September 9, 2025 • 31 mins
Pediatric obesity and metabolic syndrome are rising at alarming rates, yet misconceptions and outdated approaches often leave children without timely, effective treatment. In this episode, Dr. Fatima Cody Stanford reframes obesity as a chronic brain-mediated disease, discusses the latest evidence on early intervention, GLP-1 therapies, and bariatric surgery in youth, and addresses weight bias, disparities in access, and systemic policy levers. Listeners will gain practical insights into translating trial data into real-world care, monitoring safety in adolescents, and defining treatment success beyond BMI.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
(bright upbeat music)
- Welcome to "Stanford Medcast,"
the podcast from Stanford CME
that brings you the latest insights
from the world's leadingphysicians and scientists.
If you're joining us for the first time,
be sure to subscribe onApple Podcasts, Amazon Music,
(00:20):
Spotify, or YouTube to stay updated
with our newest episodes.
I am your host, Dr. Ruth Adewuya.
Dr. Fatima Cody Stanford
is an internationally recognizedleader in obesity medicine
and one of the firstFellowship-trained physician
in this field.
She is an Associate Professorof Medicine and Pediatrics
(00:42):
at Harvard Medical School,
and cares for patients atMassachusetts General Hospital.
Dr. Stanford's work reframes obesity
as a chronic relapsing disease
and addresses disparities in care,
weight bias in clinical settings,
and the importance of earlyevidence-based interventions
for children in adolescents.
She has authored over 275peer-reviewed publications,
(01:07):
contributed to national guidelines,
and advises organizations
including the NationalAcademies of Sciences,
Engineering, and Medicine.
A sought after educatorand public advocate,
Dr. Stanford has beenfeatured on "60 Minutes,"
"The New York Times" and CNN,
and she's deeply committed
to advancing equitable compassionate care
for patients with obesity
(01:27):
and training the nextgeneration of clinicians.
Dr. Stanford, welcome to theshow and thanks for being here.
- Thanks so much for having me.
- You've said on "60 minutes" that obesity
is a brain disease.
What does that framingunlock for pediatric care
that a willpower model never could?
- I'm so glad you startedwith that question
because a lot of peoplehave wanted to put the blame
(01:49):
on individuals that have obesity.
When we delve into thebiology of this disease,
we recognize that there isa lot of pathophysiology
that starts in the brain.
There's an anorexia geneticpathway of our brain,
and when we hear anorexia,
we hear a pathway thattells us not to eat,
and we have an orogenicpathway of our brain,
so a pathway that does tell us to eat.
(02:11):
Those of us that arelean have an upregulation
of that pathway that tells us not to eat,
and those of us that carry excess adipose,
which is fat mass, have anupregulation of that pathway
that tells us to eat.
And this helps us to understand
that when persons carry excess fat mass,
it's more than just youtelling them to eat less
and exercise more.
(02:32):
This removes a lot ofthat blame shame game
that we have put on parents or children
that carry excess adiposethroughout their childhood
and unfortunately will oftencarry that into adulthood.
There's biology behind it.
How do we then use thisto treat individuals
that struggle with this disease process?
And this has been a lot ofwhat I spend time with families
(02:55):
to help them understandthat I can be a part
of the solution,
recognizing that there'snot just one answer
to the question,
it's a multidisciplinary approach
to addressing this disease process,
but the brain is at the center of it all.
- That perspective challengesthe old willpower narrative,
and I can see how it changesboth family conversations
(03:17):
and treatment planning.
How do families respondwhen you use this language
compared to talking aboutit as a lifestyle disease?
- Parents particularly are very receptive.
When you're talking toparticularly a small child
or even a young adolescent,
they are sometimes confused by this,
but you can imagine thatthis takes a bit of a weight,
(03:38):
no pun intended off of the family
to recognize that theydidn't just cause this,
that maybe it was partof the epigenetic milieu.
I can help them get to a healthier place.
Yes, I do need them to go do some things.
I want them to set up andframe a healthy environment,
looking at healthy diet,
lean protein, wholegrains, fruits, vegetable,
(04:00):
high fiber content,
and set up a safe spacefor movement and activity.
These are things that I want,
but what if they've done those things?
What if they've tried those things
and aren't seeing any results?
What can I then do to helpchange what's happening?
One of the things that'sgreat about the work
that I have been doing, andnot just me as an individual,
(04:21):
but what I love is seeing the outcomes,
seeing those pediatric patientsbecome my adult patients
and seeing how theirlife trajectory changes.
I wanna talk specificallyabout one of my patients
that ended up needing bariatric surgery.
Unfortunately, her mother used to take her
to Weight Watchers meetingsstarting at the age of four.
(04:41):
Now, imagine a 4-year-oldgirl sitting there playing
with her Barbie dolls ina Weight Watchers meeting.
Is that the right place for a 4-year-old
to be spending their time?
I would say the answer is a resounding no.
I would say that a 4-year-oldshould be spending their time
being a 4-year-old.
That 4-year-old wenton to bariatric surgery
(05:02):
at the age of 19 or 20,
went on to become a nurse practitioner
and works treatingindividuals that have obesity,
but she was told that shewould never be healthy.
She was told that shewould never conceive.
She has two healthy young children
and is caring for individualsthat have obesity now.
(05:24):
We can treat individuals,
they can go on to lead healthy lives.
Their disease processesassociated with obesity
can go into remission,
but we don't have to be punitive
in our care for these individuals,
and this is what we've done to individuals
that have had obesity.
We assume that if we punish them,
subject them to pain and blame and shame,
(05:47):
we will make it better for them.
We only make it worsefor those individuals
by not understanding the biology
and the treatment modalities
that may get them to thehappier, healthier lives
that would be best for them.
- Such a powerful story,
and it illustrates howframing obesity as a disease
has the potential to shapesomebody's life trajectory
(06:07):
and highlights why clinicianscan treat pediatric obesity
as just diet and exercise advice.
Building on that,
what do you see as the mostdamaging misconceptions
about pediatric obesity
that you would like clinicians to abandon?
- I really want us tostop thinking of this
as the parents' fault in whatthey're feeding those kids.
(06:29):
Notice how I said those kids.
We look at those people
as if they're like some dirty objects.
Why can't we treatindividuals with obesity
with humanity and dignity and respect?
It is entirely acceptablein today's society
for us to treat persons with obesity
and including our pediatric patients
(06:49):
as if they're second class citizens.
We are able to disregard them,
we're able to choose not togive them dignity and respect,
and I can remember,
and I'm going to take you backto my pediatrics residency
and our pediatrics clinic, youcould pick up the next chart
and whoever you sawwould be the next person
(07:09):
in our pediatric clinic
because we weren't yetpracticing physicians
and had our own patient panel.
If you had an individualthat may have had obesity,
you could skip that person, right?
