Re-Run – Back by Popular Demand!
In this encore episode, Dr. Rocio Salas-Whalen, board-certified obesity medicine specialist, joins us to break down the real pros and cons of Ozempic — the blockbuster weight loss drug making headlines. We dive deep into how Ozempic (semaglutide) works, who it's really for, what side effects you should know, and whether it’s a sustainable solution for obesity.
With misinformation everywhere, Dr. Salas-Whalen brings evidence-based clarity to one of the most controversial treatments in modern medicine. If you missed it the first time — or need a refresher — this rerun is back by popular demand for a reason.
In this encore episode, Dr. Rocio Salas-Whalen, board-certified obesity medicine specialist, joins us to break down the real pros and cons of Ozempic — the blockbuster weight loss drug making headlines. We dive deep into how Ozempic (semaglutide) works, who it's really for, what side effects you should know, and whether it’s a sustainable solution for obesity.
With misinformation everywhere, Dr. Salas-Whalen brings evidence-based clarity to one of the most controversial treatments in modern medicine. If you missed it the first time — or need a refresher — this rerun is back by popular demand for a reason.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Body Pod. Today we are rerunning one
of our favorite and most popular episodes from twenty twenty four,
which is with doctor Rossio Salas Whalen on all Things
GLP ones and obesity treatment. Now, while this episode is
more than a year old and lots of research has
come out since this airing, we will be having doctor
(00:24):
Whyalan on in a upcoming course of mine this fall.
Enjoy this rerun with doctor Whalin.
Speaker 2 (00:31):
Hi everyone, my name is Haley and this is Lara,
and welcome.
Speaker 3 (00:35):
To the Body Pod. Welcome everyone to the Body Pod.
I am so honored to have our special guest today,
doctor Rossio Salas Whalen, who is a triple board certified
end yourcinologist and obesity specialist practicing in New York City.
(00:58):
So welcome dot Org your Waylan.
Speaker 4 (01:01):
Thank you so much. I'm so happy and excited to
be here with both of you.
Speaker 3 (01:06):
We are so excited. And U you're on vacation. Are
you on vacation?
Speaker 1 (01:09):
Are you?
Speaker 5 (01:10):
I'm with my kids.
Speaker 6 (01:12):
She's just showed us the view and Haley and I
are so envious that we're not there doing it.
Speaker 2 (01:19):
I know, I'm so mad.
Speaker 3 (01:22):
I'm going to come see you in New York though,
I'm going to take you to lunch when i'm there next.
Speaker 7 (01:25):
I was just there.
Speaker 5 (01:26):
Please please please let me know when you're in the city.
Speaker 7 (01:29):
Yes, let's go. Yeah time Hill.
Speaker 3 (01:32):
Oh I just was there a week ago. Yeah, a
week and a half ago. So anyways, next time I'm there,
I'm going to hit you up. But anyhow, welcome, welcome, welcome.
We have so many questions to cover, so today everyone,
we are talking about all things sema, glue, tide, and
(01:52):
the obesity epidemic that we are facing. So doctor Whylan
is one of the top, if not I would say
the top in her field, definitely for me, that owns
a practice in New York City. So I'm just curious.
Can you just give us a little background about you know,
(02:14):
how long you've been practicing, what made you get into
this specific area. I'm so curious about that.
Speaker 5 (02:20):
Yeah.
Speaker 4 (02:21):
So I've been practicing since twenty ten when I finished
my specialty. And you know, fourteen years ago, we didn't
treat obesity, or we didn't talk about obesity as we
talk about it now. In fact, we didn't have a
specialty back then in obesity, right, it was into chronology
and that's the reason that I went into chronology was
(02:44):
to work on metabolism. I was always interested in type
two diabetes and its relationship with weight, right, and how
if you control one, you would control the other one.
Speaker 5 (02:58):
And then obesity.
Speaker 4 (03:00):
Then we started having medications for weight loss, and I
think that opened a huge Pandora box, right that for
the first time we could offer patients something that actually worked.
And then it just my path became more obesity and
weight loss and not so much type two diabetes.
Speaker 3 (03:24):
Oh well, I want to start with this staggering statistic
that I heard you say that by the year twenty thirty,
the World Health Organization estimates that fifty percent of the
world population will have obesity.
Speaker 2 (03:39):
Yes, I mean that is like so scarce, so terrified.
Speaker 5 (03:45):
It is it is that we have.
Speaker 4 (03:48):
And including children, right, I mean I think that's that's
the biggest difference in future statistics, is that it includes children,
and those children will become adults with obesity.
Speaker 5 (04:03):
Right.
Speaker 4 (04:04):
So we're not talking in the next seven years, We're
talking in the next decades.
Speaker 3 (04:09):
Right, But do you do you think that America is like,
is America the worst?
Speaker 5 (04:17):
America is not the worst.
Speaker 4 (04:19):
The worst is the middle East right now, in certain
countries in Latin America, Mexico unfortunately, it is also very top.
But definitely the United States is i believe is number
three or number fourth in regards of world obesity, which
is pretty hard.
Speaker 6 (04:37):
And obesity is do you find it growing because of
food quality or habit And obesity is a disease, so
some people technically are born with it also, correct.
Speaker 4 (04:54):
Yes, so what we There's a lot of recent published
papers showing that prenatal mother's weight impacts the weight of
the offspring in the future. Right, so even your weight
preconception is going to impact the future of your future children.
(05:17):
So we're going even back then, right. And then we
live in a very industrialized world. We live that we
call obesogenic environments. Right, Everything in our life, from food industry,
the chemicals working from home promote obesity, right or make
it difficult.
Speaker 5 (05:36):
For people to lose weight.
Speaker 4 (05:39):
So if you think about it, I feel like we're
set for failure.
Speaker 6 (05:42):
Right.
Speaker 5 (05:43):
It's a very difficult.
Speaker 4 (05:45):
Fight to win against everything else that is promoting waking
and obesity becoming part of our genes.
Speaker 3 (05:54):
Literally, Ah, this is okay, And I think that a
lot of it has to do with I mean, you're
in New York City. I lived in New York City
for a hot minute. But when people can feed their
family at Taco Bell for twenty five dollars, I mean,
I know, New York City has made like the fruit
stands outside of the actual you know, grocery stores, you
(06:17):
can get decent, you know, really good pricing on that.
But I mean some places in the southeast, I mean
there's there's just a lot like it's easier to feed
your family at McDonald's.
Speaker 2 (06:30):
I mean that's a problem.
Speaker 4 (06:31):
And you know, I mean New York City is changing.
I remember when I moved to New York City.
Speaker 5 (06:37):
You could see you didn't see so much of the city.
It wasn't it wasn't there.
Speaker 4 (06:42):
But now there are Taco Bells next to the subway station.
There's Dunkin Donuts, there's Chick Filey, there's McDonald's, there's Krispy Kreme,
and they become so popular that even there's lines outside
those restaurants. Right, So, and New York City is different
now you can see how much more in regards to
(07:06):
a bcity has changed New York City. And we're a
city that we walk and we take the stairs and
we take the subway.
Speaker 5 (07:13):
But even with that, the.
Speaker 4 (07:15):
Food industry it's really really making it very difficult.
Speaker 6 (07:20):
Yes, yeah, we're having to overcome the food industry, but yeah,
convenience and.
Speaker 7 (07:25):
The quality of food and rice just yeah, I'm price huge.
Speaker 4 (07:32):
You can ask a family, a single mother that is
working two jobs and has two three kids to buy
organic and buy everything clean, and I mean it's expensive.
Speaker 3 (07:48):
So this is really interesting because I run like fat
loss courses throughout the year and it really.
Speaker 2 (07:56):
Is just an eduction. It's an education course.
Speaker 3 (07:59):
I mean we walk every one through it, but it's
just like giving all like taking out all the bs
of you know, everyone that's like do this, do this,
eat this, don't eat this, and just really being like,
this is what the evidence says, you know, in this area.
Speaker 2 (08:13):
And we cover that.
Speaker 3 (08:14):
But I can't tell you how many women come in
and they're like, I'm really not eating that bad and
I just keep put like packing on the weight.
Speaker 2 (08:23):
And it's so hard.
Speaker 3 (08:24):
Because the food industry, as you said, I mean it's like.
Speaker 2 (08:30):
It's made to taste good.
Speaker 3 (08:31):
Yeah, and all of these processed foods like where we
actually don't get full on them, and the brain doesn't
get the message to stop eating and all of that.
I mean, it's just fascinating because women come to me
all the time. They're like, I'm just like I'm done,
I'm done, Like I really, I'm exercising, I'm doing this.
And that's what's hard, is you just a lot of
(08:53):
it is we don't know the calorie content in our
foods as well, and we go to I mean, if
you're eating these restaurants or fast food places that I
call America the Land of Convenience, that are just anywhere
you go, it's really hard to be like, well, you know,
I'm really not eating that much, but what consists in
(09:14):
those calories? And and you know and yes, well and
and the I think the stigma that obesity is strictly like, well,
you just need to have more will power. I mean, like, no,
that's not that's not it.
Speaker 5 (09:32):
I see that.
Speaker 4 (09:33):
I'm talking about the food industry. Like I have a
lot of patients that are from different countries that they
coming from here, They're coming from Asia, they come from
and they all have the same story. They all gained
twenty thirty pounds when they move to America, do they not?
Speaker 2 (09:49):
Yes?
Speaker 4 (09:50):
Not surprising every single patient that I see, like in
that came immigrated here is the same story they gained
twenty thirty forty pounds of way right, And and yes,
I mean we know now that obesity is a chronic,
multifactorial disease, right, So it's not a problem of willpower.
(10:11):
I do feel I do think that the food industry
one day will become accountable for producing the statistics that
we have in obesity worldwide, right like this, like the
tobacco industry at one point. I feel like it's going
to be it's going to be the same. Hopefully one
day it will be. Because we talk about many solutions,
right and including way thot medications, but really the main
(10:34):
solution is changing.
Speaker 5 (10:36):
What we eat.
Speaker 4 (10:37):
Right, That's a huge part, and we have we have
little control, but but we haven't lost of control. I
always tell education is going to be our biggest weapon
against the food industry, right because the less we know,
the more they can control what we eat. The more
(10:57):
we know, the more we can sum how control what
food choices we make. So we still have some control
on it.
Speaker 6 (11:06):
So if I'm a client of yours, and for example,
what you just said, if I'm a patient, I come
to you I'm thirty sixty pounds overweight?
Speaker 7 (11:20):
How do you address And I know everyone is different,
but what.
Speaker 6 (11:25):
Are the things before you know ozembic and all of
the medications in that family you know, or before you
treat them with that? What do you do to address
the situation besides what you just said educating educating them?
Speaker 4 (11:42):
So first I take a very thorough family history, right,
I ask all my patients, all of my patients the
same question, at what age did you were you conscious
about your weight? Or at what age you being careful
of what you ate?
Speaker 5 (12:02):
Right?
Speaker 4 (12:03):
At what age did you stop being unconscious about how
you look or your weight? And the majority have the
same nine years old? Eight years old?
Speaker 7 (12:12):
So young, that's heartbreaking.
Speaker 5 (12:14):
Tell me.
Speaker 4 (12:15):
I was put on my first diet at nine, I
had my first personal trainer at twelve. I was sent
to fat camps since twelve. So I just want to
see how far back in the patient's history was this
something of an issue, right, because then that tells me
how complex the disease is, how complex the obesity is,
(12:39):
and how little or not is lifestyle involved in this
patient's life.
Speaker 5 (12:46):
Right.
Speaker 4 (12:48):
So it's doing that, doing a family tree, right, I
want to know what's the weight history of the mom,
the dad, the siblings, even the grandparents, the uncles, just
to see where is.
Speaker 5 (12:59):
This coming from.
Speaker 4 (13:00):
And I would say in seventy eighty percent of my patients,
there's always some family inheritance of obesity.
Speaker 6 (13:07):
So it's like seventy to eighty percent is kind of
a genetic.
Speaker 4 (13:11):
Kind there is either coming from the father or the
mother's side, and there's impacting their weight, or that there's
a history of struggling of weight in one side of
the family or sometimes in both families.
Speaker 6 (13:22):
Right.
Speaker 4 (13:23):
Then definitely a medication list. I mean there's some medications
that can promote waking until the presence blood pressure medications,
some anti diabetic medications like insulin can promote waking too.
And then going into their lifestyle, their work, their sleep patterns, right, exercise,
what are there exercising? What normally they eat? I tell them,
(13:46):
tell me what you ate for breakfast, yesterday, lunch and dinner.
I just want to get a sense of really deep,
deep dive, dive deep into the patient's life and where
can there be twigs if any? But for the majority
of patients, it's something very humbling that I learned through
(14:06):
practicing obesity medicine is that the majority of patients with
obesity or struggling with weight, they're doing everything they can right,
They're exercising, they're eating healthy, they've tried hundreds of diets.
