The Daria Hamrah Podcast
Do you want to change or simply improve your life? Take your business or your personal relationships to the next level? Have you ever thought why change is so difficult? Ever wondered how people become successful and we just call them "lucky". The Daria Hamrah Podcast gives you Dr. Hamrah's personal insights and pathways to his successes and what he calls "true happiness". Featuring interviews with some of the most successful entrepreneurs, authors and experts in their field, he shares their insights into what he calls the "Secret of Life".
The Daria Hamrah Podcast
Beyond Diets: The Truth About Obesity Medicine - with Dr. Rocio Salas-Whalen
Two physicians challenge everything you thought you knew about weight loss in this eye-opening discussion on the biology behind obesity. Dr. Rocio Salas-Whalen, a triple board-certified endocrinologist and obesity medicine expert, joins Dr. Daria Hamrah to reframe obesity as a complex medical condition—not a failure of willpower.
The conversation delves into why "eat less, exercise more" fails most people long-term. Dr. Salas-Whalen explains how genetics can account for up to 70% of obesity risk, with parents' weight before conception significantly affecting their children's predisposition. Beyond genetics, we learn how hormonal changes, aging, and environmental factors create what she calls "the perfect storm" working against sustainable weight loss.
Perhaps most fascinating is the detailed explanation of how GLP-1 medications work by targeting both survival and reward eating patterns. Unlike restrictive diets, these treatments address the biological roots of weight regulation while providing psychological relief many patients describe as life-changing. The doctors share moving patient stories, including one man who transformed so dramatically he was unrecognizable—ultimately quitting his job to become a nutrition specialist after experiencing the profound impact of effective treatment.
The episode also covers the alarming impact of endocrine-disrupting chemicals found in everyday items like plastic bottles and food containers, with practical advice on reducing exposure. You'll learn why building muscle might be the most important thing you can do for metabolic health, and why body composition analysis offers far more valuable information than BMI alone.
Whether you're struggling with weight, supporting someone who is, or simply interested in the science of metabolism, this conversation offers compassionate, evidence-based perspectives that could change how you think about health forever. Listen now to understand why weight management shouldn't be treated as a cosmetic concern—but rather as the serious medical issue it truly is.
Dr. Rocio Salas-Whalen
IG: @drsalaswhalen
NEW YORK ENDOCRINOLOGY, P.C.
1107 PARK AVENUE
NEW YORK, NY 10128
PHONE / (212) 722-ENDO (3636)
FAX / 212.722.3639
Tweet me @realdrhamrah
IG @drhamrah
All right, welcome back to the show. I'm your host, Dr Daria Hamrah, and today's episode is going to reshape how you think about weight loss, hormones and your health. Joining me is Dr Rocio Salas-Walen, a triple board certified endocrinologist and obesity medicine expert, based in New York City. She's a global voice in metabolic health and obesity. Today, we're going to talk about hormones and hormone disruptors, demystify GLP-1s, talk about why most diets fail, unpack the myths around obesity and highlight how modern medicine is empowering people to take back control of their health. So, rocio, thank you so much for coming on, and I'm gonna hit it off with the first question. We're gonna dive right into it. What is actually obesity? We all heard the word obesity. People have this image of what obesity might mean Probably a really super overweight person and we hear it in the news. That is kind of like the pandemic what 70% of Americans are obese? But what's the definition? As an endocrinologist and obesity medicine physician, can you please define it? So, for the sake of this conversation today we can have a basis.
Dr. Rocio Salas-Whalen:Definitely, I think so. Obesity is a disease of the fat tissue. Basically it's a. It's a disease of adipose tissue, right.
Dr. Daria Hamrah:So it's a medical condition.
Dr. Rocio Salas-Whalen:It's a medical condition that the fat there's an excess of fat tissue that can cause or causes disease, right? Fat tissue is pro-inflammatory, so this can increase the risks for metabolic disease, type 2 diabetes, even more than 13 type of cancers that are related to this excess of fat tissue, of what we call the bad fat right, which is like visceral fat. And also the definition of obesity is it's a chronic, multifactorial disease, right? And when we talk about chronic, meaning that is long-term, like other chronic diseases that we have type 2 diabetes, osteoarthritis, hypertension they are not curable, they're controllable, multifactorial, that there's many different factors that can contribute for this disease or for obesity and this is a definition of obesity.
Dr. Daria Hamrah:So a lot of people have heard of the fact that fat causes inflammation. But fat we have it in our body. Can you clarify for people what that exactly means, that not having fat is not a bad thing, but then too much of it, how too much of the fat causes this type of inflammation? And then how do you know too much is too much?
Dr. Rocio Salas-Whalen:So we have brown fat, which is what we consider a good fat right, it's thermoactive. And then we have the white fat. What is what we consider dangerous? And fat tissue is an active tissue. It's actually an endocrine tissue. It can produce hormones, cytokines, so pro-inflammatory chemicals, and an excess of the white fat tissue, also known as visceral fat, increases inflammation.
Dr. Rocio Salas-Whalen:It's in a chronic state of inflammation and I think the best example, and that is more recent in our minds, is COVID, the COVID pandemic, right. So people with obesity were the ones having higher mortality or the ones that were sicker or more visits to the ICU, and it was due to that chronic inflammatory state that the person with obesity was in, to that chronic inflammatory state that the person with obesity was in, and I think that was a very palpable view of being in a diseased state for people with obesity. I remember in my practice people were coming and telling me I don't want to die from COVID, I need to lose weight. So I feel like people very quickly got the message, versus when we used to say in 20 years you can develop type two diabetes or complications if you don't lose weight now, but came a virus and it was something acute.
Dr. Daria Hamrah:You mentioned COVID. Do you think COVID? Because I could tell, right after COVID almost this health conscious movement started. After COVID, almost this health conscious movement started. Now you've been practicing obesity medicine and endocrinology for many years. Have you seen a type of shift in your patient's mindset, this heightened awareness when it comes to health and obesity, or it's been always like that. We just more aware of it because of the social media and the internet?
Dr. Rocio Salas-Whalen:no, I saw a completely shift and incline on awareness of somebody's weight. Uh, my, my practice when I opened it six, six years ago my private practice here in manhattan it was more of a like mix of endocrinology and weight loss. But during COVID it made a completely shift and I would say 95% of my patients now and coming in is for weight loss.
Dr. Daria Hamrah:What do you think created that shift?
Dr. Rocio Salas-Whalen:So one the awareness that having obesity put you in an acute disease state or make you, put you acutely at risk for other diseases to happen. Right, that was one. So the demand of, of awareness was there and wanted to change it, and then it happened to be that we actually had the treatment for it for the first time. So it was the demand was there and the supply was there, or the means to improve this was there, and that was like the boom. I call it like the perfect storm. That is where we are right now is where we are right now.
Dr. Daria Hamrah:So at what point would you say I'm just curious at what point did you actively make it your mission to treat obesity during this pandemic I know 2020 it hit and then we found out that obese patients and patients with multiple risk factor are obviously at heightened risk for mortality from COVID. At what point did you say okay, I really have to take obesity even more serious than I have been and really get out there and promote weight loss?
Dr. Rocio Salas-Whalen:It was.
Dr. Daria Hamrah:Do you remember that moment?
Dr. Rocio Salas-Whalen:I remember I remember it was not a a a single point in time, it was it was a period of time when I started having this influx of patients with obesity and me interviewing them and their appointment and and and talking to them. Um that I learned. What I never learned in medical and endocrinology fellowship, or even as I was taking my obesity boards, is that patients, every single one of them, was telling me that they were eating better, that they were counting calories, that they were exercising, that they will tell me a list of diets through their life following recommendations. They were aware some had chefs, some have private trainers, they were doing everything in their control to lose weight and it was not happening. So for me it was such an eye opening to learn that patients were actually listening to us and following our recommendations, because before we used to think we give them this, the recommendations eat less, exercise more and then the patient would come back and there was no weight loss.
