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>>> TURNING TO A HEALTH CRISIS INTO THE UNITED STATES, A BIDEN PROPOSAL GETTING OBESITY DRUGS COVERED BY MEDICARE AND MEDICAID FINDING THREE QUARTERS OF AMERICAN ADULTS ARE OVER OBESE.
A WORRYING RISE SINCE 1990.
OUR NEXT GUEST IS AN EXPERT ON THE TOPIC DOCTOR FATIMA, A PHYSICIAN AND PROFESSOR AT HARVARD MEDICAL SCHOOL AND IS MEDICATIONS LIKE OZEMPIC BECOMES A HOUSEHOLD NAME THE DOCTOR JOINS US TO TALK ABOUT THIS.
>> THERE'S NEWS OUT THERE THE BIDEN ADMINISTRATION PROPOSING MEDICARE AND MEDICAID COVER THIS CATEGORY OF ANTI-OBESITY DRUGS.
HOW SIGNIFICANT IS THAT?
>> I THINK IT'S TREMENDOUSLY SIGNIFICANT AND I TELL YOU I SPEND A LOT OF TIME AT THE WHITE HOUSE DISCOVERING THIS ISSUE.
I'VE TAKEN SEVERAL TRIPS TO POSE THIS AS A SIGNIFICANT AREA OF COVERAGE.
THESE ISSUES HAVE DISPROPORTIONATELY AFFECTED THE MEDICARE POPULATION AND THOSE THAT ARE OF LOWER SOCIO- ECONOMICAL POSITION AND I COULD TELL YOU THAT I'M ENTHUSIASTIC ABOUT THIS SHIP TO COVER THE POPULATIONS WHICH HAVE IS PROPORTIONATELY BEEN AFFECTED BY OBESITY.
>> BEFORE WE TALK MORE ABOUT THE DRUGS I THINK THAT THE MOST PEOPLE WILL THINK OF IS THE STICKER SHOCK, THESE ARE EXPENSIVE DRUGS.
WHAT ARE THE COSTS ASSOCIATED WITH THIS IF WE WERE TO COVER THIS FOR 3 MILLION PEOPLE TO 4 MILLION PEOPLE?
>> THE COSTS UP FRONT MIGHT BE QUITE LARGE FOR THE BIDEN ADMINISTRATION FOR THE GOVERNMENT ALSO.
I WANT TO THINK OF THE DOWNSTREAM IMPACTS.
OBESITY CAUSES OVER 200 COMPLICATIONS OF CARDIO METABOLIC DISEASES AND OTHER DISEASE PROCESSES FROM DIABETES TO HYPERTENSION TO HYPERLIPIDEMIA WHICH IS HIGH CHOLESTEROL, OSTEOARTHRITIS, EVERYTHING ACROSS THE BOARD .
WHAT WE KNOW IS THAT IF WE TREAT OBESITY WE COULD TREAT THESE DOWNSTREAM DISEASE PROCESSES.
WHAT I'VE GOT THE PRESSURE OF DOING AS A MEDICINE PHYSICIAN, REMOVING THE DIAGNOSIS FROM PEOPLE'S CHARTS.
I'VE HAD THE PLEASURE OF WORKING WITH PATIENTS ACROSS THE LIFESPAN.
MOST PATIENTS HAVE BEEN WITH ME FOR 10 YEARS OR MORE.
WHEN WE ARE DOING THIS WORK, WE FIND OVER THE DECADE OR SO, THEY GET HEALTHIER.
AT 70 YEARS OLD THEY ARE HEALTHIER AT 70 THAN THEY WERE AT 60.
IT'S AMAZING.
THEY ARE LIVING HEALTHIER LIVES.
THIS LAST WEEKEND I SPENT TIME WITH ONE FAMILY, THEY ARE IN THEIR 70s.
THEY ARE LIVING HEALTHIER LIVES THAN THEY DID IN THEIR 60s.
WHAT IS THE SAY OF THE POPULATION?
THIS IS THE POPULATION YOU ARE SPEAKING TO.
THEY ARE ABLE TO DO THINGS THEY WERE NOT ABLE TO DO WHEN THEY WERE IN THEIR 60s.
THIS IS THE POPULATION TARGET OF THIS ACTUAL CHANGE.
