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Amanpour
Interview with Deputy Speaker of Lebanese Parliament Elias Bou Saab; Netanyahu Delivers Speech After Israel-Hezbollah Ceasefire Vote; Israeli Cabinet Approves Ceasefire Deal in Lebanon; Interview with "Bad Sisters" Creator and Actor Sharon Horgan; Interview with Massachusetts General Hospital Obesity Medicine Physician and Harvard Medical School Professor Dr. Fatima Cody Stanford. Aired 1-2p ET
Aired November 26, 2024 - 13:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
[13:00:00]
CHRISTIANE AMANPOUR, CNN CHIEF INTERNATIONAL ANCHOR: Hello, everyone, and welcome to "Amanpour." Here's what's coming up.
Will the Lebanon war end now? The latest from there. Then no end in Gaza.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE (through translator): There is no medicine. Where should we go?
UNIDENTIFIED MALE (through translator): Instead of receiving aid, we've received tanks.
(END VIDEO CLIP)
AMANPOUR: Doctors call it an utterly catastrophic situation. Jomana Karadzheh takes us inside one of the last hospitals functioning in the
North.
Also coming up --
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: We are all involved in this.
UNIDENTIFIED FEMALE: We covered up a murder.
UNIDENTIFIED FEMALE: The world's better off without you.
UNIDENTIFIED FEMALE: Even the pope would say that.
(END VIDEO CLIP)
AMANPOUR: -- the hit comedy series "Bad Sisters" is back for season two. And this time it's a darker tone. I'll speak to the show creator and actor
Sharon Horgan.
Also, ahead, obesity rising at higher rates despite new weight loss drugs like Ozempic. Hari Sreenivasan speaks to Dr. Fatima Cody Stanford at
Harvard University Medical School about why those drugs are not a cure all.
Welcome to the program, everyone. I'm Christiane Amanpour in London. A ceasefire deal between Israel and Hezbollah appears within reach. An
address by Israeli Prime Minister Benjamin Netanyahu will lay out the terms, which calls for a 60-day pause in hostilities to set the stage for a
lasting truce. A spokesman for his right-wing Likud Party says that party has approved it.
The U.S. helped broker the ceasefire, and Secretary of State Antony Blinken talked about getting it over the line while he was at the G7 Summit in
Italy.
(BEGIN VIDEO CLIP)
ANTONY BLINKEN, U.S. SECRETARY OF STATE: It will make a big difference in saving lives and livelihoods in Lebanon and in Israel. It will make a big
difference in creating the conditions that will allow people to return to their homes safely in Northern Israel and in Southern Lebanon.
And I also believe that by de-escalating tensions in the region, it can also help us to end the conflict in Gaza. In particular, Hamas will know
that it can't count on other fronts opening up in the war.
(END VIDEO CLIP)
AMANPOUR: Now, in the final hours before the ceasefire is meant to be agreed, Israel has been pounding what it says are Hezbollah targets. A
series of airstrikes hit in and around the Lebanese capital on Tuesday. Hezbollah has also been firing into Israel.
Lebanon's government has agreed to the U.S.-backed proposal after the speaker of the parliament there, Nabih Berri, received Hezbollah's approval
to move forward. Elias Bou Saab is the deputy speaker of parliament, and he's joining me now from Beirut. Deputy Speaker, welcome to the program.
Can I ask you how close you think this actually is?
ELIAS BOU SAAB, DEPUTY SPEAKER OF LEBANESE PARLIAMENT: Thank you, Christiane, for having me on the show. I think we are very close. We are
probably, you know, minutes off an announcement that may take place now in Israel. And later on, we're expecting a statement by the president of the
United States and the president of France, a joint statement, maybe to announce the deal. And after that, we will expect a statement from the
Lebanese government. And hopefully, this ceasefire will take effect 12 hours from now or from when it's announced, if things continue to go in the
direction that we understand it to be.
Because historically, we had different experiences with a Netanyahu. Those experiences were not encouraging. We don't know if this is going to happen
for sure or something may change the last minute. So, we are skeptical here in Lebanon because of the bad experiences we had in the past.
AMANPOUR: OK. And of course, you mentioned France, they also helped broker this with the United States. But let me ask you, there's been a lot said,
and I said that part of this deal could be a 60-day pause in anticipation of a more permanent truce. Can you give us, first of all, confirm whether
that's the case and give us more of the details, what will this truce or this agreement or arrangement look like?
[13:05:00]
SAAB: There are several points, but the main important ones, Christiane, would be the minute this is announced, last I had the information was 12
hours from announcement, the ceasefire will take effect. And we probably call it halt of operation or, you know, military operation because this
term was used in 1701, in the United Nation, you know, that was passed on Lebanon, which was back in 2006, after the war of 2006.
So, we say halt of operation, halt of military operation. And then, we have 60 days period to implement the terms of this agreement. It all focuses
around 1701. 1701 clearly states that there should be immediate withdrawal of all Israeli soldiers from any territory they may have entered or
occupied during that war and they are currently at the border in some villages or areas in the southern part of Lebanon.
So, this will happen within the 60 days. It will start being -- you know, it will -- it's what start to be implemented immediately, but we have up to
60 days to complete that.
AMANPOUR: OK.
SAAB: After this, Lebanese army will start filling in. So, at any place that the Israelis leave, the Lebanese army will enter and the Lebanese army
will have a major role together with UNIFIL to fill in the positions that were, you know, left by the Israeli soldiers.
