GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters

Summary

The Tamsen Show: GLP-1s For Menopause Belly Fat – What the Science Says and Why It Matters

Released on May 28, 2025

Hosted by Emmy-winning journalist, filmmaker, and New York Times best-selling author Tamsen Fadal, The Tamsen Show delves deep into the intersection of health, hormones, and personal empowerment for women navigating midlife. In the episode titled "GLP-1s For Menopause Belly Fat: What the Science Says and Why It Matters," Tamsen engages in an insightful conversation with Dr. Rocio Salis Whalen, a triple board-certified endocrinologist and expert in obesity medicine. This episode unpacks the emerging role of GLP-1 medications in managing weight gain associated with menopause and beyond.

---

Understanding GLP-1s: The Basics

Tamsen opens the discussion by highlighting the unique challenges women face in midlife, particularly concerning weight loss plans that often ignore hormonal and psychological factors. She introduces GLP-1s (Glucagon-Like Peptide-1 receptors) as a promising solution, setting the stage for a comprehensive exploration of their benefits and limitations.

Dr. Rocio Salis Whalen explains:
"GLP1 is a hormone that we make in our gut, in our small intestine in response to food... current medications like Ozempic, Wegovy, and Mounjaro are synthetic versions designed to be long-acting." (05:17)

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The Evolution and Science of GLP-1s

Dr. Whalen provides a historical perspective on GLP-1 research, tracing its origins back to the 1980s at Harvard and the subsequent discovery in the venom of the Gila monster by Dr. John Eng in 1992. This breakthrough led to the development of Exenatide in 2005, marking the first FDA-approved GLP-1 for type 2 diabetes.

"Every cycle they just come better, safer," Dr. Whalen analogizes GLP-1s to the evolution of iPhones, emphasizing continuous improvements in efficacy and safety with each new formulation. (05:43)

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GLP-1s and Weight Loss: Beyond the Scale

While GLP-1s are often marketed for weight loss, Dr. Whalen emphasizes their multifaceted benefits. They enhance insulin production in a glucose-dependent manner, increase satiety, and suppress hunger hormones, leading to reduced food intake without causing hypoglycemia. Additionally, patients report feeling less inflammation, experiencing better sleep, and having reduced joint pain even before significant weight loss occurs.

"Patients start to feel better even before any significant weight loss starts to happen." (08:50)

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Integrating GLP-1s with Hormone Therapy

The conversation shifts to the synergistic potential of using GLP-1s alongside hormone replacement therapy (HRT) for menopausal women. Dr. Whalen notes that women on HRT often experience more effective weight loss when combined with GLP-1s.

"Women that are on hormone replacement therapy tend to lose more weight than the ones that are not when they're taking a GLP1." (19:31)

She further explains that combining these treatments can address both hormonal imbalances and weight management, offering a holistic approach to midlife health.

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Practical Considerations and Side Effects

Dr. Whalen addresses common concerns and misconceptions surrounding GLP-1s, including their classification as "vanity drugs." She clarifies that obesity and weight gain are multifactorial diseases influenced by genetics, hormones, environment, and lifestyle, debunking the notion that weight management is solely a matter of willpower.

Notable Quote:
"Obesity or weight gain, it's a disease and it's chronic and it's multifactorial." (23:48)

She outlines potential side effects such as nausea, vomiting, and diarrhea, particularly when consuming fatty or processed foods. Dr. Whalen stresses the importance of a balanced diet rich in lean proteins to prevent muscle loss, which can lead to complications like hair loss.

"Common side effects could be nausea... vomiting... diarrhea with certain fatty food or fried food." (30:39)

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Psychological and Social Impacts of Weight Loss

The episode delves into the psychological adjustments that accompany significant weight loss. Dr. Whalen shares that patients often experience anxiety about maintaining their new weight and grapple with changes in self-image and societal perceptions.

"Patients have extreme anxiety that they're going to regain their weight... They don't see themselves as that person yet." (28:18)

She also discusses the social benefits, such as improved interactions and increased compliments, which can bolster self-esteem and motivation to maintain a healthier lifestyle.

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Future Outlook: GLP-1s in Preventive Medicine

Looking ahead, Dr. Whalen is optimistic about the transformative potential of GLP-1s in medicine. She predicts a significant reduction in chronic diseases associated with obesity, such as type 2 diabetes and certain cancers, over the next few generations.

"We're going to change the way we practice medicine because GLP1s... allow us to do preventive medicine." (33:46)

Dr. Whalen envisions a future where the prevalence of obesity-related complications is minimized, leading to a healthier society overall.

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Access and Education

The episode underscores the importance of patient education in the effective use of GLP-1s. Dr. Whalen mentions her upcoming book, set to release on December 30th, which aims to demystify GLP-1s and provide comprehensive guidance for patients.

