January 13, 2026 • 47 mins
If you’re a midlife woman who feels like you’re doing everything right — lifting weights, eating well, walking, managing stress — and your body still isn’t responding, this episode is for you.
In this powerful, myth-busting conversation, I’m joined by Dr. Rocio Salas-Whalen, a triple board-certified endocrinologist, obesity medicine specialist, author, and early adopter of GLP-1 therapies in the U.S. Dr. Salas-Whalen helps us understand why weight gain in midlife is not a willpower problem — it’s a biology problem.
We break down:
- Why midlife metabolism changes so dramatically during perimenopause and menopause
- How GLP-1 medications actually work (in plain English)
- Why muscle is the true organ of longevity — and how to protect it while using GLP-1s
- The truth about side effects like hair loss, nausea, and “Ozempic face”
- Microdosing vs. full dosing, long-term use, and what’s coming next in obesity medicine
- Why shame-based weight loss advice is outdated — and harmful
We also talk about Dr. Salas-Whalen’s new book, Weightless, a science-backed, compassionate guide to GLP-1 medications and metabolic health that validates what so many women have experienced for decades. You can find Weightless wherever books are sold.
This episode is about options, not pressure. Facts, not fear. And building health for the long game.
Instagram https://www.instagram.com/drsalaswhalen/
Website https://www.nyendocrinology.com/
_________________________________________
If you’re doing “all the right things” and still feel stuck, adding a layer of support may be an option. I’ve partnered with a trusted telehealth platform offering modern solutions for women in midlife—including micro-dosed GLP-1 and other peptide therapies.
https://elliemd.com/michelefolan - Create a free account to view all products.
Follow us on Instagram https://www.instagram.com/askingforafriend_pod/
✨ Sign up for my weekly newsletter:
https://michelefolanfasterway.myflodesk.com/i6i44jw4fq
Like to connect? Email me at askingforafriendpodcast1@gmail.com
Transcripts are created with AI and may not be perfectly accurate.
Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified healthcare provider with any questions regarding a medical condition.
Listen
Watch
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Michele Folan (00:00):
I want to take a minute to talk to the woman
who's doing everything right.
You're eating well, you'relifting weights, you're walking,
managing stress, and trying tosleep, and yet your body isn't
responding the way it used to.
I see this every single day asa coach, and I've lived it
myself.
And here's what I want you tohear clearly: there is no
(00:22):
failure here.
Midlife physiology isdifferent.
Hormones shift, metabolismadapts, inflammation and muscle
loss become real obstacles, evenwhen your habits are solid.
That's why I went looking foranswers, not shortcuts.
After a lot of research,conversations with physicians,
and personal experience, I choseto partner with a medical team
(00:46):
that offers physician-prescribedpeptides as an adjunct to a
healthy lifestyle, not areplacement for it.
Peptides aren't magic, theydon't override poor habits.
But when used appropriately andmedically supervised, they can
help support things likemetabolic health, recovery, body
composition, and overallvitality, especially when
(01:08):
lifestyle alone isn't moving theneedle anymore.
If you're curious, if you wantreal information, not hype, and
you want to explore whether thisextra layer of support makes
sense for your body, I've madethat resource available.
You'll find the link in theshow notes.
No pressure, no shame, justoptions for the long game.
(01:30):
Health, wellness, fitness, andeverything in between.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michelle Folan,and this is Asking for a Friend.
Today's episode is a big one,friends.
(01:53):
I'm absolutely thrilled towelcome a woman who is reshaping
the entire conversation aroundweight, hormones, and metabolic
health.
Dr.
Rosio Salas Whalen is a tripleboard certified endocrinologist,
an obesity medicine specialist,and one of the earliest
adopters of GLP1 therapies inthe United States.
(02:14):
She's helped thousands ofpatients rewrite their metabolic
story, and now she's bringingthat wisdom to all of us.
And here's the exciting part.
Her new book, Weightless, aDoctor's Guide to GLP1
Medications, arrives with astarred review from Publishers
Weekly, which is basically theOscars of Publishing.
This book is already beingcalled a must-read for anyone
(02:35):
who wants to understandhormones, weight loss
medications, midlife metabolism,and what it really takes to
create lasting change.
In this conversation, Dr.
Salis Whalen breaks down thescience behind GLP1s in a way
that finally makes sense.
And she helps us understandwhere lifestyle ends and
medication begins and whymidlife women especially deserve
(02:56):
better than shame-based adviceand outdated guidance.
We talk about obesity,menopause, muscle health,
metabolic markers, microdosing,long-term therapy, the future of
these medications, and the onething every woman should know
before starting or stopping aGLP1.
This is an empowering,myth-busting, deeply passionate
(03:17):
conversation that every midlifewoman needs to hear.
Dr.
Rocio Salas Whalen, welcome toAsking for a Friend.
Rocio Salas-Whalen, MD (03:26):
Thank you so much.
Michele Folan (03:27):
I am so honored to have you here.
Thank you.
This topic comes up all thetime.
I do coach midlife women infitness and nutrition, and I
always want to provide them thebest, most accurate, up-to-date
information.
And I feel like thisconversation is going to be
(03:47):
great for everyone.
Before we dive in, I want youto tell the audience a little
bit more about you.
You have a powerful personalstory immigrating to the US from
Mexico.
Tell us a little bit about yourdreams of becoming a physician.
So if you could take us back tothe beginning and tell us a
(04:09):
little more about your careerpath.
Rocio Salas-Whalen, MD (04:10):
The beginning is very early in my
life when I had the dream ofbecoming a doctor.
I that was the only thing Iever remember wanting to be.
It was not a what, it was a howand how fast can I get there.
And that was all my, I rememberall my studies was like with
one goal in particular, and itwas just going to medical
(04:31):
school.
And when I was in medicalschool, I developed also a
passion for diabetes andmetabolic disease.
Type 2 diabetes morespecifically.
And type 2 diabetes and obesitygo hand in hand.
We have to improve one toimprove the other one, and vice
versa.
And this was back in Mexico.
In Mexico, diabetes is thesecond lead of cause of death.
(04:55):
My father had it, mygrandfather had it, my uncles,
aunts have it.
So it's really ingrained in ourgenes in Mexico.
And this was also one of thereasons that I got pulled into
endocrinology, okay, I need towork on diabetes, I have to
study endocrinology.
And then I finished medicalschool in Mexico, and then I
(05:16):
decided to come to the UnitedStates and try my luck, do my
boards.
Took me quite a few years toget there.
And then I finally passed allmy boards.
I started residency in JacobyAlbert Einstein, internal
medicine.
And there in my first year ofresidency is where I met Dr.
John Eng, who is theendocrinologist who isolated the
(05:40):
GLP1 from the Gila monster.
And I remember back then, thiswas 2005, leaving such an
impression of me, thatpresentation that he did
regarding a xenotide, which wasVietta back then, that I saw a
glimpse of what the future waswith this drug.
I saw huge potential.
(06:01):
For the first time we had adrug that decreased your blood
glucose and decreased yourweight.
Usually either decreases yourglucose, but it promotes waking.
So we didn't have somethingthat can target both things.
It was so new, sorevolutionary.
And when I went into myfellowship on endocrinology, I
started already prescribing.
(06:22):
And as soon as I finished mytraining, I started prescribing
Victosa back then, which was2010.
Michele Folan (06:29):
Yeah.
And I had to compete againstVictosa because as I was telling
Dr.
Salas Whalen before we started,that I was part of the team
that launched Bayeta back in2005.
And I've met Dr.
John Eng as well.
So yeah, this is this is such acool story that you were really
(06:50):
inspired by the science.
But you're you're also a board,triple board certified,
endocrinology, and that'sobesity medicine and turtle
medicine.
That's kind of rare.
How has each layer of trainingshaped the way you practice
today?
Rocio Salas-Whalen, MD (07:10):
Oh, enormously.
Even my my training in Mexico,because in Mexico, you do seven
years of medical school, fiveyears of academics, and then one
year of internship in ahospital, and then one year of
working in an underserved area.
And I really think that what Iin the day-to-day now bring to
my patients when I see them,it's a accumulation of all these
(07:33):
experiences.
And training in Mexico addsanother layer of intuition.
And you depend a lot on theconversation that you have with
your patient to figure thingsout because we don't have that
access of imaging and bloodworks and all the things that we
have here.
So you depend a lot on clinicalcriteria into diagnosing and
(07:57):
treating patients, right?
So I think that is really,really gives me a plus
practicing medicine here forsure.
Michele Folan (08:05):
And you know, the other aspect of this is as you
were speaking, like you'rereally treating the whole
patient.
You're not just treating anumber, a blood sugar, an HBA1C.
You're really treating thewhole patient.
Rocio Salas-Whalen, MD (08:19):
Because if you don't, then you won't
have sustainable results withthe patient, right?
If it becomes, if you putsomething to the patient that it
doesn't meet them where theyare, you don't take into their
lifestyle, if their genetics,their environment into an
account, then you're really notgiving them a fair chance of
sustainability in regards toimprovement of their health.
Michele Folan (08:42):
Yeah.
And rates of obesity in the UScontinue to climb, like
unprecedented.
From your vantage point, whatis the real story behind that
rise?
Rocio Salas-Whalen, MD (08:56):
I think a lot of it was that we didn't
have the proper tools.
Although, just having thisdiscussion, we've had them since
2010 that we started using itmore for weight loss, right?
Because when Valletta camefirst and then bidurin, it was
more glucose control.
It was more for our type 2diabetes.
I think after with Victosa.
(09:17):
And also, if you remember well,I'm sure if that there was less
compliance of patients becauseit was a twice-a day injection.
Exactly.
They had a lot of nausea, somore side effects.
So we didn't have theacceptance that it did now, that
we can see more now what arethe results.
And going back to yourquestion, is that's why the
(09:39):
rates continue to increase, eventhough we had a treatment for
obesity, is because one, westill didn't accept obesity as a
disease, right?
I think that's a big, that'sprobably the main reason we're
that we are where we are,because we've been attributing
it even as a medical healthcommunity as a willpower, right?
As a sole and onlyresponsibility of the patient to
(10:02):
improve their weight, which nowwe know it's the patient has
the almost the least of thecontrol in how what happens with
their weight.
