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Speaker 1: I talked to my doctor a long time ago and said, "Look, can we agree that BMI's bullshit?" She said, "Yes."

Speaker 2: The number one gold star-like badge of honor is going into a clothing store that has clothes you could never fit before and putting on a 2X and having it fit.

Speaker 1: When you gain the weight, you get older, things get harder. I approached 40 with a knee that was going to need a knee replacement within 5 to 10 years. A blood glucose that was just above what's considered normal range, a blood pressure that was a little high.

Speaker 2: Imagine a mountain, if losing weight is climbing the mountain and gaining weight is coming back down. I've gone up the mountain. I've come down the mountain. I've never reached the summit.

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Kai Wright: It's Notes from America. I'm Kai Wright. Welcome to the show and welcome to 2024. The voices you just heard are from episodes of the podcast Weight For It hosted by Ronald Young Jr. That's weight as in body weight. It's a show that, "unpacks the nuanced thoughts of fat folks and folks who think about their weight all the time." That means it's a show for most of us, particularly at this time of year.

We'll hear from Ronald later this hour, but we're going to begin our conversation this week with a physician because any conversation about body weight these days, unavoidably means talking about Ozempic. The drug became a social media buzzword last year as high-profile celebrities began turning to the medication for its fast results in their efforts to lose weight. It was initially approved by the FDA to treat type 2 diabetes way back in 2017. It wasn't until this past year that the medication, which is made by the Danish healthcare company, Novo Nordisk, became a catchall phrase.

It's now synonymous with a new class of drugs. They include Wegovy, which is also from Novo Nordisk, as well as Mounjaro and Zepbound, both from the pharmaceutical company Eli Lilly. The newfound popularity of these drugs as tools for weight loss has caused demand to skyrocket to the point where there have now been supply shortages.

On the one hand, this all sounds like the makings of yet another body-shaming craze. Here's the thing, roughly 42% of people in the United States have obesity. That number goes up when we're talking specifically about Black and Hispanic people. Illnesses associated with obesity such as heart disease and diabetes, they have long been among the leading causes of death in this country. These drugs are potentially game-changing for our collective health. Some in the medical community even believe their efficacy could eliminate obesity altogether.

To begin pulling all of this apart, we have invited Dr. Fatima Cody Stanford to take our questions. Dr. Stanford is an obesity medicine physician and scientist and associate professor of medicine and pediatrics at Massachusetts General Hospital and just one of the prominent scholars in this field. Dr. Stanford, welcome to Notes from America. Thanks so much for joining us.

Dr. Fatima Cody Stanford: Thanks so much for having me. It's a delight to be here with you this evening.

Kai Wright: Listeners, we want to hear from you all hour. We can take your questions about the prescription weight loss drugs themselves. Also, I'm wondering if and how all the talk about these drugs has caused you to think differently about your own body or your health. Dr. Stanford, first let us level-set a bit. 2013, the American Medical Association recognized obesity as a disease. You have specified further that obesity is a disease of the brain. Can you just break that idea down for us?

Dr. Fatima Cody Stanford: Absolutely. Actually, Kaya was actually the doctor that went to speak to the AMA right before that pivotal vote that the AMA acknowledged obesity as a disease. Let's break this down, why is it a disease? When we think about weight and weight regulation, it actually happens in the brain and a lot of people don't know that to be the case. There is a portion of our brain all in the hypothalamus. You don't have to necessarily look this up, but I would welcome you to do so if you'd like. In the hypothalamus, there is a part of our brain, what we call the anorexigenic. When we hear anorexigenic, we have a part of our brain that tells us not to eat a lot, it's called the POMC or the pro-opiomelanocortin portion of our brain.

This is the part of our brain that tells us not to eat a lot. Some of us have this augmented in our brain, and for those of us that have that augmented in our brain, we just don't have a really strong desire to eat a lot. That's one part of our brain, the anorexigenic or the POMC portion of our brain. Then there's another part of our brain that you can imagine if there's an anorexigenic portion of our brain, we also have an orexigenic part of our brain. Anorexigenic. Orexigenic is the opposite of anorexigenic. Orexigenic is the AgRP or the Agouti-Related Peptide pathway part of our brain. This pathway does the opposite of the anorexigenic pathway, and guess what that does? It tells us to eat more. Some of us have this augmented. Now, believe it or not--

Kai Wright: Let me just jump in real quick to make sure none of that got past people too fast. Part of our brain tells us when to eat more, part of our brain tells us when not to eat more.

