Throughout my life I’ve been fat, thin and various sizes in between. Since I was a kid, I’ve gained and lost weight repeatedly, putting on 20 pounds, taking it off, putting on 30 pounds and then losing it again. It has been a cycle of despair.
The fact that I’m a doctor, was a dean of two medical schools and ran the Food and Drug Administration for six and a half years was of no help to me. Like millions of others, I was caught between what the food industry has done to make the American diet unhealthy and addictive and what my metabolism could accommodate.
We may now be at the brink of reclaiming our health. New and highly effective anti-obesity medications known as GLP-1s have revolutionized our understanding of weight loss and of obesity itself. These drugs alone are not a panacea for the obesity crisis that has engulfed the nation, and we should not mistake them for one. But their effectiveness underscores the fact that being overweight or obese was never the result of a lack of willpower.
It is the result of biology instead, and that is why these drugs work. They help people feel full after eating and reduce the cravings that are central to our addiction to the irresistible, highly processed, highly palatable foods that have glutted our shelves over the past five decades. For many of us, our biology makes the pull of these ultraformulated foods nearly impossible to resist.
These foods typically are called ultraprocessed, but I refer to them as ultraformulated because they have been engineered to manipulate the brain’s reward system. These foods have become the new cigarette and, similarly, have resulted in a health catastrophe.
Forty percent of American adults are obese. These foods have contributed to a rise in diseases characterized by visceral fat, or what I call toxic fat — fat that accumulates in our abdomens and surrounds the liver, heart and pancreas. These chronic illnesses include cardiovascular disease, stroke, diabetes, cancer and probably some forms of dementia. Visceral fat and obesity more generally are among the reasons that Americans have an average life expectancy that is four years shorter than that of people in other large, industrialized countries.
By the time many people reach old age, doctors are often treating multiple health complications that stem in large part from a lifetime buildup of visceral fat. Doctors typically treat these conditions piecemeal, with drugs that lower cholesterol, reduce high blood pressure and control diabetes. GLP-1s could be an alternative to this piecemeal treatment because they seem to improve so many markers of health.
The Trump administration recently rejected a plan by the Biden administration to expand access to these drugs by requiring Medicare and Medicaid to pay for them, a decision that will deny access to millions of people who otherwise cannot afford them.
This is a mistake. GLP-1s appear to modify addictive brain pathways that are activated by ultraformulated foods, helping people to change their body weight in a decisive way. Traditional dieting might result in a weight loss of 5 to 7 percent. The new GLP-1 drugs more than double that.
Even so, these are not magic medications. Prescribing them without other interventions, like healthier eating, exercise and behavioral therapies aimed at developing other lasting lifestyle changes, isn’t good medical care. Unfortunately, most doctors are not trained in nutrition or weight management. And whether patients can safely and practically use these drugs over the long term is still largely unknown.
Numerous studies affirm a truth so many of us have experienced: Sooner or later, almost every weight-loss plan fails. Even GLP-1 medications have a high dropout rate. The data suggests that most people take these drugs for less than a year and that after they stop, their lost weight is mostly regained.
One of the reasons people stop taking GLP-1s is that they are expensive and may not be covered by insurance. Another reason is the side effects. They work by causing us to eat less, in some cases much less, which can be dangerous. They keep food in the stomach longer, which can induce feelings of fullness but can also generate feelings of nausea or distress.
Pharmaceutical companies must be more transparent about these reactions, which counterbalance the rewarding and addictive properties of food and reduce the so-called food noise that plays in the heads of people who struggle with weight. The key is that people on these medications can learn to eat less. This is one of the great benefits of these medications.
What’s troubling is that the Food and Drug Administration approved GLP-1s for long-term use without requiring companies to conduct long-term studies on how these drugs are used in the real world. It is not realistic to believe that people will stay for life on expensive drugs with side effects. Research is needed to show how patients can safely stop taking them and to better understand the risks of rapid weight loss when appetite is suppressed. Combining treatment approaches under the care of well-trained obesity medicine doctors and dietitians may be the best long-term strategy.
In my case, with the help of a GLP-1 drug, I lost 65 pounds in seven months, reaching a level of body fat I never thought I would achieve. More important, in what felt like a life transformation, my relationship with food has changed completely.
After seven months, I stopped using the medication; I didn’t want to remain on it indefinitely. At one point, when my weight went up, I took up the injections again. But I’ve preferred to stick with healthy eating and other behavioral changes, and I’ve been able to keep my weight fairly stable, with a much healthier level of visceral fat than before. Still, we need data on whether intermittent use like this is safe or sustainable.
The drug I used helped to control the addictive circuits in my brain, enabling me to reset my appetite. What happens for me next month or next year is a different story. My journey, like everyone’s, will require an ongoing effort.
The stereotypical perception that addiction captures the weak misses its biological nature. Addiction takes hold not because the brain is not working well but because it is working too well. It directs our attention to the most salient stimuli in our environment — in this case, energy-dense foods.
These drugs offer a chance for people to improve their health even as our national body is ill. Our health has been hijacked by the ultraformulated food bombs that GLP-1s offer the hope of defusing. If we truly want to make America healthy, as President Trump claims he wants to do, we are going to have to confront the metabolic damage these foods have caused and take steps to protect the public from them.
Current food labeling requirements are simply not fully transparent. Consumers should know about the function and health consequences of every ingredient in the packaged foods they buy, and that information should be available for every product. Our current national dietary guidance is written for healthy bodies. We need dietary guidance for the many Americans who are insulin-resistant and at risk for Type 2 diabetes and other health problems or who are having trouble maintaining a healthy weight.
GLP-1s are revolutionary drugs that can drastically reduce caloric intake and improve health in a way I didn’t expect I would ever see. Now we need to complete that revolution by taking on the food industry and its engineered foods that are contributing to some of the most harmful health issues America faces today.
David A. Kessler is a physician who served as the commissioner of the Food and Drug Administration during the George H.W. Bush and Clinton administrations and was the Biden administration’s chief science officer during the Covid-19 pandemic. He was also the dean of the medical schools at Yale and the University of California, San Francisco, where he is a professor of pediatrics. He is the author of the forthcoming book “Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight.”
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