Speaker 7 (14:21):
I mean, it's they've been on a diet since they're nine.
Speaker 4 (14:24):
It's really sad. And it's when you hear somebody's even
from childhood weight and they're eating and their food in
front of them. It's twenty for seven, a full time job, right,
it's everything that is in front of them. How is
this going to impact my weight? Am I going to
(14:47):
feel guilty after I eat it? Am I not going
to feel guilty? Or how can I compensate? And it
becomes a mental health draining right from their weight. So
it's really unfair, and I always try to speak this
very out loud, is that we.
Speaker 2 (15:04):
Had it wrong.
Speaker 4 (15:05):
Patients are not the couch potato that we're thinking, and
that we have the idea that they're just eating, they
don't care and they're just gaining weight.
Speaker 5 (15:12):
It's quite the opposite.
Speaker 4 (15:14):
Patients with ob city, No, they have obesity, they want
to lose weight, they're trying to lose weight, but it's
just not happening.
Speaker 3 (15:22):
This is I remember I reposted something that you had,
like something on your Instagram months ago that said, imagine
the noise that's constantly going on in their head? What
am I going to eat? What is it going to
do to me? How is it going to impact my weight?
Constant noise, like it's exhausting to think about an.
Speaker 5 (15:44):
A every day?
Speaker 6 (15:45):
Yeah, consuming which then affects how you show up every day,
your mental.
Speaker 4 (15:50):
Health, mental health, your mental space, the mental space that
this occupies in people with ob city, overweight or struggling
with weight, it's a huge part of their of their
mental space that you can that you can think, what
would happen.
Speaker 5 (16:05):
If we take that out, right?
Speaker 4 (16:08):
What what are the possibilities to occupy that other mental
space that is being occupied by the constant thinking.
Speaker 5 (16:15):
Of their weight and food? Mm hmm.
Speaker 7 (16:19):
Yeah.
Speaker 4 (16:19):
And it's something that well, you don't realize because in medicine,
as doctors, we hear, we learn about the pathology, like
the doctor side or what we can do, but we
never learn about what the patient is going through. Right,
we don't hear those stories that I hear every day
in my clinic. Right, is that that it makes you think,
like Wow, we've been telling patients go eat less, exercise more,
(16:44):
and that's all they've been doing all the time.
Speaker 2 (16:48):
Well there's another.
Speaker 3 (16:52):
I messaged you a few months ago when I was
doing a podcast with I don't know if you're familiar
with doctor Bill Campbell, but he's an in the fitness
world and he was just doing like the research on
ozepic and semaglue, tide and all that, Like that was
just the purpose of like, here's all of the current
(17:12):
research that we have. And so I reached out to
you because I mean when I put it on, I
was like, holy cow, this is a polarizing topic because
people were like, you know how they're taking it away
from type two diabetes and just freaking out. I was
like I'm the journalist here, like I'm not the one
(17:33):
taking it away. But I remember I reached out and
I was like, what's your like, what's your view on this?
Speaker 2 (17:39):
And you you said that.
Speaker 3 (17:42):
There's seventy two million people that were obese I mean
a few months ago, versus forty one million people with
type two diabetes. So it comes down to can you
explain that? Because I was just like, this is it
right here?
Speaker 4 (17:57):
So this Mady case, this class of drops our impretense
glp ones. They were designed for type two diabetes and
it's a really I like the.
Speaker 5 (18:07):
Story of how it was discovered.
Speaker 4 (18:09):
It was in nineteen ninety four by an endochronologist and
researcher at the VA Hospital in the Bronx in New York,
doctor John Ng And he was studying the Gila monsters,
which are lizards from the south from the southwest, and
the Gila monster in its prey, they killed its prey
causing puncretitis. So doctor Ang wanted to know what in
(18:34):
the venom of the Gila monster causes puncretitis, what effect
does it happen the pancreas, and that's how he isolated
the first YELP one called accentotide back in nineteen ninety four,
So thanks to him we have this evolution of the
DLP once.
Speaker 5 (18:52):
And then in two thousand and five.
Speaker 4 (18:54):
Was the first FDA approved GLP one made from eccentotide
what he had isolated from the gillamnster, and it was
named Bayeta, and that was a daily injection before.
Speaker 5 (19:07):
Breakfast, thirty minutes before breakfast.
Speaker 4 (19:08):
And thirty minutes before dinner, and then after that Bayeta,
came Victosa, which was once a day injection, and then
twenty seventeen ozampek or semaglutide, which is once a week injection.
But when in twenty ten when I started practicing Victosa,
which is leraglutide also for nov northisk was fdata profer
(19:30):
type two diabetes, and I remember started using it in
my patients and they were coming back with better glucose
control and weight loss, which was the first time that
we were seeing that in a medication, because most medications
for diabetes promote waking actually, but this drug only asking
your pancreas if your sugar is elevated, so you actually
(19:52):
have to have diabetes to work as an anti diabetic drug,
meaning they don't cause hypoglycemia on somebody who doesn't have
diabetes like insulin. Right, if you've given to somebody who
doesn't have diabetes, the sugar is gonna drop, but they.
Speaker 5 (20:07):
Can they can past, they can die. But in cretains
LP one, your sugar is normal.
Speaker 4 (20:13):
It's not going to touch the pancres it's just going
to pass it next to it. But then we get
the benefits of the whales and that's when we started
using it off label, including myself, back in twenty ten
for whals independent of type two diabetes, and then in
twenty twelve it was fdat approof for whals. So these
medications have the f data approval for whales since two
(20:37):
thousand twelve.
Speaker 7 (20:38):
So it really isn't just for diabetes.
Speaker 4 (20:40):
It's not only for type two diabetes. We have clear
FD eight guidelines for whals independent of diabetes. What they
did the pharmaceuticals they changed the name bictosa to saxenda,
ozampic to Wegobi and now Munjaro to set down same drug,
same molecules, same pharmaceuticals, same dosing, same pen just different
(21:01):
names for different indications.
Speaker 2 (21:04):
Oh that's so interesting.
Speaker 3 (21:06):
So okay with when people are looking at this, I think,
I mean, I'm in the you know, personal training fitness world,
but when I have clients come to me, they're like, well,
I kind of am interested in this, but you know,
I don't want to have another fan fan of the
nineties where people are really free that there's going to
(21:26):
be all of these you know, side effects that come
out in ten twenty thirty years. Do you think that
there are some or what? What do you think of
the side effects.
Speaker 4 (21:37):
So I mean and long term, going back to what
I just mentioned, I mean, we have close to thirty
years of data on this class of drugs.
Speaker 5 (21:45):
Right.
Speaker 4 (21:47):
The newer versions are newer generations, but with the same
concept back in nineteen ninety four. Right, So we have
enough data on these drugs to know it's safety.
Speaker 5 (22:01):
Now.
Speaker 4 (22:02):
I say this, and I said it multiple times, and
I said to all my patients, the safety of these
drugs and even the effectiveness the benefits of it will
depend on how much expertise who's giving you this drug
on them half. Right, If I start prescribing medications that
(22:25):
I don't have much experience, just because I'm a doctor,
I can prescribe chemo drugs, I'm going to create more
harm than actual benefits. So those side effects that.
Speaker 5 (22:35):
We're seeing now that that were not reported in all
the control studies are being caused by providers.
Speaker 4 (22:42):
That don't have experience on this medication, right, that don't
know how to lead the patient's journey with this drug.
Because every patient is different, one may work for one
may not work for the other one. So every treatment
should be very individualized to their lifestyle, to their necessities,
to their way to their other medications that they're taking.
Speaker 5 (23:06):
But when you don't do that, then you run.
Speaker 4 (23:08):
The risk of creating side effects that were not expected,
that were not seen in the control studies, Patients that
are not being followed properly, right, patients that are not
guided the right way. And then sometimes we have patients
that want to get results too fast and they may
overrun our recommendations.
Speaker 5 (23:28):
Then we're going to see other side effects.
Speaker 4 (23:30):
Right, So I feel like all those side effects that
we're seeing are really caused by improper use of the medication.
That makes sense, even and this is talking long term
and short term side effects.
Speaker 6 (23:42):
Right, And if people that are obese, there are so
many risks and problems that help issues that come from that.
And a lot of people I know that have gone
on the medication and have lost a lot of way,
they actually are so much healthier now and issues health
(24:06):
issues they were having are now they aren't concerned. They
aren't concerned anymore. So it seems that the benefits far
out weigh anything than not taking it right.
Speaker 4 (24:21):
Definitely, So we know there's more than sixteen cancers related
to obesity. Even now we're seeing more breast cancer related
to obesity than genetics, right, colon cancer, stomach cancer, thyrol cancer,
pancreatic cancer. We see more of that with obesity than
from the medications that we're hearing that right, These medications
(24:41):
really are going to change the way that we practice
medicine because I feel like in the next two three generations,
we're going to have less chronic diseases, much less type
two diabetes, less different types of cancers related to obesity.
So really we are exchanging one drug for a long
(25:01):
list of other medications or other health problems.
Speaker 6 (25:05):
Do you think okays drug class will help the obesity epidemic?
Do you think that it could actually really drop the
numbers and make a change in this world.
Speaker 4 (25:18):
I think that prediction of the who that twenty thirty,
I feel like that is going to be less thanks
to our current treatment that we have for obesity.
Speaker 2 (25:32):
It's so interesting.
Speaker 3 (25:33):
I mean, coming from the fitness world, I know that
I've been on a lot of like in groups where
we're discussing this because it's changing the fitness world.
Speaker 2 (25:44):
Absolutely.
Speaker 3 (25:45):
People are getting more comfortable to come into the gym,
you know, making a lot of changes, and there's of
course pros and cons on both sides of the issue.
But the conside would be trainers that are like, well,
now everyone's just taking it. It's super easy and they're
not actually learning, you know, the proper education and the
psychological component. But I'm going to guess that this is
(26:09):
where you're going to say, well, it comes down to
the provider. If someone at the next to the Walmart is,
you know, prescribing this drug that has no experience, just
for the sake of financial gain, then that's not helping either.
What what's your opinion on that?
Speaker 4 (26:27):
Definitely, I think in regards to the fitness world, I
see something happening in my practice and I foresee that
this is what's going to happen, is that people are
going to start exercising for.
Speaker 5 (26:46):
Us and not for weight loss. I think that I
feel like that's huge.
Speaker 4 (26:53):
And it makes me so happy when I see patients.
I started going to the gym because one thing, I mean,
you're more self confident. Number one, when patients start losing weight,
you're more flexible, you're more movable, you're not short of breath,
you physically can perform better, right, and then patients, it's
(27:15):
very amazing to see the journey of patients they come
with the concept of wanting something external right, to look
certain certain way, to feel a certain way.
Speaker 5 (27:27):
And then halfway of the journey, when we.
Speaker 4 (27:31):
Because I always talk about muscle protein, it flips. They
start to feel healthy, they start to feel strong, and
it becomes a fitness journey and not a weight loss
journey anymore So, more than ever, I feel people are
start going to embracing exercising for the right reason and
(27:53):
not for the weight loss right because for the weight
loss you always see it as something temporary, as a punishment,
and you're exercising because you feel better, you want to
extend your longevity, you want to feel healthy. Then you
adapt it. It becomes part of your life. So I
think it's a very positive shift that you trainers are
(28:17):
going to see people coming in for the right reasons.
And not that everybody doesn't, but the majority of mentality
is exercise to lose weight, because that's what we we're
teaching before. That's changing, and more than ever, I feel
like the medical community and the personal trainer business we
have to be more in a allions than more because
(28:40):
together we're going to make the patient healthy and fit right.
More than ever, I've never recommended to my patients to
go to the gym or personal trainers as much as
I'm doing every day.
Speaker 3 (28:52):
Now, well, I do have to say it's you know,
I have women coming into my courses all the time,
either one on one or in these groups that I
run multiple times a year. And when I'm running the numbers,
like I always like, there's always a couple of obese
people that come into the group, and emotionally, I am like,
(29:17):
I don't want this to be another source of failure
for them, because so this is totally I mean from
my point of view when I've been on these you know, panels,
I'm like, this this only helps us because it's giving
someone that they're then they're like, okay, well i don't
have as much noise in my head. I'm seeing some change,
(29:40):
so now I can take on this education component or
you know, in the behavior change and habit change and
all of those things that are needed when someone starts
to wean off of the drug. Do you recommend I mean,
I know this is still fairly new and this may change.
Do you have like and somebody beyond this for the
(30:01):
rest of their life or is the goal to get
them to a place where you're like Okay, we're going
to wan you off, but the habits, the behaviors, the
education has to be there as well.
