Podcast Episode 11 | Understanding the Disease of Obesity

With Fatima Cody Stanford, MD

About the WCW Podcast

The White Coat Wellness podcast by Spaugh Dameron Tenny highlights real-life stories from doctors and dentist to encourage and inspire listeners through discussions of professional successes and failures in addition to personal stories and financial wellness advice.

Shane Tenny, CFP® is our podcast host and Partner at SDT. He has lectured numerous times for hospitals and physician groups and, most importantly, helped hundreds of clients develop strategies to navigate through turbulent times toward their financial goals.

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Fatima Stanford: 00:00 So when we were about five or six years old in dance class, you came up to me in class and said to me that I was fat, and then you walked off and that has damaged me for my entire life.

Intro: 00:15 From Spaugh Dameron Tenny it's White Coat Wellness, a show for doctors who are ready to improve their financial wellness. We know you work hard to help your patients, but you can't be at your best if you don't have your own finances. In order in White Coat Wisdom, we highlight real life stories from physicians and dentists to educate, encourage and inspire you to personal, professional, and financial wellness now from spa Damon Tenny, please welcome your host Shane Tenny.

Shane Tenny: 00:44 Welcome to today's episode of White Coat Wisdom, where we deal with important, real life topics facing real life providers around the country. And today's topic is obesity. We know that over 40% of adults in the U.S. Are classified as having some level of obesity, and 20% of all healthcare dollars are spent on obesity related issues, and it's a pretty difficult and personal disease for those struggling with it. And also leads to one of the most accepted forms of discrimination and bias in our country.

Shane Tenny: 01:18 And today I'm fortunate to have with us and expert to share her journey of both teaching patients how to manage their weight and obesity and also teaching physicians and practitioners to become aware of their own subconscious weight bias. And so the expert I'm talking about is with me, Dr. Fatima Cody Stanford. Dr. Stanford is an obesity medicine physician at Massachusetts General Hospital. She's also an assistant professor of medicine and pediatrics at Harvard Medical School and is the 2017 recipient of their Amos Diversity Award and Massachusetts Medical Society's Award for Women's Health.

Shane Tenny: 01:58 Dr. Sanford, it is great to have you here today. Thanks so much.

Fatima Stanford: 02:01 Well thanks for having me. I'm excited to be here.

Shane Tenny: 02:04 Can you start at the beginning? Just give us a little bit of a background about yourself and your journey into medicine.

Fatima Stanford: 02:11 So around the age of three, I mean because why not? I decided I wanted to be a physician. I did not come from a family where my parents or grandparents or anyone else in my family was a physician, but for some reason pretty early I thought that my calling was in medicine. So I, from the age of three, really sought after this dream of becoming a physician and have spent many years now in the field. Now four years, four degrees later, two residencies, two fellowships later, I'm doing the work here in obesity medicine.

Fatima Stanford: 02:42 So I first did my Bachelor's of Science and Anthropology and Herbology, and was a dance minor at Emory University. And then immediately thereafter did my Masters in Public Health and Health Policy and Management. Worked in public health at the Center for Disease Control and Prevention in Atlanta, also the American Cancer Society. Then I worked in a rape crisis center for two years before actually starting medical school. Went to medical school, and actually after medical school did a year of orthopedic surgery, sports medicine fellowship in New York city before completing residencies in internal medicine and pediatrics in Columbia, South Carolina.

Fatima Stanford: 03:15 After which I did a three year obesity medicine fellowship here at Massachusetts General Hospital and at Harvard Medical School, because of why not? And my very last year there did my mid-career degree at the Harvard Kennedy school of government specifically looking at government and policy issues surrounding obesity throughout the U.S. and throughout the world. So that's really my journey, in about 30 seconds, specifically to where I am today in medicine, and with my background in public health, and in public administration complementing the work that I do in obesity.

Shane Tenny: 03:45 Yeah, and through your training and exposure to different fields of medicine, orthopedics, as you mentioned, what happened that caused you to have such an interest and specialize in obesity medicine?