Because that was gonnabe a more complex person
that had more chronic disease.
So, I would see myco-residents strategically skip
those individuals that had obesity.
(07:29):
What's the humanity in all of that?
Why are you choosing to skip that chart?
Is it harder work?
Are there going to bemore areas of discussion?
Absolutely.
If we go back to the question,what are we able to do?
How are we able to just skippast or choose not to address?
That's what I often see insome of my pediatric colleagues
(07:52):
even as we progress and becomemore advanced in our training
and complete our BoardCertification, let's not address that
or let's move on to aneasier, simpler case
that brings up a bit more joy.
I actually get the joyout of moving that person
to a healthier lifestyle.
Now, I'm gonna take you to mymost poignant pediatric case,
(08:14):
a case that defined how Ithink about this entire field
of obesity medicine.
It was also the case that it helped me get
the American Medical Associationto acknowledge obesity
as a chronic disease andintroduce you to a patient
by the name of Twinkie.
Think about why she mighthave been called Twinkie,
and let that resonate with you.
So, we're gonna meet Twinkie,
(08:36):
a young Black girl in South Carolina
where I did my Residency.
I was an InternalMedicine-Pediatrics Residency.
I was tasked with havingTwinkie as a patient.
She had made her transition
from the Pediatric ICU down to the floor
where she had come into the hospital
with an asthma exacerbation.
When I walked in to do my morning rounds,
(08:58):
I noticed that Twinkie was not breathing.
I went to figure out whyTwinkie wasn't breathing,
and I shook her.
She did (gasping) kindof gasp, choke for air,
she then started resumedbreathing and I said,
well, probably Twinkiewho was around the age
of 11 years old hasobstructive sleep apnea.
I reported this to my senior residents
and attending physicians,
(09:19):
and they were like, good job Fatima,
acknowledging that she hasobstructive sleep apnea.
What she came in for wasan asthma exacerbation.
We need to make sure shegets her asthma training
and get her prepared for discharge.
We still had another day toarrange all of that information,
and now that we have thisnew potential diagnosis
of obstructive sleep apnea, gether set up for her discharge
(09:41):
with a sleep study forthat important diagnosis.
Next morning comes as I do my rounds,
here she is not breathing again,
but we're gotta get her discharged
because you gotta flipthose beds in the hospital.
For those of us thatpractice clinical care,
it's about turnover.
We gotta make sure that wehave those beds reserved
for those that need thehighest security of care
in the hospital.
(10:02):
We could her discharge paperwork,
do my duty as the faithful intern.
We make sure that she'sdischarged for sleep study
is scheduled along withher asthma education.
All of those things are done,
and she's scheduled to have a sleep study
in approximately two weeks,which is actually quite fast
for those of us thatknow how long it can take
to get these types of studies.
Unfortunately, within just a few days,
(10:25):
I get notification thatTwinkie is no longer living.
Cause of death, obstructive sleep apnea.
And so when we talk about whether or not
we should treat obesity,
whether we should treat individuals
that have obesity in thepediatric population,
whether we should just focus on lifestyle,
I asked you to think about Twinkie,
and whether I should be getting invites
(10:47):
to 11-year olds funerals.
As someone in their late 40s,
I don't like to get funeral invitations
for persons in my age group,let alone 11-year olds
who should still be around.
When I told this story to theAmerican Medical Association
before their pivotal voteto acknowledge obesity
as a chronic disease,
I can tell you that foranyone who has any compassion
(11:09):
or empathy for individuals,that it was indeed that story
that convinced the House of Delegates
that we should indeed acknowledge obesity
as a chronic disease.
- Thank you for sharing thatand what a heartbreaking,
but also formative story that underscores
how easily obesity-related complications
(11:30):
can be overlooked whenthe focus stays narrow,
and the fact that this case helped
catalyze broader recognition by the AMA
just shows how individualstories like this
can drive systemic change.
That brings us to this question of timing.
The 2023 EP guideline movedaway from watchful waiting
(11:51):
and emphasized earliermore active treatment.
How do you think cliniciansshould balance that urgency
with the sensitivity families need
in those early conversations?
- I'm gonna go back to Twinkie.
I think this story speaksto why watchful waiting
can lead to premature death.
We wait, patients die.
(12:12):
This is the reality of what we see.
Patients do indeed die.
Unfortunately, many ofthe pediatric patients
that I see in my clinicpresent with greater morbidity
than my adult patients,
both have severe obesity,
but the burden of disease
much higher in my pediatric patients.
(12:34):
Higher glucose levels,
higher evidence of lipid abnormalities,
worsened liver disease.
They come in and I'm justsupposed to sit there and look
and say, oh, you know what?
Maybe they just get tolerantthey'll outgrow this disease.
The time for action is now.
I was penalized as a resident,
(12:55):
particularly on my pediatric side
for putting obesity as aproblem list on my notes,
but how can we not putobesity as a problem list
when it was indeed the contributor
to these obesity-relatedchronic disease risk factors?
And obviously my residencywas far before 2023
when the AAP finally madethis very pivotal decision
(13:17):
to change the guidelines to say,
we can no longer watchfully wait
and need more aggressive measures
for those that carry ahigh burden of disease.
What we do know, and every clinical study
has demonstrated this, is thatif we don't intervene early,
these young individualsthat have this high burden
of disease have much moreaggressive disease as adults
(13:40):
compared to those that justdevelop disease in adulthood.
Let's say I have a patient that comes in
and they develop obesity at the age of 30,
compare that to someone thathad disease at the age of four,
imagine how great thatburden of disease would be
if we didn't intervenefrom four all the way
until they finally present.
The disease burden is so much higher.
(14:02):
The risk of death is so much higher.
We need to intervene so thatwe can have better outcomes,
and unfortunately wedon't see that happening.
Even when I'm doing consultswith my pediatric colleagues
and I offer very specific-outlined advice,
I'm only one person andthere's only so many of us
that can actually dothe high level of care.
(14:24):
So, if I give you anoutline, my goal is to say,
I need you to share the burden with me.
There's only one me and so manyothers trained in the field,
but if I can teach youand provide clear steps
on how to move beyond watchful waiting
to using other modalities and therapies
beyond lifestyle modification,
(14:45):
my goal is to make surethat you and your community
are equipped with this information
so that it doesn't have to funnel in
to a very small cohort of individuals
that may be trained on how to do this.
My goal is to guide and teachso that you can then do that
for the wonderful patientsyou care for as a clinician
(15:05):
in your particularsetting as a pediatrician.
- That's a really helpful way
to think about balancingurgency with sensitivity,
and also a call to actionfor the healthcare team
and clinicians to really think about this
as not the responsibility foronly a subset of clinicians,
but a responsibility for all.
It brings us to one of thenewer tools in our toolbox,
(15:28):
GLP-1 agonists that arenow approved for teens.
