WEBVTT 00:00:00.000 --> 00:00:09.520 Welcome to Medically Speaking, a podcast of Self Regional Healthcare. This is our first podcast and 00:00:09.520 --> 00:00:14.800 I'm super excited to have Dr. Jamel Felder with us today. I'm going to give you a little bit of 00:00:14.800 --> 00:00:19.840 background on Dr. Felder. Dr. Felder is a native of Florence, South Carolina. She currently lives 00:00:19.840 --> 00:00:25.420 here in Greenwood with her husband and family and she is one of our pediatricians at Self Regional 00:00:25.420 --> 00:00:31.520 health care. She's married to Dr. Alan Pasinger, a personal friend of mine, and a farmer over in 00:00:31.520 --> 00:00:37.200 Newberry County as well. Good guy. And Dr. Felder earned her bachelor of science degree from Duke 00:00:37.200 --> 00:00:41.760 University and her medical degree from Medical University of South Carolina down in Charleston 00:00:41.760 --> 00:00:46.900 and completed pediatric residency at East Carolina Brody School of Medicine. She's board certified in 00:00:46.900 --> 00:00:53.360 both pediatrics and obesity medicine, and we'll be talking about those topics today. She also has a 00:00:53.360 --> 00:00:57.840 Certificate in Diversity and Inclusion Training and has been working at Self Regional since 2005. 00:00:57.840 --> 00:01:04.520 So welcome, Jamel. So glad to have you here today. Thank you, Dr. Logan, for inviting me and I'm very 00:01:04.520 --> 00:01:09.660 excited to be on this first podcast. Great, great. And again, I'll introduce myself real quick, Matt 00:01:09.660 --> 00:01:14.940 Logan. I'm the CEO here at Self Regional. I've been with Self Regional for 18 years in a variety 00:01:14.940 --> 00:01:19.700 of roles, some clinical, some administrative, and excited to start this podcast series. And Jamel, 00:01:19.700 --> 00:01:25.800 super glad that you can be our first guest today. So with that said, I thought we would just maybe 00:01:25.800 --> 00:01:31.500 kick off with a little, some questions. So we're going to be talking today about pediatrics, some, 00:01:31.500 --> 00:01:40.320 and some about obesity, and some about how it seems like some races may be more affected by 00:01:40.320 --> 00:01:45.380 the obesity pandemic or epidemic than others. So I really appreciate your insights on that. 00:01:45.380 --> 00:01:50.640 So maybe we'll start with what are some just basic statistics on children with obesity? 00:01:50.640 --> 00:02:00.420 Okay, so I'll talk about the highest rates of obesity among children from 2 to 19 years old in the United States. 00:02:00.420 --> 00:02:12.760 So the highest rates you may not know, but are in African-American girls at 29.1% and Hispanic boys at 28.1%. 00:02:12.760 --> 00:02:22.780 And that's been stable, that those minority groups are the highest in obesity rates. 00:02:22.780 --> 00:02:33.660 And then in South Carolina, overall, for all children, we're ranked ninth for obesity rates in children 10 to 17, and that rate is 20%. 00:02:33.660 --> 00:02:39.580 Okay, so yeah, definitely some significant impact on our communities, for sure. 00:02:40.980 --> 00:02:50.160 So with that said, what would you say are the most impacted groups with obesity overall? 00:02:50.160 --> 00:02:52.240 And we're looking at, like, say, the state of South Carolina. 00:02:52.240 --> 00:02:52.780 Okay. 00:02:52.780 --> 00:02:54.840 Well, I do have some stats on that. 00:02:54.840 --> 00:03:02.900 So the adult obesity rates in the country are as high as in African Americans at 49.6%. 00:03:02.900 --> 00:03:08.860 So, you know, half of black adults struggle with obesity. 00:03:09.500 --> 00:03:18.320 And then that cohort of black adults, the most highest group is black females at 56 percent. 00:03:18.320 --> 00:03:34.800 And then in South Carolina, that also pars out with the highest rate being in black adults at 45 percent, followed by Hispanics in the country at 44 percent and then whites at 42 percent. 00:03:35.880 --> 00:03:43.060 Gotcha. Gotcha. What are some treatment options, for example, like say for obesity or some 00:03:43.060 --> 00:03:47.700 lifestyle modifications that could be made by people who struggle with obesity? 00:03:47.700 --> 00:03:57.000 So when I went to get my board certification in obesity medicine, I did a course at Harvard 00:03:57.000 --> 00:04:04.260 called a Blackburn course. And basically, we haven't been taught this, how to treat obesity. 00:04:04.480 --> 00:04:08.080 We weren't even really taught about obesity when I went to medical school. 00:04:08.080 --> 00:04:20.200 And, you know, now changing the narrative about obesity, that it's a chronic disease just like cancer, high blood pressure, diabetes, is where those of us who are board certified are tasked to now do. 00:04:20.200 --> 00:04:26.240 Basically, you know, we talk calories in, calories out, eat less, move more. 00:04:26.240 --> 00:04:28.320 And that just doesn't work. 00:04:28.320 --> 00:04:48.320 You have to have a behavior modification piece, and you have to kind of sit with families and figure out the social determinants of health that may be affecting their behaviors that are causing them to be obese, as well as the lack of understanding on how they can make those changes. 