1 00:00:02,800 --> 00:00:06,920 Speaker 1: Today on the bright side, endocrinologist and obesity medicine specialist, 2 00:00:07,040 --> 00:00:10,119 Speaker 1: doctor Roscio Salas Whalen is here to answer all of 3 00:00:10,119 --> 00:00:13,480 Speaker 1: our burning questions about GLP one weight loss drugs and 4 00:00:13,520 --> 00:00:16,760 Speaker 1: what they mean for hormones, menopause, and body image. 5 00:00:16,880 --> 00:00:21,520 Speaker 2: We can't control our weight with medications and hormone replacement therapy, 6 00:00:21,600 --> 00:00:24,960 Speaker 2: so they're like our tools that will help us get 7 00:00:25,200 --> 00:00:27,560 Speaker 2: to the next decade in a good place. 8 00:00:28,240 --> 00:00:30,720 Speaker 1: And don't worry if you have complicated feelings about this topic, 9 00:00:30,840 --> 00:00:33,440 Speaker 1: You're not alone. I'm simone voice and this is the 10 00:00:33,440 --> 00:00:43,280 Speaker 1: bride side from Hello Sunshine. When you hear the word ozembic, 11 00:00:43,840 --> 00:00:47,320 Speaker 1: what comes up for you? Does it feel like a breakthrough, 12 00:00:47,440 --> 00:00:51,440 Speaker 1: like cause for celebration, or does it make your heart 13 00:00:51,479 --> 00:00:55,920 Speaker 1: ache a little like we're sliding back into this old 14 00:00:56,080 --> 00:01:01,319 Speaker 1: narrative of celebrating dangerously thin bodies. I don't think there's 15 00:01:01,360 --> 00:01:03,680 Speaker 1: a right or wrong answer here. It's natural to have 16 00:01:03,760 --> 00:01:06,400 Speaker 1: mixed feelings about the meteoric rise of GLP one weight 17 00:01:06,400 --> 00:01:10,240 Speaker 1: loss medications. I have mixed feelings too. I look at 18 00:01:10,280 --> 00:01:13,720 Speaker 1: influencers online, and I look at celebrities on the red carpet, 19 00:01:13,720 --> 00:01:17,959 Speaker 1: and I just have this fear that all of our 20 00:01:18,120 --> 00:01:24,240 Speaker 1: differences are disappearing, that we are prioritizing homogeneous beauty, this 21 00:01:24,400 --> 00:01:29,600 Speaker 1: one narrow definition of what is beautiful today, and that 22 00:01:29,640 --> 00:01:33,039 Speaker 1: really scares me. And at the same time, there is 23 00:01:33,080 --> 00:01:36,319 Speaker 1: a bright side to these medications. If a drug exists 24 00:01:36,400 --> 00:01:38,960 Speaker 1: that helps people feel healthier, feel more at home in 25 00:01:39,000 --> 00:01:42,280 Speaker 1: their bodies, and more like themselves, there is power in that. 26 00:01:42,520 --> 00:01:45,840 Speaker 1: There is freedom in that. In our guest today, doctor 27 00:01:45,920 --> 00:01:48,720 Speaker 1: Rocio Salas Waylan has had a front row seat to 28 00:01:48,800 --> 00:01:52,800 Speaker 1: that freedom. She's actually been prescribing GLP one medications long 29 00:01:52,880 --> 00:01:57,080 Speaker 1: before they ever entered the mainstream conversation, and she's actually 30 00:01:57,120 --> 00:02:00,600 Speaker 1: taken them herself, which is a perspective I really I appreciate. 31 00:02:00,920 --> 00:02:04,920 Speaker 1: In her new book Witless, she's asking thoughtful human questions 32 00:02:05,320 --> 00:02:08,800 Speaker 1: in a space that's moving really fast. She's opening up 33 00:02:08,800 --> 00:02:11,560 Speaker 1: about it all. Today, she's sharing the origins of GLP 34 00:02:11,639 --> 00:02:15,000 Speaker 1: one medications, what you need to know about long term usage, 35 00:02:15,040 --> 00:02:17,679 Speaker 1: and why these drugs could be a game changer for 36 00:02:17,840 --> 00:02:21,360 Speaker 1: menopausal women. My hope for this conversation today is that 37 00:02:21,400 --> 00:02:27,200 Speaker 1: it brings you clarity, healing, and real science backed breakthroughs, 38 00:02:27,440 --> 00:02:30,280 Speaker 1: so we can all make empowered choices for our health. 39 00:02:30,840 --> 00:02:35,919 Speaker 1: Let's get into it. Doctor Rossillo, Salas Waylan, Welcome to 40 00:02:35,960 --> 00:02:36,680 Speaker 1: the bright Side. 41 00:02:36,840 --> 00:02:38,160 Speaker 3: Thank you so much for having me. 42 00:02:38,800 --> 00:02:41,280 Speaker 1: I want to start by asking you to respond to 43 00:02:41,800 --> 00:02:45,920 Speaker 1: recent comments from actress Kate Winslet about the rise of 44 00:02:46,080 --> 00:02:49,560 Speaker 1: weight loss drugs. Here's what she said, quote, it is 45 00:02:49,680 --> 00:02:53,560 Speaker 1: devastating if a person's self esteem is so bound up 46 00:02:53,600 --> 00:02:58,280 Speaker 1: in how they look. It's frightening and it's puzzling because 47 00:02:58,280 --> 00:03:00,840 Speaker 1: I have moments when I think it's better when I 48 00:03:00,880 --> 00:03:04,560 Speaker 1: look at actresses at events stressed how they want, whichever shape. 49 00:03:04,880 --> 00:03:08,760 Speaker 1: But then so many people are on weight loss drugs. 50 00:03:09,160 --> 00:03:12,160 Speaker 1: And then she goes on to say, do they know 51 00:03:12,200 --> 00:03:14,880 Speaker 1: what they are putting in? The disregard for one's health 52 00:03:14,960 --> 00:03:19,480 Speaker 1: is terrifying. So in that last bit she's referencing potential 53 00:03:19,639 --> 00:03:23,160 Speaker 1: unknown side effects of these drugs. When you think about 54 00:03:23,160 --> 00:03:28,600 Speaker 1: her comments here commenting about the narrative around body image 55 00:03:29,080 --> 00:03:32,960 Speaker 1: in this country, in celebrity culture, and also the potential 56 00:03:32,960 --> 00:03:35,280 Speaker 1: side effects of these drugs, what are your thoughts on 57 00:03:35,480 --> 00:03:37,040 Speaker 1: Kate Winsled's comments here. 58 00:03:37,480 --> 00:03:43,160 Speaker 2: I thought it was a very upsetting comment, but understandable, right, 59 00:03:43,240 --> 00:03:46,680 Speaker 2: I mean, I'm hearing this as a and the chronologist 60 00:03:46,720 --> 00:03:51,640 Speaker 2: obesity doctor GLP one expert with So I'm watching it 61 00:03:51,640 --> 00:03:55,280 Speaker 2: with that lens, but I'm also watching the lens as 62 00:03:55,280 --> 00:03:58,600 Speaker 2: somebody who a woman, right that I have two daughters 63 00:03:58,880 --> 00:04:03,560 Speaker 2: and I know what body image is. I think the 64 00:04:03,600 --> 00:04:08,600 Speaker 2: biggest misconception of society in regards to weight is that 65 00:04:08,680 --> 00:04:14,680 Speaker 2: we attribute an appearance with health, right, And I think 66 00:04:14,840 --> 00:04:19,720 Speaker 2: her comment is very biased in the idea of something 67 00:04:19,760 --> 00:04:26,040 Speaker 2: superficial equaling health, or being skinny or being thin being healthy. Right, 68 00:04:26,080 --> 00:04:29,080 Speaker 2: you can be very slim, you can be very thin 69 00:04:29,320 --> 00:04:34,080 Speaker 2: and be completely unhealthy. So first of all, we have 70 00:04:34,200 --> 00:04:37,760 Speaker 2: to step back and think about what health is in 71 00:04:37,800 --> 00:04:40,720 Speaker 2: regard to body weight and body weight. What counts us 72 00:04:40,760 --> 00:04:44,080 Speaker 2: health is your body composition, right, is the amount of 73 00:04:44,200 --> 00:04:47,560 Speaker 2: muscle mass, your percentage body had, your visceral fat. Those 74 00:04:47,600 --> 00:04:49,560 Speaker 2: are the important things that can either make you sick 75 00:04:49,839 --> 00:04:53,200 Speaker 2: or improve your health. And by looking at somebody physically, 76 00:04:53,480 --> 00:04:57,160 Speaker 2: we really cannot tell what the body composition is. We 77 00:04:57,320 --> 00:05:02,320 Speaker 2: have to stop viewing health as something esthetic. My problem 78 00:05:02,320 --> 00:05:05,520 Speaker 2: with her comments is that she's missing the mark. She 79 00:05:05,720 --> 00:05:09,920 Speaker 2: herself is thinking of a weight loss drug as something 80 00:05:10,000 --> 00:05:13,920 Speaker 2: superficial to get you to fit into certain dress, which 81 00:05:14,040 --> 00:05:17,720 Speaker 2: that's not ever, the reason why somebody should prescribe a 82 00:05:17,839 --> 00:05:21,279 Speaker 2: gop one gop one medication such as so sampec wagobi. 