Where do you see pharmacotherapy fitting
into pediatric obesity care,
and talk about what areyour non-negotiable criteria
for starting, and importantly,when do you not start?
- We know that GLP-1 receptor agonists
are now currently approvedfor the treatment of obesity
(15:49):
in the pediatric population.
We can begin using themstarting at the age of 12.
These medications are currently approved
for thinking about highpotency medications
like Semaglutide which areonce-weekly injection we can use.
And what's very interesting also,
if we look at the clinical trial data
and even data for patientsthat I'm seeing in clinic,
we see that pediatric patients
(16:09):
tend to do a littlebit better than adults.
Overall if we were to look atmetabolic bariatric surgery,
the kids always seem todo a little bit better
than the adult patients.
With regards to when weutilize these therapies,
we would use these forpatients that have maximized
their lifestyle modifications.
They have tried dietary modifications,
tried physical activity modifications,
(16:30):
and have maximized those therapies.
Now, we are saying, okay,we've tried to maximize those,
now we may need to utilize a GLP-1.
Maybe they have glucose intolerance,
maybe their blood sugar's abit higher than we would like.
Maybe they're curing someexcess fat around the midsection
and have what we call Metabolic-associated
steatotic liver disease.
There are a variety of reasonswhere these could be helpful.
(16:53):
Often I find that theparents are more fearful
of the needle injectionthan the pediatric patients,
so their kids are like,"Hey, mom, I can do this,"
or, "Hey, dad, I can do this."
Then the parents are like, "Are you sure?"
With regards to the sideeffects of these medications,
the side effects are exactly what we see
in the adult population.
Nausea is by far themost common side effect
(17:14):
affecting up to 40% of patients
as we are titrating thedose of these medications.
The key thing is makingsure that the parents
or caregivers of these patients are aware
that these medicationsare going to cause nausea,
particularly as we're titrating these.
What I often do,
particularly since theseare pediatric patients,
I give these medications on the weekend
(17:35):
so they're not impairingacademic performance
or their school day, Idon't feel good at school.
Another key issue is constipation.
Kids don't often talkabout their stool patterns,
neither do adults.
This is something that you have
to be very direct with kids about,
in terms of whether or not
they're having normal bowel movements
and things of the source.
We of course, look at BMI percentiles.
For pediatric populations beforeabove the 95th percentile,
(17:59):
we've moved into childrenthat have obesity,
between the 95th and the 120thwe're in that first category,
120th and 140th we're in the second,
and then anyone over the 140th
we've gotten into that reallysevere category of obesity.
These patients, you're startingto watch them come down
those growth charts.
It's really interestingto watch these individuals
that are responders move from the,
(18:20):
let's say 136 down to the127, down to the 115th,
down to the 95th
and see that major shift whenthey go on these therapies
and are consistent with the utilization.
One of the key things,however, with the medications
is making sure that they'remaintaining their muscle mass.
(18:40):
We don't really think aboutthis because there are kids
and you're like they'regonna retain muscle,
but the medications dopotentially cause muscle loss.
How do you negotiate that?
You wanna make sure that they're active
and engaged in some strength training?
Absolutely.
Non-negotiables for theseare the exact same as adults.
You don't wanna use these in individuals
that have a history of multipleendocrine neoplasia Type 2
(19:04):
anywhere in the family,
anyone with a history of pancreatitis,
medullary thyroid cancer,
these are patients that you would not use
these medications in.
But like adult patients,if they are responders,
we will continue the utilizationof these medications.
However, it should be noted that children
that are reproductive potential,
we do need to be usingforms of birth control
(19:26):
because there is apotential for birth defects
as noted in animal models,
particularly rodentmodels and rabbit models,
we haven't necessarilyseen that in human models,
but we do need to be thoughtful about that
in our young ladies.
A lot of clinicians arelooking at the STEP TEENS Trial
as a reference pointwith impressive outcomes.
How do you help familiesinterpret those results
(19:48):
in real world practice, bothin setting expectations,
but also defining whatsuccess could look like
in three, six months?
Instead of them justlooking at three or six,
I give them a year-long process.
If we look at the trial data,
it really goes out more like 72 months.
If we're not seeing anyresponse in three months,
maybe this isn't a gooddrug for you and it's okay.
(20:09):
Not everyone responds to every agent.
Particularly also if they're having
significant side effects.
Let's say the nausea is relentless
and they can't even sit upand go to school or a study,
then this is also not the agent for you.
But if we're starting to see some response
without any of these sideeffects at three months
and that could be characterized
by 5% total body weight loss,
(20:31):
then we start to set expectationsaround that percentage
of their total body weight loss,
so comparing them to themand not them to someone else.
- As you mentioned earlier,
sometimes medications don't work,
and sometimes medications are not enough.
Let's talk a little bitabout bariatric surgery,
which is still oftenseen as the last resort.
(20:51):
What do we know now about its safety
and effectiveness in teens,
and when should it be on the table?
- Bariatric surgery is stillthe best option for patients
with severe obesity.
I have utilized this as a therapy
for patients with severeobesity for many years
and has much more data thanwe do with pharmacotherapy.
(21:12):
We have 20, 30 plusyear data on individuals
that have undergone surgical interventions
in the pediatric population.
If we look at Thomas Inge'sdata the Teen‑LABS trial,
and I can even pull from my patients
that have gone to surgery15, 20 plus years ago
and look at that data, it'simportant for individuals
that undergo surgery to knowthat this is a lifestyle change
(21:35):
that we need to monitor indefinitely.
If it's a sleeve gastrectomy,
which is the most commonprocedure versus a gastric bypass,
which is the second,
they're gonna need to supplementfor the rest of their life,
they're gonna need amultivitamin, Vitamin D,
they're gonna need calciumcitrate plus vitamin D,
plus vitamin B12 forever.
So, this means that you'realso gonna need to follow up
and get labs tested to checkfor vitamin deficiencies.
(22:00):
We're also going to need tolet people know at the outset
that surgical interventionsaffect both bone and muscle.
That is also what I callthe honeymoon period,
post-surgical intervention.
What do I mean by that?
In the first 12 months post-surgery,
you are going to feel amazing.
You're gonna be losingweight, filling great,
(22:20):
but what you don't know isthat there's a honeymoon period
it comes to an end,
meaning you had surgery donein the abdominal region,
but your brain hasn't recognized
that surgery happened down in the gut.
The brain takes over.
Hormones in the brain start to reignite.
Ghrelin or key hungerhormone starts to reemerge.
(22:42):
GLP-1, not a medication,
because we all have GLP-1inside of us starts to go down.
GIP starts to go down.
Cholecystokinin starts to go down.
Peptide YY starts to go down.
When people look at individuals
that may have regainedweight post-surgery,
they assume it's their willpower,
they didn't do something right.
