>>> NOW WE TURN TO A DRUG THAT OUR NEXT GUEST SAYS COULD CHANGE THE CONVERSATION ABOUT STIGMATIZING MEDICAL CONDITION.
NEARLY THAT'S NOT ADULTS LIVE BETWEEN OVERWEIGHT AND OBESE.
WITH THE HELP OF LEG THROUGH WEIGHT LOSS DRUGS DR. IS SEEING SOME PATIENTS LOSE AS MUCH IS 15 TO 16% IN WEIGHT AND SHE JOINS US TO DISCUSS THE RECENT BUZZ AROUND THESE MEDICINES.
>> THANK YOU FOR JOINING US.
YOU ARE AN OBESITY MEDICINE PHYSICIAN AT MASS GENERAL AND I WANT TO KNOW RIGHT NOW IF I OPEN THE NEWSPAPER, IF I OPEN MY PHONE I SEE HEADLINES ABOUT A NEW CLASS OF MEDICATIONS WITH NAMES LIKE WEGOVY AND OZEMPIK.
FIRST OF ALL, EXPLAIN WHAT THESE MEDICINES DO.
>> 'S PARTICULAR CLASSES OF ANTI-CITY --ARE CALLED --IN ADVANCE FOR GLUCAGON LIKE PEPTIDE 1 RECEPTIVE AGONIST.
LET'S TALK ABOUT HOW THESE MEDICATIONS WORK IN YOUR BODY.
THEY ACTUALLY WORK PRIMARILY IN THE BRAIN BUT CAUSING TWO YOU WANT THEM TO.
THERE IS A PATHWAY OF OUR GAME CALLED A PALM C PATHWAY WHICH TELLS US TO EAT LESS AND STORE LESS AND THESE MEDICATIONS WORK BY REALLY AUGMENTING THAT PATHWAY STIMULANT THAT PATHWAY TO BEING MORE ACTIVE BUT IT ALSO WORKS DOWN REGULATING OR INHIBITING THE PATHWAY CALLED THE AG RP PATHWAY AND THAT PATHWAY TELLS US TO EAT MORE AND STORE MORE YOU CAN IMAGINE THAT SENSES WORKING DIRECTLY IN THE RAIN WE SEE POTENT DEGREES OF WEIGHT LOSS FROM 15 TO 20% ON AVERAGE FOR THE AGENTS THAT YOU MENTIONED.
THEY WORK A FEW OTHER WAYS.
THEY ACTUALLY SLOW MOVEMENT FOR YOUR G.I.
TRACT.
YOU GO AND EAT THEM THING AND IT MOVES SLOWLY YOU CAN IMAGINE IF YOU ACCESS AND THINGS MOVE SLOWLY BY THE TIME LUNCH HAPPENS YOU ARE PROBABLY STILL FULL WARES YOU WOULD NORMALLY BE HUNGRY SO THAT'S ANOTHER WAY IT WORKS AND IT ACTUALLY IMPROVES HOW YOUR BODY SECRETES A HORMONE CALLED INSULIN AND THEN FINALLY AND THIS IS WHERE PEOPLE DON'T KNOW, IT ACTUALLY --.
THE MORE BROWN OUR FAT TISSUE IS THE MORE ACTIVE IT IS WHICH MEANS THAT EVEN WHEN WE ARE ADDING HERE LIKE WE ARE DOING WE ARE BURNING MORE AT REST THEN WE WOULD BE NORMALLY SO IT WORKS IN A LOT OF DIFFERENT WAYS IN THE BODY AND THIS IS WHY I INC.
IT HAS GOTTEN AS MUCH ATTENTION AS IT HAS GOTTEN.
>> WE SHOULD MENTION THAT YOU DO CONSULT FOR A NUMBER OF PHARMACEUTICAL COMPANIES INCLUDING PEOPLE WHO MANUFACTURE OZEPMIC AND YOU SAY THIS IS A GAME CHANGER FOR HOW WE INC. OF OBESITY AND WHY IS THAT?
>> I DON'T NECESSARILY THINK OF THIS AS A GAME CHANGER I THINK THESE MEDICATIONS HAVE GOTTEN ATTENTION THAT THEY ARE CHANGING WHAT WE THINK ABOUT THIS DISEASE.
