GLP-1s and Midlife Metabolism: Dr. Rocio Salas-Whalen Breaks Down the Science of Weight Loss and Menopause: Part 1

Are GLP-1 medications a game-changer for women in midlife—or just another quick fix? In this conversation, triple Board-certified in Obesity Medicine; fellowship-trained in Endocrinology, Diabetes & Metabolism Dr. Rocio Salas-Whalen joins Dr. Mary Claire Haver to cut through the hype and share what women really need to know about Ozempic, Wegovy, Mounjaro, and the science behind sustainable weight loss. Dr. Salas-Whalen, founder of New York Endocrinology and author of the upcoming book Weightless, explains why GLP-1 receptor agonists represent a fundamental shift in how we understand and treat obesity—not as a willpower problem, but as a chronic medical condition with biological drivers including hormones, genetics, and metabolism. For women navigating perimenopause and menopause, the conversation gets even more specific. Dr. Salas-Whalen breaks down why estrogen decline drives fat redistribution to the abdomen, increases visceral fat, and makes it nearly impossible to lose weight using the same strategies that worked before. She reveals how GLP-1 medications can address the metabolic changes of midlife while protecting what matters most: muscle mass. Dr. Salas-Whalen shares her clinical experience treating thousands of patients and addresses the viral misinformation circulating online. She explains why obesity is a transgenerational disease influenced by genetics, environment, food accessibility, and even childhood trauma—not personal failure. Guest links: Meet Your Endocrinologist - Dr. Salas-Whalen https://www.nyendocrinology.com/dr-salas-whalen (NY Endocrinology) Dr. Rocio Salas-Whalen https://www.instagram.com/drsalaswhalen/?hl=en (Instagram) Books “Weightless: A Doctor's Guide to GLP-1 Medications, Sustainable Weight Loss, and the Health You Deserve” https://www.amazon.com/Weightless-Doctors-Medications-Sustainable-Deserve/dp/0593981200 by Dr. Rocio Salas-Whalen “The New Perimenopause,”⁠ https://thepauselife.com/pages/the-new-perimenopause-book by Dr. Mary Claire Haver ⁠"The New Menopause"⁠ https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/059379625X/ref=sr_1_2?adgrpid=190238689390&dib=eyJ2IjoiMSJ9.djG88jtefTqLpTg36Li8QMNmXkpzLIfbFdY438Vro2vit_rKymy65UpF10hk_VTrxmazFUemwk7ywlmqHYY80j-V3LaeSD824-02PCtdlS8Fzp1XPcZs68nYHCL4V_ZdZBTJya---9Ng5PtKdOf-U3ENtuDXbDw68ULSk2wNk6Lt6mEhIPkuLM7FhztUzBJZ0wNBUQCSs6Pk1ZhoV2JDlzRapnMjnZgOq7PBA7Wy2KM._ZZSn21KJ43AyMvvSvI9_Hs3q74tpMBoCJ2zwi9enkc&dib_tag=se&hvadid=779626799212&hvdev=c&hvexpln=0&hvlocphy=9004331&hvnetw=g&hvocijid=16430100151400627515--&hvqmt=e&hvrand=16430100151400627515&hvtargid=kwd-2465259580440&hydadcr=15551_13558570_10211&keywords=perimenopause+book+mary+claire&mcid=ab159bad5384301d948e659e4b52f68d&qid=1774909744&sr=8-2 by Dr. Mary Claire Haver Articles Loss of Visceral Fat is Associated with a Reduction in Inflammatory Status in Patients with Metabolic Syndrome https://pubmed.ncbi.nlm.nih.gov/36416291/ (Molecular Nutrition and Food Research) Increased visceral fat and decreased energy expenditure during the menopausal transition https://www.nature.com/articles/ijo200825 (International Journal of Obesity) Sex-specific body fat distribution predicts cardiovascular ageing https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf553/8237967?login=false (European Heart Journal) Association between metabolic healthy obe ...

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  You've heard of osempic face, but have you heard of osempic liver and showing an improvement in the liver function test or the osempic pancreas, less insulin resistance, right? Because there's more good than bad with these medications. And whenever a drug is FDA approved or whenever I prescribe a drug is because I know the benefits outweigh the risks. If it's in the right hands, we're going to have very minimal side effects. Okay. If it's in the wrong hands, somebody who doesn't know how this drug works, they don't know how to guide the patient, right? Then that's where we see this crazy side effects that we're hearing in the headlines.

• 0:44Dr. Mary Claire Haver?

  The views and opinions expressed on Unpause are those of the talent and guests alone. They are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. Menopause weight gain is so incredibly common. Eighty percent of my patients come in with unexplained body composition changes as they're going through perimenopause and menopause. It can be so difficult to lose that weight and keep it off with diet and exercise alone. Quite frankly, when I first heard the hype around GLP-1s, I was skeptical. Everything I saw on social media described it as the easy way out and that it was cheating.

• 1:28Dr. Mary Claire Haver?

  I hadn't realized that GLP-1 medications had been used safely in diabetes care for more than 20 years before they suddenly became part of the public conversation around weight and metabolic health. Then I came across our guest, Dr. Rocio Saliswaelen on social media, and she explained these medications in such a compassionate, clear, and evidence-based way that I learned more in three minutes than I had in months of reading headlines. I was so struck by her ability to translate complex science and real patient stories, I shared her video with my own audience and the response went viral. I reached out to her, curious to learn more, and that message started a friendship.

• 2:10Dr. Mary Claire Haver?

  That has changed my life. Since then, she's continued to educate me, challenge me and inspire me. And I'm so excited to share her voice with you today. She filled the gaps in my knowledge. She taught me how to prescribe these drugs, the science behind them and why they work. She also gave me the confidence to start suggesting them in my clinic. The difference this treatment makes is night and day for my patients. And that's why I'm here now, talking with my colleague and friend, Dr. Rocio Salas Whalen, because she's not only changed my perspective, but the lives and the health of my patients. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner.

• 2:55Dr. Mary Claire Haver?

  I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to UnPaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. Joining me today is my friend, Dr. Rocio Salas Whalen, a triple board certified internist, endocrinologist, and obesity medicine specialist. She's also the founder of New York Endocrinology, who's leading the conversation on GLP-1 medications and how they can transform women's health. She's not only an expert in obesity medicine, but also a powerful advocate for women in midlife, challenging the stigma around weight, hormones, and menopause.

• 3:38Dr. Mary Claire Haver?

  Her upcoming book, Weightless: A Doctor's Guide to GLP-1 Medications, Sustainable Weight Loss, and the Health You Deserve, is going to change the way we think about GLP-1s and sustainable health. Today, she's here to help us cut through the hype and share what women really need to know. For those of you who've managed to tune out all of the talk about GLP-1s, let me give you a quick 101. Depending on who you talk to, GLP-1s are either a crutch or a cure. A lifesaver or a drug that wreaks havoc on your life? These injectable drugs, which we all know by the brand names Ozempic, Monjaro, are technically called glucagon-like peptide 1 receptor agonists, and were originally developed to treat type 2 diabetes.

• 4:23Dr. Mary Claire Haver?

  Here's how they work. They mimic a gut hormone that tells your brain you're full, slows the emptying of the stomach, and improves how your body handles insulin and blood sugar. In just a few years, they've gone from niche prescriptions to cultural touchstones as breakthrough tools for addressing obesity. There is no doubt they are effective. But this has fueled both excitement and scrutiny, with some saying they're life-changing interventions that finally validate obesity as a treatable, biologically-driven disease.