Dr. Rocio Salas-Whalen:And the first thing we would assume is the patient didn't follow our recommendations, didn't do better, that if they wanted it they would have happened already. So we doubted patients, right? I mean, like, is he really listening to me when they tell you I really eat very small. We used to say, yeah, if I'm sure if I go to your house I'm going to realize and see how much you're eating. That's our thinking as doctors, right? Yes, and it was very humbling for me to learn and to and and I was very lucky to have the availability to have that time to really talk to patients. Right, because in a 15 minute appointment, in a in a 20 minute conversation, you're not going to dive deep, the patients won't open to you in such a vulnerable state, right?
Dr. Rocio Salas-Whalen:they won't even trust you enough to open up yeah to open up Like you're going to judge them, you're going to misjudge them, right. So I had this great opportunity in my time that I designed my practice in a way that it was patient-centric, not insurance-centric, not quantity. I immediately said I want quality care and through these conversations that I had through my patients, I learned all of this. And that is the moment that I said, okay, we've got it wrong. We've had it wrong all this time. It really is not working.
Dr. Daria Hamrah:So it was not something you learned in medical school or in residency. It's something you learned in medical school or in residency. It's something you learned from your patients, once you spend enough time talking to them where you realize there is more to it. It's not just you're lazy or you're this or that, almost like shaming them. It's a much deeper psychological issue and and physiologic issue.
Dr. Rocio Salas-Whalen:And I learned that some patients this has been their life for decades, their life revolves around their weight, around that plate in front of them. Like how is that going to impact my weight? Am I going to feel guilty? What do I have to do later to reduce the calories that I consume? It's just like it was like 24, seven and and to me it was very. I felt shame that I contribute as a doctor to that thinking through my patients, because I didn't have the knowledge Right and and I asked I, I the first question that I asked a new patient is at what age were you conscious about your weight? At what age was you conscious about your weight?
Dr. Daria Hamrah:There is such a thing that you have to pay attention to.
Dr. Rocio Salas-Whalen:Seven, eight, nine. My mom put me on a diet at 10. So it goes so far back, right.
Dr. Daria Hamrah:So what's the solution? I mean, let's say you're a mom with two children and you see it's not going well, how do you then not, I guess, traumatize or stigmatize things for your children? I mean, that's a very I mean, I guess for one, the usual things that we do, just a healthy lifestyle and make sure they get used and develop habits of a healthy lifestyle, right?
Dr. Rocio Salas-Whalen:yeah, but but again, it's not lifestyle. Only that's going to prevent obesity right for children.
Dr. Daria Hamrah:I'm talking about for children for children too.
Dr. Rocio Salas-Whalen:So we know now that the's weight preconception can impact or predispose the weight of their children in their lifetime.
Dr. Rocio Salas-Whalen:Right there's a lot of data, a lot of papers, a lot of data showing of. So we have obesity, which could be monogenic and polygenic, right, which could be monogenic and polygenic right. So monogenic is a single gene disease and those type of monogenic causes of obesity are very severe and really showed in very, very young age. At two years old, at three years old, children have severe obesity right. Now we have the polygenic, when it's just not a single gene mutation, it's different genes and that is where heritability comes into play, right. So if the father is overweight or has obesity preconception, or the mother, or in many cases both, that can account to 50 to 70% heritability on the children's weight, right. So also it's found that hyperpalatable genes are also transmitted through the offspring, right. So we're learning more. That goes even beyond preconception that can predispose somebody's weight. So you have starting with that for children, obesity, right. Or for children, they're already coming in with a high probability of struggling with their weight if their parents also did.
Dr. Rocio Salas-Whalen:Then we add to that food industry, right, the access to good food is very low, to good food is very low, and even if you have the access, it's still difficult to get good, healthy, quality food. And then we go into environmental factors. Living in areas that doesn't promote activity, right, doesn't promote walking, sedentarism, and then food in schools, right? I mean really, when you ask a parent to take it into their own to control their kids' weight, it's almost like I don't want to say mission impossible, but we're set to failure, right? So you really have to go to extremes to avoid that. I'm not saying it's not possible, I'm just saying the environment that we live doesn't make it easy for us.
Dr. Daria Hamrah:So I guess, is that why most diets fail, or? I know you pointed out a lot of important and interesting points, from genetics to environment, to availability, to education. At which point, then, or where does one start? Because this, anytime you bring in the word genetic, I feel people use it as an excuse and it's very dangerous. It's a very slippery slope, because I feel, um, sometimes is it's used as an excuse, although oftentimes and I don't know the um, the statistics on these obesity genes, how frequently they are as far as epidemiology, epidemiology, epidemiologically, how frequent it is disseminated in a general population.
Dr. Daria Hamrah:But at what point do you explain to the patient that it's even though it could be genetics that they have to take accountability and make some changes? How do you do that? This? This seems to me like such a complicated thing and I guess if it was so easy, we wouldn't be talking about it right now. It wouldn't be the main topping point of our society. Where does one Like, let's say, someone is obese and they might not even have access to you to come to your practice, what is recommendations that you can give these people?
Dr. Rocio Salas-Whalen:So we can talk about currently what we can do with our giving situation of this obesity epidemic right, and we can talk about what we can do in the next generations to prevent this. And I start with a patient that comes to me and tells me wants to get pregnant right. My biggest recommendation to avoid this being constantly passed to generations is that preconception you start at a healthy weight right. If you're thinking of having kids, of getting pregnant, preconception, the best advice is that you start in a healthy way, because you're already cutting by half the chances of your next generation to struggle with their weight right.
Dr. Rocio Salas-Whalen:Second is education right Educating yourself about food industry, about food choices, about what is the control that you can still have right. I mean eating a healthy diet exercising strength training and then also the acknowledgement that we have medications right. But when you talk about accountability, we go back to the same idea that we just begun talking about it. Right, a patient can have 100% accountability and still not lose weight. And what happens in those situations is that to have that accountability, that it influence their weight completely, is usually something very restrictive and not sustainable long term.
Dr. Daria Hamrah:Right.
Dr. Daria Hamrah:Because, again, lifestyle is not just the, which is why most diets fail, in my opinion, exactly Because most diets are restrictive, whether it's caloric, whether it is ingredients. They're so restrictive and most people can't sustain them long-term. And so that's a very good point. But my question was where does one draw the line between genetics meaning factors that they can't influence and factors that they can influence? How does one?
Dr. Daria Hamrah:Because to me, I've I've been um treating patients for weight loss in the past two years now to prepare them for surgery. So for my patients, if they are obese and they want to have a some cosmetic surgery and that's how I got into obesity medicine I felt like it's not safe for them to undergo a six-hour anesthesia, so they have to lose weight. And the story was the same yeah, I've been trying for six years. And me then asking, well, how is it going? He's like well, I actually gained 40 pounds. I'm like you gained 40 pounds trying to lose weight.
Dr. Daria Hamrah:So that's how it got on my radar, where I said you know, obviously the primary cares aren't doing enough to help these patients or whoever they're seeing. Obviously they're not getting the information that they need. I need to educate myself so at least I can help them, to guide them in the right direction. And when that happened I went down the rabbit hole. And then the GLP-1s I came across the GLP-1s and the rest is history. But where does one draw the line between genetics accountability and accountability as far as changing their environment or looking deeper into their health, whether it is hormones, whether it is other methods or peptides or exercise, meaning help from the outside? Where does one draw the line as to what they need to be doing? Because I feel this is such a wild west out there and people, especially with primary care physicians, becoming these gatekeepers due to just lack of knowledge and understanding, even contributing to the confusion of the population.
Dr. Rocio Salas-Whalen:I am a very proactive type of physician, so I would say I draw the line earlier than later, right, and we can talk even about treating adolescents for obesity, right, that early. That is where I draw the line is if we can spare somebody from those years of struggle. And I would say, when for somebody, losing weight or maintaining weight becomes a full-time job, that's where the line needs to be drawn and I would say, why let them get to that point?
Dr. Daria Hamrah:right, it becomes counterproductive.
