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Transcript: Health Equity: The State of Obesity in America with Ala Stanford, MD & Rep. Brad Wenstrup (R-Ohio)

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MS. WINFIELD CUNNINGHAM: Hello, and welcome to Washington Post Live. I’m Paige Winfield Cunningham, the editor of The Health 202 newsletter here at The Post, and today we’re going to be talking about the obesity epidemic that affects more than 40 percent of Americans and now is the second leading cause of death in the United States.

My first guest today is Ohio Congressman Dr. Brad Wenstrup. Welcome to Washington Post Live, Congressman.

REP. WENSTRUP: Thank you, Paige. It's good to be with you on an important topic, so I'm glad to share some insights with you.

MS. WINFIELD CUNNINGHAM: Well, let's jump right in and start by sort of setting the stage. We all know that overweight obesity has been a big problem in American life for a long time, but can you share with us where we're at right now, and what are your biggest concerns when it comes to obesity at this moment?

REP. WENSTRUP: Well, one of the problems that we see with obesity is it is usually not just an isolated medical condition. It comes with many other conditions that we end up having to address, whether it could be end-stage renal disease, it could be respiratory problems, orthopedic problems for sure, and there is a tremendous toll on the patient when they are obese in so many ways.

So I can tell you, as we look at medicine, we've always been very good at treatments and innovations and break-it/fix-it type of role, and I think that where we need to be heading in America is always focusing on cures, if we can, but also we need to be addressing what we can do preemptively and what we can do in a preventative manner. And the way we like to term it is rather than just focusing on life span, which we do pretty well in America if you take out suicides and if you take out drug overdoses, we have pretty good life span in America, but let's focus on health span. How do we keep people healthier longer? And so that's one of the challenges that we have with many things, but with obesity comes diabetes, other problems, and therefore, we want to address this to help Americans be healthier along the way and make sure that they have access to the care that they need to be able to fight this.

MS. WINFIELD CUNNINGHAM: Well, right, and this issue of prevention versus treatment, obesity, as you know, we've been talking about this for a really long time. It's a very complex problem, and I hate to be a downer, but why don't we have any kind of optimism that we can make a dent in this? We see the obesity rates seemingly getting worse and worse every year, including after the pandemic.

REP. WENSTRUP: Yeah. So, you know, a lot of times, it just takes greater public awareness, public awareness for people to be able to recognize this long-term cost on our society. With obesity may come sick days, days you can't go to work, all these types of things, and so, you know, the country has to recognize it. The medical community has long recognized it, but sometimes we've been tied up, and so how do we work with the FDA to get drugs approved that can help patients with obesity and work with several aspects of the condition itself? So sometimes it's a matter of what Medicare approves, and as Medicare goes, so goes the others.

So we do have a bill, as you're aware, and I'm the Republican lead, and it's called the Treat and Reduce Obesity Act. And it's a bipartisan bill, and it's with me, Representative Ruiz as well as Representatives Kinds and Reed. Well, in this, you have two Republicans, two Democrats, and you have two physicians, one on each side of the aisle.

So, currently, FDA-approved medication for chronic weight management are not covered by Medicare Part D. So the bill that we have would require Medicare Part D to cover at least two anti-obesity drugs, and that would go a long way and, again, as I'm talking about access, access to types of treatments, access to care.

And, you know, another problem that we see is Medicare currently reimburses physicians, certified nurse specialists, physician assistants for intense behavioral therapy related to patients with obesity, and they're the only ones covered. But what this bill does is also allow others outside--or other treatments, if you will, if a physician refers a patient to a clinical psychologist, for example, or a registered dietician or a nutrition professional. All of these things, all of these specialties, they're part of the team, part of the team in treating obesity. So this bill would expand that and allow us to get a more broader range of care available to patients, and as I said, as Medicare goes, so goes the other health care coverages.

MS. WINFIELD CUNNINGHAM: Well, I'm glad you brought up that bill because I did want to ask you about that, and that brings up an interesting question of the preventive piece versus the treatment piece, and I could see someone criticizing or possibly critiquing your legislation saying, okay, you're just trying to put a patch on the problem instead of actually fixing the underlying issue of people becoming obese to begin with. How would you respond to that kind of criticism in terms of kind of balancing that preventative part then with the treatment part?