• 4:57Dr. Mary Claire Haver?

  Welcome to UnPaused.

• 4:59Speaker 00

  Thank you.

• 4:59Dr. Mary Claire Haver?

  Glad to have you here. I am so excited about this. When I sent a question out to my followers on social media, this was one of the top topics that they wanted to discuss. And I could not think of a better expert to have on the show.

• 5:14Speaker 00

  Well, thank you so much.

• 5:16Dr. Mary Claire Haver?

  You and I met after you shared a few social media posts discussing GLP-1s, and I had never seen anyone do it in such an understandable, digestible way that was also led with compassion. What I'd been seeing were a lot of the people in the wellness section or personal trainers who were really skeptical about GLP-1s, and it made me skeptical as well until I heard you talk. And I think I sent you a DM or shared one of your posts, and it went viral.

• 5:49Speaker 00

  Yeah.

• 5:50Dr. Mary Claire Haver?

  And I sent you a DM, and we started chatting. And then I was in New York for business, and you texted and said, hey, let's meet for dinner. And I think we were out for about three hours talking that night.

• 6:00Speaker 00

  Yes, we were in a Greek restaurant.

• 6:02Dr. Mary Claire Haver?

  So I feel like I know you so well, but let's catch our listeners up. You were not born in the United States.

• 6:08Speaker 00

  No, I am born and raised in Mexico. I'm from the north. I'm from a border town in Mexico. And I completed my medical training in Mexico. And then I decided to venture to New York specifically to continue with my medical training, my residency, my fellowship.

• 6:26Dr. Mary Claire Haver?

  For our listeners, you went to medical school in Mexico?

• 6:29Speaker 00

  I did medical school in Mexico. Then when you come as a foreign medical graduate, you do your USMLE, your American boards. Once you pass them and you get certified, then you can apply for training, for residency, and then fellowship.

• 6:42Dr. Mary Claire Haver?

  So how long did that take you?

• 6:44Speaker 00

  A good 14 years.

• 6:46Dr. Mary Claire Haver?

  Wow, to go through all of the training. So walk me through, I mean, were you originally like, I'm gonna get three board certifications? Like, explain to our listeners what a board certification is.

• 6:57Speaker 00

  So board certification is when you pass the exam, but you need to complete the training, right? So in medical school, I fell in love with endocrinology. I fell in love with diabetes, metabolism, weight. Diabetes is the third cause of death in Mexico, so it was a disease that I was exposed to since very little with family members. So in medical school, decided endocrinology. So when I came to my training here, I knew I had to complete internal medicine first and then apply to endocrinology. During my endocrinology fellowship, these new medications that we're gonna talk about came out. And so I decided to become even more specialized in this and became obesity board certified, too.

• 7:37Dr. Mary Claire Haver?

  So basically, you did three residencies?

• 7:39Speaker 00

  Yes.

• 7:39Dr. Mary Claire Haver?

  I've only done one to give people...

• 7:41Speaker 00

  And one is enough.

• 7:42Dr. Mary Claire Haver?

  I was really honored to be asked to write the foreword for Waitlist and so, so impressed with everything that you had to say and how you laid it out. But this is such an explosive topic, and today, we're here to make sure that we get it right, that our, you know, listeners and everybody watching the podcast truly understands pros and cons, the good and the bad, and what realistically what a GLP-1 can do for patients. Tell me... Why you picked the title Weightless? And I think you got pushback from the publisher a little bit, maybe?

• 8:16Speaker 00

  So the publisher wanted the GLP-1 word on my, on my title. But I felt, and I know, and the vision of my book was beyond the GLP-1. Right? Yeah, GLP-1, it's a, it's a big part of it. It's, it's the end, is the treatment. But my book is more about understanding why we're using a GLP-1, right? Understanding obesity, understanding, removing the, the bias, removing, removing the, the headlines, the negative headlines. In fact, I start my book with an apology, right? Because I feel like we owe an apology to patients with obesity. Because we were underestimating, we were doubting them.

• 9:01Speaker 00

  And they were actually following our recommendations. It was just not working because that was not the solution. And what I see in my patients as they're losing weight is they're losing not just the physical weight, but they're losing emotional weight. They're losing years of guilt, years of trauma.

• 9:23Dr. Mary Claire Haver?

  Yeah.

• 9:23Speaker 00

  Right? Of shame.

• 9:24Dr. Mary Claire Haver?

  Yeah.

• 9:25Speaker 00

  So they become lighter, not just physically, but mentally.

• 9:30Dr. Mary Claire Haver?

  Mentally.

• 9:30Speaker 00

  Emotionally. So that's why I chose the, the word or the title Weightless. Because this, this is what I see my patients to become. And it's not just the physical weight. Is they're releasing, letting go of everything that was weighing them down.

• 9:46Dr. Mary Claire Haver?

  In your book, you write about a story. And you're talking about a patient, a man, that you saw. And you said, "I explained to him what we now understand about obesity. That it's not just about what you eat or how much you move. It's about hormones, genetics, the brain, the gut, and many factors outside of willpower." And then something unexpected happened. There was a visible shift. I watched the tension in his shoulders ease. As this emotional burden was lifted, he started to cry.

• 10:22Dr. Mary Claire Haver?

  For the first time, he heard that he hadn't failed. He felt the validation that what he was up against wasn't a personal flaw, but a medical condition. And I hadn't even told him the best part yet. There was something we could do about it. Why did you write Weightless?

• 10:41Speaker 00

  It makes me emotional because I remember exactly that moment with the patient. And it was not an isolated event. It was not an isolated visit. I saw this with many patients and that's why the idea of Weightless came. For many patients, which this patient was in his mid 50s, has struggled with weight since childhood. He spent most of his life feeling guilty, right? He had never heard that it was not his fault. And me being an endocrinologist, exposed to metabolism, obesity, for me was an eye opening when I started seeing patients with obesity. After one after the other were telling me that they were actually doing what we were recommending them.

• 11:26Dr. Mary Claire Haver?

  Right.

• 11:26Speaker 00

  I would ask the questions and they knew the answers. And they told me about diets that I've never heard. I'm learning about diets from my patients. Some can have personal trainers, chefs. They've been to camps. They have life coaches, nutrition coaches. You can name it and they've done it. And it's not, they were not losing weight. And I learned this by listening to my patients. And I think as a doctor, we always have to take the time to listen. But especially when you're talking about obesity, about somebody's weight. It's such a vulnerable conversation.

• 12:01Dr. Mary Claire Haver?

  Yeah.

• 12:01Speaker 00

  That they've been let down by family members, by doctors. They don't trust, right? And rightfully so, they have given up. So for many patients, their visit to me is like their last stop. Right? I'm like their last opportunity for that to happen. And as I was learning this, I said to myself, people have to know this. Doctors have to know this, the general population have. If we doctors don't understand that people were actually listening to us, let less people that are not in the medical field, right? That we assume because even we as doctors, we would think they're lying to us.

• 12:39Dr. Mary Claire Haver?

  Yeah.

• 12:39Speaker 00

  Oh, you're telling me you're eating healthy? Oh, I'm sure if I go to your house, I will find out that is not. Or you're exercising? I don't think you're exercising the right. We were questioning what they were doing.

