Health, Fitness & Personal Growth Tips for Women in Midlife: Asking for a Friend

Ep.189 GLP-1s, Muscle, and Midlife Metabolism: Dr. Rocio Salas-Whalen on Weight Loss Without Shame

• Michele Henning Folan • Episode 189

Share episode

If you’re a midlife woman who feels like you’re doing everything right — lifting weights, eating well, walking, managing stress — and your body still isn’t responding, this episode is for you.

In this powerful, myth-busting conversation, I’m joined by Dr. Rocio Salas-Whalen, a triple board-certified endocrinologist, obesity medicine specialist, author, and early adopter of GLP-1 therapies in the U.S. Dr. Salas-Whalen helps us understand why weight gain in midlife is not a willpower problem — it’s a biology problem.

We break down:

  • Why midlife metabolism changes so dramatically during perimenopause and menopause
  • How GLP-1 medications actually work (in plain English)
  • Why muscle is the true organ of longevity — and how to protect it while using GLP-1s
  • The truth about side effects like hair loss, nausea, and “Ozempic face”
  • Microdosing vs. full dosing, long-term use, and what’s coming next in obesity medicine
  • Why shame-based weight loss advice is outdated — and harmful

We also talk about Dr. Salas-Whalen’s new book, Weightless, a science-backed, compassionate guide to GLP-1 medications and metabolic health that validates what so many women have experienced for decades. You can find Weightless wherever books are sold.

This episode is about options, not pressure. Facts, not fear. And building health for the long game.

Instagram https://www.instagram.com/drsalaswhalen/

Website https://www.nyendocrinology.com/


_________________________________________
1:1 health and nutrition coaching or Faster Way - Reach me anytime at mailto:mfolanfasterway@gmail.com

If you’re doing “all the right things” and still feel stuck, it may be time to look deeper. I’ve partnered with EllieMD, a trusted telehealth platform offering modern solutions for women in midlife—including micro-dosed GLP-1 peptide therapy—to support metabolic health and longevity.

https://elliemd.com/michelefolan - Create a free account to view all products.

✨ Sign up for my weekly newsletter:
https://michelefolanfasterway.myflodesk.com/i6i44jw4fq

🎤 In addition to coaching, I speak to women’s groups, moderate health panel discussions, and bring experts together for real, evidence-based conversations about midlife health.

Transcripts are created with AI and may not be perfectly accurate.

Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified healthcare provider with any questions regarding a medical condition.

Michele Folan:

I want to take a minute to talk to the woman who's doing everything right. You're eating well, you're lifting weights, you're walking, managing stress, and trying to sleep, and yet your body isn't responding the way it used to. I see this every single day as a coach, and I've lived it myself. And here's what I want you to hear clearly: there is no failure here. Midlife physiology is different. Hormones shift, metabolism adapts, inflammation and muscle loss become real obstacles, even when your habits are solid. That's why I went looking for answers, not shortcuts. After a lot of research, conversations with physicians, and personal experience, I chose to partner with a medical team that offers physician-prescribed peptides as an adjunct to a healthy lifestyle, not a replacement for it. Peptides aren't magic, they don't override poor habits. But when used appropriately and medically supervised, they can help support things like metabolic health, recovery, body composition, and overall vitality, especially when lifestyle alone isn't moving the needle anymore. If you're curious, if you want real information, not hype, and you want to explore whether this extra layer of support makes sense for your body, I've made that resource available. You'll find the link in the show notes. No pressure, no shame, just options for the long game. Health, wellness, fitness, and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, Michelle Folan, and this is Asking for a Friend. Today's episode is a big one, friends. I'm absolutely thrilled to welcome a woman who is reshaping the entire conversation around weight, hormones, and metabolic health. Dr. Rosio Salas Whalen is a triple board certified endocrinologist, an obesity medicine specialist, and one of the earliest adopters of GLP1 therapies in the United States. She's helped thousands of patients rewrite their metabolic story, and now she's bringing that wisdom to all of us. And here's the exciting part. Her new book, Weightless, a Doctor's Guide to GLP1 Medications, arrives with a starred review from Publishers Weekly, which is basically the Oscars of Publishing. This book is already being called a must-read for anyone who wants to understand hormones, weight loss medications, midlife metabolism, and what it really takes to create lasting change. In this conversation, Dr. Salis Whalen breaks down the science behind GLP1s in a way that finally makes sense. And she helps us understand where lifestyle ends and medication begins and why midlife women especially deserve better than shame-based advice and outdated guidance. We talk about obesity, menopause, muscle health, metabolic markers, microdosing, long-term therapy, the future of these medications, and the one thing every woman should know before starting or stopping a GLP1. This is an empowering, myth-busting, deeply passionate conversation that every midlife woman needs to hear. Dr. Rocio Salas Whalen, welcome to Asking for a Friend.