When they don't realize
that it was the hormones in their brain
(23:04):
and gut that start to reactivate,
that starts pulling themback in the direction
of where they were prior to surgery.
Now, one of my biggest areas of research
has been using medications as an adjunct
to surgical intervention, soabout 90 to 95% of my patients
that are post-op are also on medications,
or we can double or triple their response
to surgical interventions.
(23:25):
These patients may lose 30, 40, 50,
even 60 plus percenttotal body weight loss
with the combination of medications
and their surgical intervention.
If you've never been told thatprior to going to surgery,
you just assumed you failed.
So, going back to that samethought process that you had
before you went to surgery,
here again, I did something wrong,
(23:46):
I didn't eat well enough.
The surgeon reinforces this narrative
'cause you did something wrong,
here you had this method of last resort,
which I hate that language,
they don't realize that itwas this lovely brain of yours
that pulled them back, notbecause it was their fault.
What I do to my patients is I inform them
before they go to surgery,
look, the honeymoon will come to an end.
(24:08):
When that happens, we need to think
about what we're going to add
so that you don't succumb to the fate
that many persons thatgo to surgery succumb to.
This isn't your fault.
The biology was sosignificant that we needed
to send you to surgical intervention,
so why do we think we're gonna solve it
all of a sudden with lifestyle alone?
(24:30):
This is an important consideration,
even in my pediatric patients,
because if they're going tosurgery as a pediatric patient,
we have a longer time tosustain these results.
- You've highlightedvery well how powerful
and effective bariatric surgery can be,
but what I also heard isthe need for effective
and comprehensivecommunication with the patient,
(24:50):
preparing them for both thehighs and the lows of it,
which would be a game changer
for how they approach their recovery.
Not every patient has thesame access to these benefits.
We know that Black and Hispanic youth
experience higher rates of obesity,
yet they're less likelyto receive treatment.
How do you interpret these disparities,
(25:11):
but also what should cliniciansbe doing differently?
- What drew me to the fill,
particularly as a Blackwoman born and raised
in Atlanta, Georgia,
was because I saw in my community
that particularly Black women,
Black girls were disproportionatelyaffected by obesity.
But when I saw the people
that were actively involved in the field,
(25:32):
none of them looked like me.
Were they going to be asinvested in understanding
how to address this in the community?
Whether in the pediatricor adult population,
I didn't feel as though thatwas going to be the case.
Why don't we have access inBlack and Brown communities?
Why can't we ensure that the communities
(25:52):
that are disproportionately
more likely to have obesity get access?
When we think about pharmacotherapy
and metabolic and bariatric surgery,
we have to be thinking aboutpolicies that allow access
to all of the things that I just mentioned
and recognize thatunfortunately there's barriers
to all of those things
when we think about these communities.
(26:14):
If we don't have the clinicians
that are willing to care for communities,
then we're gonna also face that barrier
even if we advance the therapies.
I practice at Mass General Hospital,
our encatchment area doesn'tinclude a lot of people
that look like me,
but close to 45% of my patientshappen to be Black patients.
So, if you look at my colleagues,
only about 8% of theirpatients are Black patients.
(26:36):
Why is there such a differential?
Because those patients come seeking me.
They know who I am.
They seek me, then their family members.
It goes to show you thatif there's a clinician
that someone identifies with,
then they will seek thatindividual that provides the care
to those underserved communities.
We serve Mass health patients,those that are Medicaid,
(26:58):
lower socioeconomic position,our older adult patients,
patients identify with individuals,
but we know that there'sbarriers to entry for clinicians,
and we are seeing thattaken away systematically
for our medical students,Residents, Fellows,
our nursing students, et cetera,
across the healthcare ecosystem,
(27:19):
we know that there's barriers
to having healthy living environments
that allow those to havereduced allostatic load,
which allows individuals tohave a healthier environment
where obesity doesn't flourish.
These are really important conversations
that we have to have ifwe think about wanting
to tackle these different leversthat contribute to obesity.
(27:41):
- Your research showsthat income and education
can be stronger deciding factors
than raise alone in termsof access to benefits.
How should that reshape theway we think about equity
in pediatric obesity care?
- We have to have it suchthat there's more money
and more education.
This is interesting, but let's look at one
of the most highly educateddemographics in the country,
(28:04):
which is Black women.
Somehow the most highlyeducated demographic
still has the highest obesity rates.
There's a pull and a push.
This is what brought me to the field
because I was seeing women
with four and five degrees still struggle,
so I knew that therewas more to the story.
If you look at a lot of my research
and you're seeing this income disparity,
you're seeing this issue with people
(28:26):
that have greater income beable to have greater access,
but we can think of individualsthat have great income
who've always struggled with obesity.
The story is much morecomplicated than that.
- I agree with that.
Another component is insurance coverage,
which often lags behind the clinical need.
If you could change one policy tomorrow,
(28:46):
what would it be to improvepediatric obesity care?
- It would be universal coveragewith regards to healthcare.
If we had universal access and clinicians
that are willing to treatindividuals with obesity,
we could help addresssome of the disparities
because some of my researchis also demonstrated
(29:07):
that even when we haveequivalent insurance,
that individuals that are from racial
and minority populations
still don't get accessto the same therapy.
We need to have cliniciansthat are willing
to utilize such insurance
to ensure that there isequity in terms of access,
whether it be lifestyle modalities
like intensive behavioraltherapy, pharmacotherapy,
(29:29):
access to GLP-1s and bariatric surgery,
and ensure that each of thoseare being equitably used
to ensure that thosethat need them the most
are actually getting access to them.
- You've worn many hats,clinicians, scientists, educator,
policy advocate,
and when I was reading thisin your "Lancet" piece,
you mentioned feeling the need
(29:50):
to do 10 times more thanpeers to be recognized.
What lessons have you learnedthat might inspire listeners
who want to advocate for change?
- Follow your passion.
If you have a passion and a drive,
you'll continue to move forward.
My high school in Atlanta, Georgia,
was named after Dr. Benjamin Elijah Mays,
(30:11):
a famous educator and orator,
or one of the teachers forDr. Martin Luther King, Jr.
And he says, 'Strive todo whatever you do so well
that no person living, no person dead,
and no person yet to be borncould do it any better."
That's a really heavy lesson to live by,
but it is how I live my life.
- Thank you so much forsharing your expertise
and perspective with us.
(30:31):
This conversation has really challenged us
to move beyond outdated assumptions,
recognize obesity as acomplex chronic disease
that requires early evidence-basedand compassionate care.
You've given us some practical insights
that we can all carry backto our clinical teams.
To our listeners, we hopetoday's discussion helps you
(30:51):
approach pediatricobesity with fresh eyes,
renewed urgency, and strategies
that improve care forevery child and family.
Thank you for joining usin "Stanford Medcast."
Thanks for tuning in.
