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Speaker 1: Welcome to the Therapy for Black Girls Podcast, a weekly

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Speaker 1: conversation about mental health, personal development, and all the small

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Speaker 1: decisions we can make to become the best possible versions

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Speaker 1: of ourselves. I'm your host, doctor Joy hard and Bradford,

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Speaker 1: a licensed psychologist in Atlanta, Georgia. For more information or

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Speaker 1: to find a therapist in your area, visit our website

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Speaker 1: at Therapy for Blackgirls dot com. While I hope you

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Speaker 1: love listening to and learning from the podcast, it is

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Speaker 1: not meant to be a substitute for a relationship with

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Speaker 1: a licensed mental health professional. Hey, y'all, thanks so much

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Speaker 1: for joining us for session four twenty six of the

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Speaker 1: Therapy for Black Girls Podcast. We'll get right into our

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Speaker 1: conversation after a word from our sponsors. Today, doctor Fatima

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Speaker 1: Cody Stanford joins us for a compassionate conversation about weight,

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Speaker 1: health and healing. We're exploring why obesity should be understood

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Speaker 1: as a chronic disease and not a moral failing, and

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Speaker 1: discussing new treatment options like GLP one medications that are

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Speaker 1: changing lives. Doctor Stanford brings both scientific expertise and deep

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Speaker 1: empathy to this work. She's an obesity medicine physician scientist

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Speaker 1: at Massachusetts General Hospital and Harvard Medical School. What makes

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Speaker 1: our perspective so valuable is that she understands the unique

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Speaker 1: experiences of Black women navigating weight and health in a

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Speaker 1: world that often judges us harshly as one of the

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Speaker 1: few black women leading research in this fields. Please how

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Speaker 1: chronic stress, systemic barriers, and generational trauma show up in

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Speaker 1: our bodies, and ways that traditional medicine has often overlooked.

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Speaker 1: During our conversation, we talk about the science behind weight regulation,

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Speaker 1: how new medications actually work, and why it's time to

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Speaker 1: move beyond VMI as the only measure of health. Most importantly,

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Speaker 1: doctor Stamford reminds us that seeking help for weight related

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Speaker 1: health concerns isn't giving up or taking the easy way out.

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Speaker 1: Is taking care of yourself with the same compassion you'd

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Speaker 1: show a loved one. If something resonates with you while

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Speaker 1: enjoying our conversation, please share with us on social media

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Speaker 1: using the hashtag TVG in session, or join us over

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Speaker 1: in our Patreon channel To talk more about the episode.

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Speaker 1: You can join us at community dot therapy for Blackgirls

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Speaker 1: dot com. Here's our conversation. Thank you so much for

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Speaker 1: joining us today, doctor Fatima.

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Speaker 2: Well, it's a delight to be here.

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Speaker 1: Thank you. So you have done so much incredible work

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Speaker 1: around obesity, medicine, health disparity. You know a lot of

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Speaker 1: your work in your clinical research has been around why

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Speaker 1: obesity really should be classified as a chronic health condition.

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Speaker 1: Can you say more about why you think that shift

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Speaker 1: needs to happen?

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Speaker 2: Absolutely, and I'm actually going to change it from being

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Speaker 2: a condition to a disease specifically, and I'm going to

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Speaker 2: tell you why a disease is opposed to condition. So

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Speaker 2: when it's classified as a disease, we actually treat it

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Speaker 2: with the wherewithal that it needs. So when it's a disease,

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Speaker 2: we have different forms of therapy from lifestyle to medication

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Speaker 2: to surgical interventions that we might utilize to treat it.

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Speaker 2: And we actually have those full gamut of things that

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Speaker 2: we can actually use to treat obesity. So let's talk

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Speaker 2: about different things. We have bariatric surgery or what we

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Speaker 2: call metabolic and bearatric surgery that treat it for patients

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Speaker 2: that have the most severe disease, process pharmacotherapy for those

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Speaker 2: with kind of moderate disease, and then lifestyle forms of

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Speaker 2: therapy which may fall in the diet, physical activity, and

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Speaker 2: behavioral strategies which may be working with our psychologists and

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Speaker 2: psychiatrists and things of that sort. And so when we

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Speaker 2: recognize it for the disease that it is, and we

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Speaker 2: can get into that a little bit in terms of

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Speaker 2: talking about its origin points, which are in the brain

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Speaker 2: and the atapost tissue out of post is a fancy

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Speaker 2: word for fat, but that is actually an organ and

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Speaker 2: people don't realize that that is a metabolically active organ

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Speaker 2: that has targets. And so when we can target these

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Speaker 2: organs within our body, the brain, the fat mass, we

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Speaker 2: can actually treat it for the disease that it is

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Speaker 2: and give it the wherewithal that it actually needs.

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Speaker 1: So, Asima, I am not a physician, so I feel

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Speaker 1: like some of these things I will definitely not understand,

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Speaker 1: but I got you. I do want to understand, Like

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Speaker 1: why has this been missed in the field, Like why

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Speaker 1: are we just now kind of understanding obesity as a

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Speaker 1: condition of our disease of the brain in fat as

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Speaker 1: opposed to like a wheel pop kind of being.

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Speaker 2: I think it comes down to it being a visual disease, right.

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Speaker 2: We judge the book by its cover. We look at

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Speaker 2: a person. If someone happens to carry more excess weight,

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Speaker 2: we assumed that they just did something wrong, right, they

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Speaker 2: didn't get up and exercise this morning, or they ate

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Speaker 2: too much, they didn't push away from the table, so

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Speaker 2: we assume that it's their fault, right, that they caused

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Speaker 2: this for themselves. Most diseases that people have aren't ones

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Speaker 2: that are visual in nature. You can't see if someone's

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Speaker 2: blood pressure is high, right. You can't necessarily see if

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Speaker 2: someone has diabetes unless they've developed indoor and damage from

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Speaker 2: the diabetes. Maybe they've lost some of their limbs, maybe

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Speaker 2: they developed blindness, maybe they've developed kidney disease and are

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Speaker 2: having to go to dialysis or something. Similarly, with some

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Speaker 2: of the types of cancers, you don't necessarily see that

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Speaker 2: they have cancer unless they've started to lose their hair

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Speaker 2: or things of that sort. You don't really know that

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Speaker 2: someone has cancer. Most things you don't really know unless

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Speaker 2: you're the doctor and you have the patient chart. And

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Speaker 2: the chart isn't usually a physical piece of paper any more,

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Speaker 2: rights on a computer and I can read it and

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Speaker 2: I say, oh, well, you have this, you have asthma,

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Speaker 2: or you have this or you know, these diagnoses that

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Speaker 2: you can actually read. But unfortunately, obesity is very visual,

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Speaker 2: and so we as humans we start to judge the

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Speaker 2: book by its cover, and we start really early in

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Speaker 2: life we actually start to demonstrate signs of bias towards

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Speaker 2: individuals that carry excess weight. I'm going to tell you

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Speaker 2: the age we start to really judge people. Three years old.

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Speaker 2: That's when we really start to judge people. So it

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Speaker 2: starts on the playground, it starts in preschools. It's when

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Speaker 2: we say, that person is larger than me, and so

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Speaker 2: I'm going to hooke fun at that person and assume

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Speaker 2: that they did something wrong. And we are getting those

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Speaker 2: messages from the people around us, the adults around us

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Speaker 2: that are saying, oh, there's something wrong with that kid,

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Speaker 2: there's something that's not right. And you can imagine that

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Speaker 2: as we get older, we just begin to do more

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Speaker 2: and more of that. Those persons that happen to carry

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Speaker 2: more weight become the laughing stock. We turn it into comedy.

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Speaker 2: It's an acceptable form of laughter that we have. It's

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Speaker 2: no longer acceptable to do that towards someone because of

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Speaker 2: their race or their ethnic background, or for other reasons.

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Speaker 2: But if someone happens to be larger in size, it's acceptable,

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Speaker 2: and we are just given a pass to talk about

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Speaker 2: them because of their size. And so, because of all

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Speaker 2: of these things, people, and I'm going to put doctors

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Speaker 2: on the chopping block here, doctors, nurses, exercise physiologists, physical

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Speaker 2: therapists didn't take the time to really learn the pathophysiology

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Speaker 2: about the disease because they too assumed that it was

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Speaker 2: just a matter of eating less and exercising more.

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Speaker 1: So, can you talk a little bit more about, like

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Speaker 1: some of the science behind why OBCD should now be

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Speaker 1: classified as a disease, what is actually happening in the

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Speaker 1: brain and in.

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Speaker 2: The ved Absolutely, I'm so glad you've asked me to

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Speaker 2: do that. So there's two really pathways around the brain

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Speaker 2: that tell us how much to eat and how much

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Speaker 2: to store. So there's a particular part of the brain

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Speaker 2: called the hypothalamus. It's a really small part of the brain,

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Speaker 2: but there's two pathways, and one pathway is our anorexigenic pathway.

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Speaker 2: You know, when we hear anorexia, people are told not

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Speaker 2: to eat right or told not to store fat. Mask

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Speaker 2: and that part of the brain is the fancy word

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Speaker 2: I'm going to throw out there, don't worry about it.

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Speaker 2: It's called the palm sea or the propium milaniportant pathway.

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Speaker 2: And so if we travel down or we signaled out

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Speaker 2: down that pathway, you can imagine we're going to be

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Speaker 2: leaner in appearance. Right, We're gonna store very little fat mass.

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Speaker 2: For those people that travel down that pathway, they have

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Speaker 2: high levels of something called B D and F which

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Speaker 2: stands for a brain derived neurotropic factor. So they have

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Speaker 2: high levels of that, they have lean appearance. Okay, So

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Speaker 2: they signal down that anal rexogenic pathway. Now I exclusively

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Speaker 2: treat patients with obesity, and they don't signal so well

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Speaker 2: down that pathway. They signal down a different pathway called

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Speaker 2: the A g r P pathway, which stands for the

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Speaker 2: agoty related Peptie pathway. Now we talk about anal rexogenic,

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Speaker 2: there is the opposite of that, which is called orexogenic orexigenic.

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Speaker 2: You express more fat mass and you have low levels

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Speaker 2: of BDNF. Okay, So when you have that, you are

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Speaker 2: stimulated to eat and you're stimulated to store more fat mass.

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Speaker 2: So that's what's going on in the brain. Okay, so

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Speaker 2: that's the brain piece of it now talked about is

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Speaker 2: a metabolically active organ right, So it actually is metabolically active.

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Speaker 2: And when it's being metabolically activated, if I'm stimulating that

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Speaker 2: anorexogenic pathway, you can imagine I'm not storing as much

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Speaker 2: fat mass. But if I'm going down the other fat pathway,

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Speaker 2: I'm storing more fat mass. And there's things in our

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Speaker 2: environment that can cause us to store more or less. Right,

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Speaker 2: So if we have more stress in our bodies from

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Speaker 2: external stress or stress orders, whether it be chronic stress,

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Speaker 2: you can imagine that I'm going to store more fat

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Speaker 2: mass and actually activate more of that old rexogenic pathway.

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Speaker 2: And that's really important for us to note. So I

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Speaker 2: think it's really important, particularly as a black woman who's

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Speaker 2: drawn to this, to recognize that chronic stress and stress

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Speaker 2: ors can activate that pathway. So let's take us back

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Speaker 2: to something that all of us remember and that all

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Speaker 2: of us were affected by, and that was COVID nineteen.

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Speaker 2: And so during COVID nineteen, regardless of who you were,

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Speaker 2: where you were, I think we can all agree that

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Speaker 2: we underwent stress. Some of us had more or less stress.

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Speaker 2: But I think that we universally experienced stress, and so

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Speaker 2: during that time we may have noticed some weight changes

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Speaker 2: during that time that we can't maybe account for. Because

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Speaker 2: what was very interesting also is that there was an

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Speaker 2: increase in physical activity and sometimes even healthier eating because

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Speaker 2: a lot of us were at home. We weren't going

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Speaker 2: out to eat, we weren't doing all of these things.

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Speaker 2: So what was it? What was the universal thing that

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Speaker 2: was across all of us. We had an increase in stress,

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Speaker 2: and we had an increase of stress. We have an

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Speaker 2: increase in storage of ada posts. What is ada posts?

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Speaker 2: That mass because our body thinks something bad is happening,

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Speaker 2: and something bad was happening, it was a whole pandemic,

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Speaker 2: and it thinks it needs to store to protect us

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Speaker 2: from what else is coming. So hopefully that helps us

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Speaker 2: understand a little bit about this kind of disease process.

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Speaker 2: It gets more and more complicated from that, and we

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Speaker 2: can go down different pathways and other things. But that's

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Speaker 2: some of the basics surrounding why obesity is in ded

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Speaker 2: a disease process.

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Speaker 1: Thank you so much for that explanation. That is very helpful.

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Speaker 2: I appreciate it.

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Speaker 1: Yeah, so you know something else I definitely want to

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Speaker 1: talk with you about. Is the rise in GLP ones

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Speaker 1: we are seeing lots more attention there medications like ozimpic

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Speaker 1: and we gob and manjaro, lots of different options. And

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Speaker 1: are those medications the ones that you were talking about, Like,

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Speaker 1: if we classify this as a disease, now we have

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Speaker 1: a whole arsenal of pharmacy, kinds of medicines that can

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Speaker 1: be used to actually take care of this disease.