Dr. Whalen's Contact Information:

• Social Media: @DrSilasWhelan
• Website: New York Endocrinology
• Book Release: December 30th

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Conclusion

In this enlightening episode, Tamsen Fadal and Dr. Rocio Salis Whalen shed light on the promising role of GLP-1s in managing menopause-related weight gain and improving overall health in midlife women. By combining scientific insights with practical advice, the episode serves as a valuable resource for women seeking effective and personalized solutions during their health journeys.

Key Takeaways:

• GLP-1s offer a multifaceted approach to weight management by addressing hormonal, psychological, and physiological factors.
• Integrating GLP-1s with hormone therapy can enhance weight loss and alleviate menopausal symptoms.
• Comprehensive patient education and a balanced diet are crucial for maximizing the benefits of GLP-1s while minimizing side effects.
• The future of GLP-1s holds promise for preventive medicine and reducing the burden of chronic diseases associated with obesity.

For more detailed information, listeners are encouraged to pre-order Dr. Rocio Salis Whalen’s upcoming book and follow her on social media for the latest updates.

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Timestamps for Notable Quotes:

• 05:17 - Science of GLP-1s
• 05:43 - Evolution analogy (iPhones)
• 08:50 - Early benefits before weight loss
• 19:31 - Combining GLP-1s with hormone therapy
• 23:48 - Obesity as a multifactorial disease
• 30:39 - Side effects and dietary considerations
• 28:18 - Psychological impacts of weight loss
• 33:46 - Future outlook of GLP-1s in medicine

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Stay informed and empowered on your health journey by tuning into The Tamsen Show every Wednesday. Follow @thetamsenshow for updates and behind-the-scenes content.

Transcript

[Tamsen Fadal]

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[Tamsen Fadal]

If you listen to our episode with Dr. Rocio Salis Whalen on belly fat in midlife, you'll know why. Part two of this conversation is going to be a game changer.

[Dr. Rocio Salis Whalen]

GLP1s are going to allow us to go to the next level.

[Tamsen Fadal]

GLP1's Ozempic, Wegobi Manjaro. We're talking about weight loss meds that have been marketed as miracle solutions but then also criticized as vanity drugs. But what's actually the truth?

[Dr. Rocio Salis Whalen]

I like to describe them like the iPhone. Different types of iPhones all do the same, but the newer iPhones they're better. It's the same with the GLP1s.

[Tamsen Fadal]

Dr. Salis Whalen is a triple board certified endocrinologist, an expert in obesity medicine, and the person I went to when I was struggling.

[Dr. Rocio Salis Whalen]

It's a good time right now to be in midlife because we're having all these options.

[Tamsen Fadal]

In this part of the conversation, we're going to get into the reality of what these medicines can do and what they can't do for women in midlife.

[Dr. Rocio Salis Whalen]

We're gonna live longer years in a healthier Society because of this medication.

[Tamsen Fadal]

So let's get into it. So I'm excited to have you back in this conversation. I know this is gonna be a more in depth conversation about GLP1s. We talked about them when you were here for part one, and then we paused and said, hey, wait a minute. We have a lot to dig into for GLP1. So you are a leading voice on GLP1s and obesity medicine. So I want to start with understanding it all and understanding what we know right now. But you wrote a book on it, so what made you write a book on it?

[Dr. Rocio Salis Whalen]

Because there's a lot of misinformation.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

I also wrote a book because what I've been able to do since I have my own practice is really redefine what the treatment on a GLP one looks like to get the adequate results. And that's body recomposition.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

I think we're going to start moving away from weight loss and we're going to be renaming it, renaming it to body recomposition because that's what we want to do.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

We want you to have more muscle than body fat. So many patients come with the opposite, which is less muscle mass and more body fat. So what I've been able to do through the years, I. It's been very successful for my patients. And I wanted to give it to the people that don't have access to me or that have access to specialized physicians on GLP1 so they can really understand it.

[Tamsen Fadal]

I mean, it really is almost what we're doing with hormone therapy as well.

[Dr. Rocio Salis Whalen]

Right.

[Tamsen Fadal]

Is like trying to understand it and trying to give people the knowledge about this.

[Dr. Rocio Salis Whalen]

Yeah, exactly. The right information and the right guidance, because otherwise it can have opposite effects of what we want.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

So many patients can up with sarcopenic obesity, also known as skinny fat. And we really didn't improve any of your metabolic numbers.

[Unknown Speaker]

Right? Yeah.

[Dr. Rocio Salis Whalen]

You lost 30, 40 pounds, but you lost 10 pounds of muscle. So that is not healthy either. So really to give. What I say in this book is at this time, we don't have enough educated practitioners on it. But with this book, I want to have enough patients educated on this matter right now.

[Tamsen Fadal]

It's so, so important. All right, so to educate patients and what they're going to get out of the book, which I am thrilled about, because I do think there's a lot of confusion overall. What is a GLP1?

