Dr. David A. Kessler, a longtime public health official and former FDA Commissioner, has spent much of his career promoting health. Yet, he admits he has struggled with his own weight for years. During medical school, he often relied on greasy foods like French fries and salted roast beef to stay awake for late-night studying. Over time, his weight fluctuated dramatically, sometimes gaining 20 to 40 pounds before losing it again through low-carb, high-protein diets and exercise.
After serving seven years as Commissioner of the Food and Drug Administration in the 1990s, where he pushed for improved nutrition labels and fought against the tobacco industry, Kessler continued to wrestle with weight issues. His challenges intensified after two years working as chief science officer for the White House COVID-19 Response Team, when being desk-bound led to significant weight gain. Conventional diet and exercise no longer produced the results they once had.
Kessler was introduced to a new class of drugs known as GLP-1 agonists, which include medications like Wegovy and Mounjaro. After starting injections, he lost about 60 pounds in seven months. He shares his experience in his new book, *Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight*, where he also explains the science behind obesity and why these drugs are proving so effective.
Kessler points to the modern food environment as a major cause of weight gain. He explains that highly palatable, energy-dense foods, loaded with salt, sugar, and fat, are available everywhere and at all hours. These “ultra-formulated” foods are engineered to stimulate the brain’s reward system much like addictive substances, making it difficult to resist them. According to Kessler, it’s not simply a matter of willpower but biology.
While he hopes for systemic changes to address the root causes of obesity, Kessler acknowledges such changes won’t happen quickly. In the meantime, he sees GLP-1 drugs as powerful tools to combat the effects of an unhealthy food environment.
Kessler also highlights the limitations of body mass index (BMI) as a measure of health. Instead, he focuses on visceral fat—the fat surrounding abdominal organs like the liver and intestines—which contributes to inflammation and increases the risk of diseases such as diabetes, heart disease, and certain cancers. He advises people to monitor waist circumference and consider body composition scans to better assess health risks.
GLP-1 drugs work by suppressing appetite and slowing stomach emptying, which helps users feel full sooner. However, Kessler warns that this sensation can be uncomfortable, often described as being “at the edge of nausea.” Some people experience gastrointestinal side effects like abdominal pain, diarrhea, or vomiting if they eat too much. For many, these unpleasant feelings condition them to eat less, contributing to weight loss.
Because of these side effects, Kessler stresses the importance of medical supervision when using these drugs. Finding a knowledgeable doctor or a team that includes a dietitian can help patients manage dosages and maintain healthy eating habits. He also emphasizes that GLP-1 medications do not replace the fundamentals of nutrition. A diet rich in protein and fiber remains critical to support satiety and digestive health, especially since slowed stomach emptying can lead to constipation or more serious intestinal issues.
Kessler expresses concern about potential risks that are less well known, such as the possibility of eating disorders, malnutrition, or loss of muscle mass while on these drugs. He points out that a significant portion of weight lost on medications like semaglutide may come from lean body mass, making proper nutrition and strength training especially important, particularly for older adults.
He also warns against using compounded versions of GLP-1 drugs purchased online. Unlike FDA-approved medications, compounded drugs lack consistent quality control and traceability, which can pose serious safety risks.
When it comes to stopping GLP-1 treatment, Kessler admits there is little guidance or research. After reaching his weight goal, he stopped taking the drug due to mild abdominal pain but found maintaining his weight difficult without clear protocols. He calls for drug manufacturers and regulators to study how best to taper off these medications safely.
Kessler continues to use GLP-1 drugs intermittently but believes relying on trial and error is not a sustainable approach. He urges companies and the FDA to provide clearer information and guidelines to help patients use these drugs effectively and safely.
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