The GLP-1 Masterclass with Rocio Salas-Whalen

Summary

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The Dan Buettner Podcast

Episode: The GLP-1 Masterclass with Dr. Rocio Salas-Whalen

Date: April 23, 2026

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Episode Overview

In this highly-anticipated episode, Dan Buettner (National Geographic explorer and Blue Zones founder) sits down with endocrinologist and obesity medicine expert Dr. Rocio Salas-Whalen (author of the bestseller Weightless) to demystify GLP-1 medications (e.g., Ozempic, Wegovy). They dive deep into what GLP-1s are, how they work, the current obesity epidemic, environmental and genetic contributors, controversies, benefits, risks, and the cultural implications of these blockbuster drugs.

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Key Discussion Points & Insights

1. What Are GLP-1 Medications? (01:38–03:11)

• GLP-1 is a naturally occurring gut hormone (Glucagon-like peptide-1) that helps regulate blood sugar and appetite, but is rapidly degraded (lasting only ~4 min).
• GLP-1 agonists (medications like Ozempic, Wegovy, etc.) are engineered to last much longer—up to a week—enabling appetite suppression and improved blood sugar control.
• Mechanism: Synthetic GLP-1 drugs cross the blood-brain barrier, suppressing appetite centrally and “removing the anticipation of reward” for certain foods.

"With this medication, you'll reach half of your plate and feel physically content. You lose that urge and reward anticipation for food, especially processed food."
— Dr. Rocio Salas-Whalen (05:55)

2. The Origin of GLP-1 Therapies (03:11–04:48)

• The original long-acting GLP-1 was isolated from the venom of the Gila Monster, a lizard native to the southern U.S. and Mexico.
• Major discovery by Dr. John Eng, who self-funded the patent after initial industry rejection.
• Noteworthy: The GLP-1 hormone itself was discovered by Dr. Svetlana Mokchov.

3. GLP-1 Function in the Body (04:51–05:43)

• GLP-1 increases insulin secretion only when blood sugar is high—making it safer compared to direct insulin, which can cause hypoglycemia more easily.
• This is why GLP-1s can be safely used in people without diabetes.

4. What Does GLP-1 Medication Feel Like? (05:55–07:13)

• Strong physical satiety at much lower levels of food intake.
• Diminished emotional/reward connection to foods, especially processed or highly palatable items.
• Overeating while on the medication can lead to discomfort or feeling ill.

5. Understanding the Obesity Epidemic: Multifactorial Causes (08:08–14:30)

• Obesity is not a willpower issue—it’s genetic, environmental, sociocultural, pharmaceutical, and more.
• Factors listed, in order of impact:
  1. Food Industry:
     • Cheap, addictive ultra-processed foods rich in sugar, fat, and salt are most to blame.
     • Dr. Salas-Whalen: “I compare the food industry with the cartels… they should be held accountable as the tobacco industry was." (14:30)
  2. Environmental/Industrial Factors:
     • Endocrine-disrupting chemicals (e.g., BPA in plastics), microplastics, pollution.
     • Example recommendations: avoid heated plastics, prefer stainless steel for storage (17:10).
  3. Hereditary/Genetics:
     • Transgenerational effects—obesity and trauma can be passed genetically and epigenetically.
  4. Medications:
     • Certain anti-hypertensives, antipsychotics, antidepressants, and diabetes drugs increase risk of weight gain.
     • “Always check with your doctor if your medication is causing weight gain—there may be alternatives” (23:16).
  5. Lifestyle:
     • Physical inactivity, overeating, but a comparatively smaller factor.

“We almost set people up for failure given our food industry and how we live right now.”
— Dr. Rocio Salas-Whalen (35:34)

6. Trauma, Biology, and Social Stigma (09:19–12:23; 25:11–26:17)

• Dr. Salas-Whalen opens up about apologizing to patients for blaming them for weight struggles.
• Trauma (including transgenerational) is a significant risk factor—food can be comfort and coping mechanism.
• Stigma, shame, and guilt are immense burdens for those with obesity.

“They don’t drop just the physical weight. They drop shame, guilt, trauma.”
— Dr. Rocio Salas-Whalen (25:11, 26:17)

7. GLP-1 Drugs: More than Just a Cosmetic Fix (26:17–32:57)

• GLP-1s are NOT just for vanity/cosmetic quick fixes:
  • Misuse (esp. by celebrities or untrained providers) can cause metabolic catastrophe—primarily by causing loss of muscle mass rather than just fat.
• Sarcopenia (muscle loss) is far more dangerous than obesity—muscle is crucial for longevity, glucose regulation, and metabolic health.

“With excess body weight, having sarcopenia [low muscle mass] increases all-cause mortality... If you drop muscle, you’re making somebody metabolically unhealthy—even if they’re thin.”
— Dr. Rocio Salas-Whalen (28:36)

8. When to Consider GLP-1 Medications (29:59–31:46; 34:00–35:52)

• For whom?
  • If weight loss is a full-time job/obsession and other interventions don’t work.
  • Assess your body composition; ideal thresholds: Women <28% body fat, Men 10–20%.

“Your muscle mass is high? Then you’re good to go. You’re getting all the other benefits of that.”
— Dr. Rocio Salas-Whalen (31:46)

• Beyond the individual:
  • Treating obesity before conception can lower a child’s genetic/epigenetic risk for obesity.
  • "If I can get my weight under control… my child will have a lower genetic propensity to be obese?"
    — Dan Buettner (34:00),
    "Bingo." — Dr. Rocio Salas-Whalen (34:21)

9. GLP-1s, Chronic Disease, and Longevity (36:39–41:43)

• Benefits:

  • Noted reduction in rates of type 2 diabetes, hypertension, cholesterol, osteoarthritis, and at least 13 obesity-related cancers.
  • Much of this is due to reduction in visceral fat and overall inflammation.

• How GLP-1s act as anti-inflammatories:

  • Mostly indirect, by reducing visceral fat and ultra-processed food consumption—less inflammation, lower chronic disease risk.

10. What’s Dangerous? How to Use GLP-1s Safely (56:04–62:11)

• Healthy rate of weight loss: 0.5–1 lb/week to avoid excess muscle loss.
• Supervision: Must be prescribed and monitored by a knowledgeable medical professional (ideally with expertise in obesity medicine, not just GLP-1 prescription).
• Red Flags:
  • Online/telemed providers who simply fill forms and mail out drugs without monitoring body comp, exercise, or nutrition.
• Green Flags:
  • Provider discusses exercise, nutrition, muscle preservation.
• Weight training is essential from day one to preserve muscle during rapid weight loss.

11. Misconceptions and Cautions

• Microdosing GLP-1s: No scientific support, originated from untrained providers trying to avoid side effects. Full, therapeutic doses proven in studies are preferred when indicated (61:02–62:14).
• Using GLP-1s as a "holiday fat fix": Strongly discouraged; this is a serious, long-term medication, not a temporary quick-fix or supplement.
• Side effects: If experienced, usually from poor prescription practices (wrong doses, lack of monitoring).
• Not cheap, but getting cheaper (68:08–69:17):
  • Insurance, direct-from-manufacturer pharmacies, and patient assistance programs can help.

12. Food, Joy, and the “Blue Zones” Lifestyle (65:46–68:06)

• GLP-1s change what you crave and how much you eat, not the joy of eating itself.
  • You still enjoy food, but stop with satiety and lose the craving for hyper-palatable junk.
  • Celebrates the “simple food, simple life” ethos of Blue Zones—but acknowledges industrial food makes this tough in the US.
• A healthy environment and community are still ideal, but medications address today's urgent reality.

“You will still enjoy your food. What is removed is the reward from ultra-processed, pro-inflammatory food we shouldn’t be eating.”
— Dr. Rocio Salas-Whalen (66:43–67:30)

13. Long-Term Use & Maintenance (58:04–60:44)

• Chronic users (e.g., those overweight for decades, with strong family histories) may require long-term medication.
• Key to weaning off: Build and maintain muscle mass through strength-training and good nutrition.