Speaker 4 (30:12):
So if we go back to what obesity is that
it's a chronic disease, and chronic diseases we don't cure, right,
we control. So the idea with these medications is that
they're designed for long term use. And one I think
it's a I think we should shift it as a
positive thing and that as a negative thing because for
(30:33):
the first time we have something that's going to help
you maintain the weight loss right, because many things can
probably take you there, restrictive diets, but the moment that
you stop or that you're left on your own is
when the weight regained happens. So with these medications, we
can not only take you to your goal, but we
can help you keep you on your goal.
Speaker 5 (30:52):
They're safe to be used long term. If we're talking
about safety.
Speaker 4 (30:56):
Now, weight loss medicine is very new you and a
lot of things are changing and we're learning as we're doing.
And if I can talk about my personal experience with
my patients, those patients are able to maintain their muscle mass,
those patients that are able to gain muscle mass have
(31:20):
more probability to maintaining the weight loss at the lowest
dose possible or with maybe no medication. Right because whenever
you hear oh losing weight slows down your metabolism. The
reason for that is because you lose muscle with weight loss, right,
with any and this is not exclusive to samagutai, This
(31:40):
is not exclusive to any other drugs that we're talking.
Speaker 5 (31:43):
This is just exclusive of dieting patients lose muscle.
Speaker 4 (31:47):
Muscle is our most and you know this muscle is
our most metabolic organ, right, It's our burning machine. It's
our burning calorie machine. So if you lose it while
you're losing weight, that's what's slowing down your metabolism. But
when you're losing the body fat, you're maintaining your muscle
or even gaining muscle. That becomes part of the maintenance
(32:08):
for the weight loss.
Speaker 3 (32:10):
Yes, and I think it's interesting too that a lot
of you know, young trainers or just people not even
in the profession, think that there it's shocking to think
that like someone who is obese they carry a lot
of muscle mass, they also carry a lot of fat mass,
(32:31):
but it's assumed that they just don't have a lot
of muscle mass and that's not the case.
Speaker 4 (32:36):
Well, it's interesting because research has shown that yes, people
with obesity have more muscle masks, but it's not healthy,
all healthy muscle mass because there is fat in between
the muscle vibers. So it's not necessarily that their metabolism
is higher because they have so much muscle. Their muscle
(32:57):
is not the same when it's lean muscle.
Speaker 2 (33:01):
Okay, that's the ticket, right exactly, So.
Speaker 6 (33:04):
When you're on this medication, it really is way more
beneficial to strength train and work out while you take this.
Speaker 5 (33:13):
Medication one hundred percent.
Speaker 4 (33:16):
So and it's strength training what I recommend right at
Persistence strength training. It's important for many patients. It will
take time, It will take twenty thirty pounds of weight
loss before they feel motivated physically and mentally motivated to.
Speaker 5 (33:33):
Go to exercise.
Speaker 4 (33:35):
Right, But I always have that the initial consult is
always half of it is going to be exercise improtein
exercise and protein or exercise and diet doesn't replace the medications.
The medications don't replace exercise and dieting.
Speaker 5 (33:53):
It's hand in handfete.
Speaker 7 (33:56):
Yeah, need all of the components.
Speaker 6 (34:00):
Okay, so what about people that are taking it that
aren't Obyes, but they just have that like ten to
fifteen pounds and they just want to do it short
term and take it like patients that come to you.
Speaker 7 (34:17):
I mean, do you have any patients like that?
Speaker 5 (34:19):
Yes?
Speaker 4 (34:20):
And it's easy to say when somebody, oh, it's only
ten or only fifteen, only twenty pounds that I may
have to lose, and whenever I do a body composition,
it turns out that they have really highly seal fat
or they.
Speaker 5 (34:33):
Have more than ten pounds to lose.
Speaker 4 (34:36):
Right, So if we go by the number and the scale,
or we go by the BMI, I think we are
undertreating many patients that can be that should.
Speaker 5 (34:48):
Be treated, right.
Speaker 4 (34:49):
So I feel like it's not fair to say this
patient doesn't need it just by looking at them without
knowing their body composition.
Speaker 5 (34:56):
Right.
Speaker 4 (34:57):
And then for those patients that are doing what they
should and they still cannot lose those twenty pounds, then
I dig more deeper into how much is this consuming
your life?
Speaker 5 (35:10):
Right?
Speaker 4 (35:11):
How much is this take over your day? And for
some patients it becomes again a twenty four seven to
lose twenty thirty pounds or ten to fifteen pounds. Then
those patients, if they didn't do what they were doing,
probably they will need more pounds to lose. So those
patients would benefit from the medication, right because they're being
(35:32):
consumed by that. And if we put their perimenopause menopause,
then it's going to be classic that they're doing what
they were doing in their thirties early forties and it's
not happening and they keep gaining weight, and it's because
of those changing hormones.
Speaker 2 (35:47):
Right, Yeah, which brings me to my next talk.
Speaker 6 (35:52):
The next btalkic that Haley and I love to talk about.
Speaker 2 (35:56):
The hormone replacement therapy.
Speaker 3 (35:57):
That ozembic study that just came out, which I haven't
had time to read because I just launched a course
a few days ago and I'm like buried, But I've
seen you talk about it already and I've seen it
on social media. So can we talk about that weight
loss response in regards with into hormone replacement therapy.
Speaker 4 (36:20):
So, in this study showed that women that were on
HRT on hormone replacement therapy and semalutype versus the ones
that were just on HRT, they lost more than thirty
percent more weight loss than the ones that were that
was not on SAMLU type. With HRT, it's a very
small study, right, I feel like before we jump the
(36:41):
gun into saying that HRT helps with weight loos what
it does. It changes your body composition when we lose estrogen.
When we lose estrogen, the body fat that was in
our fertile years and our hip and our legs goes intravisceral,
so in our midline. Right when we give back the estrogen,
there is again that change in body composition.
Speaker 5 (37:03):
We lose visceral fat.
Speaker 4 (37:04):
It goes more into our ferral years areas, but it
doesn't cause weight loss. It just changes the bio redistribution.
Now we know that with perimenopause and menopause, especially with
the heart flashes, the lack of sleep that demotivates a
woman to exercise, right because you're tired, you're not sleeping, well,
(37:24):
you have the heart flashes. So they didn't look that
in the study if their lifestyle changed, it that they
were more prone to follow a healthy lifestyle just from
the decrease of some of the perimenopaustal symptoms including depression,
mental health, changing mood. So it's not the actual hormone
replacement therapy causing the weight loss. We don't know if
(37:49):
there were other factors involved because they didn't check them.
Speaker 3 (37:53):
Well, I just love that there's a study on this
early with menopausal women because as you know, and I know,
and like, it's it's just we always get the shaft
in this age group.
Speaker 2 (38:07):
It's like, oh, well, you know.
Speaker 4 (38:10):
But I always tell my friends and patients, I said,
this is we're living in the right time to be
this age.
Speaker 6 (38:17):
Yeah.
Speaker 7 (38:18):
I could not agree more. That was one of my
fears in.
Speaker 5 (38:24):
Changing.
Speaker 4 (38:25):
And I'm so happy, and I'm so excited for a
woman and for myself and for my daughters because yeah,
we have ones were accepting more hormone replacement therapy. We
know it's safe, we know the short term benefits and
the long term benefits right, and now we have medications
(38:45):
that can help us with weightloads that for whatever reason,
it cannot happen on its own. So we are building superwomen,
superhuman and.
Speaker 5 (38:56):
I feel like it's well deserved.
Speaker 4 (38:59):
We waited for a long time, you know, no more
mental health, no more putting on unto the presence, no
more getting the short stick of the end. It's just
no more gaslighting. All our symptoms.
Speaker 5 (39:10):
Basically, Yeah, one amen, I know.
Speaker 6 (39:15):
I've been terrified to go through menopause and because I
thought my biggest fear was I'm not going to have
control of my body, because that's kind of what the
conversation always leads to. All of a sudden, I've gained weight,
I'm exhausted, the hormones, all of the things, and like
now we have all these tools. We have hormone replacement,
(39:37):
this medication, everything else, and it doesn't scare me, which
feels empowering.
Speaker 4 (39:43):
And the best anti aging is muscle, right, So we
also have this concept. Now we're accepting this concept that
none more exercising just to lose weight, but for longevity
and anti aging. So we have we have where where
packed with our hormones are some muglutide and our right
(40:03):
left and we have all the tools and our protect
for a long, healthy, high quality of life.
Speaker 7 (40:11):
Yeah, a lot of I'm majo.
Speaker 3 (40:16):
That was like perfection that needs to be like on
a billboard or something.
Speaker 5 (40:21):
Let me get a T shirt.
Speaker 4 (40:22):
No, it's just you know, it's like I feel like
we women, like we get asked for so much and
we have so much pressure that even like midlife is like, Okay, now,
how are you gonna uh.
Speaker 5 (40:33):
What are you gonna do now? New?
Speaker 7 (40:35):
Right?
Speaker 4 (40:35):
Like you have to reinvent yourself and yeah, it's like, no,
we've done enough. I feel like, also, we should see
it as just a continuation of our life. It doesn't
have to be this big change that what are we
going to do now? Just continue being as fabulous as
you were before going through benopause. It's just a continuation
(40:57):
of our mental life, sex life, which I think is
very important. And I feel like many women let it
go and give up after children, or.
Speaker 5 (41:08):
After forty or after fifty. It is like, we don't
deserve our sex life. We had enough. We are kids.
Speaker 4 (41:14):
No, you need to serve a healthy, satisfying sexual life,
physical life, so we we have the tools.
Speaker 7 (41:24):
I appreciate you saying all of that. That speaks volumes
to me.
Speaker 3 (41:29):
I feel like, so, what what are the drugs that
are Are there any drugs coming up? I remember you
saying something like this, and it piqued my interest a
few months ago about a new drug coming out. Maybe
it's out already, I'm not sure the timeline. It was
probably six months ago that there's a new drug that
(41:52):
can help hold on to muscle masks, Like, how is that?
Speaker 5 (41:55):
So?
Speaker 2 (41:56):
What is that?
Speaker 4 (41:57):
This what we're seeing right now in samagot at osmpic
is the tip, right, It's just it. It's the beginning
of very sophisticated drugs that are coming our way. One
of them is one that promotes the weight loss, that
has the DP part and it has medication that will
(42:18):
help prevent muscle loss and help muscle gain in the drug.
Speaker 7 (42:24):
Right, why it's like sign me up for that? Is
there a trial?
Speaker 4 (42:29):
So there's again that the drugs are going to become
very sophisticated in the future. This is just the beginning.
I mean this, what we're seeing now is probably the
biggest event in medicine that we're going to see in
our lifetime.
Speaker 7 (42:44):
Happening so exciting.
Speaker 3 (42:47):
Oh so what is your professional opinion then about if
there is a drug that can hang on the muscle
or even grow muscle, why would somebody need to eat
a lot of protein and weight train because.
Speaker 4 (43:02):
You need protein, you need the amino acids to build muscle.
Right that that is not sustainable, I mean nutrition. I
don't think there will be a point that will be
replaceable by a drug. Right, we need food, and our
muscles need amino acids right to build muscles. So you
(43:23):
can have a pro you can have a protein or
or a medication that prevents muscle laws, but you still
need the basis to promote muscle gain and to maintain
the muscle.
Speaker 5 (43:37):
Right.
Speaker 3 (43:38):
I'm trying to foresee the questions that will come up.
Speaker 4 (43:43):
And again, this is not out yet, and even when
a medication comes out, you have to realize those are
control studies of one thousand and two thousand and two thousand.
But once it's out in the public, then we learn
more about them and what is still needed or not needed.
Like Ocempic, these medications. In the studies, they never did
(44:06):
body compositions, so they didn't.
Speaker 5 (44:08):
Know that there was muscle loss.
Speaker 4 (44:11):
Okay, until now we're doing it and we're doing body
compositions and everybody and we're like, oh, they lost thirty pounds,
but ten were muscle, so we're fixing that. So the
same way it's going to be with the future drugs.
Speaker 3 (44:26):
So if somebody comes into you, I think this is
the other issue. How because it can be like five hundred,
seven hundred dollars a month, does insurance cover it for everyone?
Speaker 2 (44:37):
Or is it still.
Speaker 4 (44:38):
Hitting insurances the rock of every doctor in the shoe.
Speaker 2 (44:43):
Yes, but how is it that's crazy in America? Like
can we not fix it still?
Speaker 4 (44:50):
When there was and there was when there was shortage
of the medication? Oh, I see all my like my
assistance in my office. I call it the hunger games.
It was like getting to see who had the pharma.
You have the pharmacy had it or not? It's in
the insurance who would approve it?
Speaker 2 (45:05):
Right now?