Dr. Fatima Cody Stanford: Exactly. This is also influenced by our gut. There are this-- brain, gut, our stomach, our intestines, they all act together. Some of us have this stimulated in such a way that our bodies do this really well and tell us to do this in a way where our bodies function such that we may appear more lean. Some of us have it where it doesn't function as well and we may appear to carry more excess adipose or fat. Does that make sense?

Kai Wright: That does make sense. Which is to say the interplay between our brain and our guts really determines our desire to eat. Is desire the right word?

Dr. Fatima Cody Stanford: It's desire. Some of it is not only desire, some of it is even how our body even decides whether or not it wants to store fat or not. A lot of this is outside of our control, I can't tell my brain, "Hey, signal down that pathway." I would love to do that, and so when we talk about some of the meds you talked about at the outset, a lot of the meds are influencing that. When you talk about these category of medications, this Ozempic, Mounjaro, Zepbound, et cetera, this type of medicine or what we call GLP-1s or Glucagon-like peptide 1s, believe it or not, that type of substance is made in our bodies. Some of our bodies just make more of it than other people's bodies. When we're administering this to a person, some of-- we are giving those people that may not have as much of it as baseline more of it so that their bodies can function more like those of us that may have more of it at baseline. Does that make sense?

Kai Wright: Yes. That's the 101 of these drugs is that if your body, if the interaction between your brain and your stomach and your gut cues you to eat more or to store fat differently, this enzyme is what gets in the way of that or helps you in that. One of, whatever.

Dr. Fatima Cody Stanford: It could be one of them. There's a lot of more to the story, we could spend hours talking about it, but this-

Kai Wright: We will not do that because we can't all take that in.

Dr. Fatima Cody Stanford: -this might be one of those things. For some people when they go on these medications, they're like, "Oh my goodness, is this what other people feel? I never knew what this was like because I never felt that," whatever that is. That may be what some people feel, but they never knew what that was like because they never had that sensation, whatever that might have been, for example.

Kai Wright: Going back to the idea of obesity being a disease in the first place. Why is that framework important? You said you were amongst people who went to the AMA and said, "Hey, let's think about it this way." Why was that an important framework?

Dr. Fatima Cody Stanford: When we think about other chronic disease processes, let's think about some key ones that we think about, particularly as you-- the outset, you brought up this differentiation between Black and brown communities, ones like I belong to, ones like you belong to. We think about this disproportionate impact of disease processes like type 2 diabetes or high blood pressure on these communities. Well, at the outset, we have to recognize that the one that actually has the largest impact on these communities is obesity. Obesity happens to be a precursor to these diseases like type 2 diabetes or like heart disease or like high blood pressure.

With it being a precursor to these disease processes, often we're treating the cause and not the disease that caused those diseases at the beginning. What we're doing is we're like, "Oh, let's go and treat all of the downstream impacts without treating the precursor or the origin story," for lack of a better way of saying it. As an obesity medicine physician, what I really get my true joy out of doing when I'm working with either my pediatric or my adult or older adult patients is when I treat the disease that is their obesity, guess what I get to do, Kai. I get to begin deleting all of those downstream diagnoses that we just talked about. I might get to delete that type two diabetes or their high blood pressure, or their sleep apnea, or their fatty liver disease. All of these things that if we had just treated their obesity, to begin with, we could have begun deleting those much sooner. By recognizing obesity as the precursor to the 230 plus diseases that obesity does cause, then we begin to recognize that as the precursor to those disease processes and then actually begin treating the root cause of the issue.

Kai Wright: Why was that a big idea in the first place? I guess, on the back end of it, it seems like, "Okay, yes, that's self-evident."

Dr. Fatima Cody Stanford: That makes sense.

Kai Wright: Why do you think that hasn't been a self-evident idea in medicine prior to 2013?

Dr. Fatima Cody Stanford: I think that when we think about obesity, it's unfortunate that, unlike other disease processes, it's a disease that you wear. Because it's a disease that you wear, with it comes significant stigma and bias that we don't have that we have with other diseases. You can't look at a person and tell they have high blood pressure. You can't look at a person and tell they have cancer. You can't tell if they have hypertension. You can't tell these things by looking at an individual, but because someone has excess weight, you presume that they are lazy, that they don't care about themselves.

You have all of these preconceived notions about their value or their worth. Much like if you look at me as a Black woman, you make these assumptions about who I am, my value, my worth, my ability to carry out a task or whatever it might be because of whatever your preconceived notions are about what you've been told about Black women.

