The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now

#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now

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Summary

Mel Robbins discusses the complex world of weight loss with Dr. Rosio Solless Whan, a leading expert in metabolic health, on her podcast. The episode delves into the multifaceted causes of obesity, stressing that it's not just a result of lifestyle choices but other factors like genetics, hormonal changes, environmental influences, and aging. Dr. Solace Whan emphasizes the significance of GLP-1 medications like Ozempic and their role in assisting weight loss, alongside traditional lifestyle adjustments. The conversation also addresses common misconceptions, the psychological impact of obesity, and the importance of seeking help without shame.

Highlights

Dr. Rosio Solless Whan explains that obesity involves more than lifestyle choices; it's also about genetics, hormones, and environmental factors. 🧠
GLP-1 drugs, such as Ozempic, have been a pivotal development in treating obesity, having originally been used for diabetes. ⚕️
The conversation clears misconceptions about obesity being self-inflicted, shedding light on its nature as a multifaceted disease. 🤔
Mel and Dr. Solace Whan discuss the importance of viewing obesity as seriously as other chronic diseases like diabetes. 📈
Patients using GLP-1 medications experience significant changes, not just in weight but in quality of life, as they think less about food. ✨

Key Takeaways

Obesity is a complex, multifactorial disease, not a personal failure. 🌟
GLP-1 medications are game-changers for weight loss, offering hope and support beyond mere dieting and exercise. 💪
Understanding obesity as a disease similar to diabetes shifts the approach to treatment, focusing on medical solutions alongside lifestyle changes. 🌍
Talking about obesity needs to be done with empathy and understanding, emphasizing that it's not the individual's fault. ❤️
Building muscle and a high-protein diet are crucial when using weight loss medications to maintain overall health. 💡

Overview

In a riveting episode of the Mel Robbins Podcast, Dr. Rosio Solless Whan sheds light on the underlying causes of obesity, transforming the way we perceive weight gain. Rather than viewing it as a personal failure, Dr. Solace Whan emphasizes that it's a chronic disease influenced by a plethora of factors such as genetics, hormones, and socio-economic environments. The insightful discussion urges listeners to shift their mindset and understand the complexity behind the struggle with weight.

The podcast unveils the potential of GLP-1 medications, like Ozempic, as revolutionary tools in the fight against obesity. Initially developed for diabetes, these drugs offer overweight individuals a significant advantage by regulating hunger hormones and altering reward responses to food. Dr. Solace Whan details how these medications, when used correctly, can lead to transformative changes in both physical health and self-perception, freeing patients from the endless cycle of food obsession.

Ultimately, Mel and Dr. Solace Whan call for empathy and change in conversations surrounding weight. By comparing obesity treatment to other medical conditions like diabetes or cancer, they highlight the importance of medical interventions. The episode also discusses practical steps for patients, stressing the significance of building muscle and increasing protein intake to prevent muscle loss during weight loss. Overall, the dialogue empowers those struggling with obesity to seek help without stigma, fostering a broader understanding and compassion for this complex issue.

Chapters

00:00 - 00:30: Introduction to Obesity and Weight Loss Struggles The chapter emphasizes the emotional and psychological impact of obesity and weight loss struggles. It highlights a common experience where individuals feeling overwhelmed with their weight issues often break down emotionally, illustrating how deeply these issues can affect one's mental well-being. The narrative reinforces the idea that seeking help is completely normal and necessary. It criticizes the modern industrial society for fostering an environment conducive to obesity while acknowledging the complexity of obesity-related challenges. Importantly, it reassures individuals that struggling with weight does not signify personal failure but rather humanity, and it presents a sense of hope by acknowledging the availability of support and assistance like never before.
00:30 - 02:00: The Role of GLP1 Medications The chapter discusses GLP1 medications and their significant impact on people's lives. The speaker, Mel Robbins, expresses enthusiasm about the topic and highlights the transformative effects these drugs have had. The chapter begins with a motivational note about healthy lifestyle changes and transitions into the main discussion about GLP1 medications, emphasizing their importance and the excitement around them.
02:00 - 03:30: Meeting Dr. Rosio Solless Whan The chapter titled 'Meeting Dr. Rosio Solless Whan' introduces the audience to the Mel Robbins Podcast. It welcomes new listeners and acknowledges those interested in staying informed about evidence-based health information. The chapter sets the stage for a discussion on weight loss medications that are currently making headlines, highlighting the listener's role as someone who values their health by seeking out reliable information.
03:30 - 06:00: Understanding Obesity As a Disease ### Chapter Title: Understanding Obesity As a Disease In this chapter, the transcript begins with an emphasis on acknowledging the listener for choosing to engage with the content. The initiation suggests that someone who cares about the listener's health has forwarded this material to them. This act of sharing highlights a concern for health and wellness, either for the listener or the sender himself, intending to educate the listener on the measures they're taking regarding their health. The chapter stresses the importance of having access to healthcare professionals who encourage empowerment and provide comprehensive information about health. This empowerment involves a clear understanding of the available medical tools and resources to enhance one's health. The transcript hints at discussing a new class of weight loss solutions, setting the stage for further exploration of obesity as a disease and the innovative treatments available. This sets a framework for understanding obesity within the context of medical advancement and the critical role of informed health choices.
06:00 - 13:00: Factors Contributing to Obesity The chapter discusses medications known as GLP1s, with a focus on Ompic, and features insights from Dr. Rosio Solless Whan, a triple board-certified physician. Dr. Solless Whan provides information on the intended users of these medications, potential risks, and important considerations for those contemplating their use.
13:00 - 20:00: Treating Obesity as a Disease In the chapter titled 'Treating Obesity as a Disease,' a leading expert in metabolic health, who is also the founder of New York endocrinology and a clinical instructor at NYU Langon Hospital, discusses the treatment of obesity. She specializes in treating various endocrine disorders such as diabetes, thyroid issues, osteoporosis, and PCOS, emphasizing prevention and sustainable solutions to chronic health challenges. The chapter is particularly relevant for individuals struggling with weight or knowing someone who does.
20:00 - 28:00: Exploring the History and Function of GLP1 Exploring the History and Function of GLP1 must listen and it is a fantastic resource featuring Dr. Sus Whan on the Mel Robbins podcast. The conversation is aimed at empowering listeners.
28:00 - 36:00: Who Benefits from GLP1? This chapter introduces the complexity of obesity and weight gain, emphasizing that these issues are not straightforward. The speaker expresses excitement about the opportunity to share insights that could potentially transform the lives of the listeners or their loved ones. The focus is on the impact of taking the forthcoming teachings into account and integrating them into one's life to effect change.
36:00 - 50:00: Risks and Considerations of GLP1 The chapter discusses the idea that weight loss should not dominate one's life, whether mentally or physically. It proposes that a state where weight loss isn't all-consuming is achievable and within reach, challenging common perceptions.
50:00 - 53:00: Conclusion and Empowerment This chapter discusses the liberation one can feel by not being consumed by concerns over weight, body image, or health perceptions. It highlights the societal shame associated with body image and emphasizes the empowerment that comes with overcoming these concerns. The speaker reflects on learning these lessons through patient interactions rather than formal medical training.

