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

Summary

Podcast Summary: The Mel Robbins Podcast – Episode #1: Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now

Introduction

In the premiere episode of The Mel Robbins Podcast, host Mel Robbins delves deep into the complex issues surrounding obesity, weight loss, and the burgeoning popularity of GLP1 medications like Ozempic. Motivated by personal experiences with family members starting Ozempic, Mel seeks to provide listeners with accurate, research-backed information through a conversation with Dr. Rocio Salas Whelan, a triple board-certified physician specializing in obesity medicine, internal medicine, and endocrinology.

Meet Dr. Rocio Salas Whelan

Timestamp: [06:08]

Dr. Rocio Salas Whelan brings a wealth of expertise to the discussion. Originally from Mexico, she pursued her medical education there before relocating to New York City, where she underwent nine years of rigorous training. As the founder of New York Endocrinology and a clinical instructor at NYU Langone Hospital, Dr. Salas Whelan has dedicated her career to treating endocrine disorders, including diabetes, thyroid issues, osteoporosis, and polycystic ovarian syndrome (PCOS). Her approach emphasizes prevention and sustainable solutions to chronic health challenges.

Understanding Obesity as a Multifactorial Disease

Timestamp: [06:47]

Dr. Salas Whelan emphasizes that obesity is not a straightforward condition but a multifactorial chronic disease. She outlines five primary factors contributing to obesity:

1. Lifestyle: Includes exercise, sedentary behavior, and dietary habits.
2. Genetics: Family history and genetic mutations can predispose individuals to obesity.
3. Hormonal Changes: Conditions like PCOS, perimenopause, and menopause affect weight.
4. Aging: Metabolism slows, muscle mass decreases, and fat storage patterns change.
5. Environmental Factors: Obesogenic environments, including the food industry and exposure to endocrine-disrupting chemicals like BPA found in plastics and pesticides.

Dr. Salas Whelan asserts, “Obesity is not your fault” ([12:59]), challenging the stigma often associated with weight gain and emphasizing the role of uncontrollable factors.

The Evolution and Role of GLP1 Medications

Timestamp: [24:40]

GLP1 medications, with Ozempic being the most well-known, have been FDA-approved since 2005, initially for treating type 2 diabetes. Over the past two decades, these medications have undergone significant improvements, becoming safer and more effective. In 2021, Ozempic was rebranded as Wegovy for its approved use in weight loss independent of diabetes.

Dr. Salas Whelan explains, “GLP1s suppress appetite and increase satiety” ([34:29]), helping individuals feel full faster and reducing overall caloric intake. Additionally, these medications block the reward response in the brain associated with eating, thereby decreasing food cravings.

Personal and Clinical Impact

Timestamp: [47:53]

Dr. Salas Whelan shares her personal experience with GLP1 medications: “I used the medication for six months, got back to my weight, and haven't needed it since then” ([47:53]). This dual perspective—both as a physician and a patient—enhances her empathy and understanding of the challenges faced by those struggling with obesity.

Risks and Side Effects

Timestamp: [53:28]

While GLP1 medications offer significant benefits, they are not without risks:

• Muscle Loss: Due to reduced caloric intake, which can be mitigated by increasing protein intake and engaging in strength training.
• Gastrointestinal Issues: Such as nausea and vomiting, especially with compounded or improperly dosed medications.
• Serious Concerns: Including suicidal ideation, primarily linked to compounded medications rather than FDA-approved versions.

Dr. Salas Whelan stresses the importance of medical supervision: “The efficacy and safety of this medication depend on the expertise of the prescriber” ([59:47]). She warns against mail-order and compounded medications, highlighting the risks of inconsistent dosing and unregulated formulations.

Proper Usage and Lifestyle Integration

Timestamp: [54:37]

To maximize the benefits and minimize risks, Dr. Salas Whelan advises:

• Increase Protein Intake: Aim for approximately 90-100 grams of protein daily to preserve muscle mass.
• Engage in Strength Training: At least twice a week, focusing on upper and lower body workouts.
• Regular Monitoring: Frequent medical visits every 8-10 weeks to assess progress and adjust dosages as necessary.

Debunking Misconceptions

Timestamp: [69:41]

One prevalent misconception is that GLP1 medications are a "cheat" or require no additional lifestyle changes. Dr. Salas Whelan clarifies, “Patients must remain active and maintain a healthy diet” ([69:41]). The medications are tools to aid in weight loss, not replacements for healthy habits.

Navigating Medication Access and Affordability

Timestamp: [78:52]

Access to GLP1 medications can be challenging due to high costs and insurance barriers. Dr. Salas Whelan suggests:

• Utilize Manufacturer Coupons: Many pharmaceutical companies offer discounts that can reduce costs by 50-60%.
• Explore New Formulations: Emerging options like pill forms of GLP1 are becoming available.
• Seek Specialist Care: Consulting with obesity specialists can improve the likelihood of insurance approval and ensure proper medical oversight.

Empowering Conversations and Support

Timestamp: [75:47]

Discussing weight and obesity with loved ones requires sensitivity. Dr. Salas Whelan recommends approaching the conversation from a place of love and concern without assigning blame: “Authentic care is perceived positively, and tact is essential” ([77:53]). Providing educational resources and encouraging professional medical consultation can facilitate supportive dialogues.

Conclusion and Key Takeaways

Timestamp: [80:15]

Dr. Salas Whelan and Mel Robbins wrap up the episode by reinforcing that obesity is a complex, multifactorial disease influenced by factors beyond personal control. The introduction of GLP1 medications offers a promising avenue for effective weight management when combined with proper medical supervision and lifestyle adjustments.

Notable Quotes

• Dr. Salas Whelan: “Obesity is not your fault” ([12:59]).
• Mel Robbins: “If I'm ever hear another person in my life complain about their weight or hate on themselves, I'm gonna say, you know, it's not your fault” ([75:35]).
• Dr. Salas Whelan: “Patients are more involved in exercising, they're eating better, they're increasing their protein intake, they're working out” ([69:57]).
• Mel Robbins: “You don't have to shame yourself. This isn't my fault. And if I'm resonating with some of this stuff, I deserve to go get help” ([75:47]).

