Breakthrough Women in Science & Medicine: Dr. Fatima Cody Stanford

- This struggle that I've been on is at least a 25-year battle.

I could lose the weight or some weight and never meet, reaching my goal, and then I would regain the weight I lost, plus additional weight.

The fear set in because my mom died early.

I didn't want that to be my story, and I started to realize that I was repeating the same health concerns.

It angers me that someone who is working so hard, who just wants her health for so many reasons, had to fight so hard with people who are supposed to be helping me.

- Obesity is by far the most prevalent chronic disease in human history.

1 billion people worldwide have this disease, and the numbers continue to increase.

If we're not paying attention to this, we're going to lose our children.

We're going to lose our children's children.

It doesn't have to be that way because we have treatments that are improving if we can only believe that this is a matter of more than just calories in and calories out.

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(birds chirping) (gentle music) - My name is Charleah Torres-Vega.

I'm from Boston, Massachusetts.

I feel like the journey of weight loss and weight regain, which is really huge for me.

I can remember being a child being called big boned.

And you know, you just, that's just who you are.

And I just, I gained a lot of weight with Michael, my first son, and that's when I started to realize that I need to do something.

I need to work on my health.

I was working out at home and I felt as though I was working out really hard.

I was having fun.

So, it wasn't like a chore or anything.

I thought I was being conscious about what I was eating, salads, lean meats, and there was really no weight loss.

I went to the doctors and it was as if I did nothing.

The doctors were like, "You need more.

You need to do more."

And I didn't understand what else I needed to do because I was doing all the things.

My heaviest was 236 pounds and I was shocked when I stepped on the scale.

I was angry, frustrated, depressed, confused about my weight regain, the minimal weight loss, and I would turn to food.

That was my happy place.

So, then I would say, "You know what?

It's not working.

I'm gonna give up."

- A big misconception in obesity is that this is simply calories in versus calories out.

And when you're preventing obesity, absolutely, for your overall health, we want you to be physically active.

We want you to be mindful of what you're eating with a well-balanced diet.

But once that disease process has set in and you have that abnormal storage of fat tissue for the majority of adults, diet and exercise alone isn't enough.

- Really the big thing is teaching people that obesity is a disease process, and it is still, no matter how many times you tell people, there is so much residual weight stigma and bias in the healthcare, but also in society, and even within patients, right?

Like, you don't wanna ask for care because even though you know that you're struggling with this disease process, you think, internalized deep inside you, that it is your fault and you're afraid to even take something, and that's really challenging too.

So, I mean, I think it's hard to put all that on the patient.

I think we, as a healthcare community, really have to change that.

- You know, really lost a good 20 or more percent of your body weight.

There are many people, patients, doctors, the government, insurance companies that still think that you should be able to lose weight with diet and exercise, and that people who have obesity just eat too much and don't exercise enough and eat too much ultra-processed food.

While that's true, that people who have obesity eat more than other people, it is not true that it is under their control because of all of the hormones that make you gain the weight back.

- So, let's say you get to 250 pounds.

Let's just use that as a number.

And you lose weight and you're like, "Hey, I've gotten down to 185 pounds."

The brain knows that its set point was 250 pounds.

It's going to do whatever it can to bring you back to 250 pounds.

It's going to adjust GLP-1.

It's gonna adjust ghrelin.

It's gonna adjust leptin.

It's gonna adjust all of these hormones to bring you back without you having to do much.

Obesity is a chronic disease because it lasts over a lifetime as a storage of excess adiposity.

This is when the body stores more fat mass than it needs to hold onto.

It's caused by genetics, development, environment behavior.

These people that have this disease recognize that, at any given moment, they can be on a pathway back to storing more excess adiposity.

Hence, the chronic nature of this disease.

(light upbeat music) - [Kayla] Body mass index or BMI is a calculation using a person's height and weight to screen for obesity.

However, it's not really accurate.

We know it's not that accurate.

It's easy.

It's readily accessible, but it doesn't capture muscle mass.

- [Dr.

Stanford] So, a person is considered to have obesity if their BMI or body mass index is greater than 30.

If their body mass index is greater than 35, then they have moderate obesity, and if it's greater than 40, they have severe obesity.

- [Kayla] However, very exciting, the Lancet published new guidelines that takes someone's health into more consideration.

So, now, it's divided into preclinical or clinical obesity.

So, someone who traditionally has A BMI of 30, well, they might not be clinically obese under this new guideline.