00:04:48.320 --> 00:05:05.700 So some treatment options are stratified, of course, but you start with lifestyle modifications, you know, helping people eat better, you know, understand more about their nutrition and exercising certainly is a vast piece of that. 00:05:05.900 --> 00:05:19.480 But the main stay of treatment should be how we treat all our other chronic illnesses, and that's with medication and possibly with interventions such as bariatric surgery, if need be. 00:05:19.480 --> 00:05:32.160 But I think the main thing is to have honest and open conversations with patients about their status on whether they're overweight or if they're obese. 00:05:32.840 --> 00:05:39.740 And sometimes doctors have a hard time saying those words because people can take offense to it. 00:05:39.740 --> 00:05:43.140 And so you have to be careful how you bring those conversations up. 00:05:43.140 --> 00:05:50.100 So, Jamel, what would you say, from your perspective, what is health equity and how does obesity affect health equity? 00:05:50.100 --> 00:05:55.640 So I'm going to give you the healthy people, people, healthy people, 2020 definition. 00:05:56.180 --> 00:06:06.620 Health equity is, it requires valuing everyone equally with focused, ongoing societal efforts to address avoidable inequalities and justices to eliminate health disparities. 00:06:06.620 --> 00:06:14.160 And basically, why I wanted to read the definition is because it's kind of esoteric, but now I can kind of break down what that means. 00:06:14.160 --> 00:06:21.420 And so when I do talks and, you know, I've done several of these lectures, you know, we talk about equality versus equity. 00:06:21.700 --> 00:06:32.500 So if you can imagine someone riding a bicycle, which is the picture I always show, and everybody has the same access to the same bicycle, then that's equality. 00:06:32.500 --> 00:06:37.560 And so sometimes we get into a mindset of, well, it's available. 00:06:37.560 --> 00:06:38.300 It's there. 00:06:38.300 --> 00:06:39.800 You have a bike. 00:06:39.800 --> 00:06:43.940 You have a way to ride around if you choose to. 00:06:43.940 --> 00:06:50.340 Equity, on the other hand, is tailoring that bike to everyone for their specific needs. 00:06:50.460 --> 00:07:05.520 So if you're a child, it's a kid sized bike. If you are disabled, it's a bike where, you know, you can sit in a maybe three wheeled bicycle where you could have your hands on some of the bicycle handles. 00:07:05.520 --> 00:07:13.520 But you also are able to be in a seated position. If you're a female, maybe the bike set is lower than if you're a taller male. 00:07:13.520 --> 00:07:22.180 So I like to always give that graphic because then that can give you a picture of the difference between equality and equity. 00:07:22.180 --> 00:07:37.900 Now, as far as how that plays into obesity, where I always tell people there's a reason why the onus of that statistic lands in black Americans. 00:07:37.900 --> 00:07:57.160 So for you know, you can't just say it's because they're black, which is one of the reasons why we need to get away from identifying, you know, me and you have talked about this before about why we in medical school have to say in our histories, you know, a 60 year old black male. 00:07:57.160 --> 00:08:06.240 But what we have to do is peel that back and figure out what is happening in those communities, why they have the higher rates of obesity. 00:08:06.240 --> 00:08:12.400 It may be, I will share some stats for social determinants of health. 00:08:12.400 --> 00:08:17.040 So for African-Americans, they have a higher uninsured rate. 00:08:17.040 --> 00:08:19.660 They're less likely to have a PCP. 00:08:19.660 --> 00:08:22.760 They're more likely to live in a multigenerational home. 00:08:22.760 --> 00:08:27.500 they're more likely to have, we have higher unemployment rates and higher poverty levels 00:08:27.500 --> 00:08:35.040 and higher food insecurity. So when you take all of those pieces together, there are things that 00:08:35.040 --> 00:08:44.360 have happened socially, economically that are interfering with able to have health equity 00:08:44.360 --> 00:08:52.040 around certain diseases. Okay. So it sometimes may not be something physiologically different 00:08:52.040 --> 00:08:58.780 between, say, one race or another, but more some of the social factors that people maybe grow up in 00:08:58.780 --> 00:09:05.020 that affects their, I guess, their decisions or how they end up along the health path, 00:09:05.020 --> 00:09:07.900 either healthy or not healthy path. Would you say that's accurate? 