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Notable Quotes & Memorable Moments

• On the mental burden of obesity:
  “They live with shame, with guilt… So when we talk about the heaviness of the physical weight, we’re not talking about the mental weight.”
  — Dr. Rocio Salas-Whalen (25:23)

• On food industry accountability:
  “I compare the food industry with the cartels. Too much money to be made that it will not be changed.”
  — Dr. Rocio Salas-Whalen (14:30)

• On muscle as an organ of longevity:
  “Muscle is our organ of longevity. Muscle consumes 80% of the glucose in your blood… If you drop muscle, you’re making someone metabolically unhealthy. You may be 110 pounds, but you have type 2 diabetes now.”
  — Dr. Rocio Salas-Whalen (28:57–29:36)

• On the difficulty of food choices:
  “It’s very hard, especially in the United States, to get good quality, high quality food.”
  — Dr. Rocio Salas-Whalen (13:41)

• On genetic legacy:
  “If I can get my weight under control, go from obese to normal weight, my child will have a lower genetic propensity to be obese?”
  — Dan Buettner (34:00)
  “Bingo. That’s epigenetics.”
  — Dr. Rocio Salas-Whalen (34:21–34:42)

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Important Timestamps

• 01:38 — Introduction to GLP-1s and how they work
• 03:11 — Gila Monster origin story and discovery
• 05:55 — Patient experience on GLP-1: satiety and reward reduction
• 08:08 — Causes of obesity: trauma, food environment, genetics, medications, lifestyle
• 14:30 — Ranking the biggest drivers of obesity; Food industry as #1
• 17:10 — Endocrine disruptors, plastics, and practical mitigation tips
• 23:16 — Importance of reviewing medications that may cause weight gain
• 25:11 — The mental (not just physical) weight of obesity
• 28:36 — Dangers of rapid muscle loss with improper GLP-1 use
• 31:46 — Body composition as a better target than just scale weight
• 34:00 — Preconception treatment reduces offspring’s risk for obesity (epigenetics)
• 41:43 — GLP-1 as indirect anti-inflammatory, benefits for chronic disease
• 56:04 — Healthy weight loss velocity and muscle preservation
• 61:02 — The misunderstanding behind “microdosing” GLP-1s
• 65:46 — GLP-1s block junk food cravings but don’t kill food joy
• 69:19 — How to find resources (Dr. Salas-Whalen’s book "Weightless")

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Resources & Takeaways

• Prescribe responsibly: GLP-1s are not “supplements”—work with a knowledgeable provider, focus on muscle preservation, and avoid quick fixes.
• The “Blue Zones” lifestyle is ideal: Diet, movement, and social connection will always matter, but GLP-1s fill the gap for those trapped by modern food, genetics, and chronic disease.
• Slow, steady, supervised: Weight loss should not outpace adaptation, psychologically or physically—build muscle along the way.
• Beat the blame: Obesity is multifactorial. “It’s not your fault”—the system is stacked against you.
• Dr. Salas-Whalen’s book "Weightless" offers a structured guide for both patients and clinicians navigating the new landscape of GLP-1 medications.

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For more:

• Find Dr. Rocio Salas-Whalen on Instagram or read "Weightless" for a comprehensive, user-friendly guide to GLP-1s.
• Explore Dan Buettner’s Blue Zones work for actionable community and lifestyle solutions supporting natural longevity and health.

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Transcript

[Dan Buettner]

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[Dr. Rocio Rossille]

Mm.

[Dan Buettner]

Yeah, but I'm not itching to go downtown and tell a receptionist I'm here

[Dr. Rocio Rossille]

to talk about my downtown.

[Dan Buettner]

Some things you'd rather type than say out loud. There's no question too embarrassing for Amazon Health AI.

[Dr. Rocio Rossille]

Just chat your symptoms and get virtual care 24. 7.

[Dan Buettner]

Healthcare just got less painful.

[Dr. Rocio Rossille]

I wanna stop right there and make a huge point because what they lost is muscle mass. That is the dark side of this medication. I'm going there. I'm gonna go there. Me being from a border town in Mexico, I compare the food industry with the cartels. They don't drop just the physical weight. They drop shame, guilt, trauma.

[Dan Buettner]

Wow, you don't hear people talk of that much.

[Dr. Rocio Rossille]

Well, we have to.

[Dan Buettner]

I'm so excited for this episode. GLP1s are on fire and there's so much confusion around them. On one hand, they offer great hope. On the other hand, there seems to be complications and ramifications. And you know, there are celebrities walking the red carpet who look like emaciated waifs. And we think there may be GLP1s. I think I have the world's top expert here to unravel this mystery and to set things straight. Dr. Rossille, congratulations. Congratulations on your new national bestseller wait list.

[Dr. Rocio Rossille]

Thank you.

[Dan Buettner]

Fantastic book. Makes GLP1s accessible to everybody. We're gonna talk about it right here. So for people who know GLP1s, maybe Biozempic or wegovy. Can you tell us exactly what a GLP1 is?

[Dr. Rocio Rossille]

Definitely. GLP1 is a hormone, right? It's like any other hormone that we make in our body. It has a function. Hormones take messages to different places in our body to execute different functions. And this is what GLP1. So we naturally make it in our gut, in the small intestine by the passage of food, especially carbs or glucose. When you eat, we release GLP1 naturally, and this helps to control our glucose. But the problem with our own GLP1 is not that we don't make enough. We don't have a GLP1 deficiency. It's that it's broken down within two to four minutes. So it only lives in our system no more than four minutes because it's degraded by an enzyme, the DPP4 enzyme. What we have commercially as GLP1 that we know as Osempe, Wegovi, and all of them, they're engineered to be long acting drugs. So versus our own, that lasts four minutes. Ozempic lasts seven days, Right. So we can use it once a week. So that's the major difference. And because it's broken down so rapidly in our body, it doesn't get to cross the blood brain barrier quick enough to have effects centrally in the appetite control, which the engineer version, the synthetic ones do because of their long acting half life.

[Dan Buettner]

You were telling me that the originally it was isolated from a reptile.

[Dr. Rocio Rossille]

Yes, so. And also it's important to say that GLP1 hormone was discovered by a woman, by a scientist, Dr. Svetlana Mokchov at the Rockefeller Center. But she isolated the endogenous, the human one, which was broken down quickly. Now, Dr. John Eng in the VA hospital in the Bronx, an endocrinologist and researcher interested in pancreas and glucose and insulin was investigating this lizard found in the south of the us the north of Mexico, the Gila Monster. The Gila monster. And what interested him is that the Gila monster's benum would kill its prey with pancreatitis. It will cause pancreatitis. So him being a scientist researcher interested in the pancreas, wanted to know what does it do in the pancreas, the venom. And that's where he isolated the GLP1, long acting version of the human version. And very interesting story. When he found this, he went to the VA to patent. The VA said we're not interested. He actually went to several pharmaceuticals to patent, nobody believed in him. He had to mortgage his house and he paid for his own patent. And after that he went to a conference with a small abstract and then Amelin back then, which combined with Ilalili, saw it and bought it.

[Dan Buettner]

Nobody's living in a penthouse now.

[Dr. Rocio Rossille]

Well, I don't know for how much he sell it, but it's amazing.

[Dan Buettner]

What's the connection between pancreatitis and GLP1?

[Dr. Rocio Rossille]

The GLP1 main function is to regulate glucose by increasing the production of insulin. So that's what GLP1 is. We have receptors of GLP1 hormone in the pancreas that improve or increase the production of insulin when the glucose is high. So basically your glucose has to be elevated to act in the pancreas. So hyperglycemia and the GLP1 acts there. But if your glucose is normal, then it doesn't touch the pancreas. Right. So it's glucose dependent, that response. That's why we can use it in patients that don't have diabetes. So it's not going to cause hypoglycemia on somebody who doesn't have diabetes. It's not insulin. Insulin. If it's there, it just drops everything. But GLP1, your sugar actually has to be elevated above normal.

[Dan Buettner]

So what happens in the body when you inject a GLP one? Or I guess you can microdose it now. But in general, what does it feel like for those of us who've never tried it? Never.

