David Kessler on the Science of Weight Loss

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.

Your responses and feedback are welcome!

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

Deliver Us From Ethanol

No matter how you slice it, high-fructose corn syrup (HFCS) is a thing that humanity would be better off without. Consequently, the state of Indiana decided to ban it as a food ingredient. On the surface, this is an odd and impractical choice, because Indiana grows a lot of corn. But it mainly winds up being changed into animal feed, and fuel, via ethanol, which has psychoactive properties, and is also used in processing vanilla beans into vanilla extract.

Additionally, ethanol can be made into both gasoline and antifreeze. And also into HFCS. Some people simply don’t want to be feeding their kids anything related to jet fuel.

The Indiana attempt to put a leash on HFCS failed. A couple of years back, New York tried to ban a bunch of food additives, and Pennsylvania did too. In the latter state, Rep. Natalie Mihalek dryly remarked, “It is not asking too much for consumers to have a reasonable expectation that the foods they are eating are safe.” It appears that objectionable food additives are sometimes “grandfathered in,” just because they have been allowed for so long, even though no one has ever bothered to look into their composition or calculate the probable harm caused to humans.

Picky about prohibition

Many voters wish that the U.S. Food and Drug Administration would fix things by banning various substances on a nationwide basis, to save the trouble and expense of each state needing to fight the battle. But some states don’t really care very much, and many Americans value the freedom-of-choice principle over any other consideration.

In many cases, the problem is not so much in the composition of the product itself, but in the passion that children feel for it. Even if any one ingredient could be indisputably proven not dangerous and not addictive, there will always be a certain number of kids who react to it as if it were both. They attract the attention of journalists, and sometimes other interested parties. Professionals on both sides of the issue are forced into defending their positions.

Folks get upset. They defend their positions, and with good reason. Here is one issue, stated in practical terms. As previously noted,

Many adults feel that when a child acts addicted, she or he is as difficult to deal with as a physically addicted child would be. Whatever is in that snack or cereal may be potent enough in some way to stoke up a behavioral addiction, which sells product quite as effectively as a literal, molecular-level addictive ingredient could.

A hopped-up speed freak and a child who acts like a hopped-up speed freak are both troubling propositions, especially if the child is overweight and capable of causing more damage because of it.

This is the sort of problem that the protests attempt to bring to an end. Everyone has better things to do than argue about the obvious. Foods without all kinds of detritus mixed up in them should be just as easily available as the other kind. Or maybe the objectionable substances should not be available at all. Some folks are in favor of banning bad stuff for everybody.

Others cherish the right to pursue perdition in their own ways. At the same time, they may be willing to do what is best for everyone. In their view, research is fine, but until the results come in, leave us alone. Plenty of folks are reluctant to violate the rights of others, while at the same time endeavoring to peacefully change laws they do not like.

GRAS means “generally recognized as safe”

A while back, California assemblymember Jesse Gabriel said,

The [FDA] has increasingly avoided its responsibility to rigorously evaluate proposed food chemicals by allowing food manufacturers to self-certify that a chemical is generally recognized as safe to be used in food. Between 2000 and 2022, manufacturers have been allowed to self-certify almost 99% of the 756 new chemicals used in food.

The terms “99%” and “self-certify”, appearing in such proximity, send cold chills up the spines of many citizens. Reportedly, the whole determination process is being rethought. In September 2024, the Food and Drug Administration held a public hearing where officials announced that they recognize the need to conduct post-market assessments of the presence of chemicals in food, and are developing a “systematic process” for that purpose.

We really need to know what the substances are doing to our kids (and us). Does a certain ingredient make children obese? Even if the answer is no, what else does it do to the human body, especially to one that belongs to a still-growing and not totally formed young person? Many parents and others have a keen interest in finding out more about these issues, and in defining the rules pertaining to who gets to write the rules.

Your responses and feedback are welcome!

Source: “15 uses of Ethanol,” AllUsesOf.com, 06/13/21
Source: “How State-Led Ingredient Bans Are Reshaping Food Manufacturing Regulations,” HartDesign.com, 02/14/25
Image by fietzfotos/Pixabay