83 00:05:21,560 --> 00:05:26,040 Speaker 2: There are medical treatments to treat a medical condition such 84 00:05:26,040 --> 00:05:30,360 Speaker 2: as obesity or overweight or somebody who devotes their life 85 00:05:30,480 --> 00:05:33,640 Speaker 2: to trying to lose weight. That's what that medication was 86 00:05:33,760 --> 00:05:38,120 Speaker 2: designed for. So we have to really remember that it's 87 00:05:38,160 --> 00:05:42,400 Speaker 2: a prescription drug that requires medical supervision and that your 88 00:05:42,440 --> 00:05:45,440 Speaker 2: body composition should be checked to make sure that the 89 00:05:45,560 --> 00:05:48,080 Speaker 2: internal numbers are truly improving. 90 00:05:48,520 --> 00:05:50,880 Speaker 1: Would you talk about body composition a little bit more. 91 00:05:51,560 --> 00:05:55,960 Speaker 1: Is there a healthy picture for body composition that we 92 00:05:56,000 --> 00:05:58,919 Speaker 1: should have in our mind? What are the numbers the 93 00:05:59,000 --> 00:06:00,360 Speaker 1: metrics that we should be aim for. 94 00:06:00,800 --> 00:06:03,440 Speaker 2: So the body composition, what we need to look for 95 00:06:03,600 --> 00:06:07,039 Speaker 2: is your escletal muscle mass. That's the muscle that you 96 00:06:07,080 --> 00:06:09,240 Speaker 2: can actually work out on the gym that can you 97 00:06:09,279 --> 00:06:12,760 Speaker 2: can build. Muscle is one of the most important organs 98 00:06:12,760 --> 00:06:15,920 Speaker 2: in our body because it produces hormones. It's actually an 99 00:06:16,000 --> 00:06:21,520 Speaker 2: endocrine system. It produces hormones called myokines, which are anti inflammatory. 100 00:06:21,600 --> 00:06:25,000 Speaker 2: They have a direct effect in inflammation. So the more 101 00:06:25,080 --> 00:06:28,000 Speaker 2: muscle you have, the less inflammation in your body is 102 00:06:28,040 --> 00:06:33,200 Speaker 2: going to have. Muscle consumes eighty percent of your sugar 103 00:06:33,279 --> 00:06:36,680 Speaker 2: in your blood for energy. You don't have muscle, you 104 00:06:36,720 --> 00:06:38,800 Speaker 2: don't burn as much fat, and that's what we hear 105 00:06:38,839 --> 00:06:42,800 Speaker 2: about your metallolism slows down externally. Muscle is important for 106 00:06:42,960 --> 00:06:46,880 Speaker 2: the structural support right, for movement, for preventing falls, for 107 00:06:46,960 --> 00:06:47,960 Speaker 2: preventing injuries. 108 00:06:48,120 --> 00:06:50,719 Speaker 3: The other important marker is. 109 00:06:50,120 --> 00:06:53,080 Speaker 2: Your percentage body fat, and what that means is what 110 00:06:53,240 --> 00:06:57,080 Speaker 2: percentage of your total weight is fat. So that's the 111 00:06:57,120 --> 00:06:59,280 Speaker 2: other marker. And then the third and last is your 112 00:06:59,360 --> 00:07:02,720 Speaker 2: visceral fat. Visceral fat is your internal fat, the one 113 00:07:02,760 --> 00:07:06,840 Speaker 2: that attaches to your organs insight, right. This fat is 114 00:07:07,240 --> 00:07:11,760 Speaker 2: a chronic, active tissue producing inflammation, and this is the 115 00:07:11,840 --> 00:07:15,520 Speaker 2: fat that increases your risk for more than thirteen types 116 00:07:15,520 --> 00:07:21,560 Speaker 2: of cancers, including breast, colon, prostate, pancreas, thyroid. So we 117 00:07:21,680 --> 00:07:24,840 Speaker 2: need to reduce your visceral fat to reduce inflammation. We 118 00:07:24,920 --> 00:07:27,240 Speaker 2: need to reduce your percentage body fat, and we need 119 00:07:27,280 --> 00:07:29,280 Speaker 2: to increase your muscle mass. So this is like the 120 00:07:29,280 --> 00:07:32,200 Speaker 2: holy trinity of a good body composition. 121 00:07:32,800 --> 00:07:36,120 Speaker 1: Your book is called Weightless, a Doctor's Guide to GLP 122 00:07:36,240 --> 00:07:39,880 Speaker 1: one Medication, Sustainable weight Loss and the health you deserve, 123 00:07:40,440 --> 00:07:43,640 Speaker 1: and you open your book with an apology to patients 124 00:07:43,680 --> 00:07:48,480 Speaker 1: for how doctors have navigated conversations around weight. Why did 125 00:07:48,480 --> 00:07:50,760 Speaker 1: you want to start the book with an apology. 126 00:07:50,680 --> 00:07:53,320 Speaker 2: Because that's the first reason I decided to write a 127 00:07:53,320 --> 00:07:57,600 Speaker 2: book is when I started learning from my patients. Not 128 00:07:57,760 --> 00:08:00,200 Speaker 2: in medical school, not in a book, not for my 129 00:08:00,240 --> 00:08:03,760 Speaker 2: board exams. I learned through my patients. 130 00:08:03,280 --> 00:08:06,200 Speaker 3: That patient after patient was telling. 131 00:08:05,880 --> 00:08:08,600 Speaker 2: Me I'm exercising, I'm eating healthy, I'm doing this diet, 132 00:08:08,680 --> 00:08:11,640 Speaker 2: I've been to this program. They were doing everything that 133 00:08:11,720 --> 00:08:15,320 Speaker 2: we doctors were recommending our patients. Eat less, exercise more. 134 00:08:15,440 --> 00:08:18,480 Speaker 2: It's not working, try harder, try something different, and we 135 00:08:18,480 --> 00:08:21,120 Speaker 2: were not seeing the results. Because that's not the cause 136 00:08:21,240 --> 00:08:23,000 Speaker 2: of the waking to begin with. 137 00:08:23,200 --> 00:08:25,120 Speaker 3: I apologize because we. 138 00:08:25,120 --> 00:08:29,000 Speaker 2: Attribute not losing weight to non compliance. That's the bias 139 00:08:29,080 --> 00:08:32,319 Speaker 2: in healthcare, and bias and weight and obesity is the 140 00:08:32,400 --> 00:08:36,120 Speaker 2: highest in healthcare. So that's why I had to tell 141 00:08:36,200 --> 00:08:40,199 Speaker 2: everybody out there that patients were actually trying and doing 142 00:08:40,280 --> 00:08:42,360 Speaker 2: everything that they could and more. 143 00:08:42,679 --> 00:08:49,720 Speaker 1: Can you describe that feeling of desperation that you perceived 144 00:08:49,760 --> 00:08:52,640 Speaker 1: from your patients who are in that place of trying 145 00:08:52,800 --> 00:08:57,880 Speaker 1: every single avenue and just not having any luck in 146 00:08:57,960 --> 00:09:01,480 Speaker 1: seeing results. What is that feel for patients. 147 00:09:01,760 --> 00:09:05,200 Speaker 2: Like a full time job and top of their full 148 00:09:05,280 --> 00:09:10,920 Speaker 2: time job, right, it's a constant thinking about food. Imagine 149 00:09:12,000 --> 00:09:15,760 Speaker 2: every single plate at every single time in front of 150 00:09:15,800 --> 00:09:22,320 Speaker 2: a patient. It triggers something there. It triggers anxiety, it 151 00:09:22,360 --> 00:09:28,160 Speaker 2: triggers guilt, it triggers shame, every single meal for many 152 00:09:28,360 --> 00:09:32,800 Speaker 2: for decades. So it's that food noise that people refer as, 153 00:09:32,920 --> 00:09:36,400 Speaker 2: that constant thinking either how is this impacting me? Is 154 00:09:36,400 --> 00:09:38,160 Speaker 2: this health is it going to be helpful? Is it 155 00:09:38,200 --> 00:09:42,320 Speaker 2: setting me back? And it creates anxiety and patients it 156 00:09:42,400 --> 00:09:45,800 Speaker 2: takes a huge mental load in patience. 157 00:09:46,240 --> 00:09:48,840 Speaker 1: What do dlp ones do for that food noise? 