Speaker 4 (45:05):
There's guidelines that the insurances go by, and it's the
guidelines that were done by the Obesity Society and the
Obesity Medical Association where they state that BMI greater equal
or greater to twenty seven with one commorbidity and this
could be sleep, apnelstarthritis.
Speaker 5 (45:22):
High cholesterol are approved are for.
Speaker 4 (45:26):
Weight loss medication or a BMI equal or greater than
thirty without any commobidity. They meet the qualifications for a
weight loss medications.
Speaker 5 (45:34):
Right.
Speaker 4 (45:34):
So you have a patient that may meet the qualifications,
but then the insurance may not have it on their plan. Right,
So it's not just that you meet the qualifications that
the insurance requires, but also that they actually have it
in their plan and some insurances have what they call exclusions,
and those are never approved even that you meet the qualifications.
(45:58):
And because there's medications relatively expensive, so most insurances don't
have them in their formulary. Now, if you're going to
pay out of pocket with the medication, then then whereby
passing the insurance? Right, But there are expensive medications. But
my question is how much money do people spend on
(46:18):
all the other diets right that they go through thousands
through their lifetime.
Speaker 7 (46:25):
And how much is your health worth to you?
Speaker 6 (46:28):
In my opinion, I mean, if someone said, I mean,
I don't know the cost of all of them, but
I don't know, I would say that your health should
be the number one most important thing that you're spending
your money and time on.
Speaker 4 (46:41):
Yeah, and for out of pocket. Both pharmaceuticals right now
that have coupons. If you have a commercial insurance and
you're out of pocket meaning that the insurance is not
covering it, they have a coupon and it comes out
to about five hundred dollars a month, either Ozempegagobi, Munjaro
or step bound more likely around the same price if
(47:04):
you don't have insurance, and then it's about eleven hundred
dollars a month.
Speaker 2 (47:09):
Oh my gosh, it's a lot.
Speaker 7 (47:12):
Yeah, that is a lot.
Speaker 3 (47:13):
But how scary is it to take something like you know,
a lot of the Americans. I'm not going to say
that I've never done it, go to Mexico and get
like a sleep drug or something like how dangerous would
it be for I'm sure there's nine million places that
you can get it, but like you said, it's not
through a physician, it's not managed can.
Speaker 2 (47:37):
I mean, I'm sure those can be dangerous, just.
Speaker 4 (47:39):
For you to know it's Unfortunately in the US, how
the prices of the medications are ridiculously high. It drugs,
osmpic and a pharmacy here in the United States out
of pocket is going to be eleven hundred dollars for
a month's supply. If you go anywhere else outside not
just Mexico, if you go to the Middle East, in
Europe and in Latin America, it's about two hundred dollars
(48:01):
a month.
Speaker 5 (48:02):
Oh my what?
Speaker 2 (48:04):
Okay, So it is the same though, it is It's
not like sketchy.
Speaker 5 (48:07):
Yeah, no, it's not the same. It's the same.
Speaker 3 (48:11):
This makes me so mad, like about America, because I
had a son that needed acutane.
Speaker 2 (48:17):
And we were on like.
Speaker 3 (48:21):
Private insurance at the time, like our own insurance. My
husband owned his own business at the time, and it
was five hundred dollars a month, and that was a
hard pill to swallow. But I'm like, my team doesn't
want to go outside. But then when we swapped somewhere
in between the eighteen months or what, I don't know
how long he was on it, but another one was
(48:44):
five was five dollars a month, just like a main
provider insurance, and I was like, this is there should
not be that discrepancy of five hundred and for any medication, Like,
I don't know.
Speaker 2 (48:59):
It really is frustrated.
Speaker 5 (49:01):
It is very frustrating. It is very frustrating.
Speaker 4 (49:03):
And so you have people and then we like, there's
a Canadian there's Canadian pharmacies that they can patients get
it for about three hundred dollars a month with ascription
from from a US prescription.
Speaker 5 (49:15):
Well, yes it is.
Speaker 6 (49:18):
Yeah, do you think there'll be a shortage again since
there's it's like such a big medication.
Speaker 4 (49:26):
There are small shortages of certain doses from time to time.
Speaker 5 (49:32):
But I feel like the production Eli Leley.
Speaker 4 (49:37):
Is doing the best, they're building factors as we speak,
to be able to supply. But it's just that demand
is so great, right world.
Speaker 3 (49:46):
Yeah, well, I know I was in Australia the first
of the year and they were all sold out well
as as the strength and conditioning coaches were saying, because
all the bodybuilders were like hugging it from everyone.
Speaker 2 (50:06):
Which is terrible.
Speaker 3 (50:07):
I mean it's you know, like I don't know if
there's a shortage now, but I know that they were
like again, there were two sides to the story. But
down there it's it's very different obviously than here as well.
Every country has their own kind of issues and things,
but we've got to get the insurance part figured out
(50:29):
here in America for.
Speaker 5 (50:31):
Sure, even for so for patients and for doctors.
Speaker 3 (50:34):
Honestly, Yeah, yeah, I mean I ended up going I
ended up having a knee surgery, a major knee surgery
at HSS in New York and one of the top
physicians that there were like two that did this specific
knee surgery on women over forty because it's a terrible
success rate, and the doctor's like, well here's my price.
Speaker 2 (50:56):
I'm like I'm out of pocket, and I was like,
take my money.
Speaker 3 (51:00):
It was I mean, I was so desperate because I'd
been a year with just like nothing. But I get
why why physicians are just like, I'm not working with
us anymore.
Speaker 5 (51:09):
It's yeah, it's a circumsturance in my office. But this
is so frustrated.
Speaker 4 (51:16):
And spend one hour with my patients, right yeah, And
when you're talking to someone with obesity that they've struggled
to childhood and they're in an adult life, you cannot
have this conversation in fifteen minutes. You cannot open to
anybody in fifteen minutes. You can earn a trust and
build a relationship with a fifteen minute appointment.
Speaker 5 (51:37):
Right.
Speaker 3 (51:38):
No, I'm in love with you, and I'm like you
need to be in Let's put a trip to New York, Ailee.
Speaker 6 (51:45):
Yeah, I know.
Speaker 2 (51:46):
We're going to New York.
Speaker 3 (51:48):
And I mean, I just think of all of these
people that have reached out to me that like, I mean,
they need you on speed dial. I don't even know
if are you taking new patients?
Speaker 5 (52:00):
Yes, I am.
Speaker 7 (52:01):
You do zoom like so for people that don't live
in New York.
Speaker 4 (52:05):
Yes, I do tell a medicine I have patience all
over the world and.
Speaker 3 (52:11):
You're about to not be accepting new patients because everyone
is going to be obsessed and like coming to you exactly,
but get on the wait list for a year.
Speaker 4 (52:20):
No, I'm working very hard so I can accept I
cannot see everybody. I accepted that and I can't, but
I'm trying to see as much as I can.
Speaker 2 (52:29):
I love that too.
Speaker 6 (52:31):
Well.
Speaker 3 (52:31):
Okay, so before we close, and this is something that
we should have talked about at the very first, but
I've just been so it's been so fascinating this entire conversation.
Speaker 2 (52:41):
Can you explain for people?
Speaker 3 (52:43):
I feel like everyone knows about these drugs now, especially
from like Oprah, you know, has talked about it a lot,
and obviously a lot of big people on social media.
But for someone that's like, oh, okay, I know that
this is a weightless drug, but what is it actually
doing to help me lose weight?
Speaker 2 (53:00):
For people that don't understand that part.
Speaker 4 (53:03):
So the pharmacology of this drug is there are synthetic hormones.
We make this hormone GLP one in our small gout and.
Speaker 5 (53:15):
What they do.
Speaker 4 (53:16):
We have receptors for this hormone all over our body.
But in regards to weilos what they do is in
our gut, in our stomach, we have receptors that when
we have this medication, when we take this medication, when
this hormone is there, it increases our satiety hormones, so
it activates our satiety. So when you start eating, it
(53:39):
activates your satiety signals and you get fuller with smaller
portions of food. And then in between meals it suppresses
your hunger hormones. So when you feel hungry, you eat
small portion, you get physically full and satisfied, and then
you're not hungry for a few hours. Then you get
hungry again, but then you eat a small normal portion.
(54:01):
And then in our brain in the hedonistic eating and
drinking area where we eat for our reward, for pleasure,
anxiety border, it takes away any anticipation of our reward
from food or alcohol. So if you think about it,
let's say a glass of wine. Whenever we think, oh,
I'm going to have a glass of wine at night,
(54:22):
you're anticipating I'm gonna feel relaxed, I'm gonna feel this,
I'm going to be in a social setting. It takes
away that anticipation. You reach for it, and it doesn't
give you that back anymore, and the behavior changes.
Speaker 5 (54:37):
Same with foods.
Speaker 4 (54:38):
Of some patients that eat border or anxiety at night
or bench at night, it's because you're seeking some sort
of relief or some sort of reward.
Speaker 5 (54:46):
It takes it away.
Speaker 4 (54:47):
You still enjoy your food when you're eating and you're hungry,
but when you're physically content, you don't think of food
anymore besides us food when you're hungry. So that's what
that noise that people say that stops because you're not
you don't and then and then it's not like you
don't have anything else to look for, because many patients said, well,
(55:07):
food is my pleasure.
Speaker 5 (55:09):
Is you replace it for something else?
Speaker 4 (55:12):
Many patients replace it with exercise, anything else, Then it's
not going to be food. And for so many alcohol,
which is another great thing with these medications is that
it cut.
Speaker 7 (55:22):
Yeah, there are so many benefits.
Speaker 6 (55:24):
Okay, So if one of a patient is on this
long term, do they usually have to stay at the
same dose or do you have to increase it or
decrease it?
Speaker 7 (55:36):
Because so.
Speaker 4 (55:38):
Depending how much weight we're talking about, right, I mean,
I've have patients the one that lost the.
Speaker 5 (55:43):
Most is one hundred and seventy pounds.
Speaker 4 (55:45):
Wow, So they work. I mean, when they work, they
work great. But to get to let's say, to that
goal or to thirty forty pounds, we may use higher
doses to get there. But once we're there, when we're
in maintenance, that we're not looking for anymore weight loss.
I cut back on the doses and this slowly. As
(56:07):
slowly we went up, slowly, we will go down because
we're not looking for more weight loss. With the patient
can be eating a little bit more for maintenance.
Speaker 7 (56:19):
That makes sense.
Speaker 6 (56:20):
I cannot believe the behavior, psychological changes, all the benefits
that come from this drug.
Speaker 4 (56:29):
I've had grown men cry in my office that the
time they feel relief.
Speaker 2 (56:36):
Yeah, that's okay. So wrapping up, Laura, do you have
any other questions?
Speaker 6 (56:42):
No, I feel like you explain this so well, and
I don't know.
Speaker 7 (56:49):
This has been such an exciting conversation.
Speaker 3 (56:53):
I much needed conversation too, so to kind of wrap up.
And you have mentioned this now multiple times in this interview.
The biggest thing about the weight loss. I mean, I'm
just zoning on on one portion, but the muscle mass
(57:13):
is so imperative to keep for a myriad of reasons.
But mainly if we're looking at like, we don't want
the resting metabolic rate to go down from the lack
from the loss of muscle, especially these perimenopause postmenopause puzzle women.
So that has to be the priority. The high protein,
(57:36):
the strength training, you know, along with something like this for.
Speaker 2 (57:41):
Those who need it. That's like the magic.
Speaker 7 (57:44):
That's the trifecta.
Speaker 4 (57:46):
Yeah, and even that I didn't mention this, but what
I see in my body compositions in my patients is
that when they lose muscle mass, they could be in one,
they could be in two weightless medications. They might have
lost ten pounds. If they lose muscle mass, their percentage
(58:06):
body fat may go up even though they lost weight.
So muscle is so imperative for the proper benefit or
the maximum benefit of the medication. And when patients see this,
when they see that they lost muscle and they gain
percentage body fat, it switches completely right, They get why
(58:30):
it matters so much. So I really think we should
focus more on muscle gain or preserving muscle, then weight
loss or fat loss, because if we concentrate on the muscle,
preserving the muscle or muscle gain, the fat loss is happening. Yeah,
you maximize the benefits of these drugs. You need to
(58:52):
have the conversation about muscle.
Speaker 2 (58:57):
There it is, Mike drop. Nothing else needs to be such.
Speaker 3 (59:04):
Okay, doctor Whalan, thank you so much for joining us this.
I appreciate your time. I know you're on spring break
with your kids taking time away, so.
Speaker 2 (59:14):
We are so grateful.
Speaker 3 (59:15):
I cannot wait for this episode to air, so thank
you so much for joining us.
Speaker 4 (59:20):
Thank you for inviting me. I really enjoy this. We
should do it.
Speaker 5 (59:24):
Again talking about Yeah, explusive and menopause. Woman, I think
we should.