Fatima Stanford: 03:57 So I was born and raised in Atlanta, Georgia. And I think what's really interesting about Atlanta is in my zip code alone, we have more black doctors per capita than anywhere else in the United States. And so I was exposed to many people that look like myself that pursued medicine. What I noticed was that there was an extremely large disparity when we were looking at overweight and obesity in the black community, for example, compared to the greater community. And so many of the projects that I was engaged and involved with when I was doing my master's in public health at Emory in Atlanta were specifically surrounding looking at overweight and obesity within the black community.

Fatima Stanford: 04:32 One of the projects that I was involved with was called Healthy Body, Healthy Spirit, and it was a project that was conducted in many of the African-American churches in the Atlanta area. I also was involved in a program called Go Girls, which was specifically looking at overweight and obesity within African-American teen girls. And then another program that was involving the WIC program. So the Women Infants and Children program, which was not specifically looking at persons of color but had a large percentage of persons of color. And so what I began to notice is that, hey, this issue is disproportionately impacting my community. And it was one of the things that really drove my interest within the field.

Fatima Stanford: 05:11 I had mentioned earlier that I initially pursued orthopedics and what I often felt like we were doing in orthopedics was putting a band-aid on the situation. So we could go and give you a new knee, right? Like we could replace your knee, give you a total knee replacement, but if you still struggled with 150 pounds in excess, how long is your knee really going to last? Are we really treating the underlying issue? Or are we just putting a band-aid on the situation? So these were concepts that really drove me to the work that I do today.

Shane Tenny: 05:40 And how has the medicine and the thinking about obesity developed over the last couple of decades? Over the last hundred years? What's been the evolution of the science around obesity?

Fatima Stanford: 05:54 So for many, many years, and I would say that this is still the pervasive thinking in medicine and around the world is, people think of obesity as a pretty simple issue, right? It's all about calories in and calories out. And if you can just figure out that balance. Just work out more, eat less than you should be. Exactly the size you want to be. And I think for anyone that's listening, even if you're lean, you might recognize that, Hey, maybe I'm a size six and I want to be a size two and your body is just not wanting to get there.

Fatima Stanford: 06:22 So we can realize that it's a bit more complex than that. But that's not something that we've been taught in medical schools or persons had been taught in nursing school. And so what happens is, a person goes in to see their doctor, the doctor tells him to eat less, exercise more, and they come back next year, they weigh five more pounds, are like, "Doc, I've been doing this." And they're not really given any direction on how they could potentially treat what is now becoming their weight problem and issue.

Fatima Stanford: 06:49 So a lot of that has to do with the fact that it's just really simple, right? Like I just, you just do what I say and then you should be exactly where you are. And one of the things that I really became acclimated to was this bias that exist amongst healthcare providers, amongst physicians, when we presume that what we're saying to our patients is going in one ear and out the next. And I really came to learn my own biases when I was a resident in internal medicine and pediatrics. I had a patient that was a 45-year-old woman who struggled with severe obesity that I'd been taking care of for about three years. And so my residency was four years.

Fatima Stanford: 07:28 One day I happened to run into her at the grocery store as she was checking out. And so this was great because I could see exactly what she was buying. I'd never run into her in the grocery store, but I got a chance to do my own surveying of what was going on. So she's talking to me. She recognizes that I'm surveying her cart, and she says to me, "Dr. Stanford, I told you." And what she was saying to me was that if you looked at her cart, her cart was the most virtuous cart you could have ever seen. I mean, it had the right balance of fruits and vegetables, no processed foods. I mean literally I didn't even have to do grocery shopping. I could have just taken her cart and checked out and it would have been amazing.

Fatima Stanford: 08:07 But here she was struggling with her severe obesity and the presumption would be that maybe she's eating horribly. Maybe she's not doing anything I'm telling her. But what I'm seeing here is that she's doing everything that I'm telling her, and her body has just decided that it won't respond to these simple changes. And so I needed to probably use more aggressive measures with her. But here I had my bias that maybe she wasn't listening to the things I'd been telling her for the last three years.

Fatima Stanford: 08:36 And so that's something that I learned about myself, and how I had to check myself about what is my patient telling me, and really recognizing and believing that when the patient approaches you about wanting to have and approach their weight and really make some strides there, they're giving you the information you need to hear. You're just usually not recognizing it and doing the things you're supposed to do to help them be their best self.

