unPAUSED with Dr. Mary Claire Haver

GLP-1s and Midlife Metabolism: Dr. Rocio Salas-Whalen Breaks Down the Science of Weight Loss and Menopause (Part 1)

Date: November 11, 2025
Guest: Dr. Rocio Salas-Whalen
Host: Dr. Mary Claire Haver

Episode Overview

This episode explores the nuanced science behind GLP-1 medications (like Ozempic and Mounjaro), their role in addressing weight, metabolic health, and menopause—especially for women in midlife. Dr. Mary Claire Haver and Dr. Rocio Salas-Whalen, a triple board-certified internist, endocrinologist, and obesity medicine specialist and author of the upcoming book Weightless, challenge the stigma around obesity and the simplistic narratives about weight loss, willpower, and midlife health. The conversation emphasizes evidence, compassion, the realities of metabolic shifts in menopause, and the real-world potential and limitations of GLP-1 therapies.

Key Discussion Points & Insights

Reframing Obesity and Weight Loss

• Obesity as Disease, Not Failure

  • Obesity is not simply a result of willpower or caloric imbalance. The science now recognizes it as a complex, biologically driven, chronic disease involving hormones, genetics, brain, gut, and environment. Traditional clinical advice that fixated solely on diet and exercise was incomplete and often unfairly shamed patients ([11:44], [13:42]).
  • Quote:

    "There was a visual shift. I watched the tension in his shoulders ease as this emotional burden was lifted... For the first time, he heard that he hadn't failed. He felt the validation that what he was up against wasn't a personal flaw, but a medical condition."
    — Dr. Salas-Whalen [10:49]

• Cultural and Medical Stigma

  • Both doctors share experiences of patients shamed and disheartened by assumptions—including by other clinicians—that weight regain or difficulty losing weight is due solely to lack of effort.

• Transgenerational and Environmental Factors

  • Obesity can be driven by genes, early-life environment, generational trauma, food industry factors, and modern sedentary lifestyles. Current patients often inherit risk compounded by societal and environmental changes ([52:56], [54:10]).

The Role of GLP-1 Medications

• Mechanism and Evolution

  • GLP-1s are injectable drugs technically known as "glucagon-like peptide 1 receptor agonists," initially developed for type 2 diabetes but now central to obesity treatment ([01:47]).
  • They work by mimicking a gut hormone that signals fullness, slows stomach emptying, and enhances blood sugar metabolism ([01:47]).

• Why GLP-1s are a Game Changer for Midlife Women

  • Midlife metabolic shifts—particularly estrogen decline in menopause—drive fat to the abdomen (visceral fat), increase insulin resistance, and make weight loss via lifestyle alone unusually hard. GLP-1s directly target these mechanisms ([19:52], [27:32]).
  • Quote:

    "In midlife, their hormones are putting them against their own success... The drop of estrogen can impact the body composition of a woman. We have more tendency of storing fat in areas... centrally, intra-abdominally."
    — Dr. Salas-Whalen [18:35]

• Moving Past BMI

  • Health risks should be assessed by body composition (visceral fat, muscle mass, body fat percentage), not the outdated BMI metric ([25:03]).
  • Quote:

    "GLP-1 medications are sophisticated drugs. For sophisticated drugs, we should have sophisticated ways of diagnosing somebody with obesity... Now we know what matters in somebody's health: longevity, quality of life, independence, movement, decrease your risk of mortality."
    — Dr. Salas-Whalen [25:15]

• The GPS Prescription

  • Dr. Salas-Whalen’s “GPS” formula for GLP-1 patients:
    • G: GLP-1 medication
    • P: Protein in the diet
    • S: Strength training
  • These should be seen as equally essential for successful, sustainable weight loss without excessive muscle loss ([31:04]).
  • Quote:

    "One third of their treatment will be strength training, another third protein in their diet, and the other third will be a GLP-1... The other two are as important as the GLP-1."
    — Dr. Salas-Whalen [31:04]

Challenges, Caveats & Nuance

• Muscle Loss Warnings

  • Any weight loss—especially when rapid—can result in loss of muscle mass, which is harmful to metabolism and overall health. GLP-1 therapy without sufficient protein and strength training can make this worse ([29:23], [32:02]).
  • Acceptable muscle loss during weight loss is less than 10%; more is potentially dangerous ([33:25]).

• Long-Term Use and Regain

  • Obesity is chronic; most patients will need long-term, possibly lifelong, medical therapy to prevent weight regain, just as with other chronic conditions. Weight regain after stopping GLP-1s is common ([34:19]).
  • Quote:

    "Obesity is a chronic disease... any diet, yeah, you will lose it, but to stay there is what becomes impossible. But now, using a drug with correct supervision, it can be used long term, it is safe... and it's designed to be used long term."
    — Dr. Salas-Whalen [35:26]

• Who Should Get GLP-1s?