REP. WENSTRUP: Well, you know, education is part of it. Patient education is always part of it that we want to see take place.

But, you know, this is a pretty broad spread problem--broad spread-out problem. It's not only in urban areas. It's in rural areas, and so we want to address that. We do have a rural and underserved health care task force that Chairman Richard Neal, Ways and Means, along with Ranking Member Brady, we put together, again, bipartisan, to increase opportunities for access to care, and so the two go together, in my opinion, that you not only want to get educated, you want to be able to reach out, and you want the care to be provided. So it's pretty broad spread, and I think that's--we have to look at it all-encompassing.

One of the problems that we run into and we're seeing this on several fronts, especially for things that prevent--you know, CBO, Congressional Budget Office, might say, well, that's going to be pretty costly if we expand this, but if you look at it over, say, 10, 15, 20 years, keeping people healthier obviously saves money.

There's probably no greater example of that than, say, the cure for hepatitis; hepatitis C, that is. You know, this came along, and it was like, boy, that's an expensive treatment. Yeah, it may cost $8,000. I think it's come down since that time, but the point is if you don't treat it, if you don't cure it like that does, then you will be treating it palliatively and possibly even needing a liver transplant, and there you're talking into the hundreds of thousands of dollars. And so we have to look at the big picture here, and again, it plays into what we're trying to do as far as health span.

MS. WINFIELD CUNNINGHAM: Well, you know, this problem is so pernicious. I've been a health policy reporter for the last decade, been writing about this, so many different bills and attempts at public policy to try to get at this problem, and yet we just haven't seen a lot of movement. Any insight into why that is?

I mean, as you know, we've tried requiring calorie counts to be displayed, changing kids' school menus. Why is this problem so hard for us to solve from a public policy standpoint?

REP. WENSTRUP: Well, you know, yeah, you're right about things. I appreciate that you can go into a restaurant, and a lot of them will tell you how many calories you're taking in. I think, you know, educating people--but this is a multifaceted problem.

You know, in health care sometimes there are things that you can get that come with the risk of bad behavior, right? Smoking is a great example of that. And then there's the other things that are the risk of bad luck. So some of the components of obesity, some of it may be heredity, and others are changing certain behaviors, changing your diet, et cetera. All of these things have to be intertwined.

I think sometimes people want to not engage necessarily because they're not sure which direction to go, and I think we have to look at it in all directions, which is what our bill is trying to do is not only talk about what can be done medically but talking about what we can do nutritionally, and again, education, when people become aware of what things could be as opposed to what they are. In other words, some people might say, "Hey, I'm obese. That's the way it is, and I'm just going to drive on," not knowing that there may be some things that they can do. So it takes a lot of outreach, I think, to patients to understand that you could feel so much better if you work with us and do these types of things.

So I think that that is part of it, and I hope that we don't overshadow it because it is having a great toll cost-wise, work-wise, all these other avenues that affect our country as a whole, and so I think it's important to address it and address it with compassion and do the best that we can for patients. But let them be educated on what's available, and then again, making some of these treatments available is the key.

MS. WINFIELD CUNNINGHAM: Well, and I want to talk about costs in a minute, because you're right, this is so expensive for our nation.

But I want to ask you also one thing that I know advocates have been pressing for is talking increasingly about obesity as a disease, and so, on the one hand, you have, of course, so many different environmental, social factors affecting somebody's weight, but then you could see this in perhaps a separate category than a disease you might traditionally think of in that, obviously, personal lifestyle decisions have a huge impact on whether you develop obesity. How do you think about that idea of talking about it as a disease? Is that something we should be doing? Is that helpful, or could that detract from solving the problem? What are your thoughts on that?

REP. WENSTRUP: Oh, yeah, I do think it's important that we talk about it as a disease.

You know, I think we saw ourselves as a nation go through that with drug addiction. You know, you go back several years ago, it's like, well, you chose to do that, and so a lot of people would take that approach, right? They would take the approach that you chose to take drugs, so, you know, that's your problem. But now we have a greater understanding of the addiction, for example.