So I think that not knowing ortreating obesity as a disease
has is really what has taken uswhere we are right now.
Michele Folan (10:20):
So you have said that obesity isn't about
willpower as much as it is aboutbiology.
So what do you feel are thebiggest misconceptions that
people still hold about obesity?
Rocio Salas-Whalen, MD (10:32):
That you can still do it that or that
the majority of people withobesity can lose the weight with
only exercise and eating less.
Michele Folan (10:41):
Okay.
Rocio Salas-Whalen, MD (10:41):
That's the biggest misconception uh and
myth that we have surroundingobesity.
And even with the with theavailability of the drugs, and
definitely access is not foreverybody, unfortunately, but
even for the people that haveaccess to it, we're still not
using the medication becauseit's still of that stigma of I
(11:04):
or that idea that it you shouldbe able to do it on your own is
what what also many people arenot taking the medication,
right?
Michele Folan (11:12):
You know, speaking of which, when you talk
about access, I was readingyesterday, I don't know if
someone told me this, but theyhad a client who went ahead and
had gastric bypass because herinsurance would cover the
gastric bypass, but not GLP1s.
Rocio Salas-Whalen, MD (11:29):
Yeah.
Michele Folan (11:30):
How is that possible?
Rocio Salas-Whalen, MD (11:31):
Because at the short term, it may be
more economical than to use aGLP one long term, right?
I mean, I think it's it'smathematics for them and it's
not so much what's best for thepatient, is what's going to be
cheaper for us.
And doing $8,000, $10,000surgery once is less expensive
(11:53):
than paying for a medicationthat is going to be required for
five, 10, 15 years, who knows,right?
Michele Folan (11:59):
Right.
Okay.
Well, that that makes sense,but still in my mind, I'm like,
ah, you know, it just seemscounterintuitive.
But most of my audience iswomen 50, 55 plus.
How does the landscape changefor women and perimenopause and
menopause?
(12:19):
What are the metabolic shiftsthat are most misunderstood?
Rocio Salas-Whalen, (12:24):
Definitely uh we until recently are we
really bringing perimenopauseand menopause as a potential
cause for waking in women,right?
And it's more the hormonalfluctuation that happens in this
stage of our lives than theactual number of our age, right?
It's not that we're gettingold, it's not as more like our
(12:46):
our hormones are not helping usas they should, basically,
right?
So it's that hormonal chaosthat happens or starts in
perimenopause that can changeour body recomposition, right?
And I hear this all the time: women coming to me and saying, (12:58):
undefined
This is not how I used to gainweight.
I used to gain weight in myhips, and now everything's in my
middle.
This is not the body that Inormally have.
I don't recognize my body,right?
Because it's it's it'sdifferent than if you gain
weight in your 30s or in your20s.
It's a body recompositionwhat's happening.
Michele Folan (13:18):
So when you say, you know, we got that shift to
the middle, which I know I dotoo, because I used to gain it
in my butt and thighs.
Now it's my middle.
Is that cortisol?
What else is going on there?
Rocio Salas-Whalen, MD (13:31):
I mean, there's so many things that
happen in midlife and women,right?
It's just it's a it's layers ofthings that can promote
awaking.
And we can talk about one, thethe changes in hormones, right?
And estrogen, progesterone,testosterone.
And then we talk about what arethese hormone fluctuations are
(13:51):
doing in our day-to-day?
We may be sleep deprived,right?
And if we're not sleeping,which happens in about 70 to 80
percent of women going throughperimenopause, is then not
having continuous sleep.
You can fall asleep, but youdon't stay asleep.
That increases your cortisol.
We know that people that don'tsleep enough, that increases
your risk of mortality.
(14:11):
So it can also promote waking,that increase of cortisol
because your body's not resting,it's in content, constant
stress, it's in constant flight,right?
And then if we are notsleeping, we're not gonna have
energy to work out or to makehealthy choices when we're going
to eat, or we'll start drinkingso we can fall asleep, but then
(14:34):
that also disrupts our sleep.
And then we add to that layersand family dynamics, right?
If this is the age that ourparents start to age, that we
start seeing those changes intheir health due to aging, or
like in my case, you may loseyour parents, right?
In your 40s.
So that's another level ofstress, uh, chronic stress.
(14:58):
And then aging kids or kidsgetting older, right?
Or going leaving the house orbecoming teenagers.
And then add it to thisprofessional for many women,
this is our peak, right?
This is where we start reallyearning what we're making, what
we're working.
This is the age that our kidsare a little bit older, then we
can really focus and work.
So there's so many layers in ina woman's life and midlife that
(15:23):
it almost, almost sets us offfor failure.
Michele Folan (15:28):
Yeah.
Which is why I have you on theshow today, because I'm trying
trying to help women reallyunderstand what is
physiologically happening totheir bodies at this stage of
life.
We are going to take a realquick break and when we come
back.
I want to talk about lifestyleand how you want to pair those
with GLP1 medications.
(15:48):
Quick pause because if you'rehere, you already know this
isn't just a health podcast.
Yes, we talk about nutrition,strength, and taking care of
your body in midlife, but wealso talk about life,
relationships, energy,boundaries, and what really
matters in this season.
(16:09):
This isn't about perfection orshrinking yourself.
It's about staying strong,curious, connected, and actually
enjoying the years ahead.
If this resonates, share theepisode with a friend who'd
appreciate the conversation andfollow us on Instagram at asking
for a friend underscore pod.
Okay, we are back.
(16:32):
Before we dive intomedications, what are the
non-negotiable lifestylefoundations you want every
patient to master first?
Rocio Salas-Whal (16:42):
Weightlifting.
Michele Folan (16:43):
Okay.
Rocio Salas-Whalen, MD (17:03):
Muscle is the organ of longevity.
Sarcopenia is when there's uhvery low muscle mass.
And when somebody has very slowmuscle mass, that increases
your risk of all causemortality.
We never say that in obesity.
This increases this obesity isgoing to increase all the your
risk for all cause mortality.
(17:24):
We don't say that, but withsarcopenia, it does.
Muscle is our metabolic organ.
Muscle consumes 80% of theglucose that we have in our
blood.
Muscle burns body fat forenergy.
Muscles muscle produceshormones called myokines, and
these are anti-inflammatory, sothey protect our immune system.
(17:48):
And then that's from theinside, and then from the
outside, muscle is ourstructure.
Muscle is the pillars thatholds our body, right?
So less risk of falling,injury, independence as we age,
right?
We can get up out of the chair,we can go to the bathroom by
ourselves.
So, really, the the best thingthat anybody can do if they
(18:10):
choose to do only one thing isbuild their muscle mass.
Michele Folan (18:15):
So, how do you help people understand that the
medication is not a substitutefor strength training, protein,
sleep, and stress management?
How do you tie all thattogether for them?
Rocio Salas-Whalen, MD (18:30):
Well, you know, the majority of my
patients, when they come to me,they they've tried all of that.
They're doing a lot of thelegwork already.
I don't think I've ever had apatient that has not tried
anything and wants to try themedication first.
I really and that's one thing,that's one of the things that
drove me to write my book, whichwe'll talk about, is it's
(18:50):
learning that patients areactually trying.
They're actually doingeverything that we're asking
them and more, right?
So I have not met the patientthat this is the first choice.
They've never tried anythingelse, they never tried lifestyle
changes, and now they just wantto do something easy.
I have to yet meet a patientlike that.
So my patients, they alreadystart doing that.
(19:11):
What was interesting, and whatI like to remember them when
using a GLP1 is that now theywill continue to exercise, but
not with the pressure of weightloss in it.
Not with the pressure that I'mexercising to lose weight.
I'm exercising because I wantto live longer, because I want
to be able to carry things.
(19:31):
Like the weight loss pressureis the GLP1 takes it away,
right?
So now patients, and itchanges, right?
Because if you're doingsomething for weight loss, it's
not as fun.
I don't know, it just carries alot, it's very heavy and
complex what that carries,right?
Because it may be trauma thatyou were told young, you have to
(19:53):
exercise, exercise, do morecardio, do this.
And it just did the connotationand the association of weight
loss with exercise that may.
Pull somebody out fromexercising, right?
So when you remove thatstressor and that pressure to
exercise, it becomes morenatural.
And there's no like that youhave to do it six days a week,
seven days a week, which ispatients what they do to lose
weight.
But to build muscle, even ifyou go three times a week,
(20:16):
you're building muscle already,right?
So it's easier to adapt.
Michele Folan (20:20):
Okay.
I'm the light bulb's going offfor me here because what a great
way to frame that up.
I'm like, oh my gosh, that'sgenius, though.
Because if you are exercisingto lose weight, it really gets
to be such a drudgery, right?
Rocio Salas-Whalen, MD (20:35):
You don't want to do it.
It's like, ugh, yeah.
It's like a punishment, right?
Oh, I'm gonna eat this, butthen I have to exercise to lose
the weight.
Well, yeah, no, but when youremove that, it just patients
see it very differently.
Michele Folan (20:49):
Yeah.
And you've been using GLP1s inpractice longer than almost
anybody in the US.
Can you break down how thesemedications actually work in
simple science so people canunderstand this?
Rocio Salas-Whalen, (21:02):
Definitely.
I I want to I like to explainit, bringing it back to the
reasons that we eat.
Why, why, what are the two mainreasons that humans eat?
One is survival, right?
It's it's fuel, it's energy.
And then the other reason isfor a reward or an anticipation
(21:23):
of a reward, an association witha dopamine release, uh,
whatever it is giving you, isthere's a release of dopamine.
The medication, the GLP1medications, they they target
both things.
For the fuel, the survivalpart, what it does is it
increases your satiety hormones,your your fullness hormones.
(21:45):
When you start eating, you getfull with half of what you
normally would get half, need toget full, and then in between
meals, it suppresses your hungerhormones, right?
So it's like mechanically,you're more restricted.
You eat it small amounts, youget full faster and for longer
periods of time.
And then for the reward part,we have receptors of this for
(22:06):
this hormone because it is ahormone.
We have receptors for thesehormones in the hedonistic
eating and drinking area in ourbrain, which is the amygdala.
There, it blocks the responseof our reward to certain foods
and certain beverages, right?
