#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now

Dr. Rocio Salas-Whalen 0:00 I've had grown men in my office cry when they hear this for the first time. Weight loss should not consume your life mentally or physically. It's okay to receive help. We live in a industrialized world that really promotes obesity. Obesity, weight gain is complex, doesn't make you a failure. It means that you are human. For the first time, we actually have help beyond exercise more and eat less.

Mel Robbins 0:34 Wow. I would love to have you talk about the GLP-1 medications.

Dr. Rocio Salas-Whalen 0:41 I've seen people's lives change. The most important finding of this drug in-

Mel Robbins 0:49 Hey, it's your friend Mel, and welcome to the Mel Robbins podcast. I am so excited that you're here, I am so excited to learn about our topic today. And, you know, I just gotta say, it is such an honor to spend time with you. It's an honor to be together. If you're a new listener, I wanna take a moment and welcome you to the Mel Robbins podcast family. And because you made the time to listen to this particular episode and learn more about this particular topic, here's what I know. I know you're the kind of person who values your health and you're looking for evidenced-based information, and today you're gonna get it because we're talking about the weight loss medications that are all over the headlines. And if someone that you love sent this to you, well, first I wanna acknowledge you for choosing to hit play. Because the fact that they sent this to you means that they deeply care about you and your health, or they care about their health and want you to learn more about what they're doing, and you deserve to have great health, and you also deserve access to doctors who really care about you being empowered and informed about your health, and that you really understand the tools that are available to you. Now, you may have heard of this new class of weight loss medications called GLP-1s. The most well-known one is Ozempic, and today I brought in a world-renowned expert, Dr. Rocio Salas-Whalen, to break down the truth about these medications. Who are they for? What are the risks? And what do you or someone you love need to know if you're considering using them? Dr. Salas-Whalen is a triple board certified physician in endocrinology, obesity medicine, and internal medicine. She's a leading expert in metabolic health, the founder of New York Endocrinology, and a clinical instructor at NYU Langone Hospital. She specializes in treating a wide range of endocrine disorders, including diabetes, thyroid disorders, osteoporosis, and PCOS. Her approach is all about prevention and sustainable solutions to chronic health challenges. So if you've ever struggled with your weight, or you have a friend or a loved one who has or is, this episode is a must listen and it is a fantastic free resource with a world-renowned medical expert that could change your life. Dr. Salas-Whalen, welcome to the Mel Robbins podcast.

Dr. Rocio Salas-Whalen 3:14 Thank you so much for having me.

Mel Robbins 3:16 Well, I am so glad that you're here, and I know that by the time we're done with this conversation today, that the person who's listening and the people that they care about are gonna feel empowered and excited, at least that's what I feel. It's why I'm so excited that you're here. But I'd love to start by having you speak to the person who has hit play and is here with us right now, and just explain to them what might change about their life or their loved one's life if they truly take everything into account that you're about to teach us today and they put it to use in their life.

Dr. Rocio Salas-Whalen 3:55 That obesity, that weight gain is complex, it's not as straight line as we used to think, and that most importantly, that weight loss should not be a full-time job. Weight loss should not consume your life mentally or physically.

Mel Robbins 4:15 Wait, there's actually a world where that is true?

Dr. Rocio Salas-Whalen 4:18 It, it exists. It is possible and reachable.

Mel Robbins 4:22 Wow. Um, I mean, that's not what I thought you were gonna say. That is an amazing just thought to think that your life could... You could actually experience life and not be consumed by your weight, your body, your health, what you think people are thinking, what you think about-

Dr. Rocio Salas-Whalen 4:42 Yeah.

Mel Robbins 4:42 ... how you feel about your body, because there's just so much shame around how people think about the way that they look or their metabolism or their size, and so I, I think that's extraordinary.

Dr. Rocio Salas-Whalen 4:56 Yeah. And I learned this through my patients and not in my medical training. I learned through my patients how they... I've seen how they struggle through decades for many. I have patients, all ranges of age, I have from teenagers to 70, 80-year-old patients, how they've struggled through since childhood, for many of them, and it consumes their life and every plate in front of them could be causing guilt, anxiety, shame, and this is 24/7, seven days a week, 365 days in a year.

Mel Robbins 5:31 Well, I'm so glad that you're here because if you can help the person listening or who they're gonna share this with to no longer be consumed by that and to have a completely different approach, something that's accessible and liberating, we're here for it. So, Dr. Salas-Whalen, why don't we start with having you just tell us a little bit about your background as a physician, because you have very unique, uh, training and expertise.

Dr. Rocio Salas-Whalen 5:58 I am originally from Mexico, and that's where I studied medicine. Uh, medical... I graduated from medical school, and once I graduated from medical school, I decided to venture to the United States by myself, wanting to become a doctor in New York City. And then after nine years of...... training, residency fellowship. I completed my specialty in endocrinology, and then the following year in obesity medicine.

Mel Robbins 6:24 Now, are those two connected? What is endocrinology and how does that lead to obesity medicine?

Dr. Rocio Salas-Whalen 6:29 They are very connected and originally endocrinology takes over what's metabolism and obesity. But we've learned that obesity is complex and it requires its own specialty just to be solely dedicated for obesity. And endocrinology is the management of hormones, and yes, hormones impact weight.

Mel Robbins 6:52 I would love to have you talk to the person who's listening or watching us right now, who may be overweight or who may be struggling with the disease of obesity. What do you want them to hear from you, Dr. Salas-Whalen?

Dr. Rocio Salas-Whalen 7:09 I want to say

Dr. Rocio Salas-Whalen 7:10 that I'm sorry in behalf of the healthcare providers. We didn't know better and we failed you, and I've learned this, I've been humbled by my patients. I- I've learned and hear their stories and we got it wrong. We got it all wrong. But there is help, we're learning more, we're, we... Science advances, like everything, right? Medicine is an evolving, uh, science, um, and we are aware and we will do everything we can to fix it.

Mel Robbins 7:52 Why do you think it's important for us to really think about this issue of obesity being a disease or somebody who's struggling with their weight kind of at the same level as we think about cancer or diabetes as a disease?

Dr. Rocio Salas-Whalen 8:09 Well, obesity kills. Obesity increases your risk of mortality. There's more than 15 cancers that obesity is their biggest risk, including breast, breast cancer. You have more risk of developing breast cancer than alcohol, hormone replacement therapy, or genetics. It's obesity. Obesity is the number one cause of pancreatic cancer, colon cancer, prostate cancer, thyroid cancer.

Mel Robbins 8:42 The number one cause?

Dr. Rocio Salas-Whalen 8:43 The highest risk for developing, yes.

Mel Robbins 8:46 Wow.

Dr. Rocio Salas-Whalen 8:48 So by reducing obesity, by treating obesity, we are going to have less chronic diseases. We've built specialists, we created esp- medical specialties from the complications of obesity. So we will have less diabetes, less hypertension, less cardiovascular disease if we treat obesity now. We will have less c- less incidents of the cancers that I mentioned.

Mel Robbins 9:13 You know, if I think about the way that the world has changed, especially when you see the statistics of the number of people that are either struggling with being overweight or who are living with a condition of obesity, one of the things that strikes me is that, I think in the past, there's always been this, I don't know, like judgment as if the person that is struggling with one of those me- metabolism issues, that they're somehow to blame. And I know at least when I think about members of my family that are struggling in this area of their life, that they feel a lot of shame around their inability-

Dr. Rocio Salas-Whalen 9:54 Mm-hmm.

Mel Robbins 9:55 ... to lose weight or to whatever. And I'm excited that you're here because I think that there's a huge shift in the way that we have been very ignorant around talking about the issue, and there's a shift medically speaking, and so I would love to have you talk about the way that as a medical doctor and as a world-renowned expert in obesity medicine, how you want us to actually even talk about or view this subject.

Dr. Rocio Salas-Whalen 10:28 And this is a very interesting thing because you as a non-medical professional have felt like that, judging and assuming. We as a healthcare providers, as doctors, we did the same, right, when patients were coming to us for help.

Mel Robbins 10:49 Yep.

Dr. Rocio Salas-Whalen 10:50 A- and to play devil's advocate, we didn't have the training, we didn't have the knowledge, right, that obesity is not a self-inflicted disease.

Mel Robbins 10:59 Okay, hold on. I want to make sure that we didn't- we do not skip over what you just said. Obesity is not a self-inflicted disease. I want to unpack that-

Dr. Rocio Salas-Whalen 11:09 Yeah.

Mel Robbins 11:09 ... because I- I did not understand that until recently. So what does it even mean that obesity is a disease?

Dr. Rocio Salas-Whalen 11:16 So what we've learned is that obesity is a multifactorial chronic disease and I'll go, I'll deconstruct that. Multifactorial meaning that there's more than one cause leading to somebody to struggle with weight or have obesity. I like to break them into big five pieces. One, lifestyle, exercise, sedentarism, diet, but that's one piece of the five.

Mel Robbins 11:42 Okay.

Dr. Rocio Salas-Whalen 11:42 The other one is genetics, right? You can have a genetic mutation but also it can run in the family, so there's two, it's two different, right?