SEVERAL OF THEM ARE ON THERAPY.
THEY ARE BENEFITING FROM THIS SHIFT IN GETTING THIS FROM PRIVATE INSURANCE.
AS WE MAKE THE SHIFT, LOOKING AT MEDICARE ENROLLEES AND MEDICAID BENEFICIARIES, THIS IS THE TYPE OF SHIFT WE EXPECT TO SEE AS WE SEE THESE THINGS COMING OUT FROM THE SELECT TRIALS, SEEING THE BENEFIT OF REDUCING ADVERSE CORONARY EVENTS AND SEEING BENEFITS AND IMPROVEMENT FOR OBSTRUCTIVE SLEEP APNEA.
THAT'S WHAT WE ARE HOPING TO GET FROM COVERING THE INDIVIDUALS WHO HAVE NOT BEEN ABLE TO GET COVERAGE SO FAR.
>> WE SHOULD POINT OUT A COUPLE OF THINGS, THIS IS A PROPOSAL BY THE BIDEN ADMINISTRATION AND OBVIOUSLY THERE'S A NEW ADMINISTRATION COMING TO TOWN IN JANUARY.
THEY MAY HAVE DIFFERENT VIEWS ON THIS SO IT'S UP TO THE NEXT ADMINISTRATION TO FIGURE OUT WHETHER THEY WANT TO RUN WITH THE PROPOSAL OR NOT BUT REGARDLESS OF WHO IS IN THE WHITE HOUSE YOU WOULD SUGGEST THAT THE PROPOSAL GO FORWARD?
>> ABSOLUTELY THIS IS SOMETHING I'VE SPENT A LOT OF TIME ADVOCATING FOR IN CONJUNCTION WITH THE TREATMENT REDUCE OBESITY APP THAT WAS INTRODUCED IN THE HOUSE IN 2012, THIS WOULD SEEK TO DO THIS COVERING THE MEDICARE POPULATION WITH ANTI-OBESITY POPULATIONS WE'VE SEEN THAT THE MEDICATIONS ARE COVERED FOR THE INDIVIDUALS WITH DIABETES, DISPROPORTIONATELY NOT COVERING THOSE THAT HAVE OBESITY, WE KNOW IT'S THE MOST PREVALENT CHRONIC DISEASE YET WE SOMEHOW DO NOT SEEM TO COVER THOSE INDIVIDUALS AND PREFERENTIALLY COVER THOSE ONLY WITH DIABETES BUT WE MUST ACKNOWLEDGE THOSE WITH DIABETES, 80% WITH TYPE II DIABETES COULD CURRENTLY HAVE OBESITY SO WE HAVE THIS PREFERENCE FOR COVERING ONE POPULATION AND NOT COVERING ANOTHER.
IT SEEMS A BIT UNFAIR.
I'D BE A STRONG ADVOCATE FOR COVERING THIS POPULATION, A POPULATION I EXCLUSIVELY TREAT IN THE PRACTICE OF MEDICINE THAT I RENDERED TO PATIENTS AT THE HOSPITAL.
>> SO THIS IS THE BREAD AND BUTTER OF WHAT YOU FOCUS ON ON A DAILY BASIS AND HE WORKED WITH PATIENTS FOR SO LONG ABOUT THIS.
IS THERE SOMETHING WITH RFK JUNIOR ON THE CAMPAIGN TRAIL SAYING WE COULD FIX ALL THE STUFF THAT PEOPLE ATE BETTER, IS THERE SOMETHING ELSE WE SHOULD THINK ABOUT IN THE CONTEXT OF OBESITY WHETHER THIS IS ON A CHEMICAL LEVEL WITH OUR BRAIN AND HOW HER BODIES REACT EXTRA WEIGHT, WHAT ARE THE THINGS THAT MAKE THIS MORE COMPLEX THAN JUST SAYING EAT RIGHT?
>> I'M SO GLAD YOU ASKED ME.
WHAT WE DO KNOW, OBESITY IS A MULTIFACTORIAL LAPSE DISEASE WERE GENETICS, DEVELOPMENT, ENVIRONMENT AND BEHAVIOR WILL PLAY A ROLE.
AS PART OF THE U. S. DIETARY GUIDELINES COMMITTEE.