Rocio Salas-Whalen, MD:

Thank you so much.

Michele Folan:

I am so honored to have you here. Thank you. This topic comes up all the time. I do coach midlife women in fitness and nutrition, and I always want to provide them the best, most accurate, up-to-date information. And I feel like this conversation is going to be great for everyone. Before we dive in, I want you to tell the audience a little bit more about you. You have a powerful personal story immigrating to the US from Mexico. Tell us a little bit about your dreams of becoming a physician. So if you could take us back to the beginning and tell us a little more about your career path.

Rocio Salas-Whalen, MD:

The beginning is very early in my life when I had the dream of becoming a doctor. I that was the only thing I ever remember wanting to be. It was not a what, it was a how and how fast can I get there. And that was all my, I remember all my studies was like with one goal in particular, and it was just going to medical school. And when I was in medical school, I developed also a passion for diabetes and metabolic disease. Type 2 diabetes more specifically. And type 2 diabetes and obesity go hand in hand. We have to improve one to improve the other one, and vice versa. And this was back in Mexico. In Mexico, diabetes is the second lead of cause of death. My father had it, my grandfather had it, my uncles, aunts have it. So it's really ingrained in our genes in Mexico. And this was also one of the reasons that I got pulled into endocrinology, okay, I need to work on diabetes, I have to study endocrinology. And then I finished medical school in Mexico, and then I decided to come to the United States and try my luck, do my boards. Took me quite a few years to get there. And then I finally passed all my boards. I started residency in Jacoby Albert Einstein, internal medicine. And there in my first year of residency is where I met Dr. John Eng, who is the endocrinologist who isolated the GLP1 from the Gila monster. And I remember back then, this was 2005, leaving such an impression of me, that presentation that he did regarding a xenotide, which was Vietta back then, that I saw a glimpse of what the future was with this drug. I saw huge potential. For the first time we had a drug that decreased your blood glucose and decreased your weight. Usually either decreases your glucose, but it promotes waking. So we didn't have something that can target both things. It was so new, so revolutionary. And when I went into my fellowship on endocrinology, I started already prescribing. And as soon as I finished my training, I started prescribing Victosa back then, which was 2010.

Michele Folan:

Yeah. And I had to compete against Victosa because as I was telling Dr. Salas Whalen before we started, that I was part of the team that launched Bayeta back in 2005. And I've met Dr. John Eng as well. So yeah, this is this is such a cool story that you were really inspired by the science. But you're you're also a board, triple board certified, endocrinology, and that's obesity medicine and turtle medicine. That's kind of rare. How has each layer of training shaped the way you practice today?

Rocio Salas-Whalen, MD:

Oh, enormously. Even my my training in Mexico, because in Mexico, you do seven years of medical school, five years of academics, and then one year of internship in a hospital, and then one year of working in an underserved area. And I really think that what I in the day-to-day now bring to my patients when I see them, it's a accumulation of all these experiences. And training in Mexico adds another layer of intuition. And you depend a lot on the conversation that you have with your patient to figure things out because we don't have that access of imaging and blood works and all the things that we have here. So you depend a lot on clinical criteria into diagnosing and treating patients, right? So I think that is really, really gives me a plus practicing medicine here for sure.

Michele Folan:

And you know, the other aspect of this is as you were speaking, like you're really treating the whole patient. You're not just treating a number, a blood sugar, an HBA1C. You're really treating the whole patient.

Rocio Salas-Whalen, MD:

Because if you don't, then you won't have sustainable results with the patient, right? If it becomes, if you put something to the patient that it doesn't meet them where they are, you don't take into their lifestyle, if their genetics, their environment into an account, then you're really not giving them a fair chance of sustainability in regards to improvement of their health.

Michele Folan:

Yeah. And rates of obesity in the US continue to climb, like unprecedented. From your vantage point, what is the real story behind that rise?

Rocio Salas-Whalen, MD:

I think a lot of it was that we didn't have the proper tools. Although, just having this discussion, we've had them since 2010 that we started using it more for weight loss, right? Because when Valletta came first and then bidurin, it was more glucose control. It was more for our type 2 diabetes. I think after with Victosa. And also, if you remember well, I'm sure if that there was less compliance of patients because it was a twice-a day injection. Exactly. They had a lot of nausea, so more side effects. So we didn't have the acceptance that it did now, that we can see more now what are the results. And going back to your question, is that's why the rates continue to increase, even though we had a treatment for obesity, is because one, we still didn't accept obesity as a disease, right? I think that's a big, that's probably the main reason we're that we are where we are, because we've been attributing it even as a medical health community as a willpower, right? As a sole and only responsibility of the patient to improve their weight, which now we know it's the patient has the almost the least of the control in how what happens with their weight. So I think that not knowing or treating obesity as a disease has is really what has taken us where we are right now.