I mean, I use the example when it comes to addiction for heroin, for example. Imagine what you would do for food if you hadn't eaten in eight days, right? So this is something that people that are addicted to drugs like heroin, they go through that every few hours, and so we take a different approach and a different mindset and recognize it as a health care problem, not just a behavioral problem.

MS. WINFIELD CUNNINGHAM: If you could pick one thing right now that we could do as a society that we could change that would make a real dent in the obesity crisis, what would it be?

REP. WENSTRUP: I think the first thing really is education and starting at a young age talking about nutrition.

I have a friend and she is a chef, and she created her own entity where she takes food that's maybe about to expire from the grocery stores, but it still good, and she makes soup. And she brings it to the needy and to the poor, but she also goes into schools voluntarily to talk to kids about nutrition and diet. And one of the things that stood out with me is she had kids that maybe are even in fifth grade, and they don't know what a vegetable is. They don't even know what a vegetable is, and when she described it to them, they say, "Well, I've never had those," and this was really stunning to me. But she's relating it firsthand. They don't even know what a vegetable is, and she goes, "Well, what do you dip your chips in?" and they all said cheese. They didn't talk about salsa or something like that.

So it's really interesting what is going on, unfortunately, in so many American homes, that if we can start with our kids at a young age, and I see this happening more and more. You see schools that they take a plot of land, on the grounds, and they're growing vegetables, and I think that that's part of their health education. And I think we probably let a lot of that slip over the years in our schools, and I think that needs to be brought back and to be explaining to people why it's so important and what you can avoid, just as we have done with smoking.

MS. WINFIELD CUNNINGHAM: Well, you obviously bring your expertise as a medical doctor to Congress, which I imagine makes you more aware of these issues. What do lawmakers and Congress in general not understand right now about obesity and the obesity crisis that you wish they did?

REP. WENSTRUP: Well, I wish that they understood a little bit more what you can say with prevention, because for so many members, if they're not really in the health care arena and taking care of people, when it comes to health care, they're just looking at what it costs today. And I think as we address issues like this, we have to look and show people this is what it costs long term, because that's not necessarily on everybody's radar.

You know, I think our Founders had in mind that people would come from all walks of life to serve in Congress and bring their expertise, farmers, et cetera, whatever the case may be, bring that expertise to Congress so you can talk firsthand, and I'm pleased with the number of doctors that we have in Congress today. And it makes a difference, and it makes a difference when other members say, "Okay. We're talking about health care. We're talking about patients. Let's talk about what some of the solutions are. We want to hear from you." And we've been able to do that in a bipartisan fashion on many things. Surprise Billing Act that we got through was really driven by the doctors in the House of Representatives on both sides of the aisle.

So I think that educating what the long-term savings can be, because money is always the talk here in Washington, D.C., and if you look at how much you can make people healthier and save, it makes a lot of sense, and we just have to get that message through to a lot of our colleagues.

MS. WINFIELD CUNNINGHAM: You're also co-chair of the GOP Doctors Caucus in Congress, comprised of 18 doctors and health care providers, and I know through the years, I've enjoyed interviewing members of that caucus, and of course, for a long time, a lot of it was about trying to get the Affordable Care Act repealed. Can you talk a little bit about is that something that you're still talking about, or do you have other health priorities that you're pushing for at the moment?

REP. WENSTRUP: You know, we're really pushing for other health priorities and, again, with the underlying theme being health span. How do we have Americans healthier as we move forward? And so we do have a GOP Doctors Caucus, but we very often engage with the other doctors in the House of Representatives and sometimes in the Senate as well as we're moving things forward, and again, Surprise Billing Act was a perfect example of that.

And I have several bills with Dr. Raul Ruiz over the years, the Democrat from California. So it's nice when we as physicians are on the committees of jurisdiction to weigh in on health care, such as Energy and Commerce and Ways and Means, and so we're really looking forward.

And we also want to talk about cures. So obesity falls into the category of one of the things we want to address for our country but also diabetes, and if we can develop, say, an Operation Warp Speed type of thing to really promote and push research and development of medications and treatments that can save lives and improve people's lives, that's really what we're focusing on now more than ever.