Mel Robbins 11:50 Gotcha, okay.

Dr. Rocio Salas-Whalen 11:51 Um, then the third one, hormonal changes. We have PCOS, perimenopause, menopause in women. Then we have aging. That's unchangeable, nothing that we can do about it yet, um, but as we age, our metabolism slows down, we lose muscle mass, we tend to store more body fat. And then we have environmental factors and those are, uh, on its own, we can deconstruct that too because in environmental factors, we can talk about the food industry...... right? We can talk about obesogenic environments, so meaning places where the walking is not available or accessible or easy, where people have to drive everywhere, or even working from home now, right?

Mel Robbins 12:37 Mm.

Dr. Rocio Salas-Whalen 12:37 So there's less, uh, opportunities to being active that leads to more sedentarism. So we call that obesogenic factors, things that promote obesity in how we live. Also, we can talk about endocrine-disrupting chemicals, like BPA, what's found in plastics, pesticides, right? We live in a industrialized world that really promotes obesity. So if you think of all those five factors and you think of what the patient has control, pretty much only on one, right? Where we're talking about lifestyle, exercise, and eating healthy, and before, or when we do that, we tried or we put a lot of pressure on the patient to overcome all the other factors that are not in their control. Let's talk about genetics. We know now, there's reasear- research showing that the parents' preconception weight can impact the weight of the ins- offspring of- of their child.

Mel Robbins 13:39 Wait, so the parents' preconception weight, so the weight that your parents were when you were conceived, genetically speaking, research has proven, has an impact on your genetics in terms of-

Dr. Rocio Salas-Whalen 13:53 Yes.

Mel Robbins 13:53 ... your weight?

Dr. Rocio Salas-Whalen 13:54 Yes. And so-

Mel Robbins 13:55 And not j- and- and I- I even wanna go a layer deeper, because I'm gonna raise my hand and go right on the record and say that for most of my life, I was one of those people that had this topic completely wrong. I was the kind of person that did not understand anything that you were just explaining, and I just assumed it's lifestyle choices.

Dr. Rocio Salas-Whalen 14:17 Mm-hmm.

Mel Robbins 14:18 And when you really l- just listen and absorb what you just said, lifestyle, genetics, hormone changes, aging, environmental factors. Environmental factors are like just, uh, I mean, when you look at like the food industry and how it changes people's ability to process food and all the crap that's put into it-

Dr. Rocio Salas-Whalen 14:37 Yeah.

Mel Robbins 14:37 ... not having accessible safe walking areas, working from home and being sedentary, and then now you're talking about, I- I don't, I- I, this word was too big for me to write down. It was like endro-something destructible, but-

Dr. Rocio Salas-Whalen 14:49 Oh. (laughs)

Mel Robbins 14:50 ... that- that, but it was the things that are-

Dr. Rocio Salas-Whalen 14:51 Yeah.

Mel Robbins 14:51 ... actually impacting your body's metabolism-

Dr. Rocio Salas-Whalen 14:55 Yes.

Mel Robbins 14:55 ... that are in the environment, and forever, we have just looked at somebody who struggled with being overweight or who struggled with the disease of obesity and were like, "Oh, you're lazy," or, "Oh, you're not doing enough." And so I can see how understanding these five factors changes the game entirely, and the big thing that I'm hearing when you said we live in a world that is almost promoting, it's not even promoting, it's- it's- it's causing this disease.

Dr. Rocio Salas-Whalen 15:28 It's causing.

Mel Robbins 15:28 Which means it's not your fault.

Dr. Rocio Salas-Whalen 15:31 And when a patient hears this, I can almost physically see it how they feel relief. I've had grown men in my office cry when they hear this for the first time, because they've lev- lived decades thinking that it was their failure.

Mel Robbins 15:49 Well, what you've already shared is so enlightening and empowering, and I kinda wanna go back to each of these five things, because you said that there are kind of five factors that are part of a multi-layered cause of the disease of obesity. So let's go to the five things, and I wrote them down as you were talking 'cause I was like, "Oh my God, oh my God." So lifestyle, genetics, hormonal changes, aging, and environmental factors, and of those five causes of the disease of obesity, there's only one that you have control over, and that was some of the lifestyle choices that you make, but you are still fighting against genetics-

Dr. Rocio Salas-Whalen 16:35 Yeah.

Mel Robbins 16:35 ... hormone changes, aging, and environmental factors. So that's, that makes a lot of sense to me, why somebody can be working really hard at the lifestyle part and not seeing anything change, and so could you walk us through the four, the genetics, the hormone changes, aging, and environmental factors? I know we're gonna kinda go deeper in this, but just give us a sense of how each one of those four things really is a cause for the disease of obesity or for somebody who's struggling with overweight, with being overweight.

Dr. Rocio Salas-Whalen 17:12 Definitely. So when we talk about genetics, we're talking about family history, right? Um, if your parents struggled with weight, if your grandparents struggled with weight, then you are at higher risk of also struggling with weight. Again, we know the preconception weight of your parents impact, even the food that they eat, if they eat, consume highly palatable food, that can be transmitted to you. Uh-

Mel Robbins 17:36 What's palatable food mean?

Dr. Rocio Salas-Whalen 17:38 Food, processed food-

Mel Robbins 17:38 Oh.

Dr. Rocio Salas-Whalen 17:39 ... ultra-processed food that will lead to wanting to consume more, right?

Mel Robbins 17:43 Hmm.

Dr. Rocio Salas-Whalen 17:43 Um, then when we talk about also there's some, uh, mutations that may also cause obesity, right? Um, and then when we talk about hormonal, so, uh, through a person's life, there could be hormonal changes, shifts, imbalances, that is going to promote weight gain. We can talk about hypothyroidism, right, of which thyroid hormone controls your metabolism. Then we can talk about PCOS, polycystic ovarian syndrome, when there's hyperinsulinemia, insulin resistant, and this promotes visceral fat. Visceral fat promotes insulin resistance, insulinemia, and it goes into a vicious cycle. We also talk about perimenopause and menopause with the changes, the fluctuations, or the drop of estrogen. This promotes visceral fat. The subcutaneous fat that you had in your fertile years, in your hips and your breasts goes intra-abdominally. This visceral fat promotes insulin resistant, and then you go into that vicious cycle again. Also because of the drop of estrogen, we see a decrease in lean muscle mass.

Mel Robbins 18:42 Hmm.

Dr. Rocio Salas-Whalen 18:42 Muscle mass is your burning calorie machine. If you lose it, then your metabolism slows down.... then we go into aging. Aging also, as we age, we tend to lose muscle mass. It's harder to build muscle and also it promotes weight gain. And then we go into environmental factors. As we talked, the food industry, um, industrialization, plastic, pesticides, all of those things disrupt your endocrine system. They c- we call them endocrine disrupting chemicals because they disrupt the function, the normal function of your hormones. They mimic your hormones, so they occupy the receptors where your hormones should go and do a function, and this can promote obesity, infertility. So there are real things that are impacting people's life on the day-to-day basis.

Mel Robbins 19:35 What I love about what you're sharing is that if there are five factors (laughs) that are present and that cause the disease of obesity, I would imagine that you as a medical doctor now are able to help a patient in a very different way. And so given that obesity is now classified as a chronic disease, how does that change the way that you treat patients and the various kind of tools that you have at your disposal to empower somebody?

Dr. Rocio Salas-Whalen 20:10 Well, knowing this and- and understanding this, you move away of putting the pressure on the patient, right?

Mel Robbins 20:19 Mm-hmm.

Dr. Rocio Salas-Whalen 20:19 You move away of being a one participant in this equation. It goes more into a team, right, in- in what you can do for the patient and educating the patient. It becomes a team. Let's talk about, as an example, diabetes, type 2 diabetes. We know it's a chronic multifactorial disease, but we have no trouble prescribing and treating medications for it, right?

Mel Robbins 20:42 Right.

Dr. Rocio Salas-Whalen 20:42 It's widely accepted from the patient side-

Mel Robbins 20:45 Right.

Dr. Rocio Salas-Whalen 20:45 ... from the physician side. Let's talk about hypertension. Same thing, right? We know that lifestyle can help it or make it worse, but that is not causing the disease, therefore we feel comfortable treating it and the patients accepting treatment. And when we provide treatment for type 2 diabetes, hypertension, or high cholesterol, we always talk about eating healthier and exercising, but it doesn't replace the treatment. So if we see obesity as a disease, we can act the same way, understand and support the patient in their lifestyle, but also provide a medical treatment.

Mel Robbins 21:23 Because there are four factors outside of your control that you've just unpacked, genetics, hormone changes, aging, and all the environmental factors largely because of big farming and industrialized food and all the crap that they put in it-

Dr. Rocio Salas-Whalen 21:36 Yeah.

Mel Robbins 21:36 ... that's screwing up and confusing your body's ability to process food.

Dr. Rocio Salas-Whalen 21:40 And I'm breaking them in big five umbrella-

Mel Robbins 21:43 Yes.