Dr. Rocio Salas-Whalen:Exactly. It becomes counterproductive, it takes control of their life. It starts impacting mental health right. And when we talk about causes of obesity, it's not genetics and lifestyle right. We have hormonal changes, pcos, perimenopause, menopause, hyperthyroidism, hypogonadism. Then we go to aging right. Aging also promotes weight gain by decreasing your lean muscle mass, promoting or increasing visceral fat. And then you go into environmental factors the food industry right, is everywhere. Industrialization of where we live, endocrine-disrupting chemicals I talk about industry right is everywhere. And industrialization of where we live, endocrine disrupting chemicals I just talk about plastics right. All of those are. They mimic our own hormones and promotes obesity, promotes disease. So it's not just genetics and lifestyle right, it's multiple other issues. And trauma, transgenerational trauma, can also promote obesity. There's research on that right. So where we and I don't want to make it feel like then we're set to failure, right, because yes, it kind of sounds like it.
Dr. Rocio Salas-Whalen:It sounds like that. I'm sorry, but we have a solution currently, right, I think, for the next generations to not struggle as we struggle. Different things have to take into place. Change in the food industry, right. We need, something, has to happen for those. Those are long-term solutions. Those will be in the next three generations. If it happens now, we'll see the results.
Dr. Daria Hamrah:If we start making changes now, we won't see the difference immediately. It will take generations, you think.
Dr. Rocio Salas-Whalen:Generations for us to see changes in our health. If there's a change now, then you have all the things that you can control. You can control what you eat, how much you move and also choosing or not choosing treatment. I like to say obesity is not a choice, but treating it it is Right. And also, as a society, if we truly accepted obesity as a disease, we wouldn't be questioning treatment or we wouldn't be looking at it as the last resource.
Dr. Daria Hamrah:Sure, well, we have a diagnosis for obesity. Obesity is a medical diagnosis. So, by definition, if we have a medical diagnosis, or the reason why we have medical diagnosis, so that we can treat it Exactly, so that has been already established, is it?
Dr. Rocio Salas-Whalen:implemented though.
Dr. Daria Hamrah:It is not, and that's my question. And why is it not implemented? And why are patients being shamed?
Dr. Rocio Salas-Whalen:Yeah, because as a society, we see weight loss and we've been taught to see weight loss as something external, right. Yeah, as looking good, as being attractive, as something superficial, yes, not as a health concern, right, but if you think about somebody with diabetes, you wouldn't question them being on treatment, right, good for you that you're treating your glucose because you were sick, you were not feeling great and you can this lead to disease. But for weight loss, if you, if you as a person, are thinking of weight loss as something superficial, it's going to seem bazooks to for somebody to take a drug for weight loss.
Dr. Daria Hamrah:That's where the shaming comes in weight loss.
Dr. Rocio Salas-Whalen:That's where the shaming comes in, that's where the shaming is and that's where they call it the skinny fat, the skinny injection, because you're thinking as an individual and you were taught that, as in the society, in our culture, that skinny is superficial and that skinny is not necessarily health, it's cosmetic.
Dr. Daria Hamrah:I have to be honest with you, rocio, I'm so disappointed and I don't care if I get ripped on social media for saying this, but I mean, someone has to say it I'm so disappointed at our medical community, and for not only gatekeeping these obesity drugs, peptides like GLP-1s that we're going to talk about okay, because we're going to talk about what they are and how they can help and other benefits that they have that we're finding out every single day but also for shaming patients or telling them to do the things that we and me and you just talked about, that they've been trying for decades and they have failed. Because it's more than just that. It's more than just exercise and diet and diet because of lack of education and lack of knowledge and disseminating incorrect information and confusing the patients and omitting them from a potentially life-saving treatment. Because the reason why I'm saying that in our medical community, obesity is a diagnosis Each diagnosis should is a diagnosis.
Dr. Daria Hamrah:Each diagnosis should have a treatment. And when we choose a treatment let's say, for cancer we don't just pick a treatment out of our hat. There is protocols, there is guidelines. According to research, whether you do radiation therapy, whether you do chemotherapy, there is guidelines. You don't just pick random stuff based on what your opinion is. Yet for obesity there is no specific, unless you're a board certified or an obesity medicine physician or board certified in obesity medicine. You really don't know what you're doing. And yet is the number one metabolic disease, at least in this country, or that's contributing to then the number two, three, four metabolic diseases in the country, which is diabetes, hypertension, all the other metabolic dysfunctions. So why is that? Why is it that they don't get better guidelines, they don't get the boards of their specialty? Boards aren't really reinforcing it enough, like what is going on, like why is it that influencers have a louder voice than actual physicians? It's so bizarre to me.
Dr. Rocio Salas-Whalen:I'm going to tell you why.
Dr. Daria Hamrah:Sorry, I just had to go on a rant.
Dr. Rocio Salas-Whalen:That's fine and you are a surgeon and you do plastic surgery, right? So you don't deal with health insurance. Yes, the other side of those primary care family practitioners, usually the first doctor that a patient can go I would say 70%, 80% work with insurance or in an institution right, it's the healthcare system that doesn't. It's how the healthcare system is set up is not useful, is not helpful for patients, is not helpful for doctors. You have a doctor, right, a primary care that sees 30, 40 patients a day, that gets 15 minutes with each patient. What are they going to do in those 15 minutes? And if their primary care they're dealing with their hypertension, type 2 diabetes, high cholesterol and whatever else is happening in a patient happening in a patient In those 15 minutes, they're never going to have the opportunity to talk and learn from patients, as the example that I gave of myself.
Dr. Daria Hamrah:Yes.
Dr. Rocio Salas-Whalen:Health insurance really controls the time and how a doctor practices. And I can tell you because I was in that spot many years ago and I hated it and I said I can do so much more for my patients if I have the time. And that's the reason I went into private practice and that's the reason I don't take insurance right. And the reason that I've learned all this knowledge and that I'm here talking to you is because I took that leap of faith on myself to work off network out of network Granted.
Dr. Daria Hamrah:So I would then say, well, they're victims of the system. Right, I get it. But why do I hear, you know, not? Once, multiple times, patients come to me. They ask me for GLP-1s and I'm thinking like this shouldn't be my job. I don't know how I got into this, but this shouldn't be my job. And then when I ask them, well, did you discuss it with your primary care doctor? They say my primary care doctor won't give it to me.
Dr. Daria Hamrah:So now the first thought is okay, maybe their insurance doesn't cover it or this and that. And then I dig deeper. I say, well, why does your primary care doctor not give it to you? He said I don't know my insurance. I actually checked with my insurance and it's even covered. I'm like okay. And then they go. My doctor says it's not good, it causes thyroid cancer. It causes. So basically, they tell me all the things that this fear-mongering in the media you hear, or these uh influencers on social media do, this fear-mongering for likes or follows. But even you hear it on mainstream media, the stuff reporters talking about it, and you're thinking, wait a second, that's incorrect. You know, this is just simply not correct. But when physicians tell it to their patients. That's where I draw the line. So why, is that?
Dr. Daria Hamrah:is there an excuse for that?
Dr. Rocio Salas-Whalen:um, yes and no. We doctors, we don't prescribe what we don't feel comfortable with right because you don't want to deal with side effects. You don't prescribe what we don't feel comfortable with right Because you'd want to deal with side effects, you'd want to create more symptoms on the patient or make it worse for the patient. So we don't prescribe what we don't know, or we don't prescribe what we don't have experience with. So most likely this whatever doctor is not promoting or prescribing this type of medication, glp-1s is because they don't know how they work. They don't really know the side effects, they don't have enough expertise putting patients on it and having and seeing them come with results or side effects and how to manage them. Right, number one, second, I would say better off that they don't prescribe it if they don't know how they work, because then they'll create more side effects and bad headlines of this wonderful type of medications. But then we go to the accountability part. Right, that you don't know doesn't mean that somebody else doesn't know.
Dr. Rocio Salas-Whalen:So then you need to refer and be honest and say I don't have enough experience with this medication. I'm going to refer you to an endocrinologist or I'm going to refer you to an obesity board certified physician, right, that's where we'll add the fault on the physician, right? That they don't say, okay, I cannot prescribe it. But what is the option? What are you offering me? Refer me to somebody else who knows, guide me to where to go? Right? So that's where the accountability should be happening.