[Dr. Rocio Rossille]

I tell my patients, when I tell them the first time, they come to me and I tell them, this is what you're going to feel. They look at me like, I don't understand. And I tell them, in your second visit, we're going to have a different conversation once they experience it. Right. So what I can describe it is normally, if you need. If you would take a whole plate to feel full with this medication, you'll reach half of your plate and you'll be physically content. Right. Many times at the beginning when a patient starts the medication, they're like, I need more food. I couldn't be filled with this. And then if you overeat your fullness, then you feel sick. So it almost causes like a mechanical restriction of how much you can eat. So that's one effect. The other effect is in our brain, and it basically removes the anticipation of our reward for food. So if somebody's anticipating going to their favorite restaurant and they say, I'm gonna order this lasagna that. Oh, I love it. Oh, my.

[Dan Buettner]

I have that all the time.

[Dr. Rocio Rossille]

So with this medic, you see the lasagna and it's like you're seeing a book, you're like, oh, I don't need it.

[Dan Buettner]

That is so interesting.

[Dr. Rocio Rossille]

It can happen with alcohol. It can happen for. It's usually processed food that creates that reward response. Right. So immediately you stop consuming half or less than that of pro inflammatory processed food that are made to give you that reward. Right.

[Dan Buettner]

I totally get the feeling that I'm gonna be prematurely full with my minestrone. I make a great minestrone. But I actually. Hours before I eat my minestrone, I have minestrone every day for lunch. I start thinking about it and I salivate. And it seems like a completely different mechanism that would make me feel full. And the one that would remove my anticipatory desire. How does it remove that anticipatory desire?

[Dr. Rocio Rossille]

So it blocks the receptors that we have in our brain and the amygdala in the hedonistic eating and area of our brain, that's where we have receptors for the gi and it just blocks that release of dopamine. Of you salivating for your food is that anticipation of that dopamine, that is how you're going to make you feel when you have that meal, right? So it blocks those responses.

[Dan Buettner]

So let's back up a little bit and try to understand how we got to where we are. So over 70% of Americans are overweight or obese, and that's about triple from what it was in the 1980s. How did we get here? Why are so many people struggling with their weight or obese?

[Dr. Rocio Rossille]

And it's getting worse. The WHO said by 2035, half of the world population will have obesity. So we're talking more than 4 billion people with obesity and more than 400 million children with obesity by 2035. So it's getting worse, right? We know now that obesity is not willpower, right? It's not a poor lifestyle choice of somebody. We know that. It's multifactorial and that's what got us here, right? So when I think we should stop

[Dan Buettner]

on a point here because I think a lot of Americans think it is a fault of an individual, it is a lack of willpower. It is your responsibility to eat the right food. If you're fat or obese, you have a moral failing. But science doesn't tell us that, does it?

[Dr. Rocio Rossille]

This is one of the reasons that I wrote my book because. And I wrote my book starting with an apology letter as the introduction as a physician to my patients that I told that for years, that I doubted that I thought, oh, if I go to their house, they're really not eating what I told them to eat. I'm sure they're not exercising, they're lying to me. I'm sure I'm gonna find them in McDonald's. And that was every single. And still to this day, many doctors believe that healthcare physicians is the number one bias in obesity. But playing the devil's advocate, we didn't know the science, right? We didn't know what we know now. We know now that even transgenerational obesity exists, meaning we can inherit two generations back a gene for developing obesity. Trauma is a huge contributor to somebody gaining weight or having obesity. It could be personal trauma, sexual abuse, physical abuse, but also transgenerational trauma, right? So we know the parents weight impact the offspring's weight, right? So we're talking even beyond when the patient was conceived, they already were going to be born with 50% probability of having obesity. Then we add that environmental factors, and I know you're big on this, right? Endocrine disrupting chemicals, environmental factors, where we live, how we live, industrialization, setting and tourism. We have to talk about the food industry, right? The food industry. Ultra processed food, more quantity, less quality that also contributes to obesity. It changes our genes. They mimic our hormones. They're called endocrine disrupting chemicals because they disrupt the normal production of hormones that promote obesity. Then we go through lifestyle, life ages, right? Changing perimenopause, menopause, puberty, that also can contribute and slow down our metabolism. Then we go into medications. Many medications that we take today to control chronic diseases that were more likely caused by obesity can promote waking. Anti diabetic medications, antihypertensive medications, antipsychiatric medications, antidepressants can produce waking. So it's like we almost are every possible way that we can save ourselves. We're being blocked even by environment, genes, age, medications, and then lifestyle, right? Lifestyle is a small part, but I see many. And this is a huge awakening for me when I heard patient after patient coming to my clinic and telling me I'm exercising, I'm doing this diet and that diet and five diets, and I go to a fat camp. And since I'm 10, I've been on a diet. And it was to me, shocking to understand and learn that patients were doing everything that we were asking them and beyond, and they were still not losing weight because that was not the cause of it.

[Dan Buettner]

So, I mean, trauma is nothing new. I mean, there's been 25,000 generations of the human species, you know, generation before us, they had World War I and then World War II, and sexual abuse has been an issue and people getting battered and bullied. These aren't new problems. What is it about our environment today that is exacerbating the obesity epidemic? Mostly, what are the big culprits that are different?

[Dr. Rocio Rossille]

So trauma has existed all the time, Right? But we've never associated with obesity for many patients. Let's talk about sexual abuse or child abuse. They rely on food many times for them to feel better, right? When they cannot control anything else in their environment. So that's the precipitating factor. But then we have the environment that will feed into that. Having the availability of ultra processed food, good food, healthy food is very inaccessible, unfortunately, which should be the opposite, right? But let's say somebody would tell them, eat vegetables, eat fruits, but if they're not, then we go into pesticides, then we go into endocrine disrupting chemicals. So it's like a vicious cycle that we have no escape. It's very hard, especially in the United States, to Get good quality, high quality food. So having the precipitation of trauma plus the availability of that type of food, I think is one of those reasons that we can see a higher increase in obesity.

[Dan Buettner]

If you had to rank order them, and I know you're kind of shooting from the hip, you're an endocrinologist, but you talked about these endocrine disruptors. You talk about different drugs that can add to obesity. You talk about our food environment and the, and the glut of ultra processed food. Which ones would you rank for the population in explaining this? 70% plus people being overweight. What are the biggest culprits?

[Dr. Rocio Rossille]

Food industry number one. Number one, food industry. I think the food industry should be held accountable for obesity as the tobacco industry was held accountable. But me being from a border town in Mexico, I compare the food industry with the cartels. Too much money to be made that it will not be changed. So I would put number one as food industry number two.

[Dan Buettner]

And wait before you go on to what are the foods that are most the biggest culprits for most Americans?

[Dr. Rocio Rossille]

High in sugar and high in salt and high in fat. Right. So those are the foods that are the cheap, the easy and the quick for the masses and the ones that are made to create an addiction in that reward system. Right. High sugar creates our reward, high salt creates our reward. So those are the main culprits in our food industry.

[Dan Buettner]

Thank you.

[Dr. Rocio Rossille]

Number two, Environment. Industrialization. How we live, how we work. We don't sleep, we work all day. We commute two, three hours a day. We work from home. Right. We survive in plastic bpas, toxins in our paint while we're breathing. And it sounds, I'm not granola, but these are very real things that affect our physiology and our metabolism. So definitely industrialization and environment will be number two.

[Dan Buettner]

So what are they and where?

[Dr. Rocio Rossille]

Plastic. So forever chemicals.

[Dan Buettner]

The PPH drinking out of a plastic bottle, for example.

[Dr. Rocio Rossille]

Exactly. The microplastics. Right. So they mimic our own hormones.

[Dan Buettner]

And is that really a problem or is that just something that huge problem, really?

[Dr. Rocio Rossille]

We have guidelines with them. Right. So we cannot, we cannot solve a problem truly from the root if we don't talk about that. Right. Endocrine disrupting chemicals are real and we can find it also in ultra processed food. Right. And animal that is fed with not the right food. Not pasture raised animal, not grass fed.

[Dan Buettner]

I'm sure a lot of the listeners are getting overwhelmed.