Dr. Rocio Salas-Whalen 21:43 ... but also there's other things like medications that patients may take for certain particular disease that can promote weight gain, right? Uh, there's a lot of antidepressants that can promote weight gain, uh, blood pressure medications that can promote weight gain, right? And many times there's no other option for the patient and this can also lead to

Dr. Rocio Salas-Whalen 22:02 obesity.

Mel Robbins 22:02 So I would love to have you talk about the GLP-1 medications because I didn't realize... Uh, I- I didn't realize they've been around for decades. I- I had no idea. I- I- I've seen them in the headlines.

Dr. Rocio Salas-Whalen 22:17 Yeah.

Mel Robbins 22:17 They're all over the place. I have, like many people, I have, uh, people in my life that are taking them and they're- they're life-changing, but I didn't realize that they've been around for a long time. So could you talk to us about what they are, how long they've been around, like when you first started using them in your clinical practice?

Dr. Rocio Salas-Whalen 22:38 Definitely. The first FDA approved GLP-1 was in 2005.

Mel Robbins 22:44 2005?

Dr. Rocio Salas-Whalen 22:45 Yes.

Mel Robbins 22:45 What?

Dr. Rocio Salas-Whalen 22:46 20 years now.

Mel Robbins 22:47 20 years?

Dr. Rocio Salas-Whalen 22:48 Yes. The FDA name, it was by Eli Lilly. It was called Byetta, and this was a twice-a-day subcutaneous injection. So it was a daily, twice-a-day injection that patients had to do.

Mel Robbins 23:02 Okay.

Dr. Rocio Salas-Whalen 23:02 And the first indication was for type 2 diabetes because GLP-1 is a hormone.

Mel Robbins 23:09 What does GLP-1 stand for?

Dr. Rocio Salas-Whalen 23:11 Glucagon-like peptide and it's a peptide or a hormone, um, a-

Mel Robbins 23:17 Oh, wait. Is that what the word peptide means, hormone?

Dr. Rocio Salas-Whalen 23:20 No. Peptide is what we call a short chain of amino acids.

Mel Robbins 23:24 Okay.

Dr. Rocio Salas-Whalen 23:25 A long chain of amino acid is a protein, so s- before protein, it's a peptide.

Mel Robbins 23:31 Okay.

Dr. Rocio Salas-Whalen 23:31 Peptides can help to produce or inhibit the secretion of hormones. The most important finding of this drug, and I actually met the person, the doctor, the researcher who i- isolated this, uh, the GLP-1 outside the human body, it was in a lizard called the- the g- the Gila monster. Um, and the lizard, the venom of this lizard caused pancreatitis on its victims. So Dr. Ng, John Ng, being an endocrinologist and researcher at the V.A. Hospital in the Bronx, wonder what in the venom affected the pancreas.

Mel Robbins 24:08 Okay.

Dr. Rocio Salas-Whalen 24:09 And he isolated a GLP-1.

Mel Robbins 24:13 So this little Gila lizard bites its, like, prey or whatever, and the venom of it sends, activates the pancreas and like-

Dr. Rocio Salas-Whalen 24:22 It causes pancreati-

Mel Robbins 24:22 ... sends the thing into, like, a state of diabetic shock?

Dr. Rocio Salas-Whalen 24:26 It causes pancreatitis so the- the prey dies from pancreatitis.

Mel Robbins 24:30 What? So- so what exactly does the GLP-1 do to the pancreas?

Dr. Rocio Salas-Whalen 24:39 So it stimulates to produce insulin. The problem in type 2 diabetes, uh, is insulin resistant and hyperinsulinemia. So with time, with-... frequent stimulation of the pancreas, every time you eat, every time you eat a- anything that has glucose, uh, your pancreas produces insulin. But with time, it overworks.

Mel Robbins 25:01 Mm.

Dr. Rocio Salas-Whalen 25:01 Your body stops responding the same way to the insulin that you make, so you become resistant to your own insulin. The pancreas, in response, tries to overcompensate and make more insulin, but your, your body is resistant to it. So e- you have hyperinsulinemia and insulin resistance. So these are the two main pathologic factors that lead to somebody to develop type 2 diabetes.

Mel Robbins 25:26 And how does this connect to somebody who is struggling with being overweight or somebody who's struggling with the disease of obesity?

Dr. Rocio Salas-Whalen 25:38 And this is the beauty of medicine, right? One, one thing is made or developed for a particular disease or reason, we find out later that it has other benefits-

Mel Robbins 25:48 Mm.

Dr. Rocio Salas-Whalen 25:49 ... like this, like GLP-1.

Mel Robbins 25:52 I didn't realize that a spike in insulin means you're also gonna crave more food, which then means that if you're the kind of person that has either environmental factors where you're eating a ton of processed food that never fills you up and is just full of stuff that spikes your insulin, that is gonna become part of the cycle that you're on without even realizing that you're now trapped in this cycle and it's not your fault.

Dr. Rocio Salas-Whalen 26:16 Exactly.

Mel Robbins 26:18 Wow! So what have you seen in the last 15 years since you've been using GLP-1s as a tool in your medical practice? What have you seen in terms of the benefit to patients, how this is used as a tool, the difference that it makes?

Dr. Rocio Salas-Whalen 26:38 Um, I've seen people's change, people's lives change. Um, I've seen more acceptance to the medication. Uh-

Mel Robbins 26:47 Mm-hmm.

Dr. Rocio Salas-Whalen 26:48 ... the drugs are becoming, uh, safer, less side effects. I like to compare them with the iPhone. We have different versions of the iPhone, right? We have the iPhone 1, the iPhone 10, uh, and now we have the iPhone 16. Same is happening with this class of drugs. Their versions are newer, safer, less side effects, and more effective.

Mel Robbins 27:12 Hmm.

Dr. Rocio Salas-Whalen 27:12 So I, I feel like people are getting the message, one, or accepting the message, that obesity is a disease. They feel like giving up. For many patients, I'm the last stop of their journey, and when I talk about a journey, I'm talking decades of journey. I'm talking about diets that I've... Doing diets that I've never even heard about. I always learn about a new diet from my patients. Being with nutritionists, being in fat camps that they call them, um, so it... I've seen patients struggle through their life and how this medication are changing their lives and giving them, um, their life back basically.

Mel Robbins 27:57 If these drugs have been around for 20 years, at least in terms of a specific treatment for type 2 diabetes, why is it that we're all just hearing about it now?

Dr. Rocio Salas-Whalen 28:08 First of all, the initial versions of this drug, they cause more side effects and they were more cumbersome for somebody. People had to inject themselves twice a day every day. So even for many patients with type 2 diabetes, it was hard to accept because-

Mel Robbins 28:22 Mm.

Dr. Rocio Salas-Whalen 28:22 ... patients with diabetes, they think and feel that once they're on insulin, they're failed, right? Or i- it's just more severe. So having a medication that is injectable, it was hard to dissociate them with, with insulin-

Mel Robbins 28:37 Got it.

Dr. Rocio Salas-Whalen 28:38 ... or with failure.

Mel Robbins 28:39 So they'd basically be like, "I might as well just be injecting insulin at this point."

Dr. Rocio Salas-Whalen 28:42 Exactly.

Mel Robbins 28:42 Okay.

Dr. Rocio Salas-Whalen 28:42 So patients didn't, they didn't like to inject themself and it was a twice a day injection and there were a lot of nausea, so it was harder to tolerate back then, so-

Mel Robbins 28:53 And, and just so I remember, 'cause it's already flown out of my brain, that how it works is that it stimulates your pancreas?

Dr. Rocio Salas-Whalen 29:01 For type 2 diabetes, yes-

Mel Robbins 29:02 Okay.

Dr. Rocio Salas-Whalen 29:03 ... it stimulates your pancreas to make more insulin when your sugar goes above normal.

Mel Robbins 29:07 Okay.

Dr. Rocio Salas-Whalen 29:08 But if somebody who doesn't have diabetes and their glucose is normal, it doesn't touch the pancreas.

Mel Robbins 29:14 Interesting. Okay.

Dr. Rocio Salas-Whalen 29:15 That's why we can use it in people that don't have diabetes.

Mel Robbins 29:18 Got it. So 15 years ago, when you were prescribing this to your patients in your clinical practice, it's twice a day, the side effects were a lot worse, and it was really limited to treating type 2 diabetes.

Dr. Rocio Salas-Whalen 29:32 Type 2 diabetes.

Mel Robbins 29:33 So what has happened in the last 15 years?

Dr. Rocio Salas-Whalen 29:35 Again, as with any drug we see, we, we have off-label uses, and what we were ha- well, what's happening is when, when we started somebody with type 2 diabetes on these drugs, when they were coming back to their follow-ups, not only was their glucose improved because they're great anti-diabetic drugs, but they were losing weight. And to have that as a diabetes treatment, a drug that lowers your sugar and also helps with weight loss, it was unseen, because most medications for diabetes promote weight gain.

Mel Robbins 30:04 Okay. So this is gonna make me sound like the world's biggest idiot-

Dr. Rocio Salas-Whalen 30:07 (laughs) .