Dr. Daria Hamrah:I'll be honest with you. I think many physicians, just like me and you, they're normal human beings. They let their own personal opinion about stuff cloud their judgment and I think a lot of times and that's my feeling from talking to my patients that's why they're not referring out to an obesity medicine specialist, endocrinologist or someone that is experienced in those medication I think oftentimes which to me, it's not ethical to let your opinion, your personal opinion, which is completely emotional, guide your judgment and misinform the patient. I see a lot of that going on and I hope that that will stop. Thankfully, patients are getting so smart because they have access to information. They have access to these podcasts, to information. To have access to these podcasts and, with voices like yours increasing, they will have a higher chance and higher likelihood of hearing another side from an expert and then questioning what their doctor might have told them based on their personal opinion.
Dr. Daria Hamrah:So I think, in turn, that's where social media is a good thing. People always demonize social media. I think social media is both good and bad. It's like your kitchen knife you can cook food and live healthy with it, or you can murder someone and rob a bank with it. So but that then cheating really, because a lot of people say that's cheating. A lot of people shame patients that are on them. At which point do you first of all agree with them?
Dr. Rocio Salas-Whalen:No, of course not. But before we go into that, I want to say, also talking about doctors and like you said, I'm going to say it, I have to say it, somebody has to say it is how many of us doctors are in a healthy weight?
Dr. Daria Hamrah:Hmm, you really want to go there.
Dr. Rocio Salas-Whalen:Well, if we're talking about why we're not having, why doctors are not having the conversation, then it is really. If you took into account what you're recommending patients to, then you will be proof of that right, 100%. But doctors, we're humans, right, we struggle too. Sure, but that's where you say your own personal experience or bias is interfering in the care of somebody else. So that's the psychology behind it. But okay.
Dr. Daria Hamrah:I'll throw okay. So since you went there, I'll throw you another good one. I don't know where we're going with this conversation now, but it's just happening. What percentage? What do you think? If you would compare the prescription of antidepressant compared to the prescriptions prescribed for weight loss, which one is being prescribed more, in your opinion today Of?
Dr. Daria Hamrah:course psych medications antidepressants, anti-anxiety medications medications anti-depressants, anti-anxiety medications, um, do you think where people mankind has gone that crazy that psych medicine are some of the first. I think it's the second most often prescribed drug I mean and how much of it is?
Dr. Daria Hamrah:how much of it do you think we can treat with the things that you talked about, with the pressures of lifestyle improvement, where it feels like people are hitting a wall and the wall is so tall that they can't climb it and they constantly be told well, you need to climb it, no matter what. How much of that do you think is contributing to the need for antidepressants?
Dr. Rocio Salas-Whalen:I mean, I think we know all the metabolic complications of obesity, right, we built specialties on it. I don't think we know enough or talk enough about the mental health complications from obesity. If you're talking about a 10-year-old that it's already put on a diet, telling them that their body is not the right one, that leads to anxiety, depression, suicidal thoughts, right. So that's. I think that's one big part of our mental health situation and I think that's one big part that I see improvement with GLP-1 once. Is that peace of mind and patients say for the first time I feel control. For the first time I feel relief.
Dr. Rocio Salas-Whalen:And also, when you explain to a patient that is not there full that they were not causing 100% their obesity I can even see it in their shoulders when I have that conversation they relax, right, it's just almost a physical change when you explain to them that, hey, if your parents had obesity before they had you, that it's already putting you in a bad spot, right. And you know, what's interesting about weight loss medications is that for the majority of patients I would say all of them, I don't want to generalize, but for the majority of patients, if they have the right guidance, the healthy lifestyle choices come after there's some weight loss or once they're on that weight loss medication. It's incredible to see. And when you talk about shaming on this medication no, because this is not a self-induced disease. We wouldn't shame somebody who goes on diabetes medication or on a diuretic for blood pressure. We wouldn't even think it twice.
Dr. Daria Hamrah:I haven't. I'm so glad you said that I have this amazing I'm. I'm currently writing a book and that story is in my book. Yes, you too.
Dr. Rocio Salas-Whalen:Oh my god yeah, I'm writing a book, all right so.
Dr. Daria Hamrah:So I'm gonna have to. All right, so I'm gonna send you um manuscript. I want you to read it and I want you to give me your opinion and feedback on it, and I'll be glad to do the same, because it's it's I want people that know so much more about me, about this topic, to give me insight than just some random reader, and this is so important for me. For me, this is this is going to be the second half of my career. I'm so dialed in, so passionate about this because I think we can help so many people.
Dr. Daria Hamrah:But let me tell you the story of my patient, jose. He came to me a year ago, young patient in his 30s, for liposuction of the chin and neck, and he just wanted a chiseled jaw, which is after COVID. This was the number one procedure people came to me for, and that's how I became aware of this thing called obesity People coming for liposuction. And really handsome guy tall, he was 6'4". He had beautiful facial anatomy, from the bone structures and everything, because that really plays a role in how your soft tissues drape over your facial bones. If you have smaller bones, everything sags and it looks more heavy, and if you have more defined structures. So he had very defined structure. And I looked, he was about 60 pounds overweight. So he had very defined structure and I looked he was about 60 pounds overweight.
Dr. Daria Hamrah:And as he's talking to me, telling me about what he's looking for, what his goals are, I couldn't help it but constantly think that this young man shouldn't be overweight. Why is he overweight? What is going on? And I had this internal dialogue going on in my head while he was talking and then I said I need to bring this up. It's, it's always. I don't know. You're so much. Probably better than that because you do that for living, talking about weight loss to your patient, but for me, you know, I always am very self-conscious, so that I'm very sensible, so I don't offend them and I don't want to bring it up before they have trusted me and opened up.
Dr. Daria Hamrah:I feel, even though, as a doctor, it's our job to do that. But I always try to approach it in a sensitive way because I know they're probably insecure about it. And he had this desperation in his voice that I said you know what? I'm just going to ask him. And I said well, you can pay me a lot of money for me to do this, but I can't help it to think that at your age, losing weight you're going to benefit more from it. It's going to be more life-changing than you paying me thousands of dollars to do liposuction. And I feel like I really should have had a different conversation with you. So I'm just going to say it. And then he immediately stopped talking and looked at me and goes like I've been trying to lose weight. I just don't know how I've been trying to lose weight. I just don't know how I've been trying everything. And then his eyes got teary. I felt this helplessness and it was almost like he was so happy that I brought it up and I said look, I could help you, but you need to change a lot of things also, one thing at a time. So I spend about 40 times 40 40 minutes with him 40, 40 minutes of time with him to see what his lifestyle is like. So what I notice is that he's basically sitting in front of a computer. He has a very sedentary lifestyle sitting in front of the computer. He was a computer analyst of a government contractor and sitting in front of the computer all day long eating potato chips. And so I said well, that's easy, because that is just some minor modification. So I gave him some tips and I said if you promise me to do that, I will put you on GLP-1, and then we'll see each other once a month and and then at four months we're gonna see where you are and then can still make a decision. And and I didn't want to take him the liposuction away from me because he was really adamant I said I will do it, but give me four months. I will do it in four months, I promise you if you still need it. He said, fair, I literally shook hands and I always make this joke, I'm like handshakes or pinky promise. And then he left.
Dr. Daria Hamrah:So we put him on GLP once and you know my nurses followed him up, et cetera, and I saw him after four months. He came sat in a chair. I didn't recognize him so I didn't even know who he was. So that's how much he had changed. Uh, and I in, I introduced myself like I'm seeing a patient for the first time and he looks at me, he looks at my nerves, kind of like, is he joking?
Dr. Daria Hamrah:And I look at everybody, was this weird mood in the room. I said, what's going's going on? And he's like, well, you know me, I'm Jose, and I'm like Jose and I had to look at the chart and I had to literally read my previous notes. All of a sudden it hit me, he was the way he looked. He looked like a supermodel, Handsome, confident. I did, I swear I did not recognize, recognize him and I had to sit down. I was like, oh my god. And he see that reaction on my face and he started laughing. And then, right after he started laughing, he started crying and he goes like you changed my life.