IT WAS IN 2013 WHEN THE AMERICAN MEDICAL ASSOCIATION ACKNOWLEDGED OBESITY AS A DISEASE BUT THAT CAME AND WENT.
REALLY TAKING MEDICATION AND BENEFITING FROM THESE MEDICATIONS.
YOU --THEY REALIZE THEIR WEIGHT NOT ON THEIR PART.
I THINK THAT'S WHERE WE TALK ABOUT THIS CHANGE IN THE CONVERSATION SURROUNDING OBESITY AND WHAT WE SEE TODAY HERE IN THE U.S. AND AROUND THE WORLD.
>> TELL ME ABOUT THE SIDE EFFECTS CLASS OF DRUGS HAS.
IF WHAT I HAVE YET A DRUG THAT IS HAVE A SIDE EFFECT.
>> 100% TRUE IN TERMS OF LOOKING AT THIS.
THE NUMBER ONE BY THE FACT FROM G POWELL GPL 1 --IS NAUSEA.
PARTICULARLY AS YOU ARE TITRATING THE DOSE THE TREATMENT OF OBESITY GOES TO A DOSE OF 2.4 MILLIGRAMS AND AS THAT PATIENT IS TITRATING FROM 0.25, 1.7 AND THEN FINALLY TO.4 MILLIGRAMS THAT TITRATION MAY MAKE THEM FEEL NAUSEATED.
UP TO 44% OF INDIVIDUALS CAN EXPERIENCE THAT.
WHAT I HAVE FOUND IS THAT YOU NEED TO STATE A DOSE LONGER TO MEDICATE THAT SIDE EFFECT THAT WILL BE IMPORTANT.
BEHIND NAUSEA THE SECOND SIDE EFFECT IS, THE PATIENT AND IF YOU GO BACK TO THESE MEDICINES, THINGS CAN STOP AND SO SOMETIMES WE HAVE TO CHANGE A PERSON'S BOWEL REGIMEN TO MAKE SURE WE DON'T HAVE CONSTIPATION WHICH CAN BE VERY COMMON.
THOSE ARE THE TWO MOST COMMON SIDE EFFECTS THAT WE SEE IN THE POPULATION.
THERE ARE OTHER RARE SIDE EFFECTS BUT THOSE OF THE MOST COMMON.
>> IS THIS A FOREVER MEDICINE?
ONE OF THE THINGS THAT PEOPLE HAVE BEEN REPORTING IS THAT IF THEY GET OFF OF THIS DRUG THAT THE WEIGHT THAT THEY WORKED HARD TO LOSE IS GOING TO COME BACK.
>> THAT'S AN EXCELLENT QUESTION BECAUSE I WANT TO MAKE SURE WE UNDERSTAND THIS.
I WANT US TO THINK ABOUT THIS AND I WILL DIVERT OUR ATTENTION.
DON'T EXPECT TO EAT ONE HEALTHY MEAL SIMILARLY WE DON'T EXPECT THOSE EXERCISES WE WERE DOING BACK IN THE LATE 90s TO LAST US UNTIL TODAY.
SIMILARLY WHEN WE ARE LOOKING AT THESE MEDICATIONS THEY ONLY WORK WHEN WE ARE USING THEM.
--WAS GREAT BACK IN THE DAY BUT IF YOU DON'T DO TODAY IS NOT GIVING YOU IMPACT.
THEN YOU WITHDRAW THE MEDICATIONS AND THAT STUDIES REALLY DEMONSTRATED THIS, WHEN YOU PULL THAT BACK WHAT WE START TO SEE IS WE GET BACK TO WHERE THE PATIENT WAS PRIOR TO ADDING THAT IN.
WHY?
WE ARE NO LONGER ACTING ON THOSE PATHWAYS OF THE BRAIN.
IT CAN'T WORK IF IT'S NOT BEING UTILIZED SO IF YOU ARE A RESPONDER, IF YOU DO NEED THESE MEDICATIONS AND THEY DO MORE FOR YOU THIS IS A CHRONIC USE MEDICATION FOR THE QUANTIC OBESITY.
