Skip to content
The Mel Robbins PodcastThe Mel Robbins Podcast

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

Order your copy of The Let Them Theory 👉 https://melrob.co/let-them-theory 👈 The #1 Best Selling Book of 2025 🔥 Discover how much power you truly have. It all begins with two simple words. Let Them. — This episode is a must-listen if you or someone you love has ever struggled with weight. Today, Mel sits down with world-renowned, triple board certified endocrinologist and obesity specialist, Dr. Rocio Salas-Whalen, to explain the medical truth behind your metabolism, weight loss, and the most talked-about medications on the planet: GLP-1s like Ozempic and Wegovy. Today, she’s breaking down exactly how these medications work, who they’re for, and the critical mistakes people are making when using them without medical supervision. If you're confused about these drugs, worried about the side effects, or curious if they could help you or someone you love—this episode will answer every question you've been too afraid to ask. In this episode, you’ll learn: -The 5 real causes of weight gain—and why only one is in your control -Why obesity is not your fault (and how blaming yourself is holding you back) -What GLP-1 medications like Ozempic actually do in your body -The #1 risk no one is talking about when taking these drugs -Why these medications can change your brain, your cravings, and your relationship with food -How to avoid “Ozempic face,” hair loss, and muscle loss while on these drugs -How to know if you’re a good candidate—and the red flags to watch out for You’ll also hear Dr. Salas-Whalen’s personal story of using the medication herself after hitting perimenopause—and what she wants every woman to know about managing weight in midlife. This episode is your science-backed, shame-free guide to understanding GLP-1s, your metabolism, and what real help looks like. If you or someone you love is struggling with weight, send them this episode. It could change their life. For more resources related to today’s episode, click here for the podcast episode page: https://www.melrobbins.com/episode/episode-281 Follow The Mel Robbins Podcast on Instagram: https://www.instagram.com/themelrobbinspodcast I’m just your friend. I am not a licensed therapist, and this podcast is NOT intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I’ll see you in the next episode. In this episode: 00:00 Welcome 07:10 Reframing the Conversation: Breaking the Stigma Around Obesity 11:16 The Five Root Causes That Contribute to Obesity 22:02 The Role of GLP-1 Medications in Managing Weight 32:43 How GLP-1s Work in the Body 38:02 How to Know if GLP-1s Are Right for You 40:59 Do You Need to Stay on GLP-1s Long Term? 47:59 Why Muscle Mass Matters in Weight Loss and Metabolic Health 54:09 The Importance of Finding the Right Healthcare Provider for GLP-1 Treatment 01:00:29 Avoiding Common GLP-1 Mistakes That Lead to Side Effects 01:04:34 Clearing Up the Myths and Misconceptions About GLP-1s — Follow Mel: Instagram: https://www.instagram.com/melrobbins/ TikTok: http://tiktok.com/@melrobbins Facebook: https://www.facebook.com/melrobbins LinkedIn: https://www.linkedin.com/in/melrobbins Website: http://melrobbins.com​ — Sign up for Mel’s newsletter: https://melrob.co/sign-up-newsletter A note from Mel to you, twice a week, sharing simple, practical ways to build the life you want. — Subscribe to Mel’s channel here: https://www.youtube.com/melrobbins​?sub_confirmation=1 — Listen to The Mel Robbins Podcast 🎧 New episodes drop every Monday & Thursday! https://melrob.co/spotify https://melrob.co/applepodcasts https://melrob.co/amazonmusic — Looking for Mel’s books on Amazon? Find them here: The Let Them Theory: https://amzn.to/3IQ21Oe The Let Them Theory Audiobook: https://amzn.to/413SObp The High 5 Habit: https://amzn.to/3fMvfPQ The 5 Second Rule: https://amzn.to/4l54fah

Dr. Rocio Salas-WhalenguestMel Robbinshost
Apr 17, 20251h 17mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 7:10

    Welcome

    1. RS

      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.