Dr. Daria Hamrah:I quit my job. When I went home the next day, I quit my job because of you. I'm like, oh, that's not good. Like why'd you quit your job? It's like I'm going to school for nutrition and I'm becoming a personal trainer and this is what I'm going to do for life. I changed completely my. I want to change my profession this is. I can't believe that within one conversation, you changed my life so much and I want to help other people change their lives too. So he literally quit his job. He went to nutrition school, he is becoming a fitness instructor, and because he realized how important the importance of lifestyle modifications are, which he had done leaving my office, in addition to the GLP-1s. So when you said they can motivate you, the GLP-1s can motivate you to change your life. The question is is it the chicken or the egg? Does weight loss promote health or health promote weight loss? Which one is it? Well, in this case it was a weight. Weight loss promoted health, not the other way around, which is what we were.
Dr. Daria Hamrah:We were taught the other way around yeah so I want you to talk about your experiences in that and the importance of this so people stop shaming these drugs and realize how we can change people's lives with these. I don't like to call them drugs. They're really peptides, you know Well they're hormones.
Dr. Rocio Salas-Whalen:Hormones. Yes, I mean first is to have empathy. Number one, right, it's like you have to understand that when you see somebody with obesity. Number one, they know they have obesity. Number two, they don't want to have obesity. And number three, believe that they're trying, believe that they're modifying, believe that they're listening and understand that it's a health problem. It's not a willpower problem, it's not a cosmetic problem. It's a disease and there's treatment for it. And it should be widely accepted.
Dr. Rocio Salas-Whalen:And not let your own bias of what weight is or what has worked for you or not worked for you shame other people from doing it right. And also like respect when people are on a GLP-1. And don't push food to it right. And also like respect when people are on a GLP-1 and don't push food to them right. And don't say, oh, that's all you're going to eat. Or stop saying, oh, stop losing weight, you look sick, that's none of your business, right? Or I mean, believe me, we're trying to get to a health goal, not for somebody to look good enough for you, or that's enough of weight loss for you for you feeling comfortable, right?
Dr. Rocio Salas-Whalen:I think that's another one. And educate yourself about it. And like it happened to you, like it happened to me. Once you know, once you understand and once the blindfold is taken away from you, your responsibility is to share that knowledge and to correct. When somebody says something negative or ignorant about somebody with obesity, oh, they would have done it if they wanted it. It's just educate other people, right? I think the more we educate people, the easier it will become and it will be more accepted.
Dr. Daria Hamrah:I love the way you put it and I think and they will be more accepted. I love the way you put it and I think, especially in certain cultures, this is more extreme. I know I come from a Persian culture and if you look, if you have a perfect body composition to your mom, you're underweight.
Dr. Rocio Salas-Whalen:Yeah, Like your mom yeah.
Dr. Daria Hamrah:It's like what's going on. You look so sick, like why do you have no meat on your bones and you eat this, and it's a cultural thing. So, and for culture, I don't know how long it won't change in decades, it will take centuries. But let's talk about who is a real candidate for GLP-1s. But before we talk about who is a real candidate for GLP-1s, but before we talk about that, I just realized that we haven't even told the audience what GLP-1s are. They've been hearing it for the past 45 minutes and we haven't. I know, I mean by now you would think people know. But just for the sake of definition, how do they really work? Very briefly, in maybe one or two sentences how do they really work? Very briefly, and maybe one or two sentences how do they really work? And then, who is the ideal candidate and who should not be taking these medications?
Dr. Rocio Salas-Whalen:So GLP-1 is a hormone that we make in our gut, in the small intestine, and it's secreted or produced when our glucose raise up in our bloodstream right.
Dr. Rocio Salas-Whalen:Meaning after we eat, for example, After we eat yeah, after we eat, this hormone is produced in our intestine, but there's an enzyme, the DPP-4 enzyme, that breaks it down within two to four minutes, right. So it's produced, but it has a very short-lived effect. Glp-1 analogs what we know as Osempe Wegovi, monjaro the commercial, the synthetic version of it is a long-acting form that is not broken down by this enzyme. Reason that it has a longer life, right, like even a week, like some aglutine interceptatite and the way that they work for weight loss.
Dr. Rocio Salas-Whalen:I like to say that it targets the two reasons that humans eat we eat for survival, for energy, and then we eat for our reward. For the survival part. What it does? It increases your satiety hormones when you start eating, so you get fuller with half of what you normally would have need to get full, and then in between meals it suppresses ghrelin, your hunger hormones, right. So you eat smaller through more content periods of time in the day. That's the gut level, which is almost similar to bariatric surgery, right?
Dr. Rocio Salas-Whalen:But then we have receptors for this hormone in our brain in the amygdala, where the hedonistic eating and drinking area is, where we eat for an anticipation of our reward or drink for anticipation of our reward. This hormone blocks those responses. So the behavior at the beginning when you start on this medication if the behavior is there, you reach for it. But there's a blunted effect. You don't feel you don't get the reward anymore for whatever anxiety, depression, boredom, snacking, whatever you were getting, anticipating that reward, it stops it. So you don't think about it. You get hungry, you enjoy your food, but then you get full with smaller portions through longer periods of the day. So that's how they work.
Dr. Daria Hamrah:Wow, this was the best, most concise and shortest explanation ever that I've heard. I'm going to have to memorize it verbatim. For those of you, you mentioned the word amygdala. This is for the audience that is not in the medical community. It's the center in your brain, that is in your limbic system, responsible for emotions, flight or fight. It's called the fear center. Responsible for emotions, flight or fight is called the fear center, and that's what that pressure, that's what kind of drives, also habits, or of eating, and so it the GLP ones, also affect that part, and so that's a dual function we were talking about.
Dr. Daria Hamrah:So now, who is a candidate and who shouldn't be taking it? Let's say, let me throw you this one, dr Whalen, I really am struggling to lose these last 15 pounds and I really want to get on these GLP-1s. I've tried everything. I'm going to the gym, I just can't lose 15 pounds. If I lose another 15 pounds, I'll be happy. I don't have any medical problems. I don't have diabetes. I don't have any metabolic disorders. I just need to get into these jeans that I used to wear when I was 25, and I just need another 15 pounds.
Dr. Daria Hamrah:I will put her or him in a box, if not, I will go crazy and I'll be depressed, and I'll throw you this one too.
Dr. Rocio Salas-Whalen:So usually what I? Because I do body compositions on every single patient. You walk through my door, you get a body composition. Basically. So if I have a, most of the time that I have patients that's like that oh, I only have 10 pounds to lose, I only have. Usually it turns out to be 20 or 30, right, once we put somebody on a body composition, the truth shows right.
Dr. Daria Hamrah:Okay, let's talk about body composition then also.
Dr. Rocio Salas-Whalen:So so who's a candidate right? So if we go by BMI, then 27 and above with one comorbidity meets criteria for weight loss medication. Or BMI equal or greater than 30 without a comorbidity meets criteria. But if you go to that's, that's a very outdated tool that I don't.
Dr. Daria Hamrah:Yeah, I mean, if you're like a bodybuilder, you have a lot of muscles, you have a lot of your BMI.
Dr. Rocio Salas-Whalen:Yeah, that's not the I mean, that's, that's the old thinking, because we rarely see that, I mean, unless you're doing body compositions on WrestleMania or something like that, right, but regular people, it's actually the opposite. You see, normal BMI with high percentage body fat, high visceral fat and low muscle mass. So when you average it out, oh, it looks like a BMI of 21. And no, you're under-muscled and overly fat.
Dr. Daria Hamrah:So how do you know that? That you're under-muscled and over-fatted?
Dr. Rocio Salas-Whalen:I guess, Definitely, I mean, I think, how would you know if you're under-muscled?
Dr. Rocio Salas-Whalen:With sophisticated medications, we need to do sophisticated tools right. So I think anybody who's jumping in this wagon of prescribing GLP-1 medication should do it responsibly, with body compositions, right, Because at the end of the day, you don't know what the patient lost, could have lost 10 pounds of muscle and 10 of fat, right, and you made him even worse, metabolically unhealthy, 100%. So definitely you need a body composition. So for that person that has 15 pounds of weight loss to lose, first, I would do a body composition. So for that person that has 15 pounds of weight loss to lose, first, I would do a body composition. Second, if it feels like a full-time job trying to lose those extra 15 pounds and you need it, and you need to lose those extra 15 pounds you definitely will benefit from a GLP-1 medication. I mean, what else can you ask for the patient? Right?
Dr. Daria Hamrah:For those of you who are rolling their eyes and saying oh God, please, you know, just stop eating potato chips or go to the gym. For 15 pounds, for God's sake, you know, do you really have to? Can you please explain to them why? Because you said something important. I think it got lost. Can you explain to them why you consider them a candidate and why it is important Because it is consuming their lives and infecting them in a negative way? Can you kind of dive a little bit into it? Explain it for the biggest doubters out there?
Dr. Rocio Salas-Whalen:Because if it was as easy as just eating less, they would have lost it already, right? I mean, we cannot assume that somebody who has 15 pounds and hasn't lose them are ignorant. They don't know what they're talking about. They don't know how to count calories. They haven't read a diet book, right, uh that.
Dr. Rocio Salas-Whalen:That's another thing that I should say, because you don't struggle with weight, or because maybe you do lose weight if you restrict yourself, doesn't make you better or more intelligent than somebody who's trying and it's not happening. I think that's one thing that we have to stop. Don't assume that the person doesn't know what they're doing, hasn't tried or is not currently trying. But so if they need to lose that amount of weight or more or 10 pounds, but it's a full-time job in their life, they require weight loss medication.
Dr. Rocio Salas-Whalen:Otherwise, if they didn't require the weight loss medication, they would have lost it already. If they didn't require the weight loss medication, they would have lost it already, Meaning that there's so many other things in their environment, in their age, hormonally, that is not allowing them to reach that goal.
Dr. Daria Hamrah:Yeah, and I think the psychological impact is totally underestimated. It's so funny that we're so quick to prescribe antidepressants so quick, like. I'll tell you a story as an endocrinologist. You will be shocked. I went with my wife to the doctor. She was a new doctor that she went to, her insurance changed and she was going to pick up her thyroid medication, have them refilled or have them re-prescribed, and the doctor she was telling the doctor asked her about their symptoms. She's like, yeah, I'm kind of like tired and this and that. And she was back then in her early 30s and the doctor said, yeah, I think this sounds like depression. I'm going to prescribe you antidepressant.
Dr. Daria Hamrah:And I was sitting in the room. I was like what, I was sitting in the room. The doctor didn't know that I'm a doctor, so I didn't say I usually don't like to say anything, I just sit there. I don't like to interfere. I like I want I'll have them do their job and I thought I heard it wrong. I said, and then I saw my wife looks at me with a question in her eyes, like and she's like, I'm not depressed, I'm actually very happy. I actually very happy, I just need my thyroid medicine. I have Hashimoto's and I'm hypothyroid and my levels show. I mean, did you look at my labs? And the doctor says, yes, I know, but your symptoms are very suspicious for depression.
Dr. Daria Hamrah:And my wife, she lost it and I had to calm her down and I'm like calm down, just it's okay. She's like well, what is going on here? And, long story short, the reason why I'm mentioning it. This is not just one event. This is an event where I was involved. There are events of patients telling me or they're on antidepressant and I asked them why an antidepressant? And then I'm not a psychologist so I'm not qualified to even diagnose or question a diagnosis. In my wife's case I knew I was able to because I live with her. But the psychological impact is not often talked about and I see it a lot on my patients. They completely in the case of Jose and and in case of other patients just like him, it has such an underrated psychological impact which then has this trickle-down effect. I mean, when you look at how depression can affect your other metabolic function of your other organs, from your fat composition, all kinds of trickle-down effect.
Dr. Daria Hamrah:When someone has 15 pounds or 20 pounds overweight and they've tried everything desperately and they just can't do it. They've been on every diet under the sun. They go to the gym seven days a week, which I don't even go to the gym seven days a week. I have usually one or two off days and I'm a gymaholic. And they want to lose. Give them the 15 pounds, for the love of God, because then there will be happier people and then they can go on with their lives. And so the indications. They're much broader than the definition of obesity, in my opinion. Now, I know insurance companies have the reasons for that. That's great, but I don't think we should necessarily have insurances guide our treatment objectives.
Dr. Rocio Salas-Whalen:And also, I think, for what I see a lot clinically, a lot of the people that saying it's 10 or 15 pounds that I cannot lose and I'm doing more, or I'm doing exactly what I was doing, is usually people that didn't struggle with obesity growing up, right, it's people that were in a healthy way most of their life and now they're in perimenopause. Now they're in menopause or now they had a kid and they cannot get the weight back. So usually it's people that live the healthy but at the time that it happens, their environment, their hormones, their age is not helping them as they did before, right, because if you have somebody with severe obesity that had 80 pounds overweight and 90 pounds overweight 60, those 10 pounds doesn't make such an importance, right, but usually it's people that were always in a healthy weight and then something shifted and now they cannot get back to what they know their healthy weight is.
Dr. Daria Hamrah:So you mentioned hormones and perimenopause. I know it's a whole different topic, which I covered with Dr Mary Claire Haver in my last podcast, but I want to bring this up, especially since you're an endocrinologist. But I want to bring this up, especially since you're an endocrinologist how do you balance the prescription of GLP-1s and adjustment of hormone therapy? Do you do them at the same time? Do you do one first and then the other? What's your approach? And how do you see the contributor of the weight issue? Do you see it more in the hormone side or do you see it in a more genetic lifestyle side, or is it just a combination of all of it?
Dr. Rocio Salas-Whalen:I mean, as I said, everything in medicine is very individual, right, it's depending on the patient, but it will be what are the most pressing symptoms? Right, but it will be what are the most pressing symptoms, right? Let's say they have obesity or they are overweight, but they're also in their mid-40s and they're not sleeping right because of perimenopause. Then that's a person that I may want to start both medications at the same time. But let's say I have somebody in their early 40s and they're saying their waking morely due to perimenopause, but they're not fully symptomatic, they're not having the hot flashes and night sweats, the travel sleeping. Then I may start with weight loss medication and then see what improves, right, even sex drive. Many patients with low sex drive can improve with weight loss, right.
Dr. Daria Hamrah:Can you explain that?
Dr. Rocio Salas-Whalen:that's interesting yeah, because uh, self-confidence right, I think, for many patients more of a psychological impact, more of a psychological impact.
Dr. Rocio Salas-Whalen:They don't feel comfortable with their body, so that can suppress their sex drive. Just because of that of of poor self-confidence, that for many patients once they lose the weight, that improves. But let's say somebody who's fully menopausal and they can lose weight but their hormones are below zero, then definitely adding hormones will help them right? Also, there's some patients that are very sensitive to medications and if a patient like that, you don't want to put three new drugs on a patient right Because she won't like how she feels and she may drop treatment completely. So for those patients, again, what's more pressing is that the night sets the travel, sleeping. Then I'll start with hormone replacement therapy and then in their next visit in six or eight weeks, then we can start a GLP-1 or vice versa.
Dr. Rocio Salas-Whalen:Right so again, it's very dependent on their current symptoms weight, age, preference.
Dr. Daria Hamrah:Gosh, I could tell you one thing from what I just heard from you I wonder how many marriages and relationships these things can save, thinking of how many relationships get disrupted, how many and I talked to Mary Claire about this the percentage of relationships that break up because of you know all of these issues. That's to me another contribution of these drugs to our society, in addition to the medical aspects of it.
Dr. Rocio Salas-Whalen:But Well, I see what GLP wants.
Dr. Daria Hamrah:I see divorces happening more than well, yeah, I mean that, but but there has to be another um yeah, going on prior to that. Yes, something underlying that's just exposing something that was yeah, that's actually, that's exposing something that was going to happen eventually yes, but I'm just going to talk.
Dr. Daria Hamrah:I meant relationships and marriages. Yes, marriage and relationships that broke up because um, um, um, maybe, um, there was lack of self-confidence, lack of sex, drives like, uh, just mood swings, uh, because of everything is just too much. And, in addition, the hormonal fluctuations in perimenopause that are not being addressed, which is still baffles my mind. That what, 25 years after the study came out? That still physicians out there are not well-informed, which is a whole different topic that we already covered. That's another gatekeeping yes, another gatekeeping yes, another gatekeeping.