Michele Folan:

So you have said that obesity isn't about willpower as much as it is about biology. So what do you feel are the biggest misconceptions that people still hold about obesity?

Rocio Salas-Whalen, MD:

That you can still do it that or that the majority of people with obesity can lose the weight with only exercise and eating less.

Michele Folan:

Okay.

Rocio Salas-Whalen, MD:

That's the biggest misconception uh and myth that we have surrounding obesity. And even with the with the availability of the drugs, and definitely access is not for everybody, unfortunately, but even for the people that have access to it, we're still not using the medication because it's still of that stigma of I or that idea that it you should be able to do it on your own is what what also many people are not taking the medication, right?

Michele Folan:

You know, speaking of which, when you talk about access, I was reading yesterday, I don't know if someone told me this, but they had a client who went ahead and had gastric bypass because her insurance would cover the gastric bypass, but not GLP1s.

Rocio Salas-Whalen, MD:

Yeah.

Michele Folan:

How is that possible?

Rocio Salas-Whalen, MD:

Because at the short term, it may be more economical than to use a GLP one long term, right? I mean, I think it's it's mathematics for them and it's not so much what's best for the patient, is what's going to be cheaper for us. And doing $8,000, $10,000 surgery once is less expensive than paying for a medication that is going to be required for five, 10, 15 years, who knows, right?

Michele Folan:

Right. Okay. Well, that that makes sense, but still in my mind, I'm like, ah, you know, it just seems counterintuitive. But most of my audience is women 50, 55 plus. How does the landscape change for women and perimenopause and menopause? What are the metabolic shifts that are most misunderstood?

Rocio Salas-Whalen, MD:

Definitely uh we until recently are we really bringing perimenopause and menopause as a potential cause for waking in women, right? And it's more the hormonal fluctuation that happens in this stage of our lives than the actual number of our age, right? It's not that we're getting old, it's not as more like our our hormones are not helping us as they should, basically, right? So it's that hormonal chaos that happens or starts in perimenopause that can change our body recomposition, right? And I hear this all the time: women coming to me and saying, This is not how I used to gain weight. I used to gain weight in my hips, and now everything's in my middle. This is not the body that I normally have. I don't recognize my body, right? Because it's it's it's different than if you gain weight in your 30s or in your 20s. It's a body recomposition what's happening.

Michele Folan:

So when you say, you know, we got that shift to the middle, which I know I do too, because I used to gain it in my butt and thighs. Now it's my middle. Is that cortisol? What else is going on there?

Rocio Salas-Whalen, MD:

I mean, there's so many things that happen in midlife and women, right? It's just it's a it's layers of things that can promote awaking. And we can talk about one, the the changes in hormones, right? And estrogen, progesterone, testosterone. And then we talk about what are these hormone fluctuations are doing in our day-to-day? We may be sleep deprived, right? And if we're not sleeping, which happens in about 70 to 80 percent of women going through perimenopause, is then not having continuous sleep. You can fall asleep, but you don't stay asleep. That increases your cortisol. We know that people that don't sleep enough, that increases your risk of mortality. So it can also promote waking, that increase of cortisol because your body's not resting, it's in content, constant stress, it's in constant flight, right? And then if we are not sleeping, we're not gonna have energy to work out or to make healthy choices when we're going to eat, or we'll start drinking so we can fall asleep, but then that also disrupts our sleep. And then we add to that layers and family dynamics, right? If this is the age that our parents start to age, that we start seeing those changes in their health due to aging, or like in my case, you may lose your parents, right? In your 40s. So that's another level of stress, uh, chronic stress. And then aging kids or kids getting older, right? Or going leaving the house or becoming teenagers. And then add it to this professional for many women, this is our peak, right? This is where we start really earning what we're making, what we're working. This is the age that our kids are a little bit older, then we can really focus and work. So there's so many layers in in a woman's life and midlife that it almost, almost sets us off for failure.