With these notions that we bring to the table about persons that carry excess weight, I then have to make sure that you understand that this is a disease processes that's in the body that's governed by genetics, development, environment behavior, the interplay of these things that happens to be expressed externally, to get people to understand that our bias towards those carry excess weight governs how we care or don't care for those individuals. I would say don't care is probably really the key thing.

Kai Wright: We're going to need to take a break. Dr. Fatima Cody Stanford is an obesity medicine physician, and she is talking to us about Ozempic and the new weight loss drugs. We're going to continue this conversation after the break and we're going to start taking your calls. I'm Kai Wright, this is Notes from America. Stay with us.

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Kai Wright: It's Notes from America. I'm Kai Wright and shout out to our new listeners in Los Angeles and North Carolina this week. We are so excited to have LAS and WUNC join our community, and we can't wait to have your voices in the conversation. I'm talking with Dr. Fatima Cody Stanford about medications designed to treat obesity and why some in the medical community think this will lead to a total transformation of our nation's health.

Dr. Stanford, just to put our feet on the ground a little bit more about the drugs themselves before we get into all the conversations that come from that. As a doctor, at what point would you prescribe them to someone? I'm assuming that you wouldn't turn to a weight loss medication as a first option, but give us the brief overview of if you're somebody who's thinking about this, what is the point a doctor might say, "This is for you?"

Dr. Fatima Cody Stanford: Yes, by the time people make it to me, Kai, often they have tried diet number 74, and so have tried many things, diet programs, exercise programs. They've really tried. Unfortunately, I wouldn't say that they have failed the diet programs or the diet. I would say the diet programs have often failed them. They may have tried many exercise programs and they've really put in valiant efforts, and they've really come to the end of the rope.

Maybe they've even tried metabolic and bariatric surgery and have had weight regain, and so they're coming in after tried-- and these things have not been effective for them. I wouldn't start here, but after they have tried diet modifications, lifestyle modifications, stress modifications, sleep modifications, all of these things, this is when we would consider medications.

The reason why I think it's important for us to think about these modifications is because when we consider medication for the treatment of the disease, that is obesity, if they are effective-- and notice I'm saying if they are effective because they aren't effective for everyone. If they are effective, they are a lifelong commitment to these medications. These medications do work on the pathways that regulate weight. If they are effective, as soon as we no longer utilize them, meaning if we're no longer taking them, they're no longer going to be effective because we're no longer using them.

If we are going to use them, if they are effective, we will need to use them long-term. This is what we need to make sure we are very transparent about at the outset, so I just want to make sure that we're aware of that before we endeavor down that pathway, and that's what I'm very transparent about with my patients if we do go down that pathway.

Kai Wright: Let's go to Sonya in Union City, New Jersey, who has a question about the meds. Sonya, welcome to the show.

Sonya: Yes, hi. Thanks for having me. I'm just going to call the doctor, Dr. Fatima. I forgot her last name.

Dr. Fatima Cody Stanford: That's fine. I go by that on social media, so that's fine too. You said it and you said Fatima right, so you get gold stars all around.

Kai Wright: Doing better than me.

Sonya: Well, thank you. It's called phonics. [laughter] Listen-

Dr. Fatima Cody Stanford: Funny.

Sonya: -first of all, it's refreshing to hear that you're an African American doctor. I'm an African American woman. I'm 64. I was diagnosed with type 2 diabetes in '96 because I did have adult onset diabetes from being obese most of my life. Well, not my life, most of my adult life, and they were stress factors. Anyway, I won't do a deep dive, but what I wanted to say is, you've echoed everything I went through. I went to a food psychologist, yada, yada, yada.

I pretty much been managing my type 2 diabetes very well over the years, and at my heaviest, I was 252. I'm actually 152 now, and a lot of it I can't take credit for. It's because I've had seven surgeries on my left leg that stemmed from an initial total knee replacement. I want people listening, especially your clients, your patients, to understand that diabetes is not something to be dismissed.

I was in the hospital an entire month this past July because even though I manage my blood sugars well, I had two strains of bacterial infection in my leg. Even though I'm 152, it still happens. My point of the call is I empathize with people that have weight struggles because I'm one of those people, but I've overcome it. My issue now is my doctor has prescribed Ozempic for me since I got out of the hospital on July.

I have not been able to get my prescriptions filled on a regular basis because of the high demand. I'm not calling to complain, but it's been an issue for me because being in the hospital for a month, I don't want that to happen again. I can't even get my medication, the Ozempic, and it was prescribed for me to maintain my blood sugar.