>> ONE OF THE CRITERIA THAT YOU ARE CHECKING OFF IN YOUR MENTAL CHECKLIST THAT SAYS THIS MIGHT BE A CANDIDATE, BUT WE WOULD BENEFIT FROM THIS VERSUS ANOTHER CANDIDATE WHO MIGHT JUST HAVE TO HEAR THAT HARD NEWS THAT DIET AND EXIT TIES WILL BE THE BEST THING.
>> I TYPICALLY FOLLOW THE GUIDELINES AND THERE ARE SEVERAL SETS OF GUIDELINES BUT THEY ALL ALIGN WITH EACH OTHER SO THEY SAID THAT WE SHOULD CONSIDER MEDICATIONS FOR PATIENTS WITH A BODY MASS INDEX OF 27+ AN OBESITY RELATED DISEASES.
AND THESE ARE DISEASES LIKE HIGH BLOOD PRESSURE, TYPE TWO DIABETES, OBSTRUCTIVE SLEEP APNEA.
IF A PATIENT HAS A GREATER BMI THAN 30 WE COULD UTILIZE MEDICATIONS IN THAT GROUP ALSO.
SO THOSE ARE THE KEY CRITERIA THAT WE ARE OFTEN UTILIZING NOW.
I AM NOT A HUGE FAN OF EMI AND SO I THINK ON AN INDIVIDUAL CLINICIAN BASIS IT'S ALSO IMPORTANT TO LOOK AT THE FULL WHAT TYPE OF OBESITY DO THEY HAVE?
DO THEY HAVE OBESITY -RELATED DISEASE?
MAKING SURE LIKE YOU SAID TO USE THESE IN PATIENTS THAT NEED THEM AND NOT JUST PEOPLE THAT WANT THESE MEDICATIONS.
>> WHAT IF THERE ARE PEOPLE WATCHING RIGHT NOW WHO MAY NOT QUALIFY UNDER CATEGORY OF OBESE BUT THE DOG YOURS ARE PROBABLY CONCERNED ABOUT THEM HEADING INTO A PREDIABETIC MODE, MAYBE THEY HAVE 15 OR 20 POUNDS TO LOSE.
IS THERE A WORLD WHERE THESE DRUGS ARE INTRODUCED FOR A SHORT TIME TO TRY TO GET SOMEBODY JUMPSTART AND GET THEM INTO A SAFER ZONE WHERE THEY CAN GET OFF IT?
OR THIS IS JUST NOT FOR THAT KIND OF PERSON?
>> I DON'T SEE THESE AS MEDICATIONS AS A JUMPSTART BECAUSE THAT PUTS US INTO THIS IDEA OF WEIGHT CYCLING.
WE HAVE SOMETHING THAT BRINGS US DOWN AND WHEN WE WEIGHT CYCLE WE CAN LOSE AND THEN WE TYPICALLY REGAIN AS SOON AS WE WITHDRAW SO I LOOK AT THESE AS APPROPRIATE SCHOOLS FOR PEOPLE THAT DO MEET THESE LONG TERM.
JUST TREATING CHRONIC I WOULD SOMEONE ON A HIGH PRESSURE MEDICINE THAT CAME IN WITH ONE BAD READING AND THEN THEY DIDN'T HAVE EVIDENCE OF SUSTAINED ELEVATION IN THEIR BLOOD PRESSURE AND THAT HOW I THINK SHOULD BE THINKING ABOUT OUR MEDICATIONS.
>> ONE OF THE THINGS THAT WE HAVE SEEN WITH THIS CATEGORY OF MEDICINE IS THAT IT'S --AND YOU SEE A LOT OF PEOPLE WHO ESPECIALLY IN HOLLYWOOD WHO ALMOST BRAD ABOUT THE FACT THAT THIS IS HOW I LOST MY WEIGHT AND THIS IS WHAT WORKS FOR ME.
AND SOME PEOPLE SAY IT'S KIND OF THIS HUSH-HUSH THING WHERE THEY ARE KIND OF PASSING AROUND AND WHAT HAS THAT DONE TO PEOPLE WHO ACTUALLY NEED THE DRUGS?
>> I THINK THAT'S A LITTLE BIT DISGUSTING.