So for those that anticipatehaving something at night, uh
(22:27):
dessert, or or they're alreadythinking about it, it once
you're on this medication, youyou see that, whatever it is,
and it doesn't give you thatdopamine release.
So the behavior changes.
Michele Folan (22:39):
Okay.
And then in terms of othermetabolic markers beyond the
number on the scale, what otherareas do you see improvement in
with patients on GLP1s?
Rocio Salas-Whalen, MD (22:52):
Well, definitely decreasing their
visceral fat, decreasing thepercentage body fat.
And what I work really hardwith my patients is to maintain
or build muscle mass with aGLP1.
So being, I think that'sanother myth and misconception
is that being on a GLP1, youit's like a death sentence for
your muscle, right?
You you just be prepared,you're gonna lose 30, 40% of
your muscle mass.
That is not true, and that'sthe poor guidance of whoever is
(23:15):
prescribing you this medication.
Because in fact, patients canmaintain and build muscle while
taking a GLP1.
And I have patients in their70s that they build muscle mass.
So there's no age limit in whenyou can uh build muscle.
Michele Folan (23:34):
You highlighted the other day a patient who only
lost 17% muscle.
And that was a great number forher because many patients, if
like the industry average, youcan hear 30, 40%.
Is that typically what theindustry average would be
without getting any kind oflifestyle coaching?
Rocio Salas-Whalen, MD (23:55):
Yeah, definitely.
They're gonna lose asignificant amount of muscle.
And then the problem is thatyou lost your metabolic organ,
you lost your glucose-consumingorgan, you lost your burning fat
for energy organ, and now youare causing chronic inflammation
from not having muscle mass.
(24:16):
So you may end up worse inmetabolic health than when you
started if you lose that amountof muscle.
Michele Folan (24:23):
All right.
I do want to talk a little bitabout side effects, the any kind
of risks.
So we've heard, we've heardhair loss, we've heard ozempic
face, gastroparesis.
How do you help patientsnavigate all these things
safely?
Rocio Salas-Whalen, MD (24:40):
By starting slow and steady, right?
By seeing my patients often, byhaving an open line of
communication, by doing a verythorough medical history and
know what works for the patientand how to guide them according
to their lifestyle.
I don't like to do anythingextreme in my patients in
(25:01):
regards to diet and and exercisebecause I find that is not
sustainable long term.
And and mentally they just wantto do it until the end gold,
and then again, it's notsustainable.
So I really like to make uhthings as easy as I can for my
patients.
Michele Folan (25:20):
Do you have a certain like amount of protein
that you would like them to eatevery day?
Rocio Salas-Whalen, MD (25:25):
Yeah, women, what I've seen, because I
do body compositions on everysingle patient, every day,
multiple times a day for thelast more than 10 years.
What I've seen that works in inregards to maintenance is
around 100 grams of protein perday in women.
In men, it goes a little bitmore higher, like around 40,
(25:47):
150, right?
That's to maintain, that's notto not lose muscle, but to build
muscle, you need to do theweightlifting and potentially
keep maybe a little bit moreprotein.
Michele Folan (25:59):
Okay.
Have you had to address hairloss with any patients?
Rocio Salas-Whalen, MD (26:02):
Yeah, definitely at the beginning.
While I was also figuringthings out as I go, because we
didn't have any guidelines,right?
Patients that lose muscle willlose hair.
Patients that lose hair arelosing muscle because it all
comes from the samemacronutrient, which is protein.
So patients that are consumingthose hundred grams of protein a
day, they don't have muscle uhhair loss.
(26:25):
So definitely it's preventable.
Michele Folan (26:28):
Okay.
That is so good to know becausewomen in midlife already feel
like their hair is thinning.
And if you add that on top ofit, that will stress them the
heck out.
So, all right, that's a goodone.
There's so much buzz right nowaround microdosing.
And when is that appropriate?
When when would you have apatient microdose?
(26:50):
And who is it not for?
Rocio Salas-Whalen, MD (26:53):
I would microdose a patient that is
extremely sensitive tomedications.
And I choose for whatever theirmedical history to start them
on tirzepetide, right?
Because it's better tolerablethan semaglutide.
It causes almost zero to nonenausea.
So that's my that's mypreferred drug at the moment to
(27:13):
start a patient.
But even the lowest dose ontirzepitide, which is 2.5, is
pretty strong, right?
I've I've had patients lose 30,40 pounds even on the first
dose.
So if I have a patient that I'mnot looking for a significant
amount of weight loss, orthey're they're very sensitive
to medication and they'rescared, frankly, scared, I may
(27:34):
do half a dose for a few weeksand then move them to the
regular dose.
But most of what I considermicrodosing useful is for
maintenance, not for becauseremember, we have to remember
that in the studies, theavailable doses that we have now
are the ones where the effect,the desired effect was seen,
(27:56):
right?
Glucose control for thediabetes uh uh indication and
weight loss for the the obesityand overweight indication.
So if you talk about amicrodose, well, we're not gonna
see the results that we'reexpecting to see.
And I think I never denied thebenefits of this drug, but my
only issue is if you need thedrug, use the regular doses,
(28:17):
unless of the the reasons that Imentioned before, right?
Uh but I think doing dosesbelow what we have available is
gonna be useful for maintenancemore than to getting patients
there.
Michele Folan (28:29):
And when you say tirzepatite, that is the GLP1
GIP combination?
Rocio Salas-Whalen, MD (28:34):
Yes, that's the dual increment.
Michele Folan (28:36):
Okay.
What do you predict then forlong-term use?
Rocio Salas-Whalen, MD (28:41):
Well, a lower dose for my patients
currently is the lowest dose oftheir medication long-term.
But I think with the oraloptions coming up soon, I think
oral will may be also a goodoption for maintenance.
Although I think for themajority of people, they've
gotten out over the hump of theinjection.
(29:02):
And for many, it's easier to doan injection once a week than
to take a pill every day, right?
Maybe if cost is significantlydifferent from the in the oral
from the injection, then maythat may be a reason to move
somebody to the oral formaintenance long term.
Also, there's a once a monthcoming maritide.
(29:23):
I think it's also from EliLilly.
And I think that's going to bean option for maintenance too,
doing an injection once a monthversus once a week or versus a
daily oral tablet.
Michele Folan (29:34):
I'm so curious how they're making this oral
because it's an incretin hormoneand you would think it would be
broken down quickly.
Rocio Salas-Whalen, MD (29:42):
Well, the thing is, what what I saw
with oral semaglutide in 2019when Rebelsis was approved for
type 2 diabetes, we have oralsemaglutide for six years now.
And the reason that Ipersonally don't use it in my
patients, and that the reasonthat it's not as popular and
never got as popular as Ozempicis because being oral that we
(30:04):
saw more gastric side effects.
I saw significant nausea.
It was hard to titrate uppatients because of the side
effects.
So it's going to be interestingto see what to expect with
orphoglyprone, which is the onefrom Eli Lilly, um, if if it's
(30:25):
going to have this, becauseorphoglyprone is not GIP and
GLP.
It's one GLP, it's likesemaglutide, right?
So we potentially may see thesame side effects.
So until we don't start usingit in masses clinically, if we
can and patients tolerate it,then we won't know until then.
Michele Folan (30:43):
Do you see GLP ones becoming a chronic
metabolic medication, kind oflike we have with statins?
Rocio Salas-Whalen, MD (30:50):
Yes, for sure.
It must.
Michele Folan (30:54):
All right.
You know, some of your mostimpactful content that you post
is around expectations.
The physical, the emotional,and also social.
How do you prepare patients forsome of the psychological side
effects of major weight loss?
Rocio Salas-Whalen, MD (31:15):
I think by doing it very slow and
reframing, reframing weight losswith the end goal of metabolic
health or body recomposition,that already has an effect on
the psyche of the patient,right?
Because it's not so much moreof a physical appearance, it's
more about how do I feel?
(31:36):
Do I feel strong?
Do I feel healthy?
That prepares better thepatient for when they reach this
new body recomposition, right?
And also if you do it slow as Ido, it also allows adaptation
to the new body, to thesurroundings, right?
Versus if you take somebody tooquick, too fast in a few
(31:58):
months, I mean their body evenhasn't adapted.
Their psyche even is going totake even longer to adapt,
right?
That's another reason why itshould be done very slowly and
steady to really improve thechances of success for the
patient.
Michele Folan (32:12):
Do you see other combination therapies?
So we already have GLP1 andGIP.
You know, there's likeglucagon, there's amylin um
analogs, those types of things.
What do you what do you see onthe horizon?
I really think it's soexciting.
Rocio Salas-Whalen, MD (32:29):
You know, I think I truly think
we're in diapers right now withthe with what we have.
It's just it's just somethingso new, even though it's not
new, but this is how long ittakes to for for the healthcare
system to incorporate things.
But I I think there's so muchinvestment in the study of new
drugs for obesity, right?
(32:51):
I think that's the that's thepriority pretty much for every
pharmaceutical, I think, at thismoment.
And everybody's trying to dotheir own cocktail, their own
recipe, and adding differentmedications, as you mentioned,
semaglutide with amylin.
Uh that's going to be aninteresting one.
And apparently they alreadyapply for FDA approval, right?
So that may come very soon.
(33:11):
Then we have the tripleagonist, which is GIP, glucagon,
and GLP1, which is Retatrutide.
That's also coming end of nextyear or 2027.
And then we have combinationwith muscle preserving
medications, right?
Which are anti clonalantibodies to prevent muscle
loss, which is anotherinteresting thing.
Uh so again, I think it's justit's just the race of who's
(33:35):
bringing uh differentcombinations of for the benefit
of the patient.
So I'm I'm really excited tosee what is going to become of
health, right?
We are going to reach placesthat before they weren't they
weren't reachable for manypatients.
And what I love, what I do inmy patients, is to give them
(33:56):
that view and that thatpotential to know or to explore
what their body can do, right?
Because for many patients,they're they just accept that
where they are, and this iswhere I am.
I uh getting out of the chairis painful, so this is all I'm
going to do.
But it's like removing thoselayers as they go through
(34:17):
through treatment, you and theystart feeling stronger, and
that's why muscle is veryimportant to incorporate it.
You you start seeing this sparkin the patient of like, oh,
what can my body do?
It can do this now.
Oh, I'm gonna start running fora marathon.