Kai Wright: Sonya, I'm going to stop you there just for time because we got a lot to get to. Dr. Stanford, not being able to get medications right now because of the-- how often are you hearing this? You're nodding vigorously.

Dr. Fatima Cody Stanford: This is the nightmare that is my daily life. These medication shortages are real even for myself and I'm a very well-sought-after doctor. I can get medications probably better than most docs in the field, and I still have this issue with my patients every single day, so Sonya, I hear you. What I would recommend, however, is that Eli Lilly's drugs have now come on the market, Mounjaro and Zepound.

Mounjaro is the trade name for the medication for patients with type 2 diabete. Slightly better availability than Ozempic. That medication which is a dual agonist, a combination of a GLP-1 and a GIP, you may have better likelihood of getting it. It is a US-based company. Just a little bit better availability with that being the case. Not saying it's great availability.

No. Notice I'm saying slightly better availability. You might want to talk with your doctor about seeing if that's available somewhere in your area. This is a major issue. The supply chain issue has been a major issue and this started in 2021. It worsened in 2022 and I'm hoping that in 2024 where we are now that we'll start to see this improve. I do agree that this is a major issue. One thing that may help some of the supply chain issues is that the generic medication, which is Victoza, the daily injection will become generic this year. Meaning it will become an agent that is available more broadly, more wide scale because it will come off patent this year. I think that will help improve some of the supply chain issues.

Look out for that, Sonya, when that becomes available. It's not yet available. We just are on January 7th, so we're still early in the year, but be on the lookout for that to help with some of the supply chain issues. In the meantime, look for Mounjaro potentially for helping with some of the supply chain issues. I apologize on behalf of the supply chain, which is the bane of my existence with my patients also.

Kai Wright: More drugs to come. You got to look beyond Ozempic. Might be helpful. I want to pivot a little bit and bring in our second guest to talk about the broader conversation here around body and weight. I want to bring in Ronald Young Jr. He's the host of the podcast, Weight For It, in which he unpacks, "the nuance thoughts of fat folks." He talks about his own journey with weight loss and acceptance with candor and grace and humor. I'm so happy, Ronald, that you could join us today. Welcome to the show.

Ronald Young Jr.: Thanks for having me, Kai. It's good to be here.

Kai Wright: Just to back up from all of this medical talk [chuckles] which is very important but to talk about how this all is landing in the culture. In December, Oprah Winfrey publicly announced that she's using weight loss medication without stating a specific name. In an interview with People Magazine, she said, "The fact that there's a medically approved prescription for managing weight and staying healthier in my lifetime feels like relief, like redemption, like a gift."

Oprah was certainly not the first celebrity to talk about using these drugs, but she is arguably the most influential. Ronald, there's so much to talk about with someone like Oprah embodies, but what, if anything to you, does it mean for this person, this arguably one of the most powerful Black women in America specifically to share this news at this moment?

Ronald Young Jr.: Man, Kai. It's tough. It's tough to hear, honestly, because even from the first half of this conversation to now, I think what I'm grappling with is this idea of obesity as a disease, which I understand how it's like technically fit in there. I understand the ways in which we're talking about health and wanting people to be healthy, but I can't help but feel a sense of some sort of danger or harm toward fat folks when we're equating health so closely to being thin in this very specific way.

It just feels like, in this instance, the way that we're talking about what health is and what that means to be healthy is so closely attached to not being fat that it-- especially in this moment when we're talking about GLP-1 drugs, it feels tough for fat people to be able to walk down the street, I've had friends tell me this, without now someone questioning whether they care about their health enough to take a GLP-1 drug. To have somebody like Oprah come along and say, "Well, I'm working on my health, so I'm taking GLP-1 drugs," to me, it just feels like the type of ammunition for a battle that I never asked to be a part of.

Kai Wright: How would you reframe it when people begin talking about these drugs? I think we want to get into the whole push and pull around health and weight and all of it, but how would you reframe it when people begin talking about these drugs? How do you invite people to think about it?

Ronald Young Jr.: I think for me, when I have a conversation with my doctor, I have a conversation with my doctor about the actual problems that I'm having. "Doc I have high blood pressure," and then my doctor says, "Well, let's talk about what you're doing. Are you walking? How much water are you drinking? What types of things are you eating?" All of those questions. I feel like I've been in conversations with doctors where it's been like, "Well, obviously you have high blood pressure. You are fat." I'm also Black and my dad, who is much smaller than I am, would not be classified overweight at all, he also has high blood pressure. I've had people even acknowledge the fact that Black men typically have high blood pressure, whether they're fat or not.