FOOD DOES PLAY A ROLE BUT I WOULD LIKE US TO ACKNOWLEDGE WHILE IT DOES PLAY A ROLE THESE OTHER FLAK TEARS PLAY A ROLE.
LOOKING AT THE ROLE OF MEDICATIONS, MANY OF THESE MEDICATIONS THAT WE PRESCRIBE AS DOCTORS ARE WEIGHT PROMOTING AND INFLUENCE THE BIOCHEMICAL FACTORS IN THE BRAIN THAT ACTUALLY INFLUENCE WEIGHT CONTROL SO A LOT OF PEOPLE ASK ME WHAT ARE SOME OF THOSE MEDICATIONS WHICH COULD INFLUENCE WEIGHT REGULATION AND I LIKE TO SAY OFF THIS LIST WITH HIM, CYMBALTA, PROZAC PREDNISONE TO NAME THE ONES I LIKE TO SAY AT THE MOMENT BUT THESE COULD AFFECT WEIGHT REGULATION SO THOSE ARE MEDICATIONS COULD INFLUENCE WEIGHT CONTROL .
I'VE SEEN UPWARDS OF 200 POUNDS OF WEIGHT GAIN ASSOCIATED WITH MEDICATIONS THAT WE PRESCRIBE FOR OTHER CONDITIONS SO THAT'S ALSO IMPORTANT FOR US TO KNOW, TRAUMA COULD INFLUENCE STRESS, THE STORAGE OF ADIPOSE, THIS FANCY WORD THAT WE USE BUT ACTUALLY IT IS A MEDICAL OREGON.
SOME OF US STORE EXCESS OF THIS BECAUSE OF TRAUMA OR STRESS THAT WE'VE EXPERIENCED IN OUR LIFE OR GENERATIONAL TRAUMA OR STRESS.
DIFFERENT THINGS HAVE IMPLICATIONS.
IF YOU'RE A NIGHT SHIFT WORKER OR LIKE A DOCTOR, LET'S SAY YOU'VE GOT A NIGHT JOB, THIS DESTROYS THE NUCLEUS, A FANCY WORD YOU COULD LOOK UP.
THIS AFFECTS HOW WE STORE FAT.
SO THERE'S A VARIETY OF FACTORS THAT HAPPEN WITHIN OUR SOCIETY THAT INFLUENCE AT THIS TIME IN SOCIETY HAVE MORE FAT MASS THAN WE'VE HAD IN PREVIOUS TIMES WE HAVE OVER 1 BILLION PEOPLE WORLDWIDE THAT HAVE OBESITY.
THE UNITED STATES IS RANKED NUMBER 10 IN THE WORLD IN TERMS OF COUNTRIES WITH OBESITY SO WHILE WE AREN'T RANKED AT NUMBER ONE WE COULD RECOGNIZE THAT THIS IS AN ISSUE AFFECTING THE WORLD AND IT'S SOMETHING THAT WE MUST ACKNOWLEDGE ON A WORLDWIDE BASIS.
>> YOU HAVE ADVISED DIFFERENT DRUG COMPANIES GOP ONES, EXPLAIN HOW THEY WORK IN COMBATING OBESITY?
>> THESE MEDICATIONS WORK IN THE BRAIN .
AS YOU HAVE ALLUDED TO.
WE HAVE TO RECOGNIZE THAT WE ARE STORING EXCESS FAT IT'S ACTUALLY A DISEASE OF THE BRAIN SO THERE'S THE HYPOTHALAMUS, IT GOVERNS HOW MUCH FAT MASS WE STORE.
THESE MEDICATIONS UP REGULATE APART OF THE BRAIN TO EAT LESS AND STORE LESS, A LOT OF THE PATIENTS ACTUALLY RECEIVE SIGNALS THAT TELL THEM THEY ARE HUNGRY AND NEVER RECOGNIZE A LOT OF THE BRAIN WAS FOCUSED SO MUCH ABOUT THINKING ABOUT WHAT IS THE NEXT MEAL, WHAT'S THE NEXT SNACK?
THEY AREN'T REALLY THINKING ABOUT THIS.
I DON'T USE THIS TERM BUT A LOT OF THEM WILL REFER TO THIS AS FOOD NOISE.