I DON'T LIKE TO USE THAT WORD BUT LET'S TALK ABOUT WHY I SEE IT AS DISGUSTING.
THERE HAS BEEN A MAJOR SHORTAGE OF THESE MEDICATIONS.
THIS LASTED THROUGHOUT THE COURSE OF 2022 AND WAS A MAJOR SORE SPOT FOR ME AND MY PATIENTS.
I ONLY TREAT PATIENTS WITH OBESITY AND SO WERE PATIENTS THAT I SEE THESE ARE PATIENTS THAT DO NEED THESE MEDICATIONS BUT FORCE SIX, SEVEN, EIGHT MONTHS OF 2022 MY PATIENTS COULDN'T GET THESE MEDICATIONS SO WHEN THESE PATIENTS THAT NEED IT THAT CAN BENEFIT FROM THE METABOLIC AND IF IT'S FROM THESE DRUGS CAN GET THE MEDICINES AND THEY ARE BEING UTILIZED FOR PEOPLE THAT DON'T NEED THEM, THAT CREATES A DYNAMIC OF THE PEOPLE THAT NEED THESE FOR LONGEVITY OF LIFE, REDUCTION OF HEART ATTACK AND STROKE ARE NOT GETTING THEM AND PEOPLE THAT ARE JUST TRYING TO LOOK CUTE IN A BIKINI OR WHATEVER THEIR NEXT EVENT ON THE RED CARPET TO LOOK GREAT.
I TELL MY PATIENTS THAT I'M CARING ABOUT THEIR HEALTH AND GETTING THEM TO THE HEALTHIEST WEIGHT POSSIBLE.
I DON'T CARE ABOUT THE NEXT WEDDING OR REUNION THEY HAVE.
I WANT TO ALIGN WITH THEIR HEALTH GOALS AND NOT THEIR AESTHETIC GOALS AND I THINK THAT'S EXTREMELY IMPORTANT.
>> THERE'S ALSO SIGNIFICANT COST.
THESE ARE NOT CHEAP DRUGS IF YOU'RE NOT BEING PRESCRIBED THEM WHICH FOR ME IS IN ACCESS AND EQUITY ISSUE AS WELL.
>> ABSOLUTELY I'M ALWAYS THINKING ABOUT EQUITY AND THE ROLE IT PLAYS IN ACCESS TO THERAPY IN PARTICULAR FOR CHRONIC DISEASES LIKE OBESITY AND THIS HAS CREATED THIS DIMORPHISM IN SUCH THAT HAVE WEALTH AND TREMENDOUS ACCESS ARE ABLE TO ACCESS THEM AND THAT REALLY CREATES SIGNIFICANT --FOR ME AS SOMEONE WHO CARES FOR A SIZABLE PORTION OF THE POPULATION.
IT MEANS MEDICATIONS WOULD NOT BE COVERED.
I HAPPEN TO RESIDE IN THE COMMONWEALTH OF MASSACHUSETTS WHERE OUR PRIVATE INSURERS, ET CETERA ARE COVERING THESE MEDICATIONS FOR PATIENTS THAT HAVE THESE HIGH TIER PLANS.
PEOPLE THAT FALL INTO THE GROUP OF MYSELF.
WHAT ABOUT THOSE PEOPLE THAT DON'T HAVE THOSE PLANS?
WHERE THEY CAN'T GET THESE MEDICATIONS FOR $30 A MONTH WHICH IS VERY ASSESSABLE?
IT CREATES A SITUATION WHERE I CAN EVEN PRESCRIBE THESE MEDICATIONS TO THOSE INDIVIDUALS THAT ARE MOST EATING THESE MEDICATIONS.
I REALLY WOULD LIKE TO SEE A SHIFT IN US THINKING ABOUT THIS FROM A --APPROACH.
IF WE GIVE FULL ACCESS THEN WE CAN DRIVE DOWN COSTS.
IT'S PURE ECONOMICS.
THAT'S WHAT I WOULD LIKE TO SEE EVENTUALLY BECAUSE WE ARE TALKING ABOUT OVER 110 MILLION ADULT AND 20 MILLION CHILDREN THAT COULD POTENTIALLY BENEFIT AND RIGHT NOW THERE IS LESS THAN 2 MILLION POTENTIALLY BEING ABLE TO ACCESS ANY AGENT INCLUDING THE CLASS OF STATES.