This episode was broughtto you by Stanford CME.
To claim CME forlistening to this episode,
click on the Claim CME link below
(31:12):
or visit medcast.stanford.edu.
Check back for new episodes
by subscribing to "Stanford Medcast"
wherever you listen to podcasts.
(bright music)
(bright upbeat music)
- Welcome to "Stanford Medcast,"
the podcast from Stanford CME
that brings you the latest insights
from the world's leadingphysicians and scientists.
If you're joining us for the first time,
be sure to subscribe onApple Podcasts, Amazon Music,
(00:20):
Spotify, or YouTube to stay updated
with our newest episodes.
I am your host, Dr. Ruth Adewuya.
Dr. Fatima Cody Stanford
is an internationally recognizedleader in obesity medicine
and one of the firstFellowship-trained physician
in this field.
She is an Associate Professorof Medicine and Pediatrics
(00:42):
at Harvard Medical School,
and cares for patients atMassachusetts General Hospital.
Dr. Stanford's work reframes obesity
as a chronic relapsing disease
and addresses disparities in care,
weight bias in clinical settings,
and the importance of earlyevidence-based interventions
for children in adolescents.
She has authored over 275peer-reviewed publications,
(01:07):
contributed to national guidelines,
and advises organizations
including the NationalAcademies of Sciences,
Engineering, and Medicine.
A sought after educatorand public advocate,
Dr. Stanford has beenfeatured on "60 Minutes,"
"The New York Times" and CNN,
and she's deeply committed
to advancing equitable compassionate care
for patients with obesity
(01:27):
and training the nextgeneration of clinicians.
Dr. Stanford, welcome to theshow and thanks for being here.
- Thanks so much for having me.
- You've said on "60 minutes" that obesity
is a brain disease.
What does that framingunlock for pediatric care
that a willpower model never could?
- I'm so glad you startedwith that question
because a lot of peoplehave wanted to put the blame
(01:49):
on individuals that have obesity.
When we delve into thebiology of this disease,
we recognize that there isa lot of pathophysiology
that starts in the brain.
There's an anorexia geneticpathway of our brain,
and when we hear anorexia,
we hear a pathway thattells us not to eat,
and we have an orogenicpathway of our brain,
so a pathway that does tell us to eat.
(02:11):
Those of us that arelean have an upregulation
of that pathway that tells us not to eat,
and those of us that carry excess adipose,
which is fat mass, have anupregulation of that pathway
that tells us to eat.
And this helps us to understand
that when persons carry excess fat mass,
it's more than just youtelling them to eat less
and exercise more.
(02:32):
This removes a lot ofthat blame shame game
that we have put on parents or children
that carry excess adiposethroughout their childhood
and unfortunately will oftencarry that into adulthood.
There's biology behind it.
How do we then use thisto treat individuals
that struggle with this disease process?
And this has been a lot ofwhat I spend time with families
(02:55):
to help them understandthat I can be a part
of the solution,
recognizing that there'snot just one answer
to the question,
it's a multidisciplinary approach
to addressing this disease process,
but the brain is at the center of it all.
- That perspective challengesthe old willpower narrative,
and I can see how it changesboth family conversations
(03:17):
and treatment planning.
How do families respondwhen you use this language
compared to talking aboutit as a lifestyle disease?
- Parents particularly are very receptive.
When you're talking toparticularly a small child
or even a young adolescent,
they are sometimes confused by this,
but you can imagine thatthis takes a bit of a weight,
(03:38):
no pun intended off of the family
to recognize that theydidn't just cause this,
that maybe it was partof the epigenetic milieu.
I can help them get to a healthier place.
Yes, I do need them to go do some things.
I want them to set up andframe a healthy environment,
looking at healthy diet,
lean protein, wholegrains, fruits, vegetable,
(04:00):
high fiber content,
and set up a safe spacefor movement and activity.
These are things that I want,
but what if they've done those things?
What if they've tried those things
and aren't seeing any results?
What can I then do to helpchange what's happening?
One of the things that'sgreat about the work
that I have been doing, andnot just me as an individual,
(04:21):
but what I love is seeing the outcomes,
seeing those pediatric patientsbecome my adult patients
and seeing how theirlife trajectory changes.
I wanna talk specificallyabout one of my patients
that ended up needing bariatric surgery.
Unfortunately, her mother used to take her
to Weight Watchers meetingsstarting at the age of four.
(04:41):
Now, imagine a 4-year-oldgirl sitting there playing
with her Barbie dolls ina Weight Watchers meeting.
Is that the right place for a 4-year-old
to be spending their time?
I would say the answer is a resounding no.
I would say that a 4-year-oldshould be spending their time
being a 4-year-old.
That 4-year-old wenton to bariatric surgery
(05:02):
at the age of 19 or 20,
went on to become a nurse practitioner
and works treatingindividuals that have obesity,
but she was told that shewould never be healthy.
She was told that shewould never conceive.
She has two healthy young children
and is caring for individualsthat have obesity now.
(05:24):
We can treat individuals,
they can go on to lead healthy lives.
Their disease processesassociated with obesity
can go into remission,
but we don't have to be punitive
in our care for these individuals,
and this is what we've done to individuals
that have had obesity.
We assume that if we punish them,
subject them to pain and blame and shame,
(05:47):
we will make it better for them.
We only make it worsefor those individuals
by not understanding the biology
and the treatment modalities
that may get them to thehappier, healthier lives
that would be best for them.
- Such a powerful story,
and it illustrates howframing obesity as a disease
has the potential to shapesomebody's life trajectory
(06:07):
and highlights why clinicianscan treat pediatric obesity
as just diet and exercise advice.
Building on that,
what do you see as the mostdamaging misconceptions
about pediatric obesity
that you would like clinicians to abandon?
- I really want us tostop thinking of this
as the parents' fault in whatthey're feeding those kids.
(06:29):
Notice how I said those kids.
We look at those people
as if they're like some dirty objects.
Why can't we treatindividuals with obesity
with humanity and dignity and respect?
It is entirely acceptablein today's society
for us to treat persons with obesity
and including our pediatric patients
(06:49):
as if they're second class citizens.
We are able to disregard them,
we're able to choose not togive them dignity and respect,
and I can remember,
and I'm going to take you backto my pediatrics residency
and our pediatrics clinic, youcould pick up the next chart
and whoever you sawwould be the next person
(07:09):
in our pediatric clinic
because we weren't yetpracticing physicians
and had our own patient panel.
If you had an individualthat may have had obesity,
you could skip that person, right?
Because that was gonnabe a more complex person
that had more chronic disease.
So, I would see myco-residents strategically skip
those individuals that had obesity.
(07:29):
What's the humanity in all of that?
Why are you choosing to skip that chart?
Is it harder work?
Are there going to bemore areas of discussion?
Absolutely.