I think, one, we need to start looking at the actual health problems and say, "What can we do to fix this?" Now I know we're talking about something being upstream, which is obesity being the cause of these other factors, but I think it's one thing to talk about this scientifically and medically and listen to the actual facts that are being said in front of me, and then think about how this is actually received by people out there who just hear, "These fat folks need to be on GLP-1 drugs in order to actually get control of their health."

To be honest, Kai, I don't even think I gave you a satisfactory answer because I don't know how to reframe it. I just know that there's a danger of always equating health to thinness, and I think we have to start moving away from that.

Kai Wright: I want to talk about some of the things that you get to in your podcast. Just so that we can get on the same page in this conversation, Dr. Stanford, what do you hear when you hear Ronald saying that the idea of naming obesity as the disease, which is to your mind, an important medical development. He hears it as-- I don't want to put words in his mouth. He's just explained how he hears it. [chuckles] How do you think about that as a doctor?

Dr. Fatima Cody Stanford: I think a lot of it has to do with a lack of knowledge about the disease process. A lack of understanding of how the brain regulates weight, how the brain is interacting with the rest of the body, and a lack of understanding of even these medications and how they actually impact or cause mortality. What we know about GLP-1s, they've been around for 19 years, is that what we can see from studies.

I'm a physician-scientist. I publish studies on medications, on surgeries, et cetera, is from data from around the world. We know that these medications reduce major adverse coronary events. We know they reduce the risk for heart attacks. They reduce the risk for strokes. They reduce the risk for death from any cause. We know they reduce the risk for heart failure emissions.

We know they reduce the risk of kidney disease. If we know they reduce the risk of these issues, and if we know they reduce the risk in populations at large, then I'm not looking at these as necessarily deleterious to someone's health when I have meta-analyses that support the scientific facts that are.

Kai Wright: Let me stop you there.

Dr. Fatima Cody Stanford: I'm looking at the scientific data to support my information and also looking at what I see in patient after patient having treated over 10,000 patients with GLP-1s in my career. That's what I'm using [crosstalk]

Kai Wright: Because we're getting short in time for this segment, I just want to stop you there, because I don't want all the medicine of it to go past people. I wonder how do we have a conversation in our society where we are able to do both and where we're able to both deal with the very real consequences of diseases like diabetes and heart disease. I'm somebody who has buried a lot of people in my family from early deaths associated with those diseases that for them was associated with obesity. How do we have a conversation about that without also having a conversation that further creates shame, and tells people they have to look a certain way?

Dr. Fatima Cody Stanford: The thing is that one thing I never said, and I think that this is where we get into the issue, is I never said anything about thinness. I never said anything about the number on the scale. I think that people equate obesity to the number on the scale because that's unfortunately how doctors approach them regarding this. I never have ever, and you can ask any patient that I've ever treated for the disease of obesity, have given them a target number that they need to get to, a target BMI. I've never [crosstalk].

Kai Wright: Which is to say one thing is that we need to stop talking about numbers and talk about healthcare, which is what I hear you saying as well.

Dr. Fatima Cody Stanford: We need to talk about the health of the individual, so when I'm talking to you [crosstalk].

Kai Wright: Which is what I hear you saying as well. Right?

Dr. Fatima Cody Stanford: Right. Exactly.

Kai Wright: That you don't want to have a healthcare conversation that's about somebody's physical size.

Dr. Fatima Cody Stanford: Exactly. I talk about the health. Actually, my patients that have been with me, usually an average of 10 years when they then-- after even being with me for 10 years, say, "Hey, doc, what number am I supposed to get to?" I look at them and I say, "Wait a minute, we've been together for a decade or 12 years or 15 years. Have I ever given you an actual number?" They say," Well, no."

I said, "Well, why are we going to do that now?" I said, "How is your blood pressure?" "Oh, it's great, doc." "How is your blood sugar?" "Oh, it's looking good." "How are those liver function tests looking?" "Oh, it's fabulous." "How's that hemoglobin A1C looking?" "Oh, it's great." "Are you healthy?" "Yes." "Is that number important?" "No." "All right. I think we're doing good." I think if we can have that conversation, then we can get on the same page together.

Kai Wright: We're going to have to take a break, but when I come back, I want to come back to you, Ronald because I have a lot of stuff I want to talk to you about that you talk about in your podcast in terms of how these questions show up in our culture and have showed up in your life. As we can see, it gets complicated really fast when we try to do too much at once. I'm talking with Dr. Fatima Cody Stanford, an obesity physician at Massachusetts General Hospital. When we come back, we're going to hear a lot more from Ronald Young Jr. who is host of the podcast Weight For It.