Mel Robbins 30:08 ... but s- if you inject insulin for type 2 diabetes or ty- like, it actually makes you gain weight?

Dr. Rocio Salas-Whalen 30:15 Yes.

Mel Robbins 30:15 That does not seem fair.

Dr. Rocio Salas-Whalen 30:16 It does not. It is not. But that's all we had-

Mel Robbins 30:19 Okay.

Dr. Rocio Salas-Whalen 30:19 ... back then.

Mel Robbins 30:20 So that was an off-label finding, and so all of a sudden you're in your medical practice, you are prescribing this, some patients are using it despite the nausea and you're like, "Holy cow, we're seeing weight loss, which is fantastic for people." Okay.

Dr. Rocio Salas-Whalen 30:36 It is fantastic, especially for type 2 diabetes that weight gain or obesity goes hand in hand with diabetes, and before with the medications that we had, we had to choose. Either we help with the glucose or we help with the weight.

Mel Robbins 30:47 Right.

Dr. Rocio Salas-Whalen 30:47 And many times we wanted to bring the, the, the glucose and that's what we had available.

Mel Robbins 30:52 So how long have you been prescribing these to people as a tool for treating the disease of obesity or for somebody who's struggling-... with-

Dr. Rocio Salas-Whalen 31:01 Since-

Mel Robbins 31:01 ... being overweight?

Dr. Rocio Salas-Whalen 31:02 Since 2010.

Mel Robbins 31:04 So you're like a pioneer in this.

Dr. Rocio Salas-Whalen 31:06 Yes. (laughs)

Mel Robbins 31:07 Wow. And when did all these studies start to happen?

Dr. Rocio Salas-Whalen 31:10 They started back in 2000... So I mean, even for 2005 for the, for the FDA approval is they're starting in the '90s, right, with the first one. But in regards for weight loss, it started around 2005, 2006.

Mel Robbins 31:22 Gotcha.

Dr. Rocio Salas-Whalen 31:23 And then the first one approved for weight loss was in 2012 named Saxenda, also a daily injection. So we moved from the twice a day injection to the once a day injection, but it's still severe side effects with nausea or vomiting, and it was hard to get to higher doses where we see most of the weight loss because of the side effects. Then eventually in 2017, we have the poster child of these drugs, which is Ozempic, that was when it was approved for type 2 diabetes. In 2021, Ozempic become, became also approved, FDA approved for weight loss independent of diabetes and then rename it as Wegovy. And-

Mel Robbins 32:05 Wait. Oh, wait. Wegovy and Ozempic are the same thing?

Dr. Rocio Salas-Whalen 32:07 It's the same drug. Yeah. When GLP-1 gets approved initially for type 2 diabetes and then eventually gets approved separate, exclusively for weight loss, they, they rebrand it. They just change the name, but it's the same drug, same pharmaceutical, same dosing.

Mel Robbins 32:22 Why did they rebrand it? So that they can market it to a different segment of people who are like, "I don't wanna take the diabetes drug."?

Dr. Rocio Salas-Whalen 32:27 Well, if you don't have diabetes, you don't wanna take a medication that is for diabetes and also for insurance purposes, right?

Mel Robbins 32:33 Got it.

Dr. Rocio Salas-Whalen 32:34 Insurance will approve one drug for type 2 diabetes and will approve one drug for obesity, but unlikely that it's going to approve one for both things.

Mel Robbins 32:42 Wow.

Mel Robbins 32:43 So how exactly does, does the GLP-1 work to help somebody lose weight or to change their metabolism if they don't have diabetes?

Dr. Rocio Salas-Whalen 32:53 GLP-1, I like to explain to my patients, target the two reasons that humans eat. We eat for fuel, survival, and we eat also for reward, for a reward.

Mel Robbins 33:06 Okay.

Dr. Rocio Salas-Whalen 33:07 And the fuel part or the survival part, what this medication does, it suppresses your appetite hormones and it increases your satiety hormones. So if for somebody who's on this drug and you're gonna start eating, you get fully satisfied with a third or half of what you normally would need to feel full. And then in between meals, it suppresses your hunger hormones. So for most patients, this looks like two small meals a day, feeling physically content. That's for the survival part. Now for the reward part, we have receptors for this hormone in our brain in the hedonistic eating and drinking area of our brain where we anticipate or associate our reward either with food or beverages like alcohol.

Mel Robbins 33:53 Mm-hmm.

Dr. Rocio Salas-Whalen 33:54 And it blocks that reward response. So let's say if somebody's anticipating having a meal that they know is going to relieve or are certain reward, once you're on these medications, you see that meal and you don't get the same feedback. So the behavior change. You en- you enjoy your food when you're hungry, and eating, once you're full and satisfied, it's out of your mind.

Mel Robbins 34:18 Wow. And it doesn't touch the pancreas?

Dr. Rocio Salas-Whalen 34:21 It doesn't touch your pancreas if your glucose is normal.

Mel Robbins 34:25 Wow. So you know, one of the things that I see, that I know a lot of people see, and this is sort of like the sh- also could be more shaming, but you see, you know, celebrities who wanna lose an extra 15 pounds or you see the Ozempic face, you know, all over social media. And I'm just curious what your opinion is about who these medications are for and when you're a candidate and when you may not be.

Dr. Rocio Salas-Whalen 34:53 First, I think we need to backtrack a little bit before I, before we dive into that answer.

Mel Robbins 35:00 Sure.

Dr. Rocio Salas-Whalen 35:01 We as a society tend to associate being thin as being healthy. So whenever we see somebody that you can think they're slim, they're, they're, they're thin, they, they don't need this medication, we're assuming that they're healthy-

Mel Robbins 35:15 Yep.

Dr. Rocio Salas-Whalen 35:16 ... that they're metabolically healthy.

Mel Robbins 35:18 Yep.

Dr. Rocio Salas-Whalen 35:18 But we don't know by just looking at somebody, right? When I do body compositions on my patients, and this should be done on every patient, and basically I, I would say even patients that don't need weight loss medications just to know what's your, your body composition, because whenever we're talking about weight loss, we're really talking about fat loss, right? We're not talking about a, a, a bulk number. We're talking specifically we wanna reduce what can cause disease or increase-

Mel Robbins 35:47 Hmm.

Dr. Rocio Salas-Whalen 35:47 ... your risk of disease-

Mel Robbins 35:48 Mm-hmm.

Dr. Rocio Salas-Whalen 35:48 ... which is fat, not muscle. So by doing a body composition, we can see what's the percentage of somebody, right? What's their visceral fat and what's the muscle mass? So many patients that we may see slim or thin, they could be what we call a skinny fat or sarcopenic obesity that they may have a very low muscle mass and high body fat. There's still a risk of disease.

Mel Robbins 36:13 Mm.

Dr. Rocio Salas-Whalen 36:14 They're still in a proinflammatory chronic state, right? They can still develop type 2 diabetes or even be at risk of developing cancer. So just by looking at somebody, we cannot say what the body composition is and what they need or don't need to lose.

Mel Robbins 36:30 Got it.

Dr. Rocio Salas-Whalen 36:31 Right? So we first need to stop associating thinness with health. Many times when I see patients that think they need to lose 10 pounds or, or five pounds, when we do a body composition, surprise, surprise, they actually have to lose 20 or 25 because they're under muscle, right? So to really say who needs this medication or not, we cannot assume by looking at somebody that they do or they do not. We need to do body composition on-... on anybo- on anybody who thinks who needs to be on this medication to really know if they will benefit or not.

Mel Robbins 37:07 How do you do body composition?

Dr. Rocio Salas-Whalen 37:09 So we have machines, right? So the gold standard for a body composition is an MRI, but we're not going to do MRI on every patient-

Mel Robbins 37:16 No.

Dr. Rocio Salas-Whalen 37:16 ... on every visit. The second, uh, is a DEXA, uh, and then the third, which is the more accessible, is body impedance, also known as InBody. There's different versions of it. So those are the ones that are more easy, accessible, and they offer no radiation to the patient. And we do body compositions on initial visit and every visit when somebody starts on a weight loss journey.

Mel Robbins 37:43 So, you know, do you see a lot of people coming in that want to try these drugs to lose an extra 10 pounds?

Dr. Rocio Salas-Whalen 37:50 No. Most patients that come, it's because they need them and because they've, they've done their work, and it's just not working, it's just not happening.

Mel Robbins 37:59 If someone comes to you, Dr.

Mel Robbins 38:02 Salas-Whalen, and they're looking to be put on or prescribed one of these medications, what are some of the questions that you ask them to assess whether or not the medication is a good fit?

Dr. Rocio Salas-Whalen 38:13 So first starting with a very thorough weight history.

Mel Robbins 38:19 Hmm.

