Fatima Cody Stanford, MD, MPH, MPA, MBA, takes the lessons she learned growing up in Atlanta serving her community and applies them to her work treating obesity. In July, she’ll give the plenary presentation at ENDO 2025, “Changing the Game of Obesity Care Across Lifespan: Policies, Diets, and Drug Innovation,” offering attendees a comprehensive overview of the evolving landscape of obesity care, from addressing disparities in diets to challenging the status quo.
Fatima Cody Stanford’s parents run a food pantry out of their local Atlanta church every Thursday, something they’ve done for the past 30 years. The pantry serves fresh fruits and vegetables to all who come – foods that are often organic, often high quality.
Stanford, MD, MPH, MPA, MBA, associate professor of medicine and pediatrics at Harvard Medical School and an obesity medicine physician at Massachusetts General Hospital, helped run the pantry when she lived in Atlanta and now funds it. She says food quality has improved over the last three decades, with donations evolving from Entenmann’s cakes to bok choy and kale. On the surface, that evolution seems like a good thing, but, as Stanford tells Endocrine News, it exposes the harsh reality of food and housing insecurity.
Stanford says that people who rely on the food pantry may live in a shelter or hotel room where there is nowhere to prepare, much less store fresh fruits and vegetables. Some have never seen corn on the cob before. So, fresh fruits and vegetables end up in the church parking lot, and the people in these living situations turn to the necessity of ultra-processed foods.
“The quality has improved over the years as people have become more focused on improving the health in communities,” Stanford says. “The access and quality in areas that have low socioeconomic have improved, but that doesn’t mean that what the people desire in those areas has changed.”
Stanford will give the plenary presentation, “Changing the Game of Obesity Care Across Lifespan: Policies, Diets, and Drug Innovation,” at ENDO 2025 in San Francisco this July. Part of her talk will focus on this disparity in obesity regarding processed and ultra-processed foods – while acknowledging that these types of foods have their place. People rely on them, and healthier processed and ultra-processed foods do exist. “You can villainize even things that may be healthier for you that are also grouped into foods that we might consider bad for you,” Stanford says.
Not All Processed Foods Are Created Equal
Stanford served as one of the federal government’s Dietary Guidelines Advisory Committee (DGAC), which published their guidance last December. Stanford says this is the first time the guidelines have focused on equity, especially regarding obesity and ultra-processed foods. “We reported that we did not draw any major conclusions, which people may be frustrated with, but we had to go based upon what was represented in the literature,” she says. “What does the data tell us? Not what we believe in our hearts and souls and minds.”
“I’ll talk about that,” Stanford continues. “When we go home and look in our refrigerators, pantries, and cupboards, we seek clean diets, right? Ones that are minimally processed. However, we must recognize that when we’re talking about processing — anything like preparation, freezing your foods, all these things go into this idea of processing.”
Most people think of fast food in cellophane wrappers when they think of ultra-processed foods, and while they’re not wrong, there is some nuance involved, differences, and distinctions. A berry smoothie is processed, after all. Patients with obesity seeking treatment for it want to know what they can eat. “That’s what they’re going to ask me at the front lines, and they’re going not to ask just me, that they’re going to ask docs around this country that very question,” Stanford says. “When we draw big conclusions for the population, we have to recognize that will this potentially affect groups that are food insecure, that may need a cereal or may need a protein shake or may need other things that may not necessarily be unhealthy for you.”
An Obesity Drug Innovation Boom
And while there’s this discussion on what constitutes a “correct” diet, drug innovation for obesity is exploding. GLP-1RAs are continuously hailed as a breakthrough. Stanford says she will walk ENDO attendees through the history of medication for obesity, starting in 1933 when 2,4-dinitrophenol (DNP) was introduced to treat obesity and then banned five years later because of severe and even fatal side effects.
“I’m going to take us through approval to the withdrawal, approval to withdrawal, all the way through semaglutide, and then I’ll go to tirzepatide, and then I’ll show a slide from a publication that I just published in E-Clinical Medicine of what we think is some of the future drugs that are coming out,” Stanford says.
“When we go home and look in our refrigerators, pantries, and cupboards, we’re looking for clean diets that are minimally processed. However, we have to recognize that when we’re talking about processing, anything like preparation, freezing your foods, all of these things go into this idea of processing.” — Fatima Cody Stanford, MD, MPH, MPA, MBA, associate professor of medicine and pediatrics, Harvard Medical School; obesity medicine physician, Massachusetts General Hospital, Boston, Ma.
Stanford sees these drugs as helping patients with obesity and the physicians who treat them. Primary care physicians now have another tool that allows them to stand on the front line, treating these patients. As it stands, one hundred million have obesity, and there aren’t enough endocrinologists, much less fellowship-trained experts in obesity, to care for them. Stanford says her clinic has 5,000 people on their waiting list. “There aren’t enough people to accommodate the volume of individuals that need to be seen,” Stanford says. “I think that that’s a major issue of concern.”
“I want to take the chronology [of obesity medication innovation] and see where we’re going, and I think that I have some great slides that’ll capture that, taking it from 1933 to now and then see where we’re going as we look at what’s in the pipeline,” she continues.
Goodbye, BMI?
The first word after the colon in Stanford’s presentation title is “Policies,” and, at the time of this writing at least, that word comes with a side of tumult.
Before the idea of freezing certain federal funds was floated, Stanford had a grant for 29 scholars to help shape the careers of people who have historically been left out of the research ecosystem, particularly when looking at a disease like obesity or nutrition-related disorders, which disproportionately impact communities that have been marginalized.
Stanford was also part of the Lancet Commission, which released its complete overhaul of obesity and its definitions this past January. The international group comprising experts from low-, middle-, and high-income countries agreed on shifting the focus away from BMI as a measure of obesity.
“Our goal is not to define someone by just one number and recognize that one number for one person is not the same for everyone,” she says. “If you look at someone, let’s say, who weighs 150 pounds, that is one height versus another. They make it look very, very different. I think that this BMI number, which we’ve become fixated on, has led us astray from looking at disease and how it shows up in individuals.”
This group of experts can offer all their guidance, but Stanford laments the lack of policies the United States has adopted to address obesity. There was the Treat and Reduce Obesity Act (TROA), a bipartisan bill that still languishes on the House floor. Now, there are rumblings about cutting Medicare, and Stanford has patients saying they’re deferring retirement so they can stay on their employer-provided insurance and on their medications to treat their obesity.
For Stanford, even among all the current disarray, she turns back to her roots at the food pantry, thankful that she gets to see the impact her parents have on her community firsthand – all doing their part to improve the health of their neighbors.” It’s exciting to be entrenched in it mentally and financially,” she says. “I’m thankful that they’re able to do the work. They have the food pantry and the clothing bank all tied together. That’s always been my thing to be with the people. It’s about walking the walk. And I will remain committed to that work no matter how well-known or whatever I get in the field.”
Bagley is the senior editor of Endocrine News. He wrote about “Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement” in the February issue.
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