IT'S SOMETHING YOU'LL HEAR A LOT WITHIN THIS KIND OF THINKING OF HOW PEOPLE WOULD RECOGNIZE THEIR INFLUENCE OF BEING ON THESE MEDICATIONS.
THIS IDEA OF FOOD NOISE THAT SEEMS TO BE THE VOLUME IS TURNED DOWN WHILE THEY ARE ON THE MEDICATIONS.
SO WHEN THEY ARE ON THE MEDICATIONS IT'S INFLUENCING THAT .
I WILL TELL YOU THAT GLP- 1, YOU AND MYSELF HAVE GLP-1 INSIDE OF US.
THOSE OF US THAT HAPPEN TO HAVE IT LATER HAVE MORE GLP-1 ON BASE SO WHEN WE ADMINISTER THIS TO YOU, WE ARE GIVING YOU MORE OF WHAT YOUR BODY NATURALLY MAKES.
FOR THOSE OF US THAT DO NOT HAVE AS MUCH INHERENTLY INSIDE OF US, WE ARE GIVING YOU MORE OF WHAT YOUR BODY SHOULD MAKE AT BASELINE SO THAT'S AN IMPORTANT PIECE OF THE PUZZLE ALSO.
>> I ALSO HEARD THAT AS PEOPLE GAIN WEIGHT , SOMETIMES THERE BRAIN ALMOST RESETS TO A NEW NORM AND THEN WHEN THEY GO ON A DIET OR THEY EXERCISE AND LOSE A BUNCH OF WEIGHT IT'S LIKE THE BRAIN IS SOMEHOW GIVING THEM SIGNALS TO PUT THE WEIGHT ON EVEN THOUGH IT MIGHT NOT BE HEALTHY FOR THEM.
IS THIS TRUE?
>> IT'S ABSOLUTELY THE TRUTH.
IT'S THE IDEA OF SETPOINT.
THE BRAIN WANTS TO DEFEND ITS NEWEST SETPOINT.
IT'S THE SETPOINT THEORY THAT'S BEEN OUT AND ABOUT FOR OVER 75 YEARS.
WITH THE BODY DOES, IT RECOGNIZES THE BRAIN.
THE BRAIN IS VERY SMART.
IT WANTS TO DEFEND FAT MASS AND THINGS WHEN YOU GET TO A CERTAIN FAT MASS NEEDS TO DO WHAT IT CAN TO BRING YOU BACK TO THAT SETPOINT.
THE KEY HUNGER HORMONE CALLED GRELL AND IT WANTS TO BRING YOU BACK.
GHRELIN.
YOU'LL NOTICE THAT YOUR HUNGRY SAY I DON'T WANT TO BE HUNGRY BUT IT WILL BRING YOU BACK TO THAT SETPOINT PRIOR TO.
SO WHEN YOU GO ON A DIET, YOU LOSE WEIGHT AND THEN YOU GAIN WEIGHT BACK TO A HIGHER POINT THAN WHERE YOU WERE PRIOR TO WHATEVER DIETARY INTERVENTION.
THIS IS WHY WHEN WE GO TO THE NEW YEAR PEOPLE SAY HEY I'M GOING TO GO ON XYZ DIET AND LOSE WEIGHT THAN THEY RECOGNIZE WEIGHT A BIT I'M HIGHER THAN I WAS TO THAT PRIOR DIETARY INTERVENTION OR LIFESTYLE MODIFICATION WITH EXERCISE PLANS BECAUSE THE BODY IS GOING TO MAKE DIFFERENT MECHANISMS HAPPEN IN ORDER TO BRING YOU BACK TO APPOINT A BIT ABOVE IT AND IT WANTS TO DEFEND WHATEVER IT CAN.
THE MASS OF WHAT IT FINDS TO BE NORMAL FOR YOU DESPITE WHAT YOU MIGHT THINK IS NORMAL.
>> THIS MONTH THE STUDY WAS OUT IN THE LANCET MEDICAL JOURNAL AND FOUND NEARLY 3/4 OF AMERICAN ADULTS ARE OVERWEIGHT OR HAVE OBESITY.
ARE YOU SURPRISED BY THAT?
>> NOT AT ALL.
WE'VE FOLLOWED THESE TRENDS FOR YEARS .