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Speaker 2: Yeah, but you know what's really interesting. I'm glad you

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Speaker 2: brought those up, but I want to talk about historically,

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Speaker 2: we've actually been using medications to treat obesity since nineteen

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Speaker 2: thirty three. So my maternal grandmother was born in nineteen

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Speaker 2: thirty three, and I'm going to say that you and

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Speaker 2: I were both not quite around since then. So the

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Speaker 2: FDA has been approving medigations to treat obesity since way

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Speaker 2: back then. Now, I'm gonna say that a lot of

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Speaker 2: those medications were problematic. But let's talk about the gop ones,

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Speaker 2: which everyone is talking about these days, and let's go

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Speaker 2: back to that pathophysiology we just learned about. So the

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Speaker 2: way these medications work is they actually stimulate that anorexigenic pathway,

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Speaker 2: that pathway of the brain that tells us to eat

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Speaker 2: less and store less. So for patients that go on

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Speaker 2: these medications, they'll tell you, you know what, I'm really hungry.

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Speaker 2: I A so may not even be thirsty because it's

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Speaker 2: stimulating that anorexigenic pathway. Not everyone responds to these medicines.

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Speaker 2: These are not a cure for the disease of obesity.

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Speaker 2: I will repeat that again. These medications are not a

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Speaker 2: cure for obesity. They are a treatment amongst treatments for

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Speaker 2: the disease of obesity. Okay, actually, don't repeat it a

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Speaker 2: third time. These medications are not a cure for obesity.

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Speaker 2: But for those patients that are responders, they stimulate that

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Speaker 2: anorexogenic pathway. And so for those that are listening that

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Speaker 2: may be one of these that are responders, they'll be like, yeah,

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Speaker 2: you know, it does seem to stimulate that pathway. Wow,

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Speaker 2: I do feel different. For those that use kind of

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Speaker 2: more layman's terms and terms that I wouldn't use per se,

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Speaker 2: but they'll say it quiet's this food noise. And I'm

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Speaker 2: putting that in quotes on purpose because they may be

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Speaker 2: preoccupied with this idea of like what's my next meal?

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Speaker 2: Not only was my next meal, what are the mills

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Speaker 2: for the rest of the week or the next two weeks.

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Speaker 2: Like there's a preoccupat pation of like, gosh, I need

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Speaker 2: to be thinking about that. I need to be mil prep,

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Speaker 2: I need to be doing this, I need to be

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Speaker 2: doing that. But it turns down that noise. Think about

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Speaker 2: like turning up the volume or whatever your favorite music is,

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Speaker 2: and then all of a sudden it's on mute and

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Speaker 2: you're like, well, look at that. My patients may ask

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Speaker 2: established Eaver, is this what you feel all of the time?

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Speaker 2: And I'm like, I guess, Oh, I don't know, because

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Speaker 2: I don't that's not something that I sense, but I

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Speaker 2: understand what they're talking about. So it stimulates that pathway

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Speaker 2: and then it down regulates that other pathway, that O

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Speaker 2: rexygenic pathway that they may have been struggling with for

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Speaker 2: quite some time. It downregulates that. So this is how

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Speaker 2: those medications work. That Ozimpic and will govy ozempic wigov

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Speaker 2: are the semaglatide. They are the exact same drug, Ozimpic

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Speaker 2: as the trade name for patients with diabetes with govy

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Speaker 2: for patients with obesity. Manjaro is a dual agonis a

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Speaker 2: combination of two different drugs, a gop one. Gop one

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Speaker 2: stands for lucagon like peptide one, and then it has

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Speaker 2: another agent in it, what's called a GIP or glucose

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Speaker 2: insulin tropic polypeptide. Two medicines brought together all of these things. However,

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Speaker 2: I need this to know. Gop one is in our body. Okay,

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Speaker 2: let me repeat that again. Gop one's all of us

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Speaker 2: that are human. I don't know if there's any ai

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Speaker 2: robox work walking around yet, but all of us that

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Speaker 2: are human have gop ones in our body. For those

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Speaker 2: of us that have more gop one on board, we

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Speaker 2: have a leaner phenotype because it's stimulating that anorexogenic pathway.

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Speaker 2: So we don't need to administer a SHOP because we

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Speaker 2: already have it on board. GIP, the dual agon is

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Speaker 2: this on board. We also have GP in our body.

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Speaker 2: GOP stands for glucos insulinentropic polypeptide. So they combined these

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Speaker 2: two things. It is more powerful than the gop one alone. Okay,

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Speaker 2: It helps work together to stimulate even more total body

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Speaker 2: weight loss by helping to regulate these pathways and our

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Speaker 2: brain in our gut. So hopefully that helps us understand

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Speaker 2: that in order for us to have targets, there has

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Speaker 2: to be some disease process to target right for us

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Speaker 2: to work on.

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Speaker 1: And so I appreciate you sharing because I did not

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Speaker 1: know that there were other medications that were designed specifically

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Speaker 1: to help with the disease of obesity. But my understanding

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Speaker 1: is that the golp ones, of course, were originally designed

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Speaker 1: to or they found that they worked with diabetes management, right,

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Speaker 1: and so is the weight loss an off label impact

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Speaker 1: that they found? How did we realize that golp ones

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Speaker 1: also could be used for obesity?

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Speaker 2: Absolutely, So let's go back to twenty years ago when

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Speaker 2: these medications were first approved for the treatment of type

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Speaker 2: two diabetes, and that was a drug called exenotite was

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Speaker 2: is still called axenotype bieta, And when they were doing

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Speaker 2: those first trials that were published, they started to notice

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Speaker 2: a secondary benefit from these medications. They were noticing that

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Speaker 2: the patients going on these medicines, patients with type two diabetes,

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Speaker 2: were getting a secondary benefit with weight being a positive response.

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Speaker 2: Most of the medications used to treat type two diabetes

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Speaker 2: at the time were drugs called safana aureeas and like glipizide, glameaparide,

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Speaker 2: these types of medications. Unfortunately, those medications typically cause weight gain,

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Speaker 2: and so they were noticing, Wait a minute, what's going

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Speaker 2: on here. We're noticing some weight loss, so we're getting

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Speaker 2: dual benefits. It's also important to note because I always

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Speaker 2: hear this argument, oh, we're taking medications from patients with

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Speaker 2: type two diabetes. Let's get something straight. People, eighty percent

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Speaker 2: of patients with type two diabetes also have obesity. So

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Speaker 2: are we really taking it away? Are we just treating

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Speaker 2: the same people? First, Let's get that, let's get that

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Speaker 2: into wraps. And we must also note that when we're

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Speaker 2: looking at these medications. Now, these medications are approved in

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Speaker 2: both patient populations. They're proved for patients with type two diabetes,

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Speaker 2: and notice and capital A, N and D they're proved

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Speaker 2: in patients with obesity. Okay, so two patient populations, but

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Speaker 2: notice there is a strong overlap between those two patient populations.

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Speaker 2: Patients with type two diabetes unfortunately often half obesity conc currently. Okay,

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Speaker 2: So they noticed when they looked at those trials and

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Speaker 2: trial after trial after trial, they were noticing some weight benefit. Now,

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Speaker 2: when you look back at that initial gop one that

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Speaker 2: was approved that we just talked about exanotide or bieta,

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Speaker 2: it was a much weaker gop one, So that's why

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Speaker 2: you weren't hearing about it so much. And there was

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Speaker 2: no social media anyway back then, so you aren't going

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Speaker 2: to probably hear about it in the same way. But

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Speaker 2: as they started to refine and they moved over to

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Speaker 2: drugs like dula glutide or loraglatide and et cetera, et cetera,

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Speaker 2: they started to continue to see this so much so

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Speaker 2: they were like, hm, particularly Novo Nordisk, who was the

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Speaker 2: first to get an agent out and approved for obesity.

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Speaker 2: They said, okay, well, let's just get something approved specifically

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Speaker 2: for obesity, and that was loraglatide that was a once

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Speaker 2: daily injection under the trade name of sex Cinda after

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Speaker 2: Victoza was approved, so once daily injection, and they were like,

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Speaker 2: let's see, let's look at this both in adult patients

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Speaker 2: and in pediatric patients. And hence the first medication gets

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Speaker 2: across the finish line specifically to treat patients with obesity. Now,

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Speaker 2: I can tell you that a once daily injection was

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Speaker 2: not quite as popular as a once weekly injection, and

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Speaker 2: as we also saw the percentage of weight loss not

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Speaker 2: quite be the same as what we saw with semaglatides.

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Speaker 2: So semaglatide is that ozempic and mongovi we started to

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Speaker 2: see fifteen percent total body weight loss. Now that created

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Speaker 2: some interest from the greater population and from doctors. But

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Speaker 2: not only the total body weight loss. It was the

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Speaker 2: resolution of comorbid conditions. And what do I mean by that.

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Speaker 2: We started to see a reduction in things like major

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Speaker 2: adverse coronary events like heart attacks and strokes, improvement in

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Speaker 2: things like obstructive sleep, apnea improvement, and kidney outcomes improvement

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Speaker 2: and heart failure. All of these things we started to

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Speaker 2: see that really increased the interests of doctors. I will

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Speaker 2: say that from the general population, I think it was

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Speaker 2: the total body weight loss that really increased the interests.

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Speaker 2: Got it.

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Speaker 1: And so now we are at the stage where there's

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Speaker 1: been more development in the GLP ones and now has

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Speaker 1: led to the interest and kind of the excitement that

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Speaker 1: lots of people are expressing in terms of being able

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Speaker 1: to use these exactly.

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Speaker 2: I think that just more so, let's look at that

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Speaker 2: true zeppetite, that dual agonist. Right, we saw the fifteen

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Speaker 2: percent and some maglati. Now we're seeing numbers of like

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Speaker 2: twenty two percent in that particular medication. So people are like,

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Speaker 2: what twenty two percent? This is average? Okay. So for

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Speaker 2: those that are listening averages averages, think about when you're

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Speaker 2: in school and you got the average score and some

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Speaker 2: people got a higher score and some people got a

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Speaker 2: lower score. Average is average. So we just have to

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Speaker 2: be aware that not everyone is an average responder or

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Speaker 2: above average responder. And that's really important, which is why

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Speaker 2: I made that comment earlier. It is not a cure

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Speaker 2: right on, everyone is going to respond. There are going

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Speaker 2: to be some high responders and some low responders. And

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Speaker 2: by that it's not just in terms of like I

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Speaker 2: told you that weight loss, looking at the resolution of

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00:22:09,600 --> 00:22:14,600
Speaker 2: obesity relay, disease improvement, and metabolic profile like things like

379
00:22:14,800 --> 00:22:19,240
Speaker 2: your liver numbers or your cholesterol numbers or blood pressure,

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Speaker 2: these things that we really care about in terms of

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Speaker 2: improving your overall health. Waste circumference, right, how much way

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Speaker 2: you're hearing around the mid section, which we know predispose

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Speaker 2: this to things like stroke and heart attacks. These are

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Speaker 2: really important things when I'm working with my patients that

385
00:22:31,880 --> 00:22:34,600
Speaker 2: we go over how well does that blood sugar improve?

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Speaker 2: Are we seeing that come down? Those are things to

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Speaker 2: really really pay attention to.

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Speaker 1: Got it, And you're giving us the perfect segue into

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Speaker 1: some of my next questions around if somebody is thinking like, hey,

390
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Speaker 1: maybe this will work for me, what kinds of things

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Speaker 1: should they be thinking about, and maybe what kinds of

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Speaker 1: conversations should they have with their physicians if they're considering

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Speaker 1: GLP one.

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Speaker 2: So I think it's really important to think about is

395
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Speaker 2: this a disease they actually have. I don't want you

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Speaker 2: going on this medication.

397
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Speaker 3: Oh I just need five pounds. I need to look

398
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Speaker 3: five pounds because I want to look cute for that

399
00:23:08,760 --> 00:23:11,359
Speaker 3: winning I'm going to be in, you know, and you

400
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Speaker 3: know I want to look cute because I'm going on

401
00:23:13,200 --> 00:23:15,479
Speaker 3: a cruise and you know, I really want to look

402
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Speaker 3: cute in my biking.