00:09:07.900 --> 00:09:15.200 That is very accurate. And in fact, 20% of an individual's health is attributed to clinical 00:09:15.200 --> 00:09:21.580 medicine. So what we do in our clinics, hospital settings, but 40% is attributed to social or 00:09:21.580 --> 00:09:28.460 economic factors 30 health behaviors that we may pick up to cope with said uh social or economic 00:09:28.460 --> 00:09:33.020 factors i'll get to that in a minute and then 10 is physical environment so like if you live in a 00:09:33.020 --> 00:09:39.500 um you know a run-down place with you know lead in your water so that's the physical environment 00:09:39.500 --> 00:09:47.860 um but there are certain uh zip codes in certain cities where that's where you live and so um so 00:09:47.860 --> 00:09:55.800 that's only 10%. But if you can imagine that you live in those kind of areas where you get lead 00:09:55.800 --> 00:10:02.960 coming out of your water, and then that obviously should probably is a high poverty level. And then 00:10:02.960 --> 00:10:11.640 you, as a coping mechanism, decide to overeat or drink or smoke or what have you to cope with that. 00:10:11.640 --> 00:10:17.360 I'm not saying it's right. I'm just saying that sometimes we develop health behaviors that are 00:10:17.360 --> 00:10:22.400 not conducive to overall good health in the long run because of sometimes that's coping mechanisms 00:10:22.400 --> 00:10:29.560 um and as humans we all you know some sometimes we do that and then um the other social and 00:10:29.560 --> 00:10:36.780 economic factors poverty unemployment um and cyclical poverty uh generational poverty meaning 00:10:36.780 --> 00:10:43.500 that's all you've known from my grandmother was you know we lived in poverty then my parents and 00:10:43.500 --> 00:10:53.120 And so looking at some of those structures and how we can intervene in those aspects are ways that we need to move forward in medicine. 00:10:53.120 --> 00:11:01.820 Now, we're not social workers, and I know people want to say that that's not our job as medical professionals, but I beg to differ. 00:11:01.820 --> 00:11:14.200 And if you're going to help a family or a child or an adult tackle some of these complex chronic health illnesses, you're going to have to get at the root of the causes of why it's occurring. 00:11:14.200 --> 00:11:16.420 Yeah, I agree with you. 00:11:16.420 --> 00:11:22.060 I think getting to the root cause is really key in addressing that root cause of why are we in this situation. 00:11:22.060 --> 00:11:42.940 And, you know, as I think about that, Sue, from your perspective and your knowledge and training and us as a community here in Greenwood, South Carolina, and the surrounding communities that we serve, like what can we do as health care professionals and also as a community, you know, whether it be from the city or county governments or whatnot, what should we be doing? 00:11:42.940 --> 00:11:48.660 What can we do to make the biggest impact on health equity and specifically around obesity? 00:11:48.660 --> 00:11:53.380 If you could just name a couple things in your mind that we maybe could help focus on 00:11:53.380 --> 00:11:54.620 to really move the needle. 00:11:54.620 --> 00:11:57.860 So I think, I love that question. 00:11:57.860 --> 00:12:01.700 I think focusing, because you don't want to have all the bad stuff and no solution. 00:12:01.700 --> 00:12:03.440 So I'm definitely solution driven. 00:12:03.440 --> 00:12:07.280 So one of the things that I think is the main thing is education. 00:12:07.280 --> 00:12:11.620 So I don't think there's enough discussion about obesity. 00:12:12.220 --> 00:12:18.300 There's not enough discussion about how in a health care setting, how do we make changes around obesity? 00:12:18.300 --> 00:12:25.280 So I've had several people come to me and say, well, I go to my doctor and he says, lose weight and I'll see you in three months. 00:12:25.280 --> 00:12:35.980 Well, you you and we also need more time to, you know, to kind of deal with these complex, complex issues. 00:12:35.980 --> 00:12:39.500 But that's not really what we're talking about. But giving people tools. 00:12:39.500 --> 00:12:57.820 So not just saying lose weight. Well, how do you lose weight? You know, sitting with somebody and trying to figure out what it is they're eating, how much they're eating. You know, maybe you need to focus on eating a Mediterranean diet more different than what we typically eat as black people. 00:12:58.300 --> 00:13:02.100 But there are people that are switching their eating habits because it's healthier. 00:13:02.100 --> 00:13:04.440 It's better for your body. 00:13:04.440 --> 00:13:08.400 But also, you know, explaining that there are treatment options. 00:13:08.400 --> 00:13:12.280 So not just saying lose weight and I'll see you in three months. 00:13:12.280 --> 00:13:19.080 Try to partner with that person and try to figure out what is the biggest roadblock into making those changes. 00:13:19.080 --> 00:13:26.520 You know, is there something that's hindering them they don't understand or they feel like they've been dismissed 00:13:26.520 --> 00:13:39.160 And so they feel ashamed and they don't come back in the three months because they go home, they don't have any roadmap on what to do, they steadily are gaining weight, and then they don't want to come back to hear that again. 00:13:39.160 --> 00:13:44.040 Well, you didn't lose weight this time, keep at it, and, you know, the same cycle. 00:13:44.040 --> 00:13:50.460 So I think we have to transform the way we take care of people struggling with obesity. 00:13:50.460 --> 00:13:54.240 I think we have to eliminate the stigma around it. 00:13:54.240 --> 00:13:56.500 There's no stigma around cancer. 