#1 Weight Loss Doctor: The Truth About Obesity, Ozempic, Dieting, & How to Feel Better Now Transcription

00:00 - 00:30 I've had grown men in my office cry when they hear this for the first time. Weight loss should not consume your life mentally or physically. It's okay to receive help. We live in an industrialized world that really promotes obesity. Obesity waking is complex. Doesn't make you a failure. It means that you are human. For the first time, we actually have help beyond
00:30 - 01:00 exercise more and eat less. Wow. I would love to have you talk about the GLP1 medications. I've seen people's lives change. The most important finding of this drug. Hey, it's your friend Mel and welcome to the Mel Robbins podcast. I am so excited that you're here. I am so excited to learn about our topic today. And you know, I just got to say it is such an honor to spend time with you.
01:00 - 01:30 It's an honor to be together. If you're a new listener, I want to take a moment and welcome you to the Mel Robbins Podcast family. And because you made the time to listen to this particular episode and learn more about this particular topic, here's what I know. I know you're the kind of person who values your health and you're looking for evidencebased information. And today you're going to get it because we're talking about the weight loss medications that are all over the headlines. And if someone that you love
01:30 - 02:00 sent this to you, well, first I want to acknowledge you for choosing to hit play because the fact that they sent this to you means that they deeply care about you and your health or they care about their health and want you to learn more about what they're doing. And you deserve to have great health. And you also deserve access to doctors who really care about you being empowered and informed about your health and that you really understand the tools that are available to you. Now, you may have heard of this new class of weight loss
02:00 - 02:30 medications called GLP1s. The most well-known one is Ompic. And today, I brought in a world-renowned expert, Dr. Rosio Solless Whan, to break down the truth about these medications. Who are they for? What are the risks? And what do you or someone you love need to know if you're considering using them? Dr. Solace Whan is a triple boardcertified physician in endocrinology, obesity medicine, and internal medicine. She's a
02:30 - 03:00 leading expert in metabolic health, the founder of New York endocrinology, and a clinical instructor at NYU Langon Hospital. She specializes in treating a wide range of endocrine disorders including diabetes, thyroid disorders, osteoporosis, and PCOS. Her approach is all about prevention and sustainable solutions to chronic health challenges. So, if you've ever struggled with your weight or you have a friend or a loved one who has or is, this episode is a
03:00 - 03:30 must listen and it is a fantastic free resource with a world-renowned medical expert that could change your life. Dr. Sus Whan, welcome to the Mel Robbins podcast. Thank you so much for having me. Well, I am so glad that you're here and I know that by the time we're done with this conversation today that the person who's listening and the people that they care about are going to feel empowered and excited. At least that's
03:30 - 04:00 what I feel. It's why I'm so excited that you're here. But I'd love to start by having you speak to the person who has hit play and is here with us right now and just explain to them what might change about their life or their loved ones life if they truly take everything into account that you're about to teach us today and they put it to use in their life. That obesity, that waking gain is complex. It's not as straight line as we
04:00 - 04:30 used to think. And that most importantly that weight loss should not be a full-time job. Weight loss should not consume your life mentally or physically. Wait, there's actually a world where that is true. It exists. It is possible and reachable. Wow. Um I mean that's not what I thought you were going to say. That is an amazing just thought to think that your
04:30 - 05:00 life could you could actually experience life and not be consumed by your weight, your body, your health, what you think people are thinking, what you think about how you feel about your body because there's just so much shame around how people think about the way that they look or their metabolism or their size. And so I I think that's extraordinary. Yeah. And I learned this through my patients and not in my medical training. I learned
05:00 - 05:30 through my patients how they I've seen how they struggle through decades for many. I have patients all ranges of age. I have from teenagers to 70 80 year old patients. how they've struggled through since childhood for many of them and it consumes their life and every plate in front of them could be causing guilt, anxiety, shame and this is 24/7, 7 days a week, 365 days in a year. Well, I'm so
05:30 - 06:00 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. Solace Wellin, 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 uh training and expertise. I am originally from Mexico and that's where
06:00 - 06:30 I studied medicine. Uh medical 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 9 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
06:30 - 07:00 connected and originally endocrinology takes over what's metabolism and obesity. But we've learned that obesity is complex and it requires your own specialty just to be solely dedicated for obesity and endocrinology is the management of hormones and yes hormones impact weight. 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
07:00 - 07:30 the disease of obesity. What do you want them to hear from you, Dr. Solace Whan? I want to say that I'm sorry in behalf of the healthc care providers. We didn't know better and we fail you. And I've learned this. I've been humbled by my patients. I I've learn and hear
07:30 - 08:00 their stories and we got it wrong. We got it all wrong. But there is help. We're learning more. We're We Science advances like everything, right? Medicine is an evolving uh science. Um, 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
08:00 - 08:30 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. Breast cancer. You have more risk of developing breast cancer than alcohol, hormone replacement therapy or
08:30 - 09:00 genetics. It's obesity. Obesity is the number one cause of pancreatic cancer, colon cancer, prostate cancer, thyroid cancer. the number one cause, the highest risk for developing. Yes. Wow. So, by reducing obesity, by treating obesity, we are going to have less chronic diseases. We've built specialists. We created medical specialties from the complications of
09:00 - 09:30 obesity. So, we will have less diabetes, less hypertension, less cardiovascular disease. If we treat obesity now, we will have less less incidence of the cancers that I mentioned. 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.
09:30 - 10:00 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 met 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
10:00 - 10:30 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
10:30 - 11:00 because you as a non-medical professional have felt like that judging and assuming we as a health care providers as doctors we did the same right when patients were coming to us for help. Yeah. And to play de devil's advocate, we didn't have the training. We didn't have the knowledge, right, that obesity is not a self-inflicted disease. Okay, hold on. I want to make
11:00 - 11:30 sure that we did we do not skip over what you just said. Obesity is not a self-inflicted disease. I want to unpack that because I 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 multiffactorial chronic disease. And I'll go I'll deconstruct that. Multiffactorial meaning that there's more than one cause leading to somebody
11:30 - 12:00 to struggle with weight or have obesity. I like to break them into big five pieces. One, lifestyle, exercise, sedenturism, diet, but that's one piece of the five. Okay. The other one is genetics. Right? You can have a genetic mutation but also it can run in the family. So there's two it's two different right. Gotcha. Okay. Um then the third one hormonal changes. We have PCOS, per menopause, menopause in women. Then we have aging that's unchangeable.
12:00 - 12:30 Nothing that we can do about it yet. Um 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 uh 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
12:30 - 13:00 where people have to drive everywhere or even working from home now right so there's less uh opportunities to being active that leads to more sedentary ISM. So we call that obesogenic factors, things that promote obesity in how we live. Also we can talk about endocrine disrupting chemicals like BPA, what's found in plastics, pesticides, right? We live in a industrialized world that