Final Thoughts

This episode serves as a crucial educational resource, dismantling the stigmas associated with obesity and highlighting the scientific advancements in weight management treatments. By featuring an expert like Dr. Salas Whelan, Mel Robbins ensures that listeners receive accurate, empathetic, and actionable information to navigate their health journeys.

For more insights and empowering discussions, follow The Mel Robbins Podcast on your preferred podcast platform or join the conversation on social media @melrobbins.

Transcript

[Mel Robbins]

Hey, it's your friend Mel. And welcome to the Mel Robbins Podcast. So recently a couple of my friends and someone in my family has started taking Ozempic. And I'm going to be honest with you, I have had a wide range of reactions to it. Now, first of all, I was so excited for my family member to be prioritizing their health. And on the other hand, I was actually kind of worried. I mean, from the potential side effects. I am reading all this stuff, I'm getting targeted by these drugs online. Maybe, like me, you have questions too, because you have people in your life who have started taking the medication. Or maybe you've been struggling with your weight for a long time and you've tried to get a handle on it. Nothing's worked. And so now you're curious about GLP1s, or perhaps you're already trying them out, but you still have some mixed feelings about it, like, are they safe? How do they even work? Is this too good to be true? What about those side effects? Do I have to be on this for the rest of my life? So here's what I did. I reached out to a world renowned medical expert who is a triple board certified medical doctor with three specializations. Obesity medicine, internal medicine, and endocrinology. And she's here today in her Boston studios to tell you everything that you and your loved ones need to know. So today, you and I are gonna get all the medical facts that you need to hear about the drug everyone's talking about. You're gonna learn the medical truth about your metabolism, the surprising reasons why you or your loved ones may be struggling with their weight, food cravings, and four surprising factors that you have no control over that cause weight gain. That's why our medical expert today will tell you if you're struggling with your weight, it is not your fault. She will also tell you who GLP1 drugs are meant for and who they're not, the surprising truth about the side effects. And she has a very stern warning against mail ordering this, getting it from a website or a friend or microdosing. Now, this conversation today is a free resource with one of the world's leading experts on the medication everyone is talking about. You're not only going to leave informed and empowered, but you will never, ever think about weight loss or the struggle to lose it the same way again.

[Dr. Rocio Salas Whelan]

Every day, our world gets a little more connected, but a little further apart. But then there are moments that remind us to be more human.

[Mel Robbins]

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[Dr. Rocio Salas Whelan]

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[Mel Robbins]

Don't worry, we'll get you taken care of.

[Dr. Rocio Salas Whelan]

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[Mel Robbins]

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[Dr. Rocio Salas Whelan]

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[Mel Robbins]

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[Dr. Rocio Salas Whelan]

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[Mel Robbins]

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[Dr. Rocio Salas Whelan]

Thank you so much for having me.

[Mel Robbins]

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. That'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 that.

[Dr. Rocio Salas Whelan]

Obesity, that weight gain is complex, it's not as straight line as we used to think. And that most importantly that weight loss is, should not be a full time job. Weight loss should not consume your life mentally or physically.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

It exists. It is possible and reachable.

[Mel Robbins]

Wow. I mean, that's not what I thought you were going to say. That is an amazing 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 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 think that's extraordinary.

[Dr. Rocio Salas Whelan]

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, seven, seven days a week, 365 days in a year.

[Mel Robbins]

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. Solis, 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 training and expertise.

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

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 your own specialty just to be solely dedicated for obesity. And endocrinology is the management of hormones. And yes, hormones impact. Wait.

[Mel Robbins]

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?

[Dr. Rocio Salas Whelan]

Whalen, I want to say that I'm sorry on behalf of the healthcare providers. We didn't know better, and we failed you. And I've been humbled by my patients. 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. Science advances, like everything, right? Medicine is an evolving science, and we are aware, and we will do everything we can to fix it.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

The number one cause, the highest risk for developing.

[Dr. Rocio Salas Whelan]

Yes. Wow. So by reducing obesity, by treating obesity, we are going to have less chronic diseases. We've built specialists, we created 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 incidence of the cancers that I mentioned.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

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. And to play devil's advocate, we didn't have the training, we didn't have the knowledge that obesity is not a self inflicted.

[Mel Robbins]

Okay, hold on. I wanna make sure that we do not skip over what you just said. Obesity is not a self inflicted disease. I wanna unpack that because I did not understand that until recently. So what does it even mean that obesity is a disease?

[Dr. Rocio Salas Whelan]

So what we've learned is that obesity is a multifactorial chronic disease. And I'll deconstruct that. Multifactorial, meaning that there's more than one cause to somebody to struggle with weight or have obesity. I like to break them into five pieces. One, lifestyle, exercise, sedentarism, diet. But that's one piece of the five. 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.

[Mel Robbins]

Right, gotcha.

[Dr. Rocio Salas Whelan]

Okay, 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. 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 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. So there's less 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 an 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. While 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 research showing that the patient parents preconception weight can impact the weight of their child.

[Mel Robbins]

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 your weight.

[Dr. Rocio Salas Whelan]

Yes. And so.

[Mel Robbins]

And not. And 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. And when you really just listen and absorb what you just said, lifestyle, genetics, hormone changes, aging, environmental factors. Environmental factors. 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, not having accessible, safe walking areas, working from home and being sedentary, and then now you're talking about. This word was too big for me to write down. It was like endro something destructible. But it was the things that are actually impacting your body's metabolism 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 we're 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 causing this disease it's causing, which means it's not your fault.

[Dr. Rocio Salas Whelan]

And when a patient hears this, I can almost physically see it, how they feel relieved. I've had grown men in my office cry when they hear this for the first time because they've lived decades thinking that it was their failure.

[Mel Robbins]

Well, what you've already shared is so enlightening and empowering. And I kind of want to 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, hormone changes, aging and environmental factors. So 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 kind of 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 being overweight.