Dr. Rocio Salas-Whalen 38:19 So I need to know at what age were they conscious about their weight, at what age were there, uh, trying or, uh, being consciously about their eat or, or what they were told they need to lose weight. For many patients, they tell me 9, 10. Also, I need to know their medical history. Are there, are there, uh, comorbidities that can contribute to obesity or medications that they're taking that could contribute to obesity? Then I go into a deep family history. I need to knew up, I need to know up to two generations before, what was your parents', your grandparents' weight, your uncles' weight? If they have children, how is your children's weight? I need to see if there's a familial factor contributing to obesity, and then I look at their gynecological history, right? Are they in perimenopause, menopause, or they have PCOS? And then we move to the physical exam, and in that be- also, there's a, we do the body composition, and there, we can really target what is it that need to be improved or doesn't.

Mel Robbins 39:18 So is there a percentage of body fat that you look for to see if somebody's a good fit for this kind of medication?

Dr. Rocio Salas-Whalen 39:26 So what we consider obesity and percentage body fat is 32 and above. Normal in women is 18 to 28%. In men, it's 10 to 20%. So anything above those numbers, we either fall in the overweight range or in the obesity range.

Mel Robbins 39:42 Dr. Salas-Whalen, is there a benefit to using a GLP-1 during menopause?

Dr. Rocio Salas-Whalen 39:48 Definitely. What we see in perimenopause and menopause with the drop of estrogen is that your body composition changes. You tend to store more body fat, central, visceral body fat, and then you drop more your muscle mass. There's less lean muscle mass. Also, in this stage of life, when somebody, let's say, that didn't struggle with weight in their 20s or in their 30s, anything that they were doing to maintain a weight, once they enter midlife, perimenopause and menopause, is not going to help because of that hormonal fluctuation or drop of estrogen. So in this time of a woman's life, and we hear it all the time, "Everything that I'm doing is not working. Everything, I used to do it before, and the weight used to come off, but now I even have to work harder, and it's still not happening." Yes, because of aging and the changes in estrogen or the drop of estrogen. So here, GLP-1s have a huge place, uh, for patients that need t- or that gain weight during perimenopause, and that is just going to become even harder to lose it and easier to gain weight.

Mel Robbins 40:59 Can you give us an example of someone who should not be taking this medication?

Dr. Rocio Salas-Whalen 41:04 The only absolute contraindication that we have for this medication is a personal or first-degree family history of medullary thyroid carcinoma, which is a very rare and aggressive type of cancer. Now, if somebody has other versions of type, uh, of thyroid cancer, papillary follicular, that's not a contraindication. Exclusively medullary thyroid carcinoma. Above that, patients that are pregnant and breastfeeding, it's not recommended.

Mel Robbins 41:34 You know, when one of my family members was considering going on this medication, the concern was, "Well, am I gonna have to take this for life?" Like, is this something that you take for the rest of your life, or is it something you take for a period of time and then once you sort of rewire cravings and how full you are that it's just, like, that, that sticks or how does this work?

Dr. Rocio Salas-Whalen 41:55 So we have to remember what is obesity, right? What causes a patient to require this medication?

Mel Robbins 42:01 Mm-hmm.

Dr. Rocio Salas-Whalen 42:01 It's a chronic multifactorial disease, right? So if we assume that we can use this medication to take them to a goal and then we stop it, we didn't fix, we didn't cure the other things, the familial history, the genetics, the hormonal changes, the aging, the environmental factors. Those factors are still there. Chronic diseases, we don't cure, we control.

Mel Robbins 42:26 Hmm.

Dr. Rocio Salas-Whalen 42:27 So that's why these medications were designed to be used long term. Now, that can change. If somebody has history of obesity since childhood, and they're in their midlife or, or later decades of their life, then most likely, they will require this medication long term.

Mel Robbins 42:42 Okay.

Dr. Rocio Salas-Whalen 42:42 But if it's somebody, as an example, uh, who gained weight after pregnancy and hit midlife, and they gained 30 pounds, but they never struggled with their weight, then maybe those patients will not need that, to use them long term.

Mel Robbins 42:58 Huh. That's interesting.

Dr. Rocio Salas-Whalen 42:59 But you have this patient that had children in late in life-

Mel Robbins 43:02 Mm-hmm.

Dr. Rocio Salas-Whalen 43:02 ... and then they hit midlife.... then yes, they, they, they didn't struggle with weight in the past, but now their, their surrounding is not going to be helpful for them to maintain the weight loss, so they may benefit from long-term use.

Mel Robbins 43:18 Do you have any personal experience yourself or with, you know, a family member using this medication?

Dr. Rocio Salas-Whalen 43:25 Yes, I have a very personal family member myself. Um, I used this medication after I had my kids. I didn't struggle with weight growing up. I always used to lift weights. Since my early thir- 20s, I fell in love with weightlifting, but I had my children late in life. I had my first one at 38 and my second at 39. After that, I hit my 40s. I started with perimenopause. So what I was doing before, it didn't help me. I ended up with 30 pounds that I couldn't lose. I used the medication. I used for six months, I got back to my weight and I have not needed it since then. I re- retake back exercising and all of that and I've been able to maintain my weight with that. It was just a combination of late pregnancy, hitting mid-life at the same time.

Mel Robbins 44:21 Mm-hmm. What was it like after practicing obesity medicine to come to a point in your life where you're like, "Okay, I'm gonna try the GLP-1 myself because I got pregnant late in life, now I'm perimenopause, all the things that I used to do are no longer working." Like did you resist it for a while? What was it like for you to do that personally?

Dr. Rocio Salas-Whalen 44:49 I wouldn't say I resisted it. Um, I was waiting basically, um, to see if (laughs) if it would change. Um, but I think after, you know, the first two years of, of kids is, I mean, you really have to give yourself some credit and allow yourself some room-

Mel Robbins 45:09 Mm.

Dr. Rocio Salas-Whalen 45:09 ... to not wait abou- to not worry about your weight or punish yourself for not getting back on track so soon. I always tell women, "Give yourself one or two years before you (laughs) start doing that because just having a child at that age is hard enough." After that, I saw that I was not losing weight. I couldn't lose the weight anymore by doing what I was doing and I was in my early 40s. My mom had an early menopause, so I knew I was going to go through this transition earlier than, than not. Um, so I knew that I had to do something different before besides what I was doing, and this is what I preach, this is what I do, this is what I see, um, so I used the medication.

Mel Robbins 45:52 How did using the medication yourself change how you practice obesity medicine?

Dr. Rocio Salas-Whalen 46:00 Well, I was able to relate more with the patients in when I tell them, "This is how you're going to feel. This is what you should expect," I was telling it from my own personal experience. I think when us doctors go through certain situations, it does makes us a better doctor or more empathetic doctors, right? Because it's very hard to identify with something that you don't know necessarily. It made me more understandable. I was better to relate possible side effects and what to do about it. And definitely to be more empathetic.

Mel Robbins 46:40 Beautiful. How old were you in that h- how long ago was that?

Dr. Rocio Salas-Whalen 46:43 Uh, I was 42, so seven years ago. I'm 49.

Mel Robbins 46:47 Did you wrestle at all with any, like, of that feeling? Like, "I should be able to do this myself." I sh- I, like, did you even as a, as a world-renowned doctor practicing obesity medicine, did you shame yourself at that moment before you went on the medication?

Dr. Rocio Salas-Whalen 47:04 No, I mean, because I, I, I, I know what causes I knew what was causing my weight gain. Um, and I knew that I didn't wanna exhaust every other possible situation that at the end was not going to help me. Uh, I'm a very proactive person, uh, personally and professionally, so I really wanted to be very proactive at that time.

Mel Robbins 47:28 I love that answer and here's why. Because you don't have to shame yourself and we can learn from you, that everything that you're sharing with us today is empowering you to go, "This isn't my fault and if I'm resonating with some of this stuff, I deserve to go get help and I deserve the help that's out there for me." Just like if you had diabetes or cancer, of course you would go get the treatment.

Dr. Rocio Salas-Whalen 47:54 Yeah.

Mel Robbins 47:54 So Dr. Salas-Whalen, here's where I wanna go next. What are the risks of taking these medications?

Dr. Rocio Salas-Whalen 47:59 So as with any diet or anything that causes a restricted caloric intake or decreases how many calories you're going to eat, there's always the risk of muscle loss.

Mel Robbins 48:12 Mm.

Dr. Rocio Salas-Whalen 48:13 Right? Because it, it's hard to just exclusively lose body fat without lowering muscle mass.

Mel Robbins 48:20 Yeah.

Dr. Rocio Salas-Whalen 48:21 So one of the risk of using this medication is muscle loss. And there's no direct effect of the drug towards the muscle mass. It's an indirect effect of you eating less-

Mel Robbins 48:34 Oh.

Dr. Rocio Salas-Whalen 48:34 ... that you may lose muscle.

Mel Robbins 48:36 Got it. So the drug's not causing you to lose muscle. The fact that you're eating less means you have less protein going into your body-

Dr. Rocio Salas-Whalen 48:43 Exactly.

Mel Robbins 48:44 ... which might have you lose muscle.

Dr. Rocio Salas-Whalen 48:46 Yes.

Mel Robbins 48:46 Got it.