AMANPOUR: OK. So, just to ask you --
SAAB: After that, you'll have --
AMANPOUR: Sorry, go ahead. I was going to ask you, Israeli forces, you say, are due to pull back, but so too Hezbollah forces, correct? There's a
number of kilometers.
SAAB: This is what I was reaching. The 1701 also calls it anything this -- or all areas, the southern of the Litani River, on the south of the Litani
River, there should be no arms, no -- you know, no rockets and no military presence for Hezbollah.
So, also after the withdrawal of the Israelis and the Lebanese army enters that area, we expect also that all the arms, if they exist and all the
rockets where they exist, in that part of the Litani River should be withdrawn or, you know, find a solution to it. This will take place, of
course, also within the 60 days.
The 1701 also talks about other things, it talks about, you know, we need to reach a point in the end where we stable the region, stable that border,
and then the negotiation as part of that agreement that we are expecting to see, is that we will see the final demarcation of the land boundary between
Lebanon and Israel. There are some points that are still, you know, being discussed since 2006. We never finalized those. We expect that this time
there will be a follow up and finalization to all pending issues.
The difference between what is happening now and what happened in 2006, it's the same 1701. But because it was never implemented by Israel or by
Lebanon. This time, we are hoping that there will be a new committee or a committee that existed between Lebanon, Israel, and the United Nation that
was meeting on regular basis in the South. Now, we will add to that committee the United States and France. And whenever they meet, the United
States will preside that -- those meetings.
AMANPOUR: OK.
SAAB: So, this will be a committee that will, if you want, oversee and monitor the implementation of that agreement.
AMANPOUR: All right. Let me just step in and ask you a couple of questions. As you said, the 1701, the U.N. Security Council resolution that
ended the 2006 war, called for all these things that you're talking about. And yet, it wasn't fully implemented and the countries went back to war
against each other, most specifically after October 7th, when Hezbollah started to fire into Israel in support of Hamas.
Do you believe -- and one of the weaknesses that your country, your sovereign nation, the army has not been able to have the strength and
authority that Hezbollah militant forces do. How will that change now? Why will it change now?
SAAB: It will change, because as you know, the Lebanese army was never receiving the full support, financially or equipment wise or military, or
the Lebanese army was always in a position where we have no rights to own things that may be probably can cause, if you wish, a threat to Israel.
[13:10:00]
So, now, hopefully, that the International Community and everybody will help us to strengthen the army to be able to defend our country. The
existence of the resistance and Hezbollah in the past was because we said Israel have -- you know, may come to Lebanon, may enter Lebanon, may, you
know, attack us anytime. We have a history of wars between Lebanon and Israel.
We hope in Lebanon that we reach a point where all the threat of the Israelis interest in Lebanon or in our land will go away. And we would only
have one army, one armed forces officially called the Lebanese army. And so --
ANNOUNCER: This is CNN Breaking News.
ISA SOARES, CNN ANCHOR: Israeli Prime Minister Benjamin Netanyahu is about to speak. I want us to listen in.
BENJAMIN NETANYAHU, ISRAELI PRIME MINISTER (through translator): The war will not finish until we reach all of its goals. Until we bring all of the
residents of the north home. I'd like to tell you, it will happen exactly as it happened in the south.
My friends, residents of the north, I'm proud of you. I'm proud of your way you stand, and I'm responsible to your future, to your recovery of your
settlements.
Until now, due to the (INAUDIBLE) of IDF, the police, the Shin Bet, and the Mossad, we reached huge achievements in all fronts, and it causes the world
to be in awe of our power and in the Middle East.
First and foremost, in Iran, we destroyed most -- a lot of their aerial abilities, the capability of her missiles and our nuclear program. I'm
determined to do anything we need in order to prevent Iran from reaching nuclear weapon. This threat is always top of my priorities and moreover
today when you hear the declarations of Iran's leaders in order to be equipped with nuclear power.
Removing this threat is the most important task in order to promise our future. We dismantled Hamas battalions, we destroyed Sinwar, Deif, and
other seniors, and we brought back 194 of our hostages, and we are determined to bring the rest, 101 hostages, to bring back the torture of
their families. And we are assured to complete the destruction of Hamas.
In Judah and Samaria, we are killing hundreds of terrorists and infrastructure of terrorists who are acting in all fronts of terror. In
Yemen, we attacked the Houthis, something that the International Community didn't do. In Iraq, we prevented many attacks of UADs (ph). In Syria, we
are breaking the trials, the attempts of arming Lebanon from Iran and Hezbollah.
Assad needs to know that he's playing with fire. And now, in Lebanon, Hezbollah chose to attack us on the 8th of October. It's been a year. It's
no longer the same Hezbollah. We brought it back dozens of years. We destroyed Nasrallah, the rest of the senior personnel, its missiles and
rockets, thousands of terrorists and destroyed the underground infrastructure of terror that's been built there for years. We attacked
strategic goals around Lebanon and we make dozens of buildings falling in Beirut, and the ground is trembling there.
[13:15:00]
Citizens of Israel, three months ago it would have been sound science fiction, but it isn't. We did it. And I'd like to say to you, in any given
moment that this war, I'm looking at all fronts, this is how I acted in the beginning of the war to focus on Gaza and not opening a new front in
Lebanon. This is how I acted a few months ago where conditions were right to focus on Hezbollah. This is how I acted when the Iran missile attack
happened, when we chose specifically when to retaliate and how, and this is how I act today.