>> I ALSO WANT TO TALK ABOUT THE CULTURAL COSTS BECAUSE IT SEEMS LIKE ALL THE PREVIOUS CONVERSATIONS WE HAVE ALWAYS HAD ABOUT WEIGHTS HAS BEEN WITH A LITTLE BIT OF A BIAS AND WE HAVE ALL KIND OF BEEN TOLD IT'S DIET AND EXERCISE THAT WILL DO IT AND IF YOU DON'T EXERCISE ENOUGH OR EAT RIGHT YOU WILL END UP OBESE.
IF YOU ARE OBESE THEN THAT MEANS YOU MUST NOT BE EXERCISING AND THAT YOU MUST NOT BE EATING RIGHT, BUT I KNOW PEOPLE IN MY OWN LIFE WHO DID EVERYTHING BY THE BOOK AND CANNOT CHANGE THE WAY THEIR BODY SHAPES.
>> I'M GOING TO DELETE THE WORD OBESITY BECAUSE IT CAN PROMOTE STIGMA BUT YOU ARE RIGHT, THE MOST COMMON FORM OF THE GLAND THAT IS STILL ACCEPTABLE IS WEIGHT BIAS.
WE ARE TRYING TO TREAT PEOPLE THAT HAVE EXCESS WHEAT OR OBESITY IN WAYS THAT ARE NOT DEMEANING OR DEVALUING AND NOT NOT RECOGNIZING THAT THEY ARE PUTTING FORTH THE SWEAT EQUITY AND THEY ARE JUST NOT YIELDING RESULTS AND I REALLY WANT THIS AS A RESIDENT, MY OWN BIASES AS A PHYSICIAN AND ONE WHO HAS ALWAYS KNOCKED STRUGGLED WITH MY WEIGHT AND HAS BEEN AN ATHLETE, I HAD A PATIENT THAT WAS IN HER MID-40s WHO HAD SEVERE OBESITY AND HAD STRUGGLED WITH SEVERE OBESITY HER ENTIRE LIFE.
I WAS AN INTERNAL MEDICINE AND PEDIATRIC RESIDENT OF CAROLINA AND WHAT I WOULD DO IS EVERY SINGLE VISIT SHE WOULD COME IN AND SEE ME AND WE WOULD GIVE HER THIS OR THAT DIET RECOMMENDATION, ALL OF THESE THINGS AND OVER THE COURSE OF THREE YEARS I DIDN'T SEE HER WEIGHT SHIFT.
SHE WOULD SHIFT MAY BE BOUND TO POUNDS OR ONE POUND REALLY MAINTAINING HER --.
ONE DAY I WAS LEAVING MY WORKOUT AND I RAN TO THE STORE AND I SAW THIS PATIENT AND AS SHE WAS ABOUT TO CHECK OUT AT THE GROCERY STORE LINE I WAS TALKING TO HER AND I WAS TRYING TO GLANCE AT HER AND TRYING TO BE INCONSPICUOUS AND NOT DOING A GOOD JOB BECAUSE SHE SAYS THE FOLLOWING TO ME.
SHE SAYS, SEE DR. STANFORD, I DID EVERYTHING YOU TOLD ME TO DO AND WHEN YOU LOOKED AT HER CART IT WAS PRISTINE.
PERFECT.
EVERYTHING WE HAD EVER TALKED ABOUT FOR THREE YEARS IN HER GROCERY CART AS SHE'S ABOUT TO CHECK OUT AT THE GROCERY STORE AND IT WAS AT THAT POINT THAT I REALIZED THAT THIS IS NOT JUST ABOUT DIET AND EXERCISE.
NOW SOMEONE WHO NO LONGER WORKS AND HAS NOT WORKED IN SOUTH CAROLINA FOR OVER 12 YEARS I HAVE BEEN IN BOSTON AND I HAVE NO IDEA WHERE SHE IS AND WHAT HER HEALTH IS BUT I CAN TELL YOU WHAT I TOLD HER.
I DIDN'T KNOW THAT I WAS JUST GIVING HER MORE AND MORE RECOMMENDATIONS.