00:13:56.520 --> 00:14:01.740 or high blood pressure it's a chronic disease um now there are multifactorial reasons of why 00:14:01.740 --> 00:14:08.920 someone may be um struggling with obesity but the compassion the empathy all the tools that we use 00:14:08.920 --> 00:14:14.720 to take care of those type of patients as well we need to transfer that over to obesity so that was 00:14:14.720 --> 00:14:22.140 mainly education we and on both sides health care professionals patients the community now as far as 00:14:22.140 --> 00:14:27.560 other things communities can do you know we could um i think there was supposed to be a plan where 00:14:27.560 --> 00:14:33.740 we were supposed to have a walkable bike pad plan um i'm not sure where we are in that but you know 00:14:33.740 --> 00:14:42.220 have more safe walkable areas places where um people feel safe to come and play exercise um 00:14:42.220 --> 00:14:47.760 you know you have to have uh i remember one time one of the parks had a metal slide so the kids 00:14:47.760 --> 00:14:52.660 couldn't get on that in the middle of summer because it's too hot so you know just thinking 00:14:52.660 --> 00:15:01.680 through things like that um safe clean you know kept up parks that people can move in and also 00:15:01.680 --> 00:15:09.420 just giving people other options aside from lifestyle modifications because there are other 00:15:09.420 --> 00:15:15.660 options for treatment other than those things you know this just kind of got me thinking a little 00:15:15.660 --> 00:15:22.380 it when we're talking about community things, and education specifically. So are there some 00:15:22.380 --> 00:15:28.720 statistics that show that as the level of education increases, there is also an improvement 00:15:28.720 --> 00:15:34.480 in health equity? Like, for example, if, I don't know, if you attain a high school degree versus 00:15:34.480 --> 00:15:39.640 if you attain a couple years of college versus if you attain a bachelor's degree. I know around 00:15:39.640 --> 00:15:45.040 a lot of, like, even, like, mortality, there's, like, almost a direct correlation between level 00:15:45.040 --> 00:15:52.000 of education and length of life is there are there similar uh statistics um or data around obesity 00:15:52.000 --> 00:15:57.220 and other health equity uh with health literacy things like that as with a correlation with 00:15:57.220 --> 00:16:06.680 education and uh obviously in health there are those um studies have been done but still across 00:16:06.680 --> 00:16:15.060 um social economic status um and education um african-american females still have the 00:16:15.060 --> 00:16:26.920 highest rate um of obesity um and so there's something outside of that that's also um 00:16:26.920 --> 00:16:36.280 causing that statistic to hold steady among all um education levels um and social economic status 00:16:36.280 --> 00:16:49.440 And now that you say that, I did want to just say a small thing about maternal mortality after having infants and infant mortality. 00:16:49.440 --> 00:16:55.260 And that's still, for some reason, blacks are highest in those categories. 00:16:55.260 --> 00:17:12.640 So black mothers that are postpartum, no matter what their socioeconomic status or education, are at a higher risk of having a demise after the delivery, no matter what socioeconomic status they are in. 00:17:12.640 --> 00:17:17.600 And so, you know, there are other issues here. 00:17:17.600 --> 00:17:39.500 So some of those, I'm so glad you're getting to those. So some of those are bias in treatment and in health care and the fact that, for instance, like for maternal mortality after having an infant, sometimes infant mothers or African-American mothers are told to go home or this is just normal. 00:17:39.640 --> 00:17:42.420 And by the time they come back, it's too late. 00:17:42.420 --> 00:17:46.360 And that happens, unfortunately, too frequently. 00:17:46.360 --> 00:17:56.220 So there are other factors that, and I know that's not necessarily the question you asked me, 00:17:56.220 --> 00:18:03.960 but I think it's important to recognize that sometimes, unfortunately, 00:18:03.960 --> 00:18:08.200 when we're coming to the health care arena, 00:18:08.200 --> 00:18:09.900 sometimes we aren't treated the same. 00:18:09.900 --> 00:18:13.140 Just this week, I was telling one of my friends, 00:18:13.140 --> 00:18:18.820 there was the American Academy of Pediatrics put out a newsletter every day, 00:18:18.820 --> 00:18:25.860 every other day, and there were three headlines on one particular newsletter this week. 00:18:25.860 --> 00:18:33.340 One was about lead levels and how they affect IQ in children, in black children. 00:18:33.340 --> 00:18:46.340 The other one was the still increased preterm birth rate that is higher in our developed country than most developed countries or the other developed countries in the world. 00:18:46.340 --> 00:18:50.260 We're still high with our preterm birth rates. 00:18:50.260 --> 00:18:55.820 And they were saying that there were still gaps in care based on racial and ethnic groups. 