• 12:49Dr. Mary Claire Haver?

  I a hundred percent agree. The only thing I understood about obesity in four years of medical school, and the little bit we touched on it in OB-GYN, not much, mostly around pregnancy, was this was a willpower issue. This was simply a caloric imbalance, that nothing else, not hormones, not environment, not anything had anything to do with it other than it was a failure of the patient to not restrict calories enough or not move their body enough to burn the calories that they were consuming. Since really the revolution around the talk around GLP-1s, I've come to understand a lot more in our in-depth conversations and of course with medical articles now coming out and reading.

• 13:32Dr. Mary Claire Haver?

  In Waitlist, you talk about obesity not being a matter of willpower, but of hormone, genetics, brain and gut. How do GLP-1s fit into that broader definition now of treating obesity as a medical condition?

• 13:45Speaker 00

  Well, once we can classify obesity as a disease, then we can think of treatment, right? Beyond lifestyle changes. GLP-1 medications is what we have actually at the moment for treatment of the disease of obesity. So it should be our first, but it should not be our last resource, right? We should not exhaust all the other possibilities before a patient can earn a GLP-1.

• 14:17Dr. Mary Claire Haver?

  So walk me through this as if I'm a patient. I'm coming in, we do a body composition scan and I have excessive visceral fat. You're telling me the first thing in the treatment plan is going to be a GLP-1?

• 14:30Speaker 00

  Yes, and I'm going to tell you why.

• 14:32Dr. Mary Claire Haver?

  Why?

• 14:32Speaker 00

  Because this patient that is coming to me, that whatever age they are, I'm not going to be the first doctor that has told them eat less and exercise more.

• 14:43Dr. Mary Claire Haver?

  Mm-hmm.

• 14:43Speaker 00

  They've heard it way before I came into the picture in their lives. They've heard it and they not only have heard it, they've done it, right? So. We cannot assume that somebody with obesity doesn't know they have obesity, we cannot assume that they haven't done more than you can imagine to in order to lose weight. And if we think of somebody who has struggled with this, and let me tell you, this takes over their life. For somebody who's trying to lose weight and not necessarily obesity, but even somebody who's trying to maintain their weight, right, who may have tendency to gain weight, it takes over their life. It becomes a full time job. And what

• 15:24Speaker 00

  I was seeing it was in my patients in their 60s and their 70s, still concerned, every meal, every plate in front of them, how is this going to impact my weight? How am I going to feel after this? Am I going to feel guilty? That I ruined my weight? That I have to work harder? Even after five decades of struggling, right? So when you have a teenage patient, and you can have the opportunity to bypass that on them, imagine how much freeing it is mentally for that person. You're avoiding decades of struggle.

• 16:02Dr. Mary Claire Haver?

  I am seeing that in our clinic with our patients who we start on GLP-1. Suddenly, they are clearing up headspace that they never had before, just taking what we're now calling food noise and out of the equation. And it's just giving them back such a huge chunk of time in their lives. And they're becoming more creative and picking up new hobbies because they're not always sitting there ruminating over how much is on this plate? When am I going to eat my next meal? How many calories is in that? How am I going to do this? When women come to you, and of course, my patients are all female, so I'm, you know, I'm a little biased, and say that they're doing everything that they used to do, that used to work, but they're still gaining weight. How do you explain what is

• 16:47Dr. Mary Claire Haver?

  happening to them?

• 16:48Speaker 00

  It's a very frustrating thing for a woman in midlife to go through. Because many of them, they're exercising more, they're even eating more healthy, they're being more conscious, and the weight either is not coming down as it used to, or they keep gaining weight. In a situation like that, we have to explain to the woman, the female patient, that her current environment physiologically, hormonally, socially, is not allowing her, and will not allow her to reach to the weight goal that she needs

• 17:29Speaker 00

  to be, to be in a healthy weight, right? Because our hormones, and you're an expert on hormones in this period of a woman's life, which I've learned a lot from you too, the hormones are putting them against their own success, or moving forward in their weight, right? We know that the drop of estrogen can impact the body composition of a woman in midlife. We have more tendency of storing fat in areas where in our fertile years, our reproductive years, we did. So more, if in our reproductive years, it's more hip, breast. Due to the changes of estrogen, we start storing it centrally, intra-abdominally,

• 18:11Speaker 00

  right? It's not just subcutaneous, but it goes surrounding our internal organs. And we know that that's visceral fat, and that's what we call the bad fat, right? That's the pro-inflammatory fat that leads to hyperinsulinemia, insulin-resistant metabolic syndrome. That's why women in menopause have more risk of developing type 2 diabetes than in pre-menopause, right? Because of these changes in body composition. And not only that, but we have more easy to lose muscle, or harder to put muscle mass. So we have those two things that we're fighting against. So whatever you were doing before that it was working, now it's not because of that.

• 18:49Dr. Mary Claire Haver?

  So you're saying to our listeners that the estrogen declining in perimenopause and menopause is directly driving fat deposition to new areas?

• 19:01Speaker 00

  The storage of visceral fat, which we had in subcutaneous areas, right?

• 19:06Dr. Mary Claire Haver?

  Okay, so subcutaneous meaning under the skin?

• 19:08Speaker 00

  Under the skin, where we can pinch, right?

• 19:15Dr. Mary Claire Haver?

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• 20:24Dr. Mary Claire Haver?

  I just read a study that came out probably last week that talked about heart disease risk and where fat is deposited in males and females. In males, all fat deposition was harmful and led to increasing risk of cardiovascular disease. But in premenopausal females, fat deposited around the hips and thighs was actually protective of the heart. Postmenopausal, we lose that protection and we start shunting fat deposits to the abdomen. You actually tend to lose a little bit of subcutaneous fat of the fat under the skin over time. And that was the biggest driver of the risk of cardiovascular disease. It's so fascinating to me.

• 21:06Speaker 00

  And this is something that I see clinically. The woman in midlife that is saying, this is not my body. I never used to put weight in my center. Now it's everything's going to my middle.

• 21:16Dr. Mary Claire Haver?

  My patients.

• 21:17Speaker 00

  All the time.

• 21:17Dr. Mary Claire Haver?

  During a well woman exam, used to sit and grab their bellies in their little paper gowns and shake them at me and say, Dr. Haver, you know, where did this come from?

• 21:27Speaker 00

  It's foreign for them.

• 21:28Dr. Mary Claire Haver?

  You know, I was always taught calories in, calories out, and I would give them the same tired advice and just think this has to work. But I knew these women. These were my friends. I ran marathons with them. We hung out. Our kids went to school together. Like, I knew their lifestyles and their patterns. And I knew that all of a sudden, they weren't like eating bonbons every night and had stopped exercising. And it really was, that was the inflection point for me as a clinician to be like, wait a minute. Maybe there's something else going on outside of just lack of willpower, you know, leading to this. And then when I just focused on menopause care and was tracking the numbers, eighty to eighty-five percent of my patients are coming in

• 22:11Dr. Mary Claire Haver?

  with these body composition changes. So, so let's take it back to the basics for a second. What is body composition?

• 22:18Speaker 00

  Whenever we see a number on the scale, we're looking at some of the weight of water, muscle, bone, organs. Not everything makes you sick in your weight, right? It's specifically body fat or visceral fat, as we were just mentioning this. And also, another important metabolic marker is muscle mass, right? So whenever we're looking at somebody's weight and we want to recommend weight loss, we need to see visceral fat. We need to see percentage body fat and we need to see muscle mass. If somebody gets on a scale and gives us a total number, we cannot make the right recommendations, right?