[Dr. Rocio Rossille]

I know, I'm sorry.

[Dan Buettner]

And first of all, this information is great, but let's just go Back to plastic for a minute. I'm a mom, I have three kids, and I don't want my kids eating, being exposed to plastic, which could lead to obesity down the, down the road.

[Dr. Rocio Rossille]

And infertility.

[Dan Buettner]

And infertility. What are the biggest sources of plastic in my diet? And what's the most effective thing I can do to keep those plastics out?

[Dr. Rocio Rossille]

Drinking from plastic water bottles, number one.

[Dan Buettner]

That's the worst.

[Dr. Rocio Rossille]

That's the most common. I mean, everybody is carrying a plastic water, right? Containers in our home, food containers being plastic. Right. But even in the water we have microplastics. Right. So I personally, I have children. So steel, because we found plastic even in glass. So it's not even now moving to glass containers. So stainless steel is always better for water. Never heating anything in plastic in the microwave because that leaks the BPH into your food. Right. Also containers for food delivery or when you're taking takeout, all that plastic plus the heat of the food leaks the BPA in the food. So there are simple things that we can do in our life that can also prevent that, you know, I've spent

[Dan Buettner]

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[Dan Buettner]

so let's just say I am heating up my hot dish in a plastic container and then drinking from a warm plastic bottle. What does that plastic do in my body?

[Dr. Rocio Rossille]

So BPA is the chemical from the plastic they can block. And we know this for fertility. We know that plastics can cause infertility in both women and men. Specifically talking about women, BPA acts as estrogen in our body. It mimics our estrogen. It goes to the receptor of the estrogen where the estrogen should go, it blocks it, but it doesn't execut the same function as estrogen would. So when estrogen hormone goes to that receptor, it's occupied already by the plastic who pretended to be estrogen. So that's what endocrine disrupting chemicals do.

[Dan Buettner]

And how does that make us fat?

[Dr. Rocio Rossille]

Well also they promote obesity such difficult to get into satiety. Right. So our gut hormones that will promote satiety, that will alert us from fullness, they can mimic all those type of hormones too and prevent inhibit the proper fat functions for health.

[Dan Buettner]

So we have processed and ultra processed food. The big culprit number two are these chemicals that are environmental in our food. What's number three?

[Dr. Rocio Rossille]

Hereditary. Right. So if our parents, either mom or dad was overweight or had obesity preconception, it increases my risk. Almost 40 to 50% of me struggling with my weight. So we go back to whenever a patient comes, I like to go three generations. Okay, tell me your weight as a child. What were your parents and your grandparents and immediate relatives, uncles, aunts, cousins. Because I want to see where this is coming from. And I would say the majority of people have family history already in obesity and overweight.

[Dan Buettner]

And number four, you mentioned some drugs,

[Dr. Rocio Rossille]

antipsychotics antidepressants, anti hypertensives, beta blockers. Right. All the SSRIs.

[Dan Buettner]

Oh, really? Made of one.

[Dr. Rocio Rossille]

Metoprolol can cause weight gain. And then we go with all the diabetes medications. Insulin. Insulin promotes growth. It's a growth hormone, promotes appetite, increases weight. So there are many medications that also can be discussed with your doctor to be switched to weight neutral drugs. Right. There's always weight increasing medications, but they're weight neutral medications. So in a patient with obesity or overweight, we need to have the discussion to see if it's possible to switch them.

[Dan Buettner]

Fascinating.

[Dr. Rocio Rossille]

To. To a weight neutral drug.

[Dan Buettner]

That is a big takeaway and it's something I think everybody listening, struggling with their weight can do is check your medications for a. A weight gain gaining side effect.

[Dr. Rocio Rossille]

Yeah.

[Dan Buettner]

Is there a number five?

[Dr. Rocio Rossille]

Yeah.

[Dan Buettner]

What's five?

[Dr. Rocio Rossille]

Lifestyle. Lifestyle, right.

[Dan Buettner]

What does that mean? I always have a problem with lifestyle.

[Dr. Rocio Rossille]

I would say if you have a sedentary life. Right. If you eat more than what your body needs or consumes as energy, that can also promote weight gain. Right? Definitely. If you're consuming more calories than what your body burns, then also that can. It stores us fat in our system. Right.

[Dan Buettner]

I'm just gonna refer to 1 through 4. You know, if. If I have plastic in my diet and I live in this toxic food environment and my medicines are making me

[Dr. Rocio Rossille]

hungry and my parents were overweight, well,

[Dan Buettner]

wait, it's hard to. Well, I'm not hungry.

[Dr. Rocio Rossille]

What responsibility do I have in my weight?

[Dan Buettner]

Yeah, I just. Yes, I sort of give Americans a pass. I've started one of my books, Blue Zone Kitchen, with if you're overweight and unhealthy in America, it's probably not your fault. Why? Because if you go back to 1981, seventh, as many people were suffering from type 2 diabetes, and a third, as many people were suffering from obesity. And that's not because there were better diet programs. That's not because our parents necessarily had a better sense of individual responsibility. In fact, my ma used to feed me like wieners and Cheez Its and she thought they were my mom. You know, that was horrible. And so something else has happened that I just don't think you. I just don't think it's fair to blame the average American who's out there in a sea of fast food restaurants and Doritos and Cokes.

[Dr. Rocio Rossille]

And I can tell you, I have not met a single patient with obesity that wants to have obesity.

[Dan Buettner]

There you go. There you go. And the fact they're showing up in Your office means they want to do something about it.

[Dr. Rocio Rossille]

And you know what the sad thing about this, all of this, is that some patients that I see in their 60s, they've struggled with this since they're 8, since they're 9. So we're talking about decades that they're consumed around that plate in front of them, that they live with shame, with guilt, that they're not trying enough, that they should try a different weight. It consumes them. So when we talk about the heaviness of the physical weight, we are not talking about the heaviness of the mental weight that the patients carry. And that's the reason that I think these medications are so powerful, right? We're not getting into the medications yet. But what I see in my patients, and that's the name of my book, weightless, because they don't drop just the physical weight. What I see in them, they drop shame, guilt, trauma, they truly become weightless.

[Dan Buettner]

That's such a great metaphor. I think a lot of people put GOP1s in the same category as Botox. And there are. People are just, you know, you see the red carpet in Hollywood, and we know we don't have to say their names, but there are several actors and actresses out there who are shockingly thin all of a sudden. And we can probably guess, maybe you can see which ones are GLP1. They're doing it for cosmetic reasons. But GLP1s really transcend cosmetics, don't they?

[Dr. Rocio Rossille]

Unfortunately, due to some celebrities, some irresponsible providers or prescribers, they are trying to show them a supplement, right? Let's just take it for a week, take it for a month, like it's a supplement, but it's a prescription drug that requires medical supervision, Right? When the studies were done on these drugs, they were proof to show safe. Why? Because they were under control supervision. But if you use it as a supplement, then you really don't associate it as a drug that you need to go to your doctor and see what's happening. When I see those patients or they're not patients, but when those celebrities in the red carpet or people that are misusing this medication, I think metabolic catastrophe, because what they lost is muscle mass, right? That is the problem. That's the dark side of these medications. When they're not done responsibly, we can leave our patients sicker than when they came with us. With excess body weight, having sarcopenia or low muscle mass increases, all cause mortality. We don't say that from high body fat. Obesity does not increase all risk mortality. Sarcopenia does. If you're on this medication and you're not doing the proper supervision with body composition, then your patient is probably losing 30, 40, 50% of muscle mass.

[Dan Buettner]

So you are in how long a year?

[Dr. Rocio Rossille]

It could be in four months. Depends how they're used. Right.

[Dan Buettner]

So if 50% of your.

[Dr. Rocio Rossille]

So let's say if a patient goes

[Dan Buettner]

somewhere that is scary.

[Dr. Rocio Rossille]

It is scary. So let's say you go with, you get your medication online. Nobody, nobody you're seeing, you're filling a form, you get your medication in the mail. You're going by the number on the scale. You said, oh, I lost five pounds per week, I am losing 30 pounds in two months. This is great. Guess what? 30% or more was. Muscle mass.

