Why BMI Misses 'Skinny Fat'

In this episode, Angela sits down with endocrinologist Dr. Rocio Salas-Whalen, MD to break down the biggest myths around GLP-1 medications, midlife weight gain, and perimenopause - and to explain how women can protect muscle, metabolism, and long-term health.

Rocio explains how oestrogen decline and stress drive visceral belly fat, why you can have a normal BMI yet high visceral fat and low muscle, and why body composition matters far more than the scales. She also clarifies who GLP-1s are truly for, why microdosing “for wellness” is unsafe, and how to use these medications without losing muscle or bone.

They also explore the psychological side of lifelong food noise, binge eating, and why GLP-1s can make sustainable lifestyle change finally feel possible.

WHAT YOU’LL LEARN

• How oestrogen decline changes fat distribution in midlife

• Why “skinny fat” and sarcopenic obesity are often missed with BMI

• How stress and cortisol contribute to midlife weight gain

• Who is genuinely suited to GLP-1 therapy

• How to preserve muscle and bone while on treatment

• The mental health benefits of reducing lifelong food noise

• Why safe dosing and body composition tracking are essential

Timestamps

0:00 Intro & GLP-1 Myths

4:30 Oestrogen decline, perimenopause & new visceral belly fat

10:20 Stress, cortisol, midlife pressure & weight gain

15:05 “Skinny fat”, sarcopenic obesity & why BMI fails women

21:10 Muscle loss, slowed metabolism & weight loss resistance

27:40 Who GLP-1s are for: guidelines vs real-world practice

34:15 The truth about microdosing GLP-1s for “wellness”

40:05 Type 1 vs type 2 diabetes, insulin needs & GLP-1s

45:50 Inflammation, visceral fat & joint pain relief

52:00 Side effects, risks & how to avoid muscle/bone loss

58:10 Compounded GLP-1s, safety concerns & regulation

1:04:00 Psychology of rapid weight loss & identity change

VALUABLE RESOURCES

A BIG thank you to our sponsors who make the show possible:

• Hormone Harmony – Go to https://lvluphealth.com/angela | Use code ANGELA for an exclusive 15% off

• Beam Minerals – Go to https://beamminerals.com/angela | Use code ANGELA for an exclusive discount

• Ozlo Sleepbuds® – Go to https://ozlosleep.com/angela | Use code ANGELA for your exclusive discount

ABOUT THE GUEST

Dr Rocio Salas-Whalen, MD is a double board-certified endocrinologist and obesity medicine specialist known for her evidence-based, body-composition-focused approach to metabolic health. She is the author of Waitlists, a practical guide to safe and effective GLP-1 use, and is widely recognised for her clear, compassionate education around hormones, midlife weight gain, and modern obesity treatment.

Website & Book: https://weightlessthebook.com/

Instagram: https://www.instagram.com/drsalaswhalen/