The Mel Robbins Podcast - #1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now

Episode Date: April 17, 2025

This episode is a must-listen if you or someone you love has ever struggled with weight. Today, Mel sits down with world-renowned, triple board certified endocrinologist and obesity specialist, Dr. Rocio Salas-Whalen, to explain the medical truth behind your metabolism, weight loss, and the most talked-about medications on the planet: GLP-1s like Ozempic and Wegovy. Today, she’s breaking down exactly how these medications work, who they’re for, and the critical mistakes people are making when using them without medical supervision. If you're confused about these drugs, worried about the side effects, or curious if they could help you or someone you love—this episode will answer every question you've been too afraid to ask. In this episode, you’ll learn: -The 5 real causes of weight gain—and why only one is in your control -Why obesity is not your fault (and how blaming yourself is holding you back) -What GLP-1 medications like Ozempic actually do in your body -The #1 risk no one is talking about when taking these drugs -Why these medications can change your brain, your cravings, and your relationship with food -How to avoid “Ozempic face,” hair loss, and muscle loss while on these drugs -How to know if you’re a good candidate—and the red flags to watch out for You’ll also hear Dr. Salas-Whalen’s personal story of using the medication herself after hitting perimenopause—and what she wants every woman to know about managing weight in midlife.  This episode is your science-backed, shame-free guide to understanding GLP-1s, your metabolism, and what real help looks like. If you or someone you love is struggling with weight, send them this episode. It could change their life. For more resources, click here for the podcast episode page. If you liked this episode, and want more evidence-based tools for a healthier life, listen to this next: The Body Reset: How Women Should Eat & Exercise for Health, Fat Loss, & EnergyConnect with Mel:  Get Mel’s #1 bestselling book, The Let Them TheoryWatch the episodes on YouTubeFollow Mel on Instagram The Mel Robbins Podcast InstagramMel's TikTok Sign up for Mel’s personal letter Subscribe to SiriusXM Podcasts+ to listen to new episodes ad-freeDisclaimer

Hey, it's your friend Mel, and welcome to the Mel Robbins podcast. So recently, a couple of my friends and someone in my family has started taking azembic, and I'm going to be honest with you, I have had a wide range of reactions to it. Now, first of all, I was so excited for my family member to be prioritizing their health. And on the other hand, I was actually kind of worried. I mean, from the potential side effects,

I am reading all this stuff, I'm getting targeted by these drugs online. Maybe like me, you have questions too, because you have people in your life who have started taking the medication. Or maybe you've been struggling with your weight for a long time, and you've tried to get a handle on it. Nothing's worked, and so now you're curious about GLP-1s or perhaps you're already trying them out but you still have some mixed feelings

about it. Like are they safe? How do they even work? Is this too good to be true? What about those side effects? Do I have to be on this for the rest of my life? So here's what I did. I reached out to a world renowned medical expert who is a triple board certified medical doctor with three specializations, obesity medicine, internal medicine, and endocrinology. And she's here today in our Boston studios to tell you everything that you and your loved ones need to know.

So today, you and I are going to get all the medical facts that you need to hear about the drug everyone's talking about. You're going to learn the medical truth about your metabolism, the surprising reasons why you or your loved ones may be struggling with their weight, food cravings, and four surprising factors that you have no control over that cause weight gain. That's why our medical expert today will tell you, if you're struggling with your weight, it is not your fault. She will also tell you who GLP-1 drugs are meant for and who they're not,

the surprising truth about the side effects. And she has a very stern warning against mail ordering this, getting it from a website or a friend or microdosing. Now this conversation today is a free resource with one of the world's leading experts on the medication everyone is talking about. You're not only going gonna leave informed and empowered, but you will never ever think about weight loss or the struggle to lose it the same way again. Hey, it's your friend Mel

and welcome to the Mel Robbins podcast. I am so excited that you're here. I am so excited to learn about our topic today. And you know, I just got to say it is such an honor to spend time with you. It's an honor to be together. If you're a new listener, I want to take a moment and welcome you to the Mel Robbins podcast family. And because you made the time to listen to this particular episode and learn more about this particular topic, here's what I know. I know you're the kind of person who values your health and you're looking for evidence-based information. And today you're gonna get it because we're talking about the weight loss medications that are all

over the headlines. And if someone that you love sent this to you, well first I want to acknowledge you for choosing to hit play. Because the fact that they sent this to you means that they deeply care about you and your health, or they care about their health and want you to learn more about what they're doing. And you deserve to have great health. And you also deserve access to doctors

who really care about you being empowered and informed about your health, and that you really understand the tools that are available to you. Now, you may have heard of this new class of weight loss medications called GLP-1s. The most well-known one is Ozempic. And today, I brought in a world-renowned expert,

Dr. Rocio Salis-Waelen, to break down the truth about these medications, who are they for? What are the risks? And what do you or someone you love need to know if you're considering using them? Dr. Salis-Waelen is a triple board certified physician in endrokinology, obesity medicine, and internal medicine. She's a leading expert in metabolic health,

the founder of New York Endocrinology and a clinical instructor at NYU Langone Hospital. She specializes in treating a wide range of endocrine disorders, including diabetes, thyroid disorders, osteoporosis and PCOS. Her approach is all about prevention and sustainable solutions to chronic health challenges. So if you've ever struggled with your weight, or you have a friend or a loved one who has

or is, this episode is a must listen, and it is a fantastic free resource with a world renowned medical expert that could change your life. Dr. Salas Whalen, welcome to the Mel Robbins podcast. Thank you so much for having me. Well, I'm so glad that you're here. And I know that by the time we're done with this conversation today, that the person who's listening and the people that they care about are going to feel empowered and excited. At least that's what I feel. It's why I'm so excited that you're here. But I'd love to start by having you speak to the person who has hit play and is here with us right now and just explain to them what might change about their life or their loved one's life if

they truly take everything into account that you're about to teach us today, and they put it to use in their life? That obesity, that waking is complex, it's not as straight-line as we used to think, and that most importantly, that weight loss should not be a full-time job. Weight loss should not consume your life mentally or physically. Wait, there's actually a world where that is true? It exists. It is possible. consume your life mentally or physically. Wait, there's actually a world where that is true?

It exists. It is possible and reachable. Wow. I mean, that's not what I thought you were going to say. That is an amazing thought to think that your life could, you could actually experience life and not be consumed by your weight, your body, your health, what you think people are thinking, what you think about, how you feel about your body, because there's just so much shame around how people think about the way that they look

or their metabolism or their size. And so I think that's extraordinary. And I learned this through my patients and not in my medical training. I learned through my patients how they, I've seen how they struggle through decades for many. I have patients, all ranges of age. I have from teenagers to 70, 80 year old patients, how they've struggled through since childhood for many of them and it consumes their life.