[Dan Buettner]

Wow.

[Dr. Rocio Rossille]

Right? So that is the problem and that's a metabolic catastrophe because muscle is our organ of longevity. Muscle consumes 80% of the glucose in your blood and it utilizes for energy. Muscle burns fat for energy. So muscle is an insulin sensitizer. So we're talking about hyperinsulinemia and insulin resistance. Muscle is the best prescription for it. Right. So if you drop the muscle, you're making somebody metabolically unhealthy, insulin resistant and prone for type 2 diabetes. So you may be 110 pounds, but guess what, you have type 2 diabetes now, right? So that is the problem. And then if you lose muscle, you're losing bone, if you're losing muscle, you're losing bone, you're losing hair, you're losing collagen. So it's just a downhill from there. So now you probably have the age of a 90 year old in the body of a 45 year old female with 100 pounds weight.

[Dan Buettner]

Wow. You don't hear people talk of that much.

[Dr. Rocio Rossille]

Well, we have to.

[Dan Buettner]

If you're listening to us right now, you're in the audience and you're overweight, how do you know the time is right to look into a GLP1 if

[Dr. Rocio Rossille]

weight loss is a full time job for you? If weight loss takes over your life to lose even those 10 pounds to maintain your weight or to lose weight, then you could probably benefit from a GLP one because it shouldn't be consuming your life to lose weight or lose those extra 10 pounds.

[Dan Buettner]

So I've been trying to lose five pounds for the last five years and they're still there. I mean, should I be looking into GLP1s?

[Dr. Rocio Rossille]

Well, I would say let's start with the body composition, right, because maybe you think it's five pounds, but many times when I do a body composition, surprise, surprise, it's 15 or 20 pounds. Right? Because we don't know.

[Dan Buettner]

And what's the right amount of body fat? What's the right percentage?

[Dr. Rocio Rossille]

So for women, we ideally want percentage body fat below 28%. So anywhere from 18 to 28% of your total body weight should be fat. And for men, we want a fifth of your body to be fat. So between 10 to 20% should be your body fat. And then visceral fat, it should be less than 1.5 liters, which is a normal amount.

[Dan Buettner]

How do you find out what visceral fat is?

[Dr. Rocio Rossille]

So we do either by a DEXA scan or impedance machine or an mri. It's a gold standard. But we're not going to do MRI on every patient. So impedance machines and doctor's offices.

[Dan Buettner]

Very good answer. This is really great, Rocio. And if I'm just feeling overweight but my body, I have the right amount of visceral fat, the right amount of body composition, and we show up to your office, you're going to say, I'm not for you.

[Dr. Rocio Rossille]

If your muscle mass is high, then you're good to go. You're getting all the other benefits of that. You think you're missing out from using a GLP1 because that still matters. Having a healthy body composition still matters.

[Dan Buettner]

Americans spend last year between 72 and $73 billion a year on GLP1s. You might have another more up to date. Number these blue zones that I found five of them around the world where people are living about a decade longer. Fewer than 5% of people were overweight or obese. Fewer than 2% had type 2 diabetes. And not a lot of them indulge in a GLP one. They ate mostly a whole food plant based diet. They lived in walkable neighborhoods. They were socially connected. Shouldn't we be taking maybe this $72 billion and investing it in creating a food system where people are eating healthier naturally and moving more as opposed to this kind of shortcut.

[Dr. Rocio Rossille]

What was my number one reason that I put in number one in causes of obesity?

[Dan Buettner]

You put the food environment.

[Dr. Rocio Rossille]

Food environment. What you're finding in the blue zones, the food, the right food environment. Ideally, yes, that's what we should do. But even if we change the food industry today, we still have this problem to fix. Changing the food industry today will prevent maybe the next two or three generations to develop obesity. But what do we do for the 4 billion people that are going to have obesity in the next few years? That's why we do GLP1 now. Improving the food industry will be one solution. The patients that have currently obesity, if we treat them with GLP1 medications, their next generation will have a healthier weight and then they have the right environment with the food and the good food environment. That's where we go back to having a healthy, normal weight. So right now is greater than just fixing our food industry. It has to start, but it's going to take a few generations for us to see the effect in health.

[Dan Buettner]

I might be reading between the lines a little bit, but are you saying to me as a parent or as somebody who wants to become a parent, if I can get my weight under control, go from obese to normal weight, my child will have a lower genetic propensity to be obese?

[Dr. Rocio Rossille]

Bingo. Really? And that's why all my patients that are thinking fertility, I go over this conversation with them and I said, not only are we reducing the risk of complications in your pregnancy from obesity and pregnancy, but you're also giving your child the best possible case of not struggling with their weight as you did.

[Dan Buettner]

And that's an epigenetic change.

[Dr. Rocio Rossille]

That's epigenetics. Exactly.

[Dan Buettner]

Wow. See, I always was of the opinion that if, if I got healthier, which means that instead of having a Coke on my kitchen table for dinner, I am serving water to my family and we're eating beans and grains instead of burgers and fries, that the environment that I'm raising my child up and is going to impact his or her chance of becoming an obese adult. But you're saying it's actually a genetic or epigenetic.

[Dr. Rocio Rossille]

Actually we have studies that show that hyper palatable genes are transferred to the offspring.

[Dan Buettner]

Oh my God. Hyperpalatable means your desire to eat sugar and processed food.

[Dr. Rocio Rossille]

And processed food. Exactly. And then it's really unfair when we talk about childhood obesity and blame the parents. Right, because.

[Dan Buettner]

Or the kids for that matter.

[Dr. Rocio Rossille]

Or the kids. Because again, we almost, almost, and I don't want to sound too doom, but we're almost set to failure, right? We're almost set to fail in our health, given our food industry and our environment and how we live at this moment.

[Dan Buettner]

None of you thinks that this drug is just a band aid for a larger systematic problem.

[Dr. Rocio Rossille]

Well, we talk about the larger systematic problem. GLP1 is not going to take care of the food. It is changing the food industry. Right, where people are consuming less, people are drinking less, people are spending less in restaurants, people are buying less processed food when they're in a GLP one again because that drive of the reward system is controlled. But GLP1 is going to help us fix our current problem and prevent chronic disease by decreasing body fat and body weight and visceral fat. But we need to work governmental externally with our food environment, right? GLP1 is not going to do that.

[Dan Buettner]

I love that insight that GLP1's shifted demand away from junk food and hyper palatable food. I want to talk about the benefits and also the cautions around GLP1s. So I work with a longevity expert, biologist named Steve Austin who actually thinks that GLP1 may have some secondary or tertiary impacts on longevity. One of them being maybe lower rates of type 2 diabetes or maybe some epigenetic changes. Are you aware of any other ancillary benefits from GLP1s that might help us live longer?

[Dr. Rocio Rossille]

Definitely. I mean the root cause of many disease, chronic disease, is our weight, right? It's obesity. Obesity is a driver of many chronic diseases, including type 2 diabetes, prediabetes, hypertension, hypercholesterolemia, osteoarthritis. It is a high risk for more than 13 obesity related cancers including breast, colon, prostate, stomach, pancreas, thyroid. So.

[Dan Buettner]

So people on GLP1s have lower chances of these cancers.