403
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Speaker 2: This is not no, I'm not This is not what

404
00:23:19,119 --> 00:23:22,920
Speaker 2: this is about. This is for treating disease. Okay, So

405
00:23:23,400 --> 00:23:25,280
Speaker 2: a lot of people have gotten into this idea of

406
00:23:25,400 --> 00:23:29,600
Speaker 2: doing this for vanity. This is not that conversation. I

407
00:23:29,720 --> 00:23:32,480
Speaker 2: know a lot of people, not patients I treat. But

408
00:23:32,720 --> 00:23:37,639
Speaker 2: I've heard in the ethers in the social media community,

409
00:23:37,920 --> 00:23:40,360
Speaker 2: whether it be ig or TikTok, that people are doing

410
00:23:40,440 --> 00:23:45,800
Speaker 2: this for vanity reasons. This is not that conversation, and

411
00:23:45,920 --> 00:23:48,520
Speaker 2: I really hope people are taking this seriously because when

412
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Speaker 2: you go want a medication of this kind, this is

413
00:23:51,240 --> 00:23:56,840
Speaker 2: a long term commitment. We're treating a chronic disease. If

414
00:23:57,000 --> 00:24:01,399
Speaker 2: this medication or medication class works for you, you are

415
00:24:01,520 --> 00:24:06,320
Speaker 2: to use it indefinitely and definitely means for the rest

416
00:24:06,960 --> 00:24:10,240
Speaker 2: of your life, because if it works, you need to

417
00:24:10,320 --> 00:24:12,159
Speaker 2: use it for the rest of your life. If you

418
00:24:12,359 --> 00:24:15,680
Speaker 2: take the medication away and it worked for you, you

419
00:24:16,280 --> 00:24:20,880
Speaker 2: will regain whatever you lost. So if that was fill

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Speaker 2: in the blank number of pounds, forty fifty whatever, I

421
00:24:24,200 --> 00:24:27,159
Speaker 2: don't know, you will regain that. And then you might know, well,

422
00:24:27,200 --> 00:24:30,080
Speaker 2: how do you know that, because we've done studies. We've

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00:24:30,119 --> 00:24:33,000
Speaker 2: done studies that demonstrate this true fact. And it's not

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Speaker 2: just about regaining the weights. Also, whatever health benefits you've

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00:24:37,000 --> 00:24:40,920
Speaker 2: gleaned from being on the medication, unfortunately, those things will

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00:24:40,960 --> 00:24:43,119
Speaker 2: go away also. So this isn't like I said, a

427
00:24:43,240 --> 00:24:48,280
Speaker 2: vanity conversation. This is about looking at the overall health benefits. Now,

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00:24:48,760 --> 00:24:52,280
Speaker 2: I think that's a very important conversation to have. One

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Speaker 2: of the key issues, however, with these medications is the

430
00:24:56,080 --> 00:25:00,560
Speaker 2: access piece. These medications can be very pricey if not

431
00:25:00,680 --> 00:25:03,000
Speaker 2: covered by your insurance. Now, if you have the best

432
00:25:03,200 --> 00:25:09,200
Speaker 2: insurance plan, maybe you have the Rose Royce Bugatti insurance plan. Okay,

433
00:25:09,400 --> 00:25:12,040
Speaker 2: if you got that, what Rick Ross I've rolled up?

434
00:25:12,040 --> 00:25:13,960
Speaker 2: You know, might Begotti, right, that's what he says. Okay,

435
00:25:14,240 --> 00:25:15,920
Speaker 2: So if you rolled up in that, then you have

436
00:25:16,040 --> 00:25:19,480
Speaker 2: the insurance plan, then that's great. That means you're playing

437
00:25:19,560 --> 00:25:21,280
Speaker 2: like a thirty dollars copay a month and you're like,

438
00:25:21,359 --> 00:25:24,359
Speaker 2: I got this great, fabulous for you. Then this is

439
00:25:24,760 --> 00:25:28,399
Speaker 2: a moved conversation. I'm happy for you. This is a

440
00:25:28,480 --> 00:25:31,800
Speaker 2: non conversation. But let's say you don't have that, then

441
00:25:31,880 --> 00:25:34,919
Speaker 2: these medications can be very, very pricey out of pocket.

442
00:25:35,119 --> 00:25:37,439
Speaker 2: What are we talking about here in the US compared

443
00:25:37,480 --> 00:25:41,560
Speaker 2: to our friends in Canada or in the UK. We're

444
00:25:41,640 --> 00:25:44,680
Speaker 2: talking one thousand plus a month. That is a lot

445
00:25:44,920 --> 00:25:48,840
Speaker 2: right now. I can tell you that Eli Lilly, for example,

446
00:25:48,960 --> 00:25:52,960
Speaker 2: has discounted their prices to three hundred and fifty to

447
00:25:53,040 --> 00:25:55,480
Speaker 2: five hundred a month. That's still a lot a month

448
00:25:55,640 --> 00:26:00,520
Speaker 2: for these medications. So just be aware that if we're

449
00:26:00,560 --> 00:26:03,160
Speaker 2: talking a price point and you don't have coverage, these

450
00:26:03,280 --> 00:26:05,840
Speaker 2: medications can be out of reach. And we're hoping that

451
00:26:06,160 --> 00:26:09,080
Speaker 2: for example, Ela Lilly has an oral that may be

452
00:26:09,160 --> 00:26:11,240
Speaker 2: coming on the market at some point and then you're

453
00:26:11,280 --> 00:26:13,480
Speaker 2: Beary in your future, and we're hoping that will drop

454
00:26:13,600 --> 00:26:16,840
Speaker 2: the price point for an oral medication, not just an

455
00:26:16,880 --> 00:26:20,600
Speaker 2: injectible or a daily oral, that will make it accessible

456
00:26:20,680 --> 00:26:23,640
Speaker 2: to more individuals because the price point is so high.

457
00:26:24,160 --> 00:26:27,440
Speaker 2: We know that patients that have medicare this medication is

458
00:26:27,640 --> 00:26:31,120
Speaker 2: not covered at all if you have obesity. It's only

459
00:26:31,200 --> 00:26:34,159
Speaker 2: covered for patients with type two diabetes. We know in

460
00:26:34,320 --> 00:26:37,840
Speaker 2: certain states with Medicaid not covered. If you happen to

461
00:26:37,880 --> 00:26:40,439
Speaker 2: live in Massachusetts, it is covered. So it just depends

462
00:26:40,480 --> 00:26:42,840
Speaker 2: on which state you are in. How well have your

463
00:26:43,000 --> 00:26:47,400
Speaker 2: legislators the lawmakers govern everything that happens, and if we're

464
00:26:47,440 --> 00:26:50,600
Speaker 2: not seeing that in today's world, I think that we

465
00:26:50,800 --> 00:26:54,280
Speaker 2: are living under a rock. But the legislators are governing coverage,

466
00:26:54,320 --> 00:26:56,639
Speaker 2: and so I think that these are important considerations to

467
00:26:57,000 --> 00:26:59,879
Speaker 2: be having. I think go over sign effects with these

468
00:27:00,080 --> 00:27:03,080
Speaker 2: medications right, this key side effects. I always tell my

469
00:27:03,119 --> 00:27:05,200
Speaker 2: patients the number one, the number two. The number three

470
00:27:05,280 --> 00:27:08,360
Speaker 2: side effect is nausea. Okay, got that number one, number two,

471
00:27:08,400 --> 00:27:11,479
Speaker 2: number three. After that, we have issues with constipation. These

472
00:27:11,560 --> 00:27:14,720
Speaker 2: medications do slow movement through the GI track. I know

473
00:27:14,800 --> 00:27:16,639
Speaker 2: this kind of sounds like a smelly conversation to have

474
00:27:16,760 --> 00:27:20,000
Speaker 2: with your doctor, but this is a really important conversation.

475
00:27:20,160 --> 00:27:22,840
Speaker 2: You would have a good bowel regimen. If you're like

476
00:27:22,960 --> 00:27:25,240
Speaker 2: a have a I you know, had a bowel movement

477
00:27:25,680 --> 00:27:28,440
Speaker 2: once every five or six days. That is not normal. Okay,

478
00:27:28,520 --> 00:27:30,760
Speaker 2: that is just not normal. This is something that you

479
00:27:30,880 --> 00:27:33,119
Speaker 2: really need to be working with your doctor. You need

480
00:27:33,160 --> 00:27:35,040
Speaker 2: to be hydrating. We need to be doing things to

481
00:27:35,080 --> 00:27:37,840
Speaker 2: improve that bowel regiment because we don't want things to

482
00:27:37,880 --> 00:27:41,040
Speaker 2: get stuck. I would say other things that we want

483
00:27:41,080 --> 00:27:42,960
Speaker 2: to think about, things like fatigue. You know, are you

484
00:27:43,040 --> 00:27:46,119
Speaker 2: have running into issues with fatigue with these medications? Are

485
00:27:46,160 --> 00:27:49,280
Speaker 2: you running into more serious side effects which could be

486
00:27:49,320 --> 00:27:52,160
Speaker 2: things like pancreatitis where we would need to stop the medications,

487
00:27:52,320 --> 00:27:55,719
Speaker 2: or are you losing weight so rapidly developed gallbladder issues

488
00:27:56,600 --> 00:27:58,840
Speaker 2: if we if you've already had your gallbladder out, not

489
00:27:58,960 --> 00:28:01,359
Speaker 2: such an issue if you're on the medications. If we

490
00:28:01,640 --> 00:28:04,840
Speaker 2: need to take your gallbladder out, that's not necessarily a problem.

491
00:28:05,240 --> 00:28:08,720
Speaker 2: You can develop issues with your gallbladder surrounding wrap up

492
00:28:08,720 --> 00:28:12,800
Speaker 2: weight loss from just lifestyle modification, or with surgery or

493
00:28:12,840 --> 00:28:14,920
Speaker 2: with other conditions. It's just something that we need to

494
00:28:14,960 --> 00:28:18,320
Speaker 2: be mindful of. Partricularly started developing certain types of pain.

495
00:28:18,400 --> 00:28:20,720
Speaker 2: So these are conversations I think you should be having

496
00:28:20,800 --> 00:28:23,440
Speaker 2: with your doctor if you're on these medications.

497
00:28:24,280 --> 00:28:36,200
Speaker 1: More from our conversation after the break, I want to

498
00:28:36,240 --> 00:28:38,719
Speaker 1: go back to the conversation around the cost of the medication,

499
00:28:38,800 --> 00:28:42,040
Speaker 1: doctor Fatima. So is the cost reflective of it kind

500
00:28:42,080 --> 00:28:44,680
Speaker 1: of being a newer drug and like there's no real

501
00:28:44,760 --> 00:28:47,480
Speaker 1: generic and so of course it's more expensive. Or is

502
00:28:47,560 --> 00:28:50,480
Speaker 1: it a case of you know, the field not really

503
00:28:50,560 --> 00:28:53,480
Speaker 1: recognizing OBCD as a disease that can be treated and

504
00:28:53,640 --> 00:28:57,400
Speaker 1: then it's feeling like a luxury like kind of medication

505
00:28:57,480 --> 00:28:59,360
Speaker 1: as opposed to like, know, this person needs this to

506
00:28:59,560 --> 00:29:01,560
Speaker 1: kind of be I'm going to say it's.

507
00:29:01,680 --> 00:29:06,440
Speaker 2: Both, and let's talk about that. So Number one, these companies,

508
00:29:06,520 --> 00:29:09,239
Speaker 2: these medications haven't turned into generic yet. And so when

509
00:29:09,280 --> 00:29:13,080
Speaker 2: they haven't turned into generic, that means that there can't

510
00:29:13,080 --> 00:29:18,000
Speaker 2: be any competition yet for these medications. Now I'm going

511
00:29:18,080 --> 00:29:22,200
Speaker 2: to give a caveat because unfortunately there are compounded versions

512
00:29:22,640 --> 00:29:28,120
Speaker 2: that existed for these medications. These medications have now been

513
00:29:28,280 --> 00:29:31,680
Speaker 2: ruled to be illegal in the country. But this has

514
00:29:31,720 --> 00:29:35,680
Speaker 2: only happened within the last few months. With some people

515
00:29:35,760 --> 00:29:38,800
Speaker 2: that may be listening to what I'm talking about them maybe, well,

516
00:29:38,840 --> 00:29:42,600
Speaker 2: I get my compounded drug. So there have been strategies

517
00:29:42,640 --> 00:29:46,040
Speaker 2: I think that some compounders have used to develop a

518
00:29:46,120 --> 00:29:50,880
Speaker 2: drug that's cost effective. And I'm doing air quotes because

519
00:29:51,040 --> 00:29:54,280
Speaker 2: these are not the actual drug. And the reason why

520
00:29:54,400 --> 00:29:58,280
Speaker 2: I never prescribe compounded medications in this field is that

521
00:29:58,400 --> 00:30:02,440
Speaker 2: they've never undergone in any research trials. So how we're

522
00:30:02,480 --> 00:30:08,400
Speaker 2: prescribing them to whomever, Jane or whomever, I don't know

523
00:30:08,640 --> 00:30:12,400
Speaker 2: any of the safety data for that specific agent compared

524
00:30:12,480 --> 00:30:16,120
Speaker 2: to the trials that were performed on the seventeen thousand

525
00:30:16,240 --> 00:30:20,360
Speaker 2: that were in some magnetide or whatever. And so I

526
00:30:20,560 --> 00:30:26,720
Speaker 2: believe in giving my patients the best possible treatment and

527
00:30:27,200 --> 00:30:30,960
Speaker 2: something that I will want for myself or my siblings

528
00:30:31,080 --> 00:30:34,040
Speaker 2: or my parents. And if I don't feel comfortable in

529
00:30:34,360 --> 00:30:38,120
Speaker 2: giving my patients exactly that then I won't prescribe it.