Shane Tenny: 09:01 And you authored a book, I think, called Facing Overweight and Obesity, a Guide for Children and Adults. We'll put the link to it in the show notes here. Can you talk a little bit about just what's that a compilation of? How did you come to write that with your colleagues?

Fatima Stanford: 09:17 So I obviously only care for patients that have overweight obesity, both pediatric and adult patients. And one of the things that I struggled with was having a resource that they could go to to learn more about the complexity of their disease. To learn about the other obesity related diseases they may struggle with, to learn about how the media influences really negative thoughts about patients that have obesity, to learn about weight bias, to learn about where they go for nutritional advice, and help and things of this sort.

Fatima Stanford: 09:47 And I was trying to piece together this website and that website and recognizing that some of the information that was out there was really not sound and didn't align with what I would teach my patients. And so that was really when I was thinking about. How do I come up with a book that would really conquer these things that I'm struggling with telling my patients in an office visit? That was really where this book was born, out of that idea. When I talk about this book, I talk about its use for patients with physicians that are embarking upon doing this work often find it very useful, because unfortunately in medical schools throughout the U S and around the world, we're not learning much about obesity.

Fatima Stanford: 10:28 So they often need a resource to just look at, "Wait a minute, I never learned any of this." But you know, the first thing that the commercial tells you is that, "Hey, I'm going to start a workout program. You should go see your doctor because they'll know what to do." And really, no, they often don't know what to do because we don't learn that in medical schools, and we don't learn it in our extensive training that happens after we graduate from medical schools. I just published a paper, actually, that came out two weeks ago on obesity education and medical schools, residencies, and fellowships throughout the entire world.

Fatima Stanford: 10:58 And what we found in that particular study, which looked at every medical school, residency and fellowship throughout the world from 2005 to 2018, is that no one, no one, not the U.S., Not the UK, no one does a good job of educating doctors about obesity. And so here we have this growing problem, right? I call it a pandemic, and we have no one that knows how to treat it. And so what's going to happen is that, we have these patients that have this obesity that no one knows how to treat, and all we do is so you eat less, exercise more, it's just going to continue to get worse. And so we need to do a better job. And that's why I'm doing this work.

Shane Tenny: 11:37 I noticed your co-authors are both psychiatrists, or come from that specialty. What's the overlap? Talk a little bit about the overlap between your perspectives and theirs in working with patients suffering from obesity.

Fatima Stanford: 11:51 Absolutely. So the reason why psychiatrists are often very interested in overweight and obesity is that, unfortunately, and this is not their fault per se, but many of the medications that we use to treat psychiatric conditions like bipolar disorders, schizophrenia, depression, et cetera, cause a significant amount of weight gain. And so, here you want to treat one of those medical conditions. You want to make sure that that mental health issue is well controlled, but in treating that, I often cause another medical problem, which is mild, moderate or even severe obesity.

Fatima Stanford: 12:26 I can tell you that with some of the medications that we prescribe for these psychiatric conditions, I've seen people gain an excess of 180 pounds from some of these medications. And you can imagine that that affects their quality of life significantly. And so the psychiatrists are like, Hey, you know, we want to treat these diseases but we don't want to cause harm. But we don't want them to have, you know, an issue that won't allow them to be stable in society. And unfortunately, what some patients do is they recognize that these medications are causing weight gain and they may not use the medications when they should and then they have another issue that's obviously related to their mental health issue, but it's a balancing act.

Fatima Stanford: 13:02 So that's one of the key things that I think psychiatrists are interested in when they come to this work, is looking at how their treatments often preclude our ability to really optimally treat obesity and how can they curtail that if that's at all possible. So that's probably one of the biggest overlap. But I also would say the other overlap is when we're looking at patients that have overweight and obesity, about a third of them do struggle with either mental health disorders, much like the ones I mentioned. And so they require quite a bit of treatment, often lifelong treatment to reconcile those issues, as we are still working to treat their overweight and obesity.

Shane Tenny: 13:44 You were mentioning a minute ago the work and thinking around weight bias. I want to ask you a little bit more about that right after this break.