13:00 - 13:30 really promotes obesity. So if you think of all those five factors and you think of what the patient has control pretty much only on one, right? where we're talking about lifestyle, exercise, and eating healthy. And before or when we do that, we tried or we put a lot of pressure on the patient to overcome all the other factors that are not in their control. Let's talk about genetics. We know now there's re research showing
13:30 - 14:00 that the parents preconception weight can impact the weight of the in offspring of of their child. Wait. So the parents preconception weight, so the weight that your parents were when you were conceived, genetically speaking, research has proven has an impact on your genetics in terms of your weight. Yes. And so, and not and and I I even want to go a layer deeper because I'm going to raise my hand and go right on
14:00 - 14:30 the record and say that for most of my life, I was one of those people that had this topic completely wrong. I was the kind of person that did not understand anything that you were just explaining and I just assumed it's lifestyle choices. Mhm. And when you really just listen and absorb what you just said, lifestyle, genetics, hormone changes, aging, environmental factors, environmental factors are like just I
14:30 - 15:00 mean, when you look at like the food industry and how it changes people's ability to process food and all the crap that's put into it. Yeah. Not having accessible safe walking areas, working from home, and being sedentary. And then now you're talking about I I don't I this word was too big for me to write down. It was like endro something destructible but that but it was the things that are actually impacting your body's metabolism that are in the environment. And forever we have just looked at somebody who struggled with
15:00 - 15:30 being overweight or who struggled with the disease of obesity and we're like oh you're lazy or oh you're not doing enough. And so I can see how understanding these five factors changes the game entirely. And the big thing that I'm hearing when you said we live in a world that is almost promoting. It's not even promoting. It's it's it's causing this disease, which means it's not your fault.
15:30 - 16:00 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 left live 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
16:00 - 16:30 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
16:30 - 17:00 choices that you make. But you are still fighting against genetics, hormone changes, aging, and environmental factors. So that's 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 going to kind of go deeper in this, but
17:00 - 17:30 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 overweight with being overweight. Definitely. So, when we talk about genetics, we're talking about family history, right? Um 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. If
17:30 - 18:00 they eat consume highly palatable food, that can be transmitted to you. What's palatable food mean? Food, processed food or processed food that will lead to wanting to consume more, right? Um then when we talk about also there's some uh mutations that may also cause obesity, right? Um and then when we talk about hormonal so it through a person's life there could be hormonal changes shifts imbalances that is going to promote
18:00 - 18:30 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 resistant and this promotes visceral fat visceral fat promotes insulin resistant insulin anemia and it goes into a vicious cycle we also talk about pmenopause And menopause with the changes, the 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
18:30 - 19:00 breasts goes intraabdominally. This visceral fat promotes insulin resistant and then you go into that vicious cycle again. Also, because of the drop of estrogen, we see a decrease in lean muscle mass. Muscle mass is your burning calorie machine. If you lose it, then your metabolism slows down. Then we go into aging. Aging also as we age we tend to lose muscle mass. It's harder to build muscle and also it promotes waking. And then we go into
19:00 - 19:30 environmental factors. As we talk the food industry, um industrialization, plastic, pesticides, all of those things disrupt your endocrine system. They we call them endocrine disrupting chemicals because they disrupt the function the normal function of your hormones. They mimic your hormones. So they occupy the receptors where your hormones should go and do a function and this can promote obesity and fertility. So they're real
19:30 - 20:00 things that are impacting people's life on the dayto-day basis. What I love about what you're sharing is that if there are five factors that are present and that cause the disease of obesity, I would imagine that you as a medical doctor now are able to help a patient in a very different way. And so given that obesity is now classified as a chronic
20:00 - 20:30 disease, how does that change the way that you treat patients and the various kind of tools that you have at your disposal to empower somebody? Well, knowing this and and understanding this, you move away of putting the pressure on the patient, right? you move away of being a one participant in this equation. It goes more into a team, right? And and what you can do for the patient and educating the patient, it
20:30 - 21:00 becomes a team. Let's talk about as an example, diabetes, type 2 diabetes. We know it's a chronic multiffactorial disease, but we have no trouble prescribing and treating medications for it, right? It's widely accepted from the patient side, from the physician side. Let's talk about hypertension. Same thing, right? We know that lifestyle can help it or make it worse, but that is not causing the disease. Therefore, we feel comfortable treating it and the
21:00 - 21:30 patients accepting treatment. And when we provide treatment for type 2 diabetes, hypertension, high cholesterol, we always talk about eating healthier and exercising, but it doesn't replace the treatment. So if we see obesity as a disease, we can act the same way, understand and support the patient in their lifestyle, but also provide a medical treatment because there are four factors outside of your control that you've just unpacked. Genetics, hormone changes, aging, and all the environmental factors largely
21:30 - 22:00 because of big farming and industrialized food and all the crap that they put in it that's screwing up and confusing your body's ability to process food. and I'm breaking them in big five umbrella but also there's other things like medications that patients may take for certain particular disease that can promote waking right there's a lot of anti-depressants that can promote waking uh blood pressure medications that can promote waking right and many times there's not other option for the patient and this can also lead to
22:00 - 22:30 obesity so I would love to have you talk about the GLP1 medications because I didn't realize I didn't realize they'd been around for decades. I I had no idea. I I I've seen them in the headlines. They're all over the place. I have like many people I have uh people in my life that are taking them and they're they're life-changing, but I didn't realize that they've been around for a long time. So, could you talk to
22:30 - 23:00 us about what they are, how long they've been around, like when you first started using them in your clinical practice? Definitely. The first FDA approved GLP-1 was in 2005. 2005? Yes. What? 20 years now. 20 years. Yes. The FDA name it was by Eli Lely. It was called Bayetta. And this was a twice a day subcutaneous injection. So it was a daily twice a day
23:00 - 23:30 injection that patients had to do. Okay. Okay. And the first indication was for type 2 diabetes because GLP1 is a hormone. What does GLP1 stand for? Glucagon like peptide. And this a peptide or a hormone. Um, is that what the word peptide means? Hormone. No, peptide is what we call a short chain of amino acids. Okay. A long chain of amino acid is a protein. So before protein,
23:30 - 24:00 it's a peptide. Okay. 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 is isolated this uh the GLP1 outside the human body. It was in a lizard called the the G the Gila monster. Um and the lizard the venom of this lizard caused pancreatitis on its victims. So Dr. Ang
24:00 - 24:30 John Ang being an endocrinologist in researcher at the BA hospital in the Bronx wonder what in the benom affected the pancreas. Okay. And he isolated uh GLP1. So this little gila lizard bites its like prey or whatever and the venom of it sends activates the pancreas and puts the thing into like a state of diabetic shock. It causes pancreatitis. So the the prey dies from pancreatitis. What?