Michele Folan:

Yeah. Which is why I have you on the show today, because I'm trying trying to help women really understand what is physiologically happening to their bodies at this stage of life. We are going to take a real quick break and when we come back. I want to talk about lifestyle and how you want to pair those with GLP1 medications. Quick pause because if you're here, you already know this isn't just a health podcast. Yes, we talk about nutrition, strength, and taking care of your body in midlife, but we also talk about life, relationships, energy, boundaries, and what really matters in this season. This isn't about perfection or shrinking yourself. It's about staying strong, curious, connected, and actually enjoying the years ahead. If this resonates, share the episode with a friend who'd appreciate the conversation and follow us on Instagram at asking for a friend underscore pod. Okay, we are back. Before we dive into medications, what are the non-negotiable lifestyle foundations you want every patient to master first?

Rocio Salas-Whalen, MD:

Weightlifting.

Michele Folan:

Okay.

Rocio Salas-Whalen, MD:

Muscle is the organ of longevity. Sarcopenia is when there's uh very low muscle mass. And when somebody has very slow muscle mass, that increases your risk of all cause mortality. We never say that in obesity. This increases this obesity is going to increase all the your risk for all cause mortality. We don't say that, but with sarcopenia, it does. Muscle is our metabolic organ. Muscle consumes 80% of the glucose that we have in our blood. Muscle burns body fat for energy. Muscles muscle produces hormones called myokines, and these are anti-inflammatory, so they protect our immune system. And then that's from the inside, and then from the outside, muscle is our structure. Muscle is the pillars that holds our body, right? So less risk of falling, injury, independence as we age, right? We can get up out of the chair, we can go to the bathroom by ourselves. So, really, the the best thing that anybody can do if they choose to do only one thing is build their muscle mass.

Michele Folan:

So, how do you help people understand that the medication is not a substitute for strength training, protein, sleep, and stress management? How do you tie all that together for them?

Rocio Salas-Whalen, MD:

Well, you know, the majority of my patients, when they come to me, they they've tried all of that. They're doing a lot of the legwork already. I don't think I've ever had a patient that has not tried anything and wants to try the medication first. I really and that's one thing, that's one of the things that drove me to write my book, which we'll talk about, is it's learning that patients are actually trying. They're actually doing everything that we're asking them and more, right? So I have not met the patient that this is the first choice. They've never tried anything else, they never tried lifestyle changes, and now they just want to do something easy. I have to yet meet a patient like that. So my patients, they already start doing that. What was interesting, and what I like to remember them when using a GLP1 is that now they will continue to exercise, but not with the pressure of weight loss in it. Not with the pressure that I'm exercising to lose weight. I'm exercising because I want to live longer, because I want to be able to carry things. Like the weight loss pressure is the GLP1 takes it away, right? So now patients, and it changes, right? Because if you're doing something for weight loss, it's not as fun. I don't know, it just carries a lot, it's very heavy and complex what that carries, right? Because it may be trauma that you were told young, you have to exercise, exercise, do more cardio, do this. And it just did the connotation and the association of weight loss with exercise that may. Pull somebody out from exercising, right? So when you remove that stressor and that pressure to exercise, it becomes more natural. And there's no like that you have to do it six days a week, seven days a week, which is patients what they do to lose weight. But to build muscle, even if you go three times a week, you're building muscle already, right? So it's easier to adapt.

Michele Folan:

Okay. I'm the light bulb's going off for me here because what a great way to frame that up. I'm like, oh my gosh, that's genius, though. Because if you are exercising to lose weight, it really gets to be such a drudgery, right?

Rocio Salas-Whalen, MD:

You don't want to do it. It's like, ugh, yeah. It's like a punishment, right? Oh, I'm gonna eat this, but then I have to exercise to lose the weight. Well, yeah, no, but when you remove that, it just patients see it very differently.

Michele Folan:

Yeah. And you've been using GLP1s in practice longer than almost anybody in the US. Can you break down how these medications actually work in simple science so people can understand this?

Rocio Salas-Whalen, MD:

Definitely. I I want to I like to explain it, bringing it back to the reasons that we eat. Why, why, what are the two main reasons that humans eat? One is survival, right? It's it's fuel, it's energy. And then the other reason is for a reward or an anticipation of a reward, an association with a dopamine release, uh, whatever it is giving you, is there's a release of dopamine. The medication, the GLP1 medications, they they target both things. For the fuel, the survival part, what it does is it increases your satiety hormones, your your fullness hormones. When you start eating, you get full with half of what you normally would get half, need to get full, and then in between meals, it suppresses your hunger hormones, right? So it's like mechanically, you're more restricted. You eat it small amounts, you get full faster and for longer periods of time. And then for the reward part, we have receptors of this for this hormone because it is a hormone. We have receptors for these hormones in the hedonistic eating and drinking area in our brain, which is the amygdala. There, it blocks the response of our reward to certain foods and certain beverages, right? So for those that anticipate having something at night, uh dessert, or or they're already thinking about it, it once you're on this medication, you you see that, whatever it is, and it doesn't give you that dopamine release. So the behavior changes.