- [Dr.

Stanford] Preclinical obesity is this idea that people carry excess fat mass.

But just because you carry excess fat mass doesn't mean that it is necessarily led to any illness or disease per se.

Kind of like we think about pre-diabetes.

Now, when you develop clinical obesity, you now have negative outcomes.

- [Kayla] Some of the more common ones.

We have hypertension or high blood pressure, changes to lab values like abnormal cholesterol, abnormal triglyceride levels, fatty liver disease, which is the buildup of fat deposits in the liver, type two diabetes, heart attacks, stroke, arthritis, and joint pain, and the list goes on.

- But even sometimes with the best laid plans, persons that are predisposed will still struggle.

Genetics plays a large role in how our bodies regulate weight.

So, let's say we're born to parents that happen to have a history of obesity, that dramatically increases our likelihood of having severe obesity ourselves.

So, what do we do about it?

We determine which mechanisms and strategies do they have to utilize to address that challenge that's in front of them.

But their mountain that they have to climb might be different than being born to two very lean parents.

Could there be some also external influences?

Yes, indeed.

But before they even had a chance to get here, they were influenced by that genetic piece of the puzzle.

- [Dr.

Apovian] Obesity is considered to be caused by the interaction between our genes and the environment.

Epigenetics is a combination of epidemiology, what's going on outside of the human body, and genetics, what's going on inside the human body.

What we do know is that, let's say in 1960, about 10% of the American population had obesity, which is defined as a body mass index over 30.

And then it started to go up exponentially, starting around 1970 to where we are now.

So, that now 42% of Americans have obesity, which is a fourfold increase.

That doesn't happen from genes alone.

So, what happened, we think, is that the environment changed.

- It's hard to quantify how much external influences play a role in obesity.

I would say that every single thing that we do is important, and we do need to be paying attention to lifestyle.

We do need to be paying attention to behavior.

We do wanna optimize our diet.

So, if a patient's diagnosed with obesity, there's a variety of strategies that we may undertake.

They can use lifestyle.

They can use medication.

Maybe they need behavioral therapy work with our psychology team.

Maybe they need work with our dieticians.

They can use metabolic and bariatric surgery.

Maybe they need all or more combination thereof.

It really depends on the person.

And our goal is to tailor the treatments to the person in front of us.

- So, I think if you have the underlying disease of obesity, lifestyle alone is only gonna get you about, it's only gonna help 25% of people lose weight and keep it off.

And so, that's where you need these other pharmacotherapy and surgical interventions to help people combat the disease of obesity in their brain.

- Bariatric surgery is covered in most states, and the surgeons did a great job years ago in convincing insurance companies and the government that bariatric surgery saves lives.

Bariatric surgery changes the secretion of all of the gut hormones, so that you secrete more satiety hormone and less hunger hormone.

The two most commonly done procedures in the United States are the sleeve gastrectomy and the Roux-en-Y gastric bypass.

They both do the same thing.

They both lower your body weight set point by 25% to 33% of your total, of your initial body weight.

But the Roux-en-Y gastric bypass still causes a little bit more weight loss than the sleeve gastrectomy.

- So, there are several medications currently approved by the FDA to treat obesity.

These are the currently approved medications.

You have Phentermine, which is a stimulant style medication.

We have phentermine and topiramate in combination.

We have Bupropion and Naltrexone.

We have Orlistat.

A lot of these are seen as more of the traditional medications before we got into the current medications, which fall under the GLP-1 receptor agonists.

These include liraglutide, semaglutide,and then the dual agonist, which is tirzepatide.

It's a combination GLP-1, GIP dual agonist.

If you're talking about the GLP-1s or the dual agonists, if we're stimulating the anorexigenic, when you hear anorexigenic, people realize that it tells them to not eat.

All of us have GLP-1 in our bodies.

When I give someone a shot, they're getting a signal or a stimulus that those of us that may be lean at baseline already have.

- They make it easier for you to do the lifestyle things.

They make it easier to walk by, you know, the donuts on the table at work.

It makes it easier to go to Home Depot and not pick up a lollipop.

It makes it easier for people to exercise and to make the behavioral changes that we want them to make.

And it's because those drugs hit the parts of our brain that are driving the dysfunction.

This brain's desire to want to hold on in store calories.

- This is a really important point to talk about the language we use when we're talking about obesity.

We have eliminated the word 'obese' versus the terminology 'obesity' 'cause obese is a label.