[Dr. Rocio Salis Whalen]

So GLP1 is a hormone that we make in our gut, in our small intestine in response to food we produce this hormone in our gut. Now, our own GLP1, it works great, but the problem is that it's broken down within two to four minutes from where it's released a GLP1 analog. What we know currently as medications of osempe, Wegobi, mounjaro. They're synthetic version of our own hormone that has been designed to be long term. So that's why we can use it once a week or once a day. It's not broken down by the enzyme that breaks down our own GLP1.

[Tamsen Fadal]

So I didn't even. I didn't even realize. I don't think I didn't understand that. So we're seeing them everywhere right now. There's all different types, right? All different measurements of them, all different ways to take them, I guess. Maybe not different way. Well, I guess so. I guess there's drops and there's shots and there's all sorts of things.

[Dr. Rocio Salis Whalen]

I like to describe them like the iPhone.

[Unknown Speaker]

Right?

[Tamsen Fadal]

Okay.

[Dr. Rocio Salis Whalen]

We have different types of iPhones that they all do the same, but the newer iPhones, they're better improve.

[Tamsen Fadal]

Okay, I like that description.

[Dr. Rocio Salis Whalen]

More has different apps, more things that you can do. So it's the same with the GLP1s, right? We used to have the iPhone x, which could be the initial glp one that was twice a day, every day. And then the iPhone 12 came and we had the GLP one that is once a day. Then the iPhone 14 came out, and that's osempeg that you can use it once a week. And now we have the iPhone 16, which is terzepatide with govi, I'm sorry, sebun and mounjaro. And then next year is coming the iPhone 17, which would be retatrutri, the new GLP1.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

So every cycle they just come better, safer.

[Tamsen Fadal]

Okay, so what do they actually do in the body?

[Dr. Rocio Salis Whalen]

So we have receptors for this hormone all over our body, but more importantly, in our pancreas, it has receptors. So every time you eat something that increases your glucose in your blood, it helps the pancreas produce more insulin.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salis Whalen]

But this response is glucose dependent, meaning your glucose level has to be elevated above normal to have an effect in your pancreas. But if you don't have diabetes or your glucose is constantly normal, it's not gonna touch your pancreas. So they don't cause hypoglycemia. In our gut, we have receptors for this hormone. And what they do is they help increase satiety hormones. So the hormones that Makes you feel fuller and then in between meals, it suppresses your hunger hormones. So that's why patients eat smaller portions of food through longer periods of the day. In our brain, in the amygdala, in the hedonistic eating area of our brain, we also have receptors for them. And what they do is they block their reward response either from food or alcohol. So if you reach for food when you're anxious or bored or depression that you are anticipating to feel a relief or a release from food or alcohol, it blocks it. Right. If you're hungry, you reach for food, that's not a reward response, that's a fuel, that's an energy response.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

But if you're eating, even when you're not, when you're already full for other sort of response, that's where it blocks it out. So at the beginning when you start taking this medication, the behavior may still be there. So you go for it, you reach for it, but you don't have that reward response anymore.

[Tamsen Fadal]

So like what's the point exactly, you stop reaching.

[Dr. Rocio Salis Whalen]

So you see it and you're like, well it's not giving you back that. So your behavior changes and you learn.

[Tamsen Fadal]

To do it without feeling like I'm deprived or I want to sneak in there and go get something again.

[Dr. Rocio Salis Whalen]

You still eat and when you eat, you enjoy your food, but then you get satisfied with a smaller portion and then it's out of your mind.

[Tamsen Fadal]

Is it just for weight loss or is there more to it? Right now that we're learning about for.

[Dr. Rocio Salis Whalen]

The first time we're having masses of a population use a drug, right. So we're going to start seeing more and more feedback from people coming back with them medication. But we are seeing that also has an anti inflammatory effect, Right. So I would say patients start to feel better even before any significant weight loss starts to happen.

[Tamsen Fadal]

Feel. Feel better.

[Dr. Rocio Salis Whalen]

Just they say they feel. Exactly. They feel less inflammation, their joints hurt less, they're sleeping better.

[Tamsen Fadal]

Wow.

[Dr. Rocio Salis Whalen]

And I really think it's one, it has some anti inflammatory property, direct anti inflammatory property. Also by decreasing your visceral fat, you're decreasing inflammation. But what happens really quickly is that our consumption of food decreases dramatically.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

So if we're consuming processed food, ultra processed food, excess of sugar or excess of salt, all of that is pro inflammatory substances. Of course, if you start decreasing by half that, you're immediately going to feel better.

[Tamsen Fadal]

Incredible. Well, you know, cause I know there's question about it, I know there's been a lot of study about it leading up to this. Can we go back to what GLP1s were originally, you know, originally used for? Because for years and years. Right? 20 plus years.