Will Koster: 13:57 I'm Will Koster on this episode of White Coat Wisdom I'm going to talk about the idea of the savings snowball. You may have heard of the concept of the debt snowball. This is a very similar idea, but instead of paying off debt, we implement this strategy with our clients to capitalize on the opportunities to save money. Let me give you an example of the savings snowball and action.

Will Koster: 14:18 Imagine you have a car payment of $500 a month, but good news, you will finally pay it off this month. How exciting! Well, this accomplishment of paying off your car only positively impacts your long-term financial future if you are able to capture that $500 a month toward your savings. The key here is to have automatic monthly savings set up. Similar to automatic drafts for your bills, monthly savings should also be automatic. To capture the money you were allocating towards your car payment, you should increase your automatic monthly savings by $500. Otherwise, what happens to this $500 a month, is it gets washed down the spending stream, as we like to say. Not only will you not save this money, but it will also lead to lifestyle creep. The next time you need to finance a car, it will be more difficult to find that $500 a month to put towards the payment because you've gotten accustomed to the new lifestyle.

Will Coster: 15:13 Another example of when the savings snowball can be implemented is when you receive a raise at work. Time to increase the monthly savings goal. Saving takes discipline, and it's easier to build that discipline if you have automatic savings mechanisms, and if you're able to capitalize on opportunities to increase your savings amount, try this out the next time you have a chance. With today's White Coat Wisdom, I'm Will Koster.

Shane Tenny: 15:39 So I know last year, in the Harvard Gazette, you were interviewed and mentioned that people in society tend to view excess weight as a moral failing, I think was maybe the quote there. What is it about obesity that causes this disease to be seen this way, and how can physicians and even the general population take the blame, or take the shame out of it?

Fatima Stanford: 16:07 So, if we continue to think that, overweight and obesity is just a lifestyle choice, it's all someone's fault if they struggle with their excess weight, we'll continue to perpetuate this bias that we have to persons that have excess weight. Many of us can think to ourselves and, if you see a person that has especially severe obesity if they walk down the street past you, or get on the elevator with you, or on the airplane with you, wherever you might be, you make assumptions about who they are, what their value or their worth is, whether or not they're lazy, whether or not they're capable of reaching life goals. And this is all based upon our thought process that, if they just did better, if they just exercise a little bit more, if they just ate a little bit less, that they would be optimal, meaning in terms of their weight status.

Fatima Stanford: 16:54 What that doesn't touch on is the complexity of obesity and how the body regulates weight, which diet and exercise are two key components, but it's so much more complex and we may have things such as adequate sleep. We may have things like the bacteria in one's gut. So what we know is the bacteria in the gut of persons that are lean differs quite drastically from those that have obesity. And they're doing studies here at Mass General, for example, where they're taking the gut microbiota, which means the bacterium inside of persons that are lean, and putting it in persons that have obesity without any other changes, seeing significant shifts downward in their weight status.

Fatima Stanford: 17:31 So there's so much that we have left to learn about why patients struggle. Some people struggle, some people don't. But we make these assumptions that, oh, they just didn't do something well enough. And if they were lean, let's say they were lean, but you didn't know that they had an issue with let's say, nicotine use disorder, or opioid addiction, or whatever it is, you don't notice that per se when the person sits next to you on the train, or the subway or wherever it might be. We can't make those assumptions about any of those things because it's not visible right? Often it's not visible.

Fatima Stanford: 18:05 When people carry excess weight, we see it and we immediately make assumptions about who they are, who they're not, and what they could have done better to be a better person without recognizing that there's so much complexity to that story. And that's what's fascinating about my work when I'm working with patients, because I never know the story until they tell me the story, and I can help them sort through what things were maybe triggers that they were unaware of, and I can sort through how do I best treat this patient? Because in front of me, my goal is to help them be their happiest, healthiest self.

Shane Tenny: 18:39 I'm curious for myself and then for those listening, what are some of the subconscious things that we do, or that maybe I do that I'm not even aware of, that you hear from your patients all the time that caused them to feel embarrassed or shamed or those sorts of things?