00:18:56.720 --> 00:19:05.440 And so, you know, there are some other deeper issues that also plague our communities more 00:19:05.440 --> 00:19:06.540 than others as well. 00:19:06.540 --> 00:19:10.140 Jamel, what do you think that we should be doing at Self Regional Healthcare and really 00:19:10.140 --> 00:19:16.580 healthcare systems across the country to address these possible inequalities in care and to 00:19:16.580 --> 00:19:21.140 ensure that we're providing that high level care for every single patient, regardless 00:19:21.140 --> 00:19:27.180 of their skin color, their gender, their race, or really anything else that we could have bias 00:19:27.180 --> 00:19:32.040 around? How do we really tackle that? Well, that's a good question. And I'll just have to say 00:19:32.040 --> 00:19:40.140 thank you for your efforts of pushing diversity and inclusion to the forefront of self-regional 00:19:40.140 --> 00:19:44.640 health care. It's in our mission statement that we want to treat everyone the same and 00:19:44.640 --> 00:19:51.360 offer excellent health care. And I think in order to do that, you have to train folks as far as 00:19:51.360 --> 00:19:56.880 looking at implicit bias. Not all the time, but you have to call it out and make sure that people 00:19:56.880 --> 00:20:03.460 aren't using that. And it's an unconscious thing. It's not something that people are doing on 00:20:03.460 --> 00:20:10.540 purpose. It's that the brain is a magnificent thing and that it quickly can put things in 00:20:10.540 --> 00:20:17.160 categories based on previous experience, previous social media or TV ads or whatever. 00:20:17.160 --> 00:20:25.500 And so you may be thinking that you're treating someone with non-biased care, but you've had 00:20:25.500 --> 00:20:28.860 all of these things that have entered your brain over the course of your whole life and 00:20:28.860 --> 00:20:33.600 your whole life experience that you're not really aware of, that you have an implicit 00:20:33.600 --> 00:20:39.640 bias towards them or that racial group or women or any other thing that you could have 00:20:39.640 --> 00:20:46.660 a bias it could be weight bias it's you implicitly have a bias against someone who is in the obese 00:20:46.660 --> 00:20:51.820 category so what you have to do is kind of recognize that you have to do some self-reflection 00:20:51.820 --> 00:20:58.120 but I think educating your staff your health care team on that it exists and that it's not really 00:20:58.120 --> 00:21:04.660 you trying to be mean to somebody you're just not aware and so what and we're in a fast-paced 00:21:04.660 --> 00:21:11.120 environment in medicine, you know, visits are tried to be quick and fast and try to move people 00:21:11.120 --> 00:21:18.440 along. But in order to make sure that you're given that equitable care, that takes some time. 00:21:18.440 --> 00:21:26.040 It also takes recognizing if you are getting in that mindset of, oh, I'm, this is a bias here. 00:21:26.040 --> 00:21:30.140 This is a blind spot that I have. So the first thing I would say to do the training so that 00:21:30.140 --> 00:21:37.120 people noted that it exists. Secondly, I think, you know, making people aware of some of these 00:21:37.120 --> 00:21:42.900 studies that I'm talking about, you know, people could say, oh, yeah, yeah, there's implicit bias. 00:21:42.900 --> 00:21:48.200 But, you know, if it's something in your specialty, you know, oh, really, this is, you know, 00:21:48.200 --> 00:21:54.680 this is good to know. I wasn't aware that, you know, X, Y, and Z or, you know, African-American 00:21:54.680 --> 00:22:03.360 women were the highest category for obesity or black mothers have increased episodes of 00:22:03.360 --> 00:22:07.480 maternal demise after birth or preterm birth rates. 00:22:07.480 --> 00:22:13.940 You know, so I think education, you know, I sound like a broken record, but education, 00:22:13.940 --> 00:22:20.260 training your staff, but also making sure that you have a good diversity and inclusion 00:22:20.260 --> 00:22:27.720 program, the work that Cilento and you have done with making sure that diversity and inclusion 00:22:27.720 --> 00:22:34.940 is a part of our strategic plan going forth, I think is most important as well, because 00:22:34.940 --> 00:22:42.020 it not only affects the health care that you give, but also the place that where people 00:22:42.020 --> 00:22:43.740 work and you want people to feel included. 00:22:44.600 --> 00:22:58.260 And I had one professor tell me when I got my diversity inclusion training is that diversity is being invited to the table and inclusion is feeling comfortable in your seat and at the table. 00:22:58.260 --> 00:23:03.020 So I think we have to make sure that people feel comfortable in their seat. 00:23:03.020 --> 00:23:09.440 And when they do that, they can give the best care to the patients that are coming. 00:23:10.860 --> 00:23:32.800 Thank you, Jamel. So, you know, as I think about exactly what you said, the part of the things that come to mind is like the culture that we have at our hospital, right? So I kind of think so you hear the word culture a lot, or I certainly do is like we want to whatever culture, the inclusive culture or the, you know, the happy culture or whatever, you know, it's almost like becomes a little cliche. 00:23:32.800 --> 00:23:40.980 I heard once that culture really is a combination of core values and then behaviors that support those core values. 00:23:40.980 --> 00:23:51.500 And, you know, as I think about, like, our hospital system here in Greenwood and the surrounding counties, you know, to really get to that inclusive level, I really think it kind of fits, right? 