Oh, I'm gonna do a triathlon.
Oh, my body can take mehiking. So that that fills my
(34:39):
cup every single day.
Is when a patient starts tohave a glimpse of what their
body can do, I think there's noturning back for the patients at
that in that precise moment.
I I'm I'm tearing up right now.
And you know, giving peoplethat hope who have been hopeless
for years and years and years,and that they they may have a
(35:03):
life.
They may, they may live a long,healthy life, right?
And and this is what I don'tthink people quite understand is
not just the emotional strainof of the weight, but it is the
physiologic strain of thatweight is killing people.
(35:24):
And if if we can give themsomething that helps them at
least give them that jump startto say, you know, I'm empowered.
I am can in control now where Ican do this myself.
I can see why you love what youdo.
Thank you.
Michele Folan (35:42):
Yeah, fantastic.
And I want to talk about yourbook.
A huge congratulations on onthe the publisher's weekly
starred review.
Um, your book is calledWeightless, a doctor's guide to
GLP wanna make medications,sustainable weight loss, and the
health you deserve.
Why did you write it?
(36:02):
And who's the book for?
Rocio Salas-Whalen, MD (36:04):
For everybody.
The book is for everybody, andand I had everybody in mind,
both patients, both curiouspeople about the medication, and
doctors and providers who wantto prescribe it responsibly,
right?
I there's no competition, oh,you're gonna take away my
patients.
There's in this field ofobesity, the more I mean, we
(36:28):
need so many providers, but doit responsibly, educate
yourself, right?
Because otherwise you're doinga disservice to the patient.
And the reason that I wanted towrite this book is one, because
I wanted to everybody to hearwhat I was hearing from my
patients and and remove thatthat cons that preconception of
the lazy, ignorant patient thathas obesity, and if they wanted
(36:51):
to lose it, they already wouldhave done it.
They want to lose it and theytried everything.
So I needed people, evendoctors, to hear this because
that's not where we need to go.
And then the other reason isbecause I can reach to more
people and educate more peoplethrough a book than what I can
do in my one-to-one with mypatients and in my social media,
(37:15):
right?
So that's the reason I wantedto educate the population, even
if their provider is noteducated enough.
Michele Folan (37:23):
What gap in understanding did you most want
to fill with this book?
Rocio Salas-Whalen, MD (37:29):
Really, to validate patience.
That was my one rule that I hadwith my publisher.
I said, my book has to haveheart.
My book has to validate thatthose years of work of my
patients and the people that aregoing to read the book.
I wanted to rebuild trust,right?
(37:49):
Because I think due to thegaslighting and lack of trust
between physicians, patients andphysicians, specifically, and
that we this is very parallel towomen's health, but
specifically with people withobesity and overweight, right?
That the trust was brokenbetween the patient and the
doctor, and the doctor and thepatient.
It was just to reinstate thattrust and rebuild that trust,
(38:13):
right?
Also, I wanted to make patientsfeel empowered and that they
can also be participants of thisjourney, right?
And the educated patient doesbetter, right?
Because they become partner.
And what I found in my practiceis that patients want to be
educated.
They want to know, they wannalisten, they wanna learn.
(38:36):
The problem is the way that wepractice medicine in 10 minutes,
we don't have time to teach thepatient to us, answer their
questions.
So it becomes very it becomesvery automatic.
Uh cough, syrup, you know,blood pressure, here.
We don't we don't even askanymore, right?
We don't we don't want to knowthe why because we don't have
time.
I can fix it, but I don't havetime to understand it.
(38:57):
So with this book, I wanted togive that to the patients,
right?
The the the opportunity tolearn and and educate themselves
and understand why they're notlosing weight, why they have
obesity, and for them tounderstand that is not their
fault.
And then I also wanted to guidesomebody through the whole
journey, from the moment thateven they start thinking, could
this be for me, to the momentthat, wow, I'm here and this is
(39:20):
where I am.
How do I approach all these newthings that are gonna happen in
my life?
Michele Folan (39:25):
How exciting would it be for you to see a
patient like walking into theirdoctor's office with your book
under their arm?
Because you know that's what'sgonna happen, because they're
gonna highlight pages and say,well, Dr.
Salas Whalen says this.
What do you think?
Right.
Rocio Salas-Whalen, MD (39:40):
And and it's all the references are
there.
They're gonna say, here's thereference for this and this and
this and this, right?
I mean, again, I was very my mymy the proudest thing of my
book is that it's easy tounderstand for anybody who has
nothing to do in the medicalworld but evidence based backed
inside back with science.
Right.
(40:00):
So isn't that my opinion inthat book?
Is the science made very easyto understand and and to digest
and to bring to your doctor?
Michele Folan (40:10):
Yeah.
And you took science, you tookphysiology, even culture.
You put some real life patientstories in there.
What part of the journey areyou most excited for readers to
understand?
Rocio Salas-Whalen, MD (40:25):
Why they have obesity.
That's one.
And the other one is so theycan understand the psychology of
their weight in the head.
I mean, they of course theyunderstand it.
But how to let go of that too?
Because, and that's the titleof my book.
I want my patients to becomeweightless.
That's what I see a patient.
(40:46):
They come with the idea ofdropping physical weight, but
what happens in the journey asthey go, they drop trauma,
guilt, shame, right?
So this is what I want for mypatients to truly become become
weightless.
Michele Folan (41:02):
Yeah, because people's identity is shaped by
their weight.
And I I would assume that evenif a patient loses 80 pounds,
they still may be that obeseperson in a smaller body.
Rocio Salas-Whalen, MD (41:16):
Yes, and and they say this, I see the
body, but it's not me, right?
So that is a that's uh uhthings that we are not we're we
haven't been yet giving thosetools to our patients for with
weight loss.
We've been putting all of ourefforts in getting to a number
(41:37):
that what that would equalhealth, but we have done nothing
for the mental health of weightloss.
Michele Folan (41:43):
Yeah.
I love what you're doingthough, because I think that
you're you really are trying totreat the whole patient here,
which we're we just don't seeall that often in in the realm
of weight loss.
So this is fantastic.
And then for women listeningright now, what message from the
book do you want them to heartoday?
Rocio Salas-Whalen, MD (42:03):
Don't let fear make a decision for
you, right?
I see and I feel and I hear andI understand the fear of going
to a medication for weight loss.
You feel guilty, you you areafraid of potential side
effects, you are afraid becauseof the headlines that you're
seeing.
Make a decision informed, makea decision based on facts and
(42:29):
science and not on fear.
Michele Folan (42:32):
Yeah, and stigma.
Rocio Salas-Whalen, MD (42:34):
And exactly fear, fear of shame.
Michele Folan (42:37):
Yeah, I mean, it's it's really what what what
will my friends think?
What will my family think thatI'm not strong enough to do this
myself?
And I really I really don'twant people to feel that way
about this class of drugs.
I mean, it's it's been so sowell studied.
Um and we and you know thesmart way to do this.
Rocio Salas-Whalen, MD (42:58):
Yeah.
Yeah.
It's just the problem with itis that if that's the on by the
own bias of people, right?
Of thinking of weight assomething superficial and
aesthetic.
Yeah.
That if if they say, well, I'mgonna use a medication to lose
weight, of course it sounds likeout of this world, like why
would you put your body throughmedication just to lose weight?
But they're they're missing thepoint that it's a medical
(43:20):
treatment for a complex disease.
That's the first thing we haveto accept that obesity is a true
disease and not a risk factorand not something aesthetically
unpleasant, right?
So if we understand that and weaccept that, we would not
question treatment for obesity.
Michele Folan (43:38):
Amen.
I love that.
Okay.
This is a personal question.
What is one of your dailynon-negotiables for your own
metabolic and mental health?
What do you do for yourselfevery day?
Rocio Salas-Whalen, MD (43:50):
Walk.
I live in New York City, andfor me, walking is very
important.
Having my coffee in the morningquiet before my kids wake up.
If I don't have that, like Ifeel like I don't start my day
well.
It's just like I need toregroup in the in the morning,
write down my ideas that I havefor the day, and that's like and
(44:12):
and starting my day withprotein for sure.
Michele Folan (44:14):
Okay.
Oh, love it.
All right, we got the thetriple whammy there.
All right.
What do you wish for everywoman under 40 to understand
about her metabolism right now?
Rocio Salas-Whalen, MD (44:27):
That it's changing, that your
hormones are not going to makeit easy for you and all the life
events that I mentioned, butthat you have options.
Michele Folan (44:40):
Yeah.
Rocio Salas-Whalen, MD (44:41):
That for the first time in two decades,
women our age and mid middleage, we have options that our
mothers didn't have.
Right?
We have hormone replacementtherapy, we have testosterone,
now we have GLP1 medications.
So be proactive.
Be proactive in your optionsand and remove that idea that
(45:01):
you have to earn them withsuffering, right?
And also, what I tell mypatients here is never accept
anything less than feeling 100%.
Because you can, because now wecan.
Now we have the tools to forthat to happen.
Don't accept not sleeping,don't accept not having a sex
(45:22):
life, don't accept feeling tiredall day.
Don't, don't.
You don't want to live likethat for the next 40, 50 years.
No.
Michele Folan (45:29):
A woman after my own heart.
Rocio Salas-Whalen, MD (45:33):
Yeah.
Fight for that 100%.
Fight for that 100%.
Michele Folan (45:37):
Fight for the 100%.
Did you all hear that?
I hope you did.
Dr.
Rocio Salas Whalen, where canthe listeners find you, your
practice, and your book?
Rocio Salas-Whalen, MD (45:49):
They can pre-order my book in Amazon,
Barnes and Noble, anywhere whereyou can buy book.
It's Weightless, that's thename, or Weightless.com is also
the website where you canpre-order the book.
And I am in social media andInstagram mostly, almost
exclusively.
And my handle is Dr.
Salas Whalen,D-R-S-A-L-A-S-W-H-A-L-E-N.
(46:13):
And also I practice in New YorkCity in Upper East Side.
And the name of my practice isNew York endocrinology, and
that's where I see patients.
Michele Folan (46:24):
Wonderful.
What an incredible conversationtoday.
Dr.
Rocio Salas Waylon, thank youfor being a guest on Asking for
a Friend.