Fatima Stanford: 19:00 So I'm going to start in the doctor's office, because I think we should be held to a higher standard, because we are the ones treating these patients. So let's say you get to the doctor's office and you have obesity and you immediately get in the waiting room. And you realize there's not a chair that's available for you to sit down in. So you decide to stand in the waiting room and, and the people behind the desk, the receptionist go, "Oh no, have a seat." You say to the reception, "Oh, no, no, I'm fine standing." The reason you're fine standing is not because you want to stand, but if there are seats that have armrests that don't allow you to sit adequately there, that's a message that's being sent to that patient when they walk in the door, you're not welcome there.

Fatima Stanford: 19:37 So then they get back and they get to a scale and the scale does not weigh them because it doesn't have the appropriate weight, or they go to get their blood pressure taken and the cuff isn't large enough to really take their blood pressure. So it's bursting at the seams. They feel embarrassed. These are things we've said nothing about their weight yet, but they've gotten three different messages that they are not welcome there. Then there's the snickers they may hear from the nurses that, oh, their weight didn't go up to the right level on the scale. Or, oh, they use the tape measure to measure their waist and it wasn't quite large enough. And they have now received five different messages before they've seen the doctor about them not being welcome. So those are some of the things that you may see in the doctor's office.

Fatima Stanford: 20:20 What you might do at home, and this definitely is an issue that we give to our children. So let's say you're watching a television show and you always compliment the men and women that are, "Oh wow, they look great in that dress." Or "Oh, they look great in that suit." You know, that's a really nice tuxedo on that gentleman, whoever that person might be. And the persons that are walking down the red carpet, let's just say we're watching the Grammys or the Oscars or whatever it might be. You can name your red carpet event of choice. We never, ever, ever compliment those persons that carry excess weight.

Fatima Stanford: 20:53 And so you didn't say anything negative. But what your child noticed is that you also didn't say anything positive. And so the fact that you did not have anything positive to say shows your bias, whether you notice it or not. And so what your child picks up on is, "Oh, daddy and mommy ..." or whomever are their caregivers, " ... they never say anything positive about those people. So they must not be of the same value or worth as those persons that I compliment." As we're just watching the show. So those are some things that seem very simple and very basic, but those things people pick up on them. And what we find in terms of looking at weight bias, with study after study is that the average age when children began to demonstrate weight bias is 32 months of age. I want you to process that 32 months of age children are significantly aware that someone that has excess weight is quote, unquote not as good as someone that's leaner.

Fatima Stanford: 21:49 So that's something that we - I mean, they're not picking up in schools yet, right? They're not kindergartners yet. Some of them are not even in daycare at that point. They're picking it up from their parents that have either implicit or explicit or both types of weight bias that they're perpetuating to their children, which then of course become adults like you and I.

Speaker 4: 22:10 And when you go around the country and talk to practitioners, and we have folks that listen to this podcast that are medical providers. We have dentists that listen. What are some of the top two or three tips that you have that you encourage them to begin adopting, to be more self-aware and to interact in a healthier way with patients who are suffering from obesity?

Fatima Stanford: 22:34 So, first of all, I say listen to your patients. Your patients are giving you the answer, but we're not willing to listen to them. So if they're telling you, "Look, doc, when I went on this medication after my breast cancer treatment, I notice I gained 40 pounds." Don't dismiss what they're saying. They know. They live with their body all of the time. So listen to what they're saying, hone in on what's caused their issues. Maybe they started struggling as a teenager. What is behind this? Let's take a listen. And I think that's number one. We need to listen to the patients.

Fatima Stanford: 23:07 Number two, we need to use the appropriate language when talking to patients that have obesity, we often use quite inflammatory language in our notes, or in our discussions about patients that have obesity. What you have heard me saying throughout this interview is people have this disease of obesity, they are not obese. Obese is a label. It's a term that's stigmatizing and it usually causes people to feel uncomfortable. But if you say, "Hey, I noticed you have moderate obesity, and I want to help you treat your moderate obesity. Imagine how that shift in language can lead to a different conversation, and I would say often much better outcomes for those patients.