Michele Folan:

Okay. And then in terms of other metabolic markers beyond the number on the scale, what other areas do you see improvement in with patients on GLP1s?

Rocio Salas-Whalen, MD:

Well, definitely decreasing their visceral fat, decreasing the percentage body fat. And what I work really hard with my patients is to maintain or build muscle mass with a GLP1. So being, I think that's another myth and misconception is that being on a GLP1, you it's like a death sentence for your muscle, right? You you just be prepared, you're gonna lose 30, 40% of your muscle mass. That is not true, and that's the poor guidance of whoever is prescribing you this medication. Because in fact, patients can maintain and build muscle while taking a GLP1. And I have patients in their 70s that they build muscle mass. So there's no age limit in when you can uh build muscle.

Michele Folan:

You highlighted the other day a patient who only lost 17% muscle. And that was a great number for her because many patients, if like the industry average, you can hear 30, 40%. Is that typically what the industry average would be without getting any kind of lifestyle coaching?

Rocio Salas-Whalen, MD:

Yeah, definitely. They're gonna lose a significant amount of muscle. And then the problem is that you lost your metabolic organ, you lost your glucose-consuming organ, you lost your burning fat for energy organ, and now you are causing chronic inflammation from not having muscle mass. So you may end up worse in metabolic health than when you started if you lose that amount of muscle.

Michele Folan:

All right. I do want to talk a little bit about side effects, the any kind of risks. So we've heard, we've heard hair loss, we've heard ozempic face, gastroparesis. How do you help patients navigate all these things safely?

Rocio Salas-Whalen, MD:

By starting slow and steady, right? By seeing my patients often, by having an open line of communication, by doing a very thorough medical history and know what works for the patient and how to guide them according to their lifestyle. I don't like to do anything extreme in my patients in regards to diet and and exercise because I find that is not sustainable long term. And and mentally they just want to do it until the end gold, and then again, it's not sustainable. So I really like to make uh things as easy as I can for my patients.

Michele Folan:

Do you have a certain like amount of protein that you would like them to eat every day?

Rocio Salas-Whalen, MD:

Yeah, women, what I've seen, because I do body compositions on every single patient, every day, multiple times a day for the last more than 10 years. What I've seen that works in in regards to maintenance is around 100 grams of protein per day in women. In men, it goes a little bit more higher, like around 40, 150, right? That's to maintain, that's not to not lose muscle, but to build muscle, you need to do the weightlifting and potentially keep maybe a little bit more protein.

Michele Folan:

Okay. Have you had to address hair loss with any patients?

Rocio Salas-Whalen, MD:

Yeah, definitely at the beginning. While I was also figuring things out as I go, because we didn't have any guidelines, right? Patients that lose muscle will lose hair. Patients that lose hair are losing muscle because it all comes from the same macronutrient, which is protein. So patients that are consuming those hundred grams of protein a day, they don't have muscle uh hair loss. So definitely it's preventable.

Michele Folan:

Okay. That is so good to know because women in midlife already feel like their hair is thinning. And if you add that on top of it, that will stress them the heck out. So, all right, that's a good one. There's so much buzz right now around microdosing. And when is that appropriate? When when would you have a patient microdose? And who is it not for?

Rocio Salas-Whalen, MD:

I would microdose a patient that is extremely sensitive to medications. And I choose for whatever their medical history to start them on tirzepetide, right? Because it's better tolerable than semaglutide. It causes almost zero to none nausea. So that's my that's my preferred drug at the moment to start a patient. But even the lowest dose on tirzepitide, which is 2.5, is pretty strong, right? I've I've had patients lose 30, 40 pounds even on the first dose. So if I have a patient that I'm not looking for a significant amount of weight loss, or they're they're very sensitive to medication and they're scared, frankly, scared, I may do half a dose for a few weeks and then move them to the regular dose. But most of what I consider microdosing useful is for maintenance, not for because remember, we have to remember that in the studies, the available doses that we have now are the ones where the effect, the desired effect was seen, right? Glucose control for the diabetes uh uh indication and weight loss for the the obesity and overweight indication. So if you talk about a microdose, well, we're not gonna see the results that we're expecting to see. And I think I never denied the benefits of this drug, but my only issue is if you need the drug, use the regular doses, unless of the the reasons that I mentioned before, right? Uh but I think doing doses below what we have available is gonna be useful for maintenance more than to getting patients there.