Rocio Salas-Whalen, MD (46:34):
Thank you for having me.
Michele Folan (46:36):
Before you go, thank you for being here.
If you want to go a littledeeper, make sure you check out
the show notes for this episode.
That's where I link anything wementioned, resources, partners,
or tools I actually use andtrust.
And if you're not already onthe Asking for a Friend
community newsletter, that'swhere I share practical midlife
tips, favorite finds, recipes,and the things that don't always
(47:00):
make it onto the podcast orInstagram.
You'll find the link to join inthe show notes.
Take care, and I'll see younext week.
I want to take a minute to talk to the woman
who's doing everything right.
You're eating well, you'relifting weights, you're walking,
managing stress, and trying tosleep, and yet your body isn't
responding the way it used to.
I see this every single day asa coach, and I've lived it
myself.
And here's what I want you tohear clearly: there is no
(00:22):
failure here.
Midlife physiology isdifferent.
Hormones shift, metabolismadapts, inflammation and muscle
loss become real obstacles, evenwhen your habits are solid.
That's why I went looking foranswers, not shortcuts.
After a lot of research,conversations with physicians,
and personal experience, I choseto partner with a medical team
(00:46):
that offers physician-prescribedpeptides as an adjunct to a
healthy lifestyle, not areplacement for it.
Peptides aren't magic, theydon't override poor habits.
But when used appropriately andmedically supervised, they can
help support things likemetabolic health, recovery, body
composition, and overallvitality, especially when
(01:08):
lifestyle alone isn't moving theneedle anymore.
If you're curious, if you wantreal information, not hype, and
you want to explore whether thisextra layer of support makes
sense for your body, I've madethat resource available.
You'll find the link in theshow notes.
No pressure, no shame, justoptions for the long game.
(01:30):
Health, wellness, fitness, andeverything in between.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michelle Folan,and this is Asking for a Friend.
Today's episode is a big one,friends.
(01:53):
I'm absolutely thrilled towelcome a woman who is reshaping
the entire conversation aroundweight, hormones, and metabolic
health.
Dr.
Rosio Salas Whalen is a tripleboard certified endocrinologist,
an obesity medicine specialist,and one of the earliest
adopters of GLP1 therapies inthe United States.
(02:14):
She's helped thousands ofpatients rewrite their metabolic
story, and now she's bringingthat wisdom to all of us.
And here's the exciting part.
Her new book, Weightless, aDoctor's Guide to GLP1
Medications, arrives with astarred review from Publishers
Weekly, which is basically theOscars of Publishing.
This book is already beingcalled a must-read for anyone
(02:35):
who wants to understandhormones, weight loss
medications, midlife metabolism,and what it really takes to
create lasting change.
In this conversation, Dr.
Salis Whalen breaks down thescience behind GLP1s in a way
that finally makes sense.
And she helps us understandwhere lifestyle ends and
medication begins and whymidlife women especially deserve
(02:56):
better than shame-based adviceand outdated guidance.
We talk about obesity,menopause, muscle health,
metabolic markers, microdosing,long-term therapy, the future of
these medications, and the onething every woman should know
before starting or stopping aGLP1.
This is an empowering,myth-busting, deeply passionate
(03:17):
conversation that every midlifewoman needs to hear.
Dr.
Rocio Salas Whalen, welcome toAsking for a Friend.
Rocio Salas-Whalen, MD (03:26):
Thank you so much.
Michele Folan (03:27):
I am so honored to have you here.
Thank you.
This topic comes up all thetime.
I do coach midlife women infitness and nutrition, and I
always want to provide them thebest, most accurate, up-to-date
information.
And I feel like thisconversation is going to be
(03:47):
great for everyone.
Before we dive in, I want youto tell the audience a little
bit more about you.
You have a powerful personalstory immigrating to the US from
Mexico.
Tell us a little bit about yourdreams of becoming a physician.
So if you could take us back tothe beginning and tell us a
(04:09):
little more about your careerpath.
Rocio Salas-Whalen, MD (04:10):
The beginning is very early in my
life when I had the dream ofbecoming a doctor.
I that was the only thing Iever remember wanting to be.
It was not a what, it was a howand how fast can I get there.
And that was all my, I rememberall my studies was like with
one goal in particular, and itwas just going to medical
(04:31):
school.
And when I was in medicalschool, I developed also a
passion for diabetes andmetabolic disease.
Type 2 diabetes morespecifically.
And type 2 diabetes and obesitygo hand in hand.
We have to improve one toimprove the other one, and vice
versa.
And this was back in Mexico.
In Mexico, diabetes is thesecond lead of cause of death.
(04:55):
My father had it, mygrandfather had it, my uncles,
aunts have it.
So it's really ingrained in ourgenes in Mexico.
And this was also one of thereasons that I got pulled into
endocrinology, okay, I need towork on diabetes, I have to
study endocrinology.
And then I finished medicalschool in Mexico, and then I
(05:16):
decided to come to the UnitedStates and try my luck, do my
boards.
Took me quite a few years toget there.
And then I finally passed allmy boards.
I started residency in JacobyAlbert Einstein, internal
medicine.
And there in my first year ofresidency is where I met Dr.
John Eng, who is theendocrinologist who isolated the
(05:40):
GLP1 from the Gila monster.
And I remember back then, thiswas 2005, leaving such an
impression of me, thatpresentation that he did
regarding a xenotide, which wasVietta back then, that I saw a
glimpse of what the future waswith this drug.
I saw huge potential.
(06:01):
For the first time we had adrug that decreased your blood
glucose and decreased yourweight.
Usually either decreases yourglucose, but it promotes waking.
So we didn't have somethingthat can target both things.
It was so new, sorevolutionary.
And when I went into myfellowship on endocrinology, I
started already prescribing.
(06:22):
And as soon as I finished mytraining, I started prescribing
Victosa back then, which was2010.
Michele Folan (06:29):
Yeah.
And I had to compete againstVictosa because as I was telling
Dr.
Salas Whalen before we started,that I was part of the team
that launched Bayeta back in2005.
And I've met Dr.
John Eng as well.
So yeah, this is this is such acool story that you were really
(06:50):
inspired by the science.
But you're you're also a board,triple board certified,
endocrinology, and that'sobesity medicine and turtle
medicine.
That's kind of rare.
How has each layer of trainingshaped the way you practice
today?
Rocio Salas-Whalen, MD (07:10):
Oh, enormously.
Even my my training in Mexico,because in Mexico, you do seven
years of medical school, fiveyears of academics, and then one
year of internship in ahospital, and then one year of
working in an underserved area.
And I really think that what Iin the day-to-day now bring to
my patients when I see them,it's a accumulation of all these
(07:33):
experiences.
And training in Mexico addsanother layer of intuition.
And you depend a lot on theconversation that you have with
your patient to figure thingsout because we don't have that
access of imaging and bloodworks and all the things that we
have here.
So you depend a lot on clinicalcriteria into diagnosing and
(07:57):
treating patients, right?
So I think that is really,really gives me a plus
practicing medicine here forsure.
Michele Folan (08:05):
And you know, the other aspect of this is as you
were speaking, like you'rereally treating the whole
patient.
You're not just treating anumber, a blood sugar, an HBA1C.
You're really treating thewhole patient.
Rocio Salas-Whalen, MD (08:19):
Because if you don't, then you won't
have sustainable results withthe patient, right?
If it becomes, if you putsomething to the patient that it
doesn't meet them where theyare, you don't take into their
lifestyle, if their genetics,their environment into an
account, then you're really notgiving them a fair chance of
sustainability in regards toimprovement of their health.
Michele Folan (08:42):
Yeah.
And rates of obesity in the UScontinue to climb, like
unprecedented.
From your vantage point, whatis the real story behind that
rise?
Rocio Salas-Whalen, MD (08:56):
I think a lot of it was that we didn't
have the proper tools.
Although, just having thisdiscussion, we've had them since
2010 that we started using itmore for weight loss, right?
Because when Valletta camefirst and then bidurin, it was
more glucose control.
It was more for our type 2diabetes.
I think after with Victosa.
(09:17):
And also, if you remember well,I'm sure if that there was less
compliance of patients becauseit was a twice-a day injection.
Exactly.
They had a lot of nausea, somore side effects.
So we didn't have theacceptance that it did now, that
we can see more now what arethe results.
And going back to yourquestion, is that's why the
(09:39):
rates continue to increase, eventhough we had a treatment for
obesity, is because one, westill didn't accept obesity as a
disease, right?
I think that's a big, that'sprobably the main reason we're
that we are where we are,because we've been attributing
it even as a medical healthcommunity as a willpower, right?
As a sole and onlyresponsibility of the patient to
(10:02):
improve their weight, which nowwe know it's the patient has
the almost the least of thecontrol in how what happens with
their weight.
So I think that not knowing ortreating obesity as a disease
has is really what has taken uswhere we are right now.
Michele Folan (10:20):
So you have said that obesity isn't about
willpower as much as it is aboutbiology.
So what do you feel are thebiggest misconceptions that
people still hold about obesity?
Rocio Salas-Whalen, MD (10:32):
That you can still do it that or that
the majority of people withobesity can lose the weight with
only exercise and eating less.
Michele Folan (10:41):
Okay.
Rocio Salas-Whalen, MD (10:41):
That's the biggest misconception uh and
myth that we have surroundingobesity.
And even with the with theavailability of the drugs, and
definitely access is not foreverybody, unfortunately, but
even for the people that haveaccess to it, we're still not
using the medication becauseit's still of that stigma of I
(11:04):
or that idea that it you shouldbe able to do it on your own is
what what also many people arenot taking the medication,
right?
Michele Folan (11:12):
You know, speaking of which, when you talk
about access, I was readingyesterday, I don't know if
someone told me this, but theyhad a client who went ahead and
had gastric bypass because herinsurance would cover the
gastric bypass, but not GLP1s.
Rocio Salas-Whalen, MD (11:29):
Yeah.
Michele Folan (11:30):
How is that possible?
Rocio Salas-Whalen, MD (11:31):
Because at the short term, it may be
more economical than to use aGLP one long term, right?
I mean, I think it's it'smathematics for them and it's
not so much what's best for thepatient, is what's going to be
cheaper for us.