24:30 - 25:00 So so what exactly does the GLP1 do to the pancreas? So it it stimulates to produce insulin. The problem in type 2 diabetes uh 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, uh your pancreas produces insulin, but with time it overworks.
25:00 - 25:30 Your body stops responding the same way to the insulin that you make. So you become resistant to your own insulin. The pancreas in response tries to overcompensate and make more insulin, but your your body is resistant to it. So you have hyperinsulinemia and insulin resistance. So these are the two main pathologic factors that lead to somebody to develop type 2 diabetes. And how does this connect to somebody who is
25:30 - 26:00 struggling with being overweight or somebody who's struggling with the disease of obesity. And this is the beauty of medicine, right? When one thing is made or developed for a particular disease or reason, we find out later that it has other benefits like this, like GLP-1. I didn't realize that a spike in insulin means you're also going to crave more food. Which then means that if you're the kind of person that has either environmental
26:00 - 26:30 factors where you're eating a ton of processed food that never fills you up and is just full of stuff that spikes your insulin, that is going to become part of the cycle that you're on without even realizing that you're now trapped in this cycle and it's not your fault. Exactly. Wow. So, what have you seen in the last 15 years since you've been using GLP1s as a tool in your medical practice? What have you seen in terms of
26:30 - 27:00 the benefit to patients, how this is used as a tool, the difference that it makes? Um, I've seen people's change, people's lives change. Um, I've seen more acceptance to the medication. Um the drugs are becoming uh safer, less side effects. I like to compare them with the iPhone. We have different versions of the iPhone, right? We have the iPhone 1, the iPhone 10, uh and now we have the iPhone 16.
27:00 - 27:30 Same is happening with this class of drugs. The versions are newer, safer, less side effects, and more effective. M so I I feel like people are getting the message one or accepting the message that obesity is a disease. They feel like giving up. For many patients, I'm the last stop of their journey. And when I talk about a journey, I'm talking decades of journey.
27:30 - 28:00 I'm talking about diets that I've doing diets that I've never even heard about. I always learn about a new diet from my patients. being with nutritionists, being in fat camps that they call them. Um, so it I've seen patients struggle through their life and how this medication are changing their lives and giving them um their life back basically. If these drugs have been around for 20
28:00 - 28:30 years, at least in terms of a specific treatment for type 2 diabetes, why is it that we're all just hearing about it now? First of all, the initial versions of this drug, they cause more side effects and they were more cumbersome for somebody. People had to inject themselves twice a day every day. So even for many patients with type two diabetes, it was hard to accept because patients with diabetes, they think and feel that once they're on insulin, they're failed, right? Or it is
28:30 - 29:00 just more severe. So having a medication that is injectable, it was a hard to dissociate them with with insulin. Got it. Or with failure. So they basically be like, I might as well just be injecting insulin at this point. So patients didn't didn't like to inject themselves and it was a twice a day injection and there were a lot of nausea. So it was harder to tolerate back then. So and and just so I remember cuz it's already flown out of my brain that how it works is that it stimulates your pancreas for type 2 diabetes. Yes,
29:00 - 29:30 it stimulates your pancreas to make more insulin when your sugar goes above normal. Okay. 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
29:30 - 30:00 treating type 2 diabetes. So what has happened in the last 15 years? Again, as with any drug we see, we we have off label uses. And what we were what was happening is what when we started somebody with type two 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
30:00 - 30:30 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 or like it actually makes you gain weight. Yes, that does not seem fair. It does not. It is not. But that's all we had. Okay. Back then. So 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
30:30 - 31:00 you're like, "Holy cow, we're seeing weight loss." which is fantastic for people. It is fantastic especially for type two 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 the 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
31:00 - 31:30 with being overweight? since 2010. So you're like a pioneer in this. Yes. Wow. And when did all these studies start to happen? They started back in 200 So I mean even for 2005 for the for the FDA approval is they're starting in the '90s right with the first one. But in regards for weight loss it starting around 2005 2006. Gotcha. And then the first one approved for weight loss was in 2012 named Saxenda. Also a daily injection.
31:30 - 32:00 So we moved from the twice a day injection to the once a day injection but still severe side effects. We were 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 this drugs which is OMIC that was when it was approved for type 2 diabetes. In 2021, OAMP become became also approved FDA approved for weight loss independent
32:00 - 32:30 of diabetes and then rename it as WGOI. Wait. Oh, wait. WGO and Ompic are the same thing. It's the same drug. Yeah. When a GLP1 gets approved initially for type 2 diabetes and then eventually gets approved separate exclusively for weight loss, they they rebranded. They just changed the name, but it's the same drug, same pharmaceutical, same. brand 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
32:30 - 33:00 is for diabetes and also for insurance purposes, right? Got it. Insurance will approve one drug for type two 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 does the GLP1 work to help somebody lose weight or to change their metabolism if they don't have diabetes? GLP1, I like to explain to my patients, target the two reasons that humans eat. We eat for fuel, survival, and we eat
33:00 - 33:30 also for reward, for a reward. Okay? 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
33:30 - 34:00 patients, it looks like two small meals a day feeling physically content. That's for the survival part. Now for the reward part, we have receptors for this hormone in our brain in the hedonistic eating and drinking area of our brain where we anticipate or associate our reward either with food or beverages like alcohol and it blocks that reward response. So let's say if somebody's anticipating having a meal
34:00 - 34:30 that they know is going to relief or a certain reward once you're on this medications, you see that meal and you don't get the same feedback. So the behavior change you you enjoy your food when you're hungry and eating. Once you're full and satisfied, it's out of your mind. Wow. And it doesn't touch the pancreas. It doesn't touch your pancreas if your glucose is normal. Wow. So, you know, one of the things that I see that I know a lot of people see, and
34:30 - 35:00 this is sort of like the also could be more shaming, but you see, you know, celebrities who want to lose an extra 15 pounds or you see the Ombic face, you know, all over social media. And I'm just curious what your opinion is about who these medications are for and when you're a candidate and when you may not be. First, I think we need to backtrack a little bit before I before we dive into that answer. Sure. We as a society
35:00 - 35:30 tend to associate being thin as being healthy. So, whenever we see somebody that you can think they're slim, they're they're they're thin, they they don't need this medication, we're assuming that they're healthy. Y that they're metabolically healthy. Yep. But we don't know by just looking at somebody, right? when I do body compositions on my patients and this should be done on every patient and basically I I would say even patients that don't need weight
35:30 - 36:00 loss medications just to know what's your your body composition because whenever we're talking about weight loss we're really talking about fat loss right we're not talking about a a bulk number we're talking specifically we want to reduce what can cause disease or increase your risk of disease which is fat not muscle so by doing a body composition We can see what's the percentage of somebody, right? What's their visceral fat and what's the muscle mass? So many patients that we may see