    2. MR

      Wow. I would love to have you talk about the GLP-1 medications.

    3. RS

      I've seen people's lives change. The most important finding of this drug in-

    4. MR

      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.

    5. RS

      Thank you so much for having me.

    6. MR

      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.

    7. RS

      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.

    8. MR

      Wait, there's actually a world where that is true?

    9. RS

      It, it exists. It is possible and reachable.

    10. MR

      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-

    11. RS

      Yeah.

    12. MR

      ... 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.

    13. RS

      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.

    14. MR

      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.

    15. RS

      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.

    16. MR

      Now, are those two connected? What is endocrinology and how does that lead to obesity medicine?

    17. RS

      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.

    18. MR

      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?

    19. RS

      I want to say

  2. 7:10 – 11:16

    Reframing the Conversation: Breaking the Stigma Around Obesity

    1. RS

      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.

    2. MR

      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?

    3. RS

      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.

    4. MR

      The number one cause?

    5. RS

      The highest risk for developing, yes.

    6. MR

      Wow.

    7. RS

      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.

    8. MR

      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-

    9. RS

      Mm-hmm.

    10. MR

      ... 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.

    11. RS

      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.

    12. MR

      Yep.

    13. RS

      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.

    14. MR

      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-

    15. RS

      Yeah.

    16. MR

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

  3. 11:16 – 22:02

    The Five Root Causes That Contribute to Obesity

    1. MR

    2. RS

      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.

    3. MR

      Okay.

    4. RS

      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?

    5. MR

      Gotcha, okay.

    6. RS

      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?

    7. MR

      Mm.

    8. RS

      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.

    9. MR

      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-

    10. RS

      Yes.

    11. MR

      ... your weight?

    12. RS

      Yes. And so-

    13. MR

      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.

    14. RS

      Mm-hmm.

    15. MR

      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-

    16. RS

      Yeah.

    17. MR

      ... 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-

    18. RS

      Oh. (laughs)

    19. MR

      ... that- that, but it was the things that are-

    20. RS

      Yeah.

    21. MR

      ... actually impacting your body's metabolism-

    22. RS

      Yes.

    23. MR

      ... 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.

    24. RS

      It's causing.

    25. MR

      Which means it's not your fault.

    26. RS

      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.

    27. MR

      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-

    28. RS

      Yeah.

    29. MR

      ... 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.

    30. RS

      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-

  4. 22:02 – 32:43

    The Role of GLP-1 Medications in Managing Weight

    1. RS

      obesity.

    2. MR

      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.

    3. RS

      Yeah.

    4. MR

      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?

    5. RS

      Definitely. The first FDA approved GLP-1 was in 2005.

    6. MR

      2005?

    7. RS

      Yes.

    8. MR

      What?

    9. RS

      20 years now.

    10. MR

      20 years?

    11. RS

      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.

    12. MR

      Okay.

    13. RS

      And the first indication was for type 2 diabetes because GLP-1 is a hormone.

    14. MR

      What does GLP-1 stand for?

    15. RS

      Glucagon-like peptide and it's a peptide or a hormone, um, a-

    16. MR

      Oh, wait. Is that what the word peptide means, hormone?

    17. RS

      No. Peptide is what we call a short chain of amino acids.

    18. MR

      Okay.

    19. RS

      A long chain of amino acid is a protein, so s- before protein, it's a peptide.

    20. MR

      Okay.

    21. RS

      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.

    22. MR

      Okay.

    23. RS

      And he isolated a GLP-1.

    24. MR

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

    25. RS

      It causes pancreati-

    26. MR

      ... sends the thing into, like, a state of diabetic shock?

    27. RS

      It causes pancreatitis so the- the prey dies from pancreatitis.

    28. MR

      What? So- so what exactly does the GLP-1 do to the pancreas?

    29. RS

      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.

    30. MR

      Mm.

  5. 32:43 – 38:02

    How GLP-1s Work in the Body

    1. MR

      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?

    2. RS

      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.