If we go back to the question,what are we able to do?
How are we able to just skippast or choose not to address?
That's what I often see insome of my pediatric colleagues
(07:52):
even as we progress and becomemore advanced in our training
and complete our BoardCertification, let's not address that
or let's move on to aneasier, simpler case
that brings up a bit more joy.
I actually get the joyout of moving that person
to a healthier lifestyle.
Now, I'm gonna take you to mymost poignant pediatric case,
(08:14):
a case that defined how Ithink about this entire field
of obesity medicine.
It was also the case that it helped me get
the American Medical Associationto acknowledge obesity
as a chronic disease andintroduce you to a patient
by the name of Twinkie.
Think about why she mighthave been called Twinkie,
and let that resonate with you.
So, we're gonna meet Twinkie,
(08:36):
a young Black girl in South Carolina
where I did my Residency.
I was an InternalMedicine-Pediatrics Residency.
I was tasked with havingTwinkie as a patient.
She had made her transition
from the Pediatric ICU down to the floor
where she had come into the hospital
with an asthma exacerbation.
When I walked in to do my morning rounds,
(08:58):
I noticed that Twinkie was not breathing.
I went to figure out whyTwinkie wasn't breathing,
and I shook her.
She did (gasping) kindof gasp, choke for air,
she then started resumedbreathing and I said,
well, probably Twinkiewho was around the age
of 11 years old hasobstructive sleep apnea.
I reported this to my senior residents
and attending physicians,
(09:19):
and they were like, good job Fatima,
acknowledging that she hasobstructive sleep apnea.
What she came in for wasan asthma exacerbation.
We need to make sure shegets her asthma training
and get her prepared for discharge.
We still had another day toarrange all of that information,
and now that we have thisnew potential diagnosis
of obstructive sleep apnea, gether set up for her discharge
(09:41):
with a sleep study forthat important diagnosis.
Next morning comes as I do my rounds,
here she is not breathing again,
but we're gotta get her discharged
because you gotta flipthose beds in the hospital.
For those of us thatpractice clinical care,
it's about turnover.
We gotta make sure that wehave those beds reserved
for those that need thehighest security of care
in the hospital.
(10:02):
We could her discharge paperwork,
do my duty as the faithful intern.
We make sure that she'sdischarged for sleep study
is scheduled along withher asthma education.
All of those things are done,
and she's scheduled to have a sleep study
in approximately two weeks,which is actually quite fast
for those of us thatknow how long it can take
to get these types of studies.
Unfortunately, within just a few days,
(10:25):
I get notification thatTwinkie is no longer living.
Cause of death, obstructive sleep apnea.
And so when we talk about whether or not
we should treat obesity,
whether we should treat individuals
that have obesity in thepediatric population,
whether we should just focus on lifestyle,
I asked you to think about Twinkie,
and whether I should be getting invites
(10:47):
to 11-year olds funerals.
As someone in their late 40s,
I don't like to get funeral invitations
for persons in my age group,let alone 11-year olds
who should still be around.
When I told this story to theAmerican Medical Association
before their pivotal voteto acknowledge obesity
as a chronic disease,
I can tell you that foranyone who has any compassion
(11:09):
or empathy for individuals,that it was indeed that story
that convinced the House of Delegates
that we should indeed acknowledge obesity
as a chronic disease.
- Thank you for sharing thatand what a heartbreaking,
but also formative story that underscores
how easily obesity-related complications
(11:30):
can be overlooked whenthe focus stays narrow,
and the fact that this case helped
catalyze broader recognition by the AMA
just shows how individualstories like this
can drive systemic change.
That brings us to this question of timing.
The 2023 EP guideline movedaway from watchful waiting
(11:51):
and emphasized earliermore active treatment.
How do you think cliniciansshould balance that urgency
with the sensitivity families need
in those early conversations?
- I'm gonna go back to Twinkie.
I think this story speaksto why watchful waiting
can lead to premature death.
We wait, patients die.
(12:12):
This is the reality of what we see.
Patients do indeed die.
Unfortunately, many ofthe pediatric patients
that I see in my clinicpresent with greater morbidity
than my adult patients,
both have severe obesity,
but the burden of disease
much higher in my pediatric patients.
(12:34):
Higher glucose levels,
higher evidence of lipid abnormalities,
worsened liver disease.
They come in and I'm justsupposed to sit there and look
and say, oh, you know what?
Maybe they just get tolerantthey'll outgrow this disease.
The time for action is now.
I was penalized as a resident,
(12:55):
particularly on my pediatric side
for putting obesity as aproblem list on my notes,
but how can we not putobesity as a problem list
when it was indeed the contributor
to these obesity-relatedchronic disease risk factors?
And obviously my residencywas far before 2023
when the AAP finally madethis very pivotal decision
(13:17):
to change the guidelines to say,
we can no longer watchfully wait
and need more aggressive measures
for those that carry ahigh burden of disease.
What we do know, and every clinical study
has demonstrated this, is thatif we don't intervene early,
these young individualsthat have this high burden
of disease have much moreaggressive disease as adults
(13:40):
compared to those that justdevelop disease in adulthood.
Let's say I have a patient that comes in
and they develop obesity at the age of 30,
compare that to someone thathad disease at the age of four,
imagine how great thatburden of disease would be
if we didn't intervenefrom four all the way
until they finally present.
The disease burden is so much higher.
(14:02):
The risk of death is so much higher.
We need to intervene so thatwe can have better outcomes,
and unfortunately wedon't see that happening.
Even when I'm doing consultswith my pediatric colleagues
and I offer very specific-outlined advice,
I'm only one person andthere's only so many of us
that can actually dothe high level of care.
(14:24):
So, if I give you anoutline, my goal is to say,
I need you to share the burden with me.
There's only one me and so manyothers trained in the field,
but if I can teach youand provide clear steps
on how to move beyond watchful waiting
to using other modalities and therapies
beyond lifestyle modification,
(14:45):
my goal is to make surethat you and your community
are equipped with this information
so that it doesn't have to funnel in
to a very small cohort of individuals
that may be trained on how to do this.
My goal is to guide and teachso that you can then do that
for the wonderful patientsyou care for as a clinician
(15:05):
in your particularsetting as a pediatrician.
- That's a really helpful way
to think about balancingurgency with sensitivity,
and also a call to actionfor the healthcare team
and clinicians to really think about this
as not the responsibility foronly a subset of clinicians,
but a responsibility for all.
It brings us to one of thenewer tools in our toolbox,
(15:28):
GLP-1 agonists that arenow approved for teens.
Where do you see pharmacotherapy fitting
into pediatric obesity care,
and talk about what areyour non-negotiable criteria
for starting, and importantly,when do you not start?
- We know that GLP-1 receptor agonists
are now currently approvedfor the treatment of obesity
(15:49):
in the pediatric population.