158 00:09:49,200 --> 00:09:52,720 Speaker 2: So that food noise is anticipation of our reward, So 159 00:09:53,320 --> 00:09:57,880 Speaker 2: that anticipation of a relief or a dopamine release in 160 00:09:58,000 --> 00:10:02,720 Speaker 2: the headonistic eating of our brain. The amigaala, the medication 161 00:10:02,880 --> 00:10:08,880 Speaker 2: GLP one blocks that dopamine release, meaning that anticipation of 162 00:10:08,920 --> 00:10:10,880 Speaker 2: our reward is going to stop. 163 00:10:11,600 --> 00:10:15,280 Speaker 1: And you've been prescribing glp ones since two thousand and five. 164 00:10:15,679 --> 00:10:19,680 Speaker 1: These drugs really only entered my consciousness in honestly, the 165 00:10:19,760 --> 00:10:23,960 Speaker 1: last two years. Why did it take so long for 166 00:10:24,080 --> 00:10:26,840 Speaker 1: GLP ones to enter mainstream consciousness. 167 00:10:27,160 --> 00:10:30,719 Speaker 2: We used to think of obesity as a risk factor. Right, Oh, 168 00:10:30,760 --> 00:10:33,319 Speaker 2: if you don't lose weight now, in twenty years, you're 169 00:10:33,320 --> 00:10:37,000 Speaker 2: going to develop type two diabetes or strictritis. Came COVID 170 00:10:37,720 --> 00:10:43,600 Speaker 2: out of nowhere, unexpectedly, and it showed us that patients 171 00:10:43,640 --> 00:10:46,800 Speaker 2: and obesity don't have to wait twenty years. Came a 172 00:10:46,880 --> 00:10:50,200 Speaker 2: virus out of nowhere, and it attacked them. The worst 173 00:10:50,440 --> 00:10:53,240 Speaker 2: patients with obesity with COVID were the ones with higher 174 00:10:53,320 --> 00:10:59,400 Speaker 2: mortality hire acute care or ICU intensive care unit visits, 175 00:11:00,080 --> 00:11:03,920 Speaker 2: and were the patients that were getting sicker. So immediately 176 00:11:04,160 --> 00:11:07,600 Speaker 2: we understood that you don't have to wait. Just having 177 00:11:07,600 --> 00:11:12,520 Speaker 2: obesity already puts you in a chronic inflammatory state. So 178 00:11:12,880 --> 00:11:16,480 Speaker 2: when your body is in chronic inflammation like in obesity, 179 00:11:16,880 --> 00:11:19,640 Speaker 2: it means that your immune system that is there to 180 00:11:19,720 --> 00:11:24,240 Speaker 2: protect you is preoccupied fighting that chronic inflammation of the 181 00:11:24,280 --> 00:11:28,560 Speaker 2: obesity that comes a virus comes at a cancer cell, 182 00:11:28,840 --> 00:11:31,520 Speaker 2: a bacteria, and it's not there to protect you. So 183 00:11:31,559 --> 00:11:34,320 Speaker 2: you leave the door open for that. So people in 184 00:11:34,400 --> 00:11:38,480 Speaker 2: COVID with obesity cut the message. I remember having patients 185 00:11:38,800 --> 00:11:40,640 Speaker 2: coming to my office and saying I don't want to die, 186 00:11:40,720 --> 00:11:43,440 Speaker 2: I need to lose weight, and we had the drug 187 00:11:43,880 --> 00:11:46,400 Speaker 2: to offer the patients for the treatment. So it was 188 00:11:46,559 --> 00:11:50,280 Speaker 2: just like the perfect combination, the perfect storm, and that's 189 00:11:50,280 --> 00:11:51,200 Speaker 2: where it took over. 190 00:11:51,840 --> 00:11:55,760 Speaker 1: So COVID is the event that really put these drugs 191 00:11:55,840 --> 00:11:59,160 Speaker 1: on our radar. But there are actually decades of research 192 00:11:59,280 --> 00:12:04,400 Speaker 1: about these drugs. Why were these drugs initially created and 193 00:12:04,440 --> 00:12:06,199 Speaker 1: who created them, so. 194 00:12:06,200 --> 00:12:07,480 Speaker 3: It's a very interesting story. 195 00:12:07,559 --> 00:12:11,720 Speaker 2: So in nineteen eighties, it was actually a woman, a 196 00:12:11,840 --> 00:12:16,960 Speaker 2: researcher at Rockefeller Center in New York, doctor Isbetlana Moksof, 197 00:12:17,520 --> 00:12:21,800 Speaker 2: who discover the GOLP one hormone in humans. Our own 198 00:12:21,880 --> 00:12:26,640 Speaker 2: GLP one is very short lived. It couldn't be developed 199 00:12:26,640 --> 00:12:30,440 Speaker 2: as a therapeutic agent because of that short lifespan. And 200 00:12:30,480 --> 00:12:34,120 Speaker 2: then in nineteen ninety four, an endocrinologist at the BA 201 00:12:34,160 --> 00:12:38,680 Speaker 2: in the Bronx isolated the GLP one outside the human, 202 00:12:38,840 --> 00:12:41,960 Speaker 2: in the Gila monster, in a lizard, and that one 203 00:12:42,240 --> 00:12:45,760 Speaker 2: it was similar to ours by long acting. So what 204 00:12:45,920 --> 00:12:50,120 Speaker 2: we have commercially is a copy of our own GOLP one, 205 00:12:50,320 --> 00:12:54,240 Speaker 2: but now engineer to be long acting. So we've had 206 00:12:54,320 --> 00:12:59,080 Speaker 2: twenty years of clinical experience plus another twenty years of research. 207 00:12:59,360 --> 00:13:02,319 Speaker 1: In your book, you mentioned two times that you personally 208 00:13:02,440 --> 00:13:08,040 Speaker 1: used GLP ones. What were the medical circumstances where you, 209 00:13:08,160 --> 00:13:12,319 Speaker 1: as a doctor decided that this medication was right for you. 210 00:13:12,480 --> 00:13:14,480 Speaker 1: I want to hear what that experience was like for you. 211 00:13:15,000 --> 00:13:17,360 Speaker 2: So the first time that I decided to try it 212 00:13:17,440 --> 00:13:20,319 Speaker 2: was not because I needed it, is because I want 213 00:13:20,520 --> 00:13:23,160 Speaker 2: It was so new and so very little people a 214 00:13:23,200 --> 00:13:26,760 Speaker 2: small number of doctors were prescribing it, and I was 215 00:13:26,840 --> 00:13:30,239 Speaker 2: prescribing it like there was no tomorrow. But I couldn't 216 00:13:30,600 --> 00:13:33,280 Speaker 2: relate to my patients what is it that they were 217 00:13:33,320 --> 00:13:35,679 Speaker 2: experienced just because they were so new that nobody knew. 218 00:13:36,080 --> 00:13:38,840 Speaker 2: So I decided back in two thousand and nine to 219 00:13:39,000 --> 00:13:43,120 Speaker 2: try one of them. 220 00:13:42,080 --> 00:13:43,319 Speaker 3: To Pictosa to try. 221 00:13:43,440 --> 00:13:45,600 Speaker 2: It was a daily injection, so I and I know 222 00:13:45,679 --> 00:13:48,160 Speaker 2: that it doesn't cause hyperblesmia, so it's not like I 223 00:13:48,240 --> 00:13:52,480 Speaker 2: was injecting myself insulin and putting myself on danger. So 224 00:13:52,600 --> 00:13:55,720 Speaker 2: I wanted to see what patients experience on the medication 225 00:13:55,920 --> 00:13:59,240 Speaker 2: so I can really guide my patients better and tell 226 00:13:59,280 --> 00:14:02,120 Speaker 2: them what side of happen. So that's the first time, 227 00:14:02,440 --> 00:14:05,720 Speaker 2: and then the second time, many years later, I had 228 00:14:05,760 --> 00:14:08,360 Speaker 2: my kids at thirty eight and thirty nine years old, 229 00:14:08,800 --> 00:14:11,719 Speaker 2: and then my first pregnancy, I gained seventy pounds, and 230 00:14:11,800 --> 00:14:16,599 Speaker 2: then after I had my second one, I hid a perimenopause. 231 00:14:17,000 --> 00:14:20,520 Speaker 2: So I ended up with two kids under two with 232 00:14:20,960 --> 00:14:26,000 Speaker 2: more than fifty pounds in midlife. So I knew I 233 00:14:26,080 --> 00:14:29,760 Speaker 2: needed help. So I decided to use osampic back then, 234 00:14:29,880 --> 00:14:32,440 Speaker 2: and I only used it for six months. And because 235 00:14:32,480 --> 00:14:35,400 Speaker 2: I never struggled with obcity, there's no obsity in my family, 236 00:14:35,440 --> 00:14:37,720 Speaker 2: I was able to stay off of it since then. 237 00:14:38,160 --> 00:14:40,200 Speaker 1: Talk to me about that, So you only used it 238 00:14:40,240 --> 00:14:43,440 Speaker 1: for six months. I often hear of people needing to 239 00:14:43,440 --> 00:14:45,840 Speaker 1: be on these medications for the rest of their life, 240 00:14:45,880 --> 00:14:49,080 Speaker 1: because I've heard that it's harder to maintain the weight 241 00:14:49,120 --> 00:14:50,760 Speaker 1: loss once you're off the drugs. 