We want to get to your calls if you have questions about the drugs, but also if you want to chime in on what Ronald is bringing to the table about how all of this. These conversations about health and obesity quickly and dangerously slip into a conversation that shames people for their size. I'm Kai Wright. Stay with us.

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Kai Wright: Welcome back. It's Notes from America, I'm Kai Wright. I'm joined by Dr. Fatima Cody Stanford, an obesity medicine physician-scientist, and by Ronald Young Jr. Host of the podcast Weight For It as in body weight. We're talking about new medications that treat obesity, and that could very well be a stepping stone to eliminating obesity, eliminating the disease altogether.

Also, we need to talk about how this conversation around obesity goes off the rails and contributes to shame and stigma around people's body size. Ronald, just to back up and talk about your own experience a bit and the stuff you share in your podcast, you discuss this notion of waiting for the perfect moment, that life won't begin until you lose a certain amount of weight. Tell me about that idea and how that's shaped your experience.

Ronald Young Jr: It feels like, generally, a lot when we talk about the ways in which we live life, a lot of what is covered is looking and being a certain way. A lot of that has to do with what we look like, how attractive we are, and in some cases, how small we are. It seems like with a lot of the messaging that we get in movies, music, television, what have you, it's this idea that once everything falls into direct alignment, that everything that you want will begin to happen for you, so you get the right education, you get the right job, and if you look a certain way, it's much easier for you to find that alignment than it is for others.

In a lot of ways, I feel like, regardless of whether we explicitly state that or not, it feels like the message that especially a lot of fat folks get is that your life doesn't start until you hit a certain size or till you look a certain way. In a lot of ways, it's felt like I've been waiting, W-A-I-T, waiting for that to happen.

Kai Wright: For you, what has been the process for unwaiting, I guess, [chuckles] particularly in a moment like this, again, where we've been through a year, where the culture, it's just-- where weight loss drugs are the buzzword of 2023. What has been the process for drowning that out?

Ronald Young Jr: You really can't. You know what I mean? There's no way to really force it out of your mind because it's always there. I don't think I've ever turned on the television, watched anything without having some thought about my body come up as a part of the conversation. When I say that, I mean, as part of the conversation or as part of the thoughts that I'm thinking in my head, like, "You can't watch a movie." There was the young man from the Bear. He just did a photo shoot, I believe, for Calvin Klein, and it's been all over Instagram. I'm forgetting-- I'm blanking on his name.

I'm sorry. Yesterday, during the week on Instagram, everyone was going crazy for his pictures. I remember looking and being like, "Man, that dude is ripped." That was the one thing that I get, is looking at this dude who's terribly in shape and saying, "I couldn't take those pictures and not be laughed at." It makes me automatically turn back towards society and say, "What do we actually value? Is it just esthetics?" I think that's why I get sensitive when we start talking about health, because then the idea then says, "I just want you to be healthy," and healthy just always feels like this catch-all phrase that doesn't actually mean what people think it means. There really is no getting away from it, Kai.

Kai Wright: One of the things that's striking in your podcast is you talk a lot about love and relationships and the ups and downs of dating. This is such a gendered conversation in general, and I'm so accustomed to, as a gay man, hearing people in my community talk about our bodies. I'm accustomed to a conversation about relationships with women and their bodies. I don't think we hear as much from men, from cis-gendered men, talking vulnerability about how they feel about their bodies. I just put that to you, do you agree with that?

Ronald Young Jr: I agree. We don't hear about it much at all. Honestly, I don't see myself reflected in society as much in a very specific way. You see fat Black men being funny or in some cases being strong, you know what I mean? What you don't see them nearly as much is being sex symbols in a way that's not meant to be a punchline to a joke. It just felt like something that I thought was worth talking about, mostly from my perspective, but I don't feel like my perspective is the default perspective for fat folks generally, because I think all of us can draw from each other's stories and experiences when it comes to culturally trying to live life, especially in American society.

Kai Wright: Let's go to Lydia in Chicago. Lydia, welcome to the show.

Lydia: Hi. I guess my question was, what is the perspective of treating eating disorders in a world where these types of drugs are starting to become increasingly more popular? As someone who is bulimic but not obese, but has family members who have been going on Ozempic and things that have lost, I don't know, 20, 30 pounds, but you are still bulimic and don't qualify because you're not that heavy yet. Do you gain 15 pounds so you can lose 40, or do you try to do it the right way and be healthy, so to speak?