MS. WINFIELD CUNNINGHAM: We're running out of time, but I want to ask you about the coronavirus pandemic, impact of obesity on that. As you know, our death toll has been far greater than in many other developed countries, and I'm just wondering if you think our obesity rate played a role in that at all.

REP. WENSTRUP: Well, I think that the data would probably show you that, and I haven't seen hard data at this point, but, you know, it's definitely one of the comorbidities that people have that make them more vulnerable and susceptible to the most deleterious effects of COVID-19.

You know, through this process, we're in a situation now in America, we know that the vaccines help. We have been promoting vaccinations. There may be some medical reasons for someone not to, and I could go into that. But just for the sake of where we are vaccines, have been helpful, no doubt about it, but people that are vaccinated also get COVID. We knew that from the trials. We saw that, but what we also saw is they were less likely to be hospitalized and less likely to die unless they had a series of comorbidities. But the unvaccinated did far worse.

But we also know that viruses create variants. We know that they will mutate, if you will, and create variants. That's not new. This is not headline news, per se, except that we have an awareness of when this happens, and so I really think we need to focus on the therapeutics, monoclonal antibodies and the things that we have out there to treat COVID, because even the vaccinated are getting COVID, and certainly, if we can treat those, especially those with comorbidities that have a greater problem trying to deal with COVID, then we're going to be better off as a nation. So I'd like to see us continue to encourage people to get vaccinated, but at the same time, let's really focus on therapeutics, because vaccinated or not, people get COVID.

MS. WINFIELD CUNNINGHAM: Well, unfortunately, that's all the time we have for today, but thank you so much for joining us, Congressman. I enjoyed this conversation.

REP. WENSTRUP: Thank you. I appreciate the time.

MS. WINFIELD CUNNINGHAM: Well, please stay tuned. I will be back in just a little bit to continue this conversation on obesity with experts on the issue.

[Video plays]

MS. MESERVE: We are in the midst of an obesity epidemic, and its effects are being felt particularly in communities of color, where obesity is increasing the incidence and the severity of certain health conditions, including COVID. I'm Jeanne Meserve.

Joining me is Joe Nadglowski, president and CEO of the Obesity Action Network, and also Tammy Boyd. She is chief policy officer and counsel of the Black Women's Health Imperative. Joe, let me ask you first. How serious is the obesity epidemic in America, and what can we do about it?

MR. NADGLOWSKI: You know, more than 40 percent of Americans now have obesity, including one in three Medicare recipients. Obesity, as you mentioned in the opening, disproportionately impacts African American and Latinx Americans.

Unfortunately, rates of obesity continue to grow, with the CDC just publishing data that shows the number of states where more than 35 percent of the population that has obesity has nearly doubled.

As we talk about how to help Americans living with obesity, it's important that we shift mindsets and outdated policies about obesity. Medicare, many of our private payers, and unfortunately, too many of the public still approach obesity as a personal failing and not a disease and not as a societal problem. It was nearly 10 years ago that the AMA recognized obesity as a chronic disease, but attitudes and our payment systems haven't yet caught up.

It's important that anyone struggling with obesity know that you are not alone, and seeking help for it is something that we encourage you to do and you should do. It's time for Medicare to revise their policies to give any Medicare recipient, who wants it, easy access to obesity care. That's the center of what we're trying to do both at the Obesity Action Coalition and the Obesity Care Advocacy Network, as we recognize changing Medicare will likely create change across the whole health care system.

MS. MESERVE: Tammy, can you talk specifically about the impact in the African American community and other communities of color?

MS. BOYD: Yes, absolutely. As Joe mentioned, the number of states which have doubled is very concerning, but what is also concerning is the continued disparity we're seeing in the Black community. This is not a new issue, and we all saw the dire impact of the underlying conditions when COVID hit.

According to that CDC study that Joe mentioned, African American women have the highest rates of obesity or being overweight compared to other groups in the United States. About four out of five African American women live with obesity or overweight.