242 00:14:51,160 --> 00:14:54,960 Speaker 2: What's going to determine the most your length of use 243 00:14:55,160 --> 00:14:57,800 Speaker 2: is what's the reason that brought you to need it 244 00:14:57,920 --> 00:15:02,280 Speaker 2: to begin with? Right As myself as an example, I 245 00:15:02,400 --> 00:15:07,040 Speaker 2: lifted weights since my early twenties. Both my parents don't 246 00:15:07,080 --> 00:15:12,200 Speaker 2: struggle with obesity, nor my grandparents. I never struggled with obesity, 247 00:15:12,320 --> 00:15:18,160 Speaker 2: was more circumstantial to pregnancy late in life and then midlife. 248 00:15:18,200 --> 00:15:21,240 Speaker 2: But if I have a patient that started struggling with 249 00:15:21,320 --> 00:15:26,000 Speaker 2: their weight and childhood through their life, and they're in midlife, 250 00:15:26,040 --> 00:15:29,480 Speaker 2: they're fifty, they're sixty, then most likely they will require 251 00:15:29,520 --> 00:15:33,480 Speaker 2: the medication long term. So it really depends on the 252 00:15:33,520 --> 00:15:37,000 Speaker 2: personal reason of somebody needing the drug to begin with. 253 00:15:37,400 --> 00:15:40,760 Speaker 2: That is going to predict how long does the patient 254 00:15:40,840 --> 00:15:44,480 Speaker 2: have to be on it. But these medications were designed 255 00:15:44,600 --> 00:15:48,360 Speaker 2: for chronic use, right, so they were never designed for 256 00:15:48,440 --> 00:15:50,280 Speaker 2: something short term use. 257 00:15:51,320 --> 00:15:54,920 Speaker 1: What did it do for your self image and confidence? 258 00:15:55,600 --> 00:15:58,360 Speaker 3: Being a doctor? I knew what I had against me. 259 00:15:58,520 --> 00:16:00,640 Speaker 2: I know. I knew that I had two kids under 260 00:16:00,760 --> 00:16:06,520 Speaker 2: two years old, I had a practice, I was in midlife, 261 00:16:06,560 --> 00:16:09,000 Speaker 2: my hormones were out of whack, I was not sleeping. 262 00:16:09,680 --> 00:16:12,800 Speaker 2: I knew I needed the help at that moment. And 263 00:16:12,840 --> 00:16:15,600 Speaker 2: that's what that's what the Ocempic did for me. In 264 00:16:15,680 --> 00:16:18,200 Speaker 2: that moment, it allowed me. It gave me like a 265 00:16:18,280 --> 00:16:22,240 Speaker 2: moment of grace to myself to concentrate on my kids, 266 00:16:22,280 --> 00:16:27,760 Speaker 2: to concentrate on restarting back, exercising, eating healthy, And that's. 267 00:16:27,600 --> 00:16:30,480 Speaker 3: What it gave me. So I took it. I was 268 00:16:30,560 --> 00:16:31,320 Speaker 3: very pragmatic. 269 00:16:31,600 --> 00:16:34,520 Speaker 2: I knew I needed it, and then I was able 270 00:16:34,560 --> 00:16:38,480 Speaker 2: to maintain on my own, but not everybody. Not everybody 271 00:16:38,560 --> 00:16:42,200 Speaker 2: has that same journey on the medication, right. 272 00:16:42,320 --> 00:16:43,960 Speaker 1: And how did you feel while you were on it? 273 00:16:43,960 --> 00:16:45,280 Speaker 1: Did you have any side effects? 274 00:16:45,680 --> 00:16:53,040 Speaker 2: Yes, constipation, severe constipation, but this Ocempic, with the new versions, 275 00:16:53,040 --> 00:16:55,880 Speaker 2: we don't have that, thankfully. That was the reason that 276 00:16:56,040 --> 00:17:00,000 Speaker 2: I started decreasing my dose and not go back on it. 277 00:17:00,120 --> 00:17:03,280 Speaker 1: Also, what are some of the more common sideffcts that 278 00:17:03,320 --> 00:17:05,080 Speaker 1: you hear from patients who are on these drugs. 279 00:17:05,480 --> 00:17:10,800 Speaker 2: Nausha definitely, that's almost expected more on Osempic and Wigobi 280 00:17:11,160 --> 00:17:15,359 Speaker 2: than the newer drugs like Monjaro and set Bound. I 281 00:17:15,520 --> 00:17:18,920 Speaker 2: really don't see nasha on my patients on the newer drugs. 282 00:17:19,440 --> 00:17:23,720 Speaker 2: Constipation again mostly on semaglutite which is ocempic, and Wikoby 283 00:17:24,000 --> 00:17:28,119 Speaker 2: not so much with thersepatite. Diarrhea can happen with any 284 00:17:28,280 --> 00:17:32,720 Speaker 2: of them, with anything fatty or high and fat in food. 285 00:17:34,359 --> 00:17:37,000 Speaker 2: That again, that can happen with any of the drugs. 286 00:17:37,400 --> 00:17:41,040 Speaker 2: And then we can have muscle loss, hair loss, sagging 287 00:17:41,080 --> 00:17:43,840 Speaker 2: off the skin. But that all is not from the 288 00:17:44,119 --> 00:17:46,480 Speaker 2: direct effect of the drug. It's not like the GLP 289 00:17:46,640 --> 00:17:49,680 Speaker 2: one is going and attacking your muscle attacking your hair. 290 00:17:49,720 --> 00:17:54,120 Speaker 2: Folly kill is the lack of a macronutrient, which is protein. 291 00:17:54,960 --> 00:17:58,480 Speaker 2: You need protein for muscle, protein synthesis. You need protein 292 00:17:58,720 --> 00:18:01,960 Speaker 2: to make a lasting caledgen carat and for your skin, 293 00:18:02,119 --> 00:18:05,320 Speaker 2: your nails, and your hair. And if you're losing muscle, 294 00:18:05,359 --> 00:18:07,720 Speaker 2: you're gonna lose hair. If you're losing hair, you're gonna 295 00:18:07,720 --> 00:18:11,040 Speaker 2: lose muscle again because it all comes from the same deficiency, 296 00:18:11,119 --> 00:18:12,200 Speaker 2: which will be protein. 297 00:18:12,960 --> 00:18:14,720 Speaker 1: We've got to take a short break, but we'll be 298 00:18:14,800 --> 00:18:20,800 Speaker 1: right back with doctor Rosso Salas Whalen. And we're back 299 00:18:21,000 --> 00:18:24,439 Speaker 1: with doctor Rosso Salas Whalen. I want to transition to 300 00:18:25,400 --> 00:18:27,920 Speaker 1: a part of the conversation where we talk about how 301 00:18:27,960 --> 00:18:31,960 Speaker 1: to decide if this medication is right for you. What 302 00:18:32,000 --> 00:18:35,200 Speaker 1: are some of the biological or hormonal factors that explain 303 00:18:35,400 --> 00:18:41,639 Speaker 1: why good nutrition, healthy exercise habits alone often isn't enough 304 00:18:41,800 --> 00:18:43,920 Speaker 1: for someone to lose the weight that they want to lose. 305 00:18:44,440 --> 00:18:46,960 Speaker 2: Yeah, I mean definitely, we have to go a little 306 00:18:47,000 --> 00:18:52,000 Speaker 2: bit further back and to think about your parents' weight preconception. 307 00:18:52,160 --> 00:18:57,720 Speaker 2: So your parent's weight preconception can impact fifty to sixty. 308 00:18:57,359 --> 00:18:59,280 Speaker 3: Percent of your current weight. 309 00:18:59,760 --> 00:19:03,280 Speaker 2: Right, so even before you're born, if your parents had obesity, 310 00:19:03,520 --> 00:19:06,000 Speaker 2: you have sixty percent chance that you are also going 311 00:19:06,040 --> 00:19:06,800 Speaker 2: to have obesity. 312 00:19:06,800 --> 00:19:09,480 Speaker 3: And this can go up to two generations behind. 313 00:19:10,040 --> 00:19:12,840 Speaker 1: Why is that? Is it in our genes? How does 314 00:19:12,880 --> 00:19:14,480 Speaker 1: that get transferred down to us? 315 00:19:15,280 --> 00:19:19,399 Speaker 2: Yeah, they're called epigenetics, So it means that through time, 316 00:19:19,480 --> 00:19:24,439 Speaker 2: genes are changing and passed down through generations. So in 317 00:19:24,520 --> 00:19:29,320 Speaker 2: societies where there's trauma, that also increases your risk for obesity. 