36:00 - 36:30 slim or thin, they could be what we call a skinny fat or psychopenic obesity that they may have a very low muscle mass and high body fat. They're still at risk of disease. They're still in a pro-inflammatory chronic state, right? there can still develop type 2 diabetes or even be a risk of developing cancer. So just by looking at somebody we cannot say what the body composition is and what they need or don't need to lose.
36:30 - 37:00 Got it? Right. So we first need to stop associating thinness with health. Many times when I see patients that think they need to lose 10 lbs or or 5 lbs, when we do a body composition, surprise surprise, they actually have to lose 20 or 25 because they're under muscle, right? So to really say who needs this medication or not, we cannot assume by looking at somebody that they do or they do not. We need to do body
37:00 - 37:30 composition on on any on anybody who thinks who needs to be on this medication to really know if they will benefit or not. How do you do body composition? So we have machines, right? So the gold standard for a body composition is an MRI, but we're not going to do MRI on every patient on every visit. The second uh is uh DEXA. Uh and then the third which is the more accessible is body impedance also known as inbody. There's different versions of it. So those are the ones that are more
37:30 - 38:00 easy accessible and they offer no radiation to the patient and we do body compositions on initial visit and every visit when somebody starts on a weight loss journey. So you know do you see a lot of people coming in that want to try these drugs to lose an extra 10 pounds? No. Most patients that come is because they need them and because they've they've done their work and it's just not working. It's just not happening. If
38:00 - 38:30 someone comes to you, Dr. Solace Whan, and they're looking to be put on or prescribed one of these medications, what are some of the questions that you ask them to assess whether or not the medication is a good fit? So, first starting with a very thorough weight history. M so I need to know at what age were they conscious about their weight at what age were they uh trying or uh being consciously about they eat or or they were told they need to lose weight
38:30 - 39:00 for many patients they tell me nine 10 also I need to know their medical history are there are there uh coorbidities that can contribute to obesity or medications that they're taking that can contribute to obesity then I go into a deep family history I need to know up I need to know up to two generations before. What was your parents, your grandparents weight, your uncle's weight? If they have children, how is your children's weight? I need to see if there's a a familial factor contributing to obesity. And then I look
39:00 - 39:30 at their gynecological history, right? Are they in perimemenopause, menopause, do they have PCOS? And then we move to the physical exam. And in that also there's we do the body composition. And there we can really target what is it that need to be improved or doesn't. 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
39:30 - 40:00 18 to 28%. In men is 10 to 20%. So anything above those numbers we either fall in the overweight range or in the obesity range. Dr. Solace Whan, is there a benefit to using a GLP-1 during menopause? Definitely. What we see in pmenopause 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
40:00 - 40:30 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 pmenopause 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. everything. I used
40:30 - 41:00 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 GLP1s have a huge place uh for patients that need or that have gained weight during pmenopause 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
41:00 - 41:30 not be taking this medication? The only absolute contraindication that we have for this medication is a personal or firstdegree family history of medelary thyroid carcinoma which is a very rare and aggressive type of cancer. Now if somebody has other versions of type of thyroid cancer papillary follicular that's not a contra indication exclusively medary thyroid carcinoma above that patients that are pregnant
41:30 - 42:00 and breastfeeding is not recommended you know when one of my family members was considering going on this medication the concern was well am I going to have to take this for life like is this something that you take for the rest of your life or is it something you take for a period of time and then once you sort of rewire your cravings and how full you are that it's just like that that sticks or how does this work? So, we have to remember what is obesity, right? What causes a patient to require
42:00 - 42:30 this medication? It's a chronic multiffactorial disease, right? So if we assume that we can use this medication to take them to a goal and then we stop it, we didn't fix, we didn't cure the other things, the familial history, the genetics, the hormonal changes, the aging, the environmental factors, those factors are still there. Chronic diseases we don't cure, we control. So that's why this medications were designed to be used longterm.
42:30 - 43:00 Now that can change if somebody has history of obesity since childhood in their in their midlife or or later decades of their life then most likely they will require this medication long term. But if it's somebody as an example uh who gain weight after pregnancy and hit midlife and they gain 30 lbs but they never struggle with their weight then maybe those patients will not need them to use them long term. Huh. That's interesting. But you have this patient
43:00 - 43:30 that had children in late in life. They and then they hit midlife. Then yes, they they they didn't struggle with weight in the past, but now their their surrounding is not going to be helpful for them to maintain the weight loss. So they may benefit from long-term use. Do you have any personal experience yourself or with, you know, a family member using this medication? Yes, I have a very personal family member myself. Um, I used this medication after
43:30 - 44:00 I had my kids. I didn't struggle with weight growing up. I always used to lift weight since my early 20s. I fell in love with weightlifting, but I had my children late in life. I had my first one at 38 and my second at 39. After that, I hit my 40s. I started with pmenopause. So what I was doing before it didn't help me. I ended up with 30 lbs that I
44:00 - 44:30 couldn't lose. I used the medication. I used for 6 months. I got back to my weight and I have not needed it since then. I retake 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. Mhm. What was it like after practicing obesity medicine to come to a point in your life
44:30 - 45:00 where you're like, "Okay, I'm going to try the GLP1 myself because I got pregnant in life. Now I'm pmenopause. 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? I wouldn't say I resisted it. Um I was waiting basically um to see if if it would change. Um but I think after you
45:00 - 45:30 know the first two years of of kids is I mean you really have to give yourself some credit and allow yourself some room to not wait about 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 saw that I was not losing weight. I couldn't lose
45:30 - 46:00 the weight anymore by doing what I was doing. And I was in my early 40s. My mom had an early menopause. So, I knew I was going to go through this transition earlier than than not. Um, so I knew that I had to do something different before besides what I was doing. And this is what I preach, this is what I do, this is what I see. Um, so I use the medication. How did using the medication yourself change how you practice obesity medicine?
46:00 - 46:30 Well, I was able to relate more with the patients. And when I tell them this is how you're going to feel, this is what you should expect, I was telling it from my own personal experience. 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
46:30 - 47:00 possible side effects and what to do about it and definitely to be more empathetic. Beautiful. How old were you in that hab? How long ago was that? Uh I was 42. So 7 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? I like did you even as a as a worldrenowned doctor practicing obesity medicine, did
47:00 - 47:30 you shame yourself at that moment before you went on the medication? No. I mean because I I I I know what causes waking. I knew in what place I was in my life. Um, and I knew that I didn't want to exhaust every other possible situation that at the end was not going to help me. Uh, I'm a very proactive person uh, 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
