QUALITY IMPROVEMENT
New Understanding of Obesity: All Science, More Treatment, No Bias
By Sara Wildberger
(master of public health), MPA (master of public administration), MBA (master of business administration), FAAP (Fellow of the American Academy of Pediatrics), FACP (Fellow of the American College of Physi- cians), FTOS (Fellow of the Obesity Society), and more. Her curriculum vitae is 144 pages long—notable current positions include fac- ulty at Massachusetts General Hospital and Harvard Medical School and teaching and treating patients through the Massachusetts General Hospital Weight Center. As one of the first fellowship trained
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obesity medicine physician-scientists and educators, she is unique in the world, not only for her depth and breadth of training but for her dedication to increasing knowl- edge about and treating obesity. In the past year, she was a peer review
panelist for the Gerontological Society of America’s report, “Obesity in Older Adults: Succeeding in a Complex Clinical Situa- tion.” As the report stated, the combination of obesity and age-related challenges “can create complex clinical situations without easy solutions.” However, none of those solutions should
involve stigma, blame, or shame—in medi- cal science, obesity is recognized as a chron- ic medical condition, not a personal failing. Passionate about the need to follow the
evidence, treat obesity as the chronic disease it is, and eliminate myths, blame, and bias, Dr. Stanford advocates creating a highly individualized and continual treatment plan for people with obesity. She also is careful to use person-centered language; that is, not referring to “obese people” but “people with obesity,” as one would for other diseases.
44 SENIOR LIVING EXECUTIVE MARCH/APRIL 2022
r. Fatima Cody Stanford has more credentials than will fit next to her photo: Add to MD the letters MPH
Q. The GSA report showed a new way of regarding obesity and how it affects older adults. Can you share the basics of this view? A. Obesity is a complex disease that spans across ages. But as we home in on what we see in older adults, it’s important for us to recognize that in our population as a whole, obesity isn’t recognized for the disease that it actually is. Obesity is a chronic, complex, multifac- torial disease—genetics, development, en- vironment, and behavior all play a role in a person’s likelihood of having the disease. As we age, we develop more perturba-
tions leading to a higher predisposition to developing obesity. I will give the caveat that as we get to
around the age of 65, we may start to see weight go down slightly. That’s not a good thing; typically, it’s because we’re losing muscle mass, developing atrophy or loss of muscle. It’s not just the number on the scale that
matters. People hyper-focus on that number. But what’s important is where fat is being carried, for instance.
Q. Is obesity on the rise? Should we in senior living be getting ready for this to be a bigger problem? A. We should recognize that it probably is already a problem. When we look at who’s most likely to seek care for obesity, the num- ber one demographic is postmenopausal white women. That’s when they’re finally starting to come in to seek treatment. They realize: Oh, my gosh, I have obesity. And not only do I have obesity, but I also have several other chronic diseases associat- ed with that. I’ve been trying to look at my diet. I’ve been trying to exercise. I’ve been trying to look at the quality and duration of
Though Leader Profile
Fatima Cody Stanford, MD Massachusetts General Hospital Harvard Medical School
my sleep. But despite all of those things, I’m still struggling with my weight. This is the time to seek care.
Q. What does that care consist of? A. These may be lifestyle modifications or behavioral therapy—which might include work with one of our psychologists—or medications, or surgical interventions. But because obesity is a chronic disease, what- ever modality or treatment we’re using re- quires consistent follow up, and the degree of frequency of follow-up will vary from person to person. Obesity doesn’t go away. There’s no
magic treatment; even with metabolic and bariatric surgery, which is by far the most ef- fective for moderate to severe obesity, what we find is that people still require lifelong attention and care to monitor not only their weight, but also obesity-related diseases.
Q. Another challenge for older adults is that they may have several chronic conditions at once. What is the relationship to obesity? A. There are over 200 diseases that are as- sociated with obesity. I’ll just rattle off some: obstructive sleep apnea, osteoarthritis, kidney disease, heart disease; 15 types of cancer have obesity as the primary causitive factor.
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