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<\/p>\nIn early 2021 the Biden administration asked Dr David A Kessler to co-lead Operation Warp Speed, responsible for all the vaccines and drugs used during the pandemic. As chief science officer of the White House Covid-19 Response Team he was spending 18 hours at his desk, seven days a week. \u201cIt took all I had,\u201d he says, speaking from his home in Washington DC. \u201cNothing was more important than just getting the work done.\u201d <\/p>\n
And, \u201cFood was my drug. I used food to change how I felt, to keep me going. If I was tired, I used food. If I was anxious, I used food.\u201d When he left in 2023, the virus was \u201cdefanged\u201d and Kessler had gained 40lb. He was over 200lb (14st 4lb) at his heaviest. \u201cThings go awry.\u201d It wasn\u2019t a first. \u201cI\u2019ve gained and lost my body weight repeatedly over a lifetime.\u201d <\/p>\n
Kessler wasn\u2019t unusual in impulsively overeating during the pandemic, and the rate of obesity in the UK rose during the first year of the crisis, contributing to the British Heart Foundation\u2019s new findings that the nation\u2019s heart health declined more quickly at the start of the 2020s than any other decade for more than 50 years. But now, after seven months on GLP-1 weight-loss drugs, he\u2019s \u201csixty pounds lighter than I\u2019ve ever been\u201d. His features are, if he\u2019ll forgive me, slightly gaunt, but he has halved the amount of \u201csick fat\u201d he carries. He understands better than most why 64 per cent of British adults are estimated to be overweight or obese and why just 12 per cent of Americans are \u201cmetabolically healthy\u201d. Driving this obesity epidemic is food that dysregulates our appetite and hooks us into a cycle of overeating and weight gain.<\/p>\n
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Ultra-processed, highly palatable foods like doughnuts are designed to addict us<\/p>\n
GETTY IMAGES<\/p>\n
As Kessler explains in his rigorous new book, Diet, Drugs and Dopamine: The new science of achieving a healthy weight, ultra-processed, highly palatable, energy-dense, high-glycaemic foods (he calls them UFFs: ultra-formulated foods) are designed to addict us. \u201cThey deliver just the right combination of fat and sugar, fat and salt, fat, sugar and salt \u2014 that potent trifecta \u2014 to trigger the reward circuits.\u201d They change our brain chemistry, triggering compulsive eating and robbing us of the ability to feel full. They \u201csteal our satiety\u201d, Kessler says. \u201cLosing weight is a process of treating addiction.\u201d <\/p>\n
It\u2019s not lousy willpower making us fat. It\u2019s the powerful effect of UFFs on our biology. Over the past fifty years, what we\u2019re eating has caused \u201cthis insidious decline in health\u201d. A study, just published in the American Journal of Preventive Medicine, suggested that about 18,000 deaths of people aged 30 to 69 could be prevented each year in Britain, if ultra-processed-food consumption were reduced. Only now are cardiologists, neurologists, endocrinologists, kidney specialists and oncologists waking up to the culprit, Kessler says.<\/p>\n
\u201cIt\u2019s not how big you are, it\u2019s not how much you weigh, it\u2019s the amount of toxic fat that we carry \u2014 the visceral fat in our mid-section.\u201d Metabolically active, \u201cit creates this inflammatory milieu in our bodies that is in the causal chain of these major diseases\u201d. If we\u2019re obese, we\u2019re in a state of chronic inflammation. If we can reduce it, \u201cwe can dramatically change our health\u201d. <\/p>\n
\u2022 Read more expert advice on healthy living, fitness and wellbeing<\/b><\/a><\/p>\n Until recently, that\u2019s been near impossible. For most, trying to diet and exercise yourself slim is \u201can unmitigated disaster\u201d, he says. \u201cVery few people can keep weight off.\u201d Why? \u201cOur bodies are designed to hold on to fat for survival.\u201d The body defends its highest weight. So once you\u2019ve lost those pounds, it turbo-boosts your appetite (via the reward circuits) and slows your metabolism. \u201cIt\u2019s a double whammy.\u201d Keeping weight off is like holding an inflatable underwater, he says. \u201cIf I used to eat 2,000 calories, I\u2019m going to have to eat 1,600 calories to maintain that weight because my metabolism slowed.