00:23:51.500 --> 00:23:55.400 So our core values are quality, integrity, compassion, and respect. 00:23:55.400 --> 00:24:05.020 And if we can develop behaviors consistently around those core values, we will deliver quality, high quality care with integrity, compassion, respect. 00:24:05.020 --> 00:24:06.380 I think we're going to be at a good place. 00:24:06.380 --> 00:24:07.380 But I don't know. 00:24:07.380 --> 00:24:08.720 What are what are your thoughts on that? 00:24:08.720 --> 00:24:16.860 So I think we are at the baby steps of diversity inclusion, to be honest with you. 00:24:18.520 --> 00:24:26.240 So there are different, so diversity 1.0, 2.0, 3.0, there's a framework. 00:24:26.240 --> 00:24:34.900 And when you're starting something new, firstly, you have to recognize there's a problem, which we did. 00:24:34.900 --> 00:24:39.820 We created our diversity inclusion work group and has done a lot of work since 2017. 00:24:39.820 --> 00:24:44.180 But I think we have a lot more that we could do. 00:24:44.800 --> 00:24:56.060 But I think when you're starting and you're at the beginning, you just keep putting one foot in front of the other and you keep trying to move the culture towards where you want it to be. 00:24:56.060 --> 00:25:00.240 So do I think we have done some stuff? 00:25:00.240 --> 00:25:01.720 We have done lots of stuff. 00:25:01.720 --> 00:25:07.940 We have made great strides as far as moving our culture towards being more inclusive. 00:25:08.800 --> 00:25:23.900 But I think we can definitely work on getting that culture to the feeling of that culture to be I don't think everybody feels comfortable in their seat. 00:25:23.900 --> 00:25:31.140 I guess if I'm going back to what my professor said, I'm not sure that everybody feels comfortable in their seat. 00:25:31.140 --> 00:25:34.320 And so I think that's the second step. 00:25:34.320 --> 00:25:36.280 You know, we started the process. 00:25:36.820 --> 00:25:41.460 I think we need to make sure that everybody is comfortable in their seat. 00:25:41.460 --> 00:25:46.200 And I can't say that we're there yet, but I think we can move towards it. 00:25:46.200 --> 00:25:53.300 It's a huge endeavor to try to, you know, try to tackle diversity and inclusion. 00:25:53.300 --> 00:25:58.560 It almost is, you know, one of these cliche words, like you're saying, just like culture. 00:25:59.460 --> 00:26:06.660 and sometimes people have a negative connotation around diversity inclusion because um if you think 00:26:06.660 --> 00:26:13.380 about um if somebody else is included that i'm losing something um and that's the wrong way to 00:26:13.380 --> 00:26:19.380 think about it um everybody comes from different backgrounds and cultures and everybody has 00:26:19.380 --> 00:26:25.460 something to contribute um i think you're a better institution if not everybody's saying the same 00:26:25.460 --> 00:26:30.660 thing. People can say something differently and give you a different perspective that you've never 00:26:30.660 --> 00:26:36.700 even thought of before. And I think that's when you can say that your culture is inclusive. 00:26:36.700 --> 00:26:43.240 When the think tank and the think speak is not the same, you've included different voices from 00:26:43.240 --> 00:26:48.880 people from different backgrounds and cultures and you have everybody in on it. That's when you've 00:26:48.880 --> 00:26:52.240 So kind of, yeah, that's diversity 3.0. 00:26:52.240 --> 00:26:54.900 Yeah, I know. 00:26:54.900 --> 00:27:07.060 I really personally enjoy hearing a lot of different people's with different people's backgrounds, perspectives on things, because I 100% agree people definitely see it from a different perspective, depending on kind of how they were brought up. 00:27:07.060 --> 00:27:07.300 Right. 00:27:07.300 --> 00:27:13.900 And I think it is important to have a mix of people at the table when decisions are being made. 00:27:13.900 --> 00:27:15.340 So I definitely agree with you. 00:27:15.340 --> 00:27:17.220 And I think we are on a good path. 00:27:17.360 --> 00:27:20.600 I think we are, like you said, we've started and we still have work to do. 00:27:20.600 --> 00:27:25.240 But I know we're going to be in good place going forward. 00:27:25.240 --> 00:27:26.360 Oh, I know we are. 00:27:26.360 --> 00:27:33.540 I mean, you know, I think you and I have talked offline that it takes a couple of years to see change. 00:27:33.540 --> 00:27:40.220 But, I mean, I'm very confident that you can change the tide. 00:27:40.220 --> 00:27:42.860 I have very much confidence in that. 00:27:42.860 --> 00:27:44.380 Oh, well, thank you for saying that. 00:27:44.440 --> 00:27:47.820 So I did want to touch on one other thing just to kind of get back on the obesity topic 00:27:47.820 --> 00:27:48.360 for a second. 00:27:48.360 --> 00:27:53.100 So around treatments specific to obesity. 00:27:53.100 --> 00:27:55.840 So you mentioned there's some medicines. 