I look at all fronts and I see the full picture and I'm determined to give our soldiers, our heroic soldiers, all measurements -- all measures to keep
-- save their lives and bring back victory. This is why I will bring an agreement for the cabinet. The duration of it will depend on what happens
in Lebanon.
We keep a whole freedom for military freedom. And if Hezbollah will re-arm itself, we will attack and it will -- if it will fire missiles, if it puts
tracks with missiles, we will attack. And I know it's been said that once we agree on a ceasefire, we won't be able to do it. But I remind you, this
is exactly what we've been told when we have a ceasefire with Gaza in order to bring back hostages, our hostages, they said we will not be back
fighting and we did, big time.
They tell me Hezbollah will keep quiet for a year or two, and then they will attack. But Hezbollah will finish the ceasefire in order to shoot at
us in the future, and we will react for any such thing. I know that many do not believe we will do it, but many didn't believe we will go on the ground
in Gaza and Shifa and Khan Younis, and we did. And in front of all the international pressure to enter Rafah in Philadelphi Axis. Not only we
entered, we attacked. And many didn't believe we attack in Lebanon and we attack there as well, in huge power and sophistication that the war that
surprised the world.
And after all of that, maybe it's better to believe in our way, in our determination and our commitment to victory. So, why doing ceasefire now?
There are three main reasons. First, focusing on the Iranian threat. And I will not expand on that. Two, refreshing the military forces and our
equipment, and I'm telling you, and it's not a secret, there's been delays in bringing more weapons and arms. And this delay will finish soon. We will
have advance weaponry that will give us more power to finish our goals. And the third reason for ceasefire, detaching the front of the war from Hamas.
From the second war that Hamas pressured Hezbollah to act with him. And now, Hezbollah is no longer, and it will help us with the task of bringing
our hostages back.
We were attacked in seven fronts and we retaliated. We are changing the face of the Middle East. All of this we are doing due to our heroic
soldiers and your stand and managing this war mindfully. I said many times a good agreement is such that you can make it a reality. And with God's
help we will make the north flourish again until the victory.
[13:20:00]
SOARES: You have been listening there to Prime Minister Benjamin Netanyahu really speaking on the back of an Israeli security cabinet meeting, of
course, trying to approve this deal, ceasefire deal between Israel and Hezbollah. And the Israeli security cabinet has voted, as you could hear
there, in favor of a ceasefire deal, of course, to end the fighting with the militant group Hezbollah.
And as you heard, the prime minister, Netanyahu, said that for three reasons they're signing on this deal right now. One, he said, was focusing
on the Iranian threat, and he said he wouldn't expand on that. Two, he said it was an opportunity to refresh, he said, military forces and equipment.
He talked about delays in being -- and having more weapons and arms. And then, detaching the front of the wall from their -- from Hamas, of course.
But the start of his message was to the Israelis, 60,000 or so Israeli residents who have been pushed away from their homes because of the
fighting with Hezbollah. And he said, we will return all citizens home, talking about how proud he is of them.
Let's bring in our correspondent. Nic Robertson is in Jerusalem. I'm also joined by Jeremy Diamond in Northern Israel, and CNN Senior International
Correspondent Melissa Bell. Let me go to you, Nic, first. I mean, he didn't give us much details in terms of what's part of that proposal, but he did
give us some sense of why he's signing up to this now.
NIC ROBERTSON, CNN INTERNATIONAL DIPLOMATIC EDITOR: Yes, and I think the fact that he points to Iran is very significant and significant to the
timing of why now and he didn't say it, but Iran gives us an understanding and a clue is the fact that Donald Trump, in about two months, will be the
president of the United States and in the White House. And he had made it very clear that he doesn't want to inherit a Middle East that's full of
wars. So, the prime minister is winding one down here.
But Prime Minister Netanyahu also understands that President-Elect Donald Trump feels very strongly about Iran. And this appears to be the prime
minister here beginning to position himself and Israel to align with what the Trump administration may want to achieve on Iran and for Israel to try
to use that to achieve its own goals.
And I would point to what we heard the defense minister here say just yesterday, upping what has been becoming an increasing line from the
government that Iran is supporting and trying to get weapons into the West Bank, the occupied West Bank, Judea and Samaria, as the prime minister
calls it. And this is becoming an increasing focus of this government. It seems the defense minister yesterday saying that they were going to
accelerate putting up security fences in the occupied West Bank.
So, I do sense that this is one of the fundamental reasons behind the why now, but the prime minister points to this slow supply of weapons, the lack
of certain weapons. This was something that, really, we haven't heard a lot about. Is he here alluding to the Biden administration holding back?
Because I think that issue had really been later laid to the side and that there hadn't been a significant interruption of weapons flows from the
Biden administration. So, I'm not quite sure what the prime minister is referring to there.
Certainly, there is pressure from the military that they'd achieved goals. This was time to wrap up. That the soldiers were tired. A lot of them
called up or some called up to go and serve for the second or third time, go and serve in Lebanon. Were really not so happy to do it.
So, it's the sort of reset the military, he talks about them as being heroes. Absolutely, you would expect him to do that. But the terms and
details of precisely what's going to happen in the ceasefire, the nuance that we don't have until now, the right to strike back, I think we'll learn
about that in the coming hours.