Fatima Stanford: 23:48 The term morbid, which we throw around like it's God's gift to looking at and talking about persons that really have severe obesity, that's stigmatizing too. Let's just get rid of it. Let's talk about these patients having severe obesity and we can use, I would say tools that are more aggressive to treat the severity of obesity that these patients struggle with. I think that's one way of thinking about it. And so those are things I think about when we're talking to physicians, dentists, other healthcare providers. These are things that we really need to do to optimize our care of this patient population, which is really sizable here in the U.S and around the world.

Speaker 4: 24:25 I know you commented in one of the articles I was reading and preparing for our conversation today, just about the importance of exercise for everyone. And I'm wondering what advice do you have for fellow physicians who are struggling to encourage patients to exercise when it's more difficult to do so?

Fatima Stanford: 24:46 So I think it's important to find exercises that fit the body habitus. Right? So for patients that have, let's say, severe obesity. You want to use a lot more non weight bearing activity, or things that are going to be not as stringent on the joints. So these top three things, if you just want to look at the top three things that you would use, would be swimming. Number one, swimming or exercise that's in the water. If patients have access to a pool, like a YMCA, or things of that sort, that's great.

Fatima Stanford: 25:13 Number two, it would be the use of recumbent bicycle. So this is not Soul Cycle. This is not coming out of the saddle and doing any of these kinds of funky things that we do at spin class. A recumbent bike does not put pressure on the joints. It also does not allow the lead to flex beyond 90 degrees. So that's an excellent exercise. And it's something that, if you're buying a recumbent bicycle, they're priced very moderately. Yeah, moderately price it a Walmart. So usually on the order of about $150 so something that's not going to break the bank like these, you know, big Cybex machines and things of that sort.

Fatima Stanford: 25:46 And then the third thing is the elliptical. A lot of people don't use the elliptical correctly. So, if you're walking through your local gym, you see people struggling on the elliptical, but if you're using it correctly, you're really not putting any excess wait on the joint. So these are three different exercises that I highly encourage for my patients that may struggle, and that way they're typically safe. I would say the least safe probably out of that, maybe the elliptical, because I see people pick up their feet and do all kinds of funky things, when they're on the elliptical machine. And so I would just say that.

Fatima Stanford: 26:13 I also would tell healthcare providers to use the right messaging when we're talking about obesity. On January 1 everyone joins the gym, right? So people join the gym, they joined the gym to do what, Shane? Why do they-

Shane Tenny: 26:26 To lose weight. Yeah they want to lose weight. Get in shape. Yeah.

Fatima Stanford: 26:28 Yeah. And then February 1st, when no one's lost any weight, they leave the gym, because the messaging is wrong. When we're looking at the role that physical activity plays in weight regulation, on average, it causes weight stability. So even if you have excess weight, when you exercise you may not gain that five pounds you've gained every year for the last 10 years. You may maintain it, but you remember that brain knows that, "Hey, I'm, I'm comfortable being 275 pounds, but we don't want to be 280 pounds and then 285 right; the weight that we consistently gain often from year to year as adults.

Fatima Stanford: 27:08 So that's the message we should be selling. That's the message that fitness providers should be selling. And I'm not saying that people cannot lose weight with exercise. On average, if we look at people that are consistent with their exercise, what we do know is that, on average it leads to weight stability. So for those, I work out six days a week for the last 25 to 30 plus years, and there hasn't been significant shifts in my weight. I'm pretty much the same. Which is good, it means I didn't gain a lot of weight, but it doesn't mean that I didn't lose anything.

Fatima Stanford: 27:41 So do I just stop going to the gym all of a sudden? No, that's not what we want people to do. We know that physical activity is the number one antidepressant, right? It's the antidepressant that most of us aren't using. It improves our mood and improves our blood pressure, it improves all of these things. And so we really need to be cognizant of that, and sell that message.

Speaker 4: 28:03 As we wrap up, I want to ask you at least one final question here around some of the policy work. Because I know that's where you are spending more of your energy around public policy issues and things like that. What's the low hanging fruit here? What are the sort of things that you see and are working on to improve public policy around obesity?