    3. MR

      Okay.

    4. RS

      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.

    5. MR

      Mm-hmm.

    6. RS

      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.

    7. MR

      Wow. And it doesn't touch the pancreas?

    8. RS

      It doesn't touch your pancreas if your glucose is normal.

    9. MR

      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.

    10. RS

      First, I think we need to backtrack a little bit before I, before we dive into that answer.

    11. MR

      Sure.

    12. RS

      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-

    13. MR

      Yep.

    14. RS

      ... that they're metabolically healthy.

    15. MR

      Yep.

    16. RS

      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-

    17. MR

      Hmm.

    18. RS

      ... your risk of disease-

    19. MR

      Mm-hmm.

    20. RS

      ... 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.

    21. MR

      Mm.

    22. RS

      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.

    23. MR

      Got it.

    24. RS

      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.

    25. MR

      How do you do body composition?

    26. RS

      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-

    27. MR

      No.

    28. RS

      ... 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.

    29. MR

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

    30. RS

      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.

  6. 38:02 – 40:59

    How to Know if GLP-1s Are Right for You

    1. MR

      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?

    2. RS

      So first starting with a very thorough weight history.

    3. MR

      Hmm.

    4. RS

      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.

    5. MR

      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?

    6. RS

      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.

    7. MR

      Dr. Salas-Whalen, is there a benefit to using a GLP-1 during menopause?

    8. RS

      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.

  7. 40:59 – 47:59

    Do You Need to Stay on GLP-1s Long Term?

    1. RS

    2. MR

      Can you give us an example of someone who should not be taking this medication?

    3. RS

      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.

    4. MR

      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?

    5. RS

      So we have to remember what is obesity, right? What causes a patient to require this medication?

    6. MR

      Mm-hmm.

    7. RS

      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.

    8. MR

      Hmm.

    9. RS

      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.

    10. MR

      Okay.

    11. RS

      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.

    12. MR

      Huh. That's interesting.

    13. RS

      But you have this patient that had children in late in life-

    14. MR

      Mm-hmm.

    15. RS

      ... 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.

    16. MR

      Do you have any personal experience yourself or with, you know, a family member using this medication?

    17. RS

      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.

    18. MR

      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?

    19. RS

      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-

    20. MR

      Mm.

    21. RS

      ... 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.

    22. MR

      How did using the medication yourself change how you practice obesity medicine?

    23. RS

      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.

    24. MR

      Beautiful. How old were you in that h- how long ago was that?

    25. RS

      Uh, I was 42, so seven years ago. I'm 49.

    26. MR

      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?

    27. RS

      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.

    28. MR

      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.

    29. RS

      Yeah.

    30. MR

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

  8. 47:59 – 54:09

    Why Muscle Mass Matters in Weight Loss and Metabolic Health

    1. MR

    2. RS

      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.

    3. MR

      Mm.

    4. RS

      Right? Because it, it's hard to just exclusively lose body fat without lowering muscle mass.

    5. MR

      Yeah.

    6. RS

      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-

    7. MR

      Oh.

    8. RS

      ... that you may lose muscle.

    9. MR

      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-

    10. RS

      Exactly.

    11. MR

      ... which might have you lose muscle.

    12. RS

      Yes.

    13. MR

      Got it.

    14. RS

      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.

    15. MR

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

    16. RS

      And before we go into that, I just want to explain why we are talking about muscle.

    17. MR

      Yes.

    18. RS

      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.

    19. MR

      What does that mean?

    20. RS

      It is your calorie burning machine.

    21. MR

      Muscles?

    22. RS

      Muscle.

    23. MR

      Muscles burn calories?

    24. RS

      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.

    25. MR

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

    26. RS

      For your glucose? Yes.

    27. MR

      Wow, okay. So-

    28. RS

      Because-

    29. MR

      ... 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-

    30. RS

      Yeah.