SOARES: Yes, and we'll let you go. Nic, appreciate it. Thank you very much. Let me go to Jeremy Diamond who's in Northern Israel. And, Jeremy,
what Nic was saying we don't have the details. A lot of what was discussed prior, of course, to this was 60-day cessation of hostilities, right? Do we
have a sense of how quickly this will be implemented? And critically, you're in the Northern Israel. This would mean that some 60,000 Israelis
could return back to their homes, and Netanyahu is saying that we will return all citizens to their homes. What have you been hearing? Do --
residents in the area, do they feel safe to return with this deal as it stands right now?
[13:25:00]
JEREMY DIAMOND, CNN JERUSALEM CORRESPONDENT: I think the short answer to that question is largely no. I mean, we've been speaking to a number of
people in Northern Israel today, including a number of political leaders of some of these communities in the northern most Israel, closest to the
Lebanese border. These are those communities that have been evacuated, where been facing the threat, not only of rockets and drones, but also of
those anti-tank missiles that have up to a 10-kilometer range or so. And those leaders have been slamming this agreement as it emerged earlier today
as not a ceasefire agreement, but they've been terming it a surrender agreement.
And that is largely because they wanted to see the Israeli military effectively finish the job and defeat Hezbollah resoundingly, ensuring that
strip of land in Southern Lebanon that would potentially pose that anti- tank missile threat to their communities would be entirely eradicated. And clearly, the Israeli government has decided that they have accomplished
enough. And certainly, they have accomplished a lot in terms of military achievements in Lebanon over these last few months. And then it was a time
to translate those military achievements into a political solution.
The Israeli prime minister actually met with some of those mayors from Northern Israel today to try and reassure them. But the ultimate test of
this will be for the residents themselves, for those 60,000 or so who have been evacuated from Northern Israel, some of whom have been living in
hotels across the country for the better part of the last year and a couple of months, will they return?
And some of those who I've spoken to have said that those in particular with children may not return because they will not trust that this
agreement will ensure that Hezbollah cannot pose this threat in the future. They do not trust Hezbollah's word on this, and they also are not yet
convinced that Israel will be able to act as it needs to in Southern Lebanon, militarily, to remove any threats that emerged.
Now, I have also been speaking with Israeli officials who insist that they will have the freedom to act against any Hezbollah violations of this
ceasefire agreement in Southern Lebanon, to act militarily and unilaterally. There was a side agreement with the United States, a paper
effectively which one source familiar told me that this was a commitment from the United States that without that commitment, they would not have
entered into this agreement, a commitment that says Israel can indeed go after Hezbollah in this area.
Now, we haven't seen, of course, the language of this agreement or of that side letter between the United States and Israel and those details, of
course, will be critical to assuaging some of those concerns, perhaps in Northern Israel or perhaps even stoking them and drawing a lot of reticence
from these people to return to their homes if they don't feel safe.
SOARES: Let me go to our Melissa Bell, our senior international correspondent, who's live for us in Paris. And, Melissa, we're hearing that
we expected to hear from President Biden and about, what, less than about an hour or so from the Rose Garden because a lot -- I mean, a heavy
diplomatic muscle has gone into this ceasefire deal with both the U.S. and the French as well.
And Jeremy was hinting at that, and I wonder if you can flesh this out. There's so much mistrust between both sides. What are you hearing from the
French side about the deal and really how you can -- and the fragility of this deal and who keeps the checks here on this deal?
MELISSA BELL, CNN SENIOR INTERNATIONAL CORRESPONDENT: I think so much of the fragility of the deal and the difficulty that we had in getting here
can be summed up in what's happened over the last few days about the involvement of the French at all, Isa. They had been early on involved in
efforts to get a ceasefire to the northern front. In fact, it become heavily involved after that northern front had been opened by Israel. Their
historical ties with Lebanon, their linguistic ties with Lebanon and also the fact that Emmanuel Macron has positioned himself as a European willing
to speak out against Israel and what many Europeans see as its excessive policies not just in Gaza, but in Lebanon as well.
What we'd seen is all of the parties involved moving towards this idea of a ceasefire, and this has been on the cards, and we've been hearing that it's
imminent for about 10 days, Isa, what happened last week was the international court's decision to issue arrest warrants for Benjamin
Netanyahu and Yoav Gallant get in the way of that? Because the reaction of the French was to say, well, we will apply international law. And should
they set foot in France, they will duly be arrested.
And this was the very last straw in what had been an increasingly frosty relationship between Paris and Tel Aviv over the course last month because
of the outspokenness, not just of Emmanuel Macron, but other European leaders about the need for an arms embargo, about the need for Israel to
show restraint on its many fronts.
So, there was a question about whether France should be involved in these negotiations at all. We understand that Israel had been wanting them
entirely excluded, and certainly not involved in what will be the monitoring process once this ceasefire is implemented.
[13:30:00]
It was American pushback that allowed for the French to remain involved, and I think it's crucial. There is so much suspicion, Isa, not just in
Lebanon, but in the wider Arab and Muslim world, about the American backing full heartedly, unilaterally, without any caveats of Israel for more than a
year now, that the involvement of a power like France, of course, in central and bringing some kind of confidence to what is being done along
that border.