And the cost of the health care system, obesity costs nearly $1,900 in excess annual medical cost per person, amounting to over $170 billion in excess medical cost per year, with the highest cost occurring for adults between the ages of 60 and 70. These costs, like obesity, unfairly impact communities of color, particularly the African American community.

Also, people living with obesity are more likely to suffer from high blood pressure, high levels of blood fats, diabetes, and LDL cholesterol, all risk factors for heart disease and stroke and, as we saw, greatly affected the Black community when COVID hit.

So it's going to take a lot of work to begin to bring down these numbers, and that starts by ensuring communities of color have access to treatment that is proven to work and have the ability to have that treatment or their--be covered by Medicare.

So, thankfully, Congress has a chance to make this happen. They can take action right now to make affordable care, treat obesity, and save lives.

MS. MESERVE: So you both talked about expanding care. Joe, could you be more specific about what that would look like?

MR. NADGLOWSKI: So, right now, Congress is debating major changes to Medicare, and we think obesity care must be part of those changes. Outdated policies under Medicare only allow Medicare recipients with obesity be counseled by their primary care physician or to have bariatric surgery. While that care is important, it's not comprehensive. Expanding obesity care to include community programs, more providers to deliver intensive behavioral counseling, like dieticians and other specialists, as well as giving access to medications to treat obesity would create truly comprehensive care and give people with obesity a better chance at better health.

We believe strongly a short-term investment in those services can result in not only better health but long-term cost savings in the billions by reducing the comorbidities associated with obesity.

I will say that OCAN is not alone in these requests. Last week, over a hundred-plus organizations asked Congress and the administration to take immediate action. We can't wait. It's time to have expanded access to obesity care included in conversations around budget reconciliation as it will have an immediate impact on the health and lives of people living with obesity.

MS. MESERVE: Tammy, if these changes are made, if care is expanded, what would the impact be on people living with obesity?

MS. BOYD: Yes. Again, these disparities really have existed for generations. The impacts of obesity are deeply felt by Black Americans, but modernizing Medicare is a huge step forward. Many people living with obesity are burdened by the cost of care and want to treat the disease that they have. This will give people living with obesity the choice to receive affordable medical care of their choosing. It means they can either expand their ongoing care for obesity or begin treatments or therapy to start living healthier lives. It means our loved ones can have longer lives, healthier families, and over time, we will have healthier communities.

And so, you know, we have the technology and the research to end this epidemic, but barriers to access get in the way for people living with this disease. So, for over 38 years, Black Women's Health Imperative has been at the forefront of women's health issues through comprehensive public education initiatives that really promote the overall wellness of Black women.

So that is why we're so proud to work alongside the Obesity Care Advocacy Network and all of our partners to fight for healthier communities and families and to provide obesity care now.

MS. MESERVE: Tammy Boyd of the Black Women's Health Imperative and Joe Nadglowski of the Obesity Action Coalition, thank you both for joining us.

And now back to The Washington Post.

[Video plays]

MS. WINFIELD CUNNINGHAM: Hello. I'm Paige Winfield Cunningham, health policy editor here at The Washington Post, and I want to continue our program on obesity now with Dr. Ala Stanford, who is the founder of Black Doctors COVID-19 Consortium.

Welcome to Washington Post Live, Dr. Stanford.

DR. STANFORD: Thank you. Thank you so much.

MS. WINFIELD CUNNINGHAM: So let's just jump right in. In our last interview, we talked a lot about the costs and the ramifications of the nation's obesity crisis, but let's zoom in on the Black community, and can you share some of your thoughts on the impact of obesity on the Black community and also some of the reasons that we see this disproportionate impact?

DR. STANFORD: The impact is profound. Obviously, we're in the midst of a pandemic still, and with patients or individuals who are overweight, which we should include not just obese, their outcomes from coronavirus disease were much more unfortunate in that they were more likely to be on a ventilator, more likely to be in the ICU, and according to the CDC, at one point with hospitalizations, over 30 percent of patients were obese.

And, if I could talk about the physiology a little bit, when you are obese, the weight that pushes on your lung cavity prevents your ability to really take a deep breath, and it reduces your ability of air inflow and outflow. And we're dealing with a respiratory disease, and so that put folks at an increased risk.