Then your family members who were initially a lot more unhealthy than you take this drug and somehow are perceived to be magically healthier, even though, like the doctor mentioned, it's not equating to health per se.

Kai Wright: I want to put this to both of you. First, just on the question of these drugs and people with eating disorders, Dr. Stanford, what is the top line that you want people to understand about them?

Dr. Fatima Cody Stanford: First of all, in terms of these medications, that you surely should be in a comprehensive multidisciplinary center. In our center, we have obesity psychologists, we have five full-time PhD level psychologists. We have 5 bariatric surgeons, we have 7 dietitians, and we have 13 obesity medicine physicians. You would be seen by one of these team members and have a full team of individuals. If we don't feel as though you're appropriate for medications, then you might not be appropriate. Lydia, to answer your question, it sounds like several of these persons in your family might not be appropriate for these medications.

Doesn't mean that they're not appropriate for some type of treatment of some sort, but medications may not be the appropriate tool, particularly not medications within this treatment category. That's my thought process for this particular question.

Kai Wright: Ronald, just in general with-- I don't know how much they come up on your podcast, but in your conversations about eating disorders, how do you process-- I guess, how would you react to what Lydia is saying in terms of the conversation about obesity and disease and how it connects to the conversation about eating disorders?

Ronald Young Jr: I don't think we talk enough about-- and I think it's probably because, again, we're looking at fat folks. When we think about eating disorders, our thought of what an eating disorder is is automatically typically linked to anorexia or to binge-eating disorder. It's always the extremes, and a lot of that has to do with us evaluating a person on what they look like. It's unfortunate because I feel like because we are kind of framing it around what we see and what the stereotypes are around eating disorders, people that actually have them, that have gone through it, all of that, that have sought treatment come out the other end, I feel like they're probably having the toughest fight right now, fighting all the stereotypes that come with eating disorders, than it does the actual treatment of eating disorders.

I don't know. I wish I had a better answer. I still think it's something societally that we have to examine ourselves and saying, "What does any of this mean? What does it mean for a person to be very, very thin? What does it mean for a person to be very, very fat? What are we actually grappling with when we think that a person should be one or the other?"

Kai Wright: Let's go to Laurel in Minneapolis. Laurel, welcome to the show.

Laurel: Hi. Thanks for taking my call. I'm a medical student at the University of Minnesota. There's a lot of us coming up in the medical field who feel differently about thinking of weight as a disease from scientific reasons, but also from ethical reasons. Earlier, Kai, I heard you say something about eliminating obesity, and then you caught yourself and you said, "Eliminating obesity as a disease."

I think that points to a lot of the ethical concerns that a lot of us have about the way that we think about weight as a disease because it really feels to people like we're trying to eliminate fat people in general when we talk about obesity as if it is a disease, instead of just one of many spectrums that people exist on. I think a lot of us are really pushing to stop pathologizing weights and really just trying to start thinking of it as something that affects people's health like any other form of oppression might.

Kai Wright: Thank you for that, Laurel. Dr. Stanford, we talked about this a little bit already. I want to ask you as a physician who is working in this space. Setting aside the science questions of it-- if that's possible. I realize that maybe that's ridiculous. In how it's discussed, is this a language issue? How you as a physician can talk to people about disease without implying that people's body size is the problem.

Dr. Fatima Cody Stanford: I don't think that we're doing that. I have patients that are 350 pounds that have obesity but their size isn't their problem. They still have the disease but they are healthy still at their size. I'm going to talk about one of my absolute most, I guess, transformative patients that I've ever had in my career, and that's my train conductor patient. The patient that really transformed my career when I first came to Boston.

When I first came to Boston, I lived on the north shore of Boston and used to have to take the commuter rail into downtown Boston. This gentleman was a gentleman that had significant size. I'll tell you what his size is when we get to that point. This was indeed a patient that I wanted to have. I could see him laboring up and down the train as he went to take the tickets as I came into downtown Boston on my way into work as a first-year obesity medicine fellow.

I couldn't say to them, "Hey, I'd love for you to become my patient." I want you to fast forward about three to four years into the future, which of course, is now several years in the past. I walk into my office one day and I exclaim, "Oh my gosh, you're the train conductor." When I went to evaluate him on the first day, he was 550 pounds. I was like, "Oh my gosh, so excited to see you." He's looking at me. He has no idea who I am because to him, I was just one of the people smooshed against the train wall taking my ticket every day. I was just so excited. I was like, "Oh, I'm so glad to take care of you." There was a woman that was sitting there who started to cry. This woman who was here with this middle-aged man who was there started to cry.

