How Do We Treat Obesity?

Interview podcasts are as common as hidden fees in today’s world. Think about it. They’re cheap to produce, easier to set up than on-location recording, and enable the guest to fill in most of the script with their comments and observations.

Most interview podcasts market themselves as having culturally relevant conversations on topics of social importance. The reality, however, is far different from the hype.

Interview shows like Something You Should Know and The Jordan Harbinger Show are solid interview podcasts with interesting guests a host that knows how to ask probing questions, then listen to the response and follows up.

The New York Times’s interview podcast, First Person, is one of the best in the genre. The show’s tagline is: “Every opinion starts with a story. Intimate conversations about the big ideas shaping our world, hosted by journalist Lulu Garcia-Navarro. From New York Times Opinion.”

Garcia-Navarro has Ira Glass-level interviewing skills, and the topics chosen resonate with listeners. Consider some of the recent episodes.

Why Does Big Tech Make It So Hard to Fix Your Devices? — The C.E.O. of iFixit is fighting for your right to stop shopping and start repairing.

The Veteran Outing Domestic Extremists — Veterans are valuable recruits for far-right groups. Kris Goldsmith wants them to fight back.

A Librarian Spoke Against Censorship. Dark Money Came For Her. — Now she’s fighting back.

In the most recent episode of First Person, host Lulu Garcia-Navarro speaks to Dr. Fatima Cody Stanford, a professor at Harvard Medical School and Obesity Medicine Specialist at Massachusetts General Hospital.

When Dr. Stanford entered medical school in the early 2000s, obesity medicine was not part of the curriculum, even though obesity rates in the United States have been steadily rising since the 1980s.

Since then, she’s spent her career pushing for changes in the way the medical establishment thinks about and treats obesity, calling for interventions that recognize the condition as a disease, not simply a failure of willpower.

And one of those interventions is medication. As new weight loss drugs like Ozempic and Wegovy enter the market, Dr. Stanford finds herself at the forefront of a larger cultural debate about weight loss, body image and the role of medication in it all.

You can listen to this episode of First Person on Apple, Spotify, Google or wherever you get your podcasts. The full transcript of the interview can be found here, with highlights below:

Fatima Cody Stanford

“A lot of people believed that obesity was just a consequence of other diseases as opposed to a cause of the 200 plus diseases that obesity does cause. That was one of the arguments. A lot of people pointed to a lot of the behavioral studies that did demonstrate for some people that they had achieved success in interventions like Weight Watchers, like you mentioned earlier, or community level interventions. And so there was this pushback against this being a disease characterized by pathophysiology in the body. And a lot of that, I would say, came from the public health space, this idea that we can fix it if we just work harder.”

Lulu Garcia-Navarro

“Dr. Stanford, let me ask you this. What does that mean? When you say you began to see that obesity is a disease, what is it a disease of? I mean, do we know what causes obesity?”

Fatima Cody Stanford

“So I’m going to say it’s a disease of the brain. And the reason why I’m going to say it’s a disease of the brain is because the brain regulates how the body stores fat. The brain is the central operating system.”

Fatima Cody Stanford

“If the brain’s not there, the rest of the body doesn’t work. So let’s explain what happens. There are two primary pathways by which the brain will regulate weight. There is the pathway that tells us to eat less and store less, what we call the POMC or proopiomelanocortin pathway, or AGRP pathway, which is the agouti-related peptide pathway, which tells us to eat more and store more.”

Fatima Cody Stanford

“And we don’t choose. And this is where the willpower issue goes away. My organs, my genetics, my environment, all of these things can play a role in whether I signal down the more desirable pathway or less desirable pathway. And so this comes the complexity of this disease that is obesity. Why do certain people signal one way and other people signal another way?”

Lulu Garcia-Navarro

“Well, help me understand this. Our genetics haven’t completely changed in the past 40 years. Yet, we’ve seen this huge increase in the number of people living with obesity. So what’s changed? I mean, are there environmental factors at play?”

Fatima Cody Stanford

“Absolutely. So we’ve placed our bodies inside of what we call this obesogenic environment. And this gets into those environmental factors and how they play a role.”

Fatima Cody Stanford

“How has diet quality changed? How has our sleep quality changed? Our screen time, how does that disrupt or affect our circadian rhythm? We’re supposed to rise when it’s bright outside and go to sleep when it’s dark outside.”

Fatima Cody Stanford

“But I can tell you that most of us don’t follow that as our inherent rhythm. So when we deviate from all of these things, put ourselves in this world that our bodies weren’t really created to be in, it’s going to lead to a greater storage of adipose or fat. It’s stress on the body. And when we have stress, stress increases storage of an organ that has typically helped us out. And that organ is adipose or fat.”

The full transcript of the interview can be found here.