And every plate in front of them could be causing guilt, anxiety, shame, and this is 24-7, seven days a week, 365 days in a year. Well, I'm so glad that you're here, because if you can help the person listening, or who they're gonna share this with to no longer be consumed by that and to have a completely different approach,

something that's accessible and liberating, we're here for it. So Dr. Salas-Wilson, why don't we start with having you just tell us a little bit about your background as a physician because you have very unique training and expertise. I am originally from Mexico and that's where I studied medicine. I graduated from medical school.

And once I graduated from medical school, I decided to venture to the United States by myself, wanting to become a doctor in New York City. And then after nine years of training, residency fellowship, I completed my specialty in endocrinology, and then the following year in obesity medicine. Now, are those two connected? What is endocrinology and how does that lead to obesity medicine? They are very connected and originally endocrinology takes over what's metabolism and obesity. But we've learned that obesity is complex and it requires its

own specialty just to be solely dedicated for obesity. And endocrinology is the management of hormones and yes, hormones impact weight. I would love to have you talk to the person who's listening or watching us right now who may be overweight or who may be struggling with the disease of obesity. What do you want them to hear from you, Dr. Salas-Waylon? I want to say that I'm sorry in behalf of the healthcare providers. We didn't know better and we failed you. And I've been humbled by my patients.

I've learned and hear their stories and we got it wrong. We got it all wrong. But there is help. We're learning more. Science advances like everything, right? Medicine is an evolving science, and we are aware, and we will do everything we can to fix it. Why do you think it's important for us to really think about this issue of obesity being a disease or somebody who's struggling with their weight kind of at the same level as we think about cancer or diabetes as a disease. Well, obesity kills. Obesity increases your risk of mortality. There's more than 15 cancers that obesity is their biggest risk, including breast cancer. You have more risk of developing breast cancer than alcohol, hormone replacement therapy, or genetics.

It's obesity. Obesity is the number one cause of pancreatic cancer, colon cancer, prostate cancer, thyroid cancer. The number one cause? The highest risk for developing, yes. Wow. So by reducing obesity, by treating obesity, we are going to have less chronic diseases. We've built specialists. We created medical specialties from the complications of obesity. So we will have less diabetes, less hypertension, less cardiovascular disease. If we treat obesity now, we will have less incidence of the cancers that I mentioned. You know, if I think about the way that the world has changed, especially when you see the

statistics of the number of people that are either struggling with being overweight or who are living with a condition of obesity, one of the things that strikes me is that I think in the past, there's always been this, I don't know, like judgment as if the person that is struggling with one of those metabolism issues that they're somehow to blame. And I know, at least when I think about members of my family that are struggling in this area of their life, that they feel a lot of shame around their inability to lose weight or to whatever. And I'm excited that you're here because I think that there's a huge shift in the way

that we have been very ignorant around talking about the issue. And there's a shift medically speaking. And so I would love to have you talk about the way that, as a medical doctor and as a world renowned expert in obesity medicine, how you want us to actually even talk about or view this subject. And this is a very interesting thing because you, as a non-medical professional have felt like that, judging and assuming we as a healthcare

providers, as doctors, we did the same, right? When patients were coming to us for help and to play devil's advocate, we didn't have the training, we didn't have the knowledge that obesity is not a self-inflicted disease. Okay, hold on. I want to make sure that we do not skip self-inflicted disease. Okay, hold on. I want to make sure that we do not skip over what you just said. Obesity is not a self-inflicted disease. I want to unpack that because I did not understand that until recently. So what does it even mean that obesity is a disease. So what we've learned is that obesity is a multifactorial chronic disease and I'll

go, I'll deconstruct that. Multifactorial meaning that there's more than one cause leading to somebody to struggle with weight or have obesity. I like to break them into five pieces. One lifestyle, exercise, sedentaryism, diet, but that's one piece of the five. Okay. The other one is genetics, right? You can have a genetic mutation, but also it can run in the family, so there's two, it's two different, right? Gotcha. Okay. Then the third one, hormonal changes. We have PCOS, perimenopause, menopause in

women, then we have aging. That's unchangeable, nothing that we can do about it yet. But as we age, our metabolism slows down, we lose muscle mass, we tend to store more body fat, and then we have environmental factors. And those are on its own. We can deconstruct that too, because in environmental factors, we can talk about the food industry, right? We can talk about obesogenic environments, so meaning places where they're walking is not available or accessible or easy, where people have to

drive everywhere or even working from home now, right? So there's less opportunities to being active that leads to more sedentaryism. So we call that obesogenic factors, things that promote obesity in how we live. Also, we can talk about endocrine disrupting chemicals, like BPA, what's found in plastic, pesticides, right? We live in an industrialized world that really promotes obesity. So if

you think of all those five factors and you think of what the patient has control, pretty much only on one, right? What we're talking about lifestyle, exercise, and eating healthy. And before or when we do that, we tried or we put a lot of pressure on the patient to overcome all the other factors that are not in their control. Let's talk about genetics. We know now there's research showing that the parent's preconception weight can impact the weight of their child. Wait.

So the parent's preconception weight, so the weight that your parents were when you were conceived, genetically speaking, research has proven, has an impact on your genetics in terms of your weight. Yes, yes. And so, and not, and I even want to go a layer deeper because I'm going to raise my hand and go right on the record and say that for most of my life, I was one of those people that had this topic completely wrong. I was the kind of person that did not understand anything that you were just explaining, and I just assumed it's lifestyle choices. And when you really just listen and absorb what you just said, lifestyle, genetics, hormone changes,

aging, environmental factors, environmental factors. I mean, when you look at like the food industry and how it changes people's ability to process food and all the crap that's put into it, not having accessible safe walking areas, working from home and being sedentary. And then now you're talking about, I don't, this word was too big for me to write down, it was like, enderose something destructible. But it was the things that are actually impacting your body's metabolism that are in the environment. And forever, we have just looked at somebody who struggled with being overweight, or who

struggled with the disease of obesity, and we're like, oh oh, you're lazy or oh, you're not doing enough. And so I can see how understanding these five factors changes the game entirely. And the big thing that I'm hearing when you said we live in a world that is almost promoting, it's not even promoting, it's causing this disease. It's causing. Which means it's not your fault. And when a patient hears this, I can almost physically see it how they feel relieved. I've had grown men in my office cry when they hear this for the first time because they've

lived decades thinking that it was their failure. Well, what you've already shared is so enlightening and empowering, and I kind of want to go back to each of these five things, because you said that there are kind of five factors that are part of a multi-layered cause of the disease of obesity. So let's go to the five things,

and I wrote them down as you were talking because I was like, oh my God, oh my God. So lifestyle, genetics, hormonal changes, aging, and environmental factors. And of those five causes of the disease of obesity, there's only one that you have control over. And that was some of the lifestyle choices that you make. But you are still fighting against genetics, hormone changes, aging, and environmental

factors. So that makes a lot of sense to me why somebody can be working really hard at the lifestyle part and not seeing anything change. And so could you walk us through the four, the genetics, the hormone changes, aging and environmental factors? I know we're gonna kind of go deeper in this, but just give us a sense of how each one of those four things really is a cause for the disease of obesity or for somebody who's struggling with being overweight?