  9. 54:09 – 1:00:29

    The Importance of Finding the Right Healthcare Provider for GLP-1 Treatment

    1. RS

    2. MR

      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?

    3. RS

      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.

    4. MR

      What does that mean? That means don't go to a med spa?

    5. RS

      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.

    6. MR

      Mm.

    7. RS

      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.

    8. MR

      Mm.

    9. RS

      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.

    10. MR

      Yeah.

    11. RS

      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.

    12. MR

      And they should be a medical doctor.

    13. RS

      Ideally, they should be a medical doctor, uh, but it could be a nurse practitioner.

    14. MR

      Yep.

    15. RS

      It could be a PA that they're-

    16. MR

      Yep.

    17. RS

      ... they specialize in obesity.

    18. MR

      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?

    19. RS

      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?

    20. MR

      Mm.

    21. RS

      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?

    22. MR

      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?

    23. RS

      So the first thing to look is that we, as medical doctors, we don't sell FDA approved medications in our offices.

    24. MR

      Mm.

    25. RS

      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-

    26. MR

      Mail order.

    27. RS

      ... mail order or telemedicine platforms, what they're offering you is the compounded version of the drug.

    28. MR

      What's the difference between that and the FDA approved prescribed one?

    29. RS

      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.

    30. MR

      Oh.

  10. 1:00:29 – 1:04:34

    Avoiding Common GLP-1 Mistakes That Lead to Side Effects

    1. MR

      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?

    2. RS

      Okay. So we have to understand how a medication or how the doses are recommended, right?

    3. MR

      Mm-hmm.

    4. RS

      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.

    5. MR

      Hmm.

    6. RS

      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-

    7. MR

      Mm-hmm.

    8. RS

      ... you have that. You don't need another medication.

    9. MR

      Mm-hmm.

    10. RS

      And third, the problem with microdosing is that it's based on compounded medication.

    11. MR

      Oh.

    12. RS

      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-

    13. MR

      Yeah.

    14. RS

      ... of the lowest dose, that may potentially have a use for patients that reach a healthy weight goal that don't require higher doses-

    15. MR

      Mm-hmm.

    16. RS

      ... 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?

    17. MR

      Got it.

    18. RS

      Another reason of the microdosing was to avoid the side effects that people were having.

    19. MR

      Oh, the nausea.

    20. RS

      Yeah.

    21. MR

      What are the big side effects?

    22. RS

      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.

    23. MR

      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?

    24. RS

      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.

    25. MR

      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.

    26. RS

      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.

  11. 1:04:34 – 1:17:47

    Clearing Up the Myths and Misconceptions About GLP-1s

    1. RS

    2. MR

      Dr. Salas-Whalen, what's the most common misconception about these GLP-1 medications?

    3. RS

      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.

    4. MR

      So what's the truth that you want us to know about these medications?

    5. RS

      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.

    6. MR

      Mm.

    7. RS

      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-

    8. MR

      Mm.

    9. RS

      ... 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.

    10. MR

      Mm.

    11. RS

      "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.

    12. MR

      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-

    13. RS

      Yes.

    14. MR

      ... 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.

    15. RS

      Yeah.

    16. MR

      And so of course you'd feel discouraged.

    17. RS

      Yeah.

    18. MR

      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?

    19. RS

      It's ... I think there's no ... Anything I say is not gonna be comparable to what a patient experiences.

    20. MR

      Mm.

    21. RS

      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.

    22. MR

      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.

    23. RS

      Yeah.

    24. MR

      It's liberating.

    25. RS

      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-

    26. MR

      Hm.

    27. RS

      ... 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-

    28. MR

      Yeah.

    29. RS

      ... 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.

    30. MR

      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-

Episode duration: 1:17:47

Install uListen for AI-powered chat & search across the full episode — Get Full Transcript

Transcript of episode 57OyIDnHZAk

Get more out of YouTube videos.

High quality summaries for YouTube videos. Accurate transcripts to search & find moments. Powered by ChatGPT & Claude AI.

Add to Chrome