Dr. Rocio Salas-Whalen 48:47 But it's not a death sentence. So by informing the patient and teaching them about what is it that they need to consume while they're, they are on this treatment can prevent muscle loss and even gain muscle for those that need to gain muscle.

Mel Robbins 49:05 If someone is taking one of the GLP-1s, how do you do that with your lifestyle and diet?

Dr. Rocio Salas-Whalen 49:11 And before we go into that, I just want to explain why we are talking about muscle.

Mel Robbins 49:16 Yes.

Dr. Rocio Salas-Whalen 49:17 Why it's so important, muscle. It's not because we want to see all people bulked up and- and Arnold Schwarzenegger-like, right? Muscle is your biggest metabolic organ.

Mel Robbins 49:27 What does that mean?

Dr. Rocio Salas-Whalen 49:28 It is your calorie burning machine.

Mel Robbins 49:32 Muscles?

Dr. Rocio Salas-Whalen 49:32 Muscle.

Mel Robbins 49:33 Muscles burn calories?

Dr. Rocio Salas-Whalen 49:34 Muscles burn calories and muscle regulate your glucose, because every time a muscle contracts, it's physically being used, it sucks sugar from the bloodstream to provide its energy.

Mel Robbins 49:48 Wait a minute. Is that why taking a walk after you eat is like a really good thing to do?

Dr. Rocio Salas-Whalen 49:53 For your glucose? Yes.

Mel Robbins 49:54 Wow, okay. So-

Dr. Rocio Salas-Whalen 49:56 Because-

Mel Robbins 49:56 ... you have to pay attention to muscles, in general, we all do, but if you are going to take a GLP-1, really understanding the role that your muscles play-

Dr. Rocio Salas-Whalen 50:08 Yeah.

Mel Robbins 50:08 ... in glucose and in your overall health is a critical piece of this.

Dr. Rocio Salas-Whalen 50:12 Yeah, whenever we hear, "Oh, if you lose weight, your metabolism slows down," one of the reason is because you lost muscle along the way and that's slowing your metabolism. You're burning less calories. And I see that all the time with body compositions. When patients lose muscle, they don't lose significant amount of fat. They- they ... it's harder for them to lose fat. When patients maintain muscle or gain mus- gain muscle while on these medications, the body fat drops rapidly and significantly. So really, your muscle is going to determine how you lose the body fat, and that's why we need to have that conversation of muscle on day one. On your first appointment, your doctor needs to discuss with you what exercise you should be doing, which is strength training, hitting the- the weights, and increasing your protein in your diet, because you can lift as heavy as anybody and you will still lose muscle if the protein is not there.

Mel Robbins 51:11 Okay, so doc, you just said you got to be lifting weights and you've got to be eating more protein.

Dr. Rocio Salas-Whalen 51:17 Exactly.

Mel Robbins 51:17 Is there a standard formula that you give to your patients?

Dr. Rocio Salas-Whalen 51:20 One gram of protein per pound for ideal body weight.

Mel Robbins 51:25 Okay.

Dr. Rocio Salas-Whalen 51:25 That's what they should aim. So I- I would say the sweet spot that I've seen for most patients is between 90 to 100 grams of protein a day, which without a weight loss medication, without a medication that is suppressing your appetite, is hard enough to eat that amount of protein.

Mel Robbins 51:40 90 to 120 pounds is awfully skinny. Like, I thought you were going to be like, 150 to 200 grams of protein.

Dr. Rocio Salas-Whalen 51:45 It- I mean, it's very hard to- to ... It becomes mission impossible when you're giving somebody a medication to suppress their appetite-

Mel Robbins 51:52 Oh, that's true.

Dr. Rocio Salas-Whalen 51:53 ... but then you want them to eat 100-

Mel Robbins 51:54 That's true.

Dr. Rocio Salas-Whalen 51:55 ... and more grams of protein, right? So we have to find a- a medium point to patients to not lose muscle, and that's around 100 grams of protein a day in their diet.

Mel Robbins 52:04 Got it. And then how often do you tell patients, at a minimum, they should be lifting weights?

Dr. Rocio Salas-Whalen 52:10 I would say with twice a week-

Mel Robbins 52:12 I love you.

Dr. Rocio Salas-Whalen 52:13 ... they should feel- they should f- feel happy with it.

Mel Robbins 52:15 Twice a week, "We can do this."

Dr. Rocio Salas-Whalen 52:17 So one- one day upper body, one day lower body.

Mel Robbins 52:20 I love a formula that I actually feel like I could actually achieve.

Dr. Rocio Salas-Whalen 52:23 But I would say for- for many patients at the beginning, my main, main ... S- baby steps, right? Baby steps. If I want them to do one thing, it's to increase their protein in their diet, because at least with increasing the protein in their diet, they won't lose muscle.

Mel Robbins 52:40 Mm. Mm-hmm.

Dr. Rocio Salas-Whalen 52:41 Then we can, once the patient starts losing weight, feels a little bit more stimulated or more encouraged or physically able, then we can start incorporating exercise.

Mel Robbins 52:53 You know, I see this term all over social media, Ozempic face. What is that and why do people think that a GLP-1 changes somebody's face?

Dr. Rocio Salas-Whalen 53:04 Well, it's not the GLP-1. It's the drop of rapid weight loss or significant weight loss. And why is this? Because of not eating enough protein.

Mel Robbins 53:13 Mm.

Dr. Rocio Salas-Whalen 53:14 So as you lose ... If you're losing muscle because you're not ... don't have enough protein in your diet while on this medication, you're not only going to lose muscle, you're going to lose hair, you're going to lose elasticity in your skin, because we need protein to make collagen, elastin, right? Also, you need muscle to fill the gaps of the fat loss, right? The goal here is not skinny. It's strong, it's fit, right? So you need to fill those pockets with muscle. Now, if you're not losing muscle by increasing your protein intake, then you're going to make enough collagen. You're losing weight slowly, so you're allowing your skin to adapt to the changes.

Mel Robbins 53:59 Mm.

Dr. Rocio Salas-Whalen 53:59 But if you lose weight rapidly, it means that you're also losing muscle, it means that you're not ... don't have enough protein in your diet, so you're not making collagen and elastin.

Mel Robbins 54:09 What about some of the things that I've had at least friends report? I had one friend just talk about the constant indigestion, and I also had a friend, uh, say that he was warned about suicidal ideation. What can you tell us about those two, um, uh, side effects?

Dr. Rocio Salas-Whalen 54:29 So I'm gonna ... Uh, there's a phrase that I use a lot, and I- I'm going to repeat it until- until I don't have to, but the efficacy and the safety of this medication is going to depend on the expertise on who is prescribing it to you.

Mel Robbins 54:46 What does that mean? That means don't go to a med spa?

Dr. Rocio Salas-Whalen 54:50 Yes (laughs) . It means that it's a medication. It's a medical treatment, um, and you need medical supervision to decrease side effects and to achieve weight loss, to have the most, uh, results from this medication, right?I've personally have never had to stop the medication for any of those symptoms that you mentioned.

Mel Robbins 55:18 Mm.

Dr. Rocio Salas-Whalen 55:18 Um, it's very important to take the time to explain to the patient you need for, to have this conversation, to talk about weight with a patient, you need time.

Mel Robbins 55:28 Mm.

Dr. Rocio Salas-Whalen 55:29 It's very hard to have such a vulnerable conversation with somebody in 15 minutes, let alone then explain to them about medications and how they work. You need to build trust, right? And you can only achieve that if you take your time to talk to a patient. And that's one of the reasons that I decided to do private practice is because I knew I could offer more patients if I had the time.

Mel Robbins 55:58 Yeah.

Dr. Rocio Salas-Whalen 55:59 To decrease the possibility of side effects, you really need to make your research, do your research, do your due diligence before you go to somebody to get this medication.

Mel Robbins 56:09 And they should be a medical doctor.

Dr. Rocio Salas-Whalen 56:11 Ideally, they should be a medical doctor, uh, but it could be a nurse practitioner.

Mel Robbins 56:14 Yep.

Dr. Rocio Salas-Whalen 56:14 It could be a PA that they're-

Mel Robbins 56:16 Yep.

Dr. Rocio Salas-Whalen 56:16 ... they specialize in obesity.

Mel Robbins 56:18 And is there a kind of ramping up on this that also is something that should be done so that you're being medically supervised to see how your body and your brain tolerates this?

Dr. Rocio Salas-Whalen 56:31 Yes, so every patient should come into a visit every eight to 10 weeks when they are taking these medications, right, because to see if it's working, what's not working? How's your muscle mass? Are you losing mass?

Mel Robbins 56:43 Mm.

Dr. Rocio Salas-Whalen 56:43 Do we need to slow down the medication? Do we need to decrease for the greater good of muscle? So there's, m- every patient is a individual, and we try to adjust their lifestyle. But we need to see those frequent visits to see where the patient is, right? Are they tolerating it? Can we go up? Do we need to go up or do we need to come down on the dose?