[Dr. Rocio Salas Whelan]

Definitely. So when we talk about genetics, we're talking about family history, right. If your parents struggle with weight, if your grandparents struggle 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. Consume highly palatable food that can be transmitted to you.

[Mel Robbins]

What's palatable food mean?

[Dr. Rocio Salas Whelan]

Food. Processed food alternatives, Processed food that will lead to wanting to consume more. Right. Then when we talk about also there's some mutations that may also cause obesity. Right. And then when we talk about hormonal, so through a person's life there could be hormonal changes, shifts, imbalances, that is going to promote weight gain. We can talk about hypothyroidism, Right. Which thyroid hormone controls your metabolism. Then we can talk about pcos, polycystic ovarian syndrome, when there's hyperinsulinemia. Insulin resistance and this promotes visceral fat. Visceral fat promotes insulin resistance, insulinemia, and it goes into a vicious cycle. We also talk about perimenopause and menopause with the changes of fluctuations or the drop of estrogen. This promotes visceral fat, the subcutaneous fat that you had in your fertile years in your hips and your breasts goes intra abdominally. This visceral fat promotes insulin resistance. And then you go into that vicious cycle again. Also because of the drop of estrogen, we see a decrease in lean muscle mass. Muscle mass is your burning calories, calorie machine. If you lose it, then your metabolism slows down. Then we go into aging, Aging also as we age, we tend to lose muscle mass. It's harder to build muscle and also it promotes weight gain. And then we go into environmental factors. As we talk the food industry, industrialization, plastic pesticides, all of those things disrupt your endocrine system. We call them endocrine disrupting chemicals because they disrupt the function, the normal function of your hormones. They mimic your hormones. So they occupy the receptors where your hormones should go and do a function. And this can promote obesity, infertility. So they're real things that are impacting people's life on the day to day basis.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

Knowing this and understanding this is you move away of putting the pressure on the patient. Right? You move away of being a one participant in this equation. It goes more into a team, what you can do for the patient and educating the patient, it becomes a team. Let's talk about, as an example, diabetes, type 2 diabetes. We know it's a chronic multifactorial disease, but we have no trouble prescribing and treating medications for it. Right? It's widely accepted from the patient side, from the physician side, let's talk about hypertension, Same thing, right? We know that lifestyle can help it or make it worse, but that is not causing the disease. Therefore, we feel comfortable treating it and the patients accepting treatment. And when we provide treatment for type 2 diabetes, hypertension, high cholesterol, we always talk about eating healthier and exercising, but it doesn't replace the Treatment. So if we see obesity as a disease, we can act the same way, understand and support the patient in their lifestyle, but also provide a medical treatment.

[Mel Robbins]

Because there are four factors outside of your control that you've just unpacked. Genetics, hormone changes, aging, and all the environmental factors, largely because of big farming and industrialized food and all the crap that they put in it that's screwing up and confusing your body's ability to process food.

[Dr. Rocio Salas Whelan]

And I'm breaking them in Big five umbrella. But also there's other things like medic that patients may take for certain particular disease that can promote waking. Right. There's a lot of antidepressants that can promote waking, blood pressure medications that can promote weight gain. Right. And many times there's no other option for the patient. And this can also lead to obesity.

[Mel Robbins]

So I would love to have you talk about the GLP1 medications because I didn't realize they'd been around for decades. I had no idea. I've seen them in the headlines. They're all over the place. I have, like many people, I have people in my life that are taking them and they're life changing, but I didn't realize that they've been around for a long time. So could you talk to us about what they are, how long they've been around? Like when you first started using them in your clinical practice?

[Dr. Rocio Salas Whelan]

Definitely. The first FDA approved GLP1 was in 2005.

[Mel Robbins]

2005? Yes.

[Dr. Rocio Salas Whelan]

What, 20 years now?

[Mel Robbins]

20 years?

[Dr. Rocio Salas Whelan]

Yes. The FDA name, it was by Eli Lilly, it was called Bayera. And this was twice a day subcutaneous injection. So it was a daily twice a day injection that patients had to do.

[Mel Robbins]

Okay.

[Dr. Rocio Salas Whelan]

And the first indication was for type 2 diabetes because GLP1 is a hormone.

[Mel Robbins]

What does GLP1 stand for?

[Dr. Rocio Salas Whelan]

Glucagon, like peptide. And this a peptide or a hormone.

[Mel Robbins]

Is that what the word peptide means? Hormone?

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

Okay.

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

Okay.

[Dr. Rocio Salas Whelan]

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 isolated this, the GLP one outside the human body. It was in a lizard called the Gila Monster. And the lizard, the of this lizard caused pancreatitis on its victims. So Dr. Ng, John Eng, being an endocrinologist and researcher at the BA Hospital in the Bronx, wondered what in the venom affected the pancreas.

[Mel Robbins]

Okay.

[Dr. Rocio Salas Whelan]

And he isolated GLP1.

[Mel Robbins]

So this little gila lizard bites its, like, prey or whatever, and the venom of it sends, activates the pancreas and like, sends the thing into, like, a state of diabetic shock.

[Dr. Rocio Salas Whelan]

It causes pancreatitis. So the prey dies from pancreatitis.

[Mel Robbins]

What. So what exactly does the GLP1 do to the pancreas?

[Dr. Rocio Salas Whelan]

So it stimulates to produce insulin. The problem in type 2 diabetes is insulin resistant and hyperinsulinemia. So with time, with frequent stimulation of the pancreas every time you eat, every time you eat anything that has glucose, your pancreas produces insulin. But with time, it overworks. Your body stops responding the same way to the insulin that you make, so you become resistant to your own insulin. The pancreas, in response, tries to overcompensate and make more insulin, but your, your body is resistant to it, so you have hyperinsulinemia and insulin resistance. So these are the two main pathologic factors that lead to somebody to develop type 2 diabetes.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

And this is the beauty of medicine, right? When one thing is made or developed for a particular disease or reason, we find out later that it has other benefits, like GLP1.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

Exactly.