[Dr. Rocio Salis Whalen]

It's a great story that I love telling. So the first GLP1 isolated in human was in Harvard by researchers in the 1980s. But again, as I mentioned, our own GLP1 breaks down within two to four minutes, so nothing could be done with it. In 1992, about 10 years later, an endocrinologist and researcher at the BA Hospital, the Veteran Hospital in the Bronx, Dr. John Eng, isolated the first GLP1 outside a human body. And it was in a lizard, the Gila monster. What he saw that this lizard did in the benom when he attacked a prey, it gave it pancreatitis. So him being a researcher in diabetes and endocrinology, he wanted to know what in the venom can affect the pancreas of the prey. And it was a very similar molecule to our own GLP1. But the difference too is that that GLP1 couldn't be broken down by the same enzyme that broke down the human one. So it could be a long acting GLP1. And that's where the first GLP1, Exenatin, was approved in 2005, about nine years later, and it was approved for type 2 diabetes. And another interesting part of the story is that when he discovered this, he took it to the Veterans Hospital Manzanai at the Bronx to patent it. The VA said we're not interested. So he had to mortgage his house to patent him himself. He took it to an Endocrine Society conference in the hopes that a pharmaceutical will be interested. And Amlin, a pharmaceutical, saw it, came to him and purchased the patent. So can you imagine? That's fascinating. Can you imagine Mount Sinai, the VA hospital, having turned down that patent, that didn't believe on it. And that is revolutionizing our life and the way that we're going to live. We're going to live longer years in a healthier society because of this medication.

[Tamsen Fadal]

That is fascinating. Your eyes lit up when you were telling the story. Because it really is.

[Dr. Rocio Salis Whalen]

It's just so fascinating that it is fascinating. He saw it, he believed on it and they didn't believe on it. And he. And he never wanted the fame. Yeah, he never wanted the fame. So. And to the, to the point that we, we don't hear about him.

[Tamsen Fadal]

No, not at all. But thanks to you we do.

[Dr. Rocio Salis Whalen]

And yeah, because. And I met him when I was doing my residency.

[Tamsen Fadal]

Oh, you did? I was gonn.

[Dr. Rocio Salis Whalen]

If you knew him, he was presenting about this medication. And I was so impressed that there was a new drug that he founded in that it helped patients with diabetes. Because at that point, all the medications that we have for diabetes cause waking on the patient. We never had a drug that would also lower their glucose and make them lose weight. So we had to almost pick, right. With the first time, patients were also losing weight and their glucose was improved. So it was mind blowing, right? So in 2005, it was approved for type 2 diabetes. And then in 2010 came the once a day version, which was Victoza.

[Tamsen Fadal]

And what was that for in 2010?

[Dr. Rocio Salis Whalen]

Also type 2 diabetes. And it was not until 2012 that we got the first FDA approval for weight loss independent of diabetes.

[Tamsen Fadal]

So, independent of diabetes independent. What was that product?

[Dr. Rocio Salis Whalen]

Saxenda. It was the same as Pictosa. Liraglutide is the name of the drug and it was by Novo Nordisk. Basically, they're the same drug. It's easier to get it approved back then for type 2 diabetes and for obesity. So they will go for the type 2 diabetes approval and then show studies that it also helps with weight loss, rename it, rebrand it, and then get it approved for weight loss. What matters really is for insurance, right? If you have type 2 diabetes, they're going to approve the brand name for type 2 diabetes. But if you don't have diabetes and have obesity or need it for weight loss, they're not going to approve it with the diabetes name. They're going to approve it independent of diabetes, which a different name, which is. But if, let's say you're paying out of pocket.

[Tamsen Fadal]

Sure.

[Dr. Rocio Salis Whalen]

Doesn't matter which one you get.

[Tamsen Fadal]

This is insurance purposes, right?

[Dr. Rocio Salis Whalen]

This is insurance purposes.

[Tamsen Fadal]

What percentage of the country would you say are on GLP1s now?

[Dr. Rocio Salis Whalen]

Oh, my goodness. I think it's not enough.

[Tamsen Fadal]

Okay. I just didn't know. I didn't know. I didn't know how many. I just. I wasn't sure. I see more and more commercials all the time, but I know it's coming in all different forms. There's microdosing too, Is that correct? What is. What is the microdosing?

[Dr. Rocio Salis Whalen]

So microdosing is when you use amount, that is not a therapeutic dose. Right. So when the studies are done, they find the doses where we start seeing results either in glucose control or in weight loss, and then they move up to see more weight loss, more glucose control. But the first dose is at the minimum, where we start seeing some sort of effect. Microdosing is a dose lower than the first Therapeutic dose.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

Really microdosing. I see its use in the maintenance part, once a patient has reached their goal and weight, and then we start backing off on the doses. And some patients can benefit from a lower dose than the initial dose for long term maintenance. But to really get the results that we're looking, you really need the therapeutic doses.