Mel Robbins 57:05 Well, you know, as we were researching this conversation and digging into all kinds of information that we wanted to ask you, of course the phone is listening, and next thing you know, I am getting served up on my phone non-stop ads for GLP-1 mail order. And it gave me a pause because of the f- friends and family that have gone to a medical doctor and who are seeing results or just starting this, even the ones that have had some symptoms, the doctors are all over it and they're monitoring it. Like, I didn't even know that you take a shot once a week. Like, I had no idea whether this was a pill or how it actually works. But it did give me a lot of concern to see that there's a lot of companies, whether they're licensed or not, out there marketing that you can mail order a GLP-1. What should you look for in terms of investigating a practitioner or provider if this is a tool that you wanna look into for yourself or a family member?

Dr. Rocio Salas-Whalen 58:13 So the first thing to look is that we, as medical doctors, we don't sell FDA approved medications in our offices.

Mel Robbins 58:21 Mm.

Dr. Rocio Salas-Whalen 58:21 We, we send a prescription to your local pharmacy. It could be a commercial pharmacy, but we don't sell it in our office. If you encounter somebody who does, they're not. They're selling you the compounded version, right? Also, many of those med spas or, uh-

Mel Robbins 58:40 Mail order.

Dr. Rocio Salas-Whalen 58:41 ... mail order or telemedicine platforms, what they're offering you is the compounded version of the drug.

Mel Robbins 58:47 What's the difference between that and the FDA approved prescribed one?

Dr. Rocio Salas-Whalen 58:51 The FDA approved medications are evidence-based. They're from the clinical trials. They're heavily, heavily regulated. For an, a drug to be FDA approved, they sometimes have to, uh, show 10 years of research, right, efficacy and safety to get FDA approval. Compounded medications are not regulated. They're not FDA approved. So many times what you're getting, it may not be exactly what they're promising, right? Many times, they put fillers on the medications. Um, so safety should always be above anything. Granted, these medications, the FDA versions are expensive, right? But I always tell people safety should not be jeopardized by cost. And second, because there's always the risk of self-administrating more medication.

Mel Robbins 59:51 Oh.

Dr. Rocio Salas-Whalen 59:52 The current FDA versions, they're pre-dose pens. So there's no way that a patient can inject themself more or less. With the compounded medications and what we've seen, and there's studies showing that, that most of the hospital visits for severe side effects of GLP-1s are from compounded medications from overdosing. So you leave it to the patient many times to figure out the dosing or to run the risk of underdose or overdose, right? And this can lead to severe side effects.

Mel Robbins 1:00:28 That makes a lot of sense.

Mel Robbins 1:00:30 Dr. Salazuelan, what's your opinion of microdosing these medications for people who don't necessarily need to lose weight but they just kinda want to?

Dr. Rocio Salas-Whalen 1:00:41 Okay. So we have to understand how a medication or how the doses are recommended, right?

Mel Robbins 1:00:47 Mm-hmm.

Dr. Rocio Salas-Whalen 1:00:48 Medications go through clinical trials, clinical studies, where many doses are tried. Then we reach a therapeutic dose, which is a dose that exerts an effect.

Mel Robbins 1:01:03 Hmm.

Dr. Rocio Salas-Whalen 1:01:04 That's what we call therapeutic doses. That's what, when medication is approved, they come with therapeutic doses. If we think about microdosing or using less amount of the actual therapeutic dose, well, we're not gonna get the, the effects that the drug was designed for, right? Number one.Second, if you do need this medication and you have obesity, then you need the therapeutic doses, not the sub-therapeutic doses. Now, the other thinking is, "Well, I don't need to lose weight. I just want the positive effects of the medication." Well, if you don't need to lose weight, then if, if you are already in a healthy metabolic weight, then you don't need the ex- you're already getting the benefits, right? You're already ... Just by being fit-

Mel Robbins 1:01:50 Mm-hmm.

Dr. Rocio Salas-Whalen 1:01:50 ... you have that. You don't need another medication.

Mel Robbins 1:01:53 Mm-hmm.

Dr. Rocio Salas-Whalen 1:01:54 And third, the problem with microdosing is that it's based on compounded medication.

Mel Robbins 1:01:59 Oh.

Dr. Rocio Salas-Whalen 1:02:00 Currently, the FDA-approved drug, they come pre-dosed. So there's no an easy way to give yourself a lower dose. It's a single use pen for most of them, pre-dosed, so you cannot really play around with the dosing. Now, when Eli Lilly came with the vial-

Mel Robbins 1:02:22 Yeah.

Dr. Rocio Salas-Whalen 1:02:22 ... of the lowest dose, that may potentially have a use for patients that reach a healthy weight goal that don't require higher doses-

Mel Robbins 1:02:33 Mm-hmm.

Dr. Rocio Salas-Whalen 1:02:33 ... that can maintain a weight with a small dose, then we can do a lower dose. But currently, we only have tirzepatide in a vial, right?

Mel Robbins 1:02:43 Got it.

Dr. Rocio Salas-Whalen 1:02:44 Another reason of the microdosing was to avoid the side effects that people were having.

Mel Robbins 1:02:48 Oh, the nausea.

Dr. Rocio Salas-Whalen 1:02:49 Yeah.

Mel Robbins 1:02:49 What are the big side effects?

Dr. Rocio Salas-Whalen 1:02:51 The problem with those side effects, they were that they were initially created by people using compounded medication and that didn't have expertise on tha- on that. So their thinking was, "Well, maybe if you use less, you'll have less of the side effects." But that's not a problem (laughs) o- of the actual drug of itself, right? It's an actual of problem of who was prescribing it and also using compounded medication.

Mel Robbins 1:03:15 Wow. So if I'm following correctly, if somebody is getting a compounded medication from somebody who's telling them to just microdose to back off on the symptoms, that's not actually the formula that was approved by the FDA?

Dr. Rocio Salas-Whalen 1:03:32 If you're using the FDA-approved drug the right way, by somebody who knows how these medications work, you won't have those side effects that will make you use a microdose.

Mel Robbins 1:03:44 Wow. I have three people I'm sending this to right away who've been, like, talking non-stop about the nausea and this, and then the microdosing. And I didn't even realize that if you're microdosing, you're not getting the FDA-approved drug. You're getting a compounded formula of it that is being prescribed by somebody that's not doing it the way the FDA said.

Dr. Rocio Salas-Whalen 1:04:11 They're not heavily regulated. We don't know exactly what you're getting in the medication. There's a risk of overdosing yourself. There's higher risk of side effects, one, from not knowing what it is in the medication and not doing the right dose. And third, there's no evidence-based research that says that microdosing is effective.

Mel Robbins 1:04:34 Dr. Salas-Whalen, what's the most common misconception about these GLP-1 medications?

Dr. Rocio Salas-Whalen 1:04:40 That they're easy way out, that it's cheating, that you can sit back and not worry about how you eat and if you exercise or not.

Mel Robbins 1:04:52 So what's the truth that you want us to know about these medications?

Dr. Rocio Salas-Whalen 1:04:56 Patients are more involved in exercising. They're eating better. They're increasing their protein intake. They're working out. Uh, because when you explain to a patient the possibility of muscle loss, and when they see it physically when they come and do their body compositions and they s- they think, "Oh, I lost three pounds, great," and then they go into their body composition and they saw that half of it was muscle, they get it. They understand.

Mel Robbins 1:05:21 Mm.

Dr. Rocio Salas-Whalen 1:05:22 And they become part of the treatment. They start working out. They start lifting weights. They start eating better. And then halfway the journey, which is for me is what drives me, uh, m- of what I do every day, is there's a switch. There's a switch from when the patient comes thinking of something externally-

Mel Robbins 1:05:45 Mm.

Dr. Rocio Salas-Whalen 1:05:46 ... physically, and then halfway it becomes something internally. They like how they feel strong. They start to worry more a- more about muscle in every visit than weight loss.

Mel Robbins 1:06:00 Mm.

Dr. Rocio Salas-Whalen 1:06:01 "How did I do on my muscle? Did I gain muscle?" Once a patient feels strong, understands on how to eat, there's no turning back. When a, a patient comes to me, they struggled through decades. Exercise program, personal trainers, some have personal chefs. They're doing the, what we're recommending. They, they've been doing it. They've been listening to us. Also, when somebody says, "Oh, if they wanted to lose weight, if they really want it, they would have done it," they want it. They know. But unfortunately, it was not their sole responsibility. I have yet to meet the couch potato that is just eating, sitting, and not doing anything, and that's why they gain weight.

Mel Robbins 1:06:48 I, I mean, I think the, the thing that's very clear about this is that s- a person who is struggling with their weight or struggling with obesity as a disease and a chronic condition, they're probably working harder on their health than the rest of us-

Dr. Rocio Salas-Whalen 1:07:05 Yes.

Mel Robbins 1:07:06 ... because they're thinking about it all the time. And I choose to believe that everybody wants to thrive, every... Like, it is so demoralizing when you're doing the things people tell you that you need to do and it's not working.And if you've never struggled with this in your health, I bet you've struggled with it when you've tried to find a job, or when you've tried to save money. You follow the things and it's just not working, you don't understand why, and what you're here to say is there's four other factors outside your control from genetics to hormones to age to things in the environment that are impacting and screwing up your metabolism that are interfering with your body's ability to metabolize food and to, like, help you help yourself.