  • Medications are best for those with high body fat, visceral fat, or those fighting biological and metabolic headwinds (not just for cosmetic "quick fixes"). Assessment must be individualized ([37:07], [40:12]).
  • Quote:

    "We're treating numbers. We are not treating the patient. And we have to meet patients where they are."
    — Dr. Salas-Whalen [40:12]

• Myth-Busting Microdosing

  • Microdosing GLP-1s (very small doses for minor benefits or wellness, not weight loss) is not generally recommended or supported by strong evidence ([46:46]).

• Side Effects: Truth vs Hype

  • Most frequent side effects are gastrointestinal: nausea (especially with semaglutide), diarrhea, and, rarely, bowel obstruction. The majority are manageable with appropriate guidance ([61:48], [65:05]).
  • Rare complications (thyroid cancer, pancreatitis) have not been seen by Dr. Salas-Whalen in her years of practice, though they are mentioned in some case reports ([64:36]).
  • Quote:

    "Whenever a drug is FDA approved or whenever I prescribe a drug, it's because I know the benefits outweigh the risks... in the right hands, we're gonna have very minimal side effects."
    — Dr. Salas-Whalen [01:03], [61:59]

• Proper Supervision is Essential

  • GLP-1s should be prescribed by clinicians trained in obesity medicine, with regular monitoring of body composition and patient education. Dr. Salas-Whalen emphasizes the risk of harm if used irresponsibly, such as losing too much muscle or not being tailored to actual patient needs ([58:05]).

Notable & Memorable Moments

• The Emotional Weight Lifted:
  Dr. Salas-Whalen describes seeing patients realize for the first time that their struggle with weight is not their fault—a deeply validating experience for many who have internalized decades of blame ([10:49], [11:44]).

• Redefining Success:
  Both doctors advocate for moving the focus from numbers on the scale or BMI to health, function, and self-acceptance—a critical mindshift for patients feeling “failed” by traditional approaches ([41:30]).

• Breaking Family Patterns:
  The concept that treating obesity now can "break the cycle" of transgenerational obesity—a positive, hopeful message for families ([56:15]).

• Re-education for Patients and Providers:
  The need for doctors to re-educate themselves and then their patients about body composition, metabolism, and sustainable change ([31:50], [42:01]).

Timestamps for Key Segments

| Timestamp | Topic/Quote | |------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------| | 07:11 | Dr. Salas-Whalen’s background coming from Mexico, medical training, and triple board certification | | 09:20 | Why the book is titled "Weightless"—the emotional as well as physical burden of obesity | | 13:42 | The failure of the "willpower" narrative and the shift in understanding obesity | | 14:48 | Obesity as a chronic disease—GLP-1s as a primary (but not only) treatment | | 18:35 | Midlife hormonal changes and their effect on body fat and health | | 24:18 | Defining body composition versus BMI | | 31:04 | Introducing the GPS (GLP-1, Protein, Strength training) approach | | 34:19 | The necessity for long-term therapy; why weight regain occurs once off GLP-1s | | 40:12 | How eligibility for GLP-1s is individualized, not just based on BMI | | 46:46 | Microdosing GLP-1s: what it is and why it’s not generally advisable | | 52:56 | The familial, genetic, and environmental roots of obesity | | 61:59 | Side effects—fact versus sensationalism; importance of proper supervision | | 65:05 | Most common real-world side effects (nausea, diarrhea, dehydration) | | 66:03 | End of content and program wrap-up |

Additional Insights

• Menopause and Fat Redistribution:
  Estrogen decline in perimenopause and menopause drives fat from the hips/thighs (which was protective for cardiovascular health) to the abdominal cavity as visceral fat, increasing metabolic risks ([20:05], [23:07]).

• Social Determinants:
  Healthy food costs, convenience culture, sedentary cities, and environmental chemicals—all contribute to the obesogenic environment ([50:24], [51:37]).

• GLP-1s Across the Lifespan:
  Some GLP-1s are approved for use in adolescents (ages 10+ for some indications), but use must always be individualized ([28:02]).

Tone & Takeaway

This episode is science- and compassion-driven, deconstructing diet culture and medical bias, and offering hope via modern medicine—without sugarcoating the challenges, risks, or necessity of thoughtful, patient-centric care. Both doctors speak with warmth, validation, and a fierce commitment to helping women thrive—not just shrink.

Final Quotes & Highlights

"When you have a teenage patient and you can have the opportunity to bypass decades of struggle for them, imagine how much freer they will be."
— Dr. Salas-Whalen [16:25]

"GLP-1s are a treatment for a chronic condition... This is going to change the way we think about GLP-1s and sustainable health."
— Dr. Haver [01:47]

For further information, pre-order Dr. Salas-Whalen’s book "Weightless," and follow the hosts on Instagram. For clinical or personalized questions, always consult your healthcare provider.