[Tamsen Fadal]

Okay. Because I feel like some of these words are thrown around and they can be confusing.

[Dr. Rocio Salis Whalen]

Well, many people are saying, I don't need to lose weight. Yeah. I'm going to microdose to get the anti inflammatory effect. Right. Or to get other positive effects.

[Tamsen Fadal]

Is that a thing?

[Dr. Rocio Salis Whalen]

Well, if you don't. When somebody tells me I don't need to lose weight, I need to see your body composition number one.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

If you have high muscle mass, low visceral fat, then that tells me that you have a very good diet, that you're eating lean animal protein, that you're strength training, that you're not consuming so much pro inflammatory food. Sugar. Right. Starches, grains, alcohol, whole.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salis Whalen]

Then I'm gonna say you already getting all the benefits that you can potentially get from the drug.

[Tamsen Fadal]

Okay.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

But if somebody says I don't need to lose weight, but then you put them in a body composition machine and maybe their weight seem normal because they have very low muscle mass and high visceral fat, then you do need to lose weight, you need to lose visceral fat.

[Tamsen Fadal]

Okay. If you don't feel like you're the kind of person that wants to inject themselves, you're afraid to do that. There are other ways to take GLP ones.

[Dr. Rocio Salis Whalen]

So we have oral GLP one, we have oral Semaglutide, which is the same as Ozempic. It's called Rivelsis and that was approved in 2019. All right, now the current indication that we have for the oral drug is type 2 diabetes.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

But many times we use them off label when they came Approved for type 2 diabetes. Off label for weight loss. While we got the FDA approval, the problem with the oral medication is that at the doses that we have currently, we don't see significant weight loss. We see good glucose control, but we don't see weight loss. And the side effects are worse than the injectable for many patients.

[Tamsen Fadal]

Oh, wow. So what are the side effects?

[Dr. Rocio Salis Whalen]

So more nausea. Right. More vomiting. So to go up at higher doses where we could see potentially weight loss, patients need to really tolerate. Now, this past week recently, the FDA accepted the application from Novo Nordisk for the oral version at much higher doses, just to Give you an example. Right now, the oral dose, max dose is 14 milligrams. For type 2 diabetes, they come in with a 25 milligram and a 50 milligram.

[Tamsen Fadal]

Wow.

[Dr. Rocio Salis Whalen]

So there we start seeing more, more comparable weight loss than the injectable. But we're going to have to wait and see if it's going to be tolerable to patients.

[Tamsen Fadal]

Is there a right and wrong way to take them? Like, is there right foods to eat if you're taking GLP1s or I mean, if we're, you know, I mean, obviously regular, you know, if you're eating something greasy or eating something fat, is that a problem? And you have to, I don't know, do you have to have different habits.

[Dr. Rocio Salis Whalen]

If you're taking, I mean, this is not a, an easy way out. This is not, oh, I'm taking the drug, I can do whatever I want. Because then you're not going to the right results and it's going to be hard to tolerate. So fatty food, processed food, fried food can give you diarrhea in any of the versions that we have. So any of the iPhones that we have in GLP1s, you can have diarrhea. Now, with the older versions, we have more side effects. So with Semaglutide, which is Ozempic and WeGovy, we see more nausea, more vomiting. And with the newer versions, as I explained, they're safer, they're less side effects, so we see much less of that. But you do have to modify what you're eating, otherwise what you're going to lose is muscle.

[Unknown Speaker]

Right.

[Tamsen Fadal]

Because you're just losing weight at this point.

[Dr. Rocio Salis Whalen]

Exactly. Because you're decreasing your caloric intake and you're just going to be losing fat, water and muscle. So you're going to become dehydrated and sarcopenic.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

So that's not a healthy way either. So you do need to increase your protein intake, lean animal protein intake, start doing some whey protein shakes for supplementing, not to replace your meals, but to supplement, to not lose muscle and to get the right results.

[Tamsen Fadal]

You know, there's a lot of criticism about them vanity drugs. And obviously there's people that might not need them that are taking them and say, like, this is the fast and easy way to do it. What do you say to that? And are there other side effects to be aware of?

[Dr. Rocio Salis Whalen]

So that's the problem with society that we have right now is that we see weight loss as something cosmetic.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

As to fit in a dress, as for something social or we associate thinness with health.

[Unknown Speaker]

Right, Right.

[Dr. Rocio Salis Whalen]

So it's our own bias when we say somebody's using it for vanity or it's just a vanity drug is because you yourself are seeing weight loss are some as something superficial. But it goes way beyond that.

[Tamsen Fadal]

Let's go back to GLP1s and hormone therapy. Is that something that we're seeing more and more of now with women who are coming in with perimenopause or menopause symptoms of taking both those things? Is there something good about doing that together?