Obesity is a disease.

A person has obesity and is not an obese person.

So, we are making sure that the patient knows that, while they have the disease, they are not the disease itself.

- [Charleah] I was successful in my online fitness group.

I was losing weight, feeling really good.

When I went to the doctor, I went just for a regular checkup, my blood pressure was so high, my doctor immediately said I needed to be put back on high blood pressure medication.

And it was something I was not expecting.

I was shocked.

I felt desperate immediately, frustrated, and asked her, "Well, what else can be done?

I don't wanna die young like my mother.

I wanna be here for my babies.

You need to really help me."

And so, she referred me to the weight loss clinic.

I met the criteria of having high blood pressure, my BMI.

Mind you, all through these things, I'm still part of this online fitness and I have lost weight.

- Charleah was, first of all, a delight when I first met her.

She came in and she's always been this ball of energy where I could see her hurting was this was a woman who you could tell was spending hours in the gym, she was planning her meals, but still struggling with this excess weight.

That no matter what she was doing, it just wasn't happening for her.

I said, "Look, it doesn't have to be this way.

You don't have to struggle this much."

So, for her, she underwent several modalities.

She underwent a sleeve gastrectomy.

After she did that therapy, she did very, very well.

But ultimately, quite a few patients will have weight regain post-surgery.

So, we also have her on medications as a support tool, as a compliment to her surgical intervention.

- [Charleah] I still enjoy eating.

I still enjoy the endorphins.

I'm able to be in more control about it.

Maintenance and my lifestyle is absolutely important to me.

I needed medical intervention, but that's not the end all be all.

I still had to do the work myself.

It was me and my mindset of changing my surroundings, changing my behavior, understanding my relationship with food.

That's what is the silver bullet.

I have it under control.

That's the only difference.

But this is going to be a lifetime.

- We do have to use these treatments long term.

Because just like any other health condition, when you stop the treatment, the symptom returns.

The symptom of obesity is that weight gain.

One of the major barriers to the treatment of obesity as a disease, as a prevalent disease, is access to qualified healthcare professionals who are familiar with the treatment, familiar with the diagnosis and the risk factors connected to it.

By waiting until someone gets to a class one or a class three obesity before having a tough conversation, and it is a tough personal conversation to have with people, you are increasing the risk that they are going to have a health complication that could have been prevented with early intervention.

- We really need a lot more obesity medicine doctors out there.

And we desperately need our medications to be covered by insurance, by Medicare, by Medicaid, so that we can allow access to most patients in the United States.

- I see my older adult patients, those that are hitting Medicare, where we have the most likelihood of really gleaning the most benefits.

For example, if we're looking at our GLP-1 medications, we know that they reduce the incidence of heart attack.

They reduce the incidence of stroke, obstructive sleep apnea, chronic kidney disease, but they're not approved if you have overweight and obesity.

- The risk if we don't start fully acknowledging obesity as a disease, 'cause there are still some that argue that, and if we don't actively treat it, we are opening the door for a large number of health complications, putting more strain on our resources in healthcare, putting more strain on patients' finances.

And the work being done by Dr.

Fatima Cody Stanford, by gaining the recognition and by furthering the field for research into medications and different treatment options, she is a trailblazer in the treatment of this disease and finding effective treatments.

- I'm gonna give a different twist in maybe a concept as it relates to obesity medicine that's very different than what you have heard and what makes our program at Harvard novel in the way we approach obesity and obesity medicine.

- [Kayla] Dr.

Stanford's scope of work for treating obesity is global.

And that's really the one word I can use to describe it.

She is influencing practice and research and policy across the world.

- [Cynthia] On the day Fatima was born, it was just like she was ready for the world.

She came out so fast.

She just popped out.

She was always seeking more, reading, looking for the next best thing.

What can I be?

What can I do?

And from the time she was two years old, she was saying she was gonna be a physician.

- [Maya] It's not surprising that Fatima would have gone into the field of medicine.

She's always cared a lot about people, their health, their wellbeing.

Wellbeing is, of course, based on overall health.

So, that's mental, physical, and spiritual health.

And Fatima is grounded in all three.

- [Helen] She was a go-getter.

I wanna do the best and I want to be the best.

And I was very evident.

In fact, she had a briefcase of all of the schools she applied to and where she had been accepted.

She started out wanting to receive over $1 million in scholarships.

Million dollar baby.

That's what she wanted to be.

Only go to one.

But she applied to all of these schools and it was a very impressive list.