And doing $8,000, $10,000surgery once is less expensive
(11:53):
than paying for a medicationthat is going to be required for
five, 10, 15 years, who knows,right?
Michele Folan (11:59):
Right.
Okay.
Well, that that makes sense,but still in my mind, I'm like,
ah, you know, it just seemscounterintuitive.
But most of my audience iswomen 50, 55 plus.
How does the landscape changefor women and perimenopause and
menopause?
(12:19):
What are the metabolic shiftsthat are most misunderstood?
Rocio Salas-Whalen, (12:24):
Definitely uh we until recently are we
really bringing perimenopauseand menopause as a potential
cause for waking in women,right?
And it's more the hormonalfluctuation that happens in this
stage of our lives than theactual number of our age, right?
It's not that we're gettingold, it's not as more like our
(12:46):
our hormones are not helping usas they should, basically,
right?
So it's that hormonal chaosthat happens or starts in
perimenopause that can changeour body recomposition, right?
And I hear this all the time: women coming to me and saying, (12:58):
undefined
This is not how I used to gainweight.
I used to gain weight in myhips, and now everything's in my
middle.
This is not the body that Inormally have.
I don't recognize my body,right?
Because it's it's it'sdifferent than if you gain
weight in your 30s or in your20s.
It's a body recompositionwhat's happening.
Michele Folan (13:18):
So when you say, you know, we got that shift to
the middle, which I know I dotoo, because I used to gain it
in my butt and thighs.
Now it's my middle.
Is that cortisol?
What else is going on there?
Rocio Salas-Whalen, MD (13:31):
I mean, there's so many things that
happen in midlife and women,right?
It's just it's a it's layers ofthings that can promote
awaking.
And we can talk about one, thethe changes in hormones, right?
And estrogen, progesterone,testosterone.
And then we talk about what arethese hormone fluctuations are
(13:51):
doing in our day-to-day?
We may be sleep deprived,right?
And if we're not sleeping,which happens in about 70 to 80
percent of women going throughperimenopause, is then not
having continuous sleep.
You can fall asleep, but youdon't stay asleep.
That increases your cortisol.
We know that people that don'tsleep enough, that increases
your risk of mortality.
(14:11):
So it can also promote waking,that increase of cortisol
because your body's not resting,it's in content, constant
stress, it's in constant flight,right?
And then if we are notsleeping, we're not gonna have
energy to work out or to makehealthy choices when we're going
to eat, or we'll start drinkingso we can fall asleep, but then
(14:34):
that also disrupts our sleep.
And then we add to that layersand family dynamics, right?
If this is the age that ourparents start to age, that we
start seeing those changes intheir health due to aging, or
like in my case, you may loseyour parents, right?
In your 40s.
So that's another level ofstress, uh, chronic stress.
(14:58):
And then aging kids or kidsgetting older, right?
Or going leaving the house orbecoming teenagers.
And then add it to thisprofessional for many women,
this is our peak, right?
This is where we start reallyearning what we're making, what
we're working.
This is the age that our kidsare a little bit older, then we
can really focus and work.
So there's so many layers in ina woman's life and midlife that
(15:23):
it almost, almost sets us offfor failure.
Michele Folan (15:28):
Yeah.
Which is why I have you on theshow today, because I'm trying
trying to help women reallyunderstand what is
physiologically happening totheir bodies at this stage of
life.
We are going to take a realquick break and when we come
back.
I want to talk about lifestyleand how you want to pair those
with GLP1 medications.
(15:48):
Quick pause because if you'rehere, you already know this
isn't just a health podcast.
Yes, we talk about nutrition,strength, and taking care of
your body in midlife, but wealso talk about life,
relationships, energy,boundaries, and what really
matters in this season.
(16:09):
This isn't about perfection orshrinking yourself.
It's about staying strong,curious, connected, and actually
enjoying the years ahead.
If this resonates, share theepisode with a friend who'd
appreciate the conversation andfollow us on Instagram at asking
for a friend underscore pod.
Okay, we are back.
(16:32):
Before we dive intomedications, what are the
non-negotiable lifestylefoundations you want every
patient to master first?
Rocio Salas-Whal (16:42):
Weightlifting.
Michele Folan (16:43):
Okay.
Rocio Salas-Whalen, MD (17:03):
Muscle is the organ of longevity.
Sarcopenia is when there's uhvery low muscle mass.
And when somebody has very slowmuscle mass, that increases
your risk of all causemortality.
We never say that in obesity.
This increases this obesity isgoing to increase all the your
risk for all cause mortality.
(17:24):
We don't say that, but withsarcopenia, it does.
Muscle is our metabolic organ.
Muscle consumes 80% of theglucose that we have in our
blood.
Muscle burns body fat forenergy.
Muscles muscle produceshormones called myokines, and
these are anti-inflammatory, sothey protect our immune system.
(17:48):
And then that's from theinside, and then from the
outside, muscle is ourstructure.
Muscle is the pillars thatholds our body, right?
So less risk of falling,injury, independence as we age,
right?
We can get up out of the chair,we can go to the bathroom by
ourselves.
So, really, the the best thingthat anybody can do if they
(18:10):
choose to do only one thing isbuild their muscle mass.
Michele Folan (18:15):
So, how do you help people understand that the
medication is not a substitutefor strength training, protein,
sleep, and stress management?
How do you tie all thattogether for them?
Rocio Salas-Whalen, MD (18:30):
Well, you know, the majority of my
patients, when they come to me,they they've tried all of that.
They're doing a lot of thelegwork already.
I don't think I've ever had apatient that has not tried
anything and wants to try themedication first.
I really and that's one thing,that's one of the things that
drove me to write my book, whichwe'll talk about, is it's
(18:50):
learning that patients areactually trying.
They're actually doingeverything that we're asking
them and more, right?
So I have not met the patientthat this is the first choice.
They've never tried anythingelse, they never tried lifestyle
changes, and now they just wantto do something easy.
I have to yet meet a patientlike that.
So my patients, they alreadystart doing that.
(19:11):
What was interesting, and whatI like to remember them when
using a GLP1 is that now theywill continue to exercise, but
not with the pressure of weightloss in it.
Not with the pressure that I'mexercising to lose weight.
I'm exercising because I wantto live longer, because I want
to be able to carry things.
(19:31):
Like the weight loss pressureis the GLP1 takes it away,
right?
So now patients, and itchanges, right?
Because if you're doingsomething for weight loss, it's
not as fun.
I don't know, it just carries alot, it's very heavy and
complex what that carries,right?
Because it may be trauma thatyou were told young, you have to
(19:53):
exercise, exercise, do morecardio, do this.
And it just did the connotationand the association of weight
loss with exercise that may.
Pull somebody out fromexercising, right?
So when you remove thatstressor and that pressure to
exercise, it becomes morenatural.
And there's no like that youhave to do it six days a week,
seven days a week, which ispatients what they do to lose
weight.
But to build muscle, even ifyou go three times a week,
(20:16):
you're building muscle already,right?
So it's easier to adapt.
Michele Folan (20:20):
Okay.
I'm the light bulb's going offfor me here because what a great
way to frame that up.
I'm like, oh my gosh, that'sgenius, though.
Because if you are exercisingto lose weight, it really gets
to be such a drudgery, right?
Rocio Salas-Whalen, MD (20:35):
You don't want to do it.
It's like, ugh, yeah.
It's like a punishment, right?
Oh, I'm gonna eat this, butthen I have to exercise to lose
the weight.
Well, yeah, no, but when youremove that, it just patients
see it very differently.
Michele Folan (20:49):
Yeah.
And you've been using GLP1s inpractice longer than almost
anybody in the US.
Can you break down how thesemedications actually work in
simple science so people canunderstand this?
Rocio Salas-Whalen, (21:02):
Definitely.
I I want to I like to explainit, bringing it back to the
reasons that we eat.
Why, why, what are the two mainreasons that humans eat?
One is survival, right?
It's it's fuel, it's energy.
And then the other reason isfor a reward or an anticipation
(21:23):
of a reward, an association witha dopamine release, uh,
whatever it is giving you, isthere's a release of dopamine.
The medication, the GLP1medications, they they target
both things.
For the fuel, the survivalpart, what it does is it
increases your satiety hormones,your your fullness hormones.
(21:45):
When you start eating, you getfull with half of what you
normally would get half, need toget full, and then in between
meals, it suppresses your hungerhormones, right?
So it's like mechanically,you're more restricted.
You eat it small amounts, youget full faster and for longer
periods of time.
And then for the reward part,we have receptors of this for
(22:06):
this hormone because it is ahormone.
We have receptors for thesehormones in the hedonistic
eating and drinking area in ourbrain, which is the amygdala.
There, it blocks the responseof our reward to certain foods
and certain beverages, right?
So for those that anticipatehaving something at night, uh
(22:27):
dessert, or or they're alreadythinking about it, it once
you're on this medication, youyou see that, whatever it is,
and it doesn't give you thatdopamine release.
So the behavior changes.
Michele Folan (22:39):
Okay.
And then in terms of othermetabolic markers beyond the
number on the scale, what otherareas do you see improvement in
with patients on GLP1s?
Rocio Salas-Whalen, MD (22:52):
Well, definitely decreasing their
visceral fat, decreasing thepercentage body fat.
And what I work really hardwith my patients is to maintain
or build muscle mass with aGLP1.
So being, I think that'sanother myth and misconception
is that being on a GLP1, youit's like a death sentence for
your muscle, right?
You you just be prepared,you're gonna lose 30, 40% of
your muscle mass.
That is not true, and that'sthe poor guidance of whoever is
(23:15):
prescribing you this medication.
Because in fact, patients canmaintain and build muscle while
taking a GLP1.
And I have patients in their70s that they build muscle mass.
So there's no age limit in whenyou can uh build muscle.
Michele Folan (23:34):
You highlighted the other day a patient who only
lost 17% muscle.
And that was a great number forher because many patients, if
like the industry average, youcan hear 30, 40%.
Is that typically what theindustry average would be
without getting any kind oflifestyle coaching?
Rocio Salas-Whalen, MD (23:55):
Yeah, definitely.
They're gonna lose asignificant amount of muscle.
And then the problem is thatyou lost your metabolic organ,
you lost your glucose-consumingorgan, you lost your burning fat
for energy organ, and now youare causing chronic inflammation
from not having muscle mass.