47:30 - 48:00 yourself and we can learn from you. That everything that you're sharing with us today is empowering you to go, "This isn't 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. So, Dr. Solace Whan, here's where I want to go next. What are the risks of taking these medications? So, as with any diet or
48:00 - 48:30 anything that causes a restricted caloric intake or decreases how many calories you're going to eat, there's always the risk of muscle loss, right? Because it it's hard to just exclusively lose body fat without lowering muscle mass. Yeah. So, one of the risk of using this medication is muscle loss. And there's no direct effect of the drug towards the muscle mass. It's an
48:30 - 49:00 indirect effect of you eating less that you may lose muscle. Got it. So the drug's not causing you to lose muscle. The fact that you're eating less means you have less protein going into your body which might have you lose muscle. Yes. Got it. But it's not a death sentence. So by informing the patient and teaching them about what is it that they need to consume while they're they are on this treatment can prevent muscle
49:00 - 49:30 loss and even gain muscle for those that need to gain muscle. If someone is taking one of the GLP1s, how do you do that with your lifestyle and diet? And before we go into that, I just want to explain why we're talking about muscle. Why it's so important muscle is not because we want to see all people booked up and and Arnold Schwasher like right muscle is your biggest metabolic organ. What does that mean? Is your calorie
49:30 - 50:00 burning machine. Muscles muscle muscles burning calories. Muscles burn calories and muscle regulate your glucose because every time a muscle contracts is physically being used, it sucks sugar from the bloodstream to provide its energy. Wait a minute. Is that why taking a walk after you eat is like a really good thing to do for your glucose? Yes. Wow. Okay. So, you have to pay attention to muscles in general. We
50:00 - 50:30 all do. But if you are going to take a GLP1, really understanding the role that your muscles play Yeah. in glucose and in your overall health is a critical piece of this. Yeah. Whenever we hear, oh, if you lose weight, your metabolism slows down. One of the reason is because you lose muscle along the way and that slowing your metabolism. You're burning less calories. And I see that all the time with body compositions. When patients lose muscle, they don't lose
50:30 - 51:00 significant amount of fat. They they it's harder for them to lose fat. When patients maintain muscle or gain mus gain muscle while on this medications, the body fat drops rapidly and significantly. So really your muscle is going to determine how you lose the body fat. And that's why we need to have that conversation of muscle on day one on your first appointment. your doctor needs to discuss with you what exercise you should be doing, which is strength training, hitting the the the weights
51:00 - 51:30 and increasing your protein in your diet because you can lift as heavy as anybody and you will still lose muscle if the protein is not there. Okay. So, doc, you just said you got to be lifting weights and you've got to be eating more protein. Exactly. Is there a standard formula that you give to your patients? one gram of protein per pound for ideal body weight. That's what they should aim. So, I I would say the sweet spot that I've seen for most patients is
51:30 - 52:00 between 90 to 100 g of protein a day, which without a weight loss medication, without a medication that is suppressing your appetite is hard enough to eat that amount. 90 to 120 lbs is awfully skinny. Like, I thought you were going to be like 150 to 200 gram of protein. It's I mean it's very hard to to it becomes mission impossible when you're giving somebody a medication to suppress their appetite. Oh, that's true. But then you want them to eat 100 and more grams of protein, right? So we have to find a a medium point to patients to not lose
52:00 - 52:30 muscle and that's around 100 grams of protein a day in their diet. Got it. And then how often do you tell patients at a minimum they should be lifting weights? I would say with twice a week they should feel they should feel happy with it. Twice a week we can one one day upper body, one day lower body. I love a formula that I actually feel like I could actually achieve. But I would say for for many patients at the beginning my main main is baby steps, right? Baby
52:30 - 53:00 steps. If I want them to do one thing is to increase their protein in their diet because at least with increasing the protein in their diet they won't lose muscle. Mhm. Then we can once the patient starts losing weight feels a little bit more stimulated or more encouraged or physically able then we could start incorporating exercise. You know I see this term all over social media ombic face. What is that? And why do people think that a GLP-1 changes
53:00 - 53:30 somebody's face? Well, it's not the GLP-1 is the drop of rapid weight loss or significant weight loss. And why is this? Because of not eating enough protein. So, as you lose, if you're losing muscle because you're not don't have enough protein in your diet while on this medication, you're not only going to lose muscle, you're going to lose hair. You're going to lose elasticity in your skin because we need protein to make collagen, elastin, right? Also, you need muscle to fill the
53:30 - 54:00 gaps of the fat loss, right? The goal here is not skinny. It's strong, is fit, right? So, you need to fill those pockets with muscle. Now, if you're not losing muscle by increasing your protein intake, then you're going to make enough collagen, you're losing weight slowly, so you're allowing your skin to adapt to the changes. But if you lose weight
54:00 - 54:30 rapidly, it means that you're also losing muscle. It means that you're not don't have enough protein in your diet, so you're not making collagen and elastin. What about some of the things that I've had at least friends report? I had one friend just talk about the constant indigestion and I also had a friend uh say that he was warned about suicidal ideiation. What can you tell us about those two um uh side effects? So, I'm going to there's a phrase that I use a
54:30 - 55:00 lot and I I'm going to repeat it until until I don't have to. But the efficacy and the safety of this medication is going to depend on the expertise on who is prescribing it to you. What does that mean? That means don't go to a med spa. Yes. It means that it's a medication. It's a medical treatment. Um, and you need medical supervision to decrease
55:00 - 55:30 side effects and to achieve weight loss to have the most uh results from this medication. Right. I've personally have never had to stop the medication for any of those symptoms that you mentioned. Um, it's very important to take the time to explain to the patient. You need for to have this conversation to talk about weight with a patient. You need time. It's very hard to have such a vulnerable
55:30 - 56:00 conversation with somebody in 15 minutes, let alone then explain to them about medications and how they work. You need to build trust, right? And you can only achieve that if you take your time to talk to a patient. And that's one of the reasons that I decided to do private practice is because I knew I could offer more patients if I had the time. Yeah. To decrease the possibility of side
56:00 - 56:30 effects, you really need to make your research. Do your research. Do do diligence before you go to somebody to get this medication and they should be a medical doctor. Ideally, they should be a medical doctor, but it could be a nurse practitioner. It could be a PA that they're they specialize in obesity. And is there a kind of ramping up on this that also is something that should be done so that you're being medically supervised to see how your body and your brain tolerates this? Yes. So every
56:30 - 57:00 patient should come into a visit every 8 to 10 weeks when they are taking this medications. Right. Because to see if it's working, what's not working, how is your muscle mass, are you losing mass? Do we need to slow down the medication? and do we need to decrease for the greater good of muscle. So there's every patient is individual and we try to adjust their lifestyle but we need to see those frequent visits to see where the patient is right are they tolerating
57:00 - 57:30 it can we go up do we need to go up or do we need to come down on the dose well you know as we were researching this conversation and digging into all kinds of information that we wanted to ask you of course the phone is listening and next thing you know I am getting served up on my phone non-stop ads for GLP1 mail order. And it gave me a pause because of the friends and family that