Speaker 2 (59:30):
Yes, let's do it. That's around two.
Speaker 5 (59:32):
This week to serve a full podcast just for them.
Speaker 3 (59:35):
Okay, we're doing it. Thanks so much, Thanks for listening everyone.
Speaker 6 (59:41):
If you enjoyed this episode, please consider giving us a
five star rating and sharing the body Pod with your
friends until next time.
Speaker 4 (01:00:00):
The better, the better, the
Speaker 7 (01:00:00):
Middle better better
Welcome to the Body Pod. Today we are rerunning one
of our favorite and most popular episodes from twenty twenty four,
which is with doctor Rossio Salas Whalen on all Things
GLP ones and obesity treatment. Now, while this episode is
more than a year old and lots of research has
come out since this airing, we will be having doctor
(00:24):
Whyalan on in a upcoming course of mine this fall.
Enjoy this rerun with doctor Whalin.
Speaker 2 (00:31):
Hi everyone, my name is Haley and this is Lara,
and welcome.
Speaker 3 (00:35):
To the Body Pod. Welcome everyone to the Body Pod.
I am so honored to have our special guest today,
doctor Rossio Salas Whalen, who is a triple board certified
end yourcinologist and obesity specialist practicing in New York City.
(00:58):
So welcome dot Org your Waylan.
Speaker 4 (01:01):
Thank you so much. I'm so happy and excited to
be here with both of you.
Speaker 3 (01:06):
We are so excited. And U you're on vacation. Are
you on vacation?
Speaker 1 (01:09):
Are you?
Speaker 5 (01:10):
I'm with my kids.
Speaker 6 (01:12):
She's just showed us the view and Haley and I
are so envious that we're not there doing it.
Speaker 2 (01:19):
I know, I'm so mad.
Speaker 3 (01:22):
I'm going to come see you in New York though,
I'm going to take you to lunch when i'm there next.
Speaker 7 (01:25):
I was just there.
Speaker 5 (01:26):
Please please please let me know when you're in the city.
Speaker 7 (01:29):
Yes, let's go. Yeah time Hill.
Speaker 3 (01:32):
Oh I just was there a week ago. Yeah, a
week and a half ago. So anyways, next time I'm there,
I'm going to hit you up. But anyhow, welcome, welcome, welcome.
We have so many questions to cover, so today everyone,
we are talking about all things sema, glue, tide, and
(01:52):
the obesity epidemic that we are facing. So doctor Whylan
is one of the top, if not I would say
the top in her field, definitely for me, that owns
a practice in New York City. So I'm just curious.
Can you just give us a little background about you know,
(02:14):
how long you've been practicing, what made you get into
this specific area. I'm so curious about that.
Speaker 5 (02:20):
Yeah.
Speaker 4 (02:21):
So I've been practicing since twenty ten when I finished
my specialty. And you know, fourteen years ago, we didn't
treat obesity, or we didn't talk about obesity as we
talk about it now. In fact, we didn't have a
specialty back then in obesity, right, it was into chronology
and that's the reason that I went into chronology was
(02:44):
to work on metabolism. I was always interested in type
two diabetes and its relationship with weight, right, and how
if you control one, you would control the other one.
Speaker 5 (02:58):
And then obesity.
Speaker 4 (03:00):
Then we started having medications for weight loss, and I
think that opened a huge Pandora box, right that for
the first time we could offer patients something that actually worked.
And then it just my path became more obesity and
weight loss and not so much type two diabetes.
Speaker 3 (03:24):
Oh well, I want to start with this staggering statistic
that I heard you say that by the year twenty thirty,
the World Health Organization estimates that fifty percent of the
world population will have obesity.
Speaker 2 (03:39):
Yes, I mean that is like so scarce, so terrified.
Speaker 5 (03:45):
It is it is that we have.
Speaker 4 (03:48):
And including children, right, I mean I think that's that's
the biggest difference in future statistics, is that it includes children,
and those children will become adults with obesity.
Speaker 5 (04:03):
Right.
Speaker 4 (04:04):
So we're not talking in the next seven years, We're
talking in the next decades.
Speaker 3 (04:09):
Right, But do you do you think that America is like,
is America the worst?
Speaker 5 (04:17):
America is not the worst.
Speaker 4 (04:19):
The worst is the middle East right now, in certain
countries in Latin America, Mexico unfortunately, it is also very top.
But definitely the United States is i believe is number
three or number fourth in regards of world obesity, which
is pretty hard.
Speaker 6 (04:37):
And obesity is do you find it growing because of
food quality or habit And obesity is a disease, so
some people technically are born with it also, correct.
Speaker 4 (04:54):
Yes, so what we There's a lot of recent published
papers showing that prenatal mother's weight impacts the weight of
the offspring in the future. Right, so even your weight
preconception is going to impact the future of your future children.
(05:17):
So we're going even back then, right. And then we
live in a very industrialized world. We live that we
call obesogenic environments. Right, Everything in our life, from food industry,
the chemicals working from home promote obesity, right or make
it difficult.
Speaker 5 (05:36):
For people to lose weight.
Speaker 4 (05:39):
So if you think about it, I feel like we're
set for failure.
Speaker 6 (05:42):
Right.
Speaker 5 (05:43):
It's a very difficult.
Speaker 4 (05:45):
Fight to win against everything else that is promoting waking
and obesity becoming part of our genes.
Speaker 3 (05:54):
Literally, Ah, this is okay, And I think that a
lot of it has to do with I mean, you're
in New York City. I lived in New York City
for a hot minute. But when people can feed their
family at Taco Bell for twenty five dollars, I mean,
I know, New York City has made like the fruit
stands outside of the actual you know, grocery stores, you
(06:17):
can get decent, you know, really good pricing on that.
But I mean some places in the southeast, I mean
there's there's just a lot like it's easier to feed
your family at McDonald's.
Speaker 2 (06:30):
I mean that's a problem.
Speaker 4 (06:31):
And you know, I mean New York City is changing.
I remember when I moved to New York City.
Speaker 5 (06:37):
You could see you didn't see so much of the city.
It wasn't it wasn't there.
Speaker 4 (06:42):
But now there are Taco Bells next to the subway station.
There's Dunkin Donuts, there's Chick Filey, there's McDonald's, there's Krispy Kreme,
and they become so popular that even there's lines outside
those restaurants. Right, So, and New York City is different
now you can see how much more in regards to
(07:06):
a bcity has changed New York City. And we're a
city that we walk and we take the stairs and
we take the subway.
Speaker 5 (07:13):
But even with that, the.
Speaker 4 (07:15):
Food industry it's really really making it very difficult.
Speaker 6 (07:20):
Yes, yeah, we're having to overcome the food industry, but yeah,
convenience and.
Speaker 7 (07:25):
The quality of food and rice just yeah, I'm price huge.
Speaker 4 (07:32):
You can ask a family, a single mother that is
working two jobs and has two three kids to buy
organic and buy everything clean, and I mean it's expensive.
Speaker 3 (07:48):
So this is really interesting because I run like fat
loss courses throughout the year and it really.
Speaker 2 (07:56):
Is just an eduction. It's an education course.
Speaker 3 (07:59):
I mean we walk every one through it, but it's
just like giving all like taking out all the bs
of you know, everyone that's like do this, do this,
eat this, don't eat this, and just really being like,
this is what the evidence says, you know, in this area.
Speaker 2 (08:13):
And we cover that.
Speaker 3 (08:14):
But I can't tell you how many women come in
and they're like, I'm really not eating that bad and
I just keep put like packing on the weight.
Speaker 2 (08:23):
And it's so hard.
Speaker 3 (08:24):
Because the food industry, as you said, I mean it's like.
Speaker 2 (08:30):
It's made to taste good.
Speaker 3 (08:31):
Yeah, and all of these processed foods like where we
actually don't get full on them, and the brain doesn't
get the message to stop eating and all of that.
I mean, it's just fascinating because women come to me
all the time. They're like, I'm just like I'm done,
I'm done, Like I really, I'm exercising, I'm doing this.
And that's what's hard, is you just a lot of
(08:53):
it is we don't know the calorie content in our
foods as well, and we go to I mean, if
you're eating these restaurants or fast food places that I
call America the Land of Convenience, that are just anywhere
you go, it's really hard to be like, well, you know,
I'm really not eating that much, but what consists in
(09:14):
those calories? And and you know and yes, well and
and the I think the stigma that obesity is strictly like, well,
you just need to have more will power. I mean, like, no,
that's not that's not it.
Speaker 5 (09:32):
I see that.
Speaker 4 (09:33):
I'm talking about the food industry. Like I have a
lot of patients that are from different countries that they
coming from here, They're coming from Asia, they come from
and they all have the same story. They all gained
twenty thirty pounds when they move to America, do they not?
Speaker 2 (09:49):
Yes?
Speaker 4 (09:50):
Not surprising every single patient that I see, like in
that came immigrated here is the same story they gained
twenty thirty forty pounds of way right, And and yes,
I mean we know now that obesity is a chronic,
multifactorial disease, right, So it's not a problem of willpower.
(10:11):
I do feel I do think that the food industry
one day will become accountable for producing the statistics that
we have in obesity worldwide, right like this, like the
tobacco industry at one point. I feel like it's going
to be it's going to be the same. Hopefully one
day it will be. Because we talk about many solutions,
right and including way thot medications, but really the main
(10:34):
solution is changing.
Speaker 5 (10:36):
What we eat.
Speaker 4 (10:37):
Right, That's a huge part, and we have we have
little control, but but we haven't lost of control. I
always tell education is going to be our biggest weapon
against the food industry, right because the less we know,
the more they can control what we eat. The more
(10:57):
we know, the more we can sum how control what
food choices we make. So we still have some control
on it.
Speaker 6 (11:06):
So if I'm a client of yours, and for example,
what you just said, if I'm a patient, I come
to you I'm thirty sixty pounds overweight?
Speaker 7 (11:20):
How do you address And I know everyone is different,
but what.
Speaker 6 (11:25):
Are the things before you know ozembic and all of
the medications in that family you know, or before you
treat them with that? What do you do to address
the situation besides what you just said educating educating them?
Speaker 4 (11:42):
So first I take a very thorough family history, right,
I ask all my patients, all of my patients the
same question, at what age did you were you conscious
about your weight? Or at what age you being careful
of what you ate?
Speaker 5 (12:02):
Right?
Speaker 4 (12:03):
At what age did you stop being unconscious about how
you look or your weight? And the majority have the
same nine years old? Eight years old?
Speaker 7 (12:12):
So young, that's heartbreaking.
Speaker 5 (12:14):
Tell me.
Speaker 4 (12:15):
I was put on my first diet at nine, I
had my first personal trainer at twelve. I was sent
to fat camps since twelve. So I just want to
see how far back in the patient's history was this
something of an issue, right, because then that tells me
how complex the disease is, how complex the obesity is,
(12:39):
and how little or not is lifestyle involved in this
patient's life.
Speaker 5 (12:46):
Right.
Speaker 4 (12:48):
So it's doing that, doing a family tree, right, I
want to know what's the weight history of the mom,
the dad, the siblings, even the grandparents, the uncles, just
to see where is.
Speaker 5 (12:59):
This coming from.
Speaker 4 (13:00):
And I would say in seventy eighty percent of my patients,
there's always some family inheritance of obesity.
Speaker 6 (13:07):
So it's like seventy to eighty percent is kind of
a genetic.
Speaker 4 (13:11):
Kind there is either coming from the father or the
mother's side, and there's impacting their weight, or that there's
a history of struggling of weight in one side of
the family or sometimes in both families.
Speaker 6 (13:22):
Right.
Speaker 4 (13:23):
Then definitely a medication list. I mean there's some medications
that can promote waking until the presence blood pressure medications,
some anti diabetic medications like insulin can promote waking too.
And then going into their lifestyle, their work, their sleep patterns, right, exercise,
what are there exercising? What normally they eat? I tell them,
(13:46):
tell me what you ate for breakfast, yesterday, lunch and dinner.
I just want to get a sense of really deep,
deep dive, dive deep into the patient's life and where
can there be twigs if any? But for the majority
of patients, it's something very humbling that I learned through
(14:06):
practicing obesity medicine is that the majority of patients with
obesity or struggling with weight, they're doing everything they can right,
They're exercising, they're eating healthy, they've tried hundreds of diets.
Speaker 7 (14:21):
I mean, it's they've been on a diet since they're nine.
Speaker 4 (14:24):
It's really sad. And it's when you hear somebody's even
from childhood weight and they're eating and their food in
front of them. It's twenty for seven, a full time job, right,
it's everything that is in front of them. How is
this going to impact my weight? Am I going to
(14:47):
feel guilty after I eat it? Am I not going
to feel guilty? Or how can I compensate? And it
becomes a mental health draining right from their weight. So
it's really unfair, and I always try to speak this
very out loud, is that we.