[Dr. Rocio Salis Whalen]

Yeah, definitely. That's something that we're seeing more. And there's studies that show that women that are on hormone replacement therapy tend to lose more weight than that the ones that are not when they taking a GLP one. So this is to say that they're great options that we have now in midlife. I think I keep saying that it's a good time right now to be in midlife because we're having all these options. The fact that you're gonna gain weight or not sleep or have all those symptoms now we have options to not have to wing it and just like take it.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

We can use GLP1s for weight loss. We can use hormone replacement therapy to help us sleep to just overall wellbe. So I think it's great that women know that there are options for them to use. And it makes me even happier when they actually are using them.

[Tamsen Fadal]

You can take GLP1s if your hormones are out of whack?

[Dr. Rocio Salis Whalen]

Yes, 100%. It's not a contraindication.

[Tamsen Fadal]

Is there a philosophy of whether hormones should come first? So you regulate your hormones or GLP1s or does it matter which way you do it? Do you do them all together? I don't know.

[Dr. Rocio Salis Whalen]

It does. And it's very per case basis. Right. So what I look when I have a woman in midlife and is having premenopausal symptoms and also coming for weight loss, I see what is more impending at that period of time for the woman. Right. If they're not sleeping. Definitely. That's something that I want to improve. So hormone replacement therapy may start first.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

If there's some confusion of the symptoms that could be more the obesity or the weight gain causing some of the symptoms that can be attributed to perimenopause, then I go with weight loss first. And then I always give the options to the patients. And sometimes we start both, ideally, like to start one at a time just to see what's the response, what did that improve and what's left. And then we can bring the second drug and the second visit.

[Tamsen Fadal]

Okay. Yeah, I was wondering about that because I guess it's really the symptoms of which symptom is really gonna be the.

[Dr. Rocio Salis Whalen]

The more pressing symptoms.

[Tamsen Fadal]

Yeah, the more pressing one. Right. If it's brain fog, it might not be that. The GLP one.

[Dr. Rocio Salis Whalen]

Exactly.

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[Dr. Rocio Salis Whalen]

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[Dr. Rocio Salis Whalen]

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[Dr. Rocio Salis Whalen]

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[Tamsen Fadal]

1-800-Contacts. We talk about belly fat all the time in midlife. And we've talked about it. We talked about it with you the last time. Can it be lost without GLP1s or hormone therapy?

[Dr. Rocio Salis Whalen]

It depends, right? So it depends the level of body fat that you have. It depends on the history of you and your weight. So if I have somebody who struggled with weight since childhood, right. Battling obesity through their life, then most likely they can benefit from a GLP1 and they will be hard to lose it on their own because I'm sure they've tried all their life to do it and it didn't work or it's not working. But if it's a different case, if somebody after pregnancy, they hit midlife, they never struggle with weight, there's no obesity in their family, then they may be able to lose it without the medication. So it depends a lot on every individual history of their weight.

[Tamsen Fadal]

Do you find yourself having to tell patients, like, you know, you're not weak because you couldn't do it without GLP1s or with hormone therapy. Cause I feel like that there is that real bias about that, like, oh, you didn't work out hard enough or you didn't eat. You know, your diet's not perfect. And maybe that's. Why do you feel like you have to almost convince patients that, you know, hey, it's not it's not you. Because I feel like I hear myself saying that a lot.

[Dr. Rocio Salis Whalen]

I've had grown men cry in my office when I relieve them of the guilt, when I explain to them what really is causing their weight or their waking or if they have obesity, right? It's multifactorial. So we're moving away from a problem of willpower, of the patient having all the control in their weight. We understand now that obesity or weight gain, it's a disease and it's chronic and it's multifactorial. So lifestyle has a part of it, of course, sedentarism or, or the type of food that you eat. But that's not it. That's not all of it. Then we have genetic factors, hereditary factors, right? So I always go through the family tree of my patient. The mother, father, their grandparents, their aunts. Is there anywhere that there's obesity? And very often there is, right? Hormonal changes if somebody's in perimenopause mid age or have PCOS or thyroid disorder. So hormonal changes can also promote weight gain. And then we have aging. Nothing that we can do about that. It slows down our metabolism, more tendency of waking. And then the fifth one is environmental factors, all of them putting in a broad spectrum, right? We have many other things, but in environmental factors we have the area that we live. We have industrialization, right? Food industry. We cannot talk about obesity or waking without talking about the food industry. Sedentarism, if you're working from home, if you live in an area where there's no walking, that you always have to drive. So all of, of those things, even pesticides, plastics that we're exposed to, right? All of that can promote waking and obesity. So when you tell somebody that it's only one fifth of the equation, what they're doing, it gives them a sense of relief.

[Tamsen Fadal]

I'm sure it does. I'm sure you've seen all sorts of emotions, all different ways, and people coming in there with a different type of confidence afterwards. If there's weight loss and then that makes them wanna work out or. I mean, I'm sure there's just a cycle with all that, right?

[Dr. Rocio Salis Whalen]

And we tend to believe that motivation to exerc eating healthier happens before the weight loss. But for many patients, it happens during the weight loss, right? Either for physical restrictions, pain, for them to work out confidence, they feel embarrassed, they feel shame, or they associate exercise with weight loss, right? But the moment that you separate those two things and patients start to lose weight without the pressure of if you don't exercise, you're not gonna lose weight. If you don't eat better, you're not gonna lose weight. Things change, right? And they start exercising on their own, they start eating healthier on their own. So it's very easy for us to say, oh, the motivation should happen before. But actually what I see is the motivation happens after they start losing weight.

[Tamsen Fadal]

I think that makes a ton of sense. I think it makes a ton of sense. And maybe they're sleeping better now and maybe they're. Can you come off of GLP1s without all the weight piling back on?

[Dr. Rocio Salis Whalen]

You can. I mean, it's not an implanted type of medication, right? But it depends on your own personal story with your weight. Again, if you're struggling since childhood and you have a strong family predisposition of obesity, most likely you're gonna need the medication long term. If it's something that the weight can happen recently or more specific to a situation, then maybe, but also will depend if now you're in midlife, then you have other things that are going to make it hard for you to maintain the weight. So it also depends on that. But I always wanna put it in a positive than in a negative. The fact that you can use them long term, because for the first time ever, we have something that is going to help you maintain the weight loss. Because anything else can take you that, right? Any crazy restrictive diet, it can make you lose 30 pounds, but you cannot stay there because it's not sustainable, right? But with the medication, you can stay there, right? So for the first time, patients are reaching weight goals that they thought it was not possible and they're staying there. And many patients, and this is something interesting that I'm finding and that I write in my book, is that the after they lose the weight, what are the implications when somebody loses weight? Because we can think, oh, when somebody loses 50 pounds, they're going to be so happy. But there's so many changes, psychological changes, they don't see themselves as that person yet, right?

[Tamsen Fadal]

Y.

[Dr. Rocio Salis Whalen]

Many patients have extreme anxiety that they're going to regain their weight, that they feel so happy and so safe in this place that is something sporadic that they're going to sudden go back to where they were.

[Tamsen Fadal]

Like it's going to be taken away from them.

[Dr. Rocio Salis Whalen]

It's going to be taken away from them. There's a lot of anxiety on that. Patients not feeling in that new body because they lived in a different body for most of their life. So some patients take time to adapt the psychological part takes longer than the physical change. And then we go to social changes. Right. How people see you differently now and how you interpret that.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

I had a patient just today tell me now that I'm leaning, people are nicer to me.

[Tamsen Fadal]

Wow.

[Dr. Rocio Salis Whalen]

So all of those changes, adjustments that we're just starting to see because for the first time, we're having masses of people lose weight and reach goal weight. Goals that were never possible before.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

So what we're seeing in the post is something that also needs attention. Right. It's not just we got you there, you should be happy. No, there's so many other implications. I would have to say most of them are happy. And patients would choose to go through that now than to go back to before.

[Unknown Speaker]

Right?

[Tamsen Fadal]

100%. But you're right about that. I never thought about all those. It's a different person in a lot of ways. Depending on what the weight loss was. We're not talking about five or ten pounds.

[Dr. Rocio Salis Whalen]

And then we're also talking about physical adjustments, the extra excess skin. Right. So many patients of my patients have. Have to go and do skin removal surgery. Right. For cosmetic reasons, for confidence reasons, and also because excess fold skins can promote infection. Right. So also it can be detrimental to health and you're carrying excess weight that you know should not be there anymore.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

So there's a lot of changes. Again, I don't want to scare patients from this.

[Tamsen Fadal]

No, not at all.

[Dr. Rocio Salis Whalen]

Most of them, all of them are positive. But there will be adjustments that with the right doctor, will help you also go through them. You shouldn't feel like you don't know what to do at that point and you're by yourself.

[Tamsen Fadal]

Right. Are there other side effects from them? Is hair loss a side effect or. There's some different side effects that people should be aware of.

[Dr. Rocio Salis Whalen]

So the common side effects could be nausea. Right. And if you overeat your fullness, like if somebody who's used to binging and don't know how to stuff themselves at the beginning, the behavior is still there. So it takes time for them to adjust. There can be vomiting if you overeat your fullness. We talk also about diarrhea with certain fatty food or fried food. Those are the common and not too bad side effects. And then we go to the serious side effects, which could be pancreatitis. So that's an inflammation of the pancreas. I've never seen this in somebody who has no diabetes because it doesn't, in theory touch the pancreas. If you don't have diabetes. Right.