[Mel Robbins]

Wow. So what have you seen in the last 15 years since you've been using GLP1s as a tool in medical practice? What have you seen in terms of the benefit to patients, how this is used as a tool, the difference that it makes?

[Dr. Rocio Salas Whelan]

I've seen people's lives change. I've seen more acceptance to the medication. The drugs are becoming safer, less side effects. I like to compare them with the iPhone. We have different versions of the iPhone, right? We have the iPhone one, the iPhone X, and now we have the iPhone 16. Same is happening with this color loss of drugs. Their versions are newer, safer, less side effects, and more effective. So I feel like people are getting the message one or accepting the message that obesity is a disease. They feel like giving up for Many patients, I'm the last step of their journey. And when I talk about a journey, I'm talking decades of journey. I'm talking about doing diets that I've never even heard about. I always learn about a new diet from my patients, being with nutritionists, being in fat camps that they call them. So I've seen patients struggle through their life and how this medication are changing their lives and giving them their life back, basically.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

First of all, the initial versions of this drug, they caused more side effects and they were more cumbersome. For somebody inject themselves twice a day, every day. So even for many patients with type 2 diabetes, it was hard to accept because patients with diabetes, they think and feel that once they're on insulin, they're failed. Right. Or it's just more severe. So having a medication that is injectable, it was a hard to dissociate them with, with insulin.

[Mel Robbins]

Got it.

[Dr. Rocio Salas Whelan]

Or with failure.

[Mel Robbins]

So they basically be like, I might as well just be injecting insulin at this point.

[Dr. Rocio Salas Whelan]

So patients didn't like to inject themselves and it was a twice a day injection and there were a lot of nausea. So it was harder to tolerate back then.

[Mel Robbins]

And just so I remember, because it's already flown out of my brain, that how it works is that it stimulates your pancreas for type 2 diabetes.

[Dr. Rocio Salas Whelan]

Yes. It stimulates your pancreas to make more insulin when your sugar goes above normal.

[Mel Robbins]

Okay.

[Dr. Rocio Salas Whelan]

But if somebody who doesn't have diabetes and their glucose is normal, it doesn't touch the pancreas.

[Mel Robbins]

Interesting. Okay.

[Dr. Rocio Salas Whelan]

That's why we can use it in people that don't have diabetes.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

Type 2 diabetes.

[Mel Robbins]

So what has happened in the last 15 years?

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

Okay. So this is going to make me sound like the world's biggest idiot, but if you inject insulin for type 2 diabetes or like, it actually makes you gain weight. Yes. That does not seem fair.

[Dr. Rocio Salas Whelan]

It does not. It is not. But that's all we had.

[Mel Robbins]

Okay.

[Dr. Rocio Salas Whelan]

Back then.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

That is fantastic, especially for type 2 diabetes. That weight gain or obesity goes hand in hand with diabetes. And before with the medic that we had, we had to choose either we help with the glucose or we help with the weight.

[Mel Robbins]

Right.

[Dr. Rocio Salas Whelan]

And many times we wanted to bring the glucose and that's what we had available.

[Mel Robbins]

So how long have you been prescribing these to people as a tool for treating the disease of obesity or for somebody who's struggling with being overweight?

[Dr. Rocio Salas Whelan]

Since 2010.

[Mel Robbins]

So you're like a pioneer in this.

[Dr. Rocio Salas Whelan]

Yes.

[Mel Robbins]

Wow. And when did all these studies start to happen?

[Dr. Rocio Salas Whelan]

They started back in 2000. So, I mean, even for 2005, for the FDA approval, they're starting in the 90s, right. With the first one. But in regards for weight loss, it started around 2005, 2006.

[Mel Robbins]

Gotcha.

[Dr. Rocio Salas Whelan]

And then the first one approved for weight loss was in 2012, named Saxenda. Also a daily injection. So we moved from the twice a day injection to the once a day injection, but still severe side effects. We were nausea or vomiting, and it was hard to get to higher doses where we see most of the weight loss because of the side effects. Then eventually in 2017, we have the poster child of these drugs, which is Ozempic. That was when it was approved for type 2 diabetes. In 2021, Ozempic became also approved for weight loss, independent of diabetes, and then rename it as Wegovy.

[Mel Robbins]

Wait, oh, wait, Wegovy and Ozempic are the same thing?

[Dr. Rocio Salas Whelan]

It's the same drug? Yeah. When GLP1 gets approved initially for type 2 diabetes and then eventually gets approved separate exclusively for weight loss, they rebranded. They just changed the name. But it's the same drug, same pharmaceutical, same.

[Mel Robbins]

Why do they rebrand it? So that they can market it to a different segment of people who are like, I don't want to take the diabetes drug.

[Dr. Rocio Salas Whelan]

Well, if you don't have diabetes, you don't want to take a medication that is for diabetes and also for insurance. Purposes. Right.

[Mel Robbins]

Got it.

[Dr. Rocio Salas Whelan]

Insurance will approve one drug for type 2 diabetes and will approve one drug for obesity, but. But unlikely that it's going to approve one for both things.

[Mel Robbins]

Wow. So how exactly does the GLP1 work? To help somebody lose weight or to change their metabolism if they don't have diabetes?

[Dr. Rocio Salas Whelan]

GLP1, I like to explain to my patients Target the two reasons that humans eat. We eat for fuel survival, and we eat also for reward. For a reward.

[Mel Robbins]

Okay.

[Dr. Rocio Salas Whelan]

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. 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 a certain reward, Once you're on these medications, you see that meal and you don't get the same feedback, so their behavior change. You enjoy your food when you're hungry and eating once you're full and satisfied, it's out of your mind.

[Mel Robbins]

Wow. And it doesn't touch the pancreas.

