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.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
First, I think we need to backtrack a little bit before we dive into that answer. Sure. We as a society tend to associate being thin as being healthy. So whenever we see somebody that you can think they're slim, they're thin, they don't need this medication, we're assuming that they're healthy. Yep. That they're metabolically healthy. Yep. Yep.
But we don't know by just looking at somebody, right? When I do body compositions on my patients, and this should be done on every patient. And basically, I would say even patients that don't need weight loss medications, just to know what's your body composition. Because whenever we're talking about weight loss, we're really talking about fat loss, right? We're not talking about a bulk number.
We're talking specifically, we want to reduce what can cause disease or increase your risk of disease, which is Fat, not muscle. So by doing a body composition, we can see what's the percentage of somebody, right? What's their visceral fat and what's the muscle mass?
So many patients that we may see slim or thin, they could be what we call a skinny fat or sarcopenic obesity, that they may have a very low muscle mass. and high body fat, there's still a risk of disease. They're still in a pro-inflammatory chronic state, right? There can still develop type 2 diabetes or even be a risk of developing cancer.
So just by looking at somebody, we cannot say what the body composition is and what they need or don't need to lose. Got it, right? So we first need to stop associating thinness with health, right?
Many times when I see patients that think they need to lose 10 pounds or 5 pounds, when we do a body composition, surprise, surprise, they actually have to lose 20 or 25 because they're under muscle, right? So to really say who needs this medication or not, we cannot assume by looking at somebody that they do or they do not.
So we have machines, right? So the gold standard for a body composition is an MRI, but we're not going to do MRI on every patient on every visit. The second is DEXA. And then the third, which is the more accessible, is body impedance, also known as InBody. There's different versions of it. So those are the ones that are more easy, accessible, and they offer no radiation to the patient.
And we do body compositions on initial visit and every visit when somebody starts on a weight loss journey.
No. No. Most patients that come is because they need them and because they've done their work and it's just not working. It's just not happening.
So first, starting with a very thorough weight assessment. So I need to know at what age were they conscious about their weight, at what age were they trying or being consciously about the eat or they were told they need to lose weight. For many patients, they tell me nine, ten. Also, I need to know their medical history.
Are there comorbidities that can contribute to obesity or medications that they're taking that can contribute to obesity? Then I go into a deep family history. I need to know up to two generations before. What was your parents', your grandparents' weight, your uncles' weight? If they have children, how is your children's weight? I need to see if there's a familial factor contributing to obesity.
And then I look at their gynecological history, right? Are they in perimenopause, menopause? Do they have PCOS? And then we move to the physical exam. And in that, also, we do the body composition. And there, we can really target what is it that needs to be improved or doesn't.
So what we consider obesity and percentage body fat is 32 and above. Normal in women is 18 to 28 percent, in men is 10 to 20 percent. So anything above those numbers, we either fall in the overweight range or in the obesity range.
Definitely. What we see in perimenopause and menopause with the drop of estrogen is that your body composition changes. You tend to store more body fat, central visceral body fat, and then you drop more your muscle mass. There's less lean muscle mass.
Also, in this stage of life, when somebody, let's say, that didn't struggle with weight in their 20s or in their 30s, anything that they were doing to maintain a weight once they enter midlife, perimenopause and menopause, is not going to help because of that hormonal fluctuation or drop of estrogen.
So in this time of a woman's life, and we hear it all the time, everything that I'm doing is not working. I used to do it before and the weight used to come off, but now I even have to work harder and it's still not happening. Yes, because of aging and the changes in estrogen or the drop of estrogen. So here, GLP-1s have a huge place for...
for patients that need or that have gained weight doing perimenopause and that it's just going to become even harder to lose it and easier to gain weight.
The only absolute contraindication that we have for this medication is a personal or first-degree family history of medullary thyroid carcinoma, which is a very rare and aggressive type of cancer. Now, if somebody has other versions of thyroid cancer, papillary, follicular, that's not a contraindication. Exclusively medullary thyroid carcinoma.
Above that, patients that are pregnant and breastfeeding is not recommended.
Or how does this work? So we have to remember what is obesity, right? What causes a patient to require this medication? It's a chronic disease. multifactorial disease, right?
Showing 201–220 of 288 · page 11 of 15
← Previous
Next →