Session 426: Understanding GLP-1s

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
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

(00:32):
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

(00:57):
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,

(01:20):
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

(01:42):
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

(02:04):
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

(02:25):
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.

(02:45):
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.

Speaker 2 (02:57):
Well, it's a delight to be here.

Speaker 1 (02:59):
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?

Speaker 2 (03:15):
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

(03:36):
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

(03:57):
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

(04:18):
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.

Speaker 1 (04:40):
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.

Speaker 2 (05:01):
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

(05:22):
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

(05:45):
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

(06:05):
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

(06:25):
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

(06:46):
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,

(07:08):
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

(07:31):
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

(07:52):
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.

Speaker 1 (08:11):
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.

Speaker 2 (08:20):
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.

(08:43):
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.

(09:06):
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

(09:27):
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

(09:48):
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

(10:09):
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,

(10:31):
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

(10:53):
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

(11:13):
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

(11:33):
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

(11:55):
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.

Speaker 1 (12:11):
Thank you so much for that explanation. That is very helpful.

Speaker 2 (12:13):
I appreciate it.

Speaker 1 (12:14):
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

(12:36):
be used to actually take care of this disease.

Speaker 2 (12:39):
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

(13:00):
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

(13:22):
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

(13:45):
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

(14:08):
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

(14:29):
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,

(14:53):
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

(15:14):
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

(15:37):
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,

(15:58):
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

(16:22):
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

(16:43):
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.

Speaker 1 (16:55):
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

(17:16):
that they found? How did we realize that golp ones
also could be used for obesity?

Speaker 2 (17:21):
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

(17:43):
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,

(18:06):
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

(18:28):
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

(18:51):
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,

(19:14):
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

(19:37):
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,

(20:00):
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

(20:23):
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.

(20:44):
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

(21:07):
the total body weight loss that really increased the interests.
Got it.

Speaker 1 (21:12):
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.

Speaker 2 (21:24):
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

(21:44):
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

(22:05):
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

(22:27):
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.

Speaker 1 (22:39):
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.

Speaker 2 (22:54):
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.

Speaker 3 (23:04):
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.

Speaker 2 (23:16):
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,

(23:37):
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

(24:01):
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

(24:24):
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,

(24:48):
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,

(25:09):
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

(25:31):
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

(25:53):
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

(26:13):
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

(26:34):
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

(26:57):
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.

(27:20):
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

(27:41):
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

(28:01):
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.

Speaker 1 (28:24):
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

(28:44):
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.

Speaker 2 (29:01):
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

(29:22):
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

(29:46):
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

(30:08):
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

(30:31):
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

(30:51):
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

(31:13):
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

(31:35):
of combat, I don't what am I I don't know
what it is really like, what is it? I don't know?

Speaker 1 (31:40):
M thank you so much for it.

Speaker 2 (31:41):
Yeah, for breaking that down like that.

Speaker 1 (31:43):
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?

Speaker 2 (31:59):
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

(32:20):
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

(32:41):
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

(33:03):
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.

Speaker 1 (33:16):
Got it. What are some of the other big misconceptions
you think about gop ones?

Speaker 2 (33:21):
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

(33:44):
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

(34:04):
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.

Speaker 1 (34:22):
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

(34:43):
Black women community.

Speaker 2 (34:44):
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,

(35:05):
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,

(35:31):
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,

(35:53):
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

(36:14):
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

(36:36):
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

(36:57):
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

(37:21):
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

(37:43):
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

(38:04):
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

(38:26):
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

(38:47):
what they actually look like.

Speaker 1 (38:49):
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.

Speaker 2 (39:12):
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

(39:35):
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,

(39:59):
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

(40:19):
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.

(40:42):
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

(41:05):
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

(41:27):
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

(41:47):
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.

Speaker 1 (42:01):
Yeah, And do you anticipate that as it exists longer
and there are generics available, that it is something that
becomes more accessible.

Speaker 2 (42:09):
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

(42:31):
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

(42:51):
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

(43:13):
that market. Similarly, I think that we'll see this drop
and price because they have to compete against each other.

Speaker 1 (43:21):
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.

Speaker 2 (43:32):
I wouldn't say anything.

Speaker 1 (43:33):
About I got yeah, so what's going on there?

Speaker 2 (43:38):
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,

(43:58):
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

(44:20):
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,

(44:44):
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

(45:04):
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

(45:24):
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

(45:46):
clinical care. Thank you for this.

Speaker 1 (45:49):
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.

Speaker 2 (45:58):
Yes, absolutely, So what do you feel like is.

Speaker 1 (46:01):
Missing from the way that media and social platforms really
talk about things like GLP ones I.

Speaker 2 (46:07):
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?

Speaker 1 (46:24):
Show?

Speaker 2 (46:24):
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,

(46:47):
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

(47:08):
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

(47:30):
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

(47:51):
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.

Speaker 1 (48:05):
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

(48:27):
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?

Speaker 2 (48:34):
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

(48:56):
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

(49:17):
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

(49:37):
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

(50:00):
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.

(50:22):
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

(50:47):
disease pathology to change that set point.

Speaker 1 (50:51):
Got it? Okay, So that maybe what clients are wanting
to work on as opposed to like big way.

Speaker 2 (50:57):
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

(51:19):
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,

(51:40):
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

(52:01):
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

(52:21):
guideline that was never really meant for us to begin with?

Speaker 1 (52:26):
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?

Speaker 2 (52:37):
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,

(53:01):
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

(53:21):
other things to determine more of a fuller picture of
who you are instead of just relying on one number.
Got it?

Speaker 1 (53:29):
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?

Speaker 2 (53:40):
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

(54:03):
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,

(54:24):
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

(54:45):
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.

Speaker 1 (55:00):
So we might a physician choose to maybe start with
a golp one and see how that works versus like
bary egic surgery.

Speaker 2 (55:08):
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

(55:31):
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

(55:52):
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,

(56:15):
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

(56:39):
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

(57:00):
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

(57:23):
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

(57:44):
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.

(58:07):
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,

(58:30):
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.

Speaker 1 (58:51):
Got it, Okay, So it doesn't completely take away the
hunger keys. It's like you mentioned turning down the volume
the intensity.

Speaker 2 (58:57):
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,

(59:19):
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.

(59:40):
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.

(01:00:03):
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.

Speaker 1 (01:00:22):
Thank you for that doctor of her team, and I
appreciate you spending some time with day.

Speaker 2 (01:00:26):
Absolutely, it's been a delight. I just want people to
have the right information.

Speaker 1 (01:00:30):
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

(01:00:53):
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

(01:01:15):
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

(01:01:35):
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.

Speaker 2 (01:01:52):
With you all real scene, take good care.

Speaker 1 (01:02:00):
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