[Dr. Rocio Rossille]

Exactly. And let's talk about why. Let's talk. This is what I love about. This is what I love about this. Okay. What in our weight makes us sick? Right? Let's take a big step back. What in our weight makes us sick? Why do we want patients to lose weight? High body fat, specifically visceral fat, causes a chronic low grade inflammation in your body, right? It's always, there's always inflammation in your body. If you have high visceral fat, if you have high visceral fat and you have low muscle mass, well that's a double whammy because muscle is an anti inflammatory organ that produces is anti inflammatory hormones. So if you have high body fat, you're in inflammation. If you have low muscle mass, you're in inflammation. Inflammation is the driver of most of the diseases that we have beyond acute. Like an infection. Right. Chronic inflammation is a root cause of dementia, of Alzheimer's, of heart disease, of metabolic disease, and many types of cancers. What happens when our body is in inflammation? We have a system, it's called the immune system. Antibodies to protect us from any hazardous cell tumor, cells, virus, bacteria that come into our body. It goes and protects us. But when your body is in chronic inflammation, guess what your immune system is doing? It's preoccupied, fighting that high fat inflammation and Low muscle that is leaving the door open for cancer cells to reproduce, for bacteria to come in from virus to come in. What happened in Covid? Covid is the perfect example because before COVID there was a questionable People with obesity, do they have inflammation or not have inflammation? Patients with obesity during COVID pandemic, higher mortality, higher ICU states and higher chronic lung complications from COVID Why? Because their body was preoccupied fighting the inflammation of obesity. I had patients in my office coming and tell me I need to lose weight, I don't wanna die from COVID So what happened in Covid? People got the message that if you have obesity, you don't have to wait 20 years to develop type 2 diabetes. A virus out of nowhere can come and you can die from it. So people got the message that having obesity is not body positivity, you're actually in chronic inflammation. And it came a virus and you were higher chances to die. So the acceptance was there and we had the medication to treat. So boom. That was the bomb of what we're seeing now of the boom of these medications. Because GLP1s are available since 2005. We've been prescribing them since 2005. So many people tell me, why now Covid? We had the demand, we had the knowledge and we had the therapy.

[Dan Buettner]

My listeners are really interested in what they can do and I just think it's such a powerful revelation to tell them that their chances of cancer go up because of their the amount of fat in their body.

[Dr. Rocio Rossille]

And before, and before we start saying that GLP1s are an anti inflammatory drug, let's correct that. Right? There is a mild direct anti inflammatory effect from the GLP1, but its greatest anti inflammatory effect is indirect. By decreasing percentage body fat and decreasing visceral fat, decreasing the consumption of pro inflammatory food, which is the ultra processed food, right? So that's the way that they act as an anti inflammatory drug. So when somebody is in a healthy weight and they said, oh, I wanna use a micro dose of a GLP one for the anti inflammatory effects. Well, if your body composition shows that you have high muscle mass, low percentage body fat, low visceral F, it's not doing the job. You're having all the effects there, right? You're not gonna get anything extra. The benefits is by decreasing the visceral fat and you increasing your muscle mass. That's how we see the benefits.

[Dan Buettner]

And the worst fat is visceral fat is the visceral fat around our organs in our mids. How?

[Dr. Rocio Rossille]

Yes, that fat Is not a dead tissue. It's not just sitting there. It's actually an active tissue that produces chemicals.

[Dan Buettner]

And the trigger for a woman is what? And the trigger for a man is what? When it comes to visceral fat?

[Dr. Rocio Rossille]

So for women below 1.5, for men below 1 liter, now 1.5 liters. And depending on the machine that you're going to use, like impedance, they may use a scale. The inbody uses a scale. And it should be below 9 in the scale, your visceral fat. Anything above 9, then you have high visceral. Now high visceral fat is going to cause fatty liver, it's going to cause insulin resistance. So I can tell somebody has fatty liver or insulin resistance without doing blood work if they have high visceral fat.

[Dan Buettner]

How?

[Dr. Rocio Rossille]

Because if they have high visceral fat, they have insulin resistance. Insulin resistance promotes visceral fat, visceral fat promotes insulin resistance. And then you get into this vicious cycle.

[Dan Buettner]

And this may be a dumb question, but is there something I can do specifically to get rid of my visceral fat as opposed to overall fat?

[Dr. Rocio Rossille]

So visceral fat is driven by insulin. Insulin. Right. More insulin in your body, More insulin, more visceral fat. More visceral fat makes you insulin resistant. So then you have to make more insulin to have the same effect. But then more insulin promotes visceral fat, and then more visceral fat promotes insulin resistance, and then you get into that vicious cycle. So we need to give our pancreas a break, basically, if we wanna decrease our visceral fat because we are overworking our pancreas and that's producing the visceral fat. So definitely what we consume, if we consume constantly ultra processed food, then we're overusing our pancreas that can promote also visceral fat. Right.

[Dan Buettner]

We're feeding that vicious cycle.

[Dr. Rocio Rossille]

What breaks the vicious cycle? Protein. Right. Protein in our body reduces insulin, hyperinsulinemia and those spikes of insulin. So we have a very poor protein dense diet in the United States. It's mostly carbs, sugar, sugars, simple carbs, sugars, salt, fat. Right. But when we incorporate protein, we really give more of a stable glucose in our blood that doesn't require those high spikes of insulin as something high in sugar, a simple sugar, a simple carb will just shoot up your insulin level.

[Dan Buettner]

Yes, well, my blue zone responsibility requires me to chime in here. In blue zones, people aren't eating a lot of protein, as we say, about five times a month. What they are eating lots of plant proteins. They're eating lots of beans and whole grains and greens and garden vegetables.

[Dr. Rocio Rossille]

And that's what we call a complex carb. Right. Because it has fiber. So it's harder for our body to break down, so it produces a more consistent low release of insulin. But if you eat a piece of candy or, I don't know, something, a donut. Exactly. Your body, body breaks it down very quick. It produces a high spike of glucose that requires a high spike of insulin. And when you do that consistently, then your body every time has to make more and more insulin to have the same effect as it did before.

[Dan Buettner]

Right. I just want to be clear on and see if we're in sync on this. You don't necessarily need a high protein diet. Maybe you think we need a high protein diet, but can you also have a high complex carbohydrate diet or can we get our protein from plant based sources?

[Dr. Rocio Rossille]

So this is. I'm going there, I'm gonna go there because I have to and because I see it in my patients. Let's talk about my vegan patients. Patients that don't consume any animal protein. Right. Sarcopenia and osteoporosis is very high in these patients. Why? Because we need full complete protein that has all the amino acids to make muscle protein synthesis in the bone. Collagen. Right. And collagen for your skin and your hair and nails. Right. But if we don't have that basic 20amino acid full complete protein, we don't have anywhere to build. And I see this so often in my patients that are complete vegan, vegetarian and plant based. Now we can say they're healthier, but there's no single study looking into plant based diet. It with body compositions. Show me one single study that promotes muscle gain. When you're on a plant based diet. I want to see the bones, I want to see the muscle mass and I want to see the visceral and percentage body fat of those patients. So my patients that are plant based are very high in starches. Right. Starches convert into glucose in our body. Right. And I want to say all extremes are back. I'm not promoting fully only protein diet, but I'm also not promoting a fully plant based protein protein diet. Right. The extremes, even if they're good, they're going to be bad. So I'm not talking black and white here, but it's important. And many of my patients, when they see their numbers and when they see their bones, they get it and they incorporate gradually some animal based protein. And that's where we start seeing the muscle.

[Dan Buettner]

Well, I have to speak up for my community. Being plant based myself, I think that the healthy plant based eaters probably aren't showing up at your office. There's lots of bodybuilders who never touch a piece of meat and I knew several centenarians who never ate meat. But to your credit, when you live in America, you try to be a vegan and you're promoted these fake burgers and these fake meat. And I think the most unhealthy diet in America is a processed vegan diet.

[Dr. Rocio Rossille]

100%.

[Dan Buettner]

You know, I've stayed true to what I believe on or what I've observed in the longest of cultures in the world. They're eating mostly whole, they're eating mostly peasant food. Beans and corner tortilla, for example. As we see in Nicoya, meat is a celebratory food, but no processed food.

[Dr. Rocio Rossille]

So going back to the reason number one that I think that I put in number one is the quality of the food. Right. I mean, and I think it's coming here and talking to you and knowing the work that you do. It goes back to the simple things. Yes, right. The simple food that's gonna be wholesome and that will we prevent obesity. Right. But the current problem that we have, we can use medication for it. Right. And again, I never support anything in extreme because I think both extremes are not good. I think it's more of a balance type of diet.

[Dan Buettner]

Let's talk about the downsides. So you, you, we, we hear sex drive is diminished and ability to enjoy other things in life besides food. Does that show up in your practice or is it myth?