00:27:55.840 --> 00:28:00.220 Maybe we could talk for a few minutes about like specifically like what medicines or what's 00:28:00.220 --> 00:28:06.720 the role of medication in obesity treatment, as well as behavioral modification, as well 00:28:06.720 --> 00:28:11.700 as potential bariatric surgery and which patients should be considering bariatric surgery versus 00:28:11.700 --> 00:28:18.340 more of a medical or a behavioral treatment options okay so you know piggybacking on what 00:28:18.340 --> 00:28:24.500 i just said about changing this uh this changing the tide on treatment and obesity so we have to 00:28:24.500 --> 00:28:30.680 kind of get away from just telling people to move more and eat less that just clearly is not working 00:28:30.680 --> 00:28:36.800 the obesity trends have increased over the last decade and over the pandemic have really gotten 00:28:36.800 --> 00:28:41.560 And everybody jokes about the pandemic 15 or whatever it was for you personally. 00:28:41.560 --> 00:28:48.860 But that was because it was a high stressful time and cortisol levels increase your need to want to eat. 00:28:48.860 --> 00:28:52.660 So we were all in a stressful time and a lot of people self-soothe by eating. 00:28:52.660 --> 00:28:56.700 And so that post pandemic. 00:28:56.700 --> 00:28:59.720 Well, now we're moving and transitioning to endemic. 00:28:59.720 --> 00:29:02.760 But a lot of people did gain a lot of weight over the pandemic. 00:29:02.760 --> 00:29:05.600 So those obesity rates that were already high. 00:29:05.820 --> 00:29:10.420 I was going to say I put on about 15 myself, but just saying, but go ahead. 00:29:10.420 --> 00:29:15.580 I did too. So I mean, yeah, so, um, but, 00:29:15.580 --> 00:29:20.280 but I think we, so those obesity rates were high pre COVID. 00:29:20.280 --> 00:29:24.560 And then we went through this big stressful thing together. Um, 00:29:24.560 --> 00:29:29.440 and so a lot of the obesity had, those rates have increased. Um, and so, yeah, 00:29:29.440 --> 00:29:33.500 so we have to stop telling people to back from the table or making a judgment 00:29:33.500 --> 00:29:40.460 about what they're doing or not doing, um, because they are obese. And so when I, before I went to 00:29:40.460 --> 00:29:44.840 the Harvard course, I was of that mindset, right? Because we didn't learn a lot about obesity in 00:29:44.840 --> 00:29:49.120 med school. Um, and we weren't taught about, and there weren't a lot of treatments. Obesity 00:29:49.120 --> 00:29:53.780 medicine is a very young field. Um, but we're going to explode here shortly. I'm so excited 00:29:53.780 --> 00:29:58.280 to be boarded in that specialty. But so there's a couple of treatments that I want to talk about 00:29:58.280 --> 00:30:04.920 first for adults and the thing is they're not really indicated for obesity so that's one of 00:30:04.920 --> 00:30:12.140 the things that people who practice obesity medicine we're trying to get these acts passed 00:30:12.140 --> 00:30:19.000 with legislators to make sure that people insurers payers will cover obesity treatment so that's one 00:30:19.000 --> 00:30:24.840 thing that's lacking we don't cover these treatments and so these medicines are high cost 00:30:24.840 --> 00:30:31.260 So there's still only a certain segment of the population have access to it and then can afford it. 00:30:31.260 --> 00:30:32.720 So that's one of the other issues. 00:30:32.720 --> 00:30:38.540 But there's a new medicine, Terzepatide, Mongero injection. 00:30:38.540 --> 00:30:49.420 It's indicated for type 2 diabetes, but studies have shown that people can lose up to 25 pounds on that medicine as a side effect of them using it for diabetes. 00:30:49.420 --> 00:30:57.000 And so what's exciting to people who practice that specialty is that the root cause is obesity. 00:30:57.000 --> 00:31:01.400 If we can get that treated, then people can get off their diabetes medicines. 00:31:01.400 --> 00:31:03.180 They can get off their hypertension medicines. 00:31:03.180 --> 00:31:07.880 They could potentially not go on to have heart attacks, strokes, and the like. 00:31:07.880 --> 00:31:18.960 And so any medicine that can help people lose weight up to 25 pounds, that's pretty exciting for obesity medicine. 00:31:18.960 --> 00:31:21.380 So that one's Mongero, very expensive. 00:31:21.380 --> 00:31:25.560 It's a weekly injectable, fresh on the market this year. 00:31:25.560 --> 00:31:29.620 So, you know, sometimes you kind of have to wait for the masses to be able to get those. 00:31:29.620 --> 00:31:33.600 But very exciting in that it has a combination. 00:31:33.600 --> 00:31:41.640 It works on two different receptors that decreases food intake and slows your gastric 00:31:41.640 --> 00:31:44.440 emptying and helps with your insulin levels as well. 00:31:44.440 --> 00:31:45.900 So that's how that works. 00:31:45.900 --> 00:31:53.340 And then there is a new medicine, well, it's not new, but Casemia is Phentermine and Topamax together. 00:31:53.340 --> 00:31:55.500 That's been out for a while. 00:31:55.500 --> 00:31:59.260 It has this year been FDA approved for teenagers. 00:31:59.260 --> 00:32:03.840 So you can treat teenagers with Casemia down to age 12. 00:32:03.840 --> 00:32:04.940 That's huge. 00:32:04.940 --> 00:32:11.100 We don't have any medicines that are really specifically FDA approved for teens. 00:32:11.100 --> 00:32:15.040 Pediatric people have to use those drugs off-label. 