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Obesity and Aging: All Science, More Treatment, No Bias


By Sara Wildberger

Dr. Fatima Cody Stanford headshot, Black woman, dark straight hair, red blouse
Dr. Fatima Cody Stanford

Dr. Fatima Cody Stanford, who shares thoughts and findings on obesity and aging here, is one of the first fellowship trained 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 knowledge about and treating obesity.

She has more credentials than will fit next to her photo: Add to MD the letters MPH (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 Physicians), FTOS (Fellow of the Obesity Society), and more. Her curriculum vitae is 144 pages long—notable current positions include faculty at Massachusetts General Hospital and Harvard Medical School and teaching and treating patients through the Massachusetts General Hospital Weight Center.

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 Situation.” 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 medical science, obesity is recognized as a chronic 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.

Q. The GSA report showed a new way of regarding obesity and aging. 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, multifactorial disease—genetics, development, environment, and behavior all play a role in a person’s likelihood of having the disease.

As we age, we develop more perturbations 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 number 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 associated 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 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, whatever modality or treatment we’re using requires 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 effective 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 associated 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. Every organ system is impacted by obesity.

Obesity is a chronic inflammatory condition. This chronic inflammation can lead to significant other diseases.

That’s why, by the way, obesity is such a risk factor for both sickness and death related to COVID-19. That chronic inflammation is present for individuals who have the chronic disease of obesity, who then develop that acute inflammation associated with COVID-19.

Q. As obesity is a disease, is there a cause—and a treatment?

A. We say it’s a multifactorial disease: The causes can be maternal and fetal issues, psychological reasons, food and beverage behavior, and environment—everything, basically, is a potential trigger.

We’ve been focusing on having people eat fewer calories or get moving more—yet we see rates continue to increase, even as so many people increase their activity and try to eat healthier. That’s because causes and treatment is so much more complex than “calories in, calories out.”

My goal when I’m working with a patient is to figure out the variety of potential factors that led to that person having obesity—and then, determining how I develop treatment strategies that help them get to their healthiest and happiest.

Q. Many people in senior living are taking medications that can affect their weight—is this an issue?

A. Absolutely. I take an assessment of what patients are taking and see if they might be on a medication that’s no longer necessary or can be adjusted. For instance, Lyrica and gabapentin can cause weight gain; I’ve had patients gain up to 80 pounds from these medications.

Q. Senior living culinary services have started using evidence-based diets such as the MIND and the Mediterranean diets—do these types of diets help?

A. In treating obesity, we always start with the lifestyle. Food does matter. We want to focus on less processed foods, because the body stores highly processed foods very differently than foods that are less processed. We want lean protein, whole grains, fruits, and vegetables to be our predominant food sources. Dieticians and menus are very helpful.

Physical activity is also key. The goal for humans, adults older or younger, is to have at least 150 minutes of moderately intense physical activity per week. If you have obesity, the target is 300 minutes. “Moderate intensity” means you can talk during the activity, but you cannot sing, because your breathing should be too labored for you to carry a tune.

Q. Are older adults candidates for surgery?

A. Absolutely; 100 percent. People are often shocked when I say that.

One patient I had was 69, and she thought she would be too old for surgery. I told her: I’ve listened to you talk about the struggles with weight you’ve had over 69 years of your life. You have severe obesity. You have obesity-related diseases. If surgery is the most effective tool to generate the greatest weight loss, and it’s going to lead to the greatest resolution of other diseases, why not utilize that?

Interestingly enough, we’ll send older people for total knee and total hip replacements, spinal surgeries, open heart surgery—these are much more invasive. But with bariatric surgery, we can some sometimes send you home on the same day. Right now, the U.S. mortality rate from bariatric surgery is 0.7 percent—not zero, but very low.

Q. The GSA report says one barrier to treatment is the persistent idea that obesity is about individual choices rather than a disease, and that people with obesity who are aging face bias from health care providers. How can people in senior living help change this?

A. Remember that it’s not about the weight itself: It’s how that excess weight affects a person—their overall health, their mental state, their well-being, the chronic diseases they have, and the risk for additional diseases.

My goal is to help change the narrative— to help people recognize that if they’ve struggled so long, that this is not their fault, and that there are those of us that are out here that are willing, ready, and able to treat them.

With some people that are older, what I’m saying to them deviates drastically from everything they’ve heard about weight, all their lives.

For older people, I’m now trying to undo every negative thing they’ve been told about themselves, or that they’ve been taught to believe about themselves, or all the negative language over their lives. All that comes with them to that first appointment.