530
00:30:38,160 --> 00:30:40,680
Speaker 2: So I will not use the compounded because I can't

531
00:30:40,680 --> 00:30:42,440
Speaker 2: give you the paper that shows you this is what

532
00:30:42,560 --> 00:30:44,640
Speaker 2: we can see. Oh, we're going to see forty five

533
00:30:44,720 --> 00:30:46,640
Speaker 2: percent nausea, and then we're going to see you know,

534
00:30:46,720 --> 00:30:49,560
Speaker 2: this is what I'm expecting. So that's an issue. Now

535
00:30:49,640 --> 00:30:51,560
Speaker 2: the compound it will say, oh, well, we're going to

536
00:30:51,600 --> 00:30:53,239
Speaker 2: give it to you at this cheap price. But it's

537
00:30:53,360 --> 00:30:57,960
Speaker 2: like you're going to get something from the makeshift store

538
00:30:58,120 --> 00:30:59,720
Speaker 2: and you're like, I don't know if that's going to

539
00:30:59,760 --> 00:31:02,280
Speaker 2: really tastes like I wanted to taste it, may or

540
00:31:02,320 --> 00:31:04,600
Speaker 2: may not go bad. It's kind of something like that,

541
00:31:04,760 --> 00:31:09,120
Speaker 2: and we unfortunately saw several deaths last year and over

542
00:31:09,240 --> 00:31:13,040
Speaker 2: nine hundred hospitalizations from some of these compounded drugs. So

543
00:31:13,200 --> 00:31:15,400
Speaker 2: from a safety perspective, I think we just need to

544
00:31:15,440 --> 00:31:16,960
Speaker 2: be well, now I'm not saying that you won't have

545
00:31:17,120 --> 00:31:20,000
Speaker 2: something from the actual agent, but at least we know

546
00:31:20,320 --> 00:31:22,920
Speaker 2: what to expect, and if you were to go to

547
00:31:23,040 --> 00:31:25,480
Speaker 2: the hospital or whatever, we know what agent we need

548
00:31:25,520 --> 00:31:27,200
Speaker 2: to respond to you. What are we looking for? Kind

549
00:31:27,240 --> 00:31:29,000
Speaker 2: of like it was able to roll off. What are

550
00:31:29,080 --> 00:31:32,760
Speaker 2: these adverse events that we can anticipate. I know what

551
00:31:32,880 --> 00:31:35,920
Speaker 2: to look for, but if you're giving me some type

552
00:31:35,920 --> 00:31:37,440
Speaker 2: of combat, I don't what am I I don't know

553
00:31:37,480 --> 00:31:39,400
Speaker 2: what it is really like, what is it? I don't know?

554
00:31:40,160 --> 00:31:41,840
Speaker 1: M thank you so much for it.

555
00:31:41,960 --> 00:31:43,320
Speaker 2: Yeah, for breaking that down like that.

556
00:31:43,800 --> 00:31:45,960
Speaker 1: So one of the things that has also been a

557
00:31:46,120 --> 00:31:48,520
Speaker 1: large part of the conversation is this idea of something

558
00:31:48,560 --> 00:31:52,280
Speaker 1: called the ozimbic face right that people's faces start to

559
00:31:52,360 --> 00:31:55,760
Speaker 1: look different after using the medication. Is this accurate and

560
00:31:55,880 --> 00:31:58,280
Speaker 1: if so, is there a way to prevent or avoid this?

561
00:31:59,040 --> 00:32:03,080
Speaker 2: So this idea ozimpic base, ozempic butt, all the things,

562
00:32:03,560 --> 00:32:07,840
Speaker 2: is it really specific to ozimpic or any of the compounds.

563
00:32:08,320 --> 00:32:11,440
Speaker 2: Whenever someone loses weight or a large amount of weight,

564
00:32:11,720 --> 00:32:13,680
Speaker 2: we have fat stores. So we have bat stores in

565
00:32:13,720 --> 00:32:15,600
Speaker 2: our face, we have fat stores in our butt. I

566
00:32:15,760 --> 00:32:18,120
Speaker 2: e ad a post right that we've talked about, and

567
00:32:18,280 --> 00:32:20,520
Speaker 2: so you can imagine that if you lose a lot

568
00:32:20,600 --> 00:32:24,400
Speaker 2: of weight, you don't selectively choose where you lose weight, right,

569
00:32:24,520 --> 00:32:26,520
Speaker 2: like you can't be like you know what, I feel

570
00:32:26,560 --> 00:32:28,720
Speaker 2: like this is like a going back to like my

571
00:32:28,800 --> 00:32:31,360
Speaker 2: childhood and it's like zap here, you know, like you

572
00:32:31,440 --> 00:32:35,600
Speaker 2: and that from this particular area is you just lose

573
00:32:35,680 --> 00:32:37,680
Speaker 2: all over it, and so people may feel like they're

574
00:32:37,760 --> 00:32:41,280
Speaker 2: kind of more gaunt if they lose and they lose

575
00:32:41,360 --> 00:32:45,160
Speaker 2: so much from their whole body. So what I've heard

576
00:32:45,200 --> 00:32:49,040
Speaker 2: from some of my dermatology colleagues or my facial plastic

577
00:32:49,120 --> 00:32:52,320
Speaker 2: surgeon colleagues is people may do I don't even know

578
00:32:52,360 --> 00:32:56,800
Speaker 2: all the terminologis and not this like fillers and different things,

579
00:32:56,920 --> 00:33:00,280
Speaker 2: because they feel like they may have lost more if

580
00:33:00,280 --> 00:33:03,120
Speaker 2: they lose. They are high responders to these medications, but

581
00:33:03,240 --> 00:33:06,440
Speaker 2: it's not specific, like I said, to just these medications.

582
00:33:06,560 --> 00:33:10,120
Speaker 2: If they lost a lot with diet and exercise, if

583
00:33:10,160 --> 00:33:13,080
Speaker 2: they lost a lot from surgical interventions, whatever it might be.

584
00:33:13,200 --> 00:33:15,440
Speaker 2: It's so it's not specific to the medications.

585
00:33:16,240 --> 00:33:19,600
Speaker 1: Got it. What are some of the other big misconceptions

586
00:33:19,640 --> 00:33:21,080
Speaker 1: you think about gop ones?

587
00:33:21,960 --> 00:33:23,920
Speaker 2: Like I said, I think people think these are miracle drugs,

588
00:33:23,960 --> 00:33:27,280
Speaker 2: like they're just magically going to work, and that's not true.

589
00:33:27,760 --> 00:33:30,560
Speaker 2: Like I said, there are some high responders. I think

590
00:33:30,680 --> 00:33:33,720
Speaker 2: that patients presume that if they come off that they'll

591
00:33:33,840 --> 00:33:37,080
Speaker 2: just completely stay the same and that they won't regain

592
00:33:37,160 --> 00:33:41,240
Speaker 2: the weight. A large majority of patients will, and I

593
00:33:41,320 --> 00:33:44,160
Speaker 2: think that it's important to recognize that because these are

594
00:33:44,320 --> 00:33:48,120
Speaker 2: working so prominently on how the brain sees weight, I

595
00:33:48,240 --> 00:33:51,600
Speaker 2: think that people think that they're the easy way out.

596
00:33:51,800 --> 00:33:54,239
Speaker 2: I don't see these as per se, the easy way

597
00:33:54,320 --> 00:33:56,920
Speaker 2: out for a lot of people that have struggled their

598
00:33:56,960 --> 00:34:01,040
Speaker 2: whole life, or maybe they've struggled after they had children,

599
00:34:01,160 --> 00:34:04,680
Speaker 2: or maybe they struggle post menopause or whatever the reason

600
00:34:04,960 --> 00:34:07,400
Speaker 2: of why they ended up developing obec It doesn't matter

601
00:34:07,520 --> 00:34:10,360
Speaker 2: what it is. This may be a tool in the

602
00:34:10,440 --> 00:34:12,840
Speaker 2: toolkit that helps them to achieve a healthy weight. And

603
00:34:12,920 --> 00:34:15,920
Speaker 2: so this idea that it's someone that's just you know,

604
00:34:16,120 --> 00:34:18,400
Speaker 2: going the easy way out, I don't see it as that.

605
00:34:18,520 --> 00:34:21,000
Speaker 2: So I think these are all misconceptions surrounding the use

606
00:34:21,040 --> 00:34:21,839
Speaker 2: of gop ones.

607
00:34:22,920 --> 00:34:24,360
Speaker 1: The doctor of Vitiama, I know a lot of your

608
00:34:24,440 --> 00:34:27,000
Speaker 1: work has also been around like the black community and

609
00:34:27,080 --> 00:34:29,360
Speaker 1: like talking about obesity and like how that may be

610
00:34:29,800 --> 00:34:32,879
Speaker 1: connected to like culture and like food and those kinds

611
00:34:32,920 --> 00:34:35,600
Speaker 1: of things. What are you seeing or do you feel

612
00:34:35,680 --> 00:34:38,239
Speaker 1: like this is promising, like the advances that we are

613
00:34:38,239 --> 00:34:40,880
Speaker 1: seeing with gop ones and other medications in terms of

614
00:34:40,960 --> 00:34:43,160
Speaker 1: what it looks like to have obesity management in the

615
00:34:43,200 --> 00:34:44,240
Speaker 1: Black women community.

616
00:34:44,719 --> 00:34:48,240
Speaker 2: Yes, you know, I see very large percentage of black

617
00:34:48,440 --> 00:34:52,200
Speaker 2: women and men, but mostly women. For my guys, I

618
00:34:52,200 --> 00:34:54,520
Speaker 2: don't know if you're listening out there. And I think

619
00:34:54,600 --> 00:34:57,680
Speaker 2: the reason why that is is because when you see

620
00:34:57,680 --> 00:35:00,600
Speaker 2: a black woman in the space doing this, I think

621
00:35:00,680 --> 00:35:03,239
Speaker 2: you feel comfortable going to see a black woman. The

622
00:35:03,320 --> 00:35:05,640
Speaker 2: first person I saw this morning was a black woman,

623
00:35:05,719 --> 00:35:09,719
Speaker 2: and I think we sense comfort in seeing each other.

624
00:35:10,360 --> 00:35:13,600
Speaker 2: I think that we identify with each other's stories. We're

625
00:35:13,640 --> 00:35:16,640
Speaker 2: not all of the same, We're not like this monolithic person, right.

626
00:35:16,719 --> 00:35:19,719
Speaker 2: We are all different. We all have different experiences, but

627
00:35:19,920 --> 00:35:25,200
Speaker 2: we unfortunately have shared trauma, and a lot of how

628
00:35:25,360 --> 00:35:31,040
Speaker 2: we end up with developing this disease disproportionate to our counterparts,

629
00:35:31,400 --> 00:35:36,920
Speaker 2: has to do with our trauma, something we call allostatic load.

630
00:35:38,000 --> 00:35:42,960
Speaker 2: We take on more in society than I think any

631
00:35:43,000 --> 00:35:48,240
Speaker 2: other group. We're always having to prove ourselves in every space,

632
00:35:48,719 --> 00:35:53,239
Speaker 2: and that stress, that chronic stress, whether it's in our families,

633
00:35:53,400 --> 00:35:57,200
Speaker 2: whether it's in work, I think contributes to us having

634
00:35:57,719 --> 00:36:01,040
Speaker 2: the highest OBESI rate of any different group, particularly here

635
00:36:01,080 --> 00:36:04,480
Speaker 2: in the US. When you're able to come in and

636
00:36:04,640 --> 00:36:09,719
Speaker 2: see someone like me and not have to validate who

637
00:36:09,800 --> 00:36:12,799
Speaker 2: you are and explain that piece. Well, let me let

638
00:36:12,840 --> 00:36:14,800
Speaker 2: me explain. Well, you know, as a black woman, you

639
00:36:14,840 --> 00:36:16,480
Speaker 2: don't have to do that with you. I understand that

640
00:36:16,560 --> 00:36:18,719
Speaker 2: because I had I live that each and every day,

641
00:36:18,760 --> 00:36:21,000
Speaker 2: and I fill that each and every day. And so

642
00:36:21,880 --> 00:36:25,279
Speaker 2: when we have tools, whether it's surgery or medication or

643
00:36:25,280 --> 00:36:27,040
Speaker 2: all the life stules or putting any of this, I

644
00:36:27,160 --> 00:36:29,680
Speaker 2: can at least say, okay, yeah, I got that, I

645
00:36:29,760 --> 00:36:31,719
Speaker 2: live that piece. Let's talk about what we're going to

646
00:36:31,800 --> 00:36:34,440
Speaker 2: do about it now. Okay, whether it's in this family

647
00:36:34,840 --> 00:36:36,680
Speaker 2: as because I take care of a lot of families

648
00:36:36,840 --> 00:36:40,800
Speaker 2: of black women, but let me help take that burden

649
00:36:41,719 --> 00:36:44,640
Speaker 2: off of your table, and let's try to find what

650
00:36:44,800 --> 00:36:48,040
Speaker 2: works for you. Recognizing that works for you, maybe there's

651
00:36:48,040 --> 00:36:50,680
Speaker 2: a different than what works for your sister or your