318 00:19:29,440 --> 00:19:33,640 Speaker 2: So people that grew up in war and famine, they 319 00:19:34,080 --> 00:19:38,720 Speaker 2: can pass down obesity genes into their offspring. And our 320 00:19:38,800 --> 00:19:41,560 Speaker 2: parents didn't know that, our grandparents didn't know that. 321 00:19:41,640 --> 00:19:42,479 Speaker 3: But now we know. 322 00:19:42,640 --> 00:19:46,960 Speaker 2: So now here's when we can break that transgenerational passing 323 00:19:47,000 --> 00:19:50,359 Speaker 2: of obesity is by starting in a healthy weight. And 324 00:19:50,400 --> 00:19:52,920 Speaker 2: now we can we have the medication and the means 325 00:19:53,240 --> 00:19:57,640 Speaker 2: to help patients achieve a preconception at a healthy weight, 326 00:19:57,720 --> 00:20:00,879 Speaker 2: not only to improve their chances of pres ignancy, reduce 327 00:20:00,920 --> 00:20:04,840 Speaker 2: the risk complications of pregnancy with obesity, but also to 328 00:20:04,920 --> 00:20:07,680 Speaker 2: reduce the risk of having obesity in your children. 329 00:20:08,119 --> 00:20:11,560 Speaker 1: Wow, that is blowing my mind. I had no idea 330 00:20:12,240 --> 00:20:15,439 Speaker 1: that it could impact your future your bloodline like that. 331 00:20:16,000 --> 00:20:19,439 Speaker 2: Yes, for sure, you can pack like mental diseases has 332 00:20:19,520 --> 00:20:22,960 Speaker 2: passed through genes. Also, obesity is passed through genes. We 333 00:20:23,040 --> 00:20:28,440 Speaker 2: know that hyperpalatable genes, genes that promote that you wanted 334 00:20:28,440 --> 00:20:31,920 Speaker 2: to have hyperpalatable food, which is ultra process food, can 335 00:20:32,000 --> 00:20:37,600 Speaker 2: also be passed down generations. So if we talk about this, 336 00:20:37,800 --> 00:20:41,760 Speaker 2: imagine somebody thinking that is there a fault one hundred 337 00:20:41,760 --> 00:20:46,120 Speaker 2: percent having obesity or not losing weight when before they 338 00:20:46,119 --> 00:20:49,600 Speaker 2: were born it was already the risk was already increased 339 00:20:49,640 --> 00:20:50,440 Speaker 2: to have obesity. 340 00:20:50,720 --> 00:20:52,760 Speaker 3: Then we add environmental factors. 341 00:20:52,880 --> 00:20:57,119 Speaker 2: Environmental factors are things in our environment that promote obesity, 342 00:20:57,560 --> 00:21:03,520 Speaker 2: such as plastics, right, the BPA, the forever chemicals, the 343 00:21:03,680 --> 00:21:08,159 Speaker 2: process food, industrialization, seven, tourism, living in a city that 344 00:21:08,200 --> 00:21:11,960 Speaker 2: doesn't promote walking, working from home, all of those things 345 00:21:12,000 --> 00:21:16,399 Speaker 2: in our environment can also promote obesity and waking. 346 00:21:16,720 --> 00:21:19,359 Speaker 1: So we talked about some of the genetic factors that 347 00:21:19,440 --> 00:21:21,520 Speaker 1: might make someone a good candidate for these drugs. What 348 00:21:21,560 --> 00:21:23,119 Speaker 1: about the hormonal factors. 349 00:21:23,680 --> 00:21:27,120 Speaker 2: So definitely, people, especially women in midlife, if they're going 350 00:21:27,119 --> 00:21:30,879 Speaker 2: through perimenopause and menopause, with the fluctuations of hormones that 351 00:21:31,880 --> 00:21:35,000 Speaker 2: at after forty women tend to gain one to two 352 00:21:35,040 --> 00:21:38,800 Speaker 2: pounds per year consecutively, and this is mostly from the 353 00:21:38,880 --> 00:21:45,680 Speaker 2: changes from perimenopause. Also, if somebody has hypothyroidism or PCOS, 354 00:21:45,680 --> 00:21:50,119 Speaker 2: polycystic ovariant syndrome, insulin resistem pre diabetes, that also is 355 00:21:50,160 --> 00:21:53,320 Speaker 2: going to make it easier for somebody to gain weight 356 00:21:53,400 --> 00:21:55,880 Speaker 2: and harder for somebody to lose weight. 357 00:21:56,880 --> 00:22:01,280 Speaker 1: You talked about the hormonal realities that make it difficult 358 00:22:01,320 --> 00:22:04,119 Speaker 1: for someone to just eat less and move more and 359 00:22:04,160 --> 00:22:09,480 Speaker 1: lose weight. Why does that advice become almost irrelevant for 360 00:22:09,600 --> 00:22:14,359 Speaker 1: menopausal women? What's going on there with our homeoones as. 361 00:22:14,240 --> 00:22:18,360 Speaker 2: You're asking women to achieve something almost impossible, right, I'm 362 00:22:18,400 --> 00:22:23,199 Speaker 2: not going to say impossible, but either not compatible with 363 00:22:23,359 --> 00:22:27,520 Speaker 2: their day to day life because it's not the hormonal 364 00:22:27,600 --> 00:22:31,399 Speaker 2: only the hormonal changes. Is we have aging parents in 365 00:22:31,960 --> 00:22:34,960 Speaker 2: our forties is a very hard decade for women because 366 00:22:35,000 --> 00:22:39,320 Speaker 2: it's a transition hormonally, you're like in puberty again, right, 367 00:22:40,280 --> 00:22:44,280 Speaker 2: But also emotionally, a lot of things are happening. Your 368 00:22:44,280 --> 00:22:47,159 Speaker 2: parents may be aging, you may be losing a parent, 369 00:22:47,240 --> 00:22:49,719 Speaker 2: or you may be the caregiver of a parent and 370 00:22:49,760 --> 00:22:53,480 Speaker 2: then your children or either you have small children later 371 00:22:53,680 --> 00:22:57,880 Speaker 2: in life or your children are aging, are teenagers, right, 372 00:22:58,200 --> 00:23:02,600 Speaker 2: maybe professional you're your peak, and maybe you're not sleeping 373 00:23:02,640 --> 00:23:05,119 Speaker 2: because you're imperimenopause, and then you have the weight, and 374 00:23:05,200 --> 00:23:06,320 Speaker 2: then you have to go to the gym and you 375 00:23:06,359 --> 00:23:08,960 Speaker 2: have to eat this amount of It's just a lot 376 00:23:09,040 --> 00:23:12,600 Speaker 2: for a woman in that stage. So there's things that 377 00:23:12,640 --> 00:23:14,879 Speaker 2: we cannot control. We cannot control the aging of a 378 00:23:14,880 --> 00:23:18,359 Speaker 2: pairing or a chill, a child becoming a teenager. But 379 00:23:18,440 --> 00:23:21,000 Speaker 2: we can control our hormones. We can control our weight 380 00:23:21,520 --> 00:23:25,560 Speaker 2: with medications and hormone replacement therapy. So they're like our 381 00:23:25,720 --> 00:23:29,040 Speaker 2: tools that will help us get to the next decade 382 00:23:29,520 --> 00:23:30,359 Speaker 2: in a good place. 383 00:23:30,760 --> 00:23:34,439 Speaker 1: You're a big believer that GLP ones combined with HRT 384 00:23:34,760 --> 00:23:40,720 Speaker 1: hormone replacement therapy are a turbopowered metabolic solution. Why is that? 385 00:23:40,920 --> 00:23:43,399 Speaker 2: I call it the perfect marriage. If there was a 386 00:23:43,400 --> 00:23:47,720 Speaker 2: perfect marriage, it would be that too, because not having 387 00:23:47,720 --> 00:23:51,320 Speaker 2: hormones or being imperimenopause really decreases the quality of life 388 00:23:51,359 --> 00:23:54,280 Speaker 2: of a woman. To begin with. If you're not sleeping, 389 00:23:54,320 --> 00:23:58,120 Speaker 2: which is probably the most universal symptom imperimenopause is waking 390 00:23:58,200 --> 00:24:01,239 Speaker 2: up at three four am in the morning, You're not 391 00:24:01,280 --> 00:24:03,479 Speaker 2: gonna You're not gonna function. If you're not sleeping, You're 392 00:24:03,480 --> 00:24:06,399 Speaker 2: going to be irritable. You're gonna be tired, You're going 393 00:24:06,480 --> 00:24:09,600 Speaker 2: to have brain fog. You're not gonna want to work out. 394 00:24:10,440 --> 00:24:15,120 Speaker 2: You made it well or not. If you're overheating yourself, 395 00:24:15,280 --> 00:24:17,320 Speaker 2: then you're not gonna work out either. Right, you don't 396 00:24:17,320 --> 00:24:20,480 Speaker 2: want to be even hotter if you're moody from the 397 00:24:20,800 --> 00:24:25,320 Speaker 2: hormonal changes. That also doesn't doesn't set you up for success. 