain.

But remembering, surgeons didn't touch your brain, they only touch your stomach, and so you'll feel like, wait a minute, I think I'm hungry all of a sudden, So I would forewarn the patient prior to surgery.

When that happens, when you start noticing that hunger re emerge, when you start noticing that you're not full as much, that would be when we would introduce a medication as an adjunct, because if not, they'll start to regain and that's not what we want.

So, Doctor Fatima, as I hear you talk about some of these, I feel like there's something in my psychology brain that's like, yeah, but we kind of need hunger cues, right, Like, I feel like that is some of the concern you'll be hungry.

No, you're it's not be hungry at all.

You're They're like, no, we need those.

Oh my goodness.

That's very important.

So that's part of why when we send a patient to burytric Surgery, there are three persons involved in that decision to even send them to the surgeon, someone like myself, an OBC medicine physician, a dietician, and we have five PhD level psychologists one staff.

The three of us the tribecta with decided this patient is an appropriate person to see one of our five surgeons.

Then they would go through our surgical proprim to then go to surgery.

Okay, let's go back to that psychological piece.

I appreciate that you're bringing that up.

It's not that you don't want them to have any hunger, that would be inappropriate, but you don't understand the intensity of hunger and patients that often have severe disease, the preoccupation, the thinking like hmm, I'm in the middle of this taping, I'm thinking about eating right now, as opposed to being focused on what you're saying.

I can be hungry, that's one thing, but I'm so preoccupied that I'm I'm like, hmm, I should be thinking about that as opposed to like answering the question.

And I'm thinking about not only for me, but I'm also thinking about for my family, and then by the suit, and then I'm thinking about this, and then that could be how pervasive it is.

But when it starts to merge, they sense this, and it may be part of like binge eating, which is the most common eating disorder associated for patients with obesity.

There's a high overlap bengating disorder with patients with obesity.

It may not even be that, it may just be that they start to notice it emerge, but as that starts to merge, it will continue to cause weight shifts over time.

If loss weight usually come to a point of wastability.

If I don't treat it, there will be the weight regain and it will be a shame for me to send them to surgery only for them to regain all of the weight.

Got it, Okay, So it doesn't completely take away the hunger keys.

It's like you mentioned turning down the volume the intensity.

Yes, on exactly.

So, yeah, we don't want them to not eat right.

That would be inhumane, right, you know, we want them to be human.

But as soon as they start, are like, well wait a minute, Nope, this is abnormal.

They're eating right, because I want to know what breakfast, snack, lunch, snack, dinner snack is.

If they tell me nothing in any of those, we got a problem, right.

But if they are telling me, now I'm noticing, oh gosh, I need that second snack, and then I need the third.

Ooh, I'm noticing something's not right.

Something's just not right.

We need to start thinking about it.

Now.

There's something that'll resist They're like, no, I'm gonna use that willpower.

Going back to that question you asked me, I'm growing down.

I'm gonna go on that third walk and then you're like you just go on, like two wats I'm gonna go.

I'm gonna I'm gonna push harder, and you're like, why, I can help you.

I can help you, right, it's the biology that's causing you to do that way.

I can help the biology if I can get the right tools, right, because not everyone we just talked about is access to those tools.

And then they're like, you can imagine like it's a sense of calm.

I get the two I dodged.

I dodged a bullet there.

Wow.

Thanks, I thank you do share for a while.

You were right.

I do feel I feel back to how I felt some patients would, particularly those post op patients.

Oh, I feel back to how I felt after surgery.

Now I feel I feel that again, you know, so something like that.

Thank you for that doctor of her team, and I appreciate you spending some time with day.

Absolutely, it's been a delight.

I just want people to have the right information.

Thank you.

I'm so glad doctor Stanford was able to join us for today's conversation.

Her compassionate approach to this work and commitment to changing how we understand weight and health is truly inspiring.

To learn more about her work, be sure to visit our show notes at Therapy for Blackgirls dot com slash Session four two six, and don't forget to text two of your girls right now and tell them to check out the episode.

Did you know you could leave us a voicemail with your question are suggestions for the podcast.

Whether you have ideas for future topics, book or movie suggestions, or just something on your mind, we'd love to hear it.

Head on over to Memo dot fm slash Therapy for Black Girls and leave us a voice meil.

If you're looking for a therapist in your area, check out our therapist directory at Therapy for Blackgirls dot com slash directory, and don't forget to follow us over on Instagram at Therapy for Black Girls.

You can also support the podcast by joining our Patreon community.

When you join, you'll get access to exclusive content, behind the scenes updates, and monthly Q and A sessions.

Come on over and join us at community dot Therapy for Blackgirls dot com.

We love to have you.

This episode was produced by Elise Ellis, Indietubu and Tyree Rush.

Editing was done by Dennison Bradford.

Thank y'all so much for joining me again this week.

I look forward to continuing this conversation.

With you all real scene, take good care.

What