652
00:36:50,800 --> 00:36:53,399
Speaker 2: daughter or whatever it is. And I think that these

653
00:36:53,840 --> 00:36:57,680
Speaker 2: tools are helping to alleviate some of that burden, but

654
00:36:57,800 --> 00:37:02,560
Speaker 2: recognizing that that there's other stressors. I'll give one example

655
00:37:02,680 --> 00:37:06,400
Speaker 2: that helps maybe people understand of just the different types

656
00:37:06,440 --> 00:37:08,879
Speaker 2: of people. I might see one of my patients who's

657
00:37:08,920 --> 00:37:10,880
Speaker 2: been with me for twice the time she does happen

658
00:37:10,960 --> 00:37:14,960
Speaker 2: to be on a GOP one. We did her telemedicine

659
00:37:15,040 --> 00:37:17,560
Speaker 2: visit last week, and she was voting clothes in the

660
00:37:17,640 --> 00:37:21,440
Speaker 2: laundromat while we were on the telemedicine visit. Now, I

661
00:37:21,520 --> 00:37:24,680
Speaker 2: don't know how her if she had a white doctor,

662
00:37:24,719 --> 00:37:26,359
Speaker 2: how that would have gone. But I was like, wait, manut,

663
00:37:26,360 --> 00:37:28,480
Speaker 2: you're not voting that sheet right, and she was like,

664
00:37:28,920 --> 00:37:32,480
Speaker 2: I got this doctor standford. But you know what she

665
00:37:32,680 --> 00:37:34,880
Speaker 2: was dealing with. She had just lost something with section

666
00:37:35,040 --> 00:37:37,960
Speaker 2: eight at the same time she was in the laundromat. Actually,

667
00:37:38,000 --> 00:37:39,839
Speaker 2: it wanted to her to go to surgery. She wanted

668
00:37:39,880 --> 00:37:43,239
Speaker 2: to go to surgery, but the psychologist, who happens to

669
00:37:43,360 --> 00:37:47,600
Speaker 2: be person that's not like us, denied her from being

670
00:37:48,000 --> 00:37:50,920
Speaker 2: considered for that therapy. Thankfully, she was a high responder

671
00:37:50,960 --> 00:37:54,120
Speaker 2: to gop one and so no longer needed surgery. But

672
00:37:54,239 --> 00:37:57,000
Speaker 2: we're able to have this dynamic that allows her the

673
00:37:57,080 --> 00:37:58,960
Speaker 2: space and place to be wherever she needs to be

674
00:37:59,040 --> 00:38:02,160
Speaker 2: to conduct that visit. And she's done very well. She's

675
00:38:02,200 --> 00:38:04,480
Speaker 2: lost over thirty percent of her total body weight on

676
00:38:04,600 --> 00:38:12,280
Speaker 2: therapy with me, and it just feels easy and that encounter.

677
00:38:12,880 --> 00:38:15,359
Speaker 2: But here she is at Master General Hospital, this very

678
00:38:16,040 --> 00:38:19,040
Speaker 2: prominent institution where I'm sure that when she walks into

679
00:38:19,120 --> 00:38:23,239
Speaker 2: certain spaces, she's not treated in the same way that

680
00:38:23,400 --> 00:38:25,960
Speaker 2: our interaction is such that she could conduct that visit

681
00:38:26,239 --> 00:38:29,279
Speaker 2: while she's folded her sheets at the laundromat and still

682
00:38:29,400 --> 00:38:32,840
Speaker 2: get the respect and dignity that she deserves. So she's

683
00:38:32,880 --> 00:38:36,439
Speaker 2: able to have great health outcomes. And I think that's

684
00:38:37,480 --> 00:38:40,840
Speaker 2: the interaction that I want all people to have, but

685
00:38:40,960 --> 00:38:44,839
Speaker 2: particularly Black women that face so many barriers all day

686
00:38:44,880 --> 00:38:47,800
Speaker 2: every day. So hopefully that helps you understand kind of

687
00:38:47,880 --> 00:38:49,239
Speaker 2: what they actually look like.

688
00:38:49,840 --> 00:38:51,719
Speaker 1: Yeah, and I want to link back to an earlier

689
00:38:51,760 --> 00:38:54,360
Speaker 1: conversation we were having around like accessibility, right and like

690
00:38:54,400 --> 00:38:56,640
Speaker 1: the price of these medications, and we already know there

691
00:38:56,680 --> 00:38:59,719
Speaker 1: are often so many disparities in the field in terms

692
00:38:59,760 --> 00:39:02,960
Speaker 1: of access for the black community. Are you concerned that

693
00:39:03,640 --> 00:39:06,040
Speaker 1: GLP ones and the medications is going to be just

694
00:39:06,160 --> 00:39:09,759
Speaker 1: another area where we are priced out or cannot get

695
00:39:09,840 --> 00:39:11,440
Speaker 1: the services that would be really helpful.

696
00:39:12,280 --> 00:39:14,520
Speaker 2: Yes, I do think that this is an area of

697
00:39:14,640 --> 00:39:19,200
Speaker 2: significant concern. So let's use this particular woman I was

698
00:39:19,280 --> 00:39:22,160
Speaker 2: talking about. So, I happen to live in a state

699
00:39:22,320 --> 00:39:26,759
Speaker 2: where Medicaid, which is called mass health, has decided to

700
00:39:26,880 --> 00:39:30,640
Speaker 2: cover these medications, but it was only in twenty twenty three,

701
00:39:30,880 --> 00:39:34,840
Speaker 2: that these medications have come under the umbrella for coverage

702
00:39:35,480 --> 00:39:39,200
Speaker 2: for Medicaid, which are patients with lower socio economic position,

703
00:39:40,239 --> 00:39:44,000
Speaker 2: so much so that my patients with Medicaid have better

704
00:39:44,080 --> 00:39:47,800
Speaker 2: coverage than a lot of my patients that are insured

705
00:39:47,840 --> 00:39:52,919
Speaker 2: patients under private insurance employer sponsored insurance. For example, Blue

706
00:39:52,960 --> 00:39:55,120
Speaker 2: Cross Bool Shield of Massachusetts, which is one of the

707
00:39:55,239 --> 00:39:59,080
Speaker 2: largest insurers of the state, has decided as of January first,

708
00:39:59,120 --> 00:40:02,239
Speaker 2: twenty twenty six, they will not cover these medications at

709
00:40:02,280 --> 00:40:05,640
Speaker 2: all for any patients with obesity. You can imagine that

710
00:40:05,680 --> 00:40:06,840
Speaker 2: a lot of them are like, wait a minute, I

711
00:40:06,880 --> 00:40:08,799
Speaker 2: would love to get on mass Health because hey, I'm

712
00:40:08,800 --> 00:40:13,640
Speaker 2: want to be covered, and you know, you're putting patients

713
00:40:14,000 --> 00:40:16,560
Speaker 2: in a really tough predicament. Some of these patients have

714
00:40:16,640 --> 00:40:19,200
Speaker 2: been covered, they've been, you know, under this Blue Cross

715
00:40:19,239 --> 00:40:22,719
Speaker 2: Willshield of Massachusetts plan. And now as they're scrambling, they

716
00:40:22,800 --> 00:40:26,280
Speaker 2: realize January first is coming fast, and it's coming furious.

717
00:40:26,760 --> 00:40:30,879
Speaker 2: What will they do? My mass Health patients will likely

718
00:40:30,960 --> 00:40:32,640
Speaker 2: retain coverage. It took us a long time to get

719
00:40:32,680 --> 00:40:36,600
Speaker 2: them to coverage. But here again this access issue is

720
00:40:36,719 --> 00:40:41,600
Speaker 2: as a major issue. What will happen will patients health revert.

721
00:40:42,120 --> 00:40:45,439
Speaker 2: And I'm concerned that definitively this will be a major issue.

722
00:40:45,440 --> 00:40:48,320
Speaker 2: And I'm just using Massachusetts as an example for the

723
00:40:48,400 --> 00:40:51,120
Speaker 2: rest of the country. I will say that our state

724
00:40:51,200 --> 00:40:53,880
Speaker 2: tends to have better coverage than most states. I was

725
00:40:53,960 --> 00:40:57,600
Speaker 2: born and raised in Atlanta, Georgia. I know that Atlanta

726
00:40:58,760 --> 00:41:01,400
Speaker 2: tends to not to have not just Lanta, let's use

727
00:41:01,440 --> 00:41:04,760
Speaker 2: Georgia as a model, tends not to have great coverage

728
00:41:05,400 --> 00:41:09,120
Speaker 2: for these medications, whether under the private insurance model, employer's

729
00:41:09,120 --> 00:41:13,000
Speaker 2: sponsor insurance models, compared to where I currently live. And

730
00:41:13,200 --> 00:41:16,040
Speaker 2: so if I'm talking to family and friends there and

731
00:41:16,080 --> 00:41:18,600
Speaker 2: trying to guide them, they're like, gosh, I wish I

732
00:41:18,640 --> 00:41:20,759
Speaker 2: were there with you. And I'm kind of luck I

733
00:41:20,800 --> 00:41:23,600
Speaker 2: wish you were here too, But it's unfortunate. This goes

734
00:41:23,680 --> 00:41:27,440
Speaker 2: back to what's happening at the legislative level. What are

735
00:41:27,480 --> 00:41:30,200
Speaker 2: we advocating for, Going back to the question you asked

736
00:41:30,239 --> 00:41:33,840
Speaker 2: me earlier. Is it because we don't truly recognize this

737
00:41:34,160 --> 00:41:39,320
Speaker 2: as a disease. Yes, and there's so many people that

738
00:41:39,440 --> 00:41:44,120
Speaker 2: have the disease that it becomes a very expensive burden.

739
00:41:44,880 --> 00:41:47,520
Speaker 2: What if we reduce the price point for these drugs

740
00:41:47,520 --> 00:41:50,440
Speaker 2: and use like a Walmart based model, right such that

741
00:41:50,640 --> 00:41:53,120
Speaker 2: anyone that walks through that door can walk out with

742
00:41:53,280 --> 00:41:56,520
Speaker 2: something without feeling strapped for cash. And I really wish

743
00:41:56,600 --> 00:42:00,080
Speaker 2: that it were something accessible in that way, mean the

744
00:42:00,160 --> 00:42:01,120
Speaker 2: gop ones.

745
00:42:01,520 --> 00:42:05,160
Speaker 1: Yeah, And do you anticipate that as it exists longer

746
00:42:05,200 --> 00:42:07,840
Speaker 1: and there are generics available, that it is something that

747
00:42:07,960 --> 00:42:09,080
Speaker 1: becomes more accessible.

748
00:42:09,360 --> 00:42:11,680
Speaker 2: I really do, And particularly because we are going to

749
00:42:11,760 --> 00:42:15,560
Speaker 2: have more players into the space, meaning more drug companies.

750
00:42:15,680 --> 00:42:18,080
Speaker 2: Right now there are only two players. We have Novo

751
00:42:18,160 --> 00:42:22,000
Speaker 2: Nordisk and Eli Lilly, two big drugs to magnetide intracepatite

752
00:42:22,040 --> 00:42:25,480
Speaker 2: under the trade names of zempic, Wagovi, monduro zep Bound,

753
00:42:25,600 --> 00:42:27,480
Speaker 2: which is the name we haven't heard until just then.

754
00:42:28,440 --> 00:42:31,720
Speaker 2: That's all we have, right, That's period the end. Nothing

755
00:42:31,760 --> 00:42:33,520
Speaker 2: else in terms of kind of what we consider the

756
00:42:33,600 --> 00:42:37,719
Speaker 2: second generation or more highly effective medications. But we have

757
00:42:37,880 --> 00:42:40,320
Speaker 2: a lot of companies that have things in the pipeline,

758
00:42:40,360 --> 00:42:42,480
Speaker 2: and if you if you knew all of the things

759
00:42:42,520 --> 00:42:44,799
Speaker 2: in the popline, we would be here for another hour

760
00:42:44,960 --> 00:42:48,040
Speaker 2: going over all of the names. But that means that

761
00:42:48,600 --> 00:42:51,839
Speaker 2: we have more things coming into the pipeline. That means

762
00:42:51,880 --> 00:42:54,320
Speaker 2: we potentially can reduce the pists because there's more Competitors's

763
00:42:54,360 --> 00:42:56,880
Speaker 2: kind of like if you were to go to the

764
00:42:56,960 --> 00:42:59,000
Speaker 2: drug store now and go to the lotion aisle, right,

765
00:42:59,040 --> 00:43:01,560
Speaker 2: there's going to be all these differs, right they you know,

766
00:43:01,680 --> 00:43:04,680
Speaker 2: maybe there's some premium lotion, right, but you probably have

767
00:43:04,800 --> 00:43:07,120
Speaker 2: to go to Sax withth Avenue or and even Marcus

768
00:43:07,160 --> 00:43:09,320
Speaker 2: to get that. But you have all these ones and

769
00:43:09,360 --> 00:43:10,920
Speaker 2: you're going to be able to pick and they have

770
00:43:11,000 --> 00:43:13,360
Speaker 2: to price accordingly, right, because they have to compete in

771
00:43:13,440 --> 00:43:16,720
Speaker 2: that market. Similarly, I think that we'll see this drop

772
00:43:16,760 --> 00:43:20,080
Speaker 2: and price because they have to compete against each other.