Fatima Stanford: 28:21 So, one of the big acts that we've been trying to get through Congress is called TROA, or the Treat and Reduce Obesity Act. And it does have bipartisan support both in The House and the Senate. But one of the things that we've been having an issue with is really just getting this passed, and we may all have different opinions about what's going on in Washington right now. But I can tell you that the agenda is not on looking at obesity, regardless of what think about the current occupant of the White House, or whatever. We know that that's not on the agenda right now.

Fatima Stanford: 28:53 So what we're seeing is, is that if the agenda is more on foreign policy and issues of that sort, we're not thinking about how to treat the chronic disease that's causing the most healthcare costs. You know, so obesity is the most expensive of all the diseases, and so we're just not working on it. So I would say that that's one of our major struggles that the Treat and Reduce Obesity Act, if you're wondering what it does, it specifically works to cover, for example, work with dietitians. Right now, if you want to see a dietitian, you're often paying at least 40 or $50 out of pocket per session, unless you have a diagnosis of Type Two diabetes. Once you get Type Two diabetes, now your dietitian visit is covered.

Fatima Stanford: 29:35 So that's a bit backwards, right? So we wait for you to get diabetes to cover your dietitian visits. So the Treat and Reduce Obesity Act is saying, "Hey look, we know that dietitians are great in terms of giving knowledge about appropriate diet choices, high quality foods, lean proteins, whole grains, fruits, vegetables, etc. But we think they should be covered before they get type two diabetes, just saying." And so that's part of the act. The other part of the act is using pharmacotherapy, meaning medications to treat obesity and we think that these should be adequately covered by healthcare insurers. If it's covered, then you might be more likely to afford it.

Fatima Stanford: 30:09 Some of the drugs that are used to treat obesity are in excess of $500 to $600 a month without insurance. That's cost-prohibitive for even our very affluent patients. So what are we going to treat? Only the top 1% of the 1% of persons that have have obesity? That doesn't make sense when we have such a large percentage of the population that struggles. So those are really the two tenants of that particular legislation that we're trying to get through Congress and have tried for several years now. I think that we're going to continue to fight the good fight and try to rally up additional support, bipartisan support.

Fatima Stanford: 30:43 What we do know is that, what we can probably agree on is that obesity does not disproportionately affect Democrats more than Republicans, or anything of that sort. It does not have a predilection in that way across political lines. And so, what, we do know is that everyone is concerned and they may not recognize that, "Hey, we do have to evidence-based treatments that are available." What we do know is that here in the U.S., only 1% of patients that meet criteria for bariatric surgery get surgery, and only 1% of persons that meet criteria for the use of medications for weight loss get medications.

Fatima Stanford: 31:17 Which means that 99% of patients that meet both of those criteria, which are of course different criteria, don't get the treatment. And that means nobody's getting treated. Right? That's dismal. It's deplorable and we would lose our medical license if we did that for any of their disease process.

Shane Tenny: 31:33 Well, let's hope that TROA can find it's way through even though it sounds to be laced with too much common sense. Dr. Stanford, as we wrap up, I just want to ask you one final question. Is there a story that stands out in your mind that has struck you over the years?

Fatima Stanford: 31:47 Absolutely. So I was at a conference, an obesity conference about four years ago and a colleague of mine approached me and she was trying to speak to me. For persons that may know me, I'm a talker, so it was really hard to kind of corner me at any conference or even by yourself. So she really struggled with this and worked really hard to really get me alone. Just to give you a little bit of context about this particular colleague. This is a colleague that I had known since about the age of five. I'm now in my forties so to give you a little bit of context of the length of time that we've known each other, it has been quite some time.

Fatima Stanford: 32:23 So she came up to me, we actually used to take dance lessons together at Spelman College in Atlanta. And so she came up to me and she said, "You know, I don't know if you've noticed this, but over the last three plus years of our life, I've always been pretty standoffish towards you." I didn't recognize that that was the case. I just thought that was her personality since I've known her for over 30 years. But I'm recognizing that maybe she is standoffish to me, so I'm evaluating that as she's telling me the story.