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

Wow. Dr. Shilas Whelan, I am so grateful for everything that you're sharing with us today. And here's what I wanna do. I wanna take a quick pause so we can give our amazing sponsors a chance to say a few words. I also want to give you a chance to share this with people in your life that are coming to mind as you're listening to Dr. Solis Whelan. And don't go anywhere because we're just getting started in unpacking this super important topic. Dr. Sollis Whelan has so much more to teach you after this short break, so stay with us. I don't know about you, but it is 4 o'clock and I just hit the wall, powering through my day on nothing but grit, caffeine, and willpower. I used to think I'll sleep better someday. I'll have better focus later. Nope. I need real support. So do you. That's where Symbiotica comes in. Did you know that over 65% of adults in the US are magnesium deficient? Yeah, me neither. This can cause muscle cramps, brain fog, headaches and insomnia. No wonder I hit the wall at 4pm well, not anymore. I've been taking Symbiotica's magnesium L Threonate. I sleep deeper, I feel sharper, and I'm way less edgy during the day. It's a tasty liquid that comes in these cute little pouches that you can squeeze directly into your mouth or stir into your favorite beverage. Symbiotica's magnesium L Threonate is the only form of magnesium that crosses the blood brain barrier, delivering nutrients straight to your brain. Symbiotica Wellness made simple claim. 20% off and free shipping today at symbiotica.com Mel that's C Y M B I O-T-I K A.com Mel symbiotica.com Mel Bell for 20% off and free shipping.

[Dr. Rocio Salas Whelan]

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[Mel Robbins]

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[Dr. Rocio Salas Whelan]

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[Mel Robbins]

Yeah. I can test the brake pad resistance at variable speeds.

[Dr. Rocio Salas Whelan]

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[Mel Robbins]

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[Dr. Rocio Salas Whelan]

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[C]

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[Dr. Rocio Salas Whelan]

Ugh.

[C]

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[Dr. Rocio Salas Whelan]

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[Mel Robbins]

Welcome back. It's your buddy, Mel Robbins. Today you and I have the privilege of sitting and spending time with Dr. Solis Whalen. We are learning so much about the topic of weight loss and weight gain and the reason why it's not your fault if you or your family members are struggling with this. And we're also digging into the weight loss medication that everybody is talking about. So one of the things that I see that I know a lot of people see and this is sort of like the. Also could be more shaming, but you see celebrities who want to lose an extra 15 pounds or you see the Ozembic face 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 first.

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

Sure.

[Dr. Rocio Salas Whelan]

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 thin, they don't need this medication, we're assuming that they're healthy, that they're metabolically healthy, 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 would say even patients that don't need weight loss medications, just to know what's 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 bulk number. We're talking specifically. We wanna reduce what can cause dise or increase your risk of disease, 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. They're steering a pro inflammatory chronic state. Right there. Can still develop type 2 diabetes or even be at risk of developing cancer. So just by looking at somebody, we cannot say what the body composition is and what they need or don't need to lose.

[Mel Robbins]

Got it.

[Dr. Rocio Salas Whelan]

Right. So we first need to stop associating thinness with health. Many times when I see patients that think they need to lose ten pounds 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 anybody who thinks who needs to be on this medication to really know if they will benefit or not.

[Mel Robbins]

How do you do body composition?

[Dr. Rocio Salas Whelan]

So we have machines, right? So the gold standard for a body composition is an mri, but we're not gonna do MRI on every patient on every visit. The second is dex, and then the third, which is the more accessible, is body impedance, also known as in body. There's different versions of it. So those are the Ones that are more ac accessible and they offer no radiation to the patient. And we do body compositions on initial visit and every visit when somebody starts on a weight loss journey.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

No. Most patients that come is because they need them and because they've done their work and it's just not working. It's just not happening.

[Mel Robbins]

If someone comes to you, Dr. Solis, Whelan, and they're looking to be put on or prescribed one of these medications, what are some of the questions that you ask them to assess whether or not the medication is a good fit?

[Dr. Rocio Salas Whelan]

So first, starting with a very thorough weight history. So I need to know at what age were the conscious about their weight? At what age were they trying or being consciously about the eat or were 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 comorbidities that can contribute to obesity or medications that they're taking that can contribute to obesity? Then I go into a deep family history. I need to know up to two generations before, what was your parents, your grandparents weight, your uncle's weight, if they have children, how is your children? 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, do they have pcos? And then we move to the physical exam. And in that also we do the body composition and there we can really target what is it that need to be improved or doesn't.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

So what we consider obesity and percentage body fat is 32 and above normal in women is 18 to 28%. In men is 10 to 20%. So anything above those numbers, we either fall in the overweight range or in the obesity range.

[Mel Robbins]

Is there a benefit to using a GLP1 during menopause?

[Dr. Rocio Salas Whelan]

Definitely. What we see in perimenopause and menopause with a 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 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 GLP1s have a huge place for patients that need or that gain weight during perimenopause and that it's just going to become even harder to loosen and easier to gain weight.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

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 of thyroid cancer, papillary follicular, that's not a contraindication. Exclusively medullary thyroid carcinoma. Above that, patients that are pregnant and breastfeeding is not recommended.

[Mel Robbins]

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. That sticks? Or how does this work?

[Dr. Rocio Salas Whelan]

So we have to remember, what is obesity? Right? What causes a patient to require this medication? It's a chron 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. So that's why these medications were designed to be used long, long term. Now that can change. If somebody has history of obesity since childhood, in their midlife or later decades of their life, then most likely they will require this medication long term. But if it's somebody, as an example, who gained weight after pregnancy and hit midlife and they gain 30 pounds, but they never struggle with their weight, then maybe those patients will not need to use them long term.

[Mel Robbins]

Huh, that's interesting.

[Dr. Rocio Salas Whelan]

But you have this patient that had children late in life and then they hit midlife then. Yes, they didn't struggle with weight in the past, but now their surrounding is not going to be helpful for them to maintain the weight loss. So they may benefit from long term use.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

Yes, I have a very personal family member myself. I use this medication. After I had my kids. I didn't struggle with weight growing up. I always used to lift weights since my early 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 take 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 midlife at the same time.

[Mel Robbins]

What was it like after practicing obesity medicine to come to a point in your life where you're like, okay, okay, I'm gonna try the GLP one myself because I got pregnant 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?