We can begin using themstarting at the age of 12.
These medications are currently approved
for thinking about highpotency medications
like Semaglutide which areonce-weekly injection we can use.
And what's very interesting also,
if we look at the clinical trial data
and even data for patientsthat I'm seeing in clinic,
we see that pediatric patients
(16:09):
tend to do a littlebit better than adults.
Overall if we were to look atmetabolic bariatric surgery,
the kids always seem todo a little bit better
than the adult patients.
With regards to when weutilize these therapies,
we would use these forpatients that have maximized
their lifestyle modifications.
They have tried dietary modifications,
tried physical activity modifications,
(16:30):
and have maximized those therapies.
Now, we are saying, okay,we've tried to maximize those,
now we may need to utilize a GLP-1.
Maybe they have glucose intolerance,
maybe their blood sugar's abit higher than we would like.
Maybe they're curing someexcess fat around the midsection
and have what we call Metabolic-associated
steatotic liver disease.
There are a variety of reasonswhere these could be helpful.
(16:53):
Often I find that theparents are more fearful
of the needle injectionthan the pediatric patients,
so their kids are like,"Hey, mom, I can do this,"
or, "Hey, dad, I can do this."
Then the parents are like, "Are you sure?"
With regards to the sideeffects of these medications,
the side effects are exactly what we see
in the adult population.
Nausea is by far themost common side effect
(17:14):
affecting up to 40% of patients
as we are titrating thedose of these medications.
The key thing is makingsure that the parents
or caregivers of these patients are aware
that these medicationsare going to cause nausea,
particularly as we're titrating these.
What I often do,
particularly since theseare pediatric patients,
I give these medications on the weekend
(17:35):
so they're not impairingacademic performance
or their school day, Idon't feel good at school.
Another key issue is constipation.
Kids don't often talkabout their stool patterns,
neither do adults.
This is something that you have
to be very direct with kids about,
in terms of whether or not
they're having normal bowel movements
and things of the source.
We of course, look at BMI percentiles.
For pediatric populations beforeabove the 95th percentile,
(17:59):
we've moved into childrenthat have obesity,
between the 95th and the 120thwe're in that first category,
120th and 140th we're in the second,
and then anyone over the 140th
we've gotten into that reallysevere category of obesity.
These patients, you're startingto watch them come down
those growth charts.
It's really interestingto watch these individuals
that are responders move from the,
(18:20):
let's say 136 down to the127, down to the 115th,
down to the 95th
and see that major shift whenthey go on these therapies
and are consistent with the utilization.
One of the key things,however, with the medications
is making sure that they'remaintaining their muscle mass.
(18:40):
We don't really think aboutthis because there are kids
and you're like they'regonna retain muscle,
but the medications dopotentially cause muscle loss.
How do you negotiate that?
You wanna make sure that they're active
and engaged in some strength training?
Absolutely.
Non-negotiables for theseare the exact same as adults.
You don't wanna use these in individuals
that have a history of multipleendocrine neoplasia Type 2
(19:04):
anywhere in the family,
anyone with a history of pancreatitis,
medullary thyroid cancer,
these are patients that you would not use
these medications in.
But like adult patients,if they are responders,
we will continue the utilizationof these medications.
However, it should be noted that children
that are reproductive potential,
we do need to be usingforms of birth control
(19:26):
because there is apotential for birth defects
as noted in animal models,
particularly rodentmodels and rabbit models,
we haven't necessarilyseen that in human models,
but we do need to be thoughtful about that
in our young ladies.
A lot of clinicians arelooking at the STEP TEENS Trial
as a reference pointwith impressive outcomes.
How do you help familiesinterpret those results
(19:48):
in real world practice, bothin setting expectations,
but also defining whatsuccess could look like
in three, six months?
Instead of them justlooking at three or six,
I give them a year-long process.
If we look at the trial data,
it really goes out more like 72 months.
If we're not seeing anyresponse in three months,
maybe this isn't a gooddrug for you and it's okay.
(20:09):
Not everyone responds to every agent.
Particularly also if they're having
significant side effects.
Let's say the nausea is relentless
and they can't even sit upand go to school or a study,
then this is also not the agent for you.
But if we're starting to see some response
without any of these sideeffects at three months
and that could be characterized
by 5% total body weight loss,
(20:31):
then we start to set expectationsaround that percentage
of their total body weight loss,
so comparing them to themand not them to someone else.
- As you mentioned earlier,
sometimes medications don't work,
and sometimes medications are not enough.
Let's talk a little bitabout bariatric surgery,
which is still oftenseen as the last resort.
(20:51):
What do we know now about its safety
and effectiveness in teens,
and when should it be on the table?
- Bariatric surgery is stillthe best option for patients
with severe obesity.
I have utilized this as a therapy
for patients with severeobesity for many years
and has much more data thanwe do with pharmacotherapy.
(21:12):
We have 20, 30 plusyear data on individuals
that have undergone surgical interventions
in the pediatric population.
If we look at Thomas Inge'sdata the Teen‑LABS trial,
and I can even pull from my patients
that have gone to surgery15, 20 plus years ago
and look at that data, it'simportant for individuals
that undergo surgery to knowthat this is a lifestyle change
(21:35):
that we need to monitor indefinitely.
If it's a sleeve gastrectomy,
which is the most commonprocedure versus a gastric bypass,
which is the second,
they're gonna need to supplementfor the rest of their life,
they're gonna need amultivitamin, Vitamin D,
they're gonna need calciumcitrate plus vitamin D,
plus vitamin B12 forever.
So, this means that you'realso gonna need to follow up
and get labs tested to checkfor vitamin deficiencies.
(22:00):
We're also going to need tolet people know at the outset
that surgical interventionsaffect both bone and muscle.
That is also what I callthe honeymoon period,
post-surgical intervention.
What do I mean by that?
In the first 12 months post-surgery,
you are going to feel amazing.
You're gonna be losingweight, filling great,
(22:20):
but what you don't know isthat there's a honeymoon period
it comes to an end,
meaning you had surgery donein the abdominal region,
but your brain hasn't recognized
that surgery happened down in the gut.
The brain takes over.
Hormones in the brain start to reignite.
Ghrelin or key hungerhormone starts to reemerge.
(22:42):
GLP-1, not a medication,
because we all have GLP-1inside of us starts to go down.
GIP starts to go down.
Cholecystokinin starts to go down.
Peptide YY starts to go down.
When people look at individuals
that may have regainedweight post-surgery,
they assume it's their willpower,
they didn't do something right.
When they don't realize
that it was the hormones in their brain
(23:04):
and gut that start to reactivate,
that starts pulling themback in the direction
of where they were prior to surgery.
Now, one of my biggest areas of research
has been using medications as an adjunct
to surgical intervention, soabout 90 to 95% of my patients
that are post-op are also on medications,
or we can double or triple their response
to surgical interventions.