[Dr. Rocio Rossille]

Well, you know, if it's done the right way, that will not happen. And I close my book with the benefit of the drug and the side effects of the drug are going to depend of the expertise on who's giving you the medication. Right. If you're going with somebody who just wants to be part of the movement and is gonna give you the drug because you're asking for it and doesn't know nothing about dosage and you're gonna put you on a high dose, it's gonna suppress everything very quickly, including maybe your sex drive, including things that give you pleasure.

[Dan Buettner]

Very interesting.

[Dr. Rocio Rossille]

Right? So you have to know who to go to, right. When you, when you are gonna use this medication, make your due diligence. When you're going to pick your prescriber, they're not supplements, they're a prescription drug that if it's way you'll have minimal to none side effects.

[Julie Louis-Dreyfus]

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[Dan Buettner]

Amazon Health AI presents Painful Thoughts.

[Julie Louis-Dreyfus]

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[Dr. Rocio Rossille]

Now I'm stuck down a rabbit hole filled with images of alarmingly graphic source

[Julie Louis-Dreyfus]

in various stages of ooze.

[Dr. Rocio Rossille]

I can clear my search history, but

[Julie Louis-Dreyfus]

I can never unsee that.

[Dan Buettner]

Don't go down the rabbit hole. Amazon Health AI gets you the right care fast. Healthcare just got less painful for a listener right now struggling with their work weight. Interested now in GLP1s? How do you find the right doctor? Does it have to be an endocrinologist

[Dr. Rocio Rossille]

or so just to give you some stats? There's currently one. So besides an endocrinologist, I'm also an obesity board certified physician. So above endocrinology, I learn more with obesity. There's currently one obesity specialist for every 9,000 patients with obesity without counting overweight. Right. So the level of demand is going 100 miles per hour greater than the level of trained physicians in this specialty. So there's a huge mismatch. Right, and that's one of the Reasons that I wrote my book. If you have the book, even if you don't have the right doctor guiding you, you can have the right results. My book is also written for physicians that want to prescribe this medication that they can do it the right way.

[Dan Buettner]

The book again is Weightless A doctor's guide to GLP1 medications written for Everyday people. So are you saying that if I Want to explore GLP1s, I'm overweight? Pick up the book, read the book and the book along with an. My. My average doctor. My I. I can safely go on the drug or do I need a specialist?

[Dr. Rocio Rossille]

No, you can. You probably will do better even if you go to some endocrinologist that may not have the experience on a GLP1 Med. In the book, I give you like even a flow sheet on how to pick the right provider, what questions to ask when you call to make that first appointment that are going to give you green flags or red flags. I really walk you through why am I struggling with weight? Why do I have obesity till the psychological part of weight loss, which is something that we are not talking about, and that's one of my proudest parts of my book is we are currently doing a disservice to patients with obesity and on weight loss medications because we as doctors, we're concentrating on numbers, right? I want to improve your number, I want to decrease your risk of disease. I'm concentrating on numbers. But we're doing nothing about the psyche. We're not giving patients the tools for when they get to a special weight. For many patients, they've never been on this weight after they lose the weight in their life. Many patients, they've never seen themselves physically in that new weight. I would think it'd be euphoria for the majority are. But for some patients, the physical weight gets lost faster than the patient can adapt psychologically to the weight loss. Just to put it like that, right? Many patients are confronted with the idea of why am I treated differently now? Why are they opening the door for me now than before for if I was the same person. So my partner didn't met me like this. My partner doesn't want to go out to dinner with me. When I go in a social setting, I'm not the fun anymore, right? People are saying why you're not as fun as. You're not drinking anymore, you're not eating as much. Believe me, for the majority. And they wouldn't go back. I haven't met a patient that said I'd rather gain the weight back but we also have to give them tools for this. It's not fair for them to not tell them, okay, this is happening. This is what you're going to encounter. This is how you can be in certain situations. This is how you can talk to your partner, to your loved ones. If you wanna share or don't wanna share. The best way to allow a patient to adapt to the new body is to allow them to lose the weight slowly. Right? Then they'll be adapting gradually to how their body feels, to how people look at them. Versus if you have somebody lose 50 pounds in three months, it's going to be a metabolic shock and a psychosocial sh. Shock for the patient too.

[Dan Buettner]

For most people, what's a healthy weight loss per week?

[Dr. Rocio Rossille]

So what I've seen through body compositions that you're not losing significant amount of muscle is going to be between half a pound to a pound per week.

[Dan Buettner]

Per week.

[Dr. Rocio Rossille]

So if you're losing that, rest assured that you're don't. You're not losing more than 10% of your muscle mass. But if you're losing three pounds per week, you're losing 20% of your muscle mass. If you're losing four pounds per week, you're losing more percentage of muscle mass.

[Dan Buettner]

Beware of fast weight loss.

[Dr. Rocio Rossille]

Exactly.

[Dan Buettner]

Do you put people on a weight training regimen along with GLP1?

[Dr. Rocio Rossille]

So from day one.

[Dan Buettner]

From day one.

[Dr. Rocio Rossille]

From day one you have to have the, and that's one of the green flags that I give in the book. If your doctor is talking to you about what exercises you need to do, what's the nutrition that has to come along with a GLP1, then you're with the right doctor. But if they don't have those discussions with you.

[Dan Buettner]

Wrong guy.

[Dr. Rocio Rossille]

Get out of that office.

[Dan Buettner]

Any other negative ramifications of GLP1s, people's

[Dr. Rocio Rossille]

judgment, people attitudes towards that? Right. And to clarify something, this is not an easy way out for patients. Don't think that at least my patients that go on a GLP1, they're just sitting there waiting for the weight to fall off. For some, they're never lifted weights and now they're lifting weights. Now they're watching what they eat, now they're being careful about what they eat. When you remove the pressure of weight loss on exercise, it changes the perspective of the people and the patient. Right. When I tell them you have to work out but not to help the weight loss, they stop and they, they look at like, they take a second, they take a second look like, like

[Dan Buettner]

what plus they don't have to lift all that fat.

[Dr. Rocio Rossille]

It's so foreign for somebody to go, especially for somebody who struggles with weight, to go to do exercise with that weight loss being the outcome of you exercising. And when you remove that, it's because to see how people embrace exercise for

[Dan Buettner]

other reasons, how do I maintain it? Do I have to stay on GLP1s for the rest of my life?

[Dr. Rocio Rossille]

So the length of treatment really depends on your personal story that took you to use the medication. So if you are somebody who are in your 50s and you struggle with weight since the age of eight, that's a chronic condition. Most likely you will require this medication long term for the maintenance. But let's say you're a woman that never struggled with weight, you don't have family history of obesity, you got pregnant, you gained too much weight, then you hit perimenopause, maybe you'll use it and won't need it long term. Right. But if that same person has a strong family history of obesity, now they're in midlife, they're in perimenopause and menopause. Well, maybe now you will require the medication long term. And I always like to flip it, it's not a negative that we have something to maintain weight loss. This was the holy grail, right? This is what any other diet cannot do. Many diet can take you there, but to keep you there was always there, never. I also like to tell patients your biggest bet to not needing the medication long term or using the lowest dose long term is your muscle mass. Right? Because if you lose your muscle then you become almost dependent on the medication. The medication is doing 90% of the effort. So if you gain muscle, then the muscle starts taking some of the effort of the maintenance that ideally at the end for maintenance, the medication should feel like it's 30 or 40% of the effort. The rest is your muscle mass and the nutrition that you're having. But if you don't, if you don't gain muscle and you lose all your muscle, you are going to depend on very high doses of the medication long term.

[Dan Buettner]

It's very hard for a 50 year old to gain muscle mass.

[Dr. Rocio Rossille]

It's not impossible. I've had 77 year old female gain muscle while on a GLP1 medications and

[Dan Buettner]

they're eating a lot of protein, lifting weights.

[Dr. Rocio Rossille]

Exactly.

[Dan Buettner]

Once you go off it, doesn't the weight usually thunder back for people?