Definitely. So when we talk about genetics, we're talking about family history, right? If your parents struggle with weight, if your grandparents struggle with weight, then you are at higher risk of also struggling with weight. Again, we know the preconception weight of your parents' impact. Even the food that they eat consume highly pal palatable food that can be transmitted to you. What's palatable food mean? Food, processed food, ultra-processed food that will lead to wanting to consume more, right?

Then when we talk about also there's some mutations that may also cause obesity, right? And then when we talk about hormonal, so through a person's life, there could be hormonal changes, shifts, imbalances that is going to promote waking. We can talk about hypothyroidism, right? Which thyroid hormone controls your metabolism. Then we can talk about PCOS, polycystic ovarian syndrome,

when there's hyperinsulinemia, insulin-resistant, and this promotes visceral fat. Visceral fat promotes insulin-resistant, and this promotes visceral fat. Visceral fat promotes insulin-resistant, insulinemia, and it goes into a visceral cycle. We also talk about perimenopause and menopause with the changes of fluctuations or the drop of estrogen. This promotes visceral fat. The subcutaneous fat that you had in your fertile years in your hips and your breasts goes intra-abdominally.

This visceral fat promotes insulin resistance, and then you go into that vicious cycle again. Also, because of the drop of estrogen, we see a decrease in lean muscle mass. Muscle mass is your burning calorie machine. If you lose it, then your metabolism slows down. Then we go into aging. Aging also, as we age, we tend to lose muscle mass. It's harder to build muscle and also it promotes waking. And then we go into environmental factors as we talk the food industry, industrialization, plastic, pesticides, all of those things disrupt your endocrine system. We call them endocrine disrupting chemicals because they disrupt the function, the normal function of your hormones. They mimic your hormones, so they occupy the receptors

where your hormones should go and do a function, and this can promote obesity and fertility. So they're real things that are impacting people's life on the day-to-day basis. What I love about what you're sharing is that if there are five factors that are present and that cause the disease of obesity, I would imagine that you as a medical doctor now are able to help a patient in a very different way. And so given that obesity is now classified as a chronic disease, how does that change

the way that you treat patients and the various kind of tools that you have at your disposal to empower somebody? Knowing this and understanding this, you move away of putting the pressure on the patient, right? You move away of being a one participant in this equation. It goes more into a team. What you can do for the patient and educating the patient, it becomes a team. Let's talk about, as an example, diabetes, type 2 diabetes.

We know it's a chronic multifactorial disease, but we have no trouble prescribing and treating medications for it, right? It's widely accepted from the patient side, from the physician side. Let's talk about hypertension. Same thing, right? We know that lifestyle can help it or make it worse, but that is not causing the disease. Therefore, we feel comfortable treating it in the patients accepting treatment. And when we provide treatment for type 2 diabetes, hypertension, high cholesterol, we always talk about eating healthier and exercising, but it doesn't replace the treatment. So if we see obesity as a disease, we can act the same way, understand and support the patient and their lifestyle, but also provide a medical treatment.

Because there are four factors outside of your control that you've just unpacked. Genetics, hormone changes, aging, and all the environmental factors largely because of big farming and industrialized food and all the crap that they put in it that's screwing up and confusing your body's ability to process food. And I'm breaking them in big five umbrella, but also there's other things like medications that patients may take for certain particular disease that can promote waking, right? There's a lot of antidepressants that can promote waking, blood pressure medications that can promote waking, right?

And many times there's not other option for the patient. And this can also lead to obesity. So I would love to have you talk about the GLP-1 medications because I didn't realize they'd been around for decades. I had no idea. I've seen them in the headlines. They're all over the place. I have, like many people, I have people in my life that are taking them and they're life-changing, but I didn't realize that they've been around for a long time. So could you talk to us about what they are, how long they've been around, like when you first started using them in your clinical practice?

Definitely. The first FDA approved GLP-1 was in 2005. 2005? Yes. What? Yes. What? 20 years now. 20 years? Yes. The FDA name, it was Bayila Elig.

It was called Bayera. And this was twice a day subcutaneous injection. So it was a daily, twice a day injection that patients had to do. Okay. And the first indication was for type 2 diabetes because GLP-1 is a hormone. What does GLP-1 stand for? Leukogon-like peptide. And this is a peptide or a hormone.

Is that what the word peptide means, hormone? No, peptide is what we call a short chain of amino acids. Okay. A long chain of amino acid is a protein. So before protein, it's a peptide. Peptides can help to produce or inhibit the secretion of hormones. The most important finding of this drug, and I actually met the person, the doctor, the researcher, who isolated this, the GLP-1 outside the human body was in a

lizard called the Gila monster. And the lizard, the venom of this lizard caused pancreatitis on its victims. So Dr. Eng, John Eng, being an endocrinologist and researcher at the BA hospital in the Bronx, wonder what in the venom affected the pancreas. Okay. And he isolated GLP-1. So this little Gila lizard bites its prey or whatever and the venom of it sends, activates the pancreas and sends the thing into a state of diabetic shock?

It causes pancreatitis, so the prey dies from pancreatitis. What? So what exactly does the GLP-1 do to the pancreas? So it stimulates to produce insulin. The problem in type 2 diabetes is insulin resistant and hyperinsulinemia. So with time, with frequent stimulation of the pancreas, every time you eat, every time you eat anything that has glucose, your pancreas produces insulin. But with time, it overworks. Your body stops responding the same way to

the insulin that you make, so you become resistant to your own insulin. The pancreas in response tries to overcompensate and make more insulin, but your body is resistant to it. So you have hyperinsulinemia and insulin resistance. So these are the two main pathologic factors that lead to somebody to develop type 2 diabetes. And how does this connect to somebody who is struggling with being overweight or somebody who's struggling with the disease of obesity? And this is the beauty of medicine, right? One thing is made or developed for a particular disease or reason. We find out later that it has other

benefits like GLP-1. I didn't realize that a spike in insulin means you're also gonna crave more food, which then means that if you're the kind of person that has either environmental factors where you're eating a ton of processed food that never fills you up and is just full of stuff that spikes your insulin,

that is gonna become part of the cycle that you're on without even realizing that you're now trapped in this cycle and it's not your fault. Exactly. Wow. So, what have you seen in the last 15 years since you've been using GLP-1s as a tool in your medical practice? What have you seen in terms of the benefit to patients, how this is used as a tool, the difference that it makes?

I've seen people's lives change. I've seen more acceptance to the medication. The drugs are becoming safer, less side effects. I like to compare them with the iPhone. We have different versions of the iPhone, right? We have the iPhone 1, the iPhone 10, and now we have the iPhone 16. Same is happening with this class of drugs. Their versions are newer, safer, less side effects, and more effective. So I feel like people are getting the message, one, or accepting the message that obesity is a disease.

They feel like giving up. For many patients, I'm the last stop of their journey. And when I talk about a journey, I'm talking decades of journey. I'm talking about doing diets that I've never even heard about. I always learn about a new diet from my patients. Being with nutritionists, being in fat camps, that they call them. So I've seen patients struggle through their life and how this medication are changing their lives and giving them their life back, basically.

If these drugs have been around for 20 years, at least in terms of a specific treatment for type 2 diabetes. Why is it that we're all just hearing about it now? First of all, the initial versions of this drug, they caused more side effects, and they were more cumbersome for somebody. People had to inject themselves twice a day, every day. So even for many patients with type 2 diabetes, it was hard to accept because patients with diabetes, they think and feel that once they're on insulin, they're failed, right? Or it's just more severe. So having a medication that is injectable, it was hard to dissociate them with insulin

or with failure. So they basically be like, I might as well just be injecting insulin at this point. Exactly. So patients didn't like to inject themselves and it was a twice a day injection and there were a lot of nausea. So it was harder to tolerate back then. So I remember, cause it's already flown out of my brain,

that how it works is that it stimulates your pancreas? For type two diabetes, yes. It stimulates your pancreas to make more insulin when your sugar goes above normal. Okay. But if somebody who doesn't have diabetes and their glucose is normal, it doesn't touch the pancreas. Interesting.

Okay. That's why we can use it in people that don't have diabetes. Got it. So, 15 years ago, when you were prescribing this to your patients in your clinical practice, it's twice a day, the side effects were a lot worse, and it was really limited to treating type 2 diabetes. So what has happened in the last 15 years? Again, as with any drug, we see we have off-label uses, and what's happening is when we started somebody with type 2 diabetes on these drugs,

when they were coming back to their follow-ups, not only was their glucose improved because they're great anti-diabetic drugs, but they were losing weight. And to have that as a diabetes treatment, a drug that lowers your sugar and also helps with weight loss, it was unseen because most medications for diabetes promote weight gain. Okay. So this is going to make me sound like the world's biggest idiot, but if you inject insulin for type 2 diabetes, like it actually makes you gain weight? Yes.

That does not seem fair. It does not. It is not, but that's all we had back then. Okay, so that was an off-label finding, and so all of a sudden, you're in your medical practice, you are prescribing this, some patients are using it despite the nausea, and you're like, holy cow, we're seeing weight loss, which is fantastic for people. Okay.

That's fantastic, especially for type 2 diabetes that weight gain or obesity goes hand in hand with diabetes. And before, with the medications that we had, we had to choose either we help with the glucose or we help with the weight. Right. And many times we wanted to bring the glucose and that's what we had available. So how long have you been prescribing these to people as a tool for treating the disease of obesity or for somebody who's struggling with being overweight? Since 2010.

So you're like a pioneer in this. Yes. Wow. And when did all these studies start to happen? like a pioneer in this. Yes. Wow. And when did all these studies start to happen? They started back in 2000. So I mean, even for 2005 for the FDA approval, they're starting in the 90s, right, with the first one. But in regards for weight loss, it started around 2005, 2006.

Gotcha. And then the first one approved for weight loss was in 2012, named Saxenda. Also a daily injection. So we moved from the twice a day injection to the once a day injection, but it's still severe side effects. We were nausea or vomiting, and it was hard to get to higher doses where we see most of the weight loss because of the side effects. Then eventually in 2017, we have the poster child of this drugs, which is

Ozempic. That was when it was approved for type 2 diabetes. In 2021, Ozempic became also approved for weight loss independent of diabetes and then rename it as Wegovi. Danielle Pletka Wait, wait, Wegovi and Ozempic are the same thing? Oza Fajardo It's the same drug. Yeah. a GLP-1 gets approved initially for type 2 diabetes, and then eventually gets approved separate exclusively for Weylos, they rebrand it. They just changed the name, but it's the same drug, same pharmaceutical, same dosing. Why do they rebrand it? So that they can market it to a different segment of people who are like, I don't want

to take the diabetes drug. Well, if you don't have diabetes, you don't want to take a medication that is for diabetes and also for insurance purposes, right? Got it. Insurance will approve one drug for type 2 diabetes and will approve one drug for obesity, but unlikely that it's going to approve one for both things. Wow.

So how exactly does the GLP-1 work to help somebody lose weight or to change their metabolism if they don't have diabetes? GLP-1, I like to explain to my patients, target the two reasons that humans eat. We eat for fuel, survival, and we eat also for reward, for a reward. And the fuel part or the survival part, what this medication does, it suppresses your appetite hormones and it increases your satiety hormones. So if for somebody who's on this drug and you're going to start eating, you get fully

satisfied with a third or half of what you normally would need to feel full. And then in between meals, it suppresses your hunger hormones. So for most patients, it looks like two small meals a day, feeling physically content. That's for the survival part. Now, for the reward part, we have receptors for this hormone in our brain in the hedonistic eating and drinking area of our brain where we anticipate or associate our reward either with food or beverages like alcohol. Mm-hmm.

And it blocks that reward response. So let's say if somebody's anticipating having a meal that they know is going to relieve or certain reward, once you're on these medications, you see that meal and you don't get the same feedback. So their behavior change. You enjoy your food when you're hungry and eating once you're full and satisfied. It's out of your mind. Wow. And it doesn't touch the pancreas?

It doesn't touch your pancreas if your glucose is normal. Wow. Dr. Salasvillan, I am so grateful for everything that you're sharing with us today. And here's what I want to do. I want to take a quick pause so we can give our amazing sponsors a chance to say a few words. I also want to give you a chance to share this with people in your life that are coming to mind as you're listening to Dr. Salas-Waelin.

And don't go anywhere because we're just getting started in unpacking this super important topic. Dr. Salas-Waelin has so much more to teach you after this short break, so stay with us. Welcome back. It's your buddy Mel Robbins. Today, you and I have the privilege of sitting and spending time with Dr. Salas-Waelin. We are learning so much about the topic of weight loss and weight gain and the reason why it's not your fault

if you or your family members are struggling with this. And we're also digging into the weight loss medication that everybody is talking about. So, you know, one of the things that I see, that I know a lot of people see, and this is sort of like the... Also, could be more shaming, but you see, you know, celebrities who want to lose an extra 15 pounds,

or you see the Ozembic face, you know, all over social media. And I'm just curious what your opinion is about who these medications are for and when you're a candidate and when you may not be. First, I think we need to backtrack a little bit before we dive into that answer. Sure. We as a society tend to associate being thin as being healthy. So whenever we see somebody that you can think they're slim,

they're thin, they don't need this medication. We're assuming that they're healthy, that they're metabolically healthy. Yep. But we don't know by just looking at somebody. When I do body compositions on my patients, and this should be done on every patient, and basically I would say even patients that don't need weight loss medications just to

know what's your body composition, because whenever we're talking about weight loss, we're really talking about fat loss, right? We're not talking about a bulk number. We're talking specifically, we want to reduce what can cause disease or increase your risk of disease, which is fat, not muscle. So by doing a body composition, we can see what's the percentage of somebody, right? What's their visceral fat and what's the muscle mass. So many patients that we may see slim or thin,

they could be what we call a skinny fat or sarcopenic obesity, that they may have a very low muscle mass and high body fat. There's still a risk of disease. They're still in a pro-inflammatory chronic state, right? There can still develop tertiary diabetes or even be a risk of developing cancer. So just by looking at somebody, we cannot say what the body composition is and

what they need or don't need to lose. Got it, right? So we first need to stop associating thinness with health. Many times when I see patients that think they need to lose 10 pounds or 5 pounds, when we do a body composition, surprise, surprise, they actually have to lose 20 or 25 because they're under muscle. So to really say who needs this medication or not, we cannot assume by looking at somebody that they do or they do not. We need to do body composition on anybody who thinks we need to be on this medication to really know if they will benefit or not.