[Tamsen Fadal]

Okay.

[Dr. Rocio Salis Whalen]

And then we have muscle loss. But this is not a direct effect of the drug, the GLP1 analog. The hormone is not going and attacking your muscle and destroying it.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

It's the decrease in caloric intake. And then we decrease our protein intake. When we go in any caloric restriction, the first thing we cut is protein because it's what fills us the most. And we want to have room to have what we want to eat because we're eating less. That's the psychological part of it. So we're going to have muscle loss because of the decrease in protein. If you're having muscle loss because you're not eating enough protein, you're going to have hair loss because we need protein to make collagen and elastin.

[Tamsen Fadal]

Okay.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

So if you're losing hair, you're losing muscle. And if you're losing muscle, then your hair loss is from the same reason we need to increase your protein intake. And that usually solves the problem. And that's why we try to avoid rapid weight loss. Rapid weight loss means muscle loss.

[Tamsen Fadal]

So how much are you usually losing? Depending on what is it the weeks or the months or what do you go by?

[Dr. Rocio Salis Whalen]

So in a week you can lose half a pound to a pound. That is healthy. And that could be purely body fat. If you're losing more than that per week, you're also losing more muscle.

[Tamsen Fadal]

Okay. Oh, more than a pound.

[Dr. Rocio Salis Whalen]

More than a pound per week, you're losing muscle.

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[Tamsen Fadal]

What do you think the future looks like for GLP1s? I know when the when the book comes out People are going to really be educated on it, be able to take that book into a doctor and say, here's what I know, which is my hope for you, because it sounds like that's where that's going.

[Dr. Rocio Salis Whalen]

I'm gonna give my predictions because you heard it first for me. I think we're going to change the way we practice medicine because GLP1s, I think we've built medical specialties on the complications of obesity because that's what we had at that time to treat. We had the medications to treat type 2 diabetes, hypertension, high cholesterol, osteoarthritis. We didn't have anything to treat the main problem, which was the excess in body fat.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

So now, now we can do preventive medicine. We're going to prevent all these chronic complications. So I predict that we're going to have less type 2 diabetes, and this is going to be in the future generations. It's going to take two to three generations for us to see this, but we're going to have less chronic disease. We're going to live longer. We're going to have less incidence of certain types of cancer that are increased risk from obesity, breast cancer, colon cancer, prostate, stomach. Our military is going to be healthier. Three out of five in the military are overweight or have obesity.

[Tamsen Fadal]

Wow, I didn't know.

[Dr. Rocio Salis Whalen]

That sounds big. But our health is going to be. It can be our Achilles tendon or it can be our superpower.

[Tamsen Fadal]

Right, Right, right.

[Dr. Rocio Salis Whalen]

And I feel GLP1s are going to allow us to go to the next level.

[Unknown Speaker]

Right.

[Dr. Rocio Salis Whalen]

I'm seeing more and more people want to weight train, concentrate on muscle. Muscle wants to feel strong.

[Unknown Speaker]

Why?

[Dr. Rocio Salis Whalen]

Because now they can. Now that they relieve the fat loss, that we know that something works for fat loss, now they can concentrate on feeling strong and building muscle. Right. So we are going to be able to get to the next level as a society when we decrease obesity in our, in our, in our country, in.

[Tamsen Fadal]

Our world, you have to be seeing such change. Come in and out of your office now, really on all different levels. Where can people find.

[Dr. Rocio Salis Whalen]

My social media is Dr. Silas Whelan. My webpage is New York Endocrinology. My office is here in New York. But I do telemedicine and that's where they can find me. And then my book is coming December 30th. And again, it's going to be pretty much everything I do in my office translated in a book.

[Tamsen Fadal]

So people cannot get to you. You're gonna get to them somehow.

[Dr. Rocio Salis Whalen]

Exactly.

[Tamsen Fadal]

Thank you so much for the time. I really, really appreciate it.

[Dr. Rocio Salis Whalen]

Thank you.

[Tamsen Fadal]

I hope this episode cleared some things up for you or made you think differently. You can pre order Dr. Salas Whelan's new book soon and it goes even deeper into everything we talked about today. If you haven't already, make sure and follow the show on socials at the Tamsen show and please leave a review. We are figuring this out together, one conversation at a time and I'm so glad you're here for it. I'll see you next week. The Tamson show is an original production by Authentic Wave executive producers Scott Weinberger, Kevin Bennett and Rebecca Grierson. Brand director Johanna Ofznick. Our line producer is Sabrina Sarre. Editing by Zach Smith and Marquis Harris the views and opinions and information shared by guests on the Tamsen show are their own and do not necessarily reflect the views of Tamsen Fadal or the production team. This podcast is for informational purposes only and is not a substitute for professional medical, legal or financial advice.

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