(24:16):
So you may end up worse inmetabolic health than when you
started if you lose that amountof muscle.
Michele Folan (24:23):
All right.
I do want to talk a little bitabout side effects, the any kind
of risks.
So we've heard, we've heardhair loss, we've heard ozempic
face, gastroparesis.
How do you help patientsnavigate all these things
safely?
Rocio Salas-Whalen, MD (24:40):
By starting slow and steady, right?
By seeing my patients often, byhaving an open line of
communication, by doing a verythorough medical history and
know what works for the patientand how to guide them according
to their lifestyle.
I don't like to do anythingextreme in my patients in
(25:01):
regards to diet and and exercisebecause I find that is not
sustainable long term.
And and mentally they just wantto do it until the end gold,
and then again, it's notsustainable.
So I really like to make uhthings as easy as I can for my
patients.
Michele Folan (25:20):
Do you have a certain like amount of protein
that you would like them to eatevery day?
Rocio Salas-Whalen, MD (25:25):
Yeah, women, what I've seen, because I
do body compositions on everysingle patient, every day,
multiple times a day for thelast more than 10 years.
What I've seen that works in inregards to maintenance is
around 100 grams of protein perday in women.
In men, it goes a little bitmore higher, like around 40,
(25:47):
150, right?
That's to maintain, that's notto not lose muscle, but to build
muscle, you need to do theweightlifting and potentially
keep maybe a little bit moreprotein.
Michele Folan (25:59):
Okay.
Have you had to address hairloss with any patients?
Rocio Salas-Whalen, MD (26:02):
Yeah, definitely at the beginning.
While I was also figuringthings out as I go, because we
didn't have any guidelines,right?
Patients that lose muscle willlose hair.
Patients that lose hair arelosing muscle because it all
comes from the samemacronutrient, which is protein.
So patients that are consumingthose hundred grams of protein a
day, they don't have muscle uhhair loss.
(26:25):
So definitely it's preventable.
Michele Folan (26:28):
Okay.
That is so good to know becausewomen in midlife already feel
like their hair is thinning.
And if you add that on top ofit, that will stress them the
heck out.
So, all right, that's a goodone.
There's so much buzz right nowaround microdosing.
And when is that appropriate?
When when would you have apatient microdose?
(26:50):
And who is it not for?
Rocio Salas-Whalen, MD (26:53):
I would microdose a patient that is
extremely sensitive tomedications.
And I choose for whatever theirmedical history to start them
on tirzepetide, right?
Because it's better tolerablethan semaglutide.
It causes almost zero to nonenausea.
So that's my that's mypreferred drug at the moment to
(27:13):
start a patient.
But even the lowest dose ontirzepitide, which is 2.5, is
pretty strong, right?
I've I've had patients lose 30,40 pounds even on the first
dose.
So if I have a patient that I'mnot looking for a significant
amount of weight loss, orthey're they're very sensitive
to medication and they'rescared, frankly, scared, I may
(27:34):
do half a dose for a few weeksand then move them to the
regular dose.
But most of what I considermicrodosing useful is for
maintenance, not for becauseremember, we have to remember
that in the studies, theavailable doses that we have now
are the ones where the effect,the desired effect was seen,
(27:56):
right?
Glucose control for thediabetes uh uh indication and
weight loss for the the obesityand overweight indication.
So if you talk about amicrodose, well, we're not gonna
see the results that we'reexpecting to see.
And I think I never denied thebenefits of this drug, but my
only issue is if you need thedrug, use the regular doses,
(28:17):
unless of the the reasons that Imentioned before, right?
Uh but I think doing dosesbelow what we have available is
gonna be useful for maintenancemore than to getting patients
there.
Michele Folan (28:29):
And when you say tirzepatite, that is the GLP1
GIP combination?
Rocio Salas-Whalen, MD (28:34):
Yes, that's the dual increment.
Michele Folan (28:36):
Okay.
What do you predict then forlong-term use?
Rocio Salas-Whalen, MD (28:41):
Well, a lower dose for my patients
currently is the lowest dose oftheir medication long-term.
But I think with the oraloptions coming up soon, I think
oral will may be also a goodoption for maintenance.
Although I think for themajority of people, they've
gotten out over the hump of theinjection.
(29:02):
And for many, it's easier to doan injection once a week than
to take a pill every day, right?
Maybe if cost is significantlydifferent from the in the oral
from the injection, then maythat may be a reason to move
somebody to the oral formaintenance long term.
Also, there's a once a monthcoming maritide.
(29:23):
I think it's also from EliLilly.
And I think that's going to bean option for maintenance too,
doing an injection once a monthversus once a week or versus a
daily oral tablet.
Michele Folan (29:34):
I'm so curious how they're making this oral
because it's an incretin hormoneand you would think it would be
broken down quickly.
Rocio Salas-Whalen, MD (29:42):
Well, the thing is, what what I saw
with oral semaglutide in 2019when Rebelsis was approved for
type 2 diabetes, we have oralsemaglutide for six years now.
And the reason that Ipersonally don't use it in my
patients, and that the reasonthat it's not as popular and
never got as popular as Ozempicis because being oral that we
(30:04):
saw more gastric side effects.
I saw significant nausea.
It was hard to titrate uppatients because of the side
effects.
So it's going to be interestingto see what to expect with
orphoglyprone, which is the onefrom Eli Lilly, um, if if it's
(30:25):
going to have this, becauseorphoglyprone is not GIP and
GLP.
It's one GLP, it's likesemaglutide, right?
So we potentially may see thesame side effects.
So until we don't start usingit in masses clinically, if we
can and patients tolerate it,then we won't know until then.
Michele Folan (30:43):
Do you see GLP ones becoming a chronic
metabolic medication, kind oflike we have with statins?
Rocio Salas-Whalen, MD (30:50):
Yes, for sure.
It must.
Michele Folan (30:54):
All right.
You know, some of your mostimpactful content that you post
is around expectations.
The physical, the emotional,and also social.
How do you prepare patients forsome of the psychological side
effects of major weight loss?
Rocio Salas-Whalen, MD (31:15):
I think by doing it very slow and
reframing, reframing weight losswith the end goal of metabolic
health or body recomposition,that already has an effect on
the psyche of the patient,right?
Because it's not so much moreof a physical appearance, it's
more about how do I feel?
(31:36):
Do I feel strong?
Do I feel healthy?
That prepares better thepatient for when they reach this
new body recomposition, right?
And also if you do it slow as Ido, it also allows adaptation
to the new body, to thesurroundings, right?
Versus if you take somebody tooquick, too fast in a few
(31:58):
months, I mean their body evenhasn't adapted.
Their psyche even is going totake even longer to adapt,
right?
That's another reason why itshould be done very slowly and
steady to really improve thechances of success for the
patient.
Michele Folan (32:12):
Do you see other combination therapies?
So we already have GLP1 andGIP.
You know, there's likeglucagon, there's amylin um
analogs, those types of things.
What do you what do you see onthe horizon?
I really think it's soexciting.
Rocio Salas-Whalen, MD (32:29):
You know, I think I truly think
we're in diapers right now withthe with what we have.
It's just it's just somethingso new, even though it's not
new, but this is how long ittakes to for for the healthcare
system to incorporate things.
But I I think there's so muchinvestment in the study of new
drugs for obesity, right?
(32:51):
I think that's the that's thepriority pretty much for every
pharmaceutical, I think, at thismoment.
And everybody's trying to dotheir own cocktail, their own
recipe, and adding differentmedications, as you mentioned,
semaglutide with amylin.
Uh that's going to be aninteresting one.
And apparently they alreadyapply for FDA approval, right?
So that may come very soon.
(33:11):
Then we have the tripleagonist, which is GIP, glucagon,
and GLP1, which is Retatrutide.
That's also coming end of nextyear or 2027.
And then we have combinationwith muscle preserving
medications, right?
Which are anti clonalantibodies to prevent muscle
loss, which is anotherinteresting thing.
Uh so again, I think it's justit's just the race of who's
(33:35):
bringing uh differentcombinations of for the benefit
of the patient.
So I'm I'm really excited tosee what is going to become of
health, right?
We are going to reach placesthat before they weren't they
weren't reachable for manypatients.
And what I love, what I do inmy patients, is to give them
(33:56):
that view and that thatpotential to know or to explore
what their body can do, right?
Because for many patients,they're they just accept that
where they are, and this iswhere I am.
I uh getting out of the chairis painful, so this is all I'm
going to do.
But it's like removing thoselayers as they go through
(34:17):
through treatment, you and theystart feeling stronger, and
that's why muscle is veryimportant to incorporate it.
You you start seeing this sparkin the patient of like, oh,
what can my body do?
It can do this now.
Oh, I'm gonna start running fora marathon.
Oh, I'm gonna do a triathlon.
Oh, my body can take mehiking. So that that fills my
(34:39):
cup every single day.
Is when a patient starts tohave a glimpse of what their
body can do, I think there's noturning back for the patients at
that in that precise moment.
I I'm I'm tearing up right now.
And you know, giving peoplethat hope who have been hopeless
for years and years and years,and that they they may have a
(35:03):
life.
They may, they may live a long,healthy life, right?
And and this is what I don'tthink people quite understand is
not just the emotional strainof of the weight, but it is the
physiologic strain of thatweight is killing people.
(35:24):
And if if we can give themsomething that helps them at
least give them that jump startto say, you know, I'm empowered.
I am can in control now where Ican do this myself.
I can see why you love what youdo.
Thank you.
Michele Folan (35:42):
Yeah, fantastic.
And I want to talk about yourbook.
A huge congratulations on onthe the publisher's weekly
starred review.
Um, your book is calledWeightless, a doctor's guide to
GLP wanna make medications,sustainable weight loss, and the
health you deserve.
Why did you write it?
(36:02):
And who's the book for?
Rocio Salas-Whalen, MD (36:04):
For everybody.
The book is for everybody, andand I had everybody in mind,
both patients, both curiouspeople about the medication, and
doctors and providers who wantto prescribe it responsibly,
right?
I there's no competition, oh,you're gonna take away my
patients.
There's in this field ofobesity, the more I mean, we
(36:28):
need so many providers, but doit responsibly, educate
yourself, right?