How do you do body composition? So we have machines, right? So the gold standard for a body composition is an MRI, but we're not going to do MRI on every patient on every visit. The second is DEXA. And then the third, which is the more accessible, is body impedance, also known as in-body. There's different versions of it. So those are the ones that are more AC accessible, and they offer no radiation to the patient. And we do body compositions on initial visit and every visit when somebody starts on a weight loss journey. So, you know, do you see a lot of people coming in that want to try these drugs to lose an extra 10 pounds?

No. Most patients that come is because they need them and because they've done their work and it's just not working. It's just not happening. If someone comes to you, Dr. Salas-Waelan, and they're looking to be put on or prescribed one of these medications, what are some of the questions that you ask them to assess whether or not the medication is a good fit? So first, starting with a very thorough weight history. So I need to know at what age were they conscious about their weight know at what age were they conscious about their weight,

at what age were they trying or being consciously about the eat or were they told they need to lose weight. For many patients, they tell me nine, 10. Also, I need to know their medical history. Are there comorbidities that can contribute to obesity or medications that they're taking that can contribute to obesity? Then I go into a deep family history. I need to know up to two generations before, what was your parents, your grandparents' weight, your uncle's weight? If they have children, how is your children's weight?

I need to see if there's a familial factor contributing to obesity. And then I look at their gynecological history, right? Are there in perimenopause? Menopause, so they have PCOS. And then we move to the physical exam. And in that also there's a, we do the body composition. And there we can really target what is it that need to be improved or doesn't. So is there a percentage of body fat that you look for to see if somebody's a good fit for this kind of medication? So what we consider obesity and percentage body fat is 32 and above Normal in women is 18 to 28 percent in men is 10 to 20 percent So anything above those numbers we either fall in the overweight range or in the obesity range

Is there a benefit to using a GLP-1 during menopause? Definitely. What we see in perimenopause and menopause with the drop of estrogen is that your body composition changes. You tend to store more body fat, central visceral body fat, and then you drop more your muscle mass. There's less lean muscle mass.

Also, in this stage of life, when somebody, let's say, that didn't struggle with weight in their 20s or in their 30s, anything that they were doing to maintain a weight once they enter midlife, perimenopause and menopause, is not going to help because of that hormonal fluctuation or drop of estrogen. So in this time of a woman's life, and we hear all the time, everything that I'm doing is not working, everything I used to do it before and the weight used to come off, but now I even have to work harder and it's still not happening. Yes, because of aging and the changes in

estrogen or the drop of estrogen. So here, GLP ones have a huge place for patients that need or that gain weight during perimenopause and that it's just going to become even harder to lose it and easier to gain weight. Can you give us an example of someone who should not be taking this medication? The only absolute contraindication that we have for this medication is a personal or first degree

family history of medullary thyroid carcinoma, which is a very rare and aggressive type of cancer. Now, if somebody has other versions of thyroid cancer, papillary, follicular, that's not a contraindication. Exclusively medullary thyroid carcinoma. Above that, patients that are pregnant and breastfeeding is not recommended. You know, when one of my family members

was considering going on this medication, the concern was, well, am I gonna have to take this for life? Like, is this something that you take for the rest of your life, or is it something you take for a period of time, and then once you sort of rewire cravings and how full you are that it's just that sticks or how does this work? So we have to remember what is obesity, right? What causes a patient to require this medication.

It's a chronic multifactorial disease, right? So if we assume that we can use this medication to take them to a goal, and then we stop it, we didn't fix, we didn't cure the other things, the familial history, the genetics, the hormonal changes, the aging, the environmental factors, those factors are still there. Chronic diseases we don't cure, we control. So that's why these medications were designed to be used long term. Now that can change. If somebody has history of obesity since childhood

in their midlife or later decades of their life, then most likely they will require this medication long term. But if it's somebody as an example who gained weight after pregnancy and hit midlife and they gained 30 pounds, but they never struggle with their weight, then maybe those patients will not need that to use them long term. Huh, that's interesting. But you have this patient that had children and late in life, and then they hit midlife,

then yes, they didn't struggle with weight in the past, but now their surrounding is not going to be helpful for them to maintain the weight loss so they may benefit from long-term use. Do you have any personal experience yourself or with, you know, a family member using this medication? Yes, I have a very personal family member myself. I used this medication after I had my kids. I didn't struggle with weight growing up. I always used to lift weights since my early 20s. I fell in love with weightlifting, but I had my children late in life. I had my first one at 38 and my second at 39. After that, I hit my 40s. I started with perimenopause. So what I was doing before, it didn't help me. I ended up with 30 pounds that I couldn't lose. I used the medication.

I used for six months. I got back to my weight and I have not needed it since then. I take back exercising and all of that, and I've been able to maintain my weight with that. It was just a combination of late pregnancy, hitting midlife at the same time. What was it like after practicing obesity medicine to come to a point in your life where you're like, okay, I'm gonna try the GLP-1 myself because I got pregnant in life, now I'm perimenopause,

all the things that I used to do are no longer working. Did you resist it for a while? What was it like for you to do that personally? I wouldn't say I resisted it. I was waiting, basically, to see if it would change. But I think after, you know, the first two years of kids is, I mean, you really have to give yourself some credit and allow yourself some room to not wait about, to not worry about your weight or punish yourself for not getting back on track so soon. I always tell a woman, give yourself one or two years

before you start doing that because just having a child at that age is hard enough. After that, I think when us doctors go through certain situations, it does makes us a better doctor or more empathetic doctors, right? Because it's very hard to identify with something that you don't know necessarily. It made me more understandable. I was better to relate possible side effects and what to do about it. And definitely to be more empathetic.

Beautiful. How long ago was that? I was 42. So seven years ago, I'm 49. Did you wrestle at all with any, like, of that feeling, like, I should be able to do this myself? Like, did you, even as a world-renowned doctor practicing obesity medicine, did you shame yourself at that moment before you went on the medication?