[Dr. Rocio Salas Whelan]

Personally, I wouldn't say I resisted it. I was waiting basically to see if it would change. But I think after the first two years of kids, I mean, you really have to give your some credit and allow yourself some room to not wait about to not worry about your weight or punish yourself for not getting back on track so soon. I always tell a woman, give yourself one or two years before you start doing that. Because just having a child at that age is hard enough after that. I think when us doctors go through certain situations, it does make us a better doctor or more empathetic doctors.

[Mel Robbins]

Right.

[Dr. Rocio Salas Whelan]

Because it's very hard to identify with something that you don't know necessarily. It made me more understandable. I was better to relate possible side effects and what to do about it and definitely to be more empathetic.

[Mel Robbins]

Beautiful. How long ago was that?

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

No. I mean, because I know what causes waking. I knew in what place I was in my life and I knew that I didn't wanna exhaust every other possible situation that at the end was not going to help me. I'm a very proactive person, personally and professionally. So I really wanted to be very proactive at that time.

[Mel Robbins]

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 just like if you had diabetes or cancer, of course you would go get the treatment. This is a great moment for us to give our sponsors a chance to say a few words, to give you a chance to share this episode with people that you care about. And don't go anywhere because we have so much more to dig into with Dr. Solis Whalen when we return. Stay with us. Hey Kristen, how's it tracking with Carvana Value track tracker? What else? Oh, it's tracking in fact. Value surge alert.

[Dr. Rocio Salas Whelan]

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[Mel Robbins]

Just as predicted.

[Dr. Rocio Salas Whelan]

So we gonna, I don't know, could sell, could hold the power to always.

[Mel Robbins]

Know our car's worth.

[Dr. Rocio Salas Whelan]

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[C]

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[Dr. Rocio Salas Whelan]

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[Mel Robbins]

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[Dr. Rocio Salas Whelan]

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[Dr. Rocio Salas Whelan]

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[Mel Robbins]

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[Dr. Rocio Salas Whelan]

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[Mel Robbins]

Edu. Welcome back. It's your buddy Mel Robbins, and today you and I are learning from Dr. Solis Whelan. So, Dr. Sollas Whelan, here's where I want to go next. What are the risks of taking these medications?

[Dr. Rocio Salas Whelan]

So, as with any. Any diet or anything that causes a restricted caloric intake or decreases how many calories you're going to eat, there's always a risk of muscle loss. Right. Because it's hard to just exclusively lose body fat without lowering muscle mass. 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 that you may lose muscle.

[Mel Robbins]

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. Exactly. Which might have you lose muscle.

[Dr. Rocio Salas Whelan]

Yes.

[Mel Robbins]

Got it.

[Dr. Rocio Salas Whelan]

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 are on this treatment can prevent muscle loss and even gain muscle. For those that need to gain muscle, muscle.

[Mel Robbins]

If someone is taking one of the GLP1s, how do you do that with your lifestyle and diet?

[Dr. Rocio Salas Whelan]

Before we go into that, I just want to explain why we're talking about muscle, why it's so important. Muscle is not. Because we want to see people booked up and Arnold Schwarzenegger, like, right. Muscle is your biggest metabolic organ.

[Mel Robbins]

What does that mean?

[Dr. Rocio Salas Whelan]

It's your calorie burning, burning machine.

[Mel Robbins]

Muscles, muscle, muscles burning calories.

[Dr. Rocio Salas Whelan]

Muscles burn calories and muscle regulate your glucose. Because every time a muscle contracts is physically being used, it sucks sugar from the bloodstream to provide its energy.

[Mel Robbins]

Wait a minute. Is that why taking a walk after you eat is like a really good thing to do for your glucose? Yes. Wow. Okay. So you have to pay attention to muscles in general. We all do. But if you are gonna take a GL1, really understanding the role that your muscles play in glucose and in your overall health is a critical piece of this.

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

Okay, so, doc, you just said you gotta be lifting weights and you've got to be eating more protein.

[Dr. Rocio Salas Whelan]

Exactly.

[Mel Robbins]

Is there a standard formula that you give to your patients?

[Dr. Rocio Salas Whelan]

1 gram of protein per pound for ideal body weight. That's what they should aim. So I would say the sweet spot that I've seen for most patients is between 90 to 100 grams of protein a day, which without a weight loss medication, without a medication that is suppressing your appetite, is hard enough to eat that amount.

[Mel Robbins]

90 to 120 pounds is awfully skinny. Like, I thought you were gonna be like 150 to 200 grams of protein.

[Dr. Rocio Salas Whelan]

It's. I mean, it's very hard to. It becomes mission impossible when you're giving somebody a medication to suppress their appetite.

[Mel Robbins]

Oh, that's true.

[Dr. Rocio Salas Whelan]

But then you want them to eat 100 and more grams of protein. Right. So we have to find a medium point to patients to not lose muscle, and that's around 100 grams of protein a day in their diet.

[Mel Robbins]

Got it. And then do you tell patients at a minimum they should be lifting weights?

[Dr. Rocio Salas Whelan]

I would say with twice a week, they should feel happy with it.

[Mel Robbins]

Twice a week we can do this.

[Dr. Rocio Salas Whelan]

So one. One day upper body, one day lower body.

[Mel Robbins]

I love a formula that I actually feel like I could actually achieve.

[Dr. Rocio Salas Whelan]

But I would say for, for many patients, at the beginning, my main, main baby steps. Right, Baby steps, if I want them to do one thing is to increase their protein in their diet, because at least with increasing the protein in their diet. Diet, they won't lose muscle. Then we can. Once the patient starts losing weight, feels a little bit more stimulated or more encouraged or physically able, then we can start incorporating exercise.

[Mel Robbins]

You know, I see this term all over social media. Ozembic face. What is that? And why do people think that a GLP1 changes somebody's face phase?