This was his mom that had come to his visit to explain to me how he had been doing all of this work, always been working for his whole life, had struggled with his weight. She didn't have to tell me any of that because I had watched this for all of the time I had been taking the train into downtown Boston. For his whole life, she had been trying to convince doctors that he indeed mattered, but nobody ever cared because he was a man of significant size. When he first started as my patient, I told you he was 550 pounds, but now at a little over 300 pounds, he no longer has high blood pressure. He no longer has sleep apnea. He no longer has pre-diabetes. He no longer has fatty liver disease. He is healthy at a weight just over 300 pounds.

I say all that to say to you that I am not trying to get him to a weight below where he is. He's not being pathologized at his current weight. His weight is happy and healthy where he is. He can coexist in my clinic at a happy, healthy weight where he is, where his numbers are indeed at harmony with his body type. That's where we can have this conversation in a way that harmonizes with the work that I do in science, and one that harmonizes with the health that he needs to be.

Ronald Young Jr: Can I say one thing? I appreciate you, doc, for everything that you said and the way that you approached that. I think what I have issue with is that you are one doctor and you have your practice. I think it's important. I think it's important the way you said everything you said, and I think it's important what you're doing, but I'm saying, a lot of us that are dealing with doctors generally are not dealing--

Dr. Fatima Cody Stanford: Don't have me.

Ronald Young Jr: That's exactly what my point is.

Dr. Fatima Cody Stanford: I agree with that. I want more of me.

Kai Wright: Dr. Stanford, let me let Ronald finish, please. Go ahead, Ronald.

Ronald Young Jr: I encourage y'all to listen to episode three of Weight For It. It's called Weight, Don't Tell Me. I have an interaction with a doctor on that episode, in which I walk into the room having already lost 29 pounds, and ready to tell my doctor, "Hey, this is what I'm doing." Listening to him go into this blackout mode of just saying, "Hey, well, you need to be on the treadmill. You need to be doing this. You got to do cardio. You got to eat right." I'm like, doc," I'm already doing all that and I'm losing weight." Then it turns into, "Well, you don't want to lose weight too fast. You don't want to lose it too fast."

I'm like, "Well, if I do everything that you're telling me to do, I'm probably going to lose at a high rate anyway. I don't understand." I feel like most of the interactions that we're having with medical professionals are not what you just described. You just described something that blew my mind, doc. You just described something that blew my mind.

Dr. Fatima Cody Stanford: I agree with you, and this is part of why I do what I do. It's because I believe that we as docs-- and it's not just as docs, it's nurses, it's exercise physiologists and the list goes on in healthcare, we are taught one thing. We are taught to believe that BMI is the end all be all, and we ascribe that to one's health. I don't agree with that. That's what set up this negative dynamic that's created this really unfortunate conversation that makes it such that you, not you individually, but most don't want to come in to see us.

Ronald Young Jr: Also me individually, but yes.

Dr. Fatima Cody Stanford: It's unfortunate.

Kai Wright: Also, Ronald individually. We are at the very end here of a conversation that could go on for centuries. 30 seconds each. Ronald, where do you want to leave people in this moment as they think about the cultural conversation around Ozempic?

Ronald Young Jr: I think my biggest fear, and I think Doc can speak to this, is that a conversation that has been for the longest time, people looking me earnestly in their eyes and say, "I'm just concerned about your weight," are now going to look at me when I don't want to take a GLP-1 drug and say, "Don't you care about your weight?" I feel like I really want us to be in a place where we're battling even further upstream and starting to have conversations about food regulation and what actually is going in and what's addictive and what's not. There's other paths to obesity beyond just what's going on in our brains.

I think the GLP-1 drugs are addressing one thing, but what else can we address if this is a disease that we need to get down, which I have my own qualms about calling a disease, but I understand. I know that was over 30 seconds. I'm sorry.

Kai Wright: It's okay. We are going to have to leave it there though. Ronald Young Jr. is host of the podcast, Weight For It. Dr. Fatima Cody Stanford-- I'm going to get your name right on one of these chances, Dr. Cody Stanford, is an obesity medicine physician and an associate professor of medicine-pediatrics at Massachusetts General Hospital. Thanks to you both. Thanks to everybody who called in. You can keep talking to us. Just go to notesfromamerica.org. Look for the button to record a voice note right there.

This week's show was produced by Suzanne Gaber and Felice León. Music by Jared Paul. Matthew Miranda was our live engineer. We are a production of WNYC Studios. I'm Kai Wright. Thanks for spending time with us.

 

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