(23:25):
These patients may lose 30, 40, 50,
even 60 plus percenttotal body weight loss
with the combination of medications
and their surgical intervention.
If you've never been told thatprior to going to surgery,
you just assumed you failed.
So, going back to that samethought process that you had
before you went to surgery,
here again, I did something wrong,
(23:46):
I didn't eat well enough.
The surgeon reinforces this narrative
'cause you did something wrong,
here you had this method of last resort,
which I hate that language,
they don't realize that itwas this lovely brain of yours
that pulled them back, notbecause it was their fault.
What I do to my patients is I inform them
before they go to surgery,
look, the honeymoon will come to an end.
(24:08):
When that happens, we need to think
about what we're going to add
so that you don't succumb to the fate
that many persons thatgo to surgery succumb to.
This isn't your fault.
The biology was sosignificant that we needed
to send you to surgical intervention,
so why do we think we're gonna solve it
all of a sudden with lifestyle alone?
(24:30):
This is an important consideration,
even in my pediatric patients,
because if they're going tosurgery as a pediatric patient,
we have a longer time tosustain these results.
- You've highlightedvery well how powerful
and effective bariatric surgery can be,
but what I also heard isthe need for effective
and comprehensivecommunication with the patient,
(24:50):
preparing them for both thehighs and the lows of it,
which would be a game changer
for how they approach their recovery.
Not every patient has thesame access to these benefits.
We know that Black and Hispanic youth
experience higher rates of obesity,
yet they're less likelyto receive treatment.
How do you interpret these disparities,
(25:11):
but also what should cliniciansbe doing differently?
- What drew me to the fill,
particularly as a Blackwoman born and raised
in Atlanta, Georgia,
was because I saw in my community
that particularly Black women,
Black girls were disproportionatelyaffected by obesity.
But when I saw the people
that were actively involved in the field,
(25:32):
none of them looked like me.
Were they going to be asinvested in understanding
how to address this in the community?
Whether in the pediatricor adult population,
I didn't feel as though thatwas going to be the case.
Why don't we have access inBlack and Brown communities?
Why can't we ensure that the communities
(25:52):
that are disproportionately
more likely to have obesity get access?
When we think about pharmacotherapy
and metabolic and bariatric surgery,
we have to be thinking aboutpolicies that allow access
to all of the things that I just mentioned
and recognize thatunfortunately there's barriers
to all of those things
when we think about these communities.
(26:14):
If we don't have the clinicians
that are willing to care for communities,
then we're gonna also face that barrier
even if we advance the therapies.
I practice at Mass General Hospital,
our encatchment area doesn'tinclude a lot of people
that look like me,
but close to 45% of my patientshappen to be Black patients.
So, if you look at my colleagues,
only about 8% of theirpatients are Black patients.
(26:36):
Why is there such a differential?
Because those patients come seeking me.
They know who I am.
They seek me, then their family members.
It goes to show you thatif there's a clinician
that someone identifies with,
then they will seek thatindividual that provides the care
to those underserved communities.
We serve Mass health patients,those that are Medicaid,
(26:58):
lower socioeconomic position,our older adult patients,
patients identify with individuals,
but we know that there'sbarriers to entry for clinicians,
and we are seeing thattaken away systematically
for our medical students,Residents, Fellows,
our nursing students, et cetera,
across the healthcare ecosystem,
(27:19):
we know that there's barriers
to having healthy living environments
that allow those to havereduced allostatic load,
which allows individuals tohave a healthier environment
where obesity doesn't flourish.
These are really important conversations
that we have to have ifwe think about wanting
to tackle these different leversthat contribute to obesity.
(27:41):
- Your research showsthat income and education
can be stronger deciding factors
than raise alone in termsof access to benefits.
How should that reshape theway we think about equity
in pediatric obesity care?
- We have to have it suchthat there's more money
and more education.
This is interesting, but let's look at one
of the most highly educateddemographics in the country,
(28:04):
which is Black women.
Somehow the most highlyeducated demographic
still has the highest obesity rates.
There's a pull and a push.
This is what brought me to the field
because I was seeing women
with four and five degrees still struggle,
so I knew that therewas more to the story.
If you look at a lot of my research
and you're seeing this income disparity,
you're seeing this issue with people
(28:26):
that have greater income beable to have greater access,
but we can think of individualsthat have great income
who've always struggled with obesity.
The story is much morecomplicated than that.
- I agree with that.
Another component is insurance coverage,
which often lags behind the clinical need.
If you could change one policy tomorrow,
(28:46):
what would it be to improvepediatric obesity care?
- It would be universal coveragewith regards to healthcare.
If we had universal access and clinicians
that are willing to treatindividuals with obesity,
we could help addresssome of the disparities
because some of my researchis also demonstrated
(29:07):
that even when we haveequivalent insurance,
that individuals that are from racial
and minority populations
still don't get accessto the same therapy.
We need to have cliniciansthat are willing
to utilize such insurance
to ensure that there isequity in terms of access,
whether it be lifestyle modalities
like intensive behavioraltherapy, pharmacotherapy,
(29:29):
access to GLP-1s and bariatric surgery,
and ensure that each of thoseare being equitably used
to ensure that thosethat need them the most
are actually getting access to them.
- You've worn many hats,clinicians, scientists, educator,
policy advocate,
and when I was reading thisin your "Lancet" piece,
you mentioned feeling the need
(29:50):
to do 10 times more thanpeers to be recognized.
What lessons have you learnedthat might inspire listeners
who want to advocate for change?
- Follow your passion.
If you have a passion and a drive,
you'll continue to move forward.
My high school in Atlanta, Georgia,
was named after Dr. Benjamin Elijah Mays,
(30:11):
a famous educator and orator,
or one of the teachers forDr. Martin Luther King, Jr.
And he says, 'Strive todo whatever you do so well
that no person living, no person dead,
and no person yet to be borncould do it any better."
That's a really heavy lesson to live by,
but it is how I live my life.
- Thank you so much forsharing your expertise
and perspective with us.
(30:31):
This conversation has really challenged us
to move beyond outdated assumptions,
recognize obesity as acomplex chronic disease
that requires early evidence-basedand compassionate care.
You've given us some practical insights
that we can all carry backto our clinical teams.
To our listeners, we hopetoday's discussion helps you
(30:51):
approach pediatricobesity with fresh eyes,
renewed urgency, and strategies
that improve care forevery child and family.
Thank you for joining usin "Stanford Medcast."
Thanks for tuning in.
This episode was broughtto you by Stanford CME.
To claim CME forlistening to this episode,
click on the Claim CME link below
(31:12):
or visit medcast.stanford.edu.
Check back for new episodes
by subscribing to "Stanford Medcast"
wherever you listen to podcasts.
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