[Dr. Rocio Salas Whelan]

Well, it's not. The GLP1 is the drop of rapid weight loss or significant weight loss. And why is this? Because of not eating enough protein. So as you lose, if you're losing Muscle because you're not, don't have enough protein in your diet while on this medication. You're not only going to lose muscle, you're going to lose hair, you're going to lose elasticity in your skin because we need protein to make collagen, elastin. Right. Also, you need muscle to fill the gaps of the fat loss. Right. The goal here is not skinny, it's strong, it's fit. Right. So you need to fill those pockets with muscle. Now if you're not losing muscle by increasing your protein intake, then you're going to make enough collagen, you're losing weight slowly. So you're allowing your skin to adapt, adapt to the changes. But if you lose weight rapidly, it means that you're also losing muscle. It means that you're not don't have enough protein in your diet, so you're not making collagen and elastin.

[Mel Robbins]

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 say that he was warned about suicidal ideation. What can you tell us about those two side effects?

[Dr. Rocio Salas Whelan]

So I'm gonna. There's a phrase that I use a lot and I'm gonna repeat it until I don't have to. But the efficacy and the safety of this medication is going to depend on the expertise on who is prescribing it to you.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

Yes. It means that it's a medication, it's a medical treatment. And you need medicine, medical supervision to decrease side effects and to achieve weight loss, to have the most results from this medication. Right. I've never had to stop the medication for any of those symptoms that you mentioned. It's very important to take the time to explain to the patient. You need to have this conversation to talk about weight with a. You need time. 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 to decrease the of side effects. You really need to make your research, do your research, do your due diligence before you go to somebody to get this medication.

[Mel Robbins]

And they should be a medical doctor.

[Dr. Rocio Salas Whelan]

Ideally they should be a medical doctor, but it could be a nurse practitioner, it could be a PA that they specialized in obesity.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

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 is your muscle mass? Are you losing mass? Do we need to slow down the medication? Do we need to decrease for the greater good of muscle? So every patient is 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.

[Mel Robbins]

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 GLP1 mail order. And it gave me a pause because of the 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 GLP1. What should you look for in terms of investigating a practitioner or provider? If this is a tool that you want to look into for yourself or a family member.

[Dr. Rocio Salas Whelan]

So the first thing to look is that we as medical doctors, we don't sell FDA approved medications in our offices. We send a prescription to your local pharmacy. It could be a commercial pharmacy, but we don't sell it in our office anymore. If you encounter somebody who does, they're selling you the compounded version. Right. Also many of those med spas or mail order, mail order or telemedicine platforms, what they offering you is the compounded version of the drug.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

The FDA approved medications are evidence based. They're from the clinical trials, they're heavily, heavily regulated. For a drug to be FDA approved, they sometimes have to 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. So safe 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. Oh, the current FDA versions, they're pre do those pens. So there's no way that a patient can inject themselves more or less with the compounded medications. And what we've seen and there's studies showing that most of the hospital visits for severe side effects of GLP1s are from compounded medications from overdosing. So you leave it to the patient many times to fear out the dosing or to run the risk of underdose or overdose. Right. And this can lead to severe side.

[Mel Robbins]

Effects effects that makes a lot of sense. Dr. Salis Whalen, what's your opinion of microdosing these medications for people who don't necessarily need to lose weight, but they just kind of want to.

[Dr. Rocio Salas Whelan]

Okay, so we have to understand how a medication or how the doses are recommended. Right. Medications go through clinical trials, clinical studies where many doses are trained, tried, then we reach a therapeutic dose which is a dose that exerts an effect. 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 going to get 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 soup 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 you are already in a healthy metabolic weight, then you don't need the. You're already getting the benefits. Right. You're already just by being fit, you have that, you don't need another medication. And third, the problem microdosing is that it's based on compounded medication.

[Mel Robbins]

Oh.

[Dr. Rocio Salas Whelan]

Currently the FDA approved drug, they come pre dose. So there's no an easy way to give yourself a lower dose. It's a single use pen for most of them, pre dose. So you cannot really play around with the dosing. Now Eli Lilly came with a bio of the lowest dose that may potentially have a use for patients that reach a healthy weight goal, that don't require higher doses, that can maintain a weight with a small dose, then we can do a lower dose. But currently we only have tirzepatide in a bile.

[Mel Robbins]

Right, got it.

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

Oh, the nausea, what are the big side effects effects?

[Dr. Rocio Salas Whelan]

The problem with those side effects were that they were initially created by people using compounded medication and that didn't have expertise on that 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 of the actual drug of itself. Right. It's an actual of problem of who was prescribing it and also using compounded medication.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

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 Microsoft dose.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

Dr. Salis Whalen, what's the most common misconception about these GLP1 medications?

[Dr. Rocio Salas Whelan]

That they're ECUA out that is cheap cheating, that you can sit back and not worry about how you eat and if you exercise or not.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

Patients are more involved in exercising, they're eating better, they're increasing their protein intake, they're working out. 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 composition and they, they think, oh, I lost three pounds. Great. And then they go into the body composition and they saw that half of it was muscle. They get it, they understand, 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 of what I do every day is there's a switch. There's a switch from when the patient comes thinking of something externally, physically, and then halfway, it becomes something internally. They like how they feel strong. They start to worry more about muscle in every visit than weight loss. How did I do on my muscle? Did I gain muscle? Once a patient feels, feels strong, understands on how to eat, there's no turning back. When a patient comes to me, they struggle through decades. Exercise program, personal trainers, some have personal chuffs. They're doing what we recommending. 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, 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 gained weight.

[Mel Robbins]

I mean, I think that the thing that's very clear about this is that a person who is struggling with their weight or struggling with obesity as a disease and a chronic condition condition, they're probably working harder on their health than the rest of us because they're thinking about it all the time. And I choose to believe that everybody wants to thrive. 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 help you help yourself. And so, of course, you'd feel discouraged. And so it makes so much sense. One thing I'm curious about, Dr. Solis Whelan, is how does a GLP1 change how often you think about food?