• 22:54Dr. Mary Claire Haver?

  So when I was training, again, that's twenty-five years ago, we defined health risks by weight and BMI, but that's changed recently. Can you talk about that?

• 23:03Speaker 00

  Definitely. I mean, BMI is a very outdated tool.

• 23:06Dr. Mary Claire Haver?

  And what is BMI?

• 23:07Speaker 00

  Is your body mass index, but it's a simple calculation between your height and your total body weight.

• 23:13Dr. Mary Claire Haver?

  I still use the term obesity.

• 23:15Speaker 00

  Yeah. And for many people, it's easy to understand in that language, right? But it's a simple calculation that was designed for the white European male in the eighteen hundreds. But if we cannot use it as a parameter of health, I think we can use it in a very broad population, right? But it cannot be specifically for somebody when they're a single person, when they're trying to improve their health. We should look at other parameters. GLP-1 medications are sophisticated drugs. So for sophisticated drugs, we should have sophisticated ways of diagnosing somebody with obesity, right? We know better now.

• 23:58Speaker 00

  This is not 20 years ago when we didn't know what we were looking at. Now we know. We know what matters in somebody's health, for longevity, for quality of life, for independence, movement, to decrease your risk of mortality, right? To decrease the risk of more than 50 cancers related with obesity, increase fertility.

• 24:19Dr. Mary Claire Haver?

  So how do you measure body composition?

• 24:22Speaker 00

  So there's several ways. The gold standard for body composition is an MRI, right? But MRI, well, it's expensive.

• 24:29Dr. Mary Claire Haver?

  Expensive.

• 24:30Speaker 00

  Expensive. You need to be in a radiology center to have all the logistics to have an MRI machine. The second best is a DEXA scan, but also expensive machine to have some doctor in their office. The third best is an impedance machine, which uses electric current to separate fat, muscle, and water. And that's what we use, what I have in my office.

• 24:54Dr. Mary Claire Haver?

  I have the same. So do you think these drugs are a game changer for midlife weight gain?

• 24:59Speaker 00

  They're a game changer for overall health. We will live longer because of the development of these medications.

• 25:07Dr. Mary Claire Haver?

  Okay.

• 25:07Speaker 00

  But which I have to say that GLP-1 was discovered by a woman, which I think is important to mention.

• 25:14Dr. Mary Claire Haver?

  No, I think it's very important to mention.

• 25:15Speaker 00

  We don't hear their names, right?

• 25:16Dr. Mary Claire Haver?

  Right.

• 25:17Speaker 00

  It's Dr. Svetlana Mokchev. And she was in Harbor in Rockefeller Center here also in New York. And she's the one that discovered GLP-1 in the human body.

• 25:26Dr. Mary Claire Haver?

  So how should we think about GLP-1s in perimenopause and menopause?

• 25:31Speaker 00

  I think it's a great option, right? That we have. I think it's a great time to be a woman in midlife right now because of the availability of hormone therapy and GLP-1 medication, meaning no more accepting the less than 100% feeling.

• 25:52Speaker 00

  Good, or having a good quality of health.

• 25:55Dr. Mary Claire Haver?

  Right.

• 25:55Speaker 00

  There's no excuses, right? We can talk about cost accessibility, but they are available, right?

• 26:02Dr. Mary Claire Haver?

  What about in adolescents or younger patients? Do we have enough data?

• 26:05Speaker 00

  Yes, so they're actually approved. So liraglutide, which is Victos, that's a medication, a GLP-1, that is a daily injection approved for type 2 diabetes, is approved for 10 years and older with type 2 diabetes. Saxenda, which is liraglutide for weight loss, branded for weight loss, is approved for 12 years and above. Wegovy, which is semaglutide, also approved for 12 years and above.

• 26:31Dr. Mary Claire Haver?

  So rapid weight loss, if we know if someone undergoes a gastric bypass or, you know, severe caloric restriction, the studies done on those patients show a lot of muscle loss, and this has become really a hot topic on social media. How do you counsel your patients to protect their lean mass or their muscle mass while they're being treated with a GLP-1?

• 26:53Speaker 00

  And this is something that even me, at the beginning, when I started prescribing these medications, I wasn't aware of this. So it makes me think, all those patients that lost after bariatric surgery, or that we were recommending eat less, restrict yourself, and then coming and losing 10 pounds, and we were so proud, and reassuring to the patient, great, you lost the weight. It was probably a lot of muscle, right? So we were doing more harm than better, but we-

• 27:22Dr. Mary Claire Haver?

  Why? Why is losing muscle harmful?

• 27:25Speaker 00

  Muscle is our most important metabolic organ. It's actually an endocrine organ. It produces hormones called myokines. So muscle is anti-inflammatory. Muscle prevents insulin resistance, hyperinsulinemia, right? Metabolic syndrome. Muscle, when it contracts, it subtracts glucose or takes glucose from the blood and converts it to energy. Muscle burns fat for energy. So the more muscle you have, the more, it's like you're burning calorie machine, you're burning fat machine, right? The more muscle you have, the higher your metabolism is. The less muscle you have, the lower your metabolism is, right?

• 28:07Speaker 00

  So muscle is a vital organ, that we cannot talk about weight loss without talking about muscle.

• 28:15Dr. Mary Claire Haver?

  So in our clinic, we have an hour counseling visit before, you know, for a new start GLP-1. That's, we've already started them on hormone therapy. If they're a good candidate, they're coming back for this discussion and we take a whole hour to talk about ways to protect their lean mass while they're losing weight. How, what exact things do you counsel your patients about?

• 28:35Speaker 00

  Definitely. So

• 28:36Dr. Mary Claire Haver?

  Is there a medication they can take to preserve muscle?

• 28:38Speaker 00

  Not yet. Not yet. We have to go back to the gym rec. So it's vital and also I spend one hour with my patients in their initial visit because it's vital to explain to them that one part, one third of their treatment will be strength training and another third part of their treatment will be protein in their diet. And the other third will be a GLP-1.

• 29:03Dr. Mary Claire Haver?

  So that's your GPS?

• 29:04Speaker 00

  That's my GPS.

• 29:05Dr. Mary Claire Haver?

  So let the audience hear that again, because I think it's so important.

• 29:08Speaker 00

  Yeah. So if I could write it in a prescription, I would. It's the GPS. I, I call it like that.

• 29:14Dr. Mary Claire Haver?

  Wait a minute. Do you think we should be able to write that as a prescription?

• 29:17Speaker 00

  Yes, we should. It is. It is health.

• 29:19Dr. Mary Claire Haver?

  Do you think that insurance should cover personal trainers?

• 29:22Speaker 00

  100%.

• 29:23Dr. Mary Claire Haver?

  All right, keep going.

• 29:24Speaker 00

  I like to call it the GPS, like navigation system, because going on a GLP-1, going into a weight loss journey, it's a journey, right? So it's a roadmap. So the GPS consists of GLP-1.

• 29:36Dr. Mary Claire Haver?

  Okay.

• 29:37Speaker 00

  The P is for protein in your diet.

• 29:39Dr. Mary Claire Haver?

  Protein. So GLP-1 protein.

• 29:41Speaker 00

  And the S is strength training.