WE'VE SEEN THE GRADUAL RISE IN WEIGHT AND OBESITY WITHIN THE AMERICAN POPULATION.
WHAT WE FOUND IS WE'VE BEEN USING THE SAME STRATEGIES TO ADDRESS THE OBESITY WHICH IS ONLY ADDRESSING THE FOOD PORTION OF THIS.
LOOKING AT THE FOOD QUALITY, LOOKING AT DIETARY STRATEGIES AND MAY BE ADDRESSING THIS BY LOOKING AT EXERCISE MODIFICATIONS.
WHAT IS THE DEFINITION OF INSANITY, TRYING THE SAME THING AND HOPING FOR DIFFERENT RESULTS TO OCCUR.
WE FOUND THE STRATEGIES ARE INEFFECTIVE AND ALONE IN ADDRESSING THE PANDEMIC WHICH IS HERE IN THE UNITED STATES AND FRANKLY AROUND THE WORLD SO THE RISE IN OBESITY THAT'S HAPPENED OVER TIME, IT'S BY NO MEANS SURPRISING TO ANY OF US WHO'VE BEEN DOING THIS WORK FOR DECADES.
>> FINDING THAT THE PREVALENCE OF OBESITY ROSE OVER THE LAST THREE DECADES IN ADULT MALES AND FEMALES I WONDER, WHAT IS BEHIND THE RAPID INCREASE?
ARE THERE SUBPOPULATIONS THAT IF WE OVERLAY SOCIOECONOMIC DATA, IS THIS MORE LIKELY TO HAVE BEEN IN THE STATES THAT ARE HAVING GREATER AMOUNTS OF POVERTY OR LESS ACCESS TO HEALTH CARE OR FOOD DESERTS?
ONE OF THE OTHER THINGS THAT THE OVERALL PICTURE DOESN'T POINT OUT TO US?
>> IF WE DRILL IN AND LOOK A LITTLE BIT AT THE FINER TOOTH COMB, IT'S MORE PREVALENT.
MORE PREVALENT IN THE SOUTHEAST.
LOOKING IN THE MIDWEST WE SEE THIS.
IN THE NORTH WE SEE THINGS BEING A LITTLE LESS PREVALENT.
HIGHER PREVALENCE IN VARIOUS POPULATIONS.
THIS IS COMING OUT OF SOME OF THE FINER TOOTH INFORMATION COMING OUT OF THE CDC.
WE ALSO SEE THIS IN LOWER SOCIOECONOMIC POSITIONS.
WE KIND OF LOOK AT THIS IF WE ARE LOOKING AT LOWER SOCIOECONOMIC POSITION ACCESS, IT DEFINITELY PLAYS A ROLE.
YOU KNOW, THIS ISN'T OF ANY SURPRISE TO US.
IT'S GERMANE TO SOME OF THE PROBLEMS THAT WE BELIEVE ARE BEHIND THIS RAPID RISE IN OVERWEIGHT OBESITY IN BOTH POPULATIONS, REGARDLESS OF GENDER.
THIS IS SOMETHING WE ARE PAYING CLOSE ATTENTION TO.
IT'S SOMETHING THAT WE EXPECTED AND IF WE LOOK AT THE REST OF THE COUNTRY YOU COULD SEE IT'S AFFECTING EVERYONE AND DISPROPORTIONATELY AFFECTING CERTAIN POPULATIONS.
>> ONE OF THE THINGS THE STUDY POINTS OUT WAS THAT IF WE DON'T TAKE ANY ACTION THAT BY 2050, THE PREVALENCE OF OVERWEIGHT AND OBESITY IN ADULTS WILL EXCEED BY 80% NATIONWIDE.
WHAT ARE SOME OF THE LONGER- TERM IMPLICATIONS OF HOW SOCIETY FUNCTIONS AND WHAT KIND OF POLICIES WE NEED TO BE RETHINKING?
I GUESS THAT SORT OF A DOWNSIDE BUT ON A POSITIVE NOTE WHAT ARE THINGS WORKING THAT WE COULD DO NOW TO PREVENT THIS?
>> ONE OF THE KEY THINGS I THINK WE ARE DOING THAT WE NEED TO BE THOUGHTFUL IF WE NEED TO ADDRESS PARENTS PRIOR TO CONCEPTION.
WHAT DO I MEAN BY THIS?