00:32:15.900 --> 00:32:20.460 all the time. But they help the teenagers, and that's the reason why they fought very hard. A 00:32:20.460 --> 00:32:25.040 lot of people lobby in my group of obesity medicine specialists to get some of these 00:32:25.040 --> 00:32:32.360 drugs FDA approved for kids. And so, Phentermine is Adipex, and Topiramate is Topamax. And so, 00:32:32.360 --> 00:32:38.260 we've used that for quite a number of years in combination to help teenagers, as well as adults 00:32:38.260 --> 00:32:45.220 to lose weight um phentermine you know people have the side effects of that one um and it's 00:32:45.220 --> 00:32:52.560 it's um in certain states you can't use it for long term but um when you help somebody with high 00:32:52.560 --> 00:32:57.000 blood pressure medicine and three months rolls around and their blood pressure is normal you 00:32:57.000 --> 00:33:03.000 don't take them off um and that's what we have done and kind of ham you know put our hands behind 00:33:03.000 --> 00:33:07.920 our backs when we're treating obesity while we say you have to um you know not supposed to use 00:33:07.920 --> 00:33:15.040 for long terms. Topamax has its drawbacks too. Some people get fog with it, so they can't, 00:33:15.040 --> 00:33:19.800 you know, they get a really kind of haziness with their thinking. And so some people don't 00:33:19.800 --> 00:33:27.180 like that. And again, you know, payment options, all those kind of things also hinder who has 00:33:27.180 --> 00:33:32.600 access to those things. But to have a drug that's FDA approved for teens is wonderful. So like I 00:33:32.600 --> 00:33:38.200 said, we're in the infancy of obesity medicine, but I think as time goes on, we're going to see 00:33:38.200 --> 00:33:44.960 a lot of change. And then bariatric surgery is indicated for anyone who has a BMI greater than 00:33:44.960 --> 00:33:51.460 40, out the bat. So if someone has a BMI greater than 40, they can be referred for bariatric 00:33:51.460 --> 00:33:56.020 surgery. And then greater than 35. So there are a lot of people who have a BMI greater than 35, 00:33:56.020 --> 00:34:00.860 and they have to have one comorbidity. So diabetes, high blood pressure, severe 00:34:00.860 --> 00:34:07.420 obstructive sleep apnea something like of that sort um that qualifies so greater than 40 or 00:34:07.420 --> 00:34:14.300 greater than 35 in a comorbidity and then for children we use percentiles to describe obesity 00:34:14.300 --> 00:34:21.600 um so anybody and so the percentile for children is anybody greater than the 95th percentile 00:34:21.600 --> 00:34:27.340 is considered obese now you wouldn't be considered for bariatric surgery until you're at the 120th 00:34:27.340 --> 00:34:37.040 percent of the 90th percentile so 95 here you got to be up here and that is um class uh to obesity 00:34:37.040 --> 00:34:42.780 and childhood obesity is there an age where someone i just as we're talking i'm just thinking 00:34:42.780 --> 00:34:47.920 like okay well gosh i wouldn't think an eight-year-old at a high obesity level who hasn't 00:34:47.920 --> 00:34:52.920 been through puberty yet should should qualify for bariatric surgery is there an age that at which 00:34:52.920 --> 00:34:58.720 i would say 12 it's cut off 12 as young as 12 i would say as young as 12 but i don't think 00:34:58.720 --> 00:35:05.500 many bariatric surgeons across the country would do that so there is a um uh practice guidelines 00:35:05.500 --> 00:35:12.480 um but i don't have that memorized so i think 16 is probably when they would look at it okay okay 00:35:12.480 --> 00:35:20.800 but there's a 2018 so it's a older guideline it's been out for four years um and so but i don't it's 00:35:20.800 --> 00:35:23.880 it's not out to the masses yet. You know, sometimes we've, you know, 00:35:23.880 --> 00:35:25.340 straggled behind our practice guidelines. 00:35:25.340 --> 00:35:30.720 All right. Well, Jamel, listen, gosh, thank you so much for, uh, 00:35:30.720 --> 00:35:31.600 for talking with me today. 00:35:31.600 --> 00:35:34.580 Is there anything else that you want to touch on today before we wrap up? 00:35:34.580 --> 00:35:37.820 No, I think that's, um, I think that's everything. 00:35:37.820 --> 00:35:43.300 I would say that if we can, um, give some, uh, you know, like you said, 00:35:43.300 --> 00:35:47.920 have compassion around treating people with, um, obesity. 00:35:48.040 --> 00:35:51.080 I think that would be what I would want to end with. 00:35:51.080 --> 00:35:55.820 They're people just like we all are, and we all have our different struggles. 00:35:55.820 --> 00:36:02.000 And, you know, a lot of people struggle with obesity, and it's getting more and more common. 00:36:02.000 --> 00:36:06.780 The stats aren't turning around, and we have to figure out a way to help people 00:36:06.780 --> 00:36:09.660 and not just dismiss them and say, go lose weight. 00:36:09.660 --> 00:36:11.040 We need to do more than that. 00:36:11.040 --> 00:36:15.940 And if I can get that across, then I think my goal here has been accomplished. 00:36:15.940 --> 00:36:22.660 so thank you for inviting me thank you dr felder personal friend really appreciate you being here 00:36:22.660 --> 00:36:28.060 uh today and um and thank you all for joining us for this very first episode of medically 00:36:28.060 --> 00:36:30.960 speaking and we hope you'll join us for future episodes thank you