CMHC Pulse Blog

CMHC Faculty Are Policymakers

When Fatima Cody Stanford, MD, MPH, MPA, MBA, took the stage at the Spring 2022 Cardiometabolic Health Congress (CMHC) in Scottsdale last month, she was recognized even by audience members who hadn’t met her or seen her speak live. For many, Dr. Stanford’s reputation as a tireless advocate for reducing disparities in obesity medicine precedes her. Not only is Dr. Stanford an accomplished leader in organizations such as the Massachusetts Medical Society, American College of Physicians, American Academy of Pediatrics, American Heart Association, The Obesity Society, American Medical Women’s Association, and the American Medical Association, she takes her passion for reducing health care inequities to the U.S. Congress to instigate institutional change. Come to Boston this October 19-22 to see Dr. Stanford live as she dispels common myths about obesity at CMHC’s 17th Annual Congress: The Present and Future of Cardiometabolic Health: Advances and Expert Perspectives. 

Dr. Stanford’s compelling message at CMHC Spring 2022

In her CMHC Spring 2022 session, Addressing Bias, Stigma, and Racial Disparities in Obesity Care, Dr. Stanford explained that growing up in the Southern U.S. was an impetus for her interest in pursuing a career in obesity medicine. Now an associate professor of medicine and pediatrics at Harvard Medical School and a practicing obesity medicine physician-scientist, Dr. Stanford’s interest in health policy and health disparities stem from her background growing up as a Black woman and seeing how obesity affected her community. Her lab at Massachusetts General Hospital is focused on obesity as a disease in children, adolescents, and adults and on disparities in both health care and health systems.

In Scottsdale, Dr. Stanford was quick to point out several flaws in the way many doctors currently treat and even refer to obesity. She passionately called for the immediate cancellation of the words “morbid” and “obese.” Referring to someone by their disease is outdated and insensitive; it is “a patient with obesity,” not “an obese patient.” Also, there is no need to qualify a person’s disease state as “morbid.” No one has morbid cancer or morbid COVID-19, so there is no reason to say someone has “morbid obesity” or is “morbidly obese.” This language shift is a cornerstone of the policy she was instrumental in getting the American Medical Association (AMA) to adopt.

Dr. Stanford then presented some alarming insights on the history of the scale used to measure obesity. Body Mass Index (BMI), the measure used by health professionals for more than 100 years to determine if their patients are overweight, is scientifically, medically, statistically, and logically unsound. It was invented by a Belgian mathematician (not a physician) to determine the “mathematical mean” of a population, which he believed was its ideal. The problems with how the scale was created and used are too many to list, but for Dr. Stanford’s purposes, BMI measurement, besides being outdated and inaccurate, also perpetuates racial, ethnic, and gender bias because – you guessed it – it was created in 1832 using data from only white European males.

Obesity: a disease or a choice?

Despite the many issues with the way physicians and the public speak about, treat, and measure obesity, it is a frightening reality that more than 40% of adults and 20% of children in the U.S. have obesity. Until 2013 when obesity was finally recognized as a disease by the AMA, many people (including physicians) understood obesity as a lifestyle choice based on the flawed model of calories in vs. calories out – whereby individuals with obesity simply ate too much and moved too little. Although the medical community now understands that this disease is a complex interplay between the brain, environment, genetics, culture, development, and behavior – public policy is lagging to catch up.

Person-first legislation

A policy adopted by the AMA in 2017 declaring person-first language regarding patients with obesity was brought sharply into focus by Dr. Stanford. The policy discourages stigmatizing terms (remember when she banned “morbid” and “obese” earlier?) and emphasizes that facilities should have properly sized furniture, gowns, and medical equipment so that patients with obesity feel respected. She also advised the American College of Physicians to review obesity medicine education to ensure students received comprehensive training. The systematic review of the obesity education by Dr. Stanford and her colleagues found a lack of active engagement in obesity-related training material among medical students, resulting in an explicit bias against patients with obesity. “Based on our review, increasing obesity-related educational content at all levels of medical education will equip students with the tools and the confidence to effectively and compassionately treat patients with obesity,” they concluded.

Treat and Reduce Obesity Act

The Treat and Reduce Obesity Act was first introduced to U.S. Congress in 2012 with directives to:

  • Include information on the coverage of intensive behavioral therapy for obesity in the “Medicare and You Handbook.”
  • Direct the Secretary of Health and Human Services to give Medicare beneficiaries, primary care physicians, and other appropriate service providers and suppliers distinct, written notification regarding the coverage of intensive behavioral therapy for obesity under Medicare as an additional preventive service.
  • Direct the Secretary to develop and implement a plan to coordinate the efforts of all HHS offices and agencies to treat, reduce, and prevent obesity and overweight in the adult population.
  • Authorize the Secretary, in addition to qualified primary care physicians and other primary care practitioners, to allow other appropriate health care providers and instructors trained in lifestyle counseling programs such as the Diabetes Prevention Program and programs recognized by the Centers for Disease Control and Prevention (CDC) to provide intensive behavioral therapy for obesity.
  • Authorize the Secretary to cover chronic weight management drugs under SSA title XVIII part D (Voluntary Prescription Drug Benefit Program) if the Secretary determines that such coverage is appropriate.
 

As an indicator of the profound systemic roadblocks of passing legislation to address the challenges of obesity, the act failed to pass in 2012, and has stalled at the federal level in every congressional session since. The inaction of Congress to support this policy reflects misconceptions about obesity as a choice and a lack of awareness of the significant burden obesity puts on the health care system.

The current legislation: Treat and Reduce Obesity Act of 2021

Now, Dr. Stanford and her tenacious colleagues call for the government to finally adjust their mindset about obesity to one informed by science rather than prejudice. In order to enact change, they say policymakers must abandon the old view that obesity represents a lack of personal willpower and, like the AMA and other leading health organizations, recognize obesity as a serious disease. The Treat and Reduce Obesity Act of 2021 is back before U.S. Congress and would:

  • Expand Medicare benefits for intensive behavioral counseling through community-based programs and additional types of healthcare providers
  • Expand coverage of FDA-approved prescription drugs for chronic weight management
 

After a decade of stalling in Congress, Dr. Stanford and other intrepid providers of obesity medicine are hopeful that 2022 will be the year this act will finally pass to create fundamental change in the medical community’s understanding and management of obesity.

Key takeaway

As the first Black obesity medicine physician-scientist, Dr. Stanford’s impassioned pursuit of health equity has risen to the national level. To support her efforts to pass the Treat and Reduce Obesity Act of 2021, please visit the Obesity Action Coalition Action Center to urge your state’s representatives to support or cosponsor the landmark legislation.

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