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This podcast series features Mass General Brigham researchers whose work is redefining what's possible and how we care for patients. Our goal is to spotlight transformative discoveries, the people leading these transformations, and how they can improve patient outcomes, highlighting how today's research is shaping the future of medicine, including training the next generation of clinicians and scientists.
This podcast series is not accredited for CME/CE at this time.
SEASON 1: Crossing Medical Frontiers: Research Innovations Transforming Care hosted by Dr. John Co
SEASON 2: Learn, Discern & Return: An MGB Physician's Journey hosted by Dr. Erik Alexander
Hello. Welcome to our new podcast series, Crossing Medical Frontiers, Research Innovations Transforming Care. My name is Dr. John Co, and I'm the Vice President for Education at Mass General Brigham. This podcast series features Mass General Brigham researchers whose work is redefining what's possible for how we care for patients and improve health across populations and the world.
John Co:Our goal is to spotlight transformative discoveries, the people leading them, and highlight how today's research is shaping the future of medicine. Today, I'm delighted to be speaking with Doctor. Fatima Cody Stanford, an obesity medicine physician scientist, educator, and policymaker at Massachusetts General Hospital, and associate professor of medicine and pediatrics at Harvard Medical School. Dr. Stanford, it's great to have you with us today, and thanks for joining us.
John Co:I'd like our audience to get to know you a little bit, you know, as a person. So, tell us about yourself. Tell us how you got interested in obesity medicine.
Fatima Cody Stanford:Absolutely. Well, first, it's a delight to be here with you. And I think my journey to obesity medicine is somewhat circuitous in fashion. As a black woman physician scientist growing up in Atlanta, Georgia, I was always plagued with this issue of really understanding why obesity seemed to disproportionately affect black women more than any other demographic. If we look at the statistics and look at which group has the highest rates of obesity here in The United States, we notice that black women seem to have the highest rates of obesity, and that's despite socioeconomic position.
Fatima Cody Stanford:And I really was perturbed by this. Why is the demographic to which I belong have the highest rates of obesity? And so I was really drawn to this field by trying to discern that this is what brought me to the field. This is what has had me study the science, the implications behind lifestyle implications, and understanding what about lifestyle has brought us here, but also some of the genetic predispositions to obesity and looking at issues like allostatic load. And so that's what has really brought me to the field today.
John Co:So tell us tell us more about your research. Like, what are the main questions that you're trying to answer? And if you were to answer them, how is it going to improve how we care for patients, population health? How would it change and revolutionize the care that we deliver for obesity?
Fatima Cody Stanford:Absolutely. So I'll talk about some of the research that I've done previously, and then I'll bring you to some of the research that I'm doing now. Some of the research that I've done previously has looked at questions of understanding how we can use different modalities or therapies to address the issue with obesity. So how can we combine, for example, pharmacotherapy, meaning medications to treat obesity, with things like bariatric surgery. Previously, we've looked at these as really separate entities, and so my research was really the first research to combine looking at bariatric surgery with pharmacotherapy and discern that if we put these two modalities together, we can get better outcomes with particularly for persons with severe obesity.
Fatima Cody Stanford:And I'll take you to just my clinic yesterday. I was looking at patients that were coming in that are having better outcomes than looking at these two modalities as distinct entities. I had a woman who's actually about to take a trip to Sri Lanka today. Her starting weight with me, three hundred and fifty eight pounds. Happens to be a black woman, by the way.
Fatima Cody Stanford:Weight yesterday, a hundred and sixty five pounds. I had no idea when she came into me that we would be able to garner such a differential, 48% total body weight loss combining metabolic and bariatric surgery in the form of a Roux-en-Y gastric bypass with a GLP-one GIP, which is a glucagon like peptide one receptor agonist with a glucose insulinotropic polypeptide together. And we have been able to cause her type two diabetes to go into remission, her obstructive sleep apnea to go into remission with these two modalities together. And so my early research has really looked at a lot of this therapy. Some of my current research is looking at some of the clinical trials.
Fatima Cody Stanford:How can we advance some of the pharmacotherapy work that we're doing? What what can we do? We've talked about some of the dual agonist medications, and some of my work is looking at triple agonists. Okay? So we have two mechanisms, but why can't we add a third agonist or a third mechanism?
Fatima Cody Stanford:And that's looking at a glucagon receptor agonist added to a GLP one, a GIP, and a glucagon. So running trials to see how advanced can we get in our pharmacologic therapy to treat patients with obesity. And I think that that's going to help advance the therapies that we can offer individuals, particularly as we look at the gun gut brain axis when looking at individuals that have obesity and how we can overcome their predisposition to carrying excess adipose tissue, when, looking at their disease process.
John Co:What about the issue of access to these therapies? I mean, we're developing such groundbreaking research here and some say, okay, but can every patient or every individual in our society access these things?
Fatima Cody Stanford:I think this is a major issue to ponder and some of my research published recently in the Annals of Internal Medicine and the Journal of Journal of Internal Medicine actually addresses this key issue. Right now, individuals that are predisposed or have the highest burden of disease, we've already talked about racial and ethnic minority populations having a high burden of disease, aren't actually getting access to these therapies because they are cost prohibitive, and this is really something that is a major concern for individuals. If we're looking at those that have employer sponsored insurance, those like ourselves that are here at Mass General Brigham, versus those that have, government sponsored insurance like Medicare, Medicare does not cover therapy for individuals that have obesity. There is no coverage. So I'm seeing patients that as they're moving from their employer sponsored insurance over to Medicare lose access to these medications.
Fatima Cody Stanford:And if we think about the individuals most likely to benefit from these therapies, particularly if we look at the reduction in major adverse coronary events which we see from the SELECT trial, if we see improvement in kidney outcomes, if we see improvement in heart failure outcomes, these patients that are most likely to benefit are those that are of advanced age, those that are older adults. Unfortunately, they move to Medicare, which is usually that 65 population, they're losing access to these therapies. And why this is really concerning is because these patients may have received great benefit of being able to take them off of other therapies that they were on for, let's say, hypertension or for type two diabetes, other therapies. And as they're moving off these therapies, we're seeing their weight regain and we're seeing reemergence of those conditions that were being well treated or managed with the use of these medications. That's unfortunate.
Fatima Cody Stanford:What about our individuals that are on Medicaid? Here in Massachusetts, that's called MassHealth. For those that have lower socioeconomic position, they aren't able to access these therapies. And that's unfortunate because we know that those who of lower socioeconomic position are disproportionately facing the burden of obesity. So what happens is these individuals are not getting access to these therapies, and they're cross prohibitive.
Fatima Cody Stanford:So companies are saying, okay. Well, we're gonna offer these to patients, and they're discounting them. Well, let's talk about the discounted rate of these medications. $350 for the lower dose of the medication, $500 a month for the higher dose medication. That's still cost prohibitive for many individuals.
Fatima Cody Stanford:Can they really afford that on a monthly basis for these medications? And the answer is a resounding no. So what happens is they can't get access to these therapies. We can come up with the most advanced therapies, but it's really like it being on a shelf that people can't access. And I'm really concerned about this even as we continue to advance the fill and get access to therapies that are really revolutionary and and going to the source of treating these this really complex multifactorial disease, the patients that really need access to these therapies can't get access, and that's really concerning for me.
John Co:Is there other research going on at Mass General Brigham in obesity medicine? And what is that research, and what would you like people to know about that and how it connects to your own work?
Fatima Cody Stanford:Well, there's a lot of work being done in the sleep realm, so looking at circadian rhythm disorders and how circadian rhythm disruption affects obesity, a lot of people are unaware that if we have circadian rhythm disruption, that causes greater storage of adiposity. So for example, if we think about our night shift workers, and we know that in medicine we have a lot of night shift workers. We can't have babies deciding when they want to be born. But if you're a night shift worker, you have greater storage of adiposity. So we have people like Frank Shearer who's here at the Brigham doing a lot of work looking at how night shift work causes greater storage of adiposity.
Fatima Cody Stanford:That's some wonderful work that's being done on the front of looking at adiposity and circadian rhythm disruption. I think that that's really astonishing work that's being done. I mean, we have to go back to the to the really core of looking at GLP-1s. Where did that start? Really, a lot of our work in terms of the discovery of GLP-1 started right here at Harvard Medical School.