\u201d <\/p>\n But for those with the privilege of access, GLP-1 drugs have been a game-changer. They give you back your satiety. To overpower the brain\u2019s addictive circuitry, you must strengthen the satiety system, Kessler says. <\/p>\n After Operation Warp Speed, his usual dieting method \u2014 low carb, high protein \u2014 was slow. \u201cI lost maybe 6lb over a number of months.\u201d When a kidney stone put him in an endocrinologist\u2019s office, and weight-loss drugs were suggested, he agreed. He\u2019s now 137lb with a BMI of 20, which \u201cI never thought I\u2019d achieve\u201d.<\/p>\n GLP-1 drugs are markedly effective, he says. Yet, \u201cthey\u2019re not a panacea. They are potentially dangerous and they are complicated. But they provide us with an opening to reverse the epidemic of chronic disease. There\u2019s no magic in these pills.\u201d Ultimately, \u201cthey get us to eat less\u201d. <\/p>\n \u2022 The ultra-processed food Britain\u2019s top nutritionist avoids<\/b><\/a><\/p>\n Most aren\u2019t entirely clear on how they work. \u201cThe companies haven\u2019t fully levelled with the public. At least early on, they make you ill. They take you to the edge of nausea. And what\u2019s the one thing that can change reward? And change the addictive circuits? If I push you towards or over the edge of nausea.\u201d <\/p>\n GLP-1 drugs target the gut and our \u201caversive circuits\u201d. Turns out, \u201cadverse gastrointestinal events are part of the mechanism\u201d. So a feature, not a bug. Feeling sick, unpleasantly full, ill, or worse, \u201cyou don\u2019t feel like eating, they tamp down the reward circuits, they counterbalance that reward\u201d. They also keep the food in your stomach for longer \u2014 also uncomfortable \u2014 \u201cthere\u2019s a malaise associated with that\u201d. <\/p>\n There can be serious medical side-effects, which Kessler worries about. Plus he senses that, on them, \u201ca very significant number of people are eating less than 1,000 calories a day\u201d. He recalls a family dinner \u2014 ricotta-stuffed organic roast chicken, sage & brown butter polenta. He barely managed a bite. \u201cMy gastrointestinal tract basically shut down. I couldn\u2019t put anything in. I would become ill. These are very powerful drugs.\u201d He says more research is needed as to how to safely use them. Why did he stop? \u201cI had some abdominal pain, I got a little spooked.\u201d After regaining some weight, \u201cI went back on it for a while.\u201d<\/p>\n These drugs only work while you\u2019re on them, \u201cbut for one thing. They can tamp down the reward circuits so you can recondition yourself.\u201d If you know you\u2019ll feel ill if you eat again, \u201cyou\u2019re going to condition yourself not to put food in your stomach. So learning how to eat less and eat better and change what you eat is the real task \u2014 it\u2019s the gift while you\u2019re on these drugs.\u201d <\/p>\n They\u2019ve certainly helped Kessler. He describes how at college he could only focus if the little fridge in his room was full of his favourite brands of chocolate cake and doughnuts. At night, he would \u201cprowl for subs, pizza or wings\u201d. He has vivid memories of his worries melting away, \u201cas I slid headlong into the numb pleasure of overindulgence\u201d.<\/p>\n Cravings would grip around 10pm. He\u2019d feel \u201ca pressing unease\u201d. This disciplined, erudite man \u2014 former commissioner of the US Food and Drug Administration (FDA), a paediatrician, a lawyer, former dean of two medical schools, including Yale \u2014 would think, why can\u2019t I control myself? Only overeating \u201crubbish\u201d quieted the \u201cfood noise\u201d. He says, \u201cI became an alternate version of myself.\u201d <\/p>\n His hope is to remove the stigma and shame people suffer when struggling with insatiable hunger and weight gain. Our reward circuits \u201cwere built for food\u201d, he says. \u201cIt\u2019s the first addiction, for survival reasons.\u201d The stereotype of addiction as \u201cextreme\u201d or weak is false, he says. \u201cAddiction happens in the normal functioning brain. Our brains are wired to focus on the most salient stimuli. Food has been formulated to become the most salient stimuli.\u201d <\/p>\n \u2022 The snacks I will (and won\u2019t) feed my kids, by Britain\u2019s leading nutritionist<\/b><\/a><\/p>\n For appetite to be proportionate, our satiety and reward mechanisms must be in balance. And few understand how UFFs wreck that. Kessler calls them \u201cpsychoactive\u201d \u2014 like any addictive substance, they hijack our reward circuits and change how the brain works. <\/p>\n \u201cI would need food to change how I felt more than I needed food for fuel. And I think that is the hallmark of substