In his book Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight, former FDA Commissioner Dr. David A. Kessler presents an in-depth look at the science of weight loss and the forces that have fueled the obesity crisis in America. Deborah Vankin takes a look at the book for the Los Angeles Times and interviews Dr. Kessler.
“Ultraformulated” products, intentionally engineered
According to Vankin, Dr. Kessler argues that today’s food industry has deliberately crafted what he calls “ultraformulated” products — foods that are heavily processed, packed with calories, fast-digesting, and designed to be nearly impossible to resist. This strategic engineering by food manufacturers, he contends, has contributed to skyrocketing obesity rates. According to Dr. Kessler, 41.9% of U.S. adults are currently affected by obesity, and by 2030, that number could reach nearly half the population.
Dr. Kessler describes this as a “health catastrophe” that’s unfolding on a massive scale. The accumulation of visceral fat (fat that wraps around internal organs) has been linked to a wide array of serious health problems, including Type 2 diabetes, heart disease, hypertension, arthritis, dementia, stroke, and several types of cancer.
While GLP-1 medications like Wegovy and Zepbound have emerged as popular tools to reduce weight and food cravings, Dr. Kessler warns that they aren’t a silver bullet. These drugs come with their own risks, and there’s still much we don’t know about their long-term effects.
It’s personal for Dr. David Kessler
Dr. Kessler’s perspective is shaped by personal experience. Having struggled with compulsive eating since childhood, he knows firsthand how addictive certain foods can be, especially during his college and medical school years, when he relied on comfort foods as rewards. He has also faced challenges with the side effects of GLP-1 drugs. To truly address the obesity epidemic, he believes society must reframe how we understand addiction, moving away from a stigma-based model and recognizing how engineered foods help hijack the brain’s decision-making processes.
The interview takeaways
Dr. Kessler emphasizes that obesity should be treated as a long-term, chronic condition. In his conversation with the LA Times, he explores sustainable strategies for weight loss, how to approach GLP-1 use responsibly, the importance of body positivity, and ways to improve both health and longevity. Here’s a summary of the key points.
The root of the obesity crisis
Dr. Kessler identifies the “elephant in the room” as the addictive power of “ultraformulated” foods, engineered to overstimulate the brain’s reward circuits. He says,
Food is very, very powerful in changing how we feel. It’s not a question of willpower. Our bodies have experienced an insidious decline over the past half a century. And that’s been caused by this never-ending consumption of foods that can trigger the addictive circuits.
Food addiction and the role of the environment
To combat food addiction, Dr. Kessler suggests changing the cues in our surroundings that trigger cravings — like what we watch, the stores we pass, or the ads we see. Being realistic, he adds:
Many of us don’t have the opportunity to leave our environment. And the food industry isn’t prone to change their behavior any time soon. But we now have pharmaceutical aids to help tamp that down. The effect of these GLP-1 [weight loss] drugs on food noise, that’s the big discovery.
Dr. Kessler does not address the role that stress plays in driving compulsive eating, or the interplay between stress, displacement, and ultraformulated foods. Stress can definitely drive overeating, says Harvard Health Publishing, and research shows that stress shifts food preferences toward highly palatable foods.
Risks of GLP-1 drugs
While GLP-1s like Wegovy and Zepbound help reduce appetite, Dr. Kessler warns of serious health concerns such as malnutrition, gastroparesis, and hypoglycemia. Many patients are consuming dangerously low calories, and most prescribers lack training in obesity medicine. He calls for better labeling and more real-world research on long-term safety and discontinuation protocols.
Long-term weight management
Most people regain most of the lost weight after stopping GLP-1s, so the focus should be on learning sustainable habits while on them. Dr. Kessler advocates for using a full range of tools, including nutrition therapy, physical activity, and behavioral support, tailored to each individual. He says:
But the most important thing is to recognize that this is a chronic condition that needs continuous care, even after you’ve lost the weight.
Addiction vs. willpower
Dr. Kessler challenges the outdated notion that weight loss is just about “eating less and moving more,” arguing that brain chemistry plays a far more significant role. Recognizing this can reduce the shame and stigma many people experience when they struggle to lose weight.
Body positivity vs. health
Vankin asked:
There’s a delicate balance between the body positivity movement, which encourages people to accept their bodies as they are, and the health crisis that is obesity, which you say is a root cause of many diseases. How do you suggest we navigate that?
Dr. Kessler’s answer is on point:
That movement did a lot of good — it took the shame out of it, it took the stigma out. But it was at a time when we didn’t have effective tools to reduce visceral fat. You can love your body, but also do things for your health. Those things are not diametrically opposite. And I’m not comfortable with the amount of morbidity and mortality associated with visceral fat and saying we shouldn’t do something about that.
Public health concerns and institutions
Going further, Dr. Kessler is deeply concerned about the increasing burden of visceral fat-related diseases and believes the U.S. is unprepared for the long-term consequences. He also worries about the dismantling of public health institutions that were key to pandemic response efforts like Operation Warp Speed.
Even modest weight loss helps
The interview finishes on an encouraging note, that even small amounts of weight loss can meaningfully lower the risk of chronic diseases, with greater losses offering even more significant health benefits.
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Source: “You need more than Ozempic to fight food addiction. Here’s how,” Los Angeles Times, 5/20/25
Image: Diet, Drugs, and Dopamine book cover, Amazon. Used under Fair Use: Commentary
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