Fatima Cody Stanford:So if we go back to the late seventies, early eighties and look at discovery of GLP-1 as a molecule first utilized for the treatment of type two diabetes onto, of course, the treatment of obesity, that started right here in the hallowed haze of Harvard Medical School and, of course, here at the Brigham at MGH where we've been able to utilize these therapies. And so a lot of great work is being done in the realm of looking at GLP-1's , but also in other fields and domains as we think about the full gamut of the etiology of obesity and how that work is being done across the full domain of looking at this complex multifactorial disease process.
John Co:So as you know, I'm very vested in medical education. And I'm curious, if you're interested in obesity medicine and you come here, how would one get involved in this kind of research? Like, what would they have to do to get involved and work with someone like yourself or others in this field?
Fatima Cody Stanford:Think is very important. And one of the things that really attracted me as a trainee that came and did my three years in obesity medicine fellowship before coming on the faculty was the fact that this was a rich environment for education. I knew that I could come here, become invested in the research, and seek out individuals across the entire Master or Brigham ecosystem. And I feel that individuals approach me and approach others and find that we're receptive to trainees. I have currently over a 100 mentees, so I'm not necessarily seeking additional trainees.
Fatima Cody Stanford:But for those that are seeking additional trainees, you go to them and say, hey, this is a project that I'm interested in. I'm interested in this area of of focus within the obesity nutrition space. I would love to be someone that's mentored by you in this work. I'm looking at doing this population based research. I'm looking at doing this basic research or clinical research.
Fatima Cody Stanford:How can I be mentored by you or be integrated in your space? If you were not the person, do you know who you could, you know, introduce me to? And that's exactly what type of relationship we foster here within the MGB domain. There's so many cross collaborators. I think about one of my closest collaborators, the Brigham, Carolina Povian.
Fatima Cody Stanford:We've done so much great work together. I see her as a colleague, a friend, a collaborator. She's been involved in some of the pioneering clinical trials if we look at pharmacotherapy and has been a person that I consider a mentor, but also a friend who's done this work. And so if we're thinking together and we put our thinking caps in, we say, oh gosh. This would be a wonderful person to usher in to this environment.
Fatima Cody Stanford:And we set that person on a path or trajectory that allows them to become one of the greats in the space. And that's exactly what we do here at the MGB.
John Co:So is there anything else you'd like our audience to know about obesity medicine research here? Whatwhere's the field going? And if we are successful at advancing the science, how is it going to improve how we care for obesity?
Fatima Cody Stanford:Well, think right now, there's nowhere you can go where we're not talking about obesity and obesity nutrition research. If you're looking at social media, if you're looking at television, if you still do that, we are talking about obesity in nutrition research, and I think it's important for us to recognize that this is a ripe area of consideration. And so we need to recognize that at MGB, we're pioneering a lot of this research. I'm so excited to have been able to come here to do my training and to be able to grow and be one of the key leaders in this space and to be able to usher in others that have come on to from my individuals that are an undergrad that have gone on to become Rhodes and Marshall scholars. I have over seven of Rhodes scholars that have come behind me that I've been their their recommenders and their mentors.
Fatima Cody Stanford:And for those that are that are more senior, that have gone on to become, you know, associate professors, etcetera, in institutions around the country and around the world. And I'm just thankful to be a part of the sphere that's ushering in the education and knowledge of treating the most prevalent chronic disease in human history, which is obesity.
John Co:Doctor Stanford, thank you so much for being here with us today. It's been a pleasure to get to know you as a person and also about your research.
Fatima Cody Stanford:Thanks so much for having me. It's been a delight to be here, and thanks so much for allowing me to share my expertise with the listeners.
John Co:For the next episodes of this podcast series, we will be speaking with Doctor Chi Fu Yang, a thoracic surgeon at MGB, the founding director of the Center for Artificial Intelligence and Innovation Research, whose expertise is in lung cancer screening and research and policy, and Doctor Pradeep Natarajan, the Director of Preventive Cardiology at Mass General Hospital, whose expertise is in precision medicine and genomics. We hope you will subscribe and join us.