Then you take women who were overweight or obese and pregnant, and those are two doubly conditions that led to immunosuppression, and so why some of these things exist, I heard some of the prior panelists talk about, but what do people say? You need to have a better diet. You need to be active. Well, if you live in an underserved community where there's no grocery store, but there's lots of locations for processed food, if you live in a community where it's not safe because you're worried about impacts of gun violence in your community, then it's hard to be active walking in the streets to reduce that. And when folks are living in densely populated communities for low wages, it's less expendable income for children to get exercise. It's less expendable income to get fresh groceries and so forth, and it's not in your community.

And I know this is a long response, but the final is if you've ever been in a community with no grocery store and the best grocery store is two bus rides away, that's you on a bus with arms full of groceries just trying to get fresh produce that can last more than a day in your household. It's tough to do, and so those are just a few of the social determinants of health that impact that existed long before the pandemic but were more profound in the midst of coronavirus disease.

MS. WINFIELD CUNNINGHAM: Well, and you bring up so many interesting aspects of this that I want to get to, but first, just saying on the pandemic for a minute, do you fear that the pandemic itself worsened the obesity crisis among Black Americans in particular? It looks like we still don't have complete data, but we do seem to have some indicators saying that the pandemic worsened and already a serious problem.

DR. STANFORD: So I do think that in some instances, people who were already overweight became obese, and that people who were on a borderline of becoming overweight became overweight. I mean, it was a time for all of us in America that if you could shelter in place, you sheltered in place. There wasn't much to do. A lot of people found comfort in food and meals, and when everything else was closed, you could still go to a fast-food restaurant, and unfortunately, there are more fast-food restaurants than grocery stores.

And, when you look at the leading causes of death, certainly in Philadelphia but in America, number one is cardiac disease. So that includes strokes, hypertension, heart failure. Number two is cancer, and many cancers are exacerbated by obesity and being overweight. Number three right now is COVID. We've already talked about your increased likelihood of severe illness and death from coronavirus when you're overweight or obese, and number four is casualties or gun violence. And so all four of those conditions coupled with being obese, yes, impacted them severely and especially if you were a Black or brown person.

MS. WINFIELD CUNNINGHAM: I want to ask you a question that I posed to our last guest, and it's this idea of referring to obesity as a disease. Is that a helpful thing, in your opinion, and is it something that we should be--should we be treating it more as a disease? Because I know you have the preventive part of it, and then you have the treatment part of it. Can you kind of hash that out for us a little bit?

DR. STANFORD: So, yes, it's absolutely a disease. The best example I can give, especially as a pediatric surgeon primarily, is that children can only eat what you put in front of them, right? No child wakes up--and for that matter, no adult wakes up and says, "You know what? I think I want to be overweight. I think I want to be obese, that I want it to be harder when I have to walk so it can be more difficult for me to breathe, that when it's hot outside that I can sweat profusely, that I want to be ridiculed by others when they look at my size, that I want to go in to buy certain clothes, and I want them to not fit me, and for people to have preconceived notions about why my weight is the same it is.

And so once you remove that stigma, if you will, and treat it like a disease, like other conditions that are impacting our society and impacting individuals, it allows you to focus on what I can do to help you and put more emphasis on prevention. And so, when I see an obese child, I look at the parents, and I say, how can we help your child? And so, yes, it absolutely is a disease, and I think then it becomes more emphasis. Why is it important in the funding and the resources? Because it's not just about exercise and food. You can't recommend that to someone to do it and not put a grocery store in their community. You can't recommend that someone should walk a mile in their neighborhood and not make their communities more safe. And so, when you say it needs to be a preventative, it's a public health issue, then the resources follow that, but you can't make recommendations that people can't follow in their environments.

MS. WINFIELD CUNNINGHAM: This problem is so complex, as you've said, and it's an issue that's been around for such a long time. And I know that when I write about it, it almost seems like a hopeless issue in the sense that so many policymakers have tried to take a stab at this, have tried to pass bills, have tried to legislate. Is this a problem that we can even solve by public policy? What gives you any kind of optimism that we can reverse this trend that we've just seen worsen and worsen over the last few decades?