Speaker 2 (15:04):
Had it wrong.
Speaker 4 (15:05):
Patients are not the couch potato that we're thinking, and
that we have the idea that they're just eating, they
don't care and they're just gaining weight.
Speaker 5 (15:12):
It's quite the opposite.
Speaker 4 (15:14):
Patients with ob city, No, they have obesity, they want
to lose weight, they're trying to lose weight, but it's
just not happening.
Speaker 3 (15:22):
This is I remember I reposted something that you had,
like something on your Instagram months ago that said, imagine
the noise that's constantly going on in their head? What
am I going to eat? What is it going to
do to me? How is it going to impact my weight?
Constant noise, like it's exhausting to think about an.
Speaker 5 (15:44):
A every day?
Speaker 6 (15:45):
Yeah, consuming which then affects how you show up every day,
your mental.
Speaker 4 (15:50):
Health, mental health, your mental space, the mental space that
this occupies in people with ob city, overweight or struggling
with weight, it's a huge part of their of their
mental space that you can that you can think, what
would happen.
Speaker 5 (16:05):
If we take that out, right?
Speaker 4 (16:08):
What what are the possibilities to occupy that other mental
space that is being occupied by the constant thinking.
Speaker 5 (16:15):
Of their weight and food? Mm hmm.
Speaker 7 (16:19):
Yeah.
Speaker 4 (16:19):
And it's something that well, you don't realize because in medicine,
as doctors, we hear, we learn about the pathology, like
the doctor side or what we can do, but we
never learn about what the patient is going through. Right,
we don't hear those stories that I hear every day
in my clinic. Right, is that that it makes you think,
like Wow, we've been telling patients go eat less, exercise more,
(16:44):
and that's all they've been doing all the time.
Speaker 2 (16:48):
Well there's another.
Speaker 3 (16:52):
I messaged you a few months ago when I was
doing a podcast with I don't know if you're familiar
with doctor Bill Campbell, but he's an in the fitness
world and he was just doing like the research on
ozepic and semaglue, tide and all that, Like that was
just the purpose of like, here's all of the current
(17:12):
research that we have. And so I reached out to
you because I mean when I put it on, I
was like, holy cow, this is a polarizing topic because
people were like, you know how they're taking it away
from type two diabetes and just freaking out. I was
like I'm the journalist here, like I'm not the one
(17:33):
taking it away. But I remember I reached out and
I was like, what's your like, what's your view on this?
Speaker 2 (17:39):
And you you said that.
Speaker 3 (17:42):
There's seventy two million people that were obese I mean
a few months ago, versus forty one million people with
type two diabetes. So it comes down to can you
explain that? Because I was just like, this is it
right here?
Speaker 4 (17:57):
So this Mady case, this class of drops our impretense
glp ones. They were designed for type two diabetes and
it's a really I like the.
Speaker 5 (18:07):
Story of how it was discovered.
Speaker 4 (18:09):
It was in nineteen ninety four by an endochronologist and
researcher at the VA Hospital in the Bronx in New York,
doctor John Ng And he was studying the Gila monsters,
which are lizards from the south from the southwest, and
the Gila monster in its prey, they killed its prey
causing puncretitis. So doctor Ang wanted to know what in
(18:34):
the venom of the Gila monster causes puncretitis, what effect
does it happen the pancreas, and that's how he isolated
the first YELP one called accentotide back in nineteen ninety four,
So thanks to him we have this evolution of the
DLP once.
Speaker 5 (18:52):
And then in two thousand and five.
Speaker 4 (18:54):
Was the first FDA approved GLP one made from eccentotide
what he had isolated from the gillamnster, and it was
named Bayeta, and that was a daily injection before.
Speaker 5 (19:07):
Breakfast, thirty minutes before breakfast.
Speaker 4 (19:08):
And thirty minutes before dinner, and then after that Bayeta,
came Victosa, which was once a day injection, and then
twenty seventeen ozampek or semaglutide, which is once a week injection.
But when in twenty ten when I started practicing Victosa,
which is leraglutide also for nov northisk was fdata profer
(19:30):
type two diabetes, and I remember started using it in
my patients and they were coming back with better glucose
control and weight loss, which was the first time that
we were seeing that in a medication, because most medications
for diabetes promote waking actually, but this drug only asking
your pancreas if your sugar is elevated, so you actually
(19:52):
have to have diabetes to work as an anti diabetic drug,
meaning they don't cause hypoglycemia on somebody who doesn't have
diabetes like insulin. Right, if you've given to somebody who
doesn't have diabetes, the sugar is gonna drop, but they.
Speaker 5 (20:07):
Can they can past, they can die. But in cretains
LP one, your sugar is normal.
Speaker 4 (20:13):
It's not going to touch the pancres it's just going
to pass it next to it. But then we get
the benefits of the whales and that's when we started
using it off label, including myself, back in twenty ten
for whals independent of type two diabetes, and then in
twenty twelve it was fdat approof for whals. So these
medications have the f data approval for whales since two
(20:37):
thousand twelve.
Speaker 7 (20:38):
So it really isn't just for diabetes.
Speaker 4 (20:40):
It's not only for type two diabetes. We have clear
FD eight guidelines for whals independent of diabetes. What they
did the pharmaceuticals they changed the name bictosa to saxenda,
ozampic to Wegobi and now Munjaro to set down same drug,
same molecules, same pharmaceuticals, same dosing, same pen just different
(21:01):
names for different indications.
Speaker 2 (21:04):
Oh that's so interesting.
Speaker 3 (21:06):
So okay with when people are looking at this, I think,
I mean, I'm in the you know, personal training fitness world,
but when I have clients come to me, they're like, well,
I kind of am interested in this, but you know,
I don't want to have another fan fan of the
nineties where people are really free that there's going to
(21:26):
be all of these you know, side effects that come
out in ten twenty thirty years. Do you think that
there are some or what? What do you think of
the side effects.
Speaker 4 (21:37):
So I mean and long term, going back to what
I just mentioned, I mean, we have close to thirty
years of data on this class of drugs.
Speaker 5 (21:45):
Right.
Speaker 4 (21:47):
The newer versions are newer generations, but with the same
concept back in nineteen ninety four. Right, So we have
enough data on these drugs to know it's safety.
Speaker 5 (22:01):
Now.
Speaker 4 (22:02):
I say this, and I said it multiple times, and
I said to all my patients, the safety of these
drugs and even the effectiveness the benefits of it will
depend on how much expertise who's giving you this drug
on them half. Right, If I start prescribing medications that
(22:25):
I don't have much experience, just because I'm a doctor,
I can prescribe chemo drugs, I'm going to create more
harm than actual benefits. So those side effects that.
Speaker 5 (22:35):
We're seeing now that that were not reported in all
the control studies are being caused by providers.
Speaker 4 (22:42):
That don't have experience on this medication, right, that don't
know how to lead the patient's journey with this drug.
Because every patient is different, one may work for one
may not work for the other one. So every treatment
should be very individualized to their lifestyle, to their necessities,
to their way to their other medications that they're taking.
Speaker 5 (23:06):
But when you don't do that, then you run.
Speaker 4 (23:08):
The risk of creating side effects that were not expected,
that were not seen in the control studies, Patients that
are not being followed properly, right, patients that are not
guided the right way. And then sometimes we have patients
that want to get results too fast and they may
overrun our recommendations.
Speaker 5 (23:28):
Then we're going to see other side effects.
Speaker 4 (23:30):
Right, So I feel like all those side effects that
we're seeing are really caused by improper use of the medication.
That makes sense, even and this is talking long term
and short term side effects.
Speaker 6 (23:42):
Right, And if people that are obese, there are so
many risks and problems that help issues that come from that.
And a lot of people I know that have gone
on the medication and have lost a lot of way,
they actually are so much healthier now and issues health
(24:06):
issues they were having are now they aren't concerned. They
aren't concerned anymore. So it seems that the benefits far
out weigh anything than not taking it right.
Speaker 4 (24:21):
Definitely, So we know there's more than sixteen cancers related
to obesity. Even now we're seeing more breast cancer related
to obesity than genetics, right, colon cancer, stomach cancer, thyrol cancer,
pancreatic cancer. We see more of that with obesity than
from the medications that we're hearing that right, These medications
(24:41):
really are going to change the way that we practice
medicine because I feel like in the next two three generations,
we're going to have less chronic diseases, much less type
two diabetes, less different types of cancers related to obesity.
So really we are exchanging one drug for a long
(25:01):
list of other medications or other health problems.
Speaker 6 (25:05):
Do you think okays drug class will help the obesity epidemic?
Do you think that it could actually really drop the
numbers and make a change in this world.
Speaker 4 (25:18):
I think that prediction of the who that twenty thirty,
I feel like that is going to be less thanks
to our current treatment that we have for obesity.
Speaker 2 (25:32):
It's so interesting.
Speaker 3 (25:33):
I mean, coming from the fitness world, I know that
I've been on a lot of like in groups where
we're discussing this because it's changing the fitness world.
Speaker 2 (25:44):
Absolutely.
Speaker 3 (25:45):
People are getting more comfortable to come into the gym,
you know, making a lot of changes, and there's of
course pros and cons on both sides of the issue.
But the conside would be trainers that are like, well,
now everyone's just taking it. It's super easy and they're
not actually learning, you know, the proper education and the
psychological component. But I'm going to guess that this is
(26:09):
where you're going to say, well, it comes down to
the provider. If someone at the next to the Walmart is,
you know, prescribing this drug that has no experience, just
for the sake of financial gain, then that's not helping either.
What what's your opinion on that?
Speaker 4 (26:27):
Definitely, I think in regards to the fitness world, I
see something happening in my practice and I foresee that
this is what's going to happen, is that people are
going to start exercising for.
Speaker 5 (26:46):
Us and not for weight loss. I think that I
feel like that's huge.
Speaker 4 (26:53):
And it makes me so happy when I see patients.
I started going to the gym because one thing, I mean,
you're more self confident. Number one, when patients start losing weight,
you're more flexible, you're more movable, you're not short of breath,
you physically can perform better, right, and then patients, it's
(27:15):
very amazing to see the journey of patients they come
with the concept of wanting something external right, to look
certain certain way, to feel a certain way.
Speaker 5 (27:27):
And then halfway of the journey, when we.
Speaker 4 (27:31):
Because I always talk about muscle protein, it flips. They
start to feel healthy, they start to feel strong, and
it becomes a fitness journey and not a weight loss
journey anymore So, more than ever, I feel people are
start going to embracing exercising for the right reason and
(27:53):
not for the weight loss right because for the weight
loss you always see it as something temporary, as a punishment,
and you're exercising because you feel better, you want to
extend your longevity, you want to feel healthy. Then you
adapt it. It becomes part of your life. So I
think it's a very positive shift that you trainers are
(28:17):
going to see people coming in for the right reasons.
And not that everybody doesn't, but the majority of mentality
is exercise to lose weight, because that's what we we're
teaching before. That's changing, and more than ever, I feel
like the medical community and the personal trainer business we
have to be more in a allions than more because
(28:40):
together we're going to make the patient healthy and fit right.
More than ever, I've never recommended to my patients to
go to the gym or personal trainers as much as
I'm doing every day.
Speaker 3 (28:52):
Now, well, I do have to say it's you know,
I have women coming into my courses all the time,
either one on one or in these groups that I
run multiple times a year. And when I'm running the numbers,
like I always like, there's always a couple of obese
people that come into the group, and emotionally, I am like,
(29:17):
I don't want this to be another source of failure
for them, because so this is totally I mean from
my point of view when I've been on these you know, panels,
I'm like, this this only helps us because it's giving
someone that they're then they're like, okay, well i don't
have as much noise in my head. I'm seeing some change,
(29:40):
so now I can take on this education component or
you know, in the behavior change and habit change and
all of those things that are needed when someone starts
to wean off of the drug. Do you recommend I mean,
I know this is still fairly new and this may change.
Do you have like and somebody beyond this for the
(30:01):
rest of their life or is the goal to get
them to a place where you're like Okay, we're going
to wan you off, but the habits, the behaviors, the
education has to be there as well.
Speaker 4 (30:12):
So if we go back to what obesity is that
it's a chronic disease, and chronic diseases we don't cure, right,
we control. So the idea with these medications is that
they're designed for long term use. And one I think
it's a I think we should shift it as a
positive thing and that as a negative thing because for
(30:33):
the first time we have something that's going to help
you maintain the weight loss right, because many things can
probably take you there, restrictive diets, but the moment that
you stop or that you're left on your own is
when the weight regained happens. So with these medications, we
can not only take you to your goal, but we
can help you keep you on your goal.
