Dr. Rocio Salas-Whalen
speaker
288 appearances
3 recordings
2 series
first heard Apr 2025
last heard May 2025
Dr. Rocio Salas-Whalen’s voice in public audio — every appearance, attributed to the second.
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Appearances
I've seen people's lives change. I've seen more acceptance to the medication. The drugs are becoming safer, less side effects. I like to compare them with the iPhone. We have different versions of the iPhone, right? We have the iPhone 1, the iPhone 10, and now we have the iPhone 16. Same is happening with this class of drugs. Their versions are newer, safer, less side effects, and more effective.
Okay. So I feel like people are getting the message one or accepting the message that obesity is a disease. They feel like giving up. For many patients, I'm the last stop of the journey. And when I talk about a journey, I'm talking decades of journey. I'm talking about doing diets that I've never even heard about. I always learn about a new diet from my patients.
being with nutritionists, being in fat camps that they call them. So I've seen patients struggle through their life and how this medication are changing their lives and giving them their life back, basically.
First of all, the initial versions of this drug, they cause more side effects. And they were more cumbersome for somebody. People had to inject themselves twice a day, every day. So even for many patients with type 2 diabetes, it was hard to accept because patients with diabetes... They think and feel that once they're on insulin, they're failed, right? Or it's just more severe.
So having a medication that is injectable, it was hard to dissociate them with insulin. Got it. Or with failure.
So patients didn't like to inject themselves. And it was a twice a day injection and there were a lot of nausea. So it was harder to tolerate back then.
It stimulates your pancreas to make more insulin when your sugar goes above normal. But if somebody who doesn't have diabetes and their glucose is normal, it doesn't touch the pancreas. Interesting.
Again, as with any drug we see, we have off-label uses. And what's happening is when we started somebody with type 2 diabetes on these drugs, when they were coming back to their follow-ups, not only was their glucose improved because they're great anti-diabetic drugs, but they were losing weight.
And to have that as a diabetes treatment, a drug that lowers your sugar and also helps with weight loss, it was unseen because most medications for diabetes promote weight gain.
It is fantastic, especially for type 2 diabetes, that weight gain or obesity goes hand in hand with diabetes. And before, with the medications that we had, we had to choose. Either we help with the glucose or we help with the weight. And many times we wanted to bring the glucose and that's what we had available.
They started back in 2000. So, I mean, even for 2005, for the FDA approval, they're starting in the 90s. right, with the first one. But in regards for weight loss, it started around 2005, 2006. Gotcha. And then the first one approved for weight loss was in 2012, named Saxenda, also a daily injection.
So we moved from the twice a day injection to the once a day injection, but it's still severe side effects where we're nausea or vomiting. And it was hard to get to higher doses where we see most of the weight loss because of the side effects. Then eventually in 2017, we have the poster child of these drugs, which is Osempek. That was when it was approved for type 2 diabetes.
In 2021, Osempek became also approved for weight loss independent of diabetes and then renamed it as Wegovii. Wait, what, Gove and Ozempic are the same thing? It's the same drug, yeah. When a GLP-1 gets approved initially for type 2 diabetes and then eventually gets approved separate exclusively for weight loss, they're rebranded.
They just changed the name, but it's the same drug, same pharmaceutical, same dosing.
Well, if you don't have diabetes... you don't want to take a medication that is for diabetes and also for insurance purposes, right? Got it. Insurance will approve one drug for type 2 diabetes and will approve one drug for obesity, but unlikely that it's going to approve one for both things.
GLP-1, I like to explain to my patients, target the two reasons that humans eat. We eat for fuel, survival. And we eat also for reward, for a reward. And the fuel part or the survival part, what this medication does, it suppresses your appetite hormones and it increases your satiety hormones.
So if for somebody who's on this drug and you're going to start eating, you get fully satisfied with a third or half of what you normally would need to feel full. And then in between meals, it suppresses your hunger hormones. So for most patients, it looks like two small meals a day, feeling physically content. That's for the survival part.
Now, for the reward part, we have receptors for this hormone in our brain in the hedonistic eating and drinking area of our brain where we anticipate or associate our reward either with food or beverages like alcohol. And it blocks that reward response. So let's say if somebody's anticipating having a meal that they know is going to relieve or a certain reward.
Once you're on these medications, you see that meal and you don't get the same feedback. So their behavior change. You enjoy your food when you're hungry and eating. Once you're full and satisfied, it's out of your mind.
It doesn't touch your pancreas if your glucose is normal.
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