DR. STANFORD: You know, as health care providers, as politicians, as leaders, I think if more people put as much time in prevention as they put in reaction, right, to a situation, we would all be better off.

So, when we talk about education, yes, that is important in the school, but you can't educate someone to do something that they then don't have access to. It's no different than in the midst of the coronavirus when the public health message was shelter in place, work from home, don't be amongst the public, buy food and stock up for a month at a time to communities that didn't have the capacity to stock up a month at a time, didn't have the ability to stay home and shelter in place because they had to support their families, and couldn't stay off public transportation because they didn't have a car. But they were the ones who were keeping our country going, and this is no different.

So, if we as health care professionals, as politicians, put out recommendations, then we have to give someone an environment to actually follow through with what is recommended and suggested, and that comes, yes, with education, but it has to come with the dollars and in real time with the dollars. It's promoting the grocery stores in communities, real grocery stores with fresh produce. There's no reason why there are certain businesses that are able to thrive in underserved communities and others are nonexistent unless you take several busses and a subway to get to it.

So I do not think it's insurmountable. I think that people have to look at the priorities and not just the lip service and to have actions follow the words, and the action comes with dollars and resources.

MS. WINFIELD CUNNINGHAM: Let's imagine for a minute that lawmakers do as you say and really put more funding into this. We get more grocery stores with fresh vegetables in neighborhoods. Are you confident that that would solve the problem? And I ask this because, of course, we as humans, overwhelmingly, there are many reasons why we find it difficult to eat healthy and exercise. I see this in my own life all the time. It's easier to serve my kids a frozen pizza than it is to take the time to cook a fresh meal. It just takes more work, even if you have access to those fresh things. So do you have confidence that even if sort of policymakers took that step that then enough Americans would really take that extra step of cooking the healthy meals, of doing the exercise?

DR. STANFORD: So I believe--that's a great question, but I believe with education, you actually empower people to know that it's within their control. So no longer are they saying, "Well, my mom was big. My dad was big. That's just how we are in our family. There's nothing wrong with that. There's just more of me to love." You know, people explain all those things away culturally, but wait a minute. We need you to be here as a parent, and if you're that large, your heart can't sustain your body. It can't give you the strength. Your lungs can't give you the oxygen that you need, even when you sleep. And expressing that it's coming from a place of care that we're teaching you some of these things and you really have to, so the education piece coupled with--because this is a challenging disease, it requires a multifactorial approach, and the individual does play a role but not one of saying you've been doing this wrong all along. But it's more of those of us empowering them to let them know that they are a key and an integral part of not passing on the overweight and obesity to the next generation.

It's like most things. When you're younger, it's a lot easier to grab hold of it and do something about it than when you're older and you're dealing with your weight and all the sequelae that come with that, emotionally and physically.

MS. WINFIELD CUNNINGHAM: On the education piece--and I want to ask you in a minute about the consortium, but just to kind of push a little bit further on the education part, again, as a reporter, I look at all of the focus that we've had on obesity and the efforts of education, as you say, going to the schools, talking to kids about healthy eating. I'm remembering back to Michelle Obama's Let's Move! campaign.

DR. STANFORD: Mm-hmm.

MS. WINFIELD CUNNINGHAM: And it just leaves me sort of confused as to why we haven't seen any move in the needle. If anything, obesity rates among children are getting worse, and it seems like you would at least see things stabilize or flatten out, but it just seems confounding that we've had this much energy put into it and yet very little result. And I hate to sound like a pessimist, but as the outside observer, that's what it looks like to me. Can you respond to that situation?

DR. STANFORD: So I guess you have to see how much effort has really put into it. Again, I think there are lots of articles. There are lots of books, even, lots of podcasts, but when you really look to see how much in the way of dollars have been allocated--and I don't just mean for a project, for a period of time, or for a period of time when someone is in office but sustainable dollars that are like line items in budgets that we're going to focus on obesity in our elementary school children from the very beginning, that there are incentives with different health insurance programs, that when you reduce your weight, something happens and things like that.