57:30 - 58:00 have gone to a medical doctor and who are seeing results or just starting this, even the ones that have had some symptoms, the doctors are all over it and they're monitoring it. Like, I didn't even know that you take a shot once a week. Like I had no idea whether this was a pill or how it actually works. But it did give me a lot of concern to see that there's a lot of companies whether they're licensed or not out there marketing that you can mail order a GLP1. What should you look for in terms
58:00 - 58:30 of investigating a practitioner or provider if this is a tool that you want to look into for yourself or a family member? So the first thing to look is that we as medical doctors, we don't sell FDA approved medications in our offices. We we send a prescription to your local pharmacy. It could be a commercial pharmacy, but we don't sell it in our office. If you encounter
58:30 - 59:00 somebody who does, they're not they're selling you the compounded version. Right? Also, many of those med spas or mail order mail order or tele medicine platforms, what they're offering you is the compounded version of the drug. What's the difference between that and the FDA approved prescribed one? The FDA approved medications are evidence-based. They're from the clinical trials. They're heavily heavily regulated. For an a drug to be FDA approved, they
59:00 - 59:30 sometimes have to uh show 10 years of research, right, efficacy and safety to get FDA approval. Compounded medications are not regulated. They're not FDA approved. So many times what you're getting it may not be exactly what they're promising, right? Many times they put fillers on the medications. Um, so safety should always be above
59:30 - 60:00 anything. Granted, this medications, the FDA versions are expensive, right? But I always tell people safety should not be jeopardized by cost. And second, because there's always the risk of self administrating more medication. Oh, the current FDA versions, they're predos pens. So, there's no way that a patient can inject themsel more or less
60:00 - 60:30 with the compounded medications. And what we've seen and their studies showing that that most of the hospital visits for severe side effects of GLP1s are from compounded medications from overdosing. So you leave it to the patient many times to figure it out the dosing or to run the risk of underdose or overdose right and this can lead to severe side effects. That makes a lot of sense. Dr.
60:30 - 61:00 Salis whalen what's your opinion of micro doing these medications for people who don't necessarily need to lose weight but they just kind of want to. Okay. So we have to understand how a medication or how the doses are recommended. Right? Medications go through clinical trials, clinical studies where many doses are tried. Then we reach a therapeutic dose which is a
61:00 - 61:30 dose that exerts an effect. That's what we call therapeutic doses. That's what when medication is approved, they come with therapeeric doses. If we think about micro doing or using less amount of the actual therapeutic dose, well, we're not going to get the the effects that the drug was designed for, right? Number one. Second, if you do need this medication and you have obesity, then you need the therapeutic
61:30 - 62:00 doses, not the soup therapeutic doses. Now, the other thinking is, well, I don't need to lose weight. I just want the positive effects of the medication. Well, if you don't need to lose weight, then if if you are already in a healthy metabolic weight, then you don't need the you're already getting the benefits, right? You're already just by being fit, you have that. You don't need another medication. And third, the problem with micro doing is that it's based on compounded medication. Oh, currently the
62:00 - 62:30 FDA approved drug, they come pre-dose. So there's no an easy way to give yourself a lower dose. It's a single use pen for most of them pre-dose. So you cannot really play around with the dosing. Now, what Eli Lely came with the bile of the lowest dose that may potentially have a use for patients that reach a healthy weight goal that don't require
62:30 - 63:00 higher doses that can maintain a weight with a small dose then we can do a lower dose. But currently we only have tepatide in a bile. Right. Got it. Another reason of the micro doing was to avoid the side effects that people were having. Oh, the nausea. What are the big side effects? The problem with those side effects were that they were initially created by people using compounded medication and that didn't have expertise on that on that. So,
63:00 - 63:30 their thinking was well maybe if you use less you'll have less of the side effects, but that's not a problem of of the actual drug of itself, right? It's an actual of problem of who was prescribing it and also using compounded medication. Wow. So, if I'm following correctly, if somebody is getting a compounded medication from somebody who's telling them to just micro dose to back off on the symptoms, that's not actually the formula that was approved by the FDA. If
63:30 - 64:00 you're using the FDA approved drug the right way by somebody who knows how these medications work, you won't have those side effects that will make you use a micro dose. Wow. I have three people I'm sending this to right away who've been like talking non-stop about the nausea and this and then the micro doing. And I didn't even realize that if you're micro doing,
64:00 - 64:30 you're not getting the FDA approved drug. You're getting a compounded formula of it that is being prescribed by somebody that's not doing it the way the FDA said. They're not heavily regulated. we don't know exactly what you're getting in the medication. There's the risk of overdosing yourself. There's higher risk of side effects, one from not knowing what it is in the medication and not doing the right dose. And third, there's no evidence-based
64:30 - 65:00 research that says that micro doing is effective. Dr. Salis Whan, what's the most common misconception about these GLP1 medications? That they're easy way out. that is cheating that you can sit back and not worry about how you eat and if you exercise or not. So what's the truth that you want us to know about these medications? Patients are more involved in exercising. They're eating
65:00 - 65:30 better. They're increasing their protein intake. They're working out. Uh because when you explain to a patient the possibility of muscle loss and when they see it physically when they come and do their body compositions and they they think, "Oh, I lost three pounds. Great." And then they go into the body composition and they saw that half of it was muscle. They get it. They understand and they become part of the treatment. They start working out. They start lifting weights. They start eating better. And then halfway the
65:30 - 66:00 journey which is for me is what drives me of what I do every day is there's a switch. There's a switch from when the patient comes thinking of something externally physically and then halfway it becomes something internally. They like how they feel strong. They start to worry more more about muscle in every visit than weight
66:00 - 66:30 loss. How did I do on my muscle? Did I gain muscle? Once a patient feels strong, understands on how to eat, there's no turning back. When a a patient comes to me, they struggle through decades. Exercise program, personal trainers, some have personal chefs. They're doing the what we're recommending. They they've been doing it. They've been listening to us. Also, when somebody says, "Oh, if they wanted to lose weight, if they really wanted,
66:30 - 67:00 they would have done it." They want it. They know. But unfortunately, it was not their sole responsibility. I have yet to meet the couch potato that it's just eating, sitting, and not doing anything, and that's why they gain weight. I I mean I think that the thing that's very clear about this is that a person who is struggling with their weight or struggling with obesity as a disease and a chronic condition,
67:00 - 67:30 they're probably working harder on their health than the rest of us because they're thinking about it all the time. And I choose to believe that everybody wants to thrive. Every like it is so demoralizing when you're doing the things people tell you that you need to do and it's not working. And if you've never struggled with this in your health, I bet you've struggled with it when you've tried to find a job or when you've tried to save money. You follow the things and it's just not working and you don't understand why. And what you're here to say is there's four other