Speaker 5 (30:52):
They're safe to be used long term. If we're talking
about safety.
Speaker 4 (30:56):
Now, weight loss medicine is very new you and a
lot of things are changing and we're learning as we're doing.
And if I can talk about my personal experience with
my patients, those patients are able to maintain their muscle mass,
those patients that are able to gain muscle mass have
(31:20):
more probability to maintaining the weight loss at the lowest
dose possible or with maybe no medication. Right because whenever
you hear oh losing weight slows down your metabolism. The
reason for that is because you lose muscle with weight loss, right,
with any and this is not exclusive to samagutai, This
(31:40):
is not exclusive to any other drugs that we're talking.
Speaker 5 (31:43):
This is just exclusive of dieting patients lose muscle.
Speaker 4 (31:47):
Muscle is our most and you know this muscle is
our most metabolic organ, right, It's our burning machine. It's
our burning calorie machine. So if you lose it while
you're losing weight, that's what's slowing down your metabolism. But
when you're losing the body fat, you're maintaining your muscle
or even gaining muscle. That becomes part of the maintenance
(32:08):
for the weight loss.
Speaker 3 (32:10):
Yes, and I think it's interesting too that a lot
of you know, young trainers or just people not even
in the profession, think that there it's shocking to think
that like someone who is obese they carry a lot
of muscle mass, they also carry a lot of fat mass,
(32:31):
but it's assumed that they just don't have a lot
of muscle mass and that's not the case.
Speaker 4 (32:36):
Well, it's interesting because research has shown that yes, people
with obesity have more muscle masks, but it's not healthy,
all healthy muscle mass because there is fat in between
the muscle vibers. So it's not necessarily that their metabolism
is higher because they have so much muscle. Their muscle
(32:57):
is not the same when it's lean muscle.
Speaker 2 (33:01):
Okay, that's the ticket, right exactly, So.
Speaker 6 (33:04):
When you're on this medication, it really is way more
beneficial to strength train and work out while you take this.
Speaker 5 (33:13):
Medication one hundred percent.
Speaker 4 (33:16):
So and it's strength training what I recommend right at
Persistence strength training. It's important for many patients. It will
take time, It will take twenty thirty pounds of weight
loss before they feel motivated physically and mentally motivated to.
Speaker 5 (33:33):
Go to exercise.
Speaker 4 (33:35):
Right, But I always have that the initial consult is
always half of it is going to be exercise improtein
exercise and protein or exercise and diet doesn't replace the medications.
The medications don't replace exercise and dieting.
Speaker 5 (33:53):
It's hand in handfete.
Speaker 7 (33:56):
Yeah, need all of the components.
Speaker 6 (34:00):
Okay, so what about people that are taking it that
aren't Obyes, but they just have that like ten to
fifteen pounds and they just want to do it short
term and take it like patients that come to you.
Speaker 7 (34:17):
I mean, do you have any patients like that?
Speaker 5 (34:19):
Yes?
Speaker 4 (34:20):
And it's easy to say when somebody, oh, it's only
ten or only fifteen, only twenty pounds that I may
have to lose, and whenever I do a body composition,
it turns out that they have really highly seal fat
or they.
Speaker 5 (34:33):
Have more than ten pounds to lose.
Speaker 4 (34:36):
Right, So if we go by the number and the scale,
or we go by the BMI, I think we are
undertreating many patients that can be that should.
Speaker 5 (34:48):
Be treated, right.
Speaker 4 (34:49):
So I feel like it's not fair to say this
patient doesn't need it just by looking at them without
knowing their body composition.
Speaker 5 (34:56):
Right.
Speaker 4 (34:57):
And then for those patients that are doing what they
should and they still cannot lose those twenty pounds, then
I dig more deeper into how much is this consuming
your life?
Speaker 5 (35:10):
Right?
Speaker 4 (35:11):
How much is this take over your day? And for
some patients it becomes again a twenty four seven to
lose twenty thirty pounds or ten to fifteen pounds. Then
those patients, if they didn't do what they were doing,
probably they will need more pounds to lose. So those
patients would benefit from the medication, right because they're being
(35:32):
consumed by that. And if we put their perimenopause menopause,
then it's going to be classic that they're doing what
they were doing in their thirties early forties and it's
not happening and they keep gaining weight, and it's because
of those changing hormones.
Speaker 2 (35:47):
Right, Yeah, which brings me to my next talk.
Speaker 6 (35:52):
The next btalkic that Haley and I love to talk about.
Speaker 2 (35:56):
The hormone replacement therapy.
Speaker 3 (35:57):
That ozembic study that just came out, which I haven't
had time to read because I just launched a course
a few days ago and I'm like buried, But I've
seen you talk about it already and I've seen it
on social media. So can we talk about that weight
loss response in regards with into hormone replacement therapy.
Speaker 4 (36:20):
So, in this study showed that women that were on
HRT on hormone replacement therapy and semalutype versus the ones
that were just on HRT, they lost more than thirty
percent more weight loss than the ones that were that
was not on SAMLU type. With HRT, it's a very
small study, right, I feel like before we jump the
(36:41):
gun into saying that HRT helps with weight loos what
it does. It changes your body composition when we lose estrogen.
When we lose estrogen, the body fat that was in
our fertile years and our hip and our legs goes intravisceral,
so in our midline. Right when we give back the estrogen,
there is again that change in body composition.
Speaker 5 (37:03):
We lose visceral fat.
Speaker 4 (37:04):
It goes more into our ferral years areas, but it
doesn't cause weight loss. It just changes the bio redistribution.
Now we know that with perimenopause and menopause, especially with
the heart flashes, the lack of sleep that demotivates a
woman to exercise, right because you're tired, you're not sleeping, well,
(37:24):
you have the heart flashes. So they didn't look that
in the study if their lifestyle changed, it that they
were more prone to follow a healthy lifestyle just from
the decrease of some of the perimenopaustal symptoms including depression,
mental health, changing mood. So it's not the actual hormone
replacement therapy causing the weight loss. We don't know if
(37:49):
there were other factors involved because they didn't check them.
Speaker 3 (37:53):
Well, I just love that there's a study on this
early with menopausal women because as you know, and I know,
and like, it's it's just we always get the shaft
in this age group.
Speaker 2 (38:07):
It's like, oh, well, you know.
Speaker 4 (38:10):
But I always tell my friends and patients, I said,
this is we're living in the right time to be
this age.
Speaker 6 (38:17):
Yeah.
Speaker 7 (38:18):
I could not agree more. That was one of my
fears in.
Speaker 5 (38:24):
Changing.
Speaker 4 (38:25):
And I'm so happy, and I'm so excited for a
woman and for myself and for my daughters because yeah,
we have ones were accepting more hormone replacement therapy. We
know it's safe, we know the short term benefits and
the long term benefits right, and now we have medications
(38:45):
that can help us with weightloads that for whatever reason,
it cannot happen on its own. So we are building superwomen,
superhuman and.
Speaker 5 (38:56):
I feel like it's well deserved.
Speaker 4 (38:59):
We waited for a long time, you know, no more
mental health, no more putting on unto the presence, no
more getting the short stick of the end. It's just
no more gaslighting. All our symptoms.
Speaker 5 (39:10):
Basically, Yeah, one amen, I know.
Speaker 6 (39:15):
I've been terrified to go through menopause and because I
thought my biggest fear was I'm not going to have
control of my body, because that's kind of what the
conversation always leads to. All of a sudden, I've gained weight,
I'm exhausted, the hormones, all of the things, and like
now we have all these tools. We have hormone replacement,
(39:37):
this medication, everything else, and it doesn't scare me, which
feels empowering.
Speaker 4 (39:43):
And the best anti aging is muscle, right, So we
also have this concept. Now we're accepting this concept that
none more exercising just to lose weight, but for longevity
and anti aging. So we have we have where where
packed with our hormones are some muglutide and our right
(40:03):
left and we have all the tools and our protect
for a long, healthy, high quality of life.
Speaker 7 (40:11):
Yeah, a lot of I'm majo.
Speaker 3 (40:16):
That was like perfection that needs to be like on
a billboard or something.
Speaker 5 (40:21):
Let me get a T shirt.
Speaker 4 (40:22):
No, it's just you know, it's like I feel like
we women, like we get asked for so much and
we have so much pressure that even like midlife is like, Okay, now,
how are you gonna uh.
Speaker 5 (40:33):
What are you gonna do now? New?
Speaker 7 (40:35):
Right?
Speaker 4 (40:35):
Like you have to reinvent yourself and yeah, it's like, no,
we've done enough. I feel like, also, we should see
it as just a continuation of our life. It doesn't
have to be this big change that what are we
going to do now? Just continue being as fabulous as
you were before going through benopause. It's just a continuation
(40:57):
of our mental life, sex life, which I think is
very important. And I feel like many women let it
go and give up after children, or.
Speaker 5 (41:08):
After forty or after fifty. It is like, we don't
deserve our sex life. We had enough. We are kids.
Speaker 4 (41:14):
No, you need to serve a healthy, satisfying sexual life,
physical life, so we we have the tools.
Speaker 7 (41:24):
I appreciate you saying all of that. That speaks volumes
to me.
Speaker 3 (41:29):
I feel like, so, what what are the drugs that
are Are there any drugs coming up? I remember you
saying something like this, and it piqued my interest a
few months ago about a new drug coming out. Maybe
it's out already, I'm not sure the timeline. It was
probably six months ago that there's a new drug that
(41:52):
can help hold on to muscle masks, Like, how is that?
Speaker 5 (41:55):
So?
Speaker 2 (41:56):
What is that?
Speaker 4 (41:57):
This what we're seeing right now in samagot at osmpic
is the tip, right, It's just it. It's the beginning
of very sophisticated drugs that are coming our way. One
of them is one that promotes the weight loss, that
has the DP part and it has medication that will
(42:18):
help prevent muscle loss and help muscle gain in the drug.
Speaker 7 (42:24):
Right, why it's like sign me up for that? Is
there a trial?
Speaker 4 (42:29):
So there's again that the drugs are going to become
very sophisticated in the future. This is just the beginning.
I mean this, what we're seeing now is probably the
biggest event in medicine that we're going to see in
our lifetime.
Speaker 7 (42:44):
Happening so exciting.
Speaker 3 (42:47):
Oh so what is your professional opinion then about if
there is a drug that can hang on the muscle
or even grow muscle, why would somebody need to eat
a lot of protein and weight train because.
Speaker 4 (43:02):
You need protein, you need the amino acids to build muscle.
Right that that is not sustainable, I mean nutrition. I
don't think there will be a point that will be
replaceable by a drug. Right, we need food, and our
muscles need amino acids right to build muscles. So you
(43:23):
can have a pro you can have a protein or
or a medication that prevents muscle laws, but you still
need the basis to promote muscle gain and to maintain
the muscle.
Speaker 5 (43:37):
Right.
Speaker 3 (43:38):
I'm trying to foresee the questions that will come up.
Speaker 4 (43:43):
And again, this is not out yet, and even when
a medication comes out, you have to realize those are
control studies of one thousand and two thousand and two thousand.
But once it's out in the public, then we learn
more about them and what is still needed or not needed.
Like Ocempic, these medications. In the studies, they never did
(44:06):
body compositions, so they didn't.
Speaker 5 (44:08):
Know that there was muscle loss.
Speaker 4 (44:11):
Okay, until now we're doing it and we're doing body
compositions and everybody and we're like, oh, they lost thirty pounds,
but ten were muscle, so we're fixing that. So the
same way it's going to be with the future drugs.
Speaker 3 (44:26):
So if somebody comes into you, I think this is
the other issue. How because it can be like five hundred,
seven hundred dollars a month, does insurance cover it for everyone?
Speaker 2 (44:37):
Or is it still.
Speaker 4 (44:38):
Hitting insurances the rock of every doctor in the shoe.
Speaker 2 (44:43):
Yes, but how is it that's crazy in America? Like
can we not fix it still?
Speaker 4 (44:50):
When there was and there was when there was shortage
of the medication? Oh, I see all my like my
assistance in my office. I call it the hunger games.
It was like getting to see who had the pharma.
You have the pharmacy had it or not? It's in
the insurance who would approve it?
Speaker 2 (45:05):
Right now?
Speaker 4 (45:05):
There's guidelines that the insurances go by, and it's the
guidelines that were done by the Obesity Society and the
Obesity Medical Association where they state that BMI greater equal
or greater to twenty seven with one commorbidity and this
could be sleep, apnelstarthritis.
Speaker 5 (45:22):
High cholesterol are approved are for.
Speaker 4 (45:26):
Weight loss medication or a BMI equal or greater than
thirty without any commobidity. They meet the qualifications for a
weight loss medications.
Speaker 5 (45:34):
Right.