- Fatima told me that she had found this obesity medicine fellowship at Harvard, and this was the first one, you know, that had ever been, you know, developed.

And I encouraged her to find out more information about it because this is something that she was really, you know, intrigued by.

- [Dr.

Stanford] I think about my maternal great aunt.

She was one of the chief nurses at Mount Sinai Hospital in New York.

And she would say to me, "Well, I don't understand why you don't wanna be a nurse."

And I was like, "Aunt, 'cause I wanna be the doctor."

And she was like, "What are you?

What's wrong with you?"

4-year-old kid when I would talk to her.

She was one of the people that was most proud of me when I became a doctor.

Since we've done and started this work together, you've lost 33.6% of your total body weight.

My competitive nature now is, I would think it was a little bit more self-centered at that point, right?

So, now, it's a fight for my patients.

It's a fight for the whole world.

We have over 1 billion people with obesity, and my fight is for really all of them.

- Dr.

Stanford is tireless.

She is always preparing not just for today, but for tomorrow.

She is always thinking about what is the next step or the next thing I need to understand in my science.

She's gone from a medical student from Georgia to an associate professor at Harvard, and here's this role model of what excellence looks like.

- I am so blessed and fortunate that I was connected to Dr.

Stanford well over a decade ago now.

I had tried almost every commercial program known to man, and I got a referral to the weight center.

And by chance, I was assigned to her as her patient.

And I felt like I was seen for the first time.

I was more than a number on a piece of paper.

And being seen and understood and taken seriously was a turning point in my life.

It's really incredible that I've been able to transition to working as a nurse practitioner with Dr.

Stanford.

It has been career-changing.

Not only is she a fantastic provider and a brilliant woman, she is such a strong advocate for this disease.

- We're about to start enrollment for the TRIUMPH-6 trial, which is gonna Reta's study.

Everyone that goes into the trial will get agent.

- That's a great, you know, that's a great twist on the- - It is a twist.

- [Dr.

Apovian] I have watched Dr.

Stanford hone her career over the past few years, and she's positioned herself in a way that really enhances her skills in doing research, in advocacy, and in education.

- [Raymond] There's a sense of pride to see her doing what she's doing and doing a great job at it and other people feeling good about it.

It makes me feel good that I did something right.

- What drives Dr.

Stanford in this field is passion and belief that this is a disease.

You do not work in obesity medicine unless you really care about the work.

There's a large amount of burnout in healthcare in general, but especially in this field because of all the barriers that are being put in place for people to get therapy.

So, we can improve patient access to obesity care by improving the education of our healthcare providers, by spreading the knowledge that we have that Dr.

Stanford contributes greatly to, by educating healthcare professionals.

They should be taught about obesity the same way we're taught about high blood pressure and asthma when we're going through our education programs.

- I think it's recognizing the complexity of the disease itself, which we are still learning more about every single day.

And I think from there things will get better.

- So, if you think you may have chronic obesity, there are strategies and tools you can take to address this.

First, talk to your primary care physician and you might be saying, "You know what?

I've already done that, Dr.

Stanford.

That hasn't helped me."

Be an advocate for yourself.

Go to abom.org.

That's the American Board of Obesity Medicine.

Search for a clinician there.

There are now over 6,000 physicians that have gotten a certification in obesity medicine.

And they can point you to tools that are lifestyle or behavior, medication or surgery, and continue to search for tools and treatments because you don't have to settle for where you are.

- Never take no for an answer.

Your health is just as important as anyone else.

But if you don't advocate and fight, it's not gonna happen.

- There's only one Dr.

Stanford.

We need many more doctors to do this work.

And if we don't treat it, we are, in the future, gonna see that our children don't live as long a life as we've had.

- [Dr.

Stanford] For women seeking careers in STEM, I would say be bold, be courageous, and move forward.

This is exactly the time that we need you.

- [Narrator] Major funding for this program was provided by... - [Narrator] Seeking, those who won't rest until there's enough of the medicine they make for everyone who needs it.

- [Narrator] Novo Nordisk, a global healthcare leader with over 100 years in patient care, aims to drive change against chronic diseases.

Our mission is to pioneer breakthroughs, expand access to medicines, and work towards prevention and cures.

- [Narrator] Amgen uses biology and technology to fight the world's toughest diseases.

At Amgen, it's about making every moment count and counting on, having more moments.

(upbeat music) - [Narrator] Additional support provided by the following.