Dr. Rocio Salas-Whalen:Only four percent of women, or four to six percent of women four to six percent of women in the us is are on hormone replacement therapy. What, even with all the information?
Dr. Daria Hamrah:that right for four to six percent of perimenopausal women, or all total women of all ages total women of all ages.
Dr. Rocio Salas-Whalen:Total women of all ages Okay Are only four to 6% are taking hormone replacement therapy.
Dr. Daria Hamrah:And if you think about how many percentage of the total women are 50%. Candidates are 50%, right, holy shit, oh my God.
Dr. Rocio Salas-Whalen:That low, I mean it's yeah.
Dr. Daria Hamrah:Wow, I would have guessed like, by now, at least half of them.
Dr. Rocio Salas-Whalen:And that's another one that I mean and you had that conversation with the wonderful Dr Marie Claire Haver, but that's another that I see as an endocrinologist is like have you ever been talking about hormone replacement therapy? No, they told me. No, it causes cancer. That's another one that is lacking a lot of information in the medical community of the benefits of it and that it doesn't increase breast cancer, right, I think.
Dr. Daria Hamrah:Yeah well, I don't even know enough doctors in my area, in the Washington DC area, that I can refer my patients to. I know two or three physicians that I know, so if you know any endocrinologists in the DMV area here in DC, please, let me know, Dr Rachel Rubin, she's not an endocrinologist, she's a urologist but she prescribes hormone replacement therapy. I just had a patient last week. She gave me that name, rachel Rub. She's a urologist but she prescribes hormone replacement therapy.
Dr. Rocio Salas-Whalen:I just had a patient last week. She gave me that name, Rachel Rubin.
Dr. Daria Hamrah:She's amazing she's there in DC, perfect, perfect. So next question why are these drugs so expensive? I don't want to create a political conversation, but very briefly, in maybe one or two sentences why are they just so expensive and why can people get them in other countries so cheaply? Is it just simply price gouging here in the US or does it have other complicated reasons?
Dr. Rocio Salas-Whalen:I mean I think they're so expensive and they charge so much for it here in the United States because they can.
Dr. Daria Hamrah:So okay. So it's price gouging.
Dr. Rocio Salas-Whalen:I mean it's because they can. But also I think that the pen itself is an expensive mechanism to deliver the medication, right? If in other countries, like in Mexico, monjaro is now available, but it came only in vials, so just the substance syringes, so that cuts the price significantly? Right, in Europe they have a single pen for a month of Monjaro, so you're only using one pen versus four pens. Also, right, why?
Dr. Daria Hamrah:don't we have it here? Why don't we have a single pen here?
Dr. Rocio Salas-Whalen:When the pens of Monjaro came out. When Monjaro came out, I spoke with the general manager. I actually called him and I said I am fixing something, obesity, but I'm worsening our environment. They're not recyclable, they cannot be burned, they go to landfill. So it's like imagine a pen per week, per patient, millions of people using these pens. Plus, it increases the price, increases the production. They have to build new factories just to produce the pens. So I think the pen itself is an expensive process and expensive to make. But that's not the only reason, because Wegovi, let's say in Europe, it's also a third of what is here for the same amount of pens. Right, so I think it is the pen, but I think also it's because they can, here in the united states, they can get away with it interesting.
Dr. Daria Hamrah:So what is the? What is the issue with just giving vials? And yeah, I guess it logistically will be a little more difficult because you have to educate the patient handling syringes etc or having to come to the office once a week to just get an injection. But how do we do it with insulin? That's how we do it. I mean, they inject themselves with syringes. They don't have necessarily pre-filled.
Dr. Rocio Salas-Whalen:I think we're going to move into that. I think it's going to take some patient adaptation to that idea of having to inject themselves with a substance I think with the pen makes it but how to?
Dr. Daria Hamrah:how do um um diabetics do with insulin?
Dr. Rocio Salas-Whalen:well, also, it comes in pens, right. I mean rarely we use a vial and syringe. I mean we haven't used that in I don't know how many decades, because even insulin comes in pens, right. So it's. But it's just, we can learn, we can re-educate ourselves right. And if the cost goes from $1,200 to $300, believe me, many patients say, yes, I will learn how to do it right. Occasionally I have a patient that says I cannot deal with seeing the needle, I'll just, I'll rather do the pen.
Dr. Daria Hamrah:Interesting. So we mentioned, we talked about in the very beginning of the podcast about hormone disruptors. You mentioned hormone disruptors. There is this. It's almost like a buzzword that's going on with all these influencers on social media. Everything is a hormone disruptor. Can you kind of like as an endocrinologist who is an expert in hormones and hormone disruptors and endocrinology, tell us what are hormone disruptors? How do they affect our body, our metabolism, and where is it in currently today, in our environment? What are the typical things? I'm not talking about this one thing in one part of the world, like every day american in their daily lives, what they should look out for, what they should avoid. Just at least, um, tomorrow they can, or even today, after listening to the podcast, start um living a healthier life without having their hormones disrupted so endocrine disrupted chemicals are a real thing, they're completely real and they completely can affect negatively our health so it's not fear-mongering oh no.
Dr. Rocio Salas-Whalen:And when I talk about environmental causes of obesity, uh, we can talk about it's endocrine disrupting chemicals promoting obesity. Right, endocrine disrupt chemicals. They are substances or chemicals that mimic our own hormones, so they go into the receptors that our own hormones would normally go and don't allow them to do their proper function. Right.
Dr. Daria Hamrah:So they're blocking the receptors.
Dr. Rocio Salas-Whalen:Blocking the receptor of our natural hormone by mimicking our own hormones.
Dr. Daria Hamrah:Which hormones are those in specific?
Dr. Rocio Salas-Whalen:Estrogen. Estrogen is one of them, and cortisol testosterone. There are many types of hormones. They can cause infertility. We can see infertility from endocrine-resorpting chemicals. Just yesterday there was a very interesting article published in Biomedicine that it was a large study that started here at NYU. They looked at 370,000 deaths due to phthalates, which is plastic. So worldwide, 13% of cardiovascular disease deaths are caused by in 2018, just in 2018, they were caused by endocrine disrupting chemicals, specifically for phthalates that are found in plastic.
Dr. Daria Hamrah:What is the number one source of phthalate today in our environment? Like what? Like bottled water.
Dr. Rocio Salas-Whalen:So food packaging can be on it food containers.
Dr. Daria Hamrah:But everything is packed in plastic today.
Dr. Rocio Salas-Whalen:Well and that's why we have the problem that we have, right, that endocrine disrupting chemicals promote metabolic disease. Right, they promote inflammation, they put ourselves in oxidative stress. And it's found in plastics, pesticides, painting in our walls, fabric, vinyl I mean cleaners cosmetics, right, I mean it goes. The list goes on and on. We cannot, I always tell my patients, unless you go and live in a farm in the middle of Norway where there's nothing around, then that's the best way to avoid it. But we live in an industrialized world. But there's some things that you can control, starting in your home.
Dr. Daria Hamrah:So let's talk about that yeah.
Dr. Rocio Salas-Whalen:Get rid of plastic containers. Okay, I've done that.
Dr. Daria Hamrah:Yeah, get rid of plastic containers. Okay, I've done that check.
Dr. Rocio Salas-Whalen:Move to all glass containers right. Get rid of all plastic bottle waters.
Dr. Daria Hamrah:Done.
Dr. Rocio Salas-Whalen:Do glass or stainless steel? Never, ever. This is like the if one thing you can do never heat in the microwave anything in plastic, because the heat makes the BPAs, the phthalates, spill into your food or into your water. Good Right, whenever I walk here in New York and I pass through a pharmacy outside and in the window you have the boxes of plastic bottled water and the sun hitting it. I'm like, oh my God. I'm just like I know I can like oh my God, I'm just like.
Dr. Daria Hamrah:I know I can't escape it anymore either.
