The Mel Robbins Podcast
#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now
Thu, 17 Apr 2025
This episode is a must-listen if you or someone you love has ever struggled with weight. Today, Mel sits down with world-renowned, triple board certified endocrinologist and obesity specialist, Dr. Rocio Salas-Whalen, to explain the medical truth behind your metabolism, weight loss, and the most talked-about medications on the planet: GLP-1s like Ozempic and Wegovy. Today, she’s breaking down exactly how these medications work, who they’re for, and the critical mistakes people are making when using them without medical supervision. If you're confused about these drugs, worried about the side effects, or curious if they could help you or someone you love—this episode will answer every question you've been too afraid to ask. In this episode, you’ll learn: -The 5 real causes of weight gain—and why only one is in your control -Why obesity is not your fault (and how blaming yourself is holding you back) -What GLP-1 medications like Ozempic actually do in your body -The #1 risk no one is talking about when taking these drugs -Why these medications can change your brain, your cravings, and your relationship with food -How to avoid “Ozempic face,” hair loss, and muscle loss while on these drugs -How to know if you’re a good candidate—and the red flags to watch out for You’ll also hear Dr. Salas-Whalen’s personal story of using the medication herself after hitting perimenopause—and what she wants every woman to know about managing weight in midlife. This episode is your science-backed, shame-free guide to understanding GLP-1s, your metabolism, and what real help looks like. If you or someone you love is struggling with weight, send them this episode. It could change their life. For more resources, click here for the podcast episode page. If you liked this episode, and want more evidence-based tools for a healthier life, listen to this next: The Body Reset: How Women Should Eat & Exercise for Health, Fat Loss, & EnergyConnect with Mel: Get Mel’s #1 bestselling book, The Let Them TheoryWatch the episodes on YouTubeFollow Mel on Instagram The Mel Robbins Podcast InstagramMel's TikTok Sign up for Mel’s personal letter Subscribe to SiriusXM Podcasts+ to listen to new episodes ad-freeDisclaimer
Chapter 1: Who is Dr. Rocio Salas-Whalen and what is her expertise?
Well, I'm so glad that you're here because if you can help the person listening or who they're going to share this with to no longer be consumed by that and to have a completely different approach, something that's accessible and liberating, we're here for it.
So, Dr. Solis Whelan, why don't we start with having you just tell us a little bit about your background as a physician, because you have very unique training and expertise.
I am originally from Mexico, and that's where I studied medicine. I graduated from medical school. And once I graduated from medical school, I decided to venture to the United States by myself. wanting to become a doctor in New York City. And then after nine years of training, residency, fellowship, I completed my specialty in endocrinology and then the following year in obesity medicine.
Now, are those two connected? What is endocrinology and how does that lead to obesity medicine? They are very connected.
And originally, endocrinology takes over what's metabolism and obesity. But we've learned that obesity is complex and it requires its own specialty just to be solely dedicated for obesity. And endocrinology is the management of hormones. And yes, hormones impact weight, right?
I would love to have you talk to the person who's listening or watching us right now who may be overweight or who may be struggling with the disease of obesity. What do you want them to hear from you, Dr. Salas-Whalen?
I want to say that I'm sorry on behalf of the healthcare providers. We didn't know better and we failed you and I've been humbled by my patients. I've learned and hear their stories and we got it wrong. We got it all wrong, but there is help. We're learning more. Science advances like everything, right? Medicine is an evolving science and we are aware and we will do everything we can to fix it.
Why do you think it's important for us to really think about this issue of obesity being a disease or somebody who's struggling with their weight, kind of at the same level as we think about cancer or diabetes as a disease? Well, obesity kills.
obesity increases your risk of mortality. There's more than 15 cancers that obesity is their biggest risk, including breast cancer. You have more risk of developing breast cancer than alcohol, hormone replacement therapy, or genetics. It's obesity. Obesity is the number one cause of pancreatic cancer, colon cancer, prostate cancer, thyroid cancer. The number one cause?
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Chapter 2: What are the 5 real causes of weight gain?
You know, if I think about the way that the world has changed, especially when you see the statistics of the number of people that are either struggling with being overweight or who are living with a condition of obesity,
One of the things that strikes me is that I think in the past, there's always been this, I don't know, like judgment as if the person that is struggling with one of those metabolism issues, that they're somehow to blame.
And I know, at least when I think about members of my family that are struggling in this area of their life, that they feel a lot of shame around their inability to lose weight or to whatever. And I'm excited that you're here because I think that there's a huge shift in the way that we have been very ignorant around talking about the issue. And there's a shift medically speaking.
And so I would love to have you talk about the way that as a medical doctor and as a world-renowned expert in obesity medicine, how you want us to actually even talk about or view this subject.
And this is a very interesting thing because you as a non-medical professional have felt like that, judging and assuming we as a healthcare providers, as doctors, we did the same, right? When patients were coming to us for help and to play devil's advocate, we didn't have the training. We didn't have the knowledge that obesity is not a self-inflicted disease, right?
Okay, hold on. I want to make sure that we do not skip over what you just said. Obesity is not a self-inflicted disease. I want to unpack that because I did not understand that until recently. So what does it even mean that obesity is a disease?
So what we've learned is that obesity is a multifactorial chronic disease. And I'll deconstruct that. Multifactorial, meaning that there's more than one cause leading to somebody to struggle with weight or have obesity. I like to break them into five pieces. One, lifestyle, exercise, sedentarism, diet. but that's one piece of the five. The other one is genetics, right?
You can have a genetic mutation, but also it can run in the family. So it's two different, right? Then the third one, hormonal changes. We have PCOS, perimenopause, menopause in women. Then we have aging. That's unchangeable. Nothing that we can do about it yet. But as we age, our metabolism slows down. We lose muscle mass. We tend to store more body fat. And then we have environmental factors.
And those are on its own. We can deconstruct that too, because in environmental factors, we can talk about the food industry. Right. We can talk about obesogenic environments. So meaning places where the walking is not available or accessible or easy, where people have to drive everywhere or even working from home now. Right. So there's less opportunities to being active.
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Chapter 3: Why is obesity considered a disease and not a personal fault?
And when a patient hears this, I can almost physically see it how they feel relieved. I've had grown men in my office cry when they hear this for the first time because they've lived decades thinking that it was their failure.
Well, what you've already shared is so enlightening and empowering. And I kind of want to go back to each of these five things, because you said that there are kind of five factors that are part of a multi-layered cause of the disease of obesity. So let's go to the five things. And I wrote them down as you were talking because I was like, oh my God, oh my God.
So lifestyle, genetics, hormonal changes, aging, and environmental factors. And of those five causes of the disease of obesity, there's only one that you have control over. And that was some of the lifestyle choices that you make. But you are still fighting against genetics, hormone changes, aging, and environmental factors.
So that makes a lot of sense to me, why somebody can be working really hard at the lifestyle part and not seeing anything change. And so could you walk us through the four, the genetics, the hormone changes, aging, and environmental factors? I know we're gonna kinda go deeper in this, but just give us a sense of how each one of those four things really is a cause
for the disease of obesity or for somebody who's struggling with being overweight? Definitely.
So when we talk about genetics, we're talking about family history, right? If your parents struggle with weight, if your grandparents struggle with weight, then you are at higher risk of also struggling with weight. Again, we know the preconception weight of your parents impact. Even the food that they eat, consume highly palatable food that can be transmitted to you. What's palatable food mean?
food, processed food, ultra processed food that will lead to wanting to consume more. Right. Then when we talk about also there's some mutations that may also cause obesity. Right. And then when we talk about hormonal, so through a person's life, there could be hormonal changes, shifts, imbalances that is going to promote waking.
We can talk about hypothyroidism, right, which thyroid hormone controls your metabolism. Then we can talk about PCOS, polycystic ovarian syndrome, when there's hyperinsulinemia, insulin resistance, and this promotes visceral fat. Visceral fat promotes insulin resistance, insulinemia, and it goes into a vicious cycle.
We also talk about perimenopause and menopause with the changes of fluctuations or the drop of estrogen. This promotes visceral fat. The subcutaneous fat that you had in your fertile years in your hips and your breasts goes intra-abdominally. This visceral fat promotes insulin resistance, and then you go into that vicious cycle again.
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Chapter 4: How do genetics, hormones, aging, and environment contribute to obesity?