Michele Folan:

And when you say tirzepatite, that is the GLP1 GIP combination?

Rocio Salas-Whalen, MD:

Yes, that's the dual increment.

Michele Folan:

Okay. What do you predict then for long-term use?

Rocio Salas-Whalen, MD:

Well, a lower dose for my patients currently is the lowest dose of their medication long-term. But I think with the oral options coming up soon, I think oral will may be also a good option for maintenance. Although I think for the majority of people, they've gotten out over the hump of the injection. And for many, it's easier to do an injection once a week than to take a pill every day, right? Maybe if cost is significantly different from the in the oral from the injection, then may that may be a reason to move somebody to the oral for maintenance long term. Also, there's a once a month coming maritide. I think it's also from Eli Lilly. And I think that's going to be an option for maintenance too, doing an injection once a month versus once a week or versus a daily oral tablet.

Michele Folan:

I'm so curious how they're making this oral because it's an incretin hormone and you would think it would be broken down quickly.

Rocio Salas-Whalen, MD:

Well, the thing is, what what I saw with oral semaglutide in 2019 when Rebelsis was approved for type 2 diabetes, we have oral semaglutide for six years now. And the reason that I personally don't use it in my patients, and that the reason that it's not as popular and never got as popular as Ozempic is because being oral that we saw more gastric side effects. I saw significant nausea. It was hard to titrate up patients because of the side effects. So it's going to be interesting to see what to expect with orphoglyprone, which is the one from Eli Lilly, um, if if it's going to have this, because orphoglyprone is not GIP and GLP. It's one GLP, it's like semaglutide, right? So we potentially may see the same side effects. So until we don't start using it in masses clinically, if we can and patients tolerate it, then we won't know until then.

Michele Folan:

Do you see GLP ones becoming a chronic metabolic medication, kind of like we have with statins?

Rocio Salas-Whalen, MD:

Yes, for sure. It must.

Michele Folan:

All right. You know, some of your most impactful content that you post is around expectations. The physical, the emotional, and also social. How do you prepare patients for some of the psychological side effects of major weight loss?

Rocio Salas-Whalen, MD:

I think by doing it very slow and reframing, reframing weight loss with the end goal of metabolic health or body recomposition, that already has an effect on the psyche of the patient, right? Because it's not so much more of a physical appearance, it's more about how do I feel? Do I feel strong? Do I feel healthy? That prepares better the patient for when they reach this new body recomposition, right? And also if you do it slow as I do, it also allows adaptation to the new body, to the surroundings, right? Versus if you take somebody too quick, too fast in a few months, I mean their body even hasn't adapted. Their psyche even is going to take even longer to adapt, right? That's another reason why it should be done very slowly and steady to really improve the chances of success for the patient.

Michele Folan:

Do you see other combination therapies? So we already have GLP1 and GIP. You know, there's like glucagon, there's amylin um analogs, those types of things. What do you what do you see on the horizon? I really think it's so exciting.

Rocio Salas-Whalen, MD:

You know, I think I truly think we're in diapers right now with the with what we have. It's just it's just something so new, even though it's not new, but this is how long it takes to for for the healthcare system to incorporate things. But I I think there's so much investment in the study of new drugs for obesity, right? I think that's the that's the priority pretty much for every pharmaceutical, I think, at this moment. And everybody's trying to do their own cocktail, their own recipe, and adding different medications, as you mentioned, semaglutide with amylin. Uh that's going to be an interesting one. And apparently they already apply for FDA approval, right? So that may come very soon. Then we have the triple agonist, which is GIP, glucagon, and GLP1, which is Retatrutide. That's also coming end of next year or 2027. And then we have combination with muscle preserving medications, right? Which are anti clonal antibodies to prevent muscle loss, which is another interesting thing. Uh so again, I think it's just it's just the race of who's bringing uh different combinations of for the benefit of the patient. So I'm I'm really excited to see what is going to become of health, right? We are going to reach places that before they weren't they weren't reachable for many patients. And what I love, what I do in my patients, is to give them that view and that that potential to know or to explore what their body can do, right? Because for many patients, they're they just accept that where they are, and this is where I am. I uh getting out of the chair is painful, so this is all I'm going to do. But it's like removing those layers as they go through through treatment, you and they start feeling stronger, and that's why muscle is very important to incorporate it. You you start seeing this spark in the patient of like, oh, what can my body do? It can do this now. Oh, I'm gonna start running for a marathon. Oh, I'm gonna do a triathlon. Oh, my body can take me hiking. So that that fills my cup every single day. Is when a patient starts to have a glimpse of what their body can do, I think there's no turning back for the patients at that in that precise moment. I I'm I'm tearing up right now. And you know, giving people that hope who have been hopeless for years and years and years, and that they they may have a life. They may, they may live a long, healthy life, right? And and this is what I don't think people quite understand is not just the emotional strain of of the weight, but it is the physiologic strain of that weight is killing people. And if if we can give them something that helps them at least give them that jump start to say, you know, I'm empowered. I am can in control now where I can do this myself. I can see why you love what you do. Thank you.

Michele Folan:

Yeah, fantastic. And I want to talk about your book. A huge congratulations on on the the publisher's weekly starred review. Um, your book is called Weightless, a doctor's guide to GLP wanna make medications, sustainable weight loss, and the health you deserve. Why did you write it? And who's the book for?

Rocio Salas-Whalen, MD:

For everybody. The book is for everybody, and and I had everybody in mind, both patients, both curious people about the medication, and doctors and providers who want to prescribe it responsibly, right? I there's no competition, oh, you're gonna take away my patients. There's in this field of obesity, the more I mean, we need so many providers, but do it responsibly, educate yourself, right? Because otherwise you're doing a disservice to the patient. And the reason that I wanted to write this book is one, because I wanted to everybody to hear what I was hearing from my patients and and remove that that cons that preconception of the lazy, ignorant patient that has obesity, and if they wanted to lose it, they already would have done it. They want to lose it and they tried everything. So I needed people, even doctors, to hear this because that's not where we need to go. And then the other reason is because I can reach to more people and educate more people through a book than what I can do in my one-to-one with my patients and in my social media, right? So that's the reason I wanted to educate the population, even if their provider is not educated enough.

Michele Folan:

What gap in understanding did you most want to fill with this book?

Rocio Salas-Whalen, MD:

Really, to validate patience. That was my one rule that I had with my publisher. I said, my book has to have heart. My book has to validate that those years of work of my patients and the people that are going to read the book. I wanted to rebuild trust, right? Because I think due to the gaslighting and lack of trust between physicians, patients and physicians, specifically, and that we this is very parallel to women's health, but specifically with people with obesity and overweight, right? That the trust was broken between the patient and the doctor, and the doctor and the patient. It was just to reinstate that trust and rebuild that trust, right? Also, I wanted to make patients feel empowered and that they can also be participants of this journey, right? And the educated patient does better, right? Because they become partner. And what I found in my practice is that patients want to be educated. They want to know, they wanna listen, they wanna learn. The problem is the way that we practice medicine in 10 minutes, we don't have time to teach the patient to us, answer their questions. So it becomes very it becomes very automatic. Uh cough, syrup, you know, blood pressure, here. We don't we don't even ask anymore, right? We don't we don't want to know the why because we don't have time. I can fix it, but I don't have time to understand it. So with this book, I wanted to give that to the patients, right? The the the opportunity to learn and and educate themselves and understand why they're not losing weight, why they have obesity, and for them to understand that is not their fault. And then I also wanted to guide somebody through the whole journey, from the moment that even they start thinking, could this be for me, to the moment that, wow, I'm here and this is where I am. How do I approach all these new things that are gonna happen in my life?

Michele Folan:

How exciting would it be for you to see a patient like walking into their doctor's office with your book under their arm? Because you know that's what's gonna happen, because they're gonna highlight pages and say, well, Dr. Salas Whalen says this. What do you think? Right.

Rocio Salas-Whalen, MD:

And and it's all the references are there. They're gonna say, here's the reference for this and this and this and this, right? I mean, again, I was very my my my the proudest thing of my book is that it's easy to understand for anybody who has nothing to do in the medical world but evidence based backed inside back with science. Right. So isn't that my opinion in that book? Is the science made very easy to understand and and to digest and to bring to your doctor?

Michele Folan:

Yeah. And you took science, you took physiology, even culture. You put some real life patient stories in there. What part of the journey are you most excited for readers to understand?

Rocio Salas-Whalen, MD:

Why they have obesity. That's one. And the other one is so they can understand the psychology of their weight in the head. I mean, they of course they understand it. But how to let go of that too? Because, and that's the title of my book. I want my patients to become weightless. That's what I see a patient. They come with the idea of dropping physical weight, but what happens in the journey as they go, they drop trauma, guilt, shame, right? So this is what I want for my patients to truly become become weightless.

Michele Folan:

Yeah, because people's identity is shaped by their weight. And I I would assume that even if a patient loses 80 pounds, they still may be that obese person in a smaller body.