Speaker 4 (45:34):
So you have a patient that may meet the qualifications,
but then the insurance may not have it on their plan. Right,
So it's not just that you meet the qualifications that
the insurance requires, but also that they actually have it
in their plan and some insurances have what they call exclusions,
and those are never approved even that you meet the qualifications.
(45:58):
And because there's medications relatively expensive, so most insurances don't
have them in their formulary. Now, if you're going to
pay out of pocket with the medication, then then whereby
passing the insurance? Right, But there are expensive medications. But
my question is how much money do people spend on
(46:18):
all the other diets right that they go through thousands
through their lifetime.
Speaker 7 (46:25):
And how much is your health worth to you?
Speaker 6 (46:28):
In my opinion, I mean, if someone said, I mean,
I don't know the cost of all of them, but
I don't know, I would say that your health should
be the number one most important thing that you're spending
your money and time on.
Speaker 4 (46:41):
Yeah, and for out of pocket. Both pharmaceuticals right now
that have coupons. If you have a commercial insurance and
you're out of pocket meaning that the insurance is not
covering it, they have a coupon and it comes out
to about five hundred dollars a month, either Ozempegagobi, Munjaro
or step bound more likely around the same price if
(47:04):
you don't have insurance, and then it's about eleven hundred
dollars a month.
Speaker 2 (47:09):
Oh my gosh, it's a lot.
Speaker 7 (47:12):
Yeah, that is a lot.
Speaker 3 (47:13):
But how scary is it to take something like you know,
a lot of the Americans. I'm not going to say
that I've never done it, go to Mexico and get
like a sleep drug or something like how dangerous would
it be for I'm sure there's nine million places that
you can get it, but like you said, it's not
through a physician, it's not managed can.
Speaker 2 (47:37):
I mean, I'm sure those can be dangerous, just.
Speaker 4 (47:39):
For you to know it's Unfortunately in the US, how
the prices of the medications are ridiculously high. It drugs,
osmpic and a pharmacy here in the United States out
of pocket is going to be eleven hundred dollars for
a month's supply. If you go anywhere else outside not
just Mexico, if you go to the Middle East, in
Europe and in Latin America, it's about two hundred dollars
(48:01):
a month.
Speaker 5 (48:02):
Oh my what?
Speaker 2 (48:04):
Okay, So it is the same though, it is It's
not like sketchy.
Speaker 5 (48:07):
Yeah, no, it's not the same. It's the same.
Speaker 3 (48:11):
This makes me so mad, like about America, because I
had a son that needed acutane.
Speaker 2 (48:17):
And we were on like.
Speaker 3 (48:21):
Private insurance at the time, like our own insurance. My
husband owned his own business at the time, and it
was five hundred dollars a month, and that was a
hard pill to swallow. But I'm like, my team doesn't
want to go outside. But then when we swapped somewhere
in between the eighteen months or what, I don't know
how long he was on it, but another one was
(48:44):
five was five dollars a month, just like a main
provider insurance, and I was like, this is there should
not be that discrepancy of five hundred and for any medication, Like,
I don't know.
Speaker 2 (48:59):
It really is frustrated.
Speaker 5 (49:01):
It is very frustrating. It is very frustrating.
Speaker 4 (49:03):
And so you have people and then we like, there's
a Canadian there's Canadian pharmacies that they can patients get
it for about three hundred dollars a month with ascription
from from a US prescription.
Speaker 5 (49:15):
Well, yes it is.
Speaker 6 (49:18):
Yeah, do you think there'll be a shortage again since
there's it's like such a big medication.
Speaker 4 (49:26):
There are small shortages of certain doses from time to time.
Speaker 5 (49:32):
But I feel like the production Eli Leley.
Speaker 4 (49:37):
Is doing the best, they're building factors as we speak,
to be able to supply. But it's just that demand
is so great, right world.
Speaker 3 (49:46):
Yeah, well, I know I was in Australia the first
of the year and they were all sold out well
as as the strength and conditioning coaches were saying, because
all the bodybuilders were like hugging it from everyone.
Speaker 2 (50:06):
Which is terrible.
Speaker 3 (50:07):
I mean it's you know, like I don't know if
there's a shortage now, but I know that they were
like again, there were two sides to the story. But
down there it's it's very different obviously than here as well.
Every country has their own kind of issues and things,
but we've got to get the insurance part figured out
(50:29):
here in America for.
Speaker 5 (50:31):
Sure, even for so for patients and for doctors.
Speaker 3 (50:34):
Honestly, Yeah, yeah, I mean I ended up going I
ended up having a knee surgery, a major knee surgery
at HSS in New York and one of the top
physicians that there were like two that did this specific
knee surgery on women over forty because it's a terrible
success rate, and the doctor's like, well here's my price.
Speaker 2 (50:56):
I'm like I'm out of pocket, and I was like,
take my money.
Speaker 3 (51:00):
It was I mean, I was so desperate because I'd
been a year with just like nothing. But I get
why why physicians are just like, I'm not working with
us anymore.
Speaker 5 (51:09):
It's yeah, it's a circumsturance in my office. But this
is so frustrated.
Speaker 4 (51:16):
And spend one hour with my patients, right yeah, And
when you're talking to someone with obesity that they've struggled
to childhood and they're in an adult life, you cannot
have this conversation in fifteen minutes. You cannot open to
anybody in fifteen minutes. You can earn a trust and
build a relationship with a fifteen minute appointment.
Speaker 5 (51:37):
Right.
Speaker 3 (51:38):
No, I'm in love with you, and I'm like you
need to be in Let's put a trip to New York, Ailee.
Speaker 6 (51:45):
Yeah, I know.
Speaker 2 (51:46):
We're going to New York.
Speaker 3 (51:48):
And I mean, I just think of all of these
people that have reached out to me that like, I mean,
they need you on speed dial. I don't even know
if are you taking new patients?
Speaker 5 (52:00):
Yes, I am.
Speaker 7 (52:01):
You do zoom like so for people that don't live
in New York.
Speaker 4 (52:05):
Yes, I do tell a medicine I have patience all
over the world and.
Speaker 3 (52:11):
You're about to not be accepting new patients because everyone
is going to be obsessed and like coming to you exactly,
but get on the wait list for a year.
Speaker 4 (52:20):
No, I'm working very hard so I can accept I
cannot see everybody. I accepted that and I can't, but
I'm trying to see as much as I can.
Speaker 2 (52:29):
I love that too.
Speaker 6 (52:31):
Well.
Speaker 3 (52:31):
Okay, so before we close, and this is something that
we should have talked about at the very first, but
I've just been so it's been so fascinating this entire conversation.
Speaker 2 (52:41):
Can you explain for people?
Speaker 3 (52:43):
I feel like everyone knows about these drugs now, especially
from like Oprah, you know, has talked about it a lot,
and obviously a lot of big people on social media.
But for someone that's like, oh, okay, I know that
this is a weightless drug, but what is it actually
doing to help me lose weight?
Speaker 2 (53:00):
For people that don't understand that part.
Speaker 4 (53:03):
So the pharmacology of this drug is there are synthetic hormones.
We make this hormone GLP one in our small gout and.
Speaker 5 (53:15):
What they do.
Speaker 4 (53:16):
We have receptors for this hormone all over our body.
But in regards to weilos what they do is in
our gut, in our stomach, we have receptors that when
we have this medication, when we take this medication, when
this hormone is there, it increases our satiety hormones, so
it activates our satiety. So when you start eating, it
(53:39):
activates your satiety signals and you get fuller with smaller
portions of food. And then in between meals it suppresses
your hunger hormones. So when you feel hungry, you eat
small portion, you get physically full and satisfied, and then
you're not hungry for a few hours. Then you get
hungry again, but then you eat a small normal portion.
(54:01):
And then in our brain in the hedonistic eating and
drinking area where we eat for our reward, for pleasure,
anxiety border, it takes away any anticipation of our reward
from food or alcohol. So if you think about it,
let's say a glass of wine. Whenever we think, oh,
I'm going to have a glass of wine at night,
(54:22):
you're anticipating I'm gonna feel relaxed, I'm gonna feel this,
I'm going to be in a social setting. It takes
away that anticipation. You reach for it, and it doesn't
give you that back anymore, and the behavior changes.
Speaker 5 (54:37):
Same with foods.
Speaker 4 (54:38):
Of some patients that eat border or anxiety at night
or bench at night, it's because you're seeking some sort
of relief or some sort of reward.
Speaker 5 (54:46):
It takes it away.
Speaker 4 (54:47):
You still enjoy your food when you're eating and you're hungry,
but when you're physically content, you don't think of food
anymore besides us food when you're hungry. So that's what
that noise that people say that stops because you're not
you don't and then and then it's not like you
don't have anything else to look for, because many patients said, well,
(55:07):
food is my pleasure.
Speaker 5 (55:09):
Is you replace it for something else?
Speaker 4 (55:12):
Many patients replace it with exercise, anything else, Then it's
not going to be food. And for so many alcohol,
which is another great thing with these medications is that
it cut.
Speaker 7 (55:22):
Yeah, there are so many benefits.
Speaker 6 (55:24):
Okay, So if one of a patient is on this
long term, do they usually have to stay at the
same dose or do you have to increase it or
decrease it?
Speaker 7 (55:36):
Because so.
Speaker 4 (55:38):
Depending how much weight we're talking about, right, I mean,
I've have patients the one that lost the.
Speaker 5 (55:43):
Most is one hundred and seventy pounds.
Speaker 4 (55:45):
Wow, So they work. I mean, when they work, they
work great. But to get to let's say, to that
goal or to thirty forty pounds, we may use higher
doses to get there. But once we're there, when we're
in maintenance, that we're not looking for anymore weight loss.
I cut back on the doses and this slowly. As
(56:07):
slowly we went up, slowly, we will go down because
we're not looking for more weight loss. With the patient
can be eating a little bit more for maintenance.
Speaker 7 (56:19):
That makes sense.
Speaker 6 (56:20):
I cannot believe the behavior, psychological changes, all the benefits
that come from this drug.
Speaker 4 (56:29):
I've had grown men cry in my office that the
time they feel relief.
Speaker 2 (56:36):
Yeah, that's okay. So wrapping up, Laura, do you have
any other questions?
Speaker 6 (56:42):
No, I feel like you explain this so well, and
I don't know.
Speaker 7 (56:49):
This has been such an exciting conversation.
Speaker 3 (56:53):
I much needed conversation too, so to kind of wrap up.
And you have mentioned this now multiple times in this interview.
The biggest thing about the weight loss. I mean, I'm
just zoning on on one portion, but the muscle mass
(57:13):
is so imperative to keep for a myriad of reasons.
But mainly if we're looking at like, we don't want
the resting metabolic rate to go down from the lack
from the loss of muscle, especially these perimenopause postmenopause puzzle women.
So that has to be the priority. The high protein,
(57:36):
the strength training, you know, along with something like this for.
Speaker 2 (57:41):
Those who need it. That's like the magic.
Speaker 7 (57:44):
That's the trifecta.
Speaker 4 (57:46):
Yeah, and even that I didn't mention this, but what
I see in my body compositions in my patients is
that when they lose muscle mass, they could be in one,
they could be in two weightless medications. They might have
lost ten pounds. If they lose muscle mass, their percentage
(58:06):
body fat may go up even though they lost weight.
So muscle is so imperative for the proper benefit or
the maximum benefit of the medication. And when patients see this,
when they see that they lost muscle and they gain
percentage body fat, it switches completely right, They get why
(58:30):
it matters so much. So I really think we should
focus more on muscle gain or preserving muscle, then weight
loss or fat loss, because if we concentrate on the muscle,
preserving the muscle or muscle gain, the fat loss is happening. Yeah,
you maximize the benefits of these drugs. You need to
(58:52):
have the conversation about muscle.
Speaker 2 (58:57):
There it is, Mike drop. Nothing else needs to be such.
Speaker 3 (59:04):
Okay, doctor Whalan, thank you so much for joining us this.
I appreciate your time. I know you're on spring break
with your kids taking time away, so.
Speaker 2 (59:14):
We are so grateful.
Speaker 3 (59:15):
I cannot wait for this episode to air, so thank
you so much for joining us.
Speaker 4 (59:20):
Thank you for inviting me. I really enjoy this. We
should do it.
Speaker 5 (59:24):
Again talking about Yeah, explusive and menopause. Woman, I think
we should.
Speaker 2 (59:30):
Yes, let's do it. That's around two.
Speaker 5 (59:32):
This week to serve a full podcast just for them.
Speaker 3 (59:35):
Okay, we're doing it. Thanks so much, Thanks for listening everyone.
Speaker 6 (59:41):
If you enjoyed this episode, please consider giving us a
five star rating and sharing the body Pod with your
friends until next time.
Speaker 4 (01:00:00):
The better, the better, the
Speaker 7 (01:00:00):
Middle better better
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