398 00:24:25,720 --> 00:24:27,879 Speaker 1: What are the factors that can set you up for 399 00:24:27,960 --> 00:24:31,399 Speaker 1: success on these medications? And I know that you believe 400 00:24:31,400 --> 00:24:35,520 Speaker 1: that prescribers actually have a huge role to play in 401 00:24:35,520 --> 00:24:36,840 Speaker 1: those successful outcomes. 402 00:24:37,359 --> 00:24:40,440 Speaker 2: I would say the most important decision that you're going 403 00:24:40,480 --> 00:24:42,960 Speaker 2: to make after you decided that you want to try 404 00:24:42,960 --> 00:24:46,520 Speaker 2: a GLP one is who you choose to be your 405 00:24:46,680 --> 00:24:49,240 Speaker 2: prescriber and who is going to guide you in this 406 00:24:49,400 --> 00:24:53,040 Speaker 2: journey that is going to determine your success and the 407 00:24:53,160 --> 00:24:57,200 Speaker 2: safety of the medication. So I try to tell people, 408 00:24:57,560 --> 00:25:00,920 Speaker 2: choose a doctor that has at least at a minimum 409 00:25:01,160 --> 00:25:05,120 Speaker 2: five years of prescribing this medication. And a red flag 410 00:25:05,240 --> 00:25:08,399 Speaker 2: is if they're not doing body compositions. A red flag 411 00:25:08,480 --> 00:25:12,400 Speaker 2: is if they're not telling you how to preserve muscle 412 00:25:13,119 --> 00:25:13,960 Speaker 2: during the treatment. 413 00:25:14,760 --> 00:25:19,200 Speaker 1: You emphasize that GLP ones are not a shortcut, they 414 00:25:19,280 --> 00:25:25,359 Speaker 1: do require work. What is the most surprising lifestyle change 415 00:25:25,440 --> 00:25:29,200 Speaker 1: that you find patients need to adopt in order to protect. 416 00:25:28,920 --> 00:25:33,960 Speaker 2: Muscle, consuming protein in their diet and enough amount of 417 00:25:34,040 --> 00:25:37,439 Speaker 2: protein that is going to help them preserve the muscle. 418 00:25:37,520 --> 00:25:39,359 Speaker 3: If we don't preserve the muscle. 419 00:25:39,080 --> 00:25:42,040 Speaker 2: It's worse because now they don't have muscle mass, which 420 00:25:42,119 --> 00:25:45,960 Speaker 2: that's pro inflammatory, and now they have still have high 421 00:25:46,040 --> 00:25:49,320 Speaker 2: body fat, which is also inflammatory. So we potentially made 422 00:25:49,320 --> 00:25:52,879 Speaker 2: the patients help worse if we had them loose the muscle. 423 00:25:52,960 --> 00:25:56,720 Speaker 2: So that's why it's important to preserve muscle normally, even 424 00:25:56,760 --> 00:26:00,520 Speaker 2: without a GLP one medications. We're not accustomed to consume 425 00:26:00,760 --> 00:26:04,720 Speaker 2: large amount of protein in our diets, but now adding 426 00:26:05,640 --> 00:26:08,400 Speaker 2: medication that is going to suppress or appetite, it becomes 427 00:26:08,640 --> 00:26:12,840 Speaker 2: really difficult. So I think the hardest part for my 428 00:26:13,040 --> 00:26:16,840 Speaker 2: patients is needing that protein requires me needed a day 429 00:26:17,119 --> 00:26:20,080 Speaker 2: to not lose muscle, hair, and bone. 430 00:26:19,880 --> 00:26:21,840 Speaker 1: And that I would imagine it's a lot harder when 431 00:26:21,880 --> 00:26:25,000 Speaker 1: your appetite is suppressed exactly. 432 00:26:25,080 --> 00:26:29,280 Speaker 2: So ideally protein should come from food itself, but with 433 00:26:29,359 --> 00:26:32,760 Speaker 2: AJLP one medication, with this which is a medical treatment. 434 00:26:33,119 --> 00:26:37,680 Speaker 2: We need to rely on supplementing with weight protein or 435 00:26:37,720 --> 00:26:40,800 Speaker 2: a protein powder. Right, So for the majority of patients, 436 00:26:40,880 --> 00:26:43,720 Speaker 2: half of the protein will come from food and half 437 00:26:43,760 --> 00:26:47,320 Speaker 2: of the protein will come from a supplement. And this 438 00:26:47,359 --> 00:26:51,040 Speaker 2: isn't the weight lost period because we're trying to the 439 00:26:51,119 --> 00:26:53,760 Speaker 2: patient to lose weight. Once they lost the weight and 440 00:26:53,800 --> 00:26:58,680 Speaker 2: we enter a maintain space, then we replace one protein 441 00:26:58,720 --> 00:27:02,040 Speaker 2: shape for a meal, so maybe three meals in one shake, right, 442 00:27:02,080 --> 00:27:06,120 Speaker 2: because we're reducing the dose of the medication because we're 443 00:27:06,119 --> 00:27:08,120 Speaker 2: not looking for any more whare loos. We just want 444 00:27:08,160 --> 00:27:11,119 Speaker 2: to maintain the weare loss, so then they can start 445 00:27:11,280 --> 00:27:14,160 Speaker 2: to become more food than supplement. But at the beginning, 446 00:27:14,200 --> 00:27:17,680 Speaker 2: when you're still in that were loss process, we need 447 00:27:17,720 --> 00:27:18,560 Speaker 2: the supplementation. 448 00:27:19,240 --> 00:27:21,240 Speaker 1: I'm glad you brought that up. Would you break down 449 00:27:21,480 --> 00:27:25,520 Speaker 1: the different phases that are involved in taking these GLP 450 00:27:25,600 --> 00:27:26,680 Speaker 1: one medications. 451 00:27:27,359 --> 00:27:31,440 Speaker 2: Yeah, So the first phase is getting ready for a 452 00:27:31,480 --> 00:27:34,520 Speaker 2: big change of your life, right, because not just the medication, 453 00:27:34,720 --> 00:27:38,280 Speaker 2: but you're how you look at food is going to change. 454 00:27:38,400 --> 00:27:42,760 Speaker 2: How you think about food is going to change. Getting 455 00:27:42,800 --> 00:27:47,480 Speaker 2: adjusted at the protein, right. I think again, that's the 456 00:27:47,520 --> 00:27:51,479 Speaker 2: biggest hurdle for patients getting getting under their belt. What 457 00:27:52,080 --> 00:27:54,680 Speaker 2: having one hundred grounds of protein a day looks like. Right, 458 00:27:54,760 --> 00:27:56,960 Speaker 2: Once they figure that out and they know how to 459 00:27:56,960 --> 00:27:59,840 Speaker 2: break it through the day, it's easy. At any dose 460 00:27:59,880 --> 00:28:02,800 Speaker 2: of medication, if they can still consume those four portions 461 00:28:02,800 --> 00:28:06,440 Speaker 2: of protein, they won't lose significant amount of muscle. So 462 00:28:06,880 --> 00:28:09,560 Speaker 2: that's the first phase when they're coming and they don't 463 00:28:09,600 --> 00:28:12,199 Speaker 2: know really what to expect, and they're thinking they have 464 00:28:12,240 --> 00:28:15,840 Speaker 2: an idea of an external change, right. Everybody comes with 465 00:28:16,000 --> 00:28:21,040 Speaker 2: something a hope of something external changing. But then as 466 00:28:21,119 --> 00:28:24,600 Speaker 2: we're talking about protein, patients starts to lift weights, they 467 00:28:24,640 --> 00:28:28,520 Speaker 2: starts to lose body fat, They start to feel their 468 00:28:28,600 --> 00:28:34,399 Speaker 2: body changing, but in a really important weight. They start 469 00:28:34,440 --> 00:28:39,600 Speaker 2: to feel strong, they start to feel lean, they start 470 00:28:39,600 --> 00:28:43,600 Speaker 2: to feel tight, and they start to feel what their 471 00:28:43,640 --> 00:28:47,120 Speaker 2: body can do that it couldn't do before. Right, Because 472 00:28:47,280 --> 00:28:51,280 Speaker 2: we're always talking about building muscle, protein and losing body fat. 473 00:28:51,480 --> 00:28:54,400 Speaker 2: So the patient is working out, the patient is building strength, 474 00:28:54,960 --> 00:28:57,760 Speaker 2: So it becomes too more like, oh how did I 475 00:28:57,800 --> 00:29:00,400 Speaker 2: do with my muscle? Then how many pounds did I loose? 