What does GLP-1 stand for?
Glucagon-like peptide. And it's a peptide or a hormone.
Is that what the word peptide means, hormone?
No, peptide is... what we call a short chain of amino acids. A long chain of amino acid is a protein. So before protein, it's a peptide. Peptides can help to produce or inhibit the secretion of hormones. The most important finding of this drug, and I actually met the person, the doctor, the researcher who isolated this, the GLP-1 outside the human body. It was in a lizard.
called the Gila monster. And the lizard, the venom of this lizard, caused pancreatitis on its victims. So Dr. Eng, John Eng, being an endocrinologist and researcher at the VA hospital in the Bronx, wondered what in the venom affected the pancreas. And he isolated GLP-1.
So this little gila lizard bites its prey or whatever, and the venom of it activates the pancreas and sends the thing into a state of diabetic shock?
It causes pancreatitis, so the prey dies from pancreatitis.
What? ! So what exactly does the GLP-1 do to the pancreas?
So it stimulates to produce insulin. The problem in type 2 diabetes is insulin-resistant and hyperinsulinemia. So with time, with frequent stimulation of the pancreas, every time you eat, every time you eat anything that has glucose, your pancreas produces insulin. But with time, it overworks. Your body stops responding the same way to the insulin that you make.
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Chapter 5: What are GLP-1 medications and how do they work?
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.
Okay. That's why we can use it in people that don't have diabetes. Got it. So 15 years ago, When you were prescribing this to your patients in your clinical practice, it's twice a day, the side effects were a lot worse, and it was really limited to treating type 2 diabetes. So what has happened in the last 15 years?
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.
Okay, so this is going to make me sound like the world's biggest idiot, but if you inject insulin for type 2 diabetes, it actually makes you gain weight? Yes. That does not seem fair. It does not. It is not, but that's all we had back then. Okay. that was an off-label finding.
And so all of a sudden, you're in your medical practice, you are prescribing this, some patients are using it despite the nausea, and you're like, holy cow, we're seeing weight loss, which is fantastic for people.
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.
So how long have you been prescribing these to people as a tool for treating the disease of obesity or for somebody who's struggling with being overweight? Since 2010. So you're like a pioneer in this. Yes. Wow. And when did all these studies start to happen?
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Chapter 6: How have GLP-1 drugs evolved over the last 20 years?
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.
Why do they rebrand it? So that they can market it to a different segment of people who are like, I don't want to take the diabetes drug.
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.
Wow. So how exactly does the GLP-1 work to help somebody lose weight or to change their metabolism if they don't have diabetes?
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.
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Chapter 7: Who is a good candidate for GLP-1 weight loss medications?
So is there a percentage of body fat that you look for to see if somebody's a good fit for this kind of medication?
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.
Is there a benefit to using a GLP-1 during menopause?
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.
Can you give us an example of someone who should not be taking this medication?
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.
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Chapter 8: What assessments and questions does Dr. Salas-Whalen use for prescribing GLP-1s?
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.
What was it like after practicing obesity medicine to come to a point in your life where you're like, okay, I'm going to try the GLP-1 myself because I got pregnant in life. Now I'm perimenopause. All the things that I used to do are no longer working. Like, did you resist it for a while? What was it like for you to do that personally?
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.
Did you wrestle at all with any, like, of that feeling, like, I should be able to do this myself? Like, did you, even as a world-renowned doctor practicing obesity medicine, did you shame yourself at that moment before you went on the medication? No, I mean, because I...
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.
I love that answer. And here's why. Because you don't have to shame yourself. And we can learn from you. that everything that you're sharing with us today is empowering you to go, this is my fault. And if I'm resonating with some of this stuff, I deserve to go get help and I deserve the help that's out there for me. Just like if you had diabetes or cancer, of course you would go get the treatment.
This is a great moment for us to give our sponsors a chance to say a few words, to give you a chance to share this episode with people that you care about. And don't go anywhere because we have so much more to dig into with Dr. Solis Whalen when we return. Stay with us. Welcome back. It's your buddy Mel Robbins. And today you and I are learning from Dr. Salas Whalen.
So Dr. Salas Whalen, here's where I want to go next. What are the risks of taking these medications?
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