Clearly, a huge advance that this has happened, a massive piece of news, not least for those many thousands -- tens of thousands of Israelis who can
return home, but of course, on the Lebanese side, those can come back as well. And hope as well in Lebanon that this country that had been on its
knees politically, economically in so many different ways, even before this northern front was opened by Israel, that some kind of rebuilding can start
once again at last. Isa.
SOARES: Exactly. 60,000 residents moved away from their home, about a million or so displaced in Lebanon and thousands -- 3,500 or so killed on
the Lebanese side. We will, of course, keep an eye on the developments on this breaking news. Of course, what we're waiting for is that detail. And
we're also waiting to hear from President Biden. That's from roughly an hour. We will take that in my show in about an hour's time. But leaving you
with really the words we heard from Prime Minister Netanyahu, three months, it would have been a science fiction but we did it.
And we return you now to "Amanpour" already in progress.
AMANPOUR: -- you know, woman?
SHARON HORGAN, CREATOR AND ACTOR, "BAD SISTERS": Spell it right.
AMANPOUR: I can't.
HORGAN: Do you know what I like for a little while but it's so much more complex than that, you know, the story and where we take her and where the
story -- where the whole story goes over the course of --
AMANPOUR: Tell us a little bit of that. I mean, I don't want to --
HORGAN: Well, I'm a bit --
AMANPOUR: I know. I know. But what is she then? What is she --
HORGAN: Well, I think she's a woman who's from a slightly different generation to the Garveys You know, she's someone --
AMANPOUR: That's you all.
HORGAN: Yes. To us sisters who kind of looks at them and doesn't really understand why they have that kind of freedom, you know, how they're so
open or how they are with their bodies, any of that, that's not where she came from. She's like a Northern Irish woman who is sort of driven by
religion and, you know, sort of what's expected of her and what was expected of women at that time. And I think, really, at the heart of it,
all she wanted was friendship.
But she takes it too far and she gets given this piece of information, like drags it out of Roger. She says to him, you know, I'm in the guilt
industry, meaning, you know, the Catholic church. I know guilt when I see it. So, he opens up to her and she has that over Grace. And she sort of
abuses it, but -- and it's a very -- I can't wait for people to watch the whole journey, because, I mean, I love her as a villain, but there's -- you
know, it's not black and white.
AMANPOUR: It certainly is not. And look, we're laughing, but it does show that comedy can really tell these -- I mean, it's really dark. It's a
really dark family drama and all the other things that happen and lives that collapse and --
HORGAN: Yes.
AMANPOUR: Yes.
HORGAN: I love, love, love comedy for that. And I think no matter where I go, you know, instead of telling more sort of drama leaning stories I'm
always going to rely on comedy because I think it's a way into people's sort of hearts and minds as well and it makes those sort of more brutal
moments land because you're not expecting them and then you get this sort of release of a laugh after. And yes, I love it.
I mean, I would find it really hard, actually, I think, to write something that was a humor void. You know, because to me, that isn't life.
AMANPOUR: It's the vehicle, yes.
HORGAN: You know, we've all gone through really difficult, tricky things in our lives, and I can guarantee that you've laughed through them.
AMANPOUR: Yes.
HORGAN: You know?
AMANPOUR: Yes. You have really -- I mean, you're like a -- you know, like a rocket. People here know you from "Catastrophe," which was about a young
married couple and all the sort of --
HORGAN: Youngish.
AMANPOUR: Yes, youngish.
HORGAN: Thanks very much.
AMANPOUR: OK. Yes, everything's relative.
HORGAN: I know.
AMANPOUR: And all the things that go on, like in a -- which are funny and sad and crazy but you captured it really well. You have -- I mean, it is
extraordinary how much you actually produce and write. You're not just the actress, you really do a lot. What -- I mean, that's a body of work, isn't
it? Sort of examining relationships, ordinary relationships.
HORGAN: Yes.
AMANPOUR: Ordinary relationships.
[13:35:00]
HORGAN: Absolutely. Examining life and the various stages of life. You know, I mean, from my first show, "Pulling," which was like, you know,
you're sort of wasted 30s and starting life late and then "Catastrophe," "Motherland," you know, which really wasn't so much about motherhood as it
was about like finding your tribe, you know, at the school gates. And yes, divorce, but it's just -- it kind of document, well, not just my life, but
the lives of, you know, mainly the women and my family and the friends, people I see around me.
And it's like -- it's a massive privilege to get to do it, but it also feels like a great way for -- you know to express yourself and for people
to watch that and feel like, you know, a bit more normal, you know, that I've had those feelings too kind of thing.
AMANPOUR: Are you optimistic about the state of womanhood, sisterhood today?
HORGAN: Oh, sisterhood. Yes. I mean, yes. Yes, I am. I think she was an extraordinary woman to come out and wave her anonymity and I think --
AMANPOUR: This is in the real-life, you're Gizel (ph) (INAUDIBLE).
HORGAN: Yes, Gizel (ph). I mean --
AMANPOUR: Have you followed that too?
HORGAN: I have. I mean, not as closely as I should have. I found it incredibly upsetting and distressing. But, you know, I know that when we
were on set at the time, you know, the response was just incredible empathy and pride in her, you know, she chose to deal with it. What an incredible
brave woman.
But, you know, I've just come from, you know, junkets with the girls and it's the most incredible thing being around women, almost predominantly
female set, and it's -- you feel the sisterhood every day, and it's a wonderful thing.
AMANPOUR: "Bad Sisters," creator, actress Sharon Horgan, thank you so much, indeed.
HORGAN: Thank you.
AMANPOUR: And as we said, it's streaming live now -- or no, it's streaming now on Apple TV. We turn next to a health crisis in the United States. A
new Biden proposal to get obesity drugs covered by Medicare and Medicaid. It comes as a recent report found that three quarters of American adults
are obese and it's a worrying rise since 1990.
Our next guest is an expert on this topic. Dr. Fatima Cody Stanford is an obesity medicine physician and professor at Harvard Medical School. And as
medications like Ozempic become household names, Stanford joins Hari Sreenivasan to discuss the most effective treatments.
(BEGIN VIDEOTAPE)
HARI SREENIVASAN, CNN INTERNATIONAL CORRESPONDENT: Dr. Fatima Cody Stanford, thanks so much for joining us. As we're recording this
conversation, there is some news out that the Biden administration is proposing that Medicare and Medicaid cover this category of anti-obesity
drugs called GLP-1 medications. How significant is that?
DR. FATIMA CODY STANFORD, OBESITY MEDICINE PHYSICIAN, MASSACHUSETTS GENERAL HOSPITAL AND PROFESSOR, HARVARD MEDICAL SCHOOL: Well, I think it's
tremendously significant and I can tell you that I have spent a lot of time at the White House and with CMS discussing this issue. I've taken several
trips to D.C. to propose this as a significant area of coverage.
What we do know is that these issues have disproportionately affected the Medicare population and those that are of lower socioeconomic position, the
Medicaid population. And I can tell you that I am tremendously enthusiastic about this shift to cover these populations that have disproportionately
been affected by obesity.
SREENIVASAN: You know, before we talk a little bit more about the drugs, I think that the thing that most people are going to think about right now is
sort of the sticker shock. Look, these are expensive drugs that a lot of private insurers or employee health plans don't even cover. What are the
costs associated with this if we were to increase the numbers by 3 or 4 million people who might qualify under Medicare or Medicaid?
DR. STANFORD: Well, you know, the costs up front may be quite large for, you know, the Biden administration or, you know, for the government. But
what I want to think about is the downstream impacts. What we do know is that obesity causes over 200 complications of, you know, cardiometabolic
diseases, but other disease processes, everything from diabetes to hypertension to hyperlipidemia, which we know is high cholesterol to
osteoarthritis to rheumatologic conditions, really everything across the board.
And what we do know is that if we treat obesity, we can treat these downstream disease processes. What I have the pleasure of doing as an
obesity medicine physician is actually removing diagnoses from people's charts. What I have the pleasure of, you know, working with patients across
the lifespan, most of my patients have been with me for 10 years or more.
And, you know, when we're doing this work is we actually find that over that decade plus is they get healthier, you know, at 70 years old, they're
healthier than they were at 60 years old. It's a match, actually amazing. And they are living healthier lives.
Actually, just this past weekend, I spent time with a family that are immigrant -- an immigrant family. They're in their 70s. They're living
healthier lives than they did in their 60s. You know, what does this say for the population? This is exactly the population that you're speaking to.
They are actually able to do things that they weren't able to do when they were in their 60s. This is exactly the population and target of this actual
change.
[13:40:00]
Several of them are on pharmacotherapy. They are actually benefiting from this shift. They are getting this from private insurance, but as we make
this shift and looking at Medicare enrollees, Medicaid beneficiaries, this is exactly the type of shift that we're expecting to see as we see things
coming out from the Select and Surmount trials, that Semaglutide and Tirzepatide trials, seeing the benefit of reducing major adverse coronary
events, seeing benefits and improvement from obstructive sleep apnea, liver disease, et cetera. I mean, that's exactly what we're hoping to get from,
you know, covering individuals that have not been able to get coverage thus far.
SREENIVASAN: And we should point out a couple of things. One is that this is a proposal by the Biden administration. Obviously, there's a new
administration, new sheriff coming into town in January. Now, they might have different views on this. So, this is still up to the next
administration to figure out whether they want to run with this proposal or not. But regardless of who is in the White House, you would suggest that
this proposal go forward?
DR. STANFORD: Absolutely. You know, this is something -- like I said, I've spent a lot of time advocating for in conjunction with the Treat and Reduce
Obesity Act, which was initially introduced in the House in 2012. As you know, we're in 2024. This would seek to do exactly this, cover the Medicare
population with anti-obesity medications.
We have seen that we -- these medications are covered for individuals that have diabetes, but disproportionately not covering those that have obesity.
We know that obesity is the most prevalent chronic disease, yet we somehow don't seem to cover those individuals and preferentially cover only those
with diabetes. But we must acknowledge that those with diabetes, about 80 percent, particularly with type 2 diabetes, concurrently have obesity.
So, we have this preference for covering one population, not covering another population, and it seems a bit unfair. And so, I would, you know,
be a strong advocate for covering this population, a population that I exclusively treat in the practice of medicine that I render to patients at
Mass General Hospital.
SREENIVASAN: OK. So, you literally -- this is the bread and butter of what you focus on, on a daily basis, and you've been working with patients for
so long about this. I mean, is there something wrong with the thinking? RFK Jr. famously on the campaign trail, has said, look, I mean, we could fix
all of this stuff if people just ate better.
I mean, is there something else that we should be thinking about in the context of obesity, whether it's on a chemical level in our brain or how
our bodies react to extra weight? What are things that make this more complex than just saying eat right?