476 00:29:00,960 --> 00:29:04,320 Speaker 2: So patients start to fall in love with feeling strong 477 00:29:04,480 --> 00:29:06,680 Speaker 2: and seeing and pushing their body and they want to 478 00:29:06,720 --> 00:29:09,760 Speaker 2: see what else can they do. So I have patients 479 00:29:09,760 --> 00:29:12,960 Speaker 2: that start running marathons that they do with triathlons, that 480 00:29:13,400 --> 00:29:15,600 Speaker 2: they start to take a new hobby that they start 481 00:29:15,680 --> 00:29:18,680 Speaker 2: hiking because they want to see what else can their 482 00:29:18,720 --> 00:29:21,320 Speaker 2: body do now that they're not worrying about the waking 483 00:29:21,800 --> 00:29:25,240 Speaker 2: or losing the body fact. And then the third stage 484 00:29:25,320 --> 00:29:27,880 Speaker 2: is when we reach maintenance. So there's a little bit 485 00:29:27,880 --> 00:29:30,400 Speaker 2: of anxiety and patients right like, oh, how if I 486 00:29:30,480 --> 00:29:32,280 Speaker 2: reduce the dose, am I going to go back? At 487 00:29:32,280 --> 00:29:35,760 Speaker 2: the beginning, it starts to become a different anxiety of 488 00:29:35,840 --> 00:29:39,600 Speaker 2: the anxiety of weight regain. All patients say, I never 489 00:29:39,680 --> 00:29:41,720 Speaker 2: want to go back or to what I was before. 490 00:29:42,120 --> 00:29:46,000 Speaker 2: So that's another phase, is just like bringing down the 491 00:29:46,080 --> 00:29:49,520 Speaker 2: medication gradually so they can adapt at the changes in 492 00:29:49,640 --> 00:29:53,320 Speaker 2: the dose, and then reassuring them with their body composition 493 00:29:53,520 --> 00:29:56,760 Speaker 2: that they're maintaining their weight even though we're reducing the 494 00:29:56,840 --> 00:29:59,000 Speaker 2: dose and that's okay. 495 00:29:59,160 --> 00:30:03,320 Speaker 1: At that stage. And you write about patients shedding shame 496 00:30:03,560 --> 00:30:06,800 Speaker 1: along with weight, can you think of a moment in 497 00:30:06,840 --> 00:30:10,600 Speaker 1: your practice when treating obesity as a disease and not 498 00:30:10,680 --> 00:30:14,520 Speaker 1: a moral or cosmetic issue actually changed someone's life. 499 00:30:15,160 --> 00:30:18,760 Speaker 2: Every single day with my patients, with all my patients. 500 00:30:19,080 --> 00:30:21,400 Speaker 2: I'll give you an example. I had a patient that 501 00:30:21,480 --> 00:30:24,640 Speaker 2: I saw virtually and the patient she was over three 502 00:30:24,720 --> 00:30:29,200 Speaker 2: hundred pounds and she was in her early forties and 503 00:30:30,920 --> 00:30:35,040 Speaker 2: I was her last stop, her last chance that she 504 00:30:35,120 --> 00:30:37,400 Speaker 2: was giving herself. I was the last doctor that she 505 00:30:37,480 --> 00:30:39,560 Speaker 2: was going to see because she has struggled with weight 506 00:30:39,640 --> 00:30:43,760 Speaker 2: all her life. So she'd seen multiple doctors telling her 507 00:30:43,840 --> 00:30:47,800 Speaker 2: eat less, exercise more, go to this weight loss camp, 508 00:30:48,960 --> 00:30:52,240 Speaker 2: and nothing was happening. So she was done. She was frustrated. 509 00:30:52,280 --> 00:31:00,040 Speaker 2: She wouldn't smile. Her demeanor was with distrust. And I 510 00:31:00,040 --> 00:31:04,680 Speaker 2: would say on the third fourth visit and I email 511 00:31:04,720 --> 00:31:06,800 Speaker 2: her immediately she was laughing. 512 00:31:07,400 --> 00:31:08,400 Speaker 3: She was happy. 513 00:31:09,280 --> 00:31:14,880 Speaker 2: She looked completely different, and I'm not talking about significant 514 00:31:14,880 --> 00:31:18,840 Speaker 2: weight loss, but just her way of looking at my eyes, 515 00:31:19,520 --> 00:31:23,160 Speaker 2: just giggling. She was giggling, and I never saw her 516 00:31:23,200 --> 00:31:27,560 Speaker 2: that giggled before. Again, it was just more rejection and 517 00:31:27,640 --> 00:31:32,320 Speaker 2: like wondering what was this going. So it was really 518 00:31:32,360 --> 00:31:36,000 Speaker 2: really uplifting to hear her giggle, which in all our 519 00:31:36,040 --> 00:31:38,160 Speaker 2: appointments I never heard her giggle before. 520 00:31:38,440 --> 00:31:40,880 Speaker 1: A lightness took over her. It sounds like. 521 00:31:41,160 --> 00:31:43,280 Speaker 2: Yeah, and that's why I decided that I chose that 522 00:31:43,880 --> 00:31:47,800 Speaker 2: title weightless because that's what I see. My patients become 523 00:31:47,880 --> 00:31:53,640 Speaker 2: weightless from dropping body weight, emotional weight, shame, stigma, trauma 524 00:31:53,760 --> 00:31:55,560 Speaker 2: for many, and they become weightless. 525 00:31:56,840 --> 00:32:00,000 Speaker 1: More from doctor Rossio Salas Whalen. After this quick break 526 00:32:02,320 --> 00:32:05,680 Speaker 1: and we're back with doctor Rossio Salas Whalen. I know 527 00:32:05,720 --> 00:32:07,640 Speaker 1: that there are at least two decades of research about 528 00:32:07,720 --> 00:32:11,480 Speaker 1: GLP ones. Hopefully the average human who is on these 529 00:32:11,560 --> 00:32:14,440 Speaker 1: drugs lives a lot longer than that, right, lives well 530 00:32:14,480 --> 00:32:17,200 Speaker 1: into their eighties and nineties. Is there any part of 531 00:32:17,240 --> 00:32:21,000 Speaker 1: you that worries that we don't have enough research yet 532 00:32:21,040 --> 00:32:23,720 Speaker 1: about the long term side effects? Is there any part 533 00:32:23,720 --> 00:32:26,000 Speaker 1: of you that thinks that we would benefit from having, 534 00:32:27,120 --> 00:32:30,720 Speaker 1: you know, a body of research that is, you know, 535 00:32:31,320 --> 00:32:32,880 Speaker 1: sixty to eighty years long. 536 00:32:33,880 --> 00:32:38,000 Speaker 2: No, same as like when insulin came and save people's lives. 537 00:32:38,080 --> 00:32:42,240 Speaker 2: They didn't wait years and years for data. Right, what 538 00:32:42,520 --> 00:32:44,480 Speaker 2: we do know, I don't know what's going to happen 539 00:32:44,560 --> 00:32:46,880 Speaker 2: in fifty years with this medication. I can say that 540 00:32:47,080 --> 00:32:49,200 Speaker 2: it's going to be pretty safe and it's going to 541 00:32:49,240 --> 00:32:53,720 Speaker 2: become our day are common medication. I think people it 542 00:32:53,760 --> 00:32:57,080 Speaker 2: will be more normalized to use as medication. But what 543 00:32:57,280 --> 00:33:01,400 Speaker 2: we do know is the complications of obesity. Again, the 544 00:33:01,560 --> 00:33:07,320 Speaker 2: perfect example was COVID, so we know that. And this 545 00:33:07,400 --> 00:33:09,920 Speaker 2: has nothing to do with body positivity. This has to 546 00:33:09,920 --> 00:33:14,120 Speaker 2: do with internal health and your risk of disease, right, 547 00:33:14,480 --> 00:33:17,560 Speaker 2: Because what I care for any of my patients is 548 00:33:17,600 --> 00:33:20,200 Speaker 2: to reduce the risk of disease that whatever many years 549 00:33:20,240 --> 00:33:22,280 Speaker 2: are going to live, they live them in a good 550 00:33:22,440 --> 00:33:25,520 Speaker 2: quality of life. So my job is to reduce the 551 00:33:25,600 --> 00:33:28,520 Speaker 2: risk of disease has nothing to do with what it 552 00:33:28,560 --> 00:33:31,000 Speaker 2: looks on the outside. And I don't want any of 553 00:33:31,040 --> 00:33:34,320 Speaker 2: my patients to be skinny. And actually my patients will 554 00:33:34,640 --> 00:33:37,320 Speaker 2: worry if they lose muscle. What am I going to say? 555 00:33:37,520 --> 00:33:40,440 Speaker 2: I want my patients strong, I want my patients fit. 556 00:33:40,960 --> 00:33:43,240 Speaker 2: I want my patients to be able to lift heavy 557 00:33:43,280 --> 00:33:45,280 Speaker 2: things to prevent a fall. 558 00:33:45,800 --> 00:33:46,000 Speaker 3: Right. 