• 29:42Dr. Mary Claire Haver?

  Strength training.

• 29:43Speaker 00

  Right. So that has to go, I tell my patients, the other two is as important as the GLP-1.

• 29:49Dr. Mary Claire Haver?

  Okay.

• 29:50Speaker 00

  It's, it's reeducating the patient. We as physicians, as healthcare, we are reeducating ourselves, but also we have to re-educate our patients of the concept of weight loss. Right?

• 30:01Dr. Mary Claire Haver?

  So, does it work?

• 30:03Speaker 00

  100%. So that, that idea or that, that you headlines that you read, you're going to lose 30% of muscle. Yes, you can lose 30% of muscle and it will definitely happen if you don't do your GPS, right? So, once a person decreases their caloric intake, we're decreasing our protein consumption, right? So that's why we, there is muscle loss.

• 30:25Dr. Mary Claire Haver?

  Right.

• 30:26Speaker 00

  Rapid or significant weight loss is not free without muscle loss, right?

• 30:32Dr. Mary Claire Haver?

  What's an acceptable amount then? We, so what you're saying is, let me make sure I get this right. You, with any weight loss, you are going to lose muscle? Right?

• 30:41Speaker 00

  Yes.

• 30:41Dr. Mary Claire Haver?

  How much is too much? And what is your goal?

• 30:43Speaker 00

  So I recommend of what I've seen, because I perform body compositions on every single patient, on every single visit. So I know what the change is and what the changes that we're making in the patient's diet and the strength training, what changes we're seeing in the body composition. Let's say a patient comes to me after eight weeks. They lost 10 pounds. If they lose one pound of muscle, meaning 10% or less, it doesn't impact their fat loss, right? Their percentage body fat loss and their visceral fat. If they're losing more than that, I have patients that maybe they lost three pounds out of the 10 pounds, or that's 30%, right? So that impacts or slows down the body fat loss.

• 31:25Dr. Mary Claire Haver?

  And why is that? Why would that be?

• 31:27Speaker 00

  Because you're losing your burning fat

• 31:29Dr. Mary Claire Haver?

  Basal metabolic rate.

• 31:30Speaker 00

  Machine, right? Your basal metabolic rate is becoming even slower. So whenever they say, oh, when you lose a lot of weight, your metabolism becomes slower. Well, it's because of all the muscle loss

• 31:40Dr. Mary Claire Haver?

  Right.

• 31:40Speaker 00

  that happened with it.

• 31:41Dr. Mary Claire Haver?

  So what I think most of our listeners don't understand is, what is the basal metabolic rate?

• 31:47Speaker 00

  It's how many calories you burn at rest.

• 31:49Dr. Mary Claire Haver?

  Okay.

• 31:49Speaker 00

  Right? Just by doing

• 31:50Dr. Mary Claire Haver?

  And what is the one organ that determines that amount?

• 31:52Speaker 00

  Muscle mass.

• 31:53Dr. Mary Claire Haver?

  Right.

• 31:54Speaker 00

  Muscle mass.

• 31:55Dr. Mary Claire Haver?

  So if I take all the muscle out of your leg,

• 31:57Speaker 00

  Yeah.

• 31:58Dr. Mary Claire Haver?

  you know, 25% of your muscle mass, then you are not going to burn as many calories at rest. We know from studies that patients who stop GLP-1s about will regain about 70% of the weight. So there's a big debate about that.

• 32:14Speaker 00

  Well.

• 32:15Dr. Mary Claire Haver?

  And I have patients frightened, am I going to be on this for the rest of my life?

• 32:19Speaker 00

  So we have to take a step back on this because the problem that we as a society, general society, and even healthcare, we need to stop viewing

• 32:32Speaker 00

  Weight loss as something aesthetic, as something external. So if somebody is going into this medications, thinking of something external, it does seem completely crazy to be on a drug long term for it, right?

• 32:49Dr. Mary Claire Haver?

  Right.

• 32:49Speaker 00

  You got there, you got to your size, you got where you look good, then why continue with this medication? The problem is how we are viewing weight loss.

• 32:58Dr. Mary Claire Haver?

  How should we be viewing?

• 33:00Speaker 00

  It's a medical problem. Obesity is a chronic disease, that weight loss is a treatment. GLP-1s are a treatment for a chronic condition. And why do we understand by chronic conditions? That they're not curable, right? They're chronic, they will require long term treatment. Let's say somebody goes on blood pressure medication. They improve their blood pressure. Why do we say, oh, stop your blood pressure medication because now it's normal?

• 33:26Dr. Mary Claire Haver?

  Now, there are people who can stop their blood pressure medication.

• 33:28Speaker 00

  It will depend on the individual personal story that took them to the place of needing a medication, right? So if I have a 60-year-old patient that started struggling with their weight at eight years old, nine years old, that it's been a lifelong struggle, then most likely they will require the medication long term, right? And I always like to flip it and say, it is not a bad thing. Because for the first time in history, we have something that is going to help not just with the weight loss, but maintaining the weight loss, right? Because any diet, any restriction, yeah, you will lose it. But to stay there is what becomes impossible.

• 34:11Speaker 00

  But now using a drug with the correct supervision, it can be used long term. It is safe to be used long term and it's designed to be used long term. I can give you the example, my example. I never struggled with weight. I got pregnant in my late 30s, had my first kids in my early 40s. I hit perimenopause, I gained 30 pounds, my A1C went up, right? I had two toddlers. I used semaglutide for six months and I was able to stay off of it. That I strength training all my life and I didn't struggle with weight, right? So in those situations, there's a possibility, right? I always tell my patients, your biggest bet on not depending on this drug long term

• 34:56Speaker 00

  is what happens to your muscle mass in the process.

• 34:58Dr. Mary Claire Haver?

  What about patients who come in wanting to use them for short term reasons? Say for an event, for a wedding, they're using them for cosmetic reasons?

• 35:06Speaker 00

  Well, again, they they should not be used in that scenario, right? But I've learned to not to assume anything, right? And I don't know if this person is restrictive to maintain a weight and cannot get to a lower weight.

• 35:24Dr. Mary Claire Haver?

  So let walk me through that. I've heard you talk about this before and I think it's so important for our listeners. Someone comes in with a relatively healthy weight and they are asking about this medication. It's not an automatic no.

• 35:37Speaker 00

  It is not an automatic no, it's not an automatic yes.

• 35:40Dr. Mary Claire Haver?

  Because the internet will argue with you here.

• 35:42Speaker 00

  Even me, that I've treated thousands of patients, when I see somebody externally, when they walk in my in my office, I cannot say what's their visceral fat? What's their percentage body fat? What's their muscle mass? They may look slim, but maybe it's because they have very low amount of muscle and high percentage body fat and high visceral fat, right? Is what we call skinny fat or sarcopenic obesity.

• 36:07Dr. Mary Claire Haver?

  So but they come in, you do the body scan and everything kind of looks okay.

• 36:11Speaker 00

  Yeah.

• 36:12Dr. Mary Claire Haver?

  You're still saying no.

• 36:13Speaker 00

  No, and then I go walk me through your day to day, right? Like what is it that you eat? What is it that you exercise? And for many patients, it's a restrictive lifestyle to maintain that weight.

• 36:25Dr. Mary Claire Haver?

  What does restrictive lifestyle mean?