No, I mean, because I know what causes waking. I knew in what place I was in my life. And I knew that I didn't want to exhaust every other possible situation that at the end was not going to help me. I'm a very proactive person, personally and professionally. So I really wanted to be very proactive at that time. I love that answer and here's why. Because you don't have to shame yourself.

And we can learn from you that everything that you're sharing with us today is empowering you to go, this isn't my fault. And if I'm resonating with some of this stuff, I deserve to go get help and I deserve the help that's out there for me. Just like if you had diabetes or cancer, Of course you would go get the treatment. This is a great moment for us to give our sponsors a chance to say a few words, to give you a chance to share this episode with people that you care about.

And don't go anywhere, because we have so much more to dig into with Dr. Sal Esquelin when we return. Stay with us. Welcome back. It's your buddy Mel Robbins. And today you and I are learning from Dr. Salas-Waelin. So Dr. Salas-Waelin, here's where I want to go next. What are the risks of taking these medications? So as with any diet or anything that causes a restricted caloric intake or decreases how many calories you're going to eat, there's always a risk of muscle loss, right?

Because it's hard to just exclusively lose body fat without lowering muscle mass. Yeah. So, one of the risks of using this medication is muscle loss. And there's no direct effect of the drug towards the muscle mass. It's an indirect effect of you eating less that you may lose muscle. Got it. So, the drug's not causing you to lose muscle. The fact that you're eating less means you have less protein going into your body, which

might have you lose muscle. Yes. Got it. But it's not a dead sentence. So by informing the patient and teaching them about what is it that they need to consume while they are on this treatment can prevent muscle loss and even gain muscle for those that need to gain muscle.

If someone is taking one of the GLP-1s, how do you do that with your lifestyle and diet? Before we go into that, I just wanna explain why we're talking about muscle. Why is so important muscle? It's not because we wanna see all people booked up and Arnold Schwarzenegger like, right? Muscle is your biggest metabolic organ.

What does that mean? It's your calorie burning machine. Muscles? Muscle. Muscles burning calories. Muscles burn calories and muscle regulate your glucose because every time a muscle contracts is physically being used,

it sucks sugar from the bloodstream to provide its energy. Wait a minute, is that why taking a walk after you eat is like a really good thing to do? For your glucose? Yes. Wow. Okay, so you have to pay attention to muscles in general, we all do. But if you are going to take a GLP-1, really understanding the role that your muscles play in glucose and in your overall health is a critical piece of this. Yeah, whenever we hear, oh, if you lose weight, your metabolism slows down.

One of the reasons is because you lost muscle along the way and that's slowing your metabolism. You're burning less calories. And I see that all the time with body compositions. When patients lose muscle, they don't lose significant amount of fat. It's harder for them to lose fat. When patients maintain muscle or gain muscle while on these medications, the body fat drops rapidly and significantly. So really your muscle is going to determine how you lose the body fat. And that's why we need to have that conversation of muscle on day one,

on your first appointment, your doctor needs to discuss with you what exercise you should be doing, which is strength training, hitting the weights, and increasing your protein in your diet, because you can lift as heavy as anybody and you will still lose muscle if the protein is not there. Okay, so doc, you just said you gotta be lifting weights and you've got to be eating more protein. Exactly. Is there a standard formula that you give to your patients?

One gram of protein per pound for ideal body weight. That's what they should aim. So I would say the sweet spot that I've seen for most patients is between 90 to 100 grams of protein a day, which without a weight loss medication, without a medication that is suppressing your appetite, is hard enough to eat that amount. And 90 to 120 pounds is awfully skinny. Like I thought you were going to be like 150 to 200 grams of protein. I mean, it's very hard to, it becomes mission impossible when you're giving somebody a medication

to suppress their appetite. Oh, that's true. But then you want them to eat 100 That's true. And more grams of protein, right? So we have to find a medium point to patients to not lose muscle and that's around 100 grams of protein

a day in their diet. Got it. And then how often do you tell patients at a minimum they should be lifting weights? I would say with twice a week. They should feel happy with it. Twice a week. We can do this. One day upper body, one day lower body. I love a formula that I actually feel like I could actually achieve.

But I would say for many patients at the beginning, my main, main baby steps, right? Baby steps. If I want them to do one thing, it's to increase their protein in their diet, because at least with increasing the protein in their diet, they won't lose muscle. Then we can, once a patient starts losing weight, feels a little bit more stimulated or more encouraged or physically able, then we can start incorporating exercise. You know I see this term all over social media, ozembic face. What is that and why do people think that a GLP-1 changes somebody's face? Well it's not the GLP-1 is the drop of rapid weight loss or significant weight loss.

And why is this? Because of not eating enough protein. So as you lose, if you're losing muscle because you're not, don't have enough protein in your diet while on this medication, you're not only gonna lose muscle, you're gonna lose hair, you're gonna lose elasticity in your skin because we need protein to make collagen, elastin, right?

Also, you need muscle to fill the gaps of the fat loss, right? The goal here is not skinny, it's strong, it's fit, right? So you need to fill those pockets with muscle. Now, if you're not losing muscle by increasing your protein intake, then you're gonna make enough collagen. You're losing weight slowly, so you're allowing your skin to adapt to the changes. But if you lose weight rapidly, it means that you're also losing muscle.

It means that you don't have enough protein in your diet, so you're not making collagen and elastin. What about some of the things that I've had at least friends report? I had one friend just talk about the constant indigestion. And I also had a friend say that he was warned about suicidal ideation. What can you tell us about those two side effects? So I'm going to, there's a phrase that I use a lot and I'm going to repeat it until I don't have to, but the efficacy and the safety of this medication

is going to depend on the expertise on who is prescribing it to you. What does that mean? That means don't go to a med spa? Yes. It means that it's a medication. It's a medical treatment. And you need medical supervision to decrease side effects and to achieve weight loss to have the most results from this medication. Right? I've never had to stop the medication for any of those symptoms

that you mentioned. It's very important to take the medication for any of those symptoms that you mentioned. It's very important to take the time to explain to the patient. You need to have this conversation to talk about weight with a patient. You need time. It's very hard to have such a vulnerable conversation with somebody in 15 minutes, let alone then explain to them about medications and how they work. You need to build trust, right?

And you can only achieve that if you take your time to talk to a patient. And that's one of the reasons that I decided to do private practices because I knew I could offer more patients if I had the time. To decrease the possibility of side effects, you really need to make your research, do your research, do your diligence before you go to somebody to get this medication. And they should be a medical doctor. Ideally, they should be a medical doctor, but it could be a nurse practitioner, it could be a PA that they specialized in obesity. And is there a kind of ramping up on this

that also is something that should be done so that you're being medically supervised to see how your body and your brain tolerates this? Yes, so every patient should come into a visit every eight to 10 weeks when they are taking these medications, right? Because to see if it's working, what's not working, how is your muscle mass, are you losing mass?