773
00:43:21,520 --> 00:43:23,879
Speaker 1: Now, this may be a little bit beyond like your

774
00:43:24,120 --> 00:43:26,880
Speaker 1: specific area of expertise, but it sounds like there's also

775
00:43:27,480 --> 00:43:30,879
Speaker 1: some exciting research coming out around golp ones and their

776
00:43:30,920 --> 00:43:32,600
Speaker 1: impact on things like addictions.

777
00:43:32,800 --> 00:43:34,080
Speaker 2: I wouldn't say anything.

778
00:43:33,800 --> 00:43:37,480
Speaker 1: About I got yeah, so what's going on there?

779
00:43:38,640 --> 00:43:41,239
Speaker 2: So we talked about gop one receptors, we talked about

780
00:43:41,239 --> 00:43:43,359
Speaker 2: the brain, we talked about the gut, but we're finding

781
00:43:43,360 --> 00:43:46,480
Speaker 2: that GOLP one receptors are found throughout the body. What's

782
00:43:46,600 --> 00:43:49,080
Speaker 2: very interesting about that, particularly as you asked about addiction,

783
00:43:49,239 --> 00:43:51,800
Speaker 2: is we're finding that these medications seem to be effective

784
00:43:51,840 --> 00:43:55,640
Speaker 2: for a variety of conditions. We saw these and mice models,

785
00:43:55,680 --> 00:43:58,560
Speaker 2: So keep in mind these medications are often tested often,

786
00:43:58,680 --> 00:44:01,799
Speaker 2: let's just say, always test in mice before they make

787
00:44:01,880 --> 00:44:05,640
Speaker 2: it over to human models. So in mice we saw

788
00:44:05,840 --> 00:44:09,319
Speaker 2: that these were effective in looking at things like tobacco use,

789
00:44:09,880 --> 00:44:13,840
Speaker 2: alcohol use, other things. But we're seeing in humans similar

790
00:44:14,000 --> 00:44:16,560
Speaker 2: things happen. So patients might say to me, you know what,

791
00:44:16,760 --> 00:44:20,839
Speaker 2: doctor Stafford, I haven't wanted to drink I can't even

792
00:44:20,880 --> 00:44:23,879
Speaker 2: remember when I wanted to drink glass. We think it's

793
00:44:24,000 --> 00:44:28,480
Speaker 2: acting on some of the similar pathways for alcohol use disorder,

794
00:44:29,080 --> 00:44:32,840
Speaker 2: similarly for tobacco use disorder. But some of my physician

795
00:44:32,920 --> 00:44:36,520
Speaker 2: colleagues that work specifically in alcohol use disorder are saying

796
00:44:36,560 --> 00:44:39,319
Speaker 2: that it seems to be more effective than anything they

797
00:44:39,440 --> 00:44:44,160
Speaker 2: currently have FDA approved for the treatment of alcoholism. Now,

798
00:44:44,440 --> 00:44:46,719
Speaker 2: I will tell you that, as you know, we're in

799
00:44:46,840 --> 00:44:51,360
Speaker 2: a milieu where medical research is not being valued in

800
00:44:51,480 --> 00:44:54,839
Speaker 2: the same way as someone who conducts research and has

801
00:44:54,920 --> 00:44:57,279
Speaker 2: published over two hundred and seventy five papers. I can

802
00:44:57,360 --> 00:45:00,480
Speaker 2: tell you that I feel that directly. So a lot

803
00:45:00,560 --> 00:45:03,960
Speaker 2: of the studies that were set to start have been

804
00:45:04,680 --> 00:45:09,000
Speaker 2: halted surrounding not only looking at addiction, but also other

805
00:45:09,280 --> 00:45:14,400
Speaker 2: diseases and conditions like Alzheimer's disease, parkinsonism, issues like rheumatoid

806
00:45:14,480 --> 00:45:17,360
Speaker 2: arthritis and gout. I mean, we're seeing so many potential

807
00:45:17,600 --> 00:45:20,719
Speaker 2: use case scenarios because what these medications seem to do

808
00:45:20,920 --> 00:45:24,480
Speaker 2: is reduce inflammation throughout the body, and so we're seeing

809
00:45:24,800 --> 00:45:28,320
Speaker 2: other potential use case scenarios, not just in the addiction realm.

810
00:45:28,800 --> 00:45:33,040
Speaker 2: And I think that if we have a different regime

811
00:45:33,719 --> 00:45:37,920
Speaker 2: that allows us to consider actual science, that we potentially

812
00:45:38,000 --> 00:45:40,480
Speaker 2: can begin to learn more and more of the potential

813
00:45:40,520 --> 00:45:43,839
Speaker 2: benefits for these agents across a wide range of things,

814
00:45:43,920 --> 00:45:46,719
Speaker 2: including addiction, which we're already seeing at the point of

815
00:45:46,800 --> 00:45:49,440
Speaker 2: clinical care. Thank you for this.

816
00:45:49,640 --> 00:45:52,760
Speaker 1: So I'm hoping that we do eventually fee this research

817
00:45:52,840 --> 00:45:55,000
Speaker 1: take off, right because it sounds really important, right, Like

818
00:45:55,080 --> 00:45:56,840
Speaker 1: these are answers that people have been looking for. It

819
00:45:56,960 --> 00:45:58,040
Speaker 1: sounds like for a long time.

820
00:45:58,239 --> 00:46:01,200
Speaker 2: Yes, absolutely, So what do you feel like is.

821
00:46:01,239 --> 00:46:04,600
Speaker 1: Missing from the way that media and social platforms really

822
00:46:04,680 --> 00:46:07,680
Speaker 1: talk about things like GLP ones I.

823
00:46:07,800 --> 00:46:10,960
Speaker 2: Really want to get away from just like I said,

824
00:46:11,040 --> 00:46:14,480
Speaker 2: just thinking about weight wait wait, wait, wait, And I

825
00:46:14,520 --> 00:46:16,360
Speaker 2: don't think it's just about the number and the scale.

826
00:46:16,400 --> 00:46:20,000
Speaker 2: I think it's about the quality of weight loss. I

827
00:46:21,000 --> 00:46:23,120
Speaker 2: see this with my patients all the time. They're hyper

828
00:46:23,160 --> 00:46:24,239
Speaker 2: focused on what is the number?

829
00:46:24,280 --> 00:46:24,480
Speaker 1: Show?

830
00:46:24,560 --> 00:46:26,120
Speaker 2: What is the number? Show? What is the number? Show?

831
00:46:26,200 --> 00:46:29,520
Speaker 2: It's more about overall health benefits. And so I would

832
00:46:29,640 --> 00:46:32,879
Speaker 2: hope we shift away from just like b AMI, when

833
00:46:33,000 --> 00:46:35,040
Speaker 2: number am I supposed to be? That's a very common

834
00:46:35,120 --> 00:46:39,160
Speaker 2: conversation that I have with patients. They're like, well, am

835
00:46:39,200 --> 00:46:40,759
Speaker 2: I the right number? And I'm like, have I ever

836
00:46:40,840 --> 00:46:42,600
Speaker 2: given you a target number? So I never give my

837
00:46:42,840 --> 00:46:46,960
Speaker 2: patients to target weight. I do give them target waste orcumferences,

838
00:46:47,080 --> 00:46:50,480
Speaker 2: because if we can get that waist circumference down, then

839
00:46:50,560 --> 00:46:53,520
Speaker 2: we're going to reduce their risk of things like strokes

840
00:46:53,560 --> 00:46:55,440
Speaker 2: and heart attacks and things of that sort. And so

841
00:46:56,080 --> 00:46:58,480
Speaker 2: I would have shift away from this hyper focus on BMI,

842
00:46:58,560 --> 00:47:01,600
Speaker 2: which was never meant for us, and move them into

843
00:47:01,640 --> 00:47:05,239
Speaker 2: a more holistic consideration of looking at not only what

844
00:47:05,440 --> 00:47:08,040
Speaker 2: the weight status is, but how does that weight status

845
00:47:08,160 --> 00:47:11,000
Speaker 2: correlate to their blood sugar and their cholesterol and their

846
00:47:11,040 --> 00:47:13,600
Speaker 2: liver function tests and things of that sort. I think

847
00:47:13,640 --> 00:47:16,799
Speaker 2: this is a much more holistic manner of looking at things.

848
00:47:17,280 --> 00:47:19,200
Speaker 2: I think it's important for us to realize that when

849
00:47:19,360 --> 00:47:22,600
Speaker 2: people go on gop ones, we do lose not only fat,

850
00:47:22,640 --> 00:47:24,719
Speaker 2: but we lose muscle, and so we need to be

851
00:47:24,800 --> 00:47:26,680
Speaker 2: thinking about what are we eating and how does our

852
00:47:26,680 --> 00:47:30,040
Speaker 2: physical activity regimen look like. On these medicines, I see

853
00:47:30,120 --> 00:47:32,880
Speaker 2: that patients aren't doing exactly what I need to them

854
00:47:32,960 --> 00:47:36,040
Speaker 2: to be doing to retainly muscle. I need them to

855
00:47:36,160 --> 00:47:39,200
Speaker 2: be eating appropriate protein fiber, and I need them to

856
00:47:39,200 --> 00:47:42,680
Speaker 2: be engaging in a significant strength training regiment to really

857
00:47:42,840 --> 00:47:46,160
Speaker 2: retain as muchly muscle as possible. I would say that

858
00:47:46,280 --> 00:47:48,719
Speaker 2: both men and women don't do enough strength training. But

859
00:47:48,800 --> 00:47:51,520
Speaker 2: when I mentioned strength training to women, they are worried

860
00:47:51,560 --> 00:47:53,759
Speaker 2: about they're going to turn into the next bodybuilder to

861
00:47:53,800 --> 00:47:56,440
Speaker 2: go on Muscle and Fitness hers magazine, And I'm like,

862
00:47:56,520 --> 00:47:59,640
Speaker 2: that's not going to happen unless you start taking some

863
00:48:00,360 --> 00:48:03,640
Speaker 2: substances to really make you look a certain way. But

864
00:48:03,719 --> 00:48:05,840
Speaker 2: you're not gonna turn into a man overnight.

865
00:48:05,920 --> 00:48:19,960
Speaker 1: I promise more from our conversation after the break. So

866
00:48:20,080 --> 00:48:22,400
Speaker 1: you mentioned that your patients are sometimes looking like for

867
00:48:22,480 --> 00:48:24,719
Speaker 1: a particular weight or you know, like, oh, what number

868
00:48:24,760 --> 00:48:26,960
Speaker 1: should I be at? There is something in the field

869
00:48:27,040 --> 00:48:29,000
Speaker 1: that talks about like set point theory, right, like this

870
00:48:29,160 --> 00:48:32,879
Speaker 1: idea that your body like enjoys being at a particular size.

871
00:48:32,920 --> 00:48:33,800
Speaker 1: Can you talk about that?

872
00:48:34,600 --> 00:48:37,600
Speaker 2: Yeah, so set point theory is a really valid phenomenon.

873
00:48:37,800 --> 00:48:40,600
Speaker 2: So basically, let's look at it this way. Let's just

874
00:48:40,640 --> 00:48:43,759
Speaker 2: pick a number. Let's say your weight has gotten to

875
00:48:44,000 --> 00:48:47,840
Speaker 2: two hundred and thirty pounds, okay, and you notice that

876
00:48:48,960 --> 00:48:52,520
Speaker 2: no matter what you do, you always kind of come

877
00:48:52,640 --> 00:48:56,440
Speaker 2: back to that number. Like you may, you know, eat

878
00:48:56,520 --> 00:48:58,680
Speaker 2: during the holidays, and let's say you may go to

879
00:48:59,239 --> 00:49:01,600
Speaker 2: forty and after the holidays you kind of come back

880
00:49:01,640 --> 00:49:05,480
Speaker 2: to to thirty. Maybe you go on a diet, but

881
00:49:05,640 --> 00:49:08,000
Speaker 2: remember diet is in the word diet, that's what you're

882
00:49:08,000 --> 00:49:09,120
Speaker 2: going to diet, So we don't want to go on

883
00:49:09,160 --> 00:49:11,160
Speaker 2: a diet, right. But you go on a diet and

884
00:49:11,280 --> 00:49:12,799
Speaker 2: you go on an exercise plan, maybe you get down

885
00:49:12,800 --> 00:49:14,640
Speaker 2: to two twenty five, but somehow you come back up

886
00:49:14,800 --> 00:49:17,360
Speaker 2: to you to forty. You know, your body just seems

887
00:49:17,440 --> 00:49:20,319
Speaker 2: to always kind of teeter around it. And so if

888
00:49:20,360 --> 00:49:23,120
Speaker 2: you go and look at your weight chart over time

889
00:49:23,560 --> 00:49:26,879
Speaker 2: that you seem to vacillate around a certain number. Now

890
00:49:27,000 --> 00:49:29,839
Speaker 2: you might say, well, back when I was filling the blank.