• 36:27Speaker 00

  Something that is not sustainable, right? Something that is removing you from your daily life, right? So somebody who is counting calories, who is weighing their food, somebody who is exercising seven days a week, right? That they cannot enjoy the process that is a full time job.

• 36:47Dr. Mary Claire Haver?

  To maintain that weight. And what do you see with those patients?

• 36:50Speaker 00

  That they may benefit from the medication, right? It's a they can relieve them from that. And it's not just here's the drug, you don't have to wait. But then it becomes a re-education. Then you talk about the about muscle, building muscle, strength training. See, these patients may be cardio queens, right? They're they're doing spinning every day. They're running, they're doing all the cardio. Then you re-educate them on how to exercise. But once you remove that foot noise, that weight noise, then they can concentrate on exercising for health. So when you remove the pressure of weight loss to somebody.

• 37:34Dr. Mary Claire Haver?

  Or maintaining your weight.

• 37:35Speaker 00

  Or maintaining your weight. It it becomes enjoyable for many patients, right? It becomes more adaptable and easy to maintain long term. Because that's not the solution, right? That is not the solution for the weight loss.

• 37:48Dr. Mary Claire Haver?

  Okay.

• 37:48Speaker 00

  So to answer your question, it depends on the story. It depends how it's it's consuming their life. It depends on their body composition.

• 37:57Dr. Mary Claire Haver?

  So it is not FDA approved for outside of obesity, right? We've it's approved for weight loss and obesity. But in this situation, we don't have an FDA approval for this. But in your clinical experience, you feel.

• 38:12Speaker 00

  Yeah, so patients, when we're talking about the indications, currently it's indicated for a BMI greater than 27. So that even on overweight patients, right? But see, we're treating numbers.

• 38:25Dr. Mary Claire Haver?

  Right.

• 38:26Speaker 00

  Right, we're treating numbers. We're not treating the patient. And we have to meet patients where they are. And I heard you said this before. We have to see where they are in their life, in their age. We ask too much from patients sometimes without getting their their results. It's it's not, I don't think it's fair for us to gatekeep a medication that can be beneficial, not just physically, but mentally also on a patient. Now, I do say no to some patients. So if a patient comes to me and they tell me I want to lose weight, but their muscle mass is great, their percentage of body fat is great, then I say no. You don't need the medication.

• 39:06Dr. Mary Claire Haver?

  What you're doing.

• 39:07Speaker 00

  Reassuring, continue doing what you're doing. Because if somebody comes to me and their percentage body fat is low and their muscle mass is high, I already know that their lifestyle is healthy.

• 39:18Dr. Mary Claire Haver?

  Yeah.

• 39:18Speaker 00

  I already know what the nutrition is, right? I already know that they're working out. I can see their blood work is going to be good, right? Their blood pressure is good, so the parameters go with the body composition.

• 39:29Dr. Mary Claire Haver?

  That's my favorite visit is someone who's felt she was overweight or even obese her whole life and she's never had a body scan. And we get her on the scanner and I'm, look at this gorgeous muscle that you have. You have such little body fat. You have no visceral fat. You just have a few curves that your genetics and God gave you. You are, her labs look great. Her blood pressure is perfect.

• 39:50Speaker 00

  Yep.

• 39:51Dr. Mary Claire Haver?

  And she is so reassured because she has felt because of this BMI ridiculousness that she has had a weight problem her whole life.

• 40:01Speaker 00

  Yeah. And it's also teaching patients, and this is going to take time, few generations, is to understand that their weight doesn't equal their health.

• 40:08Dr. Mary Claire Haver?

  Mm hmm.

• 40:08Speaker 00

  The number in the scale is not telling us all the picture in there, right? It's your body composition.

• 40:16Dr. Mary Claire Haver?

  They're still hearing this from their clinicians and their doctors, that your weight is too high, your BMI is too high, even though the guidelines have changed.

• 40:26Speaker 00

  Yeah.

• 40:26Dr. Mary Claire Haver?

  How long do you think it's going to take before everyone gets on board?

• 40:29Speaker 00

  I think it's going to take probably the new incoming generation of medical school students, right? So probably in the next five years, 10 years, I think it's going to be more broadly accepted.

• 40:48Dr. Mary Claire Haver?

  I hear a lot on the internet about microdosing. What is that and do you recommend it?

• 40:54Speaker 00

  So microdosing is when you use a micro amount, a smaller amount than the therapeutic doses. Microdosing is when somebody wants to use a smaller dose than the, than the therapeutic dose to get benefits outside of weight loss, right? Because we know that to reach weight loss, you need the therapeutic. Doses.

• 41:15Dr. Mary Claire Haver?

  Dose.

• 41:16Speaker 00

  Now, the concept of microdosing is by people, and this is what I've seen the most, is that for the anti-inflammatory properties, or am I missing out? Am I missing on the all healthy benefits of GLP-1 that people that are losing weight are getting?

• 41:30Dr. Mary Claire Haver?

  I see it all over the internet. Every wellness influencer talks about microdosing and.

• 41:35Speaker 00

  But, so there's two things in those scenarios. One, it could be somebody who has a perfect body composition, right? Who low percentage body fat, high muscle mass, low visceral fat. That I reassure them, you already are getting all the positive benefits that somebody is going to get from a GLP-1, right? You have muscle mass, you are burning calories with your muscle, you're strong, you have a low percentage body fat, you don't have visceral fat, so you have a very low risk of disease. There's nothing extra that you're gonna get from a GLP-1. Now, that's one side of it. The other side is somebody who thinks, who doesn't need to lose weight, right?

• 42:20Speaker 00

  I don't need to lose weight and I just want to use the medication. But surprise, surprise, when we put them on the machine of truth, I like to call that the body composition, then you realize they're under muscle, they have high visceral fat, they have high percentage body fat, so you don't need the microdose, you need the

• 42:35Dr. Mary Claire Haver?

  The regular dose.

• 42:37Speaker 00

  Those. So what is that causes inflammation in our body? Visceral fat is pro-inflammatory.

• 42:42Dr. Mary Claire Haver?

  Right.

• 42:42Speaker 00

  Right? And visceral fat is increases insulin resistance, hyperinsulinemia, which also in itself is pro-inflammatory. And then many patients with obesity may have low muscle mass. So it's a triple whammy in inflammation, right? So when somebody goes on a GLP-1 and they start losing visceral fat, their inflammatory markers go down, and if they start building muscle, then their inflammatory markers go even lower, right? That's why we see improvement in autoimmune diseases, right? Because now the immune system can do its job, can protect the body, less infections, less getting sick because of that effect. But what is it in the medication? One, that you're going to decrease eating, right? Your calorie intake is is lower.

• 43:27Dr. Mary Claire Haver?

  And how would that lower inflammation?

• 43:29Speaker 00

  Because you're dropping visceral fat. Second, it's because the effect of this medication, that it decreases, suppresses your hunger hormones and increases your satiety hormones. Satiety is when you're full. So these drugs increase your fullness hormones. So you feel fuller with half of what you normally would eat. And then it suppresses your hunger hormones in between meals.

• 43:51Dr. Mary Claire Haver?

  Okay.

• 43:51Speaker 00

  So patients eat half of what they would normally eat without feeling hungry or craving in between meals. So by cutting us already immediately to one third, to two thirds or half of what you normally would consume, you're also decreases pro-inflammatory food. This medication also suppresses their reward or blocks their reward from food. So what is the reward of food for many patients? Either starches, sweets, salt.