Rocio Salas-Whalen, MD:

Yes, and and they say this, I see the body, but it's not me, right? So that is a that's uh uh things that we are not we're we haven't been yet giving those tools to our patients for with weight loss. We've been putting all of our efforts in getting to a number that what that would equal health, but we have done nothing for the mental health of weight loss.

Michele Folan:

Yeah. I love what you're doing though, because I think that you're you really are trying to treat the whole patient here, which we're we just don't see all that often in in the realm of weight loss. So this is fantastic. And then for women listening right now, what message from the book do you want them to hear today?

Rocio Salas-Whalen, MD:

Don't let fear make a decision for you, right? I see and I feel and I hear and I understand the fear of going to a medication for weight loss. You feel guilty, you you are afraid of potential side effects, you are afraid because of the headlines that you're seeing. Make a decision informed, make a decision based on facts and science and not on fear.

Michele Folan:

Yeah, and stigma.

Rocio Salas-Whalen, MD:

And exactly fear, fear of shame.

Michele Folan:

Yeah, I mean, it's it's really what what what will my friends think? What will my family think that I'm not strong enough to do this myself? And I really I really don't want people to feel that way about this class of drugs. I mean, it's it's been so so well studied. Um and we and you know the smart way to do this.

Rocio Salas-Whalen, MD:

Yeah. Yeah. It's just the problem with it is that if that's the on by the own bias of people, right? Of thinking of weight as something superficial and aesthetic. Yeah. That if if they say, well, I'm gonna use a medication to lose weight, of course it sounds like out of this world, like why would you put your body through medication just to lose weight? But they're they're missing the point that it's a medical treatment for a complex disease. That's the first thing we have to accept that obesity is a true disease and not a risk factor and not something aesthetically unpleasant, right? So if we understand that and we accept that, we would not question treatment for obesity.

Michele Folan:

Amen. I love that. Okay. This is a personal question. What is one of your daily non-negotiables for your own metabolic and mental health? What do you do for yourself every day?

Rocio Salas-Whalen, MD:

Walk. I live in New York City, and for me, walking is very important. Having my coffee in the morning quiet before my kids wake up. If I don't have that, like I feel like I don't start my day well. It's just like I need to regroup in the in the morning, write down my ideas that I have for the day, and that's like and and starting my day with protein for sure.

Michele Folan:

Okay. Oh, love it. All right, we got the the triple whammy there. All right. What do you wish for every woman under 40 to understand about her metabolism right now?

Rocio Salas-Whalen, MD:

That it's changing, that your hormones are not going to make it easy for you and all the life events that I mentioned, but that you have options.

Michele Folan:

Yeah.

Rocio Salas-Whalen, MD:

That for the first time in two decades, women our age and mid middle age, we have options that our mothers didn't have. Right? We have hormone replacement therapy, we have testosterone, now we have GLP1 medications. So be proactive. Be proactive in your options and and remove that idea that you have to earn them with suffering, right? And also, what I tell my patients here is never accept anything less than feeling 100%. Because you can, because now we can. Now we have the tools to for that to happen. Don't accept not sleeping, don't accept not having a sex life, don't accept feeling tired all day. Don't, don't. You don't want to live like that for the next 40, 50 years. No.

Michele Folan:

A woman after my own heart.

Rocio Salas-Whalen, MD:

Yeah. Fight for that 100%. Fight for that 100%.

Michele Folan:

Fight for the 100%. Did you all hear that? I hope you did. Dr. Rocio Salas Whalen, where can the listeners find you, your practice, and your book?

Rocio Salas-Whalen, MD:

They can pre-order my book in Amazon, Barnes and Noble, anywhere where you can buy book. It's Weightless, that's the name, or Weightless.com is also the website where you can pre-order the book. And I am in social media and Instagram mostly, almost exclusively. And my handle is Dr. Salas Whalen, D-R-S-A-L-A-S-W-H-A-L-E-N. And also I practice in New York City in Upper East Side. And the name of my practice is New York endocrinology, and that's where I see patients.

Michele Folan:

Wonderful. What an incredible conversation today. Dr. Rocio Salas Waylon, thank you for being a guest on Asking for a Friend.

Rocio Salas-Whalen, MD:

Thank you for having me.

Michele Folan:

Before you go, thank you for being here. If you want to go a little deeper, make sure you check out the show notes for this episode. That's where I link anything we mentioned, resources, partners, or tools I actually use and trust. And if you're not already on the Asking for a Friend community newsletter, that's where I share practical midlife tips, favorite finds, recipes, and the things that don't always make it onto the podcast or Instagram. You'll find the link to join in the show notes. Take care, and I'll see you next week.