DR. STANFORD: Absolutely. I'm so glad that you asked me this. And you know, what we do know is that obesity is a complex multifactorial relapsing
remitting disease where genetics, development, environment, and behavioral play a role.
You know, as a part of the U.S. Dietary Guidelines Committee, I can tell you that food does play a role, but I want us to acknowledge that while
food plays a role, all of these other factors that do indeed play a role. Let's look at the role of medications in the fact that many of the
medications that we prescribe is doctors are weight promoting. They influence the biochemical factors in the brain that actually influence
weight control.
And so, a lot of people ask me, so what are some of those medications that can influence weight regulation? And I'd like to spit off this list,
medications like Lithium, Depakote, Tegretol, Celexa, (INAUDIBLE) Prozac, Ambien Trazodone, Lunestic (ph), Avitentin (ph), Glyburide, Glibenclamide,
Parivital (ph), Metoprolol, Atenolol, Propranolol, long-term insulin, long- term prednisone, just to name the ones I wanted to say at that moment. But these medications can affect weight and weight regulation.
And so, those are medications that can influence weight control. I've seen upwards of 200 pounds of weight gain associated with medications that we
prescribe for other conditions. So, that's important for us to know. Trauma can influence, stress can influence the storage of adipose. Adipose is this
fancy word that we use, but actually, adipose is a metabolically active organ. Fat is a metabolically active organ. And some of us store excess
adipose because of trauma or stress that we've experienced in our life and/or generational trauma or stress.
Different things have implications. If you're a night shift worker because -- let's say you're a doctor or let's say you have a night job, that
destroys the super chiasmatic nucleus. That's a fancy word, you guys couldn't go look that up, but that affects how we store adipose or fat.
There's a variety of factors that have happened in our society that actually influence why we, at this time, in society, have more adipose or
more fat mass than we've had at previous times in society.
[13:45:00]
And it's not just here in the U.S. We have over 1 billion people worldwide that have obesity. And the United States currently is ranked number 10 in
the world in terms of countries with obesity. So, while we're not ranked number one, we can recognize that this is an issue that is affecting the
world and it's something that we must acknowledge on a worldwide basis.
SREENIVASAN: In the interest of full disclosure, you have advised different drug companies about GLP-1s. Explain kind of how they work in
combating obesity.
DR. STANFORD: So, these medications work in the brain. As you kind of have alluded to, or we actually have to recognize that when we're storing excess
fat mass, it's actually a disease of the brain. So, there's a part of the brain called the hypothalamus that actually governs how much fat mass we
store. And these medications upregulate a part of the brain that tells us to eat less and store less.
So, a lot of patients that are on these medications will tell you they actually receive signals that tell them that they're not hungry and they
never recognize that a lot of their brain was focused so much on thinking about what's the next meal, what's the next snack, and they are not really
thinking about this.
I don't necessarily use this term, but a lot of them will refer to this as food noise. But this is something that you'll hear a lot within this kind
of kind of thinking of how people will recognize their influence of being on these medications. So, there's this idea of food noise that seems to be
the volume is turned down when they're on the medications. And so, when they're on the medications, it's influencing that.
But what I will tell you is that GLP-1, you and myself, we all have GLP-1 inside of us. Those of us that happen to be leaner have more GLP-1 on base.
So, when we administer GLP-1 to you, we are giving you more of what your body would naturally make. And for those of us that don't have as much
inherently inside of us, we are giving you more of what your body should make it baseline. So, that's an important piece of the puzzle also.
SREENIVASAN: I've also heard that as people gain weight, sometimes their brain almost resets to a new norm.
DR. STANFORD: Yes.
SREENIVASAN: And then, when they start to go on a diet or they exercise and they lose a bunch of weight, it's like the brain is somehow giving them
signals to put that weight back on, even though it might not be healthy for them. But I mean, is that true?
DR. STANFORD: That's absolutely true. So, it's this idea of set point. And so, the brain wants to defend its newest set point. And this is the set
point theory that has been, you know, out in the -- out and about for over 75 plus years.
What the body does is it recognizes -- the brain, it goes back to the brain. The brain is very smart. It wants to defend fat mass, and it thinks
that once you get to a certain fat mass, it needs to do whatever it can to bring you back to a set point. And the key hunger hormone in our body is
called Ghrelin, that's spelled G-H-R-E-L-I-N. And what it does is it wants to bring you back.
And so, without you trying to do something, you'll notice that you're hungry and you're like, well, gosh, I don't want to be hungry, but it's
going to bring you back to its set point prior to. So, this is that idea of like, when you go on a diet, you lose weight, and then you gain weight back
to actually a higher point than where you were prior to whatever dietary intervention.
This is why when, you know, we go into the new year, people say, hey, I'm going to go on X, Y, or Z diet. They lose weight, and then they recognize,
wait a minute, I'm a little bit higher than I was prior to that dietary intervention, or you know, lifestyle modification, let's say it was an
exercise plan. Because the body is going to make different mechanisms happen to bring you back to a point a bit above it. It wants to defend
whatever it can amass of what it thinks is normal for you, despite what you think is normal.
SREENIVASAN: This month a study was out in the Lancet Medical Journal, and it found that nearly three quarters of American adults are overweight or
have obesity. Were you surprised by that?