891
00:49:29,960 --> 00:49:34,319
Speaker 2: Age high school or college, you were at a different point.

892
00:49:34,400 --> 00:49:37,359
Speaker 2: But over time, what we'll notice is that our weight

893
00:49:37,760 --> 00:49:42,239
Speaker 2: set point can shift, okay, up until about the age

894
00:49:42,280 --> 00:49:46,080
Speaker 2: of sixty to sixty five, we'll notice it starts to decline.

895
00:49:46,120 --> 00:49:48,040
Speaker 2: And at that point people are like, oh, I'm losing weight,

896
00:49:48,880 --> 00:49:51,839
Speaker 2: but not so fast. You're losing muscle. And the reason

897
00:49:51,880 --> 00:49:54,320
Speaker 2: why you're losing weight at that age is usually not

898
00:49:54,760 --> 00:49:56,959
Speaker 2: because you're losing the right kind of weight. It's because

899
00:49:56,960 --> 00:50:00,399
Speaker 2: you're losing muscle, okay. And so this idea of point

900
00:50:00,440 --> 00:50:03,200
Speaker 2: is your brain decides to defend this set point. No

901
00:50:03,320 --> 00:50:05,839
Speaker 2: matter what you do, you notice that you always kind

902
00:50:05,880 --> 00:50:10,680
Speaker 2: of come back to this particular set point or range.

903
00:50:10,800 --> 00:50:13,799
Speaker 2: It's probably more of a range set range. They set

904
00:50:13,880 --> 00:50:17,160
Speaker 2: point is their actual terminology, and you can become very

905
00:50:17,280 --> 00:50:20,200
Speaker 2: frustrated by it. And this is why people get frustrated

906
00:50:20,200 --> 00:50:22,279
Speaker 2: when they join gyms. At the beginning of the year.

907
00:50:22,760 --> 00:50:24,400
Speaker 2: They're like, gosh, I did all of that and I

908
00:50:24,480 --> 00:50:28,359
Speaker 2: lost three pounds. Are you kidding me? And so then

909
00:50:28,360 --> 00:50:32,680
Speaker 2: they stop going to the gym in like by February twentieth,

910
00:50:32,719 --> 00:50:34,880
Speaker 2: I don't know whatever date, because they're like, I just

911
00:50:34,960 --> 00:50:37,000
Speaker 2: put in all that work, and I just can't see

912
00:50:37,120 --> 00:50:40,279
Speaker 2: whatever I try, like, it just it just doesn't seem

913
00:50:40,320 --> 00:50:42,080
Speaker 2: to work for me. And so then they may need

914
00:50:42,200 --> 00:50:47,480
Speaker 2: something that's a bit more focused on addressing the underlying

915
00:50:47,600 --> 00:50:50,839
Speaker 2: disease pathology to change that set point.

916
00:50:51,840 --> 00:50:55,120
Speaker 1: Got it? Okay, So that maybe what clients are wanting

917
00:50:55,160 --> 00:50:57,279
Speaker 1: to work on as opposed to like big way.

918
00:50:57,520 --> 00:50:59,799
Speaker 2: Yes, yeah, but it's not like I said, I don't

919
00:50:59,800 --> 00:51:02,200
Speaker 2: want It's not that I don't want them to focus

920
00:51:02,239 --> 00:51:04,000
Speaker 2: on the number, because they will go in and look

921
00:51:04,080 --> 00:51:07,720
Speaker 2: up there be a MI and they'll say, well, okay,

922
00:51:07,800 --> 00:51:10,080
Speaker 2: well I'm three pounds from what it says I'm supposed

923
00:51:10,120 --> 00:51:12,239
Speaker 2: to be, or I'm five pounds. So if I give

924
00:51:12,280 --> 00:51:16,120
Speaker 2: them a target number, let's say it tells them they're

925
00:51:16,120 --> 00:51:19,120
Speaker 2: supposed to lose eighty seven pounds. Let's just come up

926
00:51:19,120 --> 00:51:24,400
Speaker 2: with this number, and let's say they lose sixty two pounds.

927
00:51:25,440 --> 00:51:28,920
Speaker 2: Let's just use that. We could say that that's pretty great, right,

928
00:51:29,880 --> 00:51:31,880
Speaker 2: But if they don't lose eighty seven, they're going to

929
00:51:31,920 --> 00:51:37,040
Speaker 2: feel like a failure. And let's say with that sixty

930
00:51:37,120 --> 00:51:40,400
Speaker 2: plus pound weight loss, their blood pressure is now normal,

931
00:51:40,680 --> 00:51:45,080
Speaker 2: their cholesterol is now normal, all of their living. Everything's

932
00:51:45,280 --> 00:51:49,600
Speaker 2: perfect in terms of like everything else, but they have

933
00:51:49,760 --> 00:51:55,719
Speaker 2: hyper focused on losing this number. I'm gonna say that

934
00:51:56,000 --> 00:51:58,880
Speaker 2: was flawed in their thinking because they feel like they

935
00:51:58,960 --> 00:52:01,520
Speaker 2: have to be this number defined by something that was

936
00:52:01,719 --> 00:52:06,080
Speaker 2: never meant for us. BMI was this concept that comes

937
00:52:06,120 --> 00:52:09,800
Speaker 2: from Aldolph to Lay, who was a Belgium statistician that

938
00:52:10,000 --> 00:52:12,839
Speaker 2: really sought to determine what was normal for Belgium white

939
00:52:12,880 --> 00:52:16,400
Speaker 2: male soldiers. I am not that you are not that,

940
00:52:17,440 --> 00:52:20,440
Speaker 2: So why are we trying to force ourselves into a

941
00:52:21,840 --> 00:52:24,279
Speaker 2: guideline that was never really meant for us to begin with?

942
00:52:26,320 --> 00:52:29,000
Speaker 1: Are there any advances in the field to move away

943
00:52:29,080 --> 00:52:31,960
Speaker 1: from BMI, because I keep hearing people say that, but

944
00:52:32,200 --> 00:52:35,239
Speaker 1: it feels like largely like the medical industry is still

945
00:52:35,320 --> 00:52:37,520
Speaker 1: using BMI. So are there alternatives?

946
00:52:37,719 --> 00:52:40,279
Speaker 2: Yeah, so the medical industry still largely uses that. But

947
00:52:40,400 --> 00:52:43,279
Speaker 2: I will tell you. On January sixteenth of twenty twenty five,

948
00:52:43,400 --> 00:52:47,160
Speaker 2: I had already happened. The Lanta Commission, which included fifty

949
00:52:47,200 --> 00:52:50,200
Speaker 2: eight commissioners, of which I am one of them, developed

950
00:52:50,239 --> 00:52:53,759
Speaker 2: a new criteria to look at obesity. We look at

951
00:52:53,880 --> 00:52:57,360
Speaker 2: something called preclinical obesity and clinical obesity where we don't

952
00:52:57,440 --> 00:53:00,920
Speaker 2: focus on BMI except for patients that do have severe obesity,

953
00:53:01,040 --> 00:53:03,920
Speaker 2: so BMI of forty plus we kept and retained the

954
00:53:04,000 --> 00:53:08,400
Speaker 2: BMI for patients that were under that. We look beneath

955
00:53:08,440 --> 00:53:11,400
Speaker 2: the hood. We start looking at your waste circumference or

956
00:53:11,440 --> 00:53:14,440
Speaker 2: waste to hip ratio. We start determining do you have

957
00:53:14,960 --> 00:53:19,400
Speaker 2: these obesity related conditions like type two diabetes, or like

958
00:53:19,480 --> 00:53:21,799
Speaker 2: the thirteen cancer is caused by OBC or all these

959
00:53:21,840 --> 00:53:25,160
Speaker 2: other things to determine more of a fuller picture of

960
00:53:25,239 --> 00:53:27,920
Speaker 2: who you are instead of just relying on one number.

961
00:53:28,920 --> 00:53:29,239
Speaker 2: Got it?

962
00:53:29,480 --> 00:53:31,480
Speaker 1: Got man? Well, thank you so much for all of

963
00:53:31,520 --> 00:53:34,720
Speaker 1: that information, Doctor Fatima. This has been so helpful. Please

964
00:53:34,800 --> 00:53:36,840
Speaker 1: let us know where can we stay in touch with you.

965
00:53:36,960 --> 00:53:38,680
Speaker 1: Do you have a website as well as any social

966
00:53:38,719 --> 00:53:39,959
Speaker 1: media channels you'd like to share?

967
00:53:40,280 --> 00:53:45,399
Speaker 2: So my website is ask ask doctor dr Fatima dot

968
00:53:45,480 --> 00:53:49,200
Speaker 2: com and all of my socials are also that so

969
00:53:49,760 --> 00:53:55,719
Speaker 2: one IgM asked doctor Fatima dot com one x which

970
00:53:55,719 --> 00:53:57,920
Speaker 2: I'd spend very little time there, but you've want to

971
00:53:58,000 --> 00:53:59,880
Speaker 2: go hang out there and that's where you like to

972
00:53:59,920 --> 00:54:03,600
Speaker 2: go is ask doctor Fatima. I'm not on Facebook, don't

973
00:54:03,640 --> 00:54:05,360
Speaker 2: plan on being there, so you guys can just go

974
00:54:05,719 --> 00:54:09,320
Speaker 2: have fun and chat with each other there. LinkedIn also

975
00:54:09,440 --> 00:54:12,759
Speaker 2: ask doctor Fatima, So feel free to come and hang

976
00:54:12,840 --> 00:54:15,440
Speaker 2: out with me. And I usually try to post on

977
00:54:15,640 --> 00:54:17,279
Speaker 2: ig and LinkedIn. I would se those where I spend

978
00:54:17,360 --> 00:54:20,520
Speaker 2: a lot of my times, and also my website and so. Yeah,

979
00:54:20,640 --> 00:54:24,640
Speaker 2: so I hope that you learned some things about obesity's disease,

980
00:54:24,680 --> 00:54:26,800
Speaker 2: what's going on in the field. The only thing I

981
00:54:26,880 --> 00:54:29,440
Speaker 2: didn't really say is I still think biatric surgery is

982
00:54:29,440 --> 00:54:33,280
Speaker 2: by far the most effective treatment for patients with severe obesity.

983
00:54:34,000 --> 00:54:36,360
Speaker 2: As I mentioned before, most of my patients with severe

984
00:54:36,400 --> 00:54:39,400
Speaker 2: obesity still require multiple modalities of therapy, and most of

985
00:54:39,440 --> 00:54:42,240
Speaker 2: them still do require the use of like a gop

986
00:54:42,400 --> 00:54:45,600
Speaker 2: one in addition to so I just don't want to

987
00:54:45,680 --> 00:54:48,239
Speaker 2: downplay that therapy, which I still think is a very

988
00:54:48,360 --> 00:54:52,759
Speaker 2: useful tool for patients with obesity, and particularly for those

989
00:54:52,840 --> 00:54:56,280
Speaker 2: with severe obesity, and I use it across the age spectrum,

990
00:54:56,680 --> 00:55:00,000
Speaker 2: from my pediatric patients to my older at ault.

991
00:55:00,600 --> 00:55:03,880
Speaker 1: So we might a physician choose to maybe start with

992
00:55:04,000 --> 00:55:06,600
Speaker 1: a golp one and see how that works versus like

993
00:55:06,760 --> 00:55:07,760
Speaker 1: bary egic surgery.