Fatima Stanford: 32:51 And she said, "Well, there's a reason why I'm like that towards you. So, when we were about by five or six years old in dance class, you came up to me in class and said to me that I was fat, and then you walked off. And that has damaged me for my entire life. And then I saw that you were doing this work in obesity medicine and I thought to myself ..." She tells me, "That if you are capable of change ... " me, meaning Fatima, "... then anyone is capable of change." So that came as a big blow to me that first of all, at the age of five or six I had the audacity to go up to my friend, or dancing colleague and say to her that she was fat. It also shows that obviously I was learning this from somewhere. So I guess I should blame one or both of my parents, I won't pick which one to blame, but it also shows that anyone that may have these biases, even if they're prevalent very early in life, is capable of changing their thoughts surrounding persons that struggle with excess weight.

Fatima Stanford: 33:56 We now are very close colleagues and we work together on several projects, but she had held that information in for almost 35 years, and I never knew the harm that I had caused her. I thought of myself as the good, morally strong kid. But here I was causing harm to a fellow colleague, and it shows you that even at a very early age, we can began to cause harm to persons. And so this is a story that stood out in my life. It's a story that showed me that even as this obesity expert at Harvard, that I indeed, unfortunately caused harm to individuals. And you know, obviously I apologized, but will never quite feel right about what I said to her. And I wonder what else I said to anyone else during that time span.

Shane Tenny: 34:45 Dr. Stanford, thank you so much for being with us today. I want to give a shout out again to your book, which is on Amazon. For those of you listening that realize the education should continue for you. It's Facing Overweight and Obesity, A Complete Guide for Children and Adults. And I really appreciate you coming with us today and just personally giving me an education and a glimpse into your book and medical specialty, and a greater compassion for those struggling with obesity. Thanks.

Fatima Stanford: 35:12 Well thanks, So I think that patients love hearing that there's a champion for them. I was a cheerleader back in high school, back in the early nineties and I'm still cheering for them now.

Shane Tenny: 35:23 Absolutely. Well, keep up the good work.

Fatima Stanford: 35:25 Yes. Thank you.

Will Koster: 35:30 I'm Will Koster, and on this episode of White Coat Achievement, we're dedicating our time to recognize a LinkedIn Top Voice Award winner for the category of healthcare. Dr. Lewis Profeta is an emergency medicine physician in Indianapolis, Indiana. He's made a name for himself through publishing powerful content on LinkedIn covering a variety of topics in healthcare. He's an award winning writer and has traveled the country to speak at college campuses.

Will Koster: 35:56 His speaking tour was the result of writing three articles in 2017 what are some of the most read and shared articles ever on LinkedIn. He exposed the disastrous consequences of the opioid epidemic, drug and alcohol abuse and sexual assaults on college campuses. Dr. Profeta is known for speaking honestly and openly about his experiences in the ER. Some of his most powerful talks have been aimed at the Greek communities on college campuses. We applaud Dr. Profeta and the impact he's had and will continue to have making a difference on these national systemic issues that are often hard to talk about.

Will Koster: 36:32 As always, if you know someone who wears a white coat and is achieving something noteworthy, feel free to drop us a line. We'd love to hear about it, might even feature them on a future episode, but again, this episode's White Coat Achievement goes to Dr. Lewis Profeta.

Shane Tenny: 36:49 Thanks so much for joining us today. We've got a lot more great episodes queued up to come out in the coming weeks, so please don't forget to subscribe. We definitely appreciate those who subscribe and help us work up the Google search chain. We also love any reviews on iTunes or Google play. We've also got a private group called White Coat Wisdom on Facebook. Love to have you join that, or you can find us on Instagram. If you have any questions, ideas, or suggestions for future guests that you'd like to hear on White Coat Wisdom, by all means, email me directly, Shane@whitecoatwell.com.

Shane Tenny: 37:22 Thanks so much for joining us today. We'll see you back here next time.

Outro: 37:26 This episode of White Coat Wellness is over, but you're not alone on your journey towards financial wellness. Spaugh Dameron Tenny has been helping physicians and dentists with their financial planning for over 60 years, and we'd love to answer any questions that would be of help to you. Visit sdtplanning.com today and take your financial wellness to new levels. Once again, that's sdtplanning.com and we'll see you on the next episode of White Coat Wellness.