Do we need to slow down the medication? Do we need to decrease for the greater good of muscle? So every patient is individual and we try to adjust their lifestyle, but we need to see those frequent visits to see where the patient is, right? Are they tolerating it? Can we go up?

Do we need to go up or do we need to come down on the dose? Well, you know, as we were researching this conversation and digging into all kinds of information that we wanted to ask you, of course, the phone is listening. And next thing you know, I am getting served up on my phone, nonstop ads for GLP-1 mail order. And it gave me a pause because of the friends and family that have gone to a medical doctor

and who are seeing results or just starting this, even the ones that have had some symptoms, the doctors are all over it and they're monitoring it. Like I didn't even know that you take a shot once a week. Like I had no idea whether this was a pill or how it actually works. But it did give me a lot of concern to see that there's a lot of companies, whether they're licensed or not out there marketing

that you can mail order a GLP-1. What should you look for in terms of investigating a practitioner or provider if this is a tool that you want to look into for yourself for a family member? So the first thing to look is that we, as medical doctors, we don't sell FDA-approved medications in our offices. We send a prescription to your local pharmacy. It could be a commercial pharmacy, but we don't sell it in our office.

If you encounter somebody who does, they're not, they're selling you the compounded version, right? Also, many of those med spas or mail order or telemedicine platforms, what they're offering you is the compounded version of the drug. What's the difference between that and the FDA approved prescribed one? The FDA approved medications are evidence-based, they're from the clinical trials, they're heavily, heavily regulated. For a drug to be FDA approved, they sometimes have to show 10 years of research, right, efficacy and safety to get FDA approval.

Compounded medications are not regulated. They're not FDA approved. So many times what you're getting, it may not be exactly what they're promising, right? Many times they put fillers on the medications. So safety should always be above anything. Granted, these medications, the FDA versions are expensive, right? But I always tell people safety should not be jeopardized by cost. And second, because there's always the risk of self-administrating more medication. The current FDA versions, they're pre-dose pens.

So there's no way that a patient can inject themselves more or less. With the compounded medications and what we've seen and there's studies showing that most of the hospital visits for severe side effects of GLP-1s are from compounded medications from overdosing. So you leave it to the patient many times to figure out the dosing or to run the risk of underdose or overdose, right?

And this can lead to severe side effects. That makes a lot of sense. Dr. Salis-Weyland, what's your opinion of microdosing these medications for people who don't necessarily need to lose weight, but they just kind of want to? Okay. So we have to understand how a medication or how the doses are recommended, right? Medications go through clinical trials, clinical studies, where many doses are tried. Then we reach a therapeutic dose, which is a dose that exerts an effect. That's what we call therapeutic doses. That's what, when medication is approved, they come with therapeutic doses.

If we think about microdosing or using less amount of the actual therapeutic dose, well, we're not going to get the effects that the drug was designed for, right? Number one. Second, if you do need this medication and you have obesity, then you need the therapeutic doses, not the subtherapeutic doses. Now the other thinking is,

well, I don't need to lose weight, I just want the positive effects of the medication. Well, if you don't need to lose weight, then if you are already in a healthy metabolic weight, then you don't need the, you're already getting the benefits, right? You already, just by being fit, you have that. You don't need another medication.

And third, the problem with microdosing is that it's based on compounded medication. Oh. Currently, the FDA approved drug, they come pre-dose. So there's no uneasy way to give yourself a lower dose. It's a single use pen for most of them pre-dose, so you cannot really play around with the dosing. Now, Eli Lilly came with the bile of the lowest dose. That may potentially have a use for patients that reach a healthy weight goal that don't require higher doses that can maintain a weight with a small dose, then we can do a lower

dose. But currently we only have tercepestide in a bile, right? Got it. Another reason of the microdosing was to avoid the side effects that people were having. Oh the nausea. What are the big side effects? The problem with those side effects the word that they were initially created by people using compounded medication and that didn't have expertise on that. So their thinking was well, maybe if you use less you'll have less of the side effects, but that's not a problem of the actual drug of itself, right?

It's an actual problem of who was prescribing it and also using compounded medication. Wow. So if I'm following correctly, if somebody is getting a compounded medication from somebody who's telling them to just microdose to back off on the symptoms, that's not actually the formula that was approved by the FDA? If you're using the FDA approved drug the right way by somebody who knows how these medications work, you won't have those side effects that will make you use a microdose. Wow.

I have three people I'm sending this to right away who've been talking nonstop about the nausea and this and then the micro dosing. And I didn't even realize that if you're micro dosing, you're not getting the FDA approved drug. You're getting a compounded formula of it that is being prescribed by somebody that's not doing it the way the FDA said. They're not heavily regulated. We don't know exactly what you're getting in the medication. There's the risk of overdosing yourself. There's higher risk of side effects, one, from not knowing what is in the medication and not doing

the right dose. And third, there's no evidence-based research that says that microdosing is effective. Dr. Salas-Waelan, what's the most common misconception about these GLP-1 medications? They're easy way out, that is cheating, that you can sit back and not worry about how you eat, and if you your exercise or not. So what's the truth that you want us to know about these medications? Patients are more involved in exercising. They're eating better. They're increasing their protein intake.

They're working out. Because when you explain to a patient the possibility of muscle loss and when they see it physically, when they come and do their body compositions and they think, oh, I lost three pounds, great. And then they go into the body composition and they saw that half of it was muscle. They get it. They understand. And they become part of the treatment. They start working out, they start lifting weights, they start eating better. And then halfway the journey, which is for me is what drives me of what I do every day, is there's a switch. There's a switch from when the patient

comes thinking of something externally, physically, and then halfway it becomes something internally. And then halfway it becomes something internally. They like how they feel strong. They start to worry more about muscle in every visit than weight loss. How did I do on my muscle? Did I gain muscle? Once a patient feels strong, understands on how to eat, there's no turning back. When a patient comes to me, they struggle through decades. Exercise program, personal trainers, some have personal chefs. They're doing what we're

recommending. They've been doing it. They've been listening to us. Also, when somebody says, oh, if they wanted to lose weight, if they really wanted, they would have done it. They want it. They know. But unfortunately, it was not their sole responsibility. I have yet to meet the couch potato that is just eating, sitting, and not doing anything, and that's why they gain weight. I mean, I think the thing that's very clear about this is that a person who is struggling with their weight or struggling

with obesity as a disease and a chronic condition, they're probably working harder on their health than the rest of us. Yes. Because they're thinking about it all the time. And I choose to believe that everybody wants to thrive. Every – like, it is so demoralizing when you're doing the things people tell you that you need to do and it's not working. And if you've never struggled with this in your health, I bet you've struggled with it when you've tried to find a job or when you've tried to

save money. You follow the things and it's just not working and you don't understand why. And what you're here to say is there's four other factors outside your control from genetics to hormones to age to things in the environment that are impacting and screwing up your metabolism that are interfering with your body's ability to metabolize food and to like help you help yourself. And so of course you'd feel discouraged. And so it makes so much sense. You know, one thing I'm curious about Dr. Salas-Waylon is how does a GLP-1 change how often you think about food? It's, I think there's no, anything I say is not going to be comparable to what a patient

experiences. You have to understand patients with obesity, they think about their weight 24-7, how everything that they do or put in their mouth is going to impact their weight or feel guilty about it later. When you remove that from a person, it changes their life. They feel liberated. The possibilities are endless. That's incredible. I've never taken the medication, but one of my family members is taking it, and that's exactly what they share. I just don't think about it.