• 44:19Dr. Mary Claire Haver?

  Those are high reward foods?

• 44:21Speaker 00

  They can be high reward foods, right? And that's pro-inflammatory food.

• 44:26Dr. Mary Claire Haver?

  Do you feel that part of the obesity epidemic? And do you feel it's an epidemic?

• 44:32Speaker 00

  Yes.

• 44:33Dr. Mary Claire Haver?

  Yeah, we know it is. Okay. Is due to the food industry?

• 44:37Speaker 00

  In big part, yes. The way that our food is made in this country is not the best for our health, right? We we concentrate on quantity and not quality when it comes to food. I do feel like the food industry at one point, hopefully in the not too far away future, will be held accountable for the obesity epidemic that we have, right? Food accessibility, the good, healthy food tends to be more expensive than the none, right? And you cannot argue with a family of six that they're making it month by month on their paycheck

• 45:18Dr. Mary Claire Haver?

  Right.

• 45:19Speaker 00

  to buy grass-fed meat or organic fruit, right?

• 45:23Dr. Mary Claire Haver?

  Right.

• 45:24Speaker 00

  So food accessibility has to also change, but also our environment, right? Where we live. We live in cities where walking is not promoted, is not encouraged anymore.

• 45:36Dr. Mary Claire Haver?

  You know, we take a car everywhere.

• 45:38Speaker 00

  So also now we can work from our living room. We live in an environment that exposes or makes us be sedentary.

• 45:46Dr. Mary Claire Haver?

  I've heard it called an obesogenic.

• 45:48Speaker 00

  Environment.

• 45:49Dr. Mary Claire Haver?

  Environment.

• 45:50Speaker 00

  Also, we can talk about endocrine disrupting chemicals in the obesogenic environment, right? Plastics, BPA, the forever chemicals. What's in our water, what's in our, the paint in our walls, right? So that also can promote obesity. Now, and, and when we talk about obesity, we can go even generations before us. And this is where we talk about removing the guilt for someone, right? And I can give you the example of an appointment that I had with a new patient. It was a 14 year old girl that was brought by their mom, her mom and her dad. And they were bringing her for obesity. And I had both parents there and I always want to know what's the family history.

• 46:33Speaker 00

  I, I go two generations behind that your parents struggled with obesity. In this case, she was a 14 year old, her parents were there. So I was able to talk directly to both parents. The father also struggled with obesity. The mother had PCOS. The father, his mother struggled with obesity and his maternal aunts also struggled with obesity. His brother struggled with obesity. So you can see three generations to my patient with obesity. So obesity is transgenerational.

• 47:05Dr. Mary Claire Haver?

  Yeah.

• 47:05Speaker 00

  There's even data, it's so interesting. There's even research showing that transgenerational trauma is a cause of obesity also.

• 47:17Dr. Mary Claire Haver?

  So there is a study I remember reading about in residency in OB-GYN. And it was talking about imprinting, of changing our genetics. And this was specifically on women who were in Germany had, this is World War II, and they had occupied maybe Belgium or, you know, one of the European countries. And women who were pregnant during the occupation, they were severely calorically restricted because they didn't have access to food during the occupation. So they were just eating a few potatoes a day, whatever they could get their hands on. But malnutrition and starvation was huge during this occupation. They then go on to deliver their babies. Those babies were all born underweight, okay? Which is normal when you don't feed it, a fetus, it doesn't grow.

• 47:59Dr. Mary Claire Haver?

  An overwhelming majority of those children who had non-obese parents grew up to be obese. And the thought process was, we had changed their genetics while they were, you know, embryos and forming in the uterus from this severely restricted environment.

• 48:18Speaker 00

  Yeah, so transgenerational trauma can, is a cause of obesity, right? There's so many studies that children that go through trauma, even without having family history of obesity, tend to have obesity more than those that were not exposed to trauma in early childhood. Right, so there's so many factors that if you put them all together, how many does a person with obesity actually have control of?

• 48:45Dr. Mary Claire Haver?

  And being told your whole life, this is your fault and you don't have willpower, I think that that's traumatic for patients as well.

• 48:51Speaker 00

  Very traumatic, very traumatic. And, and that's the reason that also they don't trust, right? And, and they, they stop talking about it. But when I tell patients, even before you were born, you might already have the risk of having obesity. Because we know that genetics, and I'm talking about epigenetics, right? That there's multiple genes affecting that one single gene. So we know that both parents' preconcep-, weight at preconception will impact the weight of their offspring, of their kid. Even 50 to 70%. Going back to my patient, my, the, the patient, the 14-year-old says to the dad, "Oh, so see, it's your fault that I, I develop obesity."

• 49:32Speaker 00

  And it was, it was not to blame because her, his mom had obesity too, right? She didn't know, the father didn't know. But now we know, right? So this 14-year-old that we can treat now will break that cycle Break the cycle. of transgenerational obesity. And this is something that I always have when I have my reproductive age patients that they tell me, oh, I want to get pregnant in six months. And they have obesity or overweight. I explain to them, look, what your weight is and the father's weight, this is not just the mother, both parents' weight is going to impact the weight of your children and your grandchildren.

• 50:11Speaker 00

  So with this information that we have, we can break that transgenerational obesity pattern.

• 50:24Dr. Mary Claire Haver?

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• 51:06Dr. Mary Claire Haver?

  But it also supports immune health, reduces inflammation, and has been linked to better mood regulation and cognitive function. The challenge? It's hard to get enough vitamin D from food alone. Fatty fish, egg yolks, and fortified dairy help, but sunlight is our biggest source. And depending on where you live, your skin tone, and how much time you spend indoors, that might not be enough. Most women benefit from supplementing with 1,000 to 2,000 international units per day of vitamin D3, which is the form your body absorbs best. I recommend getting your levels checked with a simple blood test and adjusting your dose under your clinician's guidance. Because when your vitamin D is optimized,

• 51:48Dr. Mary Claire Haver?

  your bones, muscles, immune system, and even your mood may thank you. And remember, always to consult a clinician before introducing any new nutritional supplement.

• 52:04Dr. Mary Claire Haver?

  You say in "Weightless" that some patients who are given GLP-1s are being set up to fail by being offered these medications.

• 52:13Speaker 00

  Well, unfortunately, everybody's prescribing these medications.

• 52:16Dr. Mary Claire Haver?

  Everybody.

• 52:17Speaker 00

  I can prescribe chemo drugs. I don't because I'm going to create harm, right? But I could, but I don't. So GLP-1 medication should be seen as the same thing, right? It's a medical treatment for a chronic condition. They're not something superficial, external, to make the patient happy. I mean, I've had neurologists, ophthalmologists asking me, "How do I prescribe this?" And I'm like, "You just shouldn't." For now, I do think that every specialty gets a patient with obesity, for whatever reason, or that they're seeing the patient from a complication from obesity.

• 53:00Speaker 00

  But before we do more harm than good by prescribing these medications, we have to educate ourselves in obesity. And every doctor who's going to prescribe, or anybody who's going to prescribe this medication, should have a body composition in their office. You need to do it responsibly.

• 53:17Dr. Mary Claire Haver?

  Yeah.

• 53:18Speaker 00

  Because otherwise, we are creating more damage than health. You're making the patient, maybe, yes, they lost 40 pounds, but they lost 20 of muscle.

• 53:26Dr. Mary Claire Haver?