559 00:33:46,320 --> 00:33:48,680 Speaker 2: I want my patients to be independent later in life, 560 00:33:48,760 --> 00:33:50,960 Speaker 2: that they can get up of the chair by themselves, 561 00:33:50,960 --> 00:33:53,280 Speaker 2: that they can go to the bathroom by themselves. That's 562 00:33:53,360 --> 00:33:55,920 Speaker 2: my long term goal for my patients and that's what 563 00:33:56,040 --> 00:33:59,360 Speaker 2: I work with them from day one. So again, whould 564 00:33:59,360 --> 00:34:02,000 Speaker 2: you choose to walk you through this journey is going 565 00:34:02,080 --> 00:34:02,800 Speaker 2: to make. 566 00:34:02,720 --> 00:34:03,720 Speaker 3: All of the difference. 567 00:34:03,960 --> 00:34:06,520 Speaker 1: Finally, I want to end on this note. I come 568 00:34:06,560 --> 00:34:11,440 Speaker 1: from a generation millennials who grew up on nineties magazines 569 00:34:11,640 --> 00:34:17,440 Speaker 1: and Heroin chic runway shows, and a lot of people 570 00:34:17,480 --> 00:34:20,480 Speaker 1: that I know grew up with mothers who were extremely 571 00:34:20,560 --> 00:34:23,440 Speaker 1: conscious about their own way and wound up passing on 572 00:34:23,520 --> 00:34:27,759 Speaker 1: some unhealthy ideas to their daughters. You have two daughters, So, 573 00:34:28,640 --> 00:34:32,319 Speaker 1: as the mother of two daughters, what are the kinds 574 00:34:32,320 --> 00:34:37,719 Speaker 1: of conversations that you have with your daughters about how 575 00:34:37,800 --> 00:34:39,520 Speaker 1: to perceive their own weight? 576 00:34:39,920 --> 00:34:43,360 Speaker 2: Yeah, and they go to an old girls Catholic school, 577 00:34:44,320 --> 00:34:46,799 Speaker 2: and it's very different from what I took at home 578 00:34:47,040 --> 00:34:50,359 Speaker 2: than what they listen in school. Right in my home, 579 00:34:50,400 --> 00:34:52,560 Speaker 2: I'm never like saying, oh is this person skinny? 580 00:34:52,680 --> 00:34:53,799 Speaker 3: Or I lost weight? 581 00:34:53,840 --> 00:34:56,160 Speaker 2: I gain weight, Like I never have a comment about 582 00:34:56,160 --> 00:35:00,120 Speaker 2: my body. I want them to not have to think 583 00:35:00,160 --> 00:35:03,520 Speaker 2: about that. I don't use the word fat. I mean, 584 00:35:03,600 --> 00:35:06,120 Speaker 2: they know what I do for a living, they know 585 00:35:06,200 --> 00:35:08,880 Speaker 2: I wrote a book about it. They see me eat protein, 586 00:35:08,960 --> 00:35:11,919 Speaker 2: they see me go and work out to the gym. 587 00:35:14,080 --> 00:35:16,680 Speaker 2: Right now, I'm working more in them seeing me than 588 00:35:16,760 --> 00:35:22,200 Speaker 2: me imposing them. Right But at school, even on fourth grade, 589 00:35:22,840 --> 00:35:27,799 Speaker 2: the girls were comparing who was the heaviest to the smallest, 590 00:35:28,239 --> 00:35:32,440 Speaker 2: already in fourth grade. Right, So even for me, an 591 00:35:32,480 --> 00:35:34,000 Speaker 2: obesity specialist, that this. 592 00:35:34,080 --> 00:35:35,960 Speaker 3: Is what I wrote a book about it. 593 00:35:36,239 --> 00:35:40,040 Speaker 2: I struggle because of society, because of what's outside. 594 00:35:40,120 --> 00:35:40,319 Speaker 3: Right. 595 00:35:40,719 --> 00:35:43,759 Speaker 2: So I'm not going to say that my kids are 596 00:35:43,760 --> 00:35:48,960 Speaker 2: not going to have any weight issues, right, But it's 597 00:35:49,040 --> 00:35:53,480 Speaker 2: a very difficult battle for parents. And I'm educated in obesity, 598 00:35:53,520 --> 00:35:55,840 Speaker 2: it's my medical specialty, and it's a struggle for me, 599 00:35:55,920 --> 00:35:59,200 Speaker 2: so I understand how hard it is, right. 600 00:35:59,400 --> 00:36:01,080 Speaker 3: But I also so I also. 601 00:36:00,920 --> 00:36:05,640 Speaker 2: Know from my patients how the restriction that their parents started, 602 00:36:05,640 --> 00:36:10,000 Speaker 2: and many times their mom or the pediatrician they still 603 00:36:10,040 --> 00:36:13,920 Speaker 2: remember who early in life told them they were fat, 604 00:36:14,080 --> 00:36:16,839 Speaker 2: or who put them on a diet first, or who 605 00:36:16,880 --> 00:36:20,160 Speaker 2: made comments about their body. So what we say about 606 00:36:20,280 --> 00:36:23,600 Speaker 2: our kids' body, they're going to be sixty and they're 607 00:36:23,640 --> 00:36:26,719 Speaker 2: going to be remembering that. So we really have to 608 00:36:26,760 --> 00:36:29,640 Speaker 2: be very kind and conscious about it because all that 609 00:36:29,760 --> 00:36:32,399 Speaker 2: trauma that I'm mentioning of my patients, and the way 610 00:36:32,480 --> 00:36:36,560 Speaker 2: and the guilt and the shame starts at home. So 611 00:36:36,800 --> 00:36:39,760 Speaker 2: we really need to be very kind to our kids 612 00:36:39,920 --> 00:36:42,040 Speaker 2: and actually teach them by example. 613 00:36:42,360 --> 00:36:44,640 Speaker 1: That is such a good point that the language that 614 00:36:44,680 --> 00:36:48,360 Speaker 1: we use at home is everything. What do you hope 615 00:36:48,440 --> 00:36:50,600 Speaker 1: the future of weight loss looks like. 616 00:36:51,520 --> 00:36:54,359 Speaker 2: I hope that we move the language from weight loss 617 00:36:54,360 --> 00:36:58,200 Speaker 2: to body recomposition, right. I think that we need to 618 00:36:58,360 --> 00:37:02,280 Speaker 2: focus less on the numbers and more on your internal numbers. 619 00:37:02,840 --> 00:37:06,920 Speaker 2: I think everybody thinking of prescribing a GLP one should 620 00:37:06,920 --> 00:37:10,480 Speaker 2: always have a body composition machine at home at their office, 621 00:37:10,640 --> 00:37:14,040 Speaker 2: and patients can invest also on a body composition for home. 622 00:37:14,280 --> 00:37:18,480 Speaker 2: We need to move from weight loss to body recomposition 623 00:37:18,960 --> 00:37:21,040 Speaker 2: and really concentrate on different numbers. 624 00:37:21,080 --> 00:37:23,400 Speaker 3: That is not the number in the scale or the 625 00:37:23,440 --> 00:37:23,880 Speaker 3: size of. 626 00:37:23,880 --> 00:37:26,719 Speaker 1: The clothes that you wear. Thank you so much. I 627 00:37:26,760 --> 00:37:28,040 Speaker 1: really enjoyed this conversation. 628 00:37:28,520 --> 00:37:28,920 Speaker 3: Thank you. 629 00:37:29,840 --> 00:37:33,360 Speaker 1: Doctor Roscio Salas. Whalen is a Board certified endocrinologist and 630 00:37:33,360 --> 00:37:37,000 Speaker 1: obesity medicine specialist. She's widely recognized as one of the 631 00:37:37,040 --> 00:37:41,160 Speaker 1: earliest adopters of GLP one therapies in the US. The 632 00:37:41,160 --> 00:37:43,960 Speaker 1: Bright Side is a production of Hello, Sunshine and iHeart 633 00:37:44,000 --> 00:37:47,319 Speaker 1: podcasts and is executive produced by Rhys Witherspoon and me 634 00:37:47,640 --> 00:37:52,239 Speaker 1: Simone Boyce. Production is by Acast Creative Studios. Our producers 635 00:37:52,239 --> 00:37:56,040 Speaker 1: are Taylor Williamson, Abby Delk and Adrian Bain. Our production 636 00:37:56,120 --> 00:38:01,000 Speaker 1: assistant is Joya putnoy Acas. Executive producer are Jenny Kaplan 637 00:38:01,080 --> 00:38:04,840 Speaker 1: and Emily Rudder. Maureen Polo and Ryese Witherspoon are the 638 00:38:04,880 --> 00:38:09,080 Speaker 1: executive producers for Hello Sunshine. Ali Perry and Lauren Hansen 639 00:38:09,400 --> 00:38:13,160 Speaker 1: are the executive producers for iHeart podcasts. Our theme song 640 00:38:13,480 --> 00:38:15,960 Speaker 1: is by Anna Stump and Hamilton Lighthouser.