And all too often, I believe we focus on conditions for a period of time, but I'd be very curious to see the information of how long it stays there. And rather than people looking at it as it's just for right now as opposed to this is something we have to live with for long after we're gone, that's where the support and the resources are continuing. Until we recognize it as a disease that impacts all of us financially and for the individual and their family, I think that we'll be right back here where we are.

MS. WINFIELD CUNNINGHAM: Last April, you founded the Black Doctors COVID-19 Consortium to help give medical care, to help give vaccines to those hardest hit in the Philadelphia area. Can you tell us a little bit about that group and what motivated you to do that?

DR. STANFORD: Sure. You know, and it actually started with testing because, as we're talking about with folks who are overweight and obese, they are impacted more. But African Americans and Latinx folks in general had the highest positivity rates in the city living in ZIP codes where COVID was one in four, but yet all the testing locations were in affluent White neighborhoods. So, here again, it was go get tested, so you know your status, so you know you can isolate and not spread to others, but there is nowhere to get tested in your neighborhood. So that's why I founded the Black Doctors COVID-19 Consortium to provide barrier-free access to testing, because at the time, there was no vaccine. There was no cure. It was just early diagnosis and supportive treatment.

And then, subsequently, with the vaccination, because people had seen us as a trusted voice and a trusted organization in the community, they came to us for their vaccine, and we stayed in the community. I think that's a huge part of access is going to where the people are and not expecting them to come to you because you are a health care provider or a health care center. People need to come where they will feel empathy and be able to trust and develop a relationship, and that's what we were able to do. In fact, over the 100,000 people that we've touched with vaccination and with testing, over 75 percent of them are people of color.

And I recently, with another new outset, read that the percentage of African Americans vaccinated in the United States in an urban city was greatest in the city of Philadelphia, and that is a testament to the work that we've done providing culturally competent, culturally sensitive care with providers that are reflective of the population that we serve in their communities, and for it being barrier-free. And I believe that that model is one not just for COVID testing and vaccination but can be applied for all of the conditions, primarily cardiac disease, cancer, COVID, and casualties of violence. That can be that model for all the conditions that are the highest rates of morbidity and mortality in our country.

MS. WINFIELD CUNNINGHAM: We're almost out of time, but when you have a patient who comes to you and expresses vaccine hesitancy, as a physician, what have you found, what kinds of messages have you found seem to resonate the most as you're trying to help patients and particularly patients of color get vaccinated?

DR. STANFORD: So the first and what's always been for me is to listen. It's just to listen because you can't assume that you know the reason why someone is not getting vaccinated. Sometimes it's a lack of education or something that they thought was true was not.

I recently had a young man, 20-year-old, say to me, "Well, it's not even FDA-approved," talking about Pfizer, and I said, "Well, actually, it was initially emergency use, but now it is FDA-approved." It was something as simple as letting him know that was enough for him to choose to get vaccinated, and so you have to listen, certainly be empathetic when people talk about the injustices towards African Americans and the health care system being untrustworthy to people of color and let them know that you're not telling them to forget that. You're not asking them not to put emphasis, but this is a different time in our society. The pandemic is impacting. The virus is impacting everyone and disproportionately Black and brown individuals and reminding them of that.

And then, finally, there are some people that really respond to mandates, that really when you say if you don't get vaccinated by this day, you will lose your job, your ability to support your family--and for them, it forces them to look at the reason why they weren't receiving it and really question the validity of that reason. And, with that, we have seen an increase in the number of folks coming to get that first and subsequently the second vaccine.

[Pause]

DR. STANFORD: Hello?

[Technical difficulties]

MS. WINFIELD CUNNINGHAM: I am so sorry. We lost connectivity for a moment, but I just want to thank you for joining us today, Dr. Stanford. It was a fascinating conversation.

DR. STANFORD: Thank you so much for having me. This was great.

MS. WINFIELD CUNNINGHAM: Well, I’m Paige Winfield Cunningham. As always, thanks for watching, and to check all the interviews we have coming up, please head to WashingtonPostLive.com to register and find out more information about all of our upcoming programs. Thanks so much.

[End recorded session]

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