  Right.

• 53:27Speaker 00

  Right? And their percentage of body fat didn't drop that much. So, yeah, outside, they look like they improved, but you might have made them less healthy than they came in.

• 53:35Dr. Mary Claire Haver?

  73% of Americans over the age of 20 have obesity or are overweight. That's 180 million people. Why?

• 53:44Speaker 00

  Again, because our knowledge of what caused obesity was not completely understood, right, as we know now. And even with the information that we have now, it's going to take several generations to make the changes. So even if today the food industry is stopped and changes the way that they produce food, it's going to take two generations, right? Three generations for us to see the impact. So that's why we're where we are, because food industry, industrialization...

• 54:14Speaker 00

  Environment, right? Because of all of that is why we are in an epidemic as we are.

• 54:21Dr. Mary Claire Haver?

  Weight watchers, Noom, telemedicine companies developed originally for hormone therapy are now shifting platforms and adding these medications. And now I've even seen new telemedicine platforms being developed. And now this is a prescription. You must be a licensed practitioner in a state in order to prescribe these. So you can't go to Walmart and pick it up, you know, for yourself. So these are all licensed clinicians. But how do you feel about this kind of wave of new options available to patients?

• 54:53Speaker 00

  Well, I think weight loss has always been a very lucrative market.

• 54:59Dr. Mary Claire Haver?

  It's a big business.

• 55:00Speaker 00

  Always, even before we had GLP-1 medication, right? So everybody's gonna want a piece of the pie. My problem with that is if they're not doing the right supervision, if they're not doing the GPS, we know that they're gonna lose muscle. We know that that increases the risk for metabolic disease. So it's, again, we cannot just concentrate on the number and the scale, on making the patient happy, on seeing a number drop or a BMI. So if they're doing body recomposition, explaining the patients have a body composition, doing DEXA scans, the more the merrier, right?

• 55:34Dr. Mary Claire Haver?

  Yeah.

• 55:34Speaker 00

  Because I'm only one. People that are experienced, that have expertise are very few. And that's the reason that I wrote my book. Because this is growing so fast, it's faster than what doctors are being trained of. So with my book, I want to have more people educated in the subject, right? Even maybe faster than what doctors are being educated.

• 55:57Dr. Mary Claire Haver?

  We've all heard horror stories of side effects, especially the viral ones on social media. But let's break it down. What are the big side effects? How do you counsel your patients? And how common are they?

• 56:07Speaker 00

  We like to talk about the bad things and we never talk about the good things, right? I even made a video where it says, oh, you've heard of osseptic face, but have you heard of osseptic liver? And showing an improvement in the liver function test or the osseptic pancreas, less insulin resistance, right?

• 56:25Speaker 00

  Because there's more good than bad with these medications. And whenever a drug is FDA approved, or whenever I prescribe a drug, it's because I know the benefits outweigh the risks. Now. If it's in the right hands, we're gonna have very minimal side effects.

• 56:40Dr. Mary Claire Haver?

  Okay.

• 56:41Speaker 00

  If it's in the wrong hands, somebody who doesn't know how this drug work, they don't know how to guide the patient, right? Then that's where we see this crazy side effects that we're hearing in the headlines, right?

• 56:52Dr. Mary Claire Haver?

  So what are the side effects?

• 56:54Speaker 00

  So these medications work by slowing your gastric emptying, right? That's how you stay fuller, that your stomach. So normally when we eat, you go, it goes through the stomach, it gets digested with the enzymes and then it goes through your bowels and then it's like a 24 hour process from when it comes in, absorb the nutrients and then dispose of what's not needed. This medication is going to be a slower process, right? And that's how you stay fuller also for longer periods of time. So what I've seen that I've had patients come that they develop some abdominal obstruction or bowel obstruction.

• 57:31Dr. Mary Claire Haver?

  What is abdominal obstruction or bowel obstruction?

• 57:33Speaker 00

  So a bowel obstruction is when there's no passage of the nutrients not needed or of stool, right? And it gets impacted and you can start vomiting, having pain. So it's, it's very serious.

• 57:47Dr. Mary Claire Haver?

  So how often should these patients be seeing a clinician while they're on these medications?

• 57:52Speaker 00

  Ideally every six to eight weeks at the beginning, right? Once you understand, once the patient understands the importance of protein in their diet, once you see they're not losing muscle, once you see they're tolerating the medication without side effects, you should see them every six to eight weeks. Once they're like halfway in the treatment, you can see them every three months, right? But always available to, to answer any questions and teach your patients what things to look for. But in reality, you don't have to change the dose before every three months.

• 58:26Dr. Mary Claire Haver?

  Okay.

• 58:26Speaker 00

  So that's another thing, right? So going up every month on the medication is not the recommended management of these medications, right? Especially with our newer drugs like tirseptatide. I have patients have lost 30 pounds even on the 2.5 or the initial dose.

• 58:41Dr. Mary Claire Haver?

  So they never, some of the patients never need to increase the dose?

• 58:44Speaker 00

  Never go to higher doses.

• 58:45Dr. Mary Claire Haver?

  So we talked about the gastrointestinal side effects. I've seen, I've seen reports on the internet of, you know, thyroid cancers and. Mark Hyman was discussing like a laundry list of, you know, potential complications, pink rhinitis and all this stuff. How frequent are these or are these just case reports?

• 59:01Speaker 00

  I can tell you, I've been prescribing GLP-1s for close to 10, 12 years.

• 59:08Dr. Mary Claire Haver?

  Okay.

• 59:08Speaker 00

  And I've never had any of those complications on my patient.

• 59:11Dr. Mary Claire Haver?

  What is the most common complication?

• 59:14Speaker 00

  Nausea especially, but more with semaglutide, which is osempaginwagoli. I don't even mention it anymore with monjaro and sebam, which is tersepatide. Diarrhea, but diarrhea can happen with any of the drugs, of any of the generation of GLP-1s. Usually, and this happens with any fatty food or fried food, they don't break the fat as easy and they may have diarrhea. Dehydration, because normally our thirst is connected with hunger.

• 59:40Dr. Mary Claire Haver?

  Mm hmm.

• 59:40Speaker 00

  So they need to proactively be hydrating themselves.

• 59:44Dr. Mary Claire Haver?

  How much water? What are we looking at?

• 59:46Speaker 00

  I like to say one and a half to two liters. They should be peeing every three hours.

• 59:50Dr. Mary Claire Haver?

  A day?

• 59:51Speaker 00

  Yeah.

• 59:51Dr. Mary Claire Haver?

  What about our menopause mama who's getting up at 8:00, you know, at night?

• 59:55Speaker 00

  Well, the day, I tell them, three hours before you go to sleep, you stop drinking water. So load your water during that first half day, the two thirds of the day, and then wind down. And this is for everybody so they don't wake up.

• 1:00:11Dr. Mary Claire Haver?

  Where to find Dr. Rocio Salas Whalen? As a reminder to our audience, your book Wait List is out in December and available for preorder right now. Listeners can also find you on Instagram at DrSalasWhelan. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at DrMaryClaire and get the honest, accurate information on health, fitness, and navigating midlife at ThePauseLife.com. If you're loving this podcast, be sure to click Follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube.

• 1:00:53Dr. Mary Claire Haver?

  UnPaused is presented by Odyssey in collaboration with Podpeople. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on UnPaused are those of the talent and guests alone. They are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.