And that's revealing how much I used to think about it. And when I'm not thinking about it, I'm not mindlessly walking into the kitchen. I'm not having a second helping. I'm not, like, constantly in this loop. It's liberating. It's liberating. It's liberating. Some patients tell me, oh, so this is how it's supposed to be. This is what is normal. And then it opens your eyes, right? It's like removing a blindfold when you're on this medication and you go out with somebody who's not on this medication and you think about like, whoa, we're overeating. You don't really need to eat that much

to feel physically satisfied, right? And then it has a rippling effect too, right? I mean, you can discuss this with family members or family members see the effect, see the positive effect, and then it's just they want it too. I know that this is a conversation that people are going to be sending to their family members and their loved ones all around the world. For anybody who's still thinking it's a human

being's fault when you look at somebody who is struggling with obesity, until we change the food system in this country, until we give people access to proper medication and health, until we give people access to places where you can live where you have affordable food that comes from the ground, not a box, and places to walk that are safe. Like, you can't blame human beings for the fact that the environment that we live in is screwing up your body's ability to process the fake food that is affordable to most people because of like how we've allowed industrialized farming and big industry to change the food that we eat. And people say, well, some people with exercise and diet, they lose weight. The key is how much, how restrictive does it have to become to reach that goal? And can it be sustainable long term?

Without punishing yourself constantly. Like what I love most about everything that you've shared so far is just that it's not your fault. And really understanding that if you had cancer, if you had diabetes, you would seek treatment. And you would seek it for your 12-year-olds and up. You would seek it for your 12-year-olds and up. You would seek it for yourself. And really embracing that, that, hey, what if something else were to blame? And what if there was something that could help my body actually process food and water and air and everything in a way that supports my health? What if it doesn't have to be so hard?

What if it's not my fault? That's the most exciting thing about everything that you're sharing with us today. One of the things that I wanted to ask you is, if you have somebody in your life that you're worried about, that you really would love to have them go see a medical doctor like you, a specialist in obesity medicine, or just somebody that is treating people,

how do you talk to somebody without making them feel wrong just somebody that is treating people. How do you talk to somebody without like making them feel wrong or blaming or assuming, you know what I mean? Because it's a very hard subject to talk about. And if you're somebody that doesn't have the same issue with your metabolism, then you don't understand. And so I just would love some advice from you about how to bring this up to somebody who, as you've already shared with us,

is thinking about it all the time. It's a difficult conversation to have, even for us doctors, that that may be the sole reason a patient is coming to see us. Some patients are not ready to have that conversation. It could be the same with a family member, with a friend. I would say if it comes from a place of love and authentic care, people perceive that, people feel that and don't feel attacked.

I think the most important thing that we have to remember with patients with obesity is that they've learned to feel blame and to feel attacked. So you have to be very, have a lot of tact on how you're going to bring the subjects with that feeling or putting more blame into the situation? You know, I had that conversation with somebody in my family that I love. This was probably six months ago. And, you know, just saying, I'm really concerned about you

and I know how hard you work at this. And have you thought at all about, you know, the GLP-1 options that are out there? And they were very defensive and then said that they had already talked to their primary care about it and they're so expensive that I can't afford it. And I didn't know what to say. And so do you have any advice for what you could say to somebody or what someone could do if they either have had an insurance claim denied or they can't afford the medication or that's

what they're telling themselves? Is there something that you should do beyond a primary care doctor in order to facilitate trying to get this covered by insurance? Both pharmaceuticals that produce these medications, they have manufacturing coupons. Okay. Meaning that if your insurance, if your commercial insurance didn't approve it, you can use a coupon that cuts the cost about 50 to 60 percent.

Okay. So they become a bit more accessible. Now, one of the current pharmaceuticals just came out with a bile of the medication. Currently, we have injections that are pre-filled pens. And this drives the cost very high. But now the medication is coming in a bile, like an insulin bile, but it's not insulin. And it had cost the price significantly. So that's another option. And then also going to a specialist, right, that is going to do and take the proper measurements

to make the diagnosis and to be able to justify the need of the use of the medication. Well, Dr. Salas-Waelan, if the person listening takes just one action today from absolutely everything that you have shared with us, what do you think the most important thing to do is? To share what you learned today. To share what impacted you the most about this conversation. Right? I think our duty and our responsibility is to share the information. Well, the thing that impacted me the most is if I ever hear another person in my life complain about their weight or hate on themselves, I'm going to say, you know, it's not your fault.

I want you to listen to this extraordinary world renowned expert because you may not believe me, but I sure as hell hope you are going to believe Dr. Salas-Waelin. What are your parting words? I would add to what you say that, one, it's not your fault, and two, it's okay to receive help. It's okay to ask for help. That doesn't make you a failure. Doesn't mean that you're cheating. It means that you understand and that you are human and that for the first time we actually have help beyond exercise work and eat less. Thank you. Thank you.

Thank you. Thank you. Incredible. Thank you for thank you, thank you, thank you. Incredible. Thank you for having me. And I also want to thank you for taking the time to listen and to learn about this life-changing topic and for also being generous with this information and sharing Dr. Salas-Waelan's information with the people that you care about.

There's no doubt in my mind that this could change the course of somebody's life. And in case no one else tells you, I wanted to be sure to tell you that I love you. about. There's no doubt in my mind that this could change the course of somebody's life. And in case no one else tells you, I wanted to be sure to tell you that I love you and I believe in you and I believe in your ability to create a better life. And taking better care of your health and using the tools that are available to you and getting the support that you deserve is one of the best ways to do that for yourself. Alrighty, I'll see you in the next episode and I'll be waiting to welcome you in

the moment you hit play. I'll see you there. I'll see you there. I'll see you there. I'm waiting for my, this is the hardest part for me. I feel like a race horse in a starting gate. I'm so excited to talk to you. Rocio.

Perfect. Hey, okay. Don't worry, I can blow it once the cameras are rolling. It's okay, you. Rocio. Perfect. Hey! Okay. Don't worry, I can blow it once the cameras are rolling. It's okay. You wouldn't be the first one. This is so pretty.

Thank you. That is really pretty. You did fantastic. How do you feel? Is there anything else that you wanted to say? Let me think. Thank you. Thank you.

Thank you. Thank you. Incredible. Thank you for having me. Come on out. Oh my gosh, you guys. Wow. She killed it. Get over here. Oh, and one more thing.

And no, this is not a blooper. This is the legal language. You know what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode. Sticher.