Podcast Summary

Podcast: unPAUSED with Dr. Mary Claire Haver
Episode: GLP-1s and Midlife Metabolism Part 2: Dr. Rocio Salas Whalen Breaks Down the Science of Weight Loss and Menopause
Date: November 19, 2025
Host: Dr. Mary Claire Haver
Guest: Dr. Rocio Salas Whalen

Overview

This episode continues the in-depth discussion on GLP-1 medications and their transformative role in women's health, especially during midlife. Dr. Mary Claire Haver and expert endocrinologist Dr. Rocio Salas Whalen examine the science, stigma, and realities around weight management, menopause, the emotional impact of rapid weight loss, body composition, the future of obesity medications, access and affordability, and the importance of whole-person care.
Dr. Whalen shares key takeaways from her upcoming book and provides practical advice for women considering or using GLP-1s, and guidance for their loved ones.

Key Discussion Points & Insights

1. Stigma, Gender, and Access in Midlife Weight Management

• Cultural Judgment & Double Standards:
  • Women face unique scrutiny and pressure about taking GLP-1s (e.g., Ozempic) similar to the debate around hormone therapy.
  • Quote:

    “She has to justify her need for anything and everything.” – Dr. Haver [05:24]

• If Obesity Was a Male Issue:
  • Dr. Whalen states the debate would be different if only men experienced obesity. For women, weight gain is often dismissed as “just aging,” hindering access to treatment.
  • Quote:

    "It's just making it more difficult for us to have access to feeling better." – Dr. Whalen [06:10]

2. Menopause, Aging, and Body Composition

• Weight Gain Is Not Only Age-Related:
  • Weight struggles in perimenopause/menopause are not solely due to age; hormones, life stressors, and muscle loss play roles.
  • Quote:

    "It's not a concept of age. It’s more our hormonal status..." – Dr. Whalen [06:57]

• Body Composition over the Number on the Scale:
  • The importance of focusing on muscle mass and strength, rather than just weight.
  • Dr. Haver shares personal stories on the life-changing impact of muscle strength:

    “I saved myself in that moment because my balance and my strength were on point...” – Dr. Haver [11:29]

3. GLP-1s: Beyond Weight Loss—Function and Psychosocial Impact

• Celebrity Example:
  • Serena Williams openly using GLP-1 post-partum normalizes medication-assisted weight loss, combats the myth that exercise and diet are always enough.
  • Quote:

    “She is an athlete... If there’s somebody who knows how to exercise, how to eat, it’s her… [but] she used a GLP-1 medication.” – Dr. Whalen [13:37]

• Redefining "Cheating":
  • Patients often feel guilt or shame, believing they should just try diet and exercise again. Both Dr. Haver and Dr. Whalen stress:
    • Using a GLP-1 is not “cheating.” Muscle preservation and high protein intake take hard work.
    • Quote:

      "It’s not an easy way out... Eating protein, the amount that is recommended... lifting weights is work. It’s not cheating." – Dr. Whalen [18:06]

• Protein Requirements:
  • To minimize muscle loss on GLP-1s: aim for ~100g protein/day, individualized based on body size and goals.
  • Quote:

    "The sweet spot... the minimal necessary to not lose muscle while you take a GLP1 is around 100 grams of protein a day." – Dr. Whalen [19:14]

4. Mental & Emotional Changes After Weight Loss

• Navigating Rapid Physical Changes:
  • Unexpected posts: cold intolerance (loss of insulation), excess skin, potential need for surgery.
  • Quote:

    "Many patients start experiencing painful cold intolerance... it’s actually painful." – Dr. Whalen [26:13]

• Emotional Adjustment:
  • Rapid changes cause anxiety about regaining weight and adapting to new social attention.
  • Therapy is crucial, especially for significant weight loss.
  • Quote:

    "100%. And right now we are doing everything ourselves... I think [mental health specialists in weight loss] is the next specialty that’s going to come out." – Dr. Whalen [30:01]

• Relationship Dynamics (“Ozempic Divorce”):
  • Mismatched weight loss in couples alters habits and relationships.
  • Sometimes leads to conflict or even divorce.
  • Quote:

    "Yes. And I’ve actually seen divorces." – Dr. Whalen [32:01]

5. GLP-1s & Addictive Behaviors

• Potential Benefits:
  • Higher doses may reduce alcohol or tobacco consumption by altering the reward system.
  • Quote:

    "GLP1s block that reward system..." – Dr. Whalen [33:23]

6. GLP-1s and Menopause Hormone Therapy

• Synergy for Weight Loss:
  • Hormone therapy alongside GLP-1 leads to greater weight loss than either alone. Improved sleep, energy, and hormonal balance helps sustain healthy habits.
  • Quote:

    "If we talk about the external things, but then hormonally also... giving somebody what they're not making [estrogen], you're helping." – Dr. Whalen [34:35]

7. Access, Costs, Compounding, and Drug Developments

• Accessibility and Socioeconomic Divide:
  • Many cannot access GLP-1s due to high costs unless covered by insurance for diabetes or prediabetes.
  • Joking memes about “you’re not fat, you’re just poor” highlight a growing social gap.
  • Quote:

    “They can charge whatever they want, because they can.” – Dr. Whalen [36:28]

• Drug Administration and Environmental Concerns:
  • Single-use pens create medical waste. Multi-use pens or vials are more cost-effective and environmentally conscious. [36:28–37:36]
• Compounded Versions:
  • Less expensive, but unregulated and potentially less safe; patients need to be aware of risks.
  • Quote:

    "The safety should not have a price... There are studies that have shown that most of the calls for toxicology for overdose of GLP1 is with compounded medication..." – Dr. Whalen [39:01]

• Future Medications:
  • Pipeline includes more sophisticated and potentially safer drugs with more hormones (incretins) combined (e.g., tirzepatide, retatrutide).
  • Orals are advancing but may have more side effects and similar high costs as injectables.
  • Quote:

    “We have the iPhone 16, which is tirzepatide... iPhone 17 is coming next year.” – Dr. Whalen [41:31]

8. Finding the Right Provider & Best Practices

• Expert Supervision is Key:
  • Look for board-certified obesity specialists (find via American Board of Obesity Medicine).
  • Providers should focus on body composition, muscle preservation, and individualized care.
  • Green Flags:

    “If they’re talking to you about muscle, about the possibility of muscle loss, and why it’s important not to lose muscle—that’s a green flag.” – Dr. Whalen [50:28]

  • Red Flags:
    • Lack of body composition assessment, little discussion of muscle preservation or protein.

    “If they’re not doing body composition, that’s a red flag.” – Dr. Whalen [51:20]

9. Supporting Loved Ones Through the Journey

• Understanding Appetite Changes:

  • Loved ones should not pressure or judge someone on a GLP-1 for not eating “as before.”
  • Respect privacy and boundaries regarding sharing about their treatment.
  • Quote:

    “It's really important... to understand that your friend, your son, your husband, whoever's on this GLP1 medication will not eat as they used to eat. Not to question, why are you sick? Why are you not eating?” – Dr. Whalen [52:06]

• Open, Honest Communication:

  • If there’s a mismatch in hunger cues or weight loss between partners, keep conversations honest but avoid oversharing about physical sensations. [53:02]

10. Contraindications for GLP-1s

• Who Should NOT Use GLP-1s:
  • Anyone with personal or family history of medullary thyroid carcinoma
  • Anyone with prior pancreatitis induced by the drug
  • Most others can safely be considered
  • Quote:

    “Anybody who has personal history of medullary thyroid carcinoma… it's contraindicated...” – Dr. Whalen [53:51]

• Who Should Consider GLP-1s:
  • Those for whom maintaining a healthy weight feels like a “full time job”
  • Widespread eligibility

Notable Quotes & Timestamps

• "You don’t have to earn their rights to feel better." – Dr. Whalen [05:33]
• "It’s not just about looking a certain way, it’s about feeling a certain way... halfway is how they feel." – Dr. Whalen [08:02]
• "Once you feel strong and you feel protected in your own body... you don’t want to get that out and you realize you avoided injury." – Dr. Haver [11:29]
• "Any diet, crazy diet, can take you to your goal – to maintain the habits, that’s the hardest thing." – Dr. Whalen [26:01]
• "For the first time in history, we’re going to have masses of people reaching weight that was unreachable before." – Dr. Whalen [25:15]
• "100%. And right now we are doing everything ourselves... we need to give therapy to give them the mental tools for patients to approach their new life." – Dr. Whalen [30:01]
• "Safety should not have a price. You should not put your health at risk because it’s cheaper." – Dr. Whalen, on compounded GLP-1s [39:01]
• "Body composition, strength training, nutrition, more focus and lean protein – and a GLP1." – Dr. Whalen, on the ideal standard of care [51:35]

Important Timestamps & Segments

• Stigma, Gender, and Access: [05:24–08:02]
• Body Composition & Muscle Importance: [09:00–12:38]
• Celebrity/Mental Health & Social Impact: [13:06–16:44]; [24:01–32:01]
• Protein Intake Guidance: [18:39–21:11]
• GLP-1s & Eating Disorders: [24:01–24:34]
• Emotional/Psychosocial Impact of Rapid Weight Loss: [24:34–31:07]
• GLP-1s and Relationship Changes: [32:01–33:23]
• Addiction and Behavioral Changes: [33:15–34:07]
• Synergy GLP-1s + Hormone Therapy: [34:07–35:25]
• Affordability, Compounding & Environmental Concerns: [35:25–41:20]
• The Drug Pipeline & Future Developments: [41:20–45:36]
• Finding an Expert Provider: [49:36–51:20]
• Supporting Loved Ones: [52:06–53:02]
• Contraindications: [53:51–55:08]
• Personal Reflections (“Best Part of this Stage”): [55:37–57:06]

Resources & Where to Learn More

• American Board of Obesity Medicine Physician Locator: [50:20]
• Dr. Rocio Salas Whalen’s Book: A Doctor’s Guide to GLP-1 Medications, Sustainable Weight Loss, and the Health You Deserve (out December 2025)
• Instagram: @DrSalasWhalen, @DoctorMaryClair

Closing Thoughts

This episode pushes past the headlines, offering real science and compassion about weight, hormones, and why women deserve access to the full spectrum of health tools in midlife. It celebrates improvements in medical care, personal empowerment, and the need for a holistic approach—acknowledging the profound physical, mental, emotional, and relational shifts such treatments can bring. Both Dr. Haver and Dr. Whalen stress the importance of expert guidance, community support, rejecting shame, and focusing on long-term health and strength.

For full details, listen to the episode or find additional resources at the podcast’s website and show notes.