994
00:55:08,160 --> 00:55:10,560
Speaker 2: Yeah, I think that gop ones are really great for

995
00:55:10,680 --> 00:55:15,759
Speaker 2: patients with mild to moderate obesity. So patients that may

996
00:55:15,880 --> 00:55:20,000
Speaker 2: have evidence of clinical disease, they have evidence of clinical obesity,

997
00:55:20,400 --> 00:55:23,000
Speaker 2: but don't have severe disease. So once we get into

998
00:55:23,080 --> 00:55:27,680
Speaker 2: that category of having severe disease, the best treatment, hands down,

999
00:55:27,760 --> 00:55:31,320
Speaker 2: like I've mentioned, is bariatric surgery, and usually in the

1000
00:55:31,400 --> 00:55:34,680
Speaker 2: form of something we call a sleeve gas strectomy. What

1001
00:55:34,719 --> 00:55:37,719
Speaker 2: does that mean? We cut out about seventy to eighty

1002
00:55:37,760 --> 00:55:41,520
Speaker 2: percent of the stomach. But before we actually think that's

1003
00:55:41,560 --> 00:55:43,400
Speaker 2: the reason why you lose weight, it's not. The surgeons

1004
00:55:43,400 --> 00:55:45,960
Speaker 2: will tell you that at this wrong grellin, which is

1005
00:55:46,040 --> 00:55:49,880
Speaker 2: the key hunger hormone, is housed in the fundest region

1006
00:55:49,920 --> 00:55:52,279
Speaker 2: of the stomach that's cut out, and so you will

1007
00:55:52,360 --> 00:55:56,200
Speaker 2: be in this honeymoon period in that first six twelve

1008
00:55:56,239 --> 00:55:59,160
Speaker 2: months post surgery. But grell and that key hunger hormone

1009
00:55:59,200 --> 00:56:01,360
Speaker 2: is cut out, and you're like, gosh, I'm never hungry,

1010
00:56:01,440 --> 00:56:05,360
Speaker 2: this is great, this is delightful. Grellan's also housed in

1011
00:56:05,440 --> 00:56:09,480
Speaker 2: the brain. But remembering, surgeons didn't touch your brain, they

1012
00:56:09,600 --> 00:56:12,040
Speaker 2: only touch your stomach, and so you'll feel like, wait

1013
00:56:12,080 --> 00:56:15,000
Speaker 2: a minute, I think I'm hungry all of a sudden,

1014
00:56:15,640 --> 00:56:19,080
Speaker 2: So I would forewarn the patient prior to surgery. When

1015
00:56:19,200 --> 00:56:22,520
Speaker 2: that happens, when you start noticing that hunger re emerge,

1016
00:56:23,840 --> 00:56:26,160
Speaker 2: when you start noticing that you're not full as much,

1017
00:56:26,920 --> 00:56:29,759
Speaker 2: that would be when we would introduce a medication as

1018
00:56:29,840 --> 00:56:35,239
Speaker 2: an adjunct, because if not, they'll start to regain and

1019
00:56:35,400 --> 00:56:39,440
Speaker 2: that's not what we want. So, Doctor Fatima, as I

1020
00:56:39,520 --> 00:56:41,120
Speaker 2: hear you talk about some of these, I feel like

1021
00:56:41,200 --> 00:56:44,040
Speaker 2: there's something in my psychology brain that's like, yeah, but

1022
00:56:44,160 --> 00:56:46,759
Speaker 2: we kind of need hunger cues, right, Like, I feel

1023
00:56:46,800 --> 00:56:49,759
Speaker 2: like that is some of the concern you'll be hungry. No,

1024
00:56:50,080 --> 00:56:54,279
Speaker 2: you're it's not be hungry at all. You're They're like, no,

1025
00:56:54,520 --> 00:56:59,640
Speaker 2: we need those. Oh my goodness. That's very important. So

1026
00:57:00,640 --> 00:57:02,600
Speaker 2: that's part of why when we send a patient to

1027
00:57:02,680 --> 00:57:07,240
Speaker 2: burytric Surgery, there are three persons involved in that decision

1028
00:57:07,280 --> 00:57:10,200
Speaker 2: to even send them to the surgeon, someone like myself,

1029
00:57:10,239 --> 00:57:14,239
Speaker 2: an OBC medicine physician, a dietician, and we have five

1030
00:57:14,280 --> 00:57:18,920
Speaker 2: PhD level psychologists one staff. The three of us the

1031
00:57:19,040 --> 00:57:22,960
Speaker 2: tribecta with decided this patient is an appropriate person to

1032
00:57:23,080 --> 00:57:26,880
Speaker 2: see one of our five surgeons. Then they would go

1033
00:57:26,960 --> 00:57:30,440
Speaker 2: through our surgical proprim to then go to surgery. Okay,

1034
00:57:31,760 --> 00:57:34,000
Speaker 2: let's go back to that psychological piece. I appreciate that

1035
00:57:34,040 --> 00:57:36,280
Speaker 2: you're bringing that up. It's not that you don't want

1036
00:57:36,320 --> 00:57:39,960
Speaker 2: them to have any hunger, that would be inappropriate, but

1037
00:57:40,360 --> 00:57:44,760
Speaker 2: you don't understand the intensity of hunger and patients that

1038
00:57:44,920 --> 00:57:51,880
Speaker 2: often have severe disease, the preoccupation, the thinking like hmm,

1039
00:57:52,000 --> 00:57:54,840
Speaker 2: I'm in the middle of this taping, I'm thinking about

1040
00:57:55,080 --> 00:57:57,360
Speaker 2: eating right now, as opposed to being focused on what

1041
00:57:57,520 --> 00:58:00,880
Speaker 2: you're saying. I can be hungry, that's one thing, but

1042
00:58:00,920 --> 00:58:03,960
Speaker 2: I'm so preoccupied that I'm I'm like, hmm, I should

1043
00:58:03,960 --> 00:58:06,720
Speaker 2: be thinking about that as opposed to like answering the question.

1044
00:58:07,520 --> 00:58:09,200
Speaker 2: And I'm thinking about not only for me, but I'm

1045
00:58:09,200 --> 00:58:11,200
Speaker 2: also thinking about for my family, and then by the suit,

1046
00:58:11,240 --> 00:58:13,160
Speaker 2: and then I'm thinking about this, and then that could

1047
00:58:13,200 --> 00:58:16,680
Speaker 2: be how pervasive it is. But when it starts to merge,

1048
00:58:16,760 --> 00:58:20,080
Speaker 2: they sense this, and it may be part of like

1049
00:58:20,240 --> 00:58:23,640
Speaker 2: binge eating, which is the most common eating disorder associated

1050
00:58:23,720 --> 00:58:27,360
Speaker 2: for patients with obesity. There's a high overlap bengating disorder

1051
00:58:27,440 --> 00:58:30,000
Speaker 2: with patients with obesity. It may not even be that,

1052
00:58:30,320 --> 00:58:32,680
Speaker 2: it may just be that they start to notice it emerge,

1053
00:58:32,720 --> 00:58:34,840
Speaker 2: but as that starts to merge, it will continue to

1054
00:58:35,000 --> 00:58:39,720
Speaker 2: cause weight shifts over time. If loss weight usually come

1055
00:58:39,760 --> 00:58:42,240
Speaker 2: to a point of wastability. If I don't treat it,

1056
00:58:42,800 --> 00:58:46,040
Speaker 2: there will be the weight regain and it will be

1057
00:58:46,080 --> 00:58:48,680
Speaker 2: a shame for me to send them to surgery only

1058
00:58:48,720 --> 00:58:50,479
Speaker 2: for them to regain all of the weight.

1059
00:58:51,520 --> 00:58:54,400
Speaker 1: Got it, Okay, So it doesn't completely take away the

1060
00:58:54,480 --> 00:58:56,760
Speaker 1: hunger keys. It's like you mentioned turning down the volume

1061
00:58:56,840 --> 00:58:57,400
Speaker 1: the intensity.

1062
00:58:57,520 --> 00:58:59,640
Speaker 2: Yes, on exactly. So, yeah, we don't want them to

1063
00:58:59,760 --> 00:59:02,560
Speaker 2: not eat right. That would be inhumane, right, you know,

1064
00:59:02,680 --> 00:59:05,400
Speaker 2: we want them to be human. But as soon as

1065
00:59:05,440 --> 00:59:06,800
Speaker 2: they start, are like, well wait a minute, Nope, this

1066
00:59:06,960 --> 00:59:08,840
Speaker 2: is abnormal. They're eating right, because I want to know

1067
00:59:08,880 --> 00:59:12,480
Speaker 2: what breakfast, snack, lunch, snack, dinner snack is. If they

1068
00:59:12,520 --> 00:59:15,320
Speaker 2: tell me nothing in any of those, we got a problem, right.

1069
00:59:16,160 --> 00:59:19,520
Speaker 2: But if they are telling me, now I'm noticing, oh gosh,

1070
00:59:19,560 --> 00:59:21,760
Speaker 2: I need that second snack, and then I need the third. Ooh,

1071
00:59:21,800 --> 00:59:26,200
Speaker 2: I'm noticing something's not right. Something's just not right. We

1072
00:59:26,440 --> 00:59:28,760
Speaker 2: need to start thinking about it. Now. There's something that'll

1073
00:59:28,760 --> 00:59:31,040
Speaker 2: resist They're like, no, I'm gonna use that willpower. Going

1074
00:59:31,040 --> 00:59:34,000
Speaker 2: back to that question you asked me, I'm growing down.

1075
00:59:34,560 --> 00:59:37,520
Speaker 2: I'm gonna go on that third walk and then you're

1076
00:59:37,560 --> 00:59:40,000
Speaker 2: like you just go on, like two wats I'm gonna go.

1077
00:59:40,120 --> 00:59:44,800
Speaker 2: I'm gonna I'm gonna push harder, and you're like, why,

1078
00:59:44,880 --> 00:59:47,120
Speaker 2: I can help you. I can help you, right, it's

1079
00:59:47,200 --> 00:59:49,400
Speaker 2: the biology that's causing you to do that way. I

1080
00:59:49,440 --> 00:59:52,680
Speaker 2: can help the biology if I can get the right tools, right,

1081
00:59:52,720 --> 00:59:55,320
Speaker 2: because not everyone we just talked about is access to

1082
00:59:55,480 --> 00:59:58,360
Speaker 2: those tools. And then they're like, you can imagine like

1083
00:59:58,440 --> 01:00:03,320
Speaker 2: it's a sense of calm. I get the two I dodged.

1084
01:00:03,400 --> 01:00:07,200
Speaker 2: I dodged a bullet there. Wow. Thanks, I thank you

1085
01:00:07,320 --> 01:00:09,160
Speaker 2: do share for a while. You were right. I do

1086
01:00:09,320 --> 01:00:12,520
Speaker 2: feel I feel back to how I felt some patients would,

1087
01:00:12,560 --> 01:00:15,400
Speaker 2: particularly those post op patients. Oh, I feel back to

1088
01:00:15,480 --> 01:00:19,560
Speaker 2: how I felt after surgery. Now I feel I feel

1089
01:00:19,600 --> 01:00:22,280
Speaker 2: that again, you know, so something like that.

1090
01:00:22,680 --> 01:00:24,120
Speaker 1: Thank you for that doctor of her team, and I

1091
01:00:24,160 --> 01:00:25,960
Speaker 1: appreciate you spending some time with day.

1092
01:00:26,480 --> 01:00:28,920
Speaker 2: Absolutely, it's been a delight. I just want people to

1093
01:00:29,000 --> 01:00:30,000
Speaker 2: have the right information.

1094
01:00:30,640 --> 01:00:38,400
Speaker 1: Thank you. I'm so glad doctor Stanford was able to

1095
01:00:38,520 --> 01:00:42,040
Speaker 1: join us for today's conversation. Her compassionate approach to this

1096
01:00:42,160 --> 01:00:44,720
Speaker 1: work and commitment to changing how we understand weight and

1097
01:00:44,840 --> 01:00:48,240
Speaker 1: health is truly inspiring. To learn more about her work,

1098
01:00:48,480 --> 01:00:50,360
Speaker 1: be sure to visit our show notes at Therapy for

1099
01:00:50,440 --> 01:00:53,960
Speaker 1: Blackgirls dot com slash Session four two six, and don't

1100
01:00:53,960 --> 01:00:55,840
Speaker 1: forget to text two of your girls right now and

1101
01:00:55,920 --> 01:00:58,120
Speaker 1: tell them to check out the episode. Did you know

1102
01:00:58,160 --> 01:01:00,320
Speaker 1: you could leave us a voicemail with your question are

1103
01:01:00,320 --> 01:01:04,320
Speaker 1: suggestions for the podcast. Whether you have ideas for future topics,

1104
01:01:04,480 --> 01:01:07,439
Speaker 1: book or movie suggestions, or just something on your mind,

1105
01:01:07,520 --> 01:01:09,880
Speaker 1: we'd love to hear it. Head on over to Memo

1106
01:01:09,960 --> 01:01:12,560
Speaker 1: dot fm slash Therapy for Black Girls and leave us

1107
01:01:12,600 --> 01:01:15,640
Speaker 1: a voice meil. If you're looking for a therapist in

1108
01:01:15,720 --> 01:01:18,560
Speaker 1: your area, check out our therapist directory at Therapy for

1109
01:01:18,640 --> 01:01:22,240
Speaker 1: Blackgirls dot com slash directory, and don't forget to follow

1110
01:01:22,360 --> 01:01:25,640
Speaker 1: us over on Instagram at Therapy for Black Girls. You

1111
01:01:25,720 --> 01:01:28,880
Speaker 1: can also support the podcast by joining our Patreon community.

1112
01:01:29,440 --> 01:01:32,440
Speaker 1: When you join, you'll get access to exclusive content, behind

1113
01:01:32,440 --> 01:01:35,720
Speaker 1: the scenes updates, and monthly Q and A sessions. Come

1114
01:01:35,760 --> 01:01:37,920
Speaker 1: on over and join us at community dot Therapy for

1115
01:01:38,000 --> 01:01:41,880
Speaker 1: Blackgirls dot com. We love to have you. This episode

1116
01:01:42,000 --> 01:01:45,880
Speaker 1: was produced by Elise Ellis, Indietubu and Tyree Rush. Editing

1117
01:01:46,000 --> 01:01:48,840
Speaker 1: was done by Dennison Bradford. Thank y'all so much for

1118
01:01:48,960 --> 01:01:51,760
Speaker 1: joining me again this week. I look forward to continuing

1119
01:01:51,800 --> 01:01:52,920
Speaker 1: this conversation.

1120
01:01:52,600 --> 01:01:55,120
Speaker 2: With you all real scene, take good care.

1121
01:02:00,080 --> 01:02:00,120
Speaker 1: What