Dr. Rocio Salas-Whalen 1:07:46 Yeah.

Mel Robbins 1:07:46 And so of course you'd feel discouraged.

Dr. Rocio Salas-Whalen 1:07:48 Yeah.

Mel Robbins 1:07:48 And so it makes so much sense. You know, one thing I'm curious about, Dr. Salas-Whalen, is how does a GLP-1 change how often you think about food?

Dr. Rocio Salas-Whalen 1:08:01 It's ... I think there's no ... Anything I say is not gonna be comparable to what a patient experiences.

Mel Robbins 1:08:08 Mm.

Dr. Rocio Salas-Whalen 1:08:09 You have to understand, patients with obesity, they think about their weight 24/7, how everything that they do or put in their mouth is going to impact their weight or feel guilty about it later. When you remove that from a person, it changes their life. They feel liberated. The possibilities are endless.

Mel Robbins 1:08:39 That's incredible. I've never taken the, the medication, but, uh, one of my family members is, is taking it and that's exactly what they share. "I just don't think about it." And that's revealing how much I used to think about it. And when I'm not thinking about it, I'm not mindlessly walking into the kitchen, I'm not having a second helping, I'm not, like, constantly in this loop.

Dr. Rocio Salas-Whalen 1:09:02 Yeah.

Mel Robbins 1:09:02 It's liberating.

Dr. Rocio Salas-Whalen 1:09:03 It's liberating. Some patients tell me, "Oh, it's, this is, so this is how it's supposed to be. This is what is normal." Um, and then it opens your eyes, right? It's like removing a blindfold-

Mel Robbins 1:09:13 Hm.

Dr. Rocio Salas-Whalen 1:09:14 ... when you're on these medications and you go out with somebody who's not on this medication and you think about like, "Whoa, uh, we were overeating. Do ... You don't really need to eat that much-

Mel Robbins 1:09:24 Yeah.

Dr. Rocio Salas-Whalen 1:09:24 ... to feel physically satisfied." Right? So it ... And then it has a rippling effect too, right? I mean, you then, you can discuss this with family members, or family members see the effect, see the positive effect, and then it's just they want it too.

Mel Robbins 1:09:39 I know that this is a conversation that people are gonna be sending to their family members and their loved ones all around the world. For anybody who's still thinking it's a human being's fault when you look at somebody who is struggling with obesity, like, until we change the food system in this country, until we give people, like, access to proper medication and health, until we give people access to places where you can live where you have affordable food that comes from the ground, not a box, and places to walk that are safe-

Dr. Rocio Salas-Whalen 1:10:13 Yeah.

Mel Robbins 1:10:13 ... like, uh, you can't blame human beings for the fact that the environment that we live in is screwing up your body's ability to process the fake food that is affordable to most people because of-

Dr. Rocio Salas-Whalen 1:10:24 And you-

Mel Robbins 1:10:24 ... like how we've allowed industrialized farming and big industry to change the food that we eat.

Dr. Rocio Salas-Whalen 1:10:32 And people say, "Well, some people with exercise and, and diet, they lose weight." The key is how much, how restrictive does it have to become to reach that goal, and can it be sustainable long term?

Mel Robbins 1:10:49 Without punishing yourself constantly. Like, what I love most about everything that you shared so far is just that it's not your fault, and really understanding that if you had cancer, if you had diabetes, you would seek treatment.

Dr. Rocio Salas-Whalen 1:11:01 Yes.

Mel Robbins 1:11:02 And you would seek it for your 12-year-olds and up, you would seek it for yourself, and really embracing that, that, "Hey, what if something else were to blame? And what if there was something that could help my body actually process things, uh, process food and water and air and everything in a way that supports my health? What if it doesn't have to be so hard? What if it's not my fault?"

Dr. Rocio Salas-Whalen 1:11:26 Mm-hmm.

Mel Robbins 1:11:26 Like, that's the most exciting thing about everything that you're sharing with us today. You know, one of the things that I wanted to ask you is if you have somebody in your life that you're worried about, that you really would love to have them go see a medical doctor like you, a specialist in obesity medicine, or just somebody that is treating people, how do you talk to somebody without, like, making them feel wrong or blaming or assuming? You know what I mean? Because it's, it's a very hard subject to talk about, and if you're somebody that doesn't have the same issue with your metabolism, then you don't understand. And so I just would love some advice from you about how to bring this up to somebody who, as you've already shared with us, is thinking about it all the time.

Dr. Rocio Salas-Whalen 1:12:24 It's a difficult conversation to have, even for us doctors, that that may be the sole reason a patient is coming to see us. Some patients are not ready to have that conversation. It could be the same with a family member, with a friend. I would say if it comes from a place of love and authentic care, people perceive that. People feel that and don't feel attacked. I think the most important thing with, that we have to remember with patients with obesity is that they've learned to feel blame-

Mel Robbins 1:13:02 Mm.

Dr. Rocio Salas-Whalen 1:13:02 ... and to feel attacked.

Mel Robbins 1:13:05 Mm.

Dr. Rocio Salas-Whalen 1:13:05 So you have to be very, have a lot of tact on how you're going to bring the subject without feeling or putting more blame into the situation.

Mel Robbins 1:13:16 You know, I had that conversation with somebody in my family that I love. This was, uh, probably six months ago. And, you know, just saying, "I'm really concerned about you."And I know how hard you work at this and have you thought at all about, you know, the GLP-1 options that are out there? And they were very defensive.

Dr. Rocio Salas-Whalen 1:13:38 Mm-hmm.

Mel Robbins 1:13:38 And then said that they had already talked to their primary care about it, and they're so expensive that, "I can't afford it." And I didn't know what to say. And so do you have any advice for what you could say to somebody or what someone could do if they either have had an insurance claim denied or they can't afford the medication or that's what they're telling themselves? Like is there something that you should do beyond a primary care doctor in order to facilitate trying to get this covered by insurance?

Dr. Rocio Salas-Whalen 1:14:17 So the, both pharmaceuticals that produce these medications, they have manufacturing coupons.

Mel Robbins 1:14:23 Okay.

Dr. Rocio Salas-Whalen 1:14:23 Meaning that if your insurance, if your commercial insurance didn't approve it, you can use a coupon that cuts the cost about 50% to 60%.

Mel Robbins 1:14:32 Okay.

Dr. Rocio Salas-Whalen 1:14:32 So they become a, a bit more accessible. Now one of, of the current pharmaceuticals just came out with a vial of the medication. Current- currently we have in- injections that are prefilled pens.

Mel Robbins 1:14:46 Mm.

Dr. Rocio Salas-Whalen 1:14:47 And this drives the, the cost very high.

Mel Robbins 1:14:50 Gotcha.

Dr. Rocio Salas-Whalen 1:14:50 But now the medication is coming in a vial, like an insulin vial but it's not insulin, and it had cost the, the price significantly. So that's another option. And then also going to a specialist, right, that is going to do and take the proper measurements to make the diagnosis and to be able to justify the need of the use of the medication.

Mel Robbins 1:15:15 Well, Dr. Salas-Whalen, if the person listening takes just one action today from absolutely everything that you have shared with us, what do you think the most important thing to do is?

Dr. Rocio Salas-Whalen 1:15:31 To share what you learned today.

Mel Robbins 1:15:33 Mm.

Dr. Rocio Salas-Whalen 1:15:34 To share what impacted you the most about this conversation, right? I think our duty and our responsibility is to share the information.

Mel Robbins 1:15:49 Well, the thing that impacted me the most is if I ever hear another person in my life complain about their weight or hate on themselves, I'm gonna say, "You know, it's not your fault. I want you to listen to this extraordinary world-renowned expert because you may not believe me, but I sure as hell hope you are going to believe Dr. Salas-Whalen." What are your parting words?

Dr. Rocio Salas-Whalen 1:16:11 I would add to what you say that, one, it's not your fault, and two, it's okay to receive help. It's okay to ask for help. That doesn't make you a failure, doesn't mean that you're cheating. It means that you understand and that you are human and that for the first time we actually have help beyond exercise more and eat less.

Mel Robbins 1:16:46 Thank you, thank you, thank you, thank you. Incredible.

Dr. Rocio Salas-Whalen 1:16:51 Thank you for having me.

Mel Robbins 1:16:52 And I also want to thank you for taking the time to listen and to learn about this life-changing topic and for also being generous with this information and sharing Dr. Salas-Whalen's information with the people that you care about. There's no doubt in my mind that this could change the course of somebody's life. And in case no one else tells you, I wanted to be sure to tell you that I love you and I believe in you and I believe in your ability to create a better life. And taking better care of your health and using the tools that are available to you and getting the support that you deserve is one of the best ways to do that for yourself. All righty, I'll see you in the next episode and I'll be waiting to welcome you in the moment you hit play. I'll see you there. You're definitely gonna love this one and I'm gonna be waiting to welcome you into it the moment you hit play. I'll see you there.