[Dr. Rocio Rossille]

Well, there's different ways to see this. First of all, you never should stop. You're so good, you should never Stop this medication cold turkey. Right. Because let's say you're on a high dose of the medication, so that's suppressing your appetite 70%. Right. You stop it, the next day your appetite is going to go back and it's going to feel like it's 200%. Right. So ideally we need to decrease the dose gradually, as ideally it went up. So to allow your body to get acclimated a little bit more appetite every time that they decrease the dose. That's number one, to prevent significant weight regain. Number two, muscle mass is your biggest bet to not have a huge weight regain. But if you, if you lost a lot of muscle and you didn't gain the muscle.

[Shopify Narrator]

Yeah.

[Dr. Rocio Rossille]

The medication was doing all the job for you, right? Yeah. And also if this is a, a, a, a chronic condition for you, then this is not a cure. Right. You did. All those factors weren't removed by being on a GLP1 medication. And most medications work. While you're.

[Dan Buettner]

How about you hear this term microdosing?

[Dr. Rocio Rossille]

GLP1 microdosing is by the wellness community and I can tell you how, because I saw this, how it came about. Microdosing. Microdosing came from inexperienced providers, clinicians, med spas, PAs, nurse practitioners that didn't know how this medication worked. They gave it to their patients, they came back with severe side effects, ended up in the hospital and they, well, then maybe if I give you a lower dose, you won't have those side effects. That's where the microdosing term came about. Right. But if you're doing it the right way and you know what the hell you're doing, you can use the regular dose because the regular dose were the therapeutic doses that were found in the studies to exert an effect, the desired effect, either to decrease your glucose or to decrease your body weight. So there's no need to microdose. If you need the medication, you need the full. If you have a body composition and you're in a healthy weight with good muscle mass, you don't need to microdose, you're not getting anything extra benefits. But if you use the medication and you say, but even if with a microdose, I feel great, most likely you need the medication full dose, Right.

[Dan Buettner]

So the bottom line, microdose is not a good idea.

[Dr. Rocio Rossille]

It's not necessary.

[Dan Buettner]

How about after the holidays? People always gain extra five, ten pounds after the holiday. Okay. To go on GLP1 to, to get rid of that body fat quicker or easier or maybe more.

[Dr. Rocio Rossille]

If it's just from the holiday Weight? No. I mean if it's something that you've been struggling carrying with, then yes. But just for like that we're going back to thinking of it as a supplement. Right. You wouldn't take an antihypertensive for four weeks just because you're gonna lose weight. Right. So don't think of this medication as something that you get over the counter. This medication, serious drug. It's a serious drug. It's a procedure, prescription medication and probably

[Dan Buettner]

a long term commitment for most people. Be aware. And it's not cheap, is it?

[Dr. Rocio Rossille]

It's getting cheaper. But how much has an individual, and I can see this in my patients, has spent on diets, books, programs, trainers, supplements, hocus pocus, thousands and thousands and thousands of dollars without long term results. So we also have to re educate the consumer on where they spend their money too. Right.

[Dan Buettner]

The whole premise of Blue Zones is we all know we should move more, we should eat better, we should socialize more, we should sleep more, we should know our purpose and live our purpose. But how do you do it for long enough to make a difference? And you know, I, I have my own answer with Blue Zones. But we, we gloss over the how.

[Dr. Rocio Rossille]

Yeah.

[Dan Buettner]

Because marketers want to sell us this thing that's going to do the trick. And I think GLP in a way falls in that category. It's the panacea. But unless you know how you miss more than half of the story.

[Dr. Rocio Rossille]

To be able to make something sustainable long term, it has to be easy.

[Dan Buettner]

Yes.

[Dr. Rocio Rossille]

If I give a patient, okay, you have to do this and this and this and follow this and wake up at this time and take this medication at this time and then exercise. If I complicate it too much, I'm going to get, get results. But they're going to be temporary, they're not going to be sustainable because if the patient has to modify or become another job to sustain that, it's not going to be long term, they're going to drop it. And the way that I talk in my book, the language that I use is also very similar. Like I need you to, I'm going to talk to you in a very easy way that you're going to be able to understand and understand the why. Because what I found through my years as a doctor and is that people want to get informed, people want to know about their disease, people want to be participants of their treatment. Right. So, and I always say the patient that knows more does better.

[Dan Buettner]

That's a good insight. When people are on a GLP1, even though their appetite is curbed, aren't they just often eating the same junk food they were eating before?

[Dr. Rocio Rossille]

No, because the junk food gives you

[Dan Buettner]

our reward, so it decouples the reward from the food. So do you see in your patients that what they're eating changes 100%? People generally eat on GOP healthy food.

[Dr. Rocio Rossille]

They like when you have the conversation with the patient, when you educate with the patient regarding muscle mass, their body composition, their concentration, the focus from weight loss changes the direction for muscle preservation and muscle gain. Because I tell them the drug is doing the fat loss for you. Your homework, your duty is to maintain and build your muscle.

[Dan Buettner]

But going back to this idea of, of desiring food and, and enjoying food, this image comes to mind. I, I go to this blue zone. Icaria and I go to a place called Thea's guest House. And she's got this terrace overlooking the Aegean. And every night she assembles her family and, and local villagers. And we sit around a giant town table. And it's mostly greens, salads, greens baked into pies. Bean dishes are big there, there might be some fish. But it's this huge Mediterranean banquet. And there's so much joy at that table. And part of the joy is the joy of eating. The joy of this ancient primal activity which is sitting around a table with good friends, good conversation and good food. And aren't we taking a third of that away?

[Dr. Rocio Rossille]

I want to stop right there and make a huge point. You will still enjoy your food when you're hungry. You eat and you enjoy the food that you're eating. Then you get fuller and then you stop. What is removing is the reward from ultra processed, pro inflammatory food that we shouldn't be eating to be. So you will still enjoy whatever food you're eating. When you are on a GLP1. This is not like you are dead. You're not feeling anything. You're just fueling yourself. No, otherwise people will not be on it, right? They wouldn't last on it. You still enjoy what you eat. You're just going to eat 60, 40% less of what you normally ate. And you're not going to crave the high sugar, the high fat, ultra processed food, right? And I love this comparison of the blue zones because what is it in the blue zones? The simple life, the simple food. It's not the industrialization, it's not the food industry, it's not the processed food. It's not the overworking, it's not the no community, it's not the not walking. It's opposite of how we live. Right. So yes, that's the ideal. That's the ideal way that we should live. Live. Do we live like that? Unfortunately for the majority of people, we don't.

[Dan Buettner]

Not enough.

[Dr. Rocio Rossille]

Not enough.

[Dan Buettner]

And not to get too nuts and bolts, but how do you pay for it?

[Dr. Rocio Rossille]

Thankfully, as more competition comes, prices will drop, right? Because right now we have a monopoly between Noble Nordisk and between Eli Lilly. Those are the only two companies that are making GLP1 medication. So as most competition comes, their prices will drop. Now, both pharmaceuticals, now they offer a direct to consumer pharmacy, meaning that they're bypassing health insurance. The pbm, which is a company between the health insurance and the pharmacy, and then the pharmacy costs. So that really decreases the price if your insurance doesn't cover it. If you're paying out of pocket, you should use the direct pharmacies. Nobody this day should be paying full price for any of the FDA approved GLP1 medications. If you have insurance and your insurance is not covering it, you have a commercial coupon that decreases the price for half. If your insurance doesn't cover it or you don't have insurance, you use one of the direct pharmacies. That brings the cost to one fourth of it. Right? Or if you're lucky enough and your insurance covers it, well, it's $25 for you.

[Dan Buettner]

How can people engage with you?

[Dr. Rocio Rossille]

My social media, my Instagram handle, I mean, honestly. And it's not because, you know, you don't make money in books. It's because I made this book. It's like me in the book while walking you through everything. So if you have the book with you and the book is designed for you to read it back and forth, to go back to certain chapters, that book is me as the specialist that you see here with you at home or at your doctor's office. So the next second best thing for me is really my book Weightless.

[Dan Buettner]

And you don't even need an appointment.

[Dr. Rocio Rossille]

Then you don't need an appointment because it's like until four or five months waiting, so you don't have to wait.

[Dan Buettner]

This is so fantastic. Thank you very much.

[Dr. Rocio Rossille]

No, thank you so much too.