IF WE ADDRESS PARENTS AND THEIR HEALTH AND HEALTH STATUS PRIOR TO CONCEIVING, WE HAVE THE BEST LIKELIHOOD OF ADDRESSING THE NEXT GENERATION SO IT'S SHOWING IF PARENTS ARE IN THEIR OPTIMAL HEALTH PRIOR TO CONCEIVING CHILDREN THEY HAVE THE BEST APPLICATIONS FOR THE NEXT GENERATION TO COME.
MATERNAL AND PATERNAL OBESITY INCREASES THE LIKELIHOOD OF A CHILD HAVING OBESITY THEMSELVES SO ARE WE ARE BEHIND THE EIGHT BALL AT THAT POINT.
THAT'S THE BEST LIKELIHOOD OR THE THOUGHT PROCESS BUT WE AREN'T THINKING OF THAT.
I THINK THAT'S THE BEST FORWARD THINKING.
IT'S A STRATEGY WE NEED TO BE THOUGHTFUL ABOUT WHICH WOULD START PRIOR TO CONCEPTION SO WE NEED TO BE THOUGHTFUL OF IT IN THIS WAY.
THE THINGS WE ARE THINKING OF IS TREATING OVERWEIGHT AND OBESITY TALKING ABOUT 75% OF THE POPULATION.
BEGINNING TO TREAT THE DISEASE THAT'S ACTUALLY HERE IN THE POPULATION WITHIN THE PEDIATRIC AND ADULT POPULATION.
FOCUSING ON THE ADULT POPULATION I CAN TELL YOU WE NEED TO BE TREATING THIS ACROSS THE AGE COURSE AND BE THOUGHTFUL ABOUT THIS AND THINK OF HOW TO ADDRESS THIS FROM LIFESTYLE FACTORS USING PHARMACOTHERAPY AND METABOLIC AND BARIATRIC SURGERY WHICH HAS HAD A SIGNIFICANT DECLINE OF THE LAST YEAR.
THE 25% DECLINE IN THE USE OF BARIATRIC SURGERY OVER THE LAST YEAR BUT WE HAVE HAD A RISE IN SEVERE OBESITY WHICH IS SOMETHING WE NEED TO BE THOUGHTFUL ABOUT.
WE ALSO NEED TO THINK ON POLICY WHICH IS HOW WE START THE CONVERSATION.
HOW DO WE THINK OF LARGE-SCALE POLICIES OR GOVERNMENTAL POLICIES INTERSECTED WITH THE HEALTHCARE SECTOR AND THINKING OF HOW DO WE ADDRESS THINGS WITH THE COST OF ACCESS NOT JUST PHARMACOTHERAPY BUT THINKING, WHAT ARE WE DOING IN OUR SCHOOLS AND HOW ARE WE THINKING ABOUT FOOD AND THINKING OF THE QUALITY OF FOODS?
WE NEED TO REDUCE ULTRA PROCESSED FOODS.
WE DO KNOW THAT'S PART OF THE PROBLEM.
WE DO NEED TO MAKE REDUCTION IN THAT TO MAKE SURE OVERALL OUR SOCIETY IS HEALTHIER BUT WE HAVE TO ADDRESS THOSE ISSUES THAT WE KNOW ARE GERMANE TO INCREASING THESE OBESITY RATES OVER TIME SO THIS WILL NEED TO BE A MULTIPRONGED APPROACH TO GET THIS DECISION.
IT'S NOT GOING TO BE JUST GOVERNMENT, IT'S GOING TO TAKE ALL PARTS OF THE EVENT, THERE'S NO WAY ONE SECTOR COULD ADDRESS THIS ALONE.
>> DOCTOR FATIMA, THANK YOU SO MUCH FOR JOINING US.
>> THANK YOU FOR HAVING ME.
IT'S BEEN A DELIGHT BEING HERE.
About This Episode EXPAND
Deputy Speaker of the Lebanese Parliament Elias Bou Saab discusses the ceasefire agreement in the works between Israel and Lebanon. Sharon Horgan talks about her show “Bad Sisters” about misogyny, violence and unity between women. Dr. Fatima Cody Stanford, an obesity medicine physician, discusses a recent study showing that nearly three-quarters of American adults are overweight or obese.
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