[Dr. Rocio Salas Whelan]

It's. I Think there's no. Anything I say is not gonna be comparable to what a patient experiences. You have to understand patients with obesity, they think about their weight 24 7, how everything that they do or put in their mouth is going to impact their weight or feel guilty about it later. When you remove that from a person, it changes their life. They feel liberated. The possibilities are endless.

[Mel Robbins]

That's incredible. I've never taken the medication, but one of my family members 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. It's liberating.

[Dr. Rocio Salas Whelan]

It's liberating. Some patients tell me, oh, this is how it's supposed to be. This is what is normal. And then it opens your eyes, right? It's like removing a blindfold. When you're on these medications and you go out with somebody who's not on this medication and you think about, like, whoa, we were overeating. You don't really need to eat that much to feel physically satisfied, right? So it. And. And then it has a rippling effect too, right? I mean, you can discuss this with family members or family members, see the effect, see the positive effect, and then it's just they want it too.

[Mel Robbins]

I know that this is a conversation that people are going to 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. Country, until we give people 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. You can't blame human beings for the fact that the environment that we live in is screwing up your body's ability to process the fake food that is affordable to most because of, like, how we've allowed industrialized farming and big industry to change the food that we eat.

[Dr. Rocio Salas Whelan]

And people say, well, some people with exercise and diet, they lose weight. The key is how much, how restrictive does it have to become to reach that goal? And can it be sustainable long term.

[Mel Robbins]

Without punishing it yourself constantly? Like, what I love most about everything that you've shared so far is just that it's not your fault. And really understanding that if you had cancer, if you had diabetes, you would seek treatment.

[Dr. Rocio Salas Whelan]

Yes.

[Mel Robbins]

And you would seek it for your 12 year olds and up, you would seek it for yourself. And really embracing that, that, hey, what if something else were to blame? And what if there was something that could help my body actually process food and water and air and everything in a way that supports my health? What if it doesn't have to be so hard? What if it's not my fault? That's the most exciting thing about everything that you're sharing with us today. One of the things that I wanted to ask you is if you have somebody in your life that you're worried about, that you really would love to have them go see a medical doctor like you, a specialist in obesity medicine or just somebody that is treating people. How do you talk to somebody without like making them feel wrong or blaming or assuming, you know what I mean? Because it's a very hard subject to talk about. And if you are somebody that doesn't have the same issue with your metabolism, then you don't understand. And so I just would love some advice from you about how to bring that this up to somebody who as you've already shared with us, is thinking about it all the time.

[Dr. Rocio Salas Whelan]

It's a difficult conversation to have, even for us doctors, that that may be the sole reason a patient is coming to see us. Some patients are not ready to have that conversation. It could be the same with a family member, with a friend. I would say if it comes from a place of love, an authentic care, care people perceive that, people feel that and don't feel attacked. I think the most important thing with that we have to remember with patients with obesity is that they've learned to feel blame and to feel attacked. So you have to be very, have a lot of tact on how you're going to bring the subjects with that feeling of putting more blame into the situation.

[Mel Robbins]

You know, I had that conversation with somebody in my family that I love. This was probably six months ago. And you know, just saying, I'm really concerned about you and I know how hard you work at this and have you thought at all about, you know, the GLP1 options that are out there? And they were very defensive and then said that they had already talked to their primary care about it and they're so expensive that I can't afford it and I didn't know what to say. And so do you have any advice for what you could say to somebody or what someone could do if they either have had an insurance claim denied or they can't afford the medication, or that's what they're telling themselves like, is there something that you should do beyond a primary care doctor in order to facilitate trying to get this covered by insurance?

[Dr. Rocio Salas Whelan]

Both pharmaceuticals that produce these medications, they have manufacturing coupons, okay? Meaning that if your insurance, if your commercial insurance didn't approve it, you can use a coupon that cuts the cost about 50 to 60% so they become a bit more accessible. Now, one of the current pharmaceuticals just came out with a bile of the medication. Currently we have injections that are pre filled pens and this drives the cost very high. But now the medication is coming in a bile like an insulin bile, but it's not insulin and it had cost the price significantly. So that's another option. And then also going to a specialist, right, that is going to do and take the proper measurements to make the diagnosis and to be able to justify the need of the use of the medication.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

What you learned today. To share what impacted you the most about this conversation. Right. I think our duty and our responsibility is to share the information.

[Mel Robbins]

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

[Dr. Rocio Salas Whelan]

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

[Mel Robbins]

Thank you, thank you, thank you, thank you. Incredible.

[Dr. Rocio Salas Whelan]

Thank you for having me.

[Mel Robbins]

And I also want to thank you for taking the time to listen and to learn about this life changing topic. And for also being generous with this information and sharing Dr. Salas Whelan's information with the people that you care about. There's no doubt in my mind that this could change the course of somebody's life. And in case no one else tells you, I wanted to be sure to tell you that I love you and I believe in you, and I believe in your ability to create a better life and taking better care of your health and using the tools that are available to you and getting the support that you deserve is one of the best ways to do that for yourself. Alrighty. I'll see you in the next episode. And I'll be waiting to welcome you in the moment moment you hit play. I'll see you there. I'm waiting for my. This is the hardest part for me. I feel like a racehorse and a starting gate. I'm so excited to talk to you, Rocio.

[Dr. Rocio Salas Whelan]

Perfect.

[Mel Robbins]

Hi. Okay. Don't worry. I can blow it once the cameras are rolling.

[Dr. Rocio Salas Whelan]

It's okay. You wouldn't be the first one.

[Mel Robbins]

This is so pretty.

[Dr. Rocio Salas Whelan]

Thank you.

[Mel Robbins]

That is really pretty. You did fantastic. How do you feel? Is there anything else that you wanted to see? Thank you. Thank you. Thank you. Thank you. Incredible.

[Dr. Rocio Salas Whelan]

Thank you for having me.

[Mel Robbins]

Come on out. Oh, my gosh, you guys. Wow. She killed it. Get over here. Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. 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.

[Dr. Rocio Salas Whelan]

Stitcher.

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[Dr. Rocio Salas Whelan]

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