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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So if we assume that we can use this medication to take them to a goal and then we stop it, we didn't fix, we didn't cure the other things, the familial history, the genetics, the hormonal changes, the aging, the environmental factors, those factors are still there. Chronic diseases, we don't cure, we control. So that's why these medications were designed to be used long term.
Now, that can change. If somebody has history of obesity since childhood in their midlife or later decades of their life, then most likely they will require this medication long term.
But if it's somebody, as an example, who gained weight after pregnancy and hit midlife and they gained 30 pounds, but they never struggled with their weight, then maybe those patients will not need to use them long term. Huh. That's interesting. But you have this patient that had children late in life, and then they hit midlife.
Then, yes, they didn't struggle with weight in the past, but now their surrounding is not going to be helpful for them to maintain the weight loss. So they may benefit from long-term use.
Yes, I have a very personal family member myself. I used this medication after I had my kids. I didn't struggle with weight growing up. I always used to lift weights since my early 20s. I fell in love with weightlifting, but I had my children late in life. I had my first one at 38 and my second at 39. After that, I hit my 40s. I started with perimenopause.
So what I was doing before, it didn't help me. I ended up with 30 pounds that I couldn't lose. I used the medication. I used for six months. I got back to my weight, and I have not needed it since then. I take back exercising and all of that, and I've been able to maintain my weight with that. It was just a combination of late pregnancy hitting midlife at the same time.
Mm-hmm. To not worry about your weight or punish yourself for not getting back on track so soon. I always tell women, give yourself one or two years before you start doing that because just having a child at that age is hard enough. After that, I think when us doctors go through certain situations, it does makes us a better doctor or more empathetic doctors, right?
Because it's very hard to identify with something that you don't know necessarily. It made me more understandable. I was better to relate possible side effects and what to do about it and definitely to be more empathetic. Beautiful. How long ago was that? I was 42, so seven years ago, I'm 49.
I know what causes waking. I knew in what place I was in my life. And I knew that I didn't want to exhaust every other possible situation that at the end was not going to help me. I'm a very proactive person personally and professionally. So I really wanted to be very proactive at that time.
So as with any diet or anything that causes a restricted caloric intake or decreases how many calories you're going to eat, there's always a risk of muscle loss, right? Because it's hard to just exclusively lose body fat without lowering muscle mass.
So one of the risks of using this medication is muscle loss. And there's no direct effect of the drug towards the muscle mass. It's an indirect effect of you eating less that you may lose muscle.
Yes. Got it. But it's not a dead sentence. So by informing the patient and teaching them about what is it that they need to consume while they are on this treatment can prevent muscle loss and even gain muscle for those that need to gain muscle.
Before we go into that, I just want to explain why we're talking about muscle. Why is so important muscle? It's not because we want to see all people bulked up and Arnold Schwarzenegger-like, right? Muscle is your biggest metabolic organ.
It's your calorie-burning machine.
Muscle.
Muscles burn calories and muscle regulate your glucose. Because every time a muscle contracts, it's physically being used, it sucks sugar from the bloodstream to provide its energy.
For your glucose? Yes.
Yeah, whenever we hear, oh, if you lose weight, your metabolism slows down. One of the reasons is because you lost muscle along the way and that's slowing your metabolism. You're burning less calories. And I see that all the time with body compositions. When patients lose muscle... They don't lose significant amount of fat. It's harder for them to lose fat.
When patients maintain muscle or gain muscle while on these medications, the body fat drops rapidly and significantly. So really your muscle is going to determine how you lose the body fat. And that's why we need to have that conversation of muscle on day one.
On your first appointment, your doctor needs to discuss with you what exercise you should be doing, which is strength training, hitting the weights, and increasing your protein in your diet. Because you can lift as heavy as anybody and you will still lose muscle if the protein is not there.
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