Because otherwise you're doinga disservice to the patient.
And the reason that I wanted towrite this book is one, because
I wanted to everybody to hearwhat I was hearing from my
patients and and remove thatthat cons that preconception of
the lazy, ignorant patient thathas obesity, and if they wanted
(36:51):
to lose it, they already wouldhave done it.
They want to lose it and theytried everything.
So I needed people, evendoctors, to hear this because
that's not where we need to go.
And then the other reason isbecause I can reach to more
people and educate more peoplethrough a book than what I can
do in my one-to-one with mypatients and in my social media,
(37:15):
right?
So that's the reason I wantedto educate the population, even
if their provider is noteducated enough.
Michele Folan (37:23):
What gap in understanding did you most want
to fill with this book?
Rocio Salas-Whalen, MD (37:29):
Really, to validate patience.
That was my one rule that I hadwith my publisher.
I said, my book has to haveheart.
My book has to validate thatthose years of work of my
patients and the people that aregoing to read the book.
I wanted to rebuild trust,right?
(37:49):
Because I think due to thegaslighting and lack of trust
between physicians, patients andphysicians, specifically, and
that we this is very parallel towomen's health, but
specifically with people withobesity and overweight, right?
That the trust was brokenbetween the patient and the
doctor, and the doctor and thepatient.
It was just to reinstate thattrust and rebuild that trust,
(38:13):
right?
Also, I wanted to make patientsfeel empowered and that they
can also be participants of thisjourney, right?
And the educated patient doesbetter, right?
Because they become partner.
And what I found in my practiceis that patients want to be
educated.
They want to know, they wannalisten, they wanna learn.
(38:36):
The problem is the way that wepractice medicine in 10 minutes,
we don't have time to teach thepatient to us, answer their
questions.
So it becomes very it becomesvery automatic.
Uh cough, syrup, you know,blood pressure, here.
We don't we don't even askanymore, right?
We don't we don't want to knowthe why because we don't have
time.
I can fix it, but I don't havetime to understand it.
(38:57):
So with this book, I wanted togive that to the patients,
right?
The the the opportunity tolearn and and educate themselves
and understand why they're notlosing weight, why they have
obesity, and for them tounderstand that is not their
fault.
And then I also wanted to guidesomebody through the whole
journey, from the moment thateven they start thinking, could
this be for me, to the momentthat, wow, I'm here and this is
(39:20):
where I am.
How do I approach all these newthings that are gonna happen in
my life?
Michele Folan (39:25):
How exciting would it be for you to see a
patient like walking into theirdoctor's office with your book
under their arm?
Because you know that's what'sgonna happen, because they're
gonna highlight pages and say,well, Dr.
Salas Whalen says this.
What do you think?
Right.
Rocio Salas-Whalen, MD (39:40):
And and it's all the references are
there.
They're gonna say, here's thereference for this and this and
this and this, right?
I mean, again, I was very my mymy the proudest thing of my
book is that it's easy tounderstand for anybody who has
nothing to do in the medicalworld but evidence based backed
inside back with science.
Right.
(40:00):
So isn't that my opinion inthat book?
Is the science made very easyto understand and and to digest
and to bring to your doctor?
Michele Folan (40:10):
Yeah.
And you took science, you tookphysiology, even culture.
You put some real life patientstories in there.
What part of the journey areyou most excited for readers to
understand?
Rocio Salas-Whalen, MD (40:25):
Why they have obesity.
That's one.
And the other one is so theycan understand the psychology of
their weight in the head.
I mean, they of course theyunderstand it.
But how to let go of that too?
Because, and that's the titleof my book.
I want my patients to becomeweightless.
That's what I see a patient.
(40:46):
They come with the idea ofdropping physical weight, but
what happens in the journey asthey go, they drop trauma,
guilt, shame, right?
So this is what I want for mypatients to truly become become
weightless.
Michele Folan (41:02):
Yeah, because people's identity is shaped by
their weight.
And I I would assume that evenif a patient loses 80 pounds,
they still may be that obeseperson in a smaller body.
Rocio Salas-Whalen, MD (41:16):
Yes, and and they say this, I see the
body, but it's not me, right?
So that is a that's uh uhthings that we are not we're we
haven't been yet giving thosetools to our patients for with
weight loss.
We've been putting all of ourefforts in getting to a number
(41:37):
that what that would equalhealth, but we have done nothing
for the mental health of weightloss.
Michele Folan (41:43):
Yeah.
I love what you're doingthough, because I think that
you're you really are trying totreat the whole patient here,
which we're we just don't seeall that often in in the realm
of weight loss.
So this is fantastic.
And then for women listeningright now, what message from the
book do you want them to heartoday?
Rocio Salas-Whalen, MD (42:03):
Don't let fear make a decision for
you, right?
I see and I feel and I hear andI understand the fear of going
to a medication for weight loss.
You feel guilty, you you areafraid of potential side
effects, you are afraid becauseof the headlines that you're
seeing.
Make a decision informed, makea decision based on facts and
(42:29):
science and not on fear.
Michele Folan (42:32):
Yeah, and stigma.
Rocio Salas-Whalen, MD (42:34):
And exactly fear, fear of shame.
Michele Folan (42:37):
Yeah, I mean, it's it's really what what what
will my friends think?
What will my family think thatI'm not strong enough to do this
myself?
And I really I really don'twant people to feel that way
about this class of drugs.
I mean, it's it's been so sowell studied.
Um and we and you know thesmart way to do this.
Rocio Salas-Whalen, MD (42:58):
Yeah.
Yeah.
It's just the problem with itis that if that's the on by the
own bias of people, right?
Of thinking of weight assomething superficial and
aesthetic.
Yeah.
That if if they say, well, I'mgonna use a medication to lose
weight, of course it sounds likeout of this world, like why
would you put your body throughmedication just to lose weight?
But they're they're missing thepoint that it's a medical
(43:20):
treatment for a complex disease.
That's the first thing we haveto accept that obesity is a true
disease and not a risk factorand not something aesthetically
unpleasant, right?
So if we understand that and weaccept that, we would not
question treatment for obesity.
Michele Folan (43:38):
Amen.
I love that.
Okay.
This is a personal question.
What is one of your dailynon-negotiables for your own
metabolic and mental health?
What do you do for yourselfevery day?
Rocio Salas-Whalen, MD (43:50):
Walk.
I live in New York City, andfor me, walking is very
important.
Having my coffee in the morningquiet before my kids wake up.
If I don't have that, like Ifeel like I don't start my day
well.
It's just like I need toregroup in the in the morning,
write down my ideas that I havefor the day, and that's like and
(44:12):
and starting my day withprotein for sure.
Michele Folan (44:14):
Okay.
Oh, love it.
All right, we got the thetriple whammy there.
All right.
What do you wish for everywoman under 40 to understand
about her metabolism right now?
Rocio Salas-Whalen, MD (44:27):
That it's changing, that your
hormones are not going to makeit easy for you and all the life
events that I mentioned, butthat you have options.
Michele Folan (44:40):
Yeah.
Rocio Salas-Whalen, MD (44:41):
That for the first time in two decades,
women our age and mid middleage, we have options that our
mothers didn't have.
Right?
We have hormone replacementtherapy, we have testosterone,
now we have GLP1 medications.
So be proactive.
Be proactive in your optionsand and remove that idea that
(45:01):
you have to earn them withsuffering, right?
And also, what I tell mypatients here is never accept
anything less than feeling 100%.
Because you can, because now wecan.
Now we have the tools to forthat to happen.
Don't accept not sleeping,don't accept not having a sex
(45:22):
life, don't accept feeling tiredall day.
Don't, don't.
You don't want to live likethat for the next 40, 50 years.
No.
Michele Folan (45:29):
A woman after my own heart.
Rocio Salas-Whalen, MD (45:33):
Yeah.
Fight for that 100%.
Fight for that 100%.
Michele Folan (45:37):
Fight for the 100%.
Did you all hear that?
I hope you did.
Dr.
Rocio Salas Whalen, where canthe listeners find you, your
practice, and your book?
Rocio Salas-Whalen, MD (45:49):
They can pre-order my book in Amazon,
Barnes and Noble, anywhere whereyou can buy book.
It's Weightless, that's thename, or Weightless.com is also
the website where you canpre-order the book.
And I am in social media andInstagram mostly, almost
exclusively.
And my handle is Dr.
Salas Whalen,D-R-S-A-L-A-S-W-H-A-L-E-N.
(46:13):
And also I practice in New YorkCity in Upper East Side.
And the name of my practice isNew York endocrinology, and
that's where I see patients.
Michele Folan (46:24):
Wonderful.
What an incredible conversationtoday.
Dr.
Rocio Salas Waylon, thank youfor being a guest on Asking for
a Friend.
Rocio Salas-Whalen, MD (46:34):
Thank you for having me.
Michele Folan (46:36):
Before you go, thank you for being here.
If you want to go a littledeeper, make sure you check out
the show notes for this episode.
That's where I link anything wementioned, resources, partners,
or tools I actually use andtrust.
And if you're not already onthe Asking for a Friend
community newsletter, that'swhere I share practical midlife
tips, favorite finds, recipes,and the things that don't always
(47:00):
make it onto the podcast orInstagram.
You'll find the link to join inthe show notes.
Take care, and I'll see younext week.
Popular Podcasts
Betrayal Weekly
Betrayal Weekly is back for a new season. Every Thursday, Betrayal Weekly shares first-hand accounts of broken trust, shocking deceptions, and the trail of destruction they leave behind. Hosted by Andrea Gunning, this weekly ongoing series digs into real-life stories of betrayal and the aftermath. From stories of double lives to dark discoveries, these are cautionary tales and accounts of resilience against all odds. From the producers of the critically acclaimed Betrayal series, Betrayal Weekly drops new episodes every Thursday. If you would like to share your story, you can reach out to the Betrayal Team by emailing them at betrayalpod@gmail.com and follow us on Instagram at @betrayalpod and @glasspodcasts. Please join our Substack for additional exclusive content, curated book recommendations, and community discussions. Sign up FREE by clicking this link Beyond Betrayal Substack. Join our community dedicated to truth, resilience, and healing. Your voice matters! Be a part of our Betrayal journey on Substack.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com