DR. STANFORD: Not at all. You know, we've been following these trends for years and we've seen this gradual rise in overweight and obesity within the
American population. And I think that what we have found is that we've been using the same strategies to address overweight and obesity, which is only
addressing the food portion of this puzzle. You know, just looking at the food quality, looking at dietary strategies, and maybe addressing it by
looking at exercise modifications.
But, you know, what is the definition of insanity, trying the same thing and hoping, you know, different results will occur. We have found that
these strategies are ineffective alone and addressing this overweight and obesity pandemic, which is here in the United States and frankly around the
world. So, this rise in obesity that has happened over time is by no means surprising to any of us that have been doing this work for decades.
[13:50:00]
SREENIVASAN: It found that the prevalence of obesity rose, especially rapidly, doubling in the past three decades in both adult males and
females. And I wonder like what is behind this rapid increase and are there subpopulations that, you know, if we overlaid socioeconomic data, is this
more likely to in states that are -- have greater amounts of poverty or less access to health care or food deserts? I mean, what are the other
things that, you know, this overall kind of picture doesn't point out to us?
DR. STANFORD: Yes, if we look at -- if we kind of drill in and kind of look a little bit with a finder tooth comb, we do see that this is more
prevalent in the southeast. If we look at in the kind of the Midwest, we see a little bit less prevalence. Also see in the west, we see a little bit
prevalence. Higher prevalence and racial and ethnic minority populations also. In the indigenous population, we see higher prevalence.
This is coming out of some of the finer tooth information that's coming out of the CDC and this -- we also see this in lower socioeconomic position.
So, you're right, if we kind of look at this, if we're looking at lower socioeconomic position, access definitely plays a role and, you know, this
is not of any surprise to us. And this is really germane to some of the problems that we believe are behind this rapid rise in overweight and
obesity in both populations, you know, regardless of gender, you know, and this is something that we're paying close attention to.
But this is something that we expected. And if we look at, like, the full picture, you can see that it's affecting everyone, but disproportionately
affecting certain populations.
SREENIVASAN: One of the things the study points out was that if we don't take any immediate action, that by 2050, the prevalence of overweight and
obesity in adults will exceed 80 percent nationwide. So, what are some of the kind of longer-term implications of how society functions, what kind of
policies we need to be rethinking? And then I guess, I mean, that's the sort of the downside, but on the positive note, like what are things that
are working that we can actually do now to prevent this?
DR. STANFORD: Yes. So, you know, one of the key things that I think we're not doing that we need to be thoughtful of is that we need to address
parents prior to conception. What do I mean by that? If we address parents and their health and health status prior to conceiving, we actually have
the best likelihood of addressing the next generation.
So, studies have shown that if parents are in their optimal health prior to conceiving children, they actually have the best implications for the next
generation to come. We know that maternal and paternal obesity increases the likelihood of a child having obesity themselves. And so, we're kind of
behind the eight-ball at that point. So, that's the best likelihood or thought process, but we aren't thinking in that way. So, that's, I think,
the best forward thinking. So, I think that's a strategy that we need to be thoughtful about. So, that would start, you know, prior to conception. So,
we need to be thoughtful in that way.
Things that we need to be thinking about is actually treating overweight and obesity since it's already here. We're talking about 75 percent of the
population. Let's begin to actually treat this disease that's actually here in the population, both in the pediatric and the adult population. This
study focused on the adult population, but I can tell you as also a pediatrician, since I take care of patients across the age spectrum, we
need to be treating this across the age course and we need to be thoughtful about that and thinking about how do we actually address this from a
lifestyle factor -- from lifestyle factors, using pharmacotherapy and also metabolic and bariatric surgery, which has had a significant decline over
the last year. We've seen a 25 percent decline in the use of a bariatric surgery in the last year. But we've had a rise in severe obesity. This is
something that we need to be thoughtful about. So, we need to be thinking about that.
But we also need to be thinking about policies, which is how we started this conversation. How do we think about large scale policies, thinking
about governmental policies intersecting with the healthcare sector and thinking about how do we also address the exorbitant costs of access, not
just to pharmacotherapy, but thinking about how -- what are we doing in our schools? How are we thinking about food and thinking about the quality of
our foods?
We need to reduce our ultra-processed foods. These do need to change within our society. We do know that that is still part of the problem. And so, we
do need to make some reduction in that to make sure that overall, our society is healthier. But we have to also address all those other issues
that we know are germane to increasing these obesity rates over time.
And so, this is going to take a multisector, multi-pronged approach to really address this issue. It's not going to be just health care. It's not
going to be just government. It's really going to take every -- all-hands- on-deck because there's no way that one sector is going to be able to address this alone.
[13:55:00]
SREENIVASAN: Obesity medicine physician and professor at Harvard Medical School Mass General Hospital, Dr. Fatima Cody Stanford, thank you so much
for joining us.
DR. STANFORD: Thanks so much for having me. It's been a delight being here.
(END VIDEOTAPE)
AMANPOUR: And the body of course is a complicated thing. And finally, tonight, in case you missed it, the United States Postal Service is giving
a sneak peek at the new stamps coming out next year. Among them, the hilarious and beloved late actress Betty White. The golden girl, who lived
to nearly 100, glows in a purple polka dot top. The Postal Service honors White as not only a television icon, but also as a compassionate advocate
for animals and their welfare.
That's it for now. Thank you for watching, and goodbye from London.
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