67:30 - 68:00 factors outside your control from genetics to hormones to age to things in the environment that are impacting and screwing up your metabolism that are interfering with your body's ability to metabolize food and to like help you help yourself. And so you'd feel so it makes so much sense. You know, one thing I'm curious about Dr. Solace Whan is how does a GLP1 change how often you think about
68:00 - 68:30 food. It's I think there's no anything I say is not going to be comparable to what a patient experiences. You have to understand patients with obesity, they think about their weight 24/7. how everything that they do or put in their mouth is going to impact their weight or feel guilty about it later. When you remove that from a
68:30 - 69:00 person, it changes their life. They feel liberated. The possibilities are endless. That's incredible. I've never taken the the medication, but one of my family members is is taking it, and that's exactly what they share. I just don't think about it. And that's revealing how much I used to think about it. And when I'm not thinking about it, I'm not mindlessly walking into the kitchen. I'm not having a second helping. I'm not like constantly in this
69:00 - 69:30 loop. It's liberating. It's liberating. Some patients tell me, "Oh, this is so this is how it's supposed to be. This is what is normal." Um, and then it opens your eyes, right? It's like removing a blindfold when you're on this medications and you go out with somebody who's not on this medication and you think about like, wo, uh, we were overeating. Do you don't really need to eat that much to feel physically satisfied, right? So it and then it has a rippling effect too, right? I mean you
69:30 - 70:00 then you can discuss this with family members or family members see the effect see the positive effect and then it's just they want it too. I know that this is a conversation that people are going to be sending to their family members and their loved ones all around the world. For anybody who's still thinking it's a human being's fault when you look at somebody who is struggling with obesity, like until we change the food system in this country, until we give people like access to proper medication
70:00 - 70:30 and health, until we give people access to places where you can live, where you have affordable food that comes from the ground, not a box, and places to walk that are safe. Yeah. Like you can't blame human beings for the fact that the environment that we live in is screwing up your body's ability to process the fake food that is affordable to most people because of like how we've allowed industrialized farming and big industry
70:30 - 71:00 to change the food that we eat. And people say, well, some people with exercise and and diet, they lose weight. The key is how much how restrictive does it have to become to reach that goal and can it be sustainable long term without punishing yourself constantly. Like what I love most about everything that you've shared so far is just that it's not your fault and really understanding that if you had cancer, if you had diabetes, you
71:00 - 71:30 would seek treatment. Yes. And you would seek it for your 12year-olds and up. you would seek it for yourself. And really embracing that that hey, what if something else were to blame? And what if there was something that could help my body actually process things, process food and water and air and everything in a way that supports my health? What if it doesn't have to be so hard? What if it's not my fault? Like that's the most exciting thing about everything that you're sharing with us today. You know,
71:30 - 72:00 one of the things that I wanted to ask you is if you have somebody in your life that you're worried about that you really would love to have them go see a medical doctor like you, a specialist in obesity medicine or just somebody that is treating people. How do you talk to somebody without like making them feel wrong or blaming or assuming? You know what I mean? because it's it's a
72:00 - 72:30 very hard subject to talk about and if you're somebody that doesn't have the same issue with your metabolism then you don't understand and so I just would love some advice from you about how to bring this up to somebody who as you've already shared with us is thinking about it all the time. It's a difficult conversation to have even for us doctors that that may be the sole reason a patient is coming to see
72:30 - 73:00 us. Some patients are not ready to have that conversation. It could be the same with a family member, with a friend. I would say if it comes from a place of love and authentic care, people perceive that, people feel that and don't feel attacked. I think the most important thing with that we have to remember with patients with obesity is that they've learned
73:00 - 73:30 to feel blame and to feel attacked. So you have to be very have a lot of tact on how you're going to bring the subjects without feeling or putting more blame into the situation. You know I had that conversation with somebody in my family that I love. This was uh probably six months ago and you know just saying I'm really concerned about you and I know how hard you work at this and have you thought at all about you know the
73:30 - 74:00 GLP1 options that are out there and they were very defensive and then said that they had already talked to their primary care about it and they're so expensive that I can't afford it and I didn't know what to pay. And so, do you have any advice for what you could say to somebody or what someone could do if they either have had an insurance claim
74:00 - 74:30 denied or they can't afford the medication or that's what they're telling themselves? Like, is there something that you should do beyond a primary care doctor in order to facilitate trying to get this covered by insurance? So the both pharmaceuticals that produce these medications, they have manufacturing coupons. Okay? Meaning that if your insurance, if your commercial insurance didn't approve it, you can use a coupon that cuts the cost
74:30 - 75:00 about 50 to 60%. Okay? So they become a bit more accessible. Now, one of of the current pharmaceuticals just came out with a bile of the medication. Current currently we have in injections that are prefilled pens and this drives the the cost very high but now the medication is coming in a bio like an insulin bile but it's not insulin and it had cost the the price significantly. So that's another option. And then
75:00 - 75:30 also going to a specialist, right, that is going to do and take the proper measurements to make the diagnosis and to be able to justify the need of the use of the medication. Well, Dr. Solace Whan, if the person listening takes just one action today from absolutely everything that you have shared with us, what do you think the most important thing to do is to share
75:30 - 76:00 what you learned today? To share what impacted you the most about this conversation. Right? I think our duty and our responsibility is to share the information. Well, the thing that impacted me the most is if I ever hear another person in my life complain about their weight or hate on themselves, I'm going to say, you know, it's not your fault. I want you to listen to this extraordinary
76:00 - 76:30 worldrenowned expert because you may not believe me, but I sure as hell hope you are going to believe Dr. Solace Whan. What are your parting words? I would add to what you say that one, it's not your fault. And two, it's okay to receive help. It's okay to ask for help. That doesn't make you a failure. Doesn't mean
76:30 - 77:00 that you're cheating. It means that you understand and that you are human and that for the first time we actually have help beyond exercise board and eat less. Thank you. Thank you. Thank you. Thank you. Incredible. Thank you for having me. And I also want to thank you for taking the time to listen and to learn about this life-changing topic and for also being generous with this
77:00 - 77:30 information and sharing Dr. Solace Whan's information with the people that you care about. There's no doubt in my mind that this could change the course of somebody's life. And in case no one else tells you, I wanted to be sure to tell you that I love you and I believe in you and I believe in your ability to create a better life. And taking better care of your health and using the tools that are available to you and getting the support that you deserve is one of the best ways to do that for yourself. All righty, I'll see you in the next
77:30 - 78:00 episode and I'll be waiting to welcome you in the moment you hit play. I'll see you there. You're definitely going to love this one and I'm going to be waiting to welcome you into it the moment you hit play. I'll see you there.