I WASN'T CHANGING HER BIOLOGY.
AND SO IT SIGNIFICANT PAIN TO KNOW THAT I WASN'T ABLE TO HAVE A MAJOR POSITIVE INFLUENCE AND IN MANY WAYS WAS REFLECTING MY OWN STIGMA AND BIAS AGAINST UNTIL THAT KEY MOMENT IN THE GROCERY STORE SO I THINK THAT WAS WHERE IT WAS A MOMENT AND INFLECTION POINT IN MY LIFE AND MY TRAINING IT'S WHAT BROUGHT ME HERE TO BOSTON AND TO HARVARD TO DEAL WITH OBESITY MEDICINE FELLOWSHIP AND LEARN HOW I COULD BE BETTER FOR PATIENTS AND THAT'S REALLY CHANGED EVERYTHING IN THE WORLD FOR ME AND MY PATIENTS.
>> WE ALSO SEE --OF THE ACADEMY OF PEDIATRICS AND I WONDER WHAT YOU THINK ABOUT GIVING CHILDREN OVER 12 ACCESS TO THESE MEDICATIONS?
>> I THINK A LOT OF PEOPLE HAVE FEAR AND A LOT OF THE BACK LASH THAT I HAVE HEARD IN THE MEDIA PARTICULARLY IN SOCIAL MEDIA ABOUT THE NEW GUIDELINES THAT WERE RELEASED BY THE AP REGARDING THE USE OF MEDICATIONS AND SURGERIES LIKE WE ARE SETTING PEOPLE UP FOR EATING DISORDERS AND WE WILL HAVE PEOPLE HYPERFOCUS ON THE WEIGHT, BUT I HAVE A 12-YEAR- OLD PATIENT THAT IS BEING TREATED WITH PHARMACOTHERAPY FOR OBESITY AND I HAPPEN TO TAKE CARE OF BOTH HER FATHER AND HER MOTHER.
RECENTLY FOR SOME REASON THEY ASKED HER WHAT SHE DIGS ABOUT HER WEIGHT DOCTOR.
I DON'T CALL MYSELF THAT WHAT SHE SAYS I DON'T SEE A WEIGHT DOCTOR.
SHE SAID IS THAT WHAT SHE DOES?
AND SO YOU WONDER HOW AM I ABLE TO TALK AND DEAL WITH A PATIENT FROM THE AGES FROM 10 TO 12 SEEING HER AT LEAST SEVEN OR EIGHT TIMES OVER THAT TIME AND FOR HER TO NOT KNOW WHAT I'M DOING BECAUSE MY FOCUS IS HER OVERALL HEALTH.
I WANT THIS TO BE DONE IN A WAY THAT'S RESPECTFUL AND DOESN'T SET SOMEONE UP FOR DISORDERED EATING AND SOMETHING THAT WHEN SHE LOOKS BACK SHE HAS NO IDEA WHAT I DO FOR A LIVING UNTIL RECENTLY WHEN HER PARENTS TOLD HER, BUT SHE WILL NOT FEEL AS THOUGH THIS IS A PUNITIVE SITUATION.
SHE'S BEEN ABLE TO LIVE LIFE IN A MUCH FULLER FASHION AFTER BEING TREATED FOR OBESITY.
SIMILARLY MY PATIENTS THAT UNDERWENT SURGERY MUST SEVERAL OF MY PATIENTS UNDERWENT BARIATRIC SURGERY IN THEIR TEENS, 14 OR 15 AND THEY ARE NOW IN THEIR MID-30s AND THE BECAUSE WE KNOW THAT WEIGHT STIGMA SETS UP FOR DISCRIMINATION IN THE WORKPLACE, DISCRIMINATION WITH HIRING, DISCRIMINATION WITH HIGHER EDUCATION AND ET CETERA.
WHEN THOSE OPPORTUNITIES ARE DIFFERENT AFTER THEY HAVE BEEN TREATED AND TREATED WITH DIGNITY AND KINDNESS IN THE RESPECT.
>> DR. FATIMA CARLY STANFORD AT MASSACHUSETTS GENERAL HOSPITAL AND A PROFESSOR AT HARVARD, THANK YOU FOR JOINING US.