Dr. Rocio Salas-Whalen:It's that. And then also like choose chemical free cleaning supplies right, we have everything, even less BOCs, which are chemicals in your paint, because then you're inhaling them right in your pain, because then you're inhaling them right. Fabrics, those like stain repellent they are very high in chemicals and things, heavy chemicals that are going to be endocrine disrupting chemicals, right. So there's little things that we can do in the day to day.
Dr. Daria Hamrah:That have a great impact yeah.
Dr. Rocio Salas-Whalen:Yeah, that can impact our health right At least the things you can control.
Dr. Daria Hamrah:I mean, there's things that we can't control because, as you said, we live in a society that it's just the way it is. But you can start at your own home.
Dr. Rocio Salas-Whalen:Yeah, you can start at your own home and even when you do grocery shopping, right.
Dr. Daria Hamrah:I don't think I agree with you on bottled water. I mean, you never know where that bottle was. It was sitting in the sun For 24 hours, yeah. So every time I see someone drinking out of a plastic bottle, I really cringe and I have to hold back to tell them no, don't do it, you know.
Dr. Rocio Salas-Whalen:There's pictures of water too. There are glass for filtering water and the filter comes in stainless steel. So I mean it's an investment. But then you're filtering the water in a glass container with zero plastic, then you put it in a stainless steel bottle or a glass water bottle and then you are really avoiding there and that makes that it is impactful. I mean I don't know why this article, that it was so well done and it showed such a high percentage of cardiovascular cardiometabolic death.
Dr. Rocio Salas-Whalen:It's not a headline right Because it's not sexy. But whenever we're talking or people say, oh, why are you just prescribing medication? What are we doing about the food industry? Then this is, this is proof. These are these are things that you think are minimal can impact really and prevent disease.
Dr. Daria Hamrah:Yeah, well, I think the reason is because right now, we don't have a replacement for all this. We don't have a replacement for plastic.
Dr. Rocio Salas-Whalen:Well, cardboard, a lot there's, cardboard there's other things.
Dr. Daria Hamrah:No, as far as mass production, as far as scale production of like, how do you bring water? How do you sell water? I mean, you have to to. Economically, it's not even feasible. You know, they have to really invent something new. It's like this. This shift can't happen. I think that's why the media doesn't talk about it enough, because if they start disrupting the whole system now without having a replacement alternative for it yet, um, it's going to create chaos I'm going to send you the the their account, their handle.
Dr. Rocio Salas-Whalen:It's a company that a guy from spain and a guy from, I think, germany. They created a membrane made out of made of algae, of of seaweed that is compostable, for water container food they're like. Now they're mass producing it. So it's like those things. One should invest on those things, right? No kidding, because they can't. They're packaging food, they're packing water. Actually, in the new york marathon they were giving them out. They were like little packages of this membrane with water or or electrolytes, and they just and they ate it. So you can eat it also because it's made of algae. What?
Dr. Daria Hamrah:yeah, it's amazing you finish drinking your water and then you eat the bottle just pull the whole thing in your mouth it's like reminds me of a guacamole. Hat you just I?
Dr. Rocio Salas-Whalen:mean but things like that. People are finding solutions for that right and but the but the industry doesn't or invest on it.
Dr. Daria Hamrah:They don't think it's well because it's it's because it's disrupting a lot of other powerful people. You know, money talks, I mean the for uh. For every one lobbies for that. There is 100 lobbies for the other companies. So that's an uphill battle and I think us as people can do something about it by pressuring our constituents and pressuring our government to pull through with these changes. Otherwise I don't see it happening in a short period.
Dr. Rocio Salas-Whalen:Yeah, I was looking for the link because I found it so interesting and they won so many awards now for this creation.
Dr. Daria Hamrah:Any other suggestions on avoiding hormone disruptors?
Dr. Rocio Salas-Whalen:I mean we talk about organic food right and non-organic, and people say, oh, it's not healthy. But I mean pesticide-free, it's healthier, right.
Dr. Daria Hamrah:Start off with that easy.
Dr. Rocio Salas-Whalen:Start off with that, but that's why that. I mean, I went to a farm one day and the process to not have pesticides in the crops is so detailed and that's why it's so expensive to really it's again, it's cheaper to have the mass production and just swipe them with pesticides, right, but avoid eating the skin of fruits and vegetables, right, because that's where the pesticides morally condense. Buying from your local farms also grass-fed meats, wild-caught fish, those are other things. Nothing that is farm. That's another important thing, because you don't get those hormones for the mass production Pasture-raised poultry, pasture-raised eggs so there's little things that you can do that if you put them together, they impact.
Dr. Daria Hamrah:I know. So thank you so much for that, because I think I feel like, personally, even though I knew a lot of the stuff, I feel so overwhelmed and, um, I wanted to leave it. Leave this conversation on a out, on a positive note, um, and not on a doomsday note, but all of these things we've talked about, they are true. So someone needs to bring awareness to these things. First, we have to acknowledge that issues exist so we can make changes. Right, I mean, we have to talk about it. Like, if we don't talk about it, who's going to talk about it?
Dr. Rocio Salas-Whalen:Exactly, and I think it's not a doom. It's where we are right now as a country, as a, as a in the 2025,. We live in an industry.
Dr. Daria Hamrah:Not just a country, everywhere.
Dr. Rocio Salas-Whalen:We live in an industrialized world, right, we have all this technology, we we're we're living smarter, but it comes with some consequences, right, and I think you having the education about how, how much you can control and what you can control, is our best way to trying to get out of this in a good, in a good way, right, and live healthy.
Dr. Daria Hamrah:And it's empowering. It's empowering, yeah, yes.
Dr. Rocio Salas-Whalen:Yes, yourself, and that's your biggest weapon against food industry and just industrialization of itself. We cannot say, oh, we're victims of our society, of where we live right now. We have some power, and the way that you can control and regain power is with education 100% and to that point kind of like to end our conversation on that note.
Dr. Daria Hamrah:if someone listening to this entire podcast who feels really overwhelmed, ashamed or lost or helpless, what's one thing they can do today to just take back control of their health, Like, where would you have them start? And I know you talk to hundreds of patients and literally give them that advice, but for our audience here, um, what would you say? That one thing would be where they would start I would say three things okay, three things fair one, build muscle.
Dr. Rocio Salas-Whalen:If you build muscle, muscle is an endocrine organ too. It releases hormones, myokines. Muscle is your best anti-inflammatory organ that you have in your body. And if you're building muscle, you're losing body fat. We don't say that by losing body fat, by you losing body fat, you're not gaining muscle. But if you concentrate on one thing, and that's building muscle, you drop body fat. By you losing body fat, you're not gaining muscle. But if you concentrate on one thing, and that's building muscle, you drop body fat. So you're already in a metabolic healthier state, right? Second, get rid of plastics as much as you can, right. And third, educate yourself.
Dr. Daria Hamrah:Thank you. This was, I think. Now it comes down to execution, and I really hope that the audience takes this to heart, and thank you so so, so, so much for sharing your knowledge, your story, your compassion. I feel so much enthusiasm and sincerity and every time you talk, that is inspiring to me as someone that has been on this path for several years now. And for those listening guys, health isn't about perfection, okay. It's about reclaiming control over your life with the tools available to you. And if you've been judged, dismissed or just frustrated with your weight journey, know that science is on our side, you know, and support is out there. And for those of you who are in the New York City area but I know Dr Sal as well and she also does virtual consultations and calls follow her online, share this episode with someone who needs to hear it and we will put her information in the caption below.
Dr. Daria Hamrah:And yeah, until next time. Say, stay curious, stay strong and keep pushing forward. Thank you, rocio. It was such a pleasure to not just get to meet you, but to get infected by your passion for what you're doing, and I can't wait to read your book, and so I hope that it be. I'm pretty certain it will become a bestseller, because I don't think there is any more pressing and important topic than this in our society than it's ever been. So thank you for all you do and keep inspiring our colleagues and keep pushing forward. Thank you, Thank you so much. Thank you so much. All right, guys. I hope you enjoyed this podcast. Please leave me a review so others can benefit from this episode, and also you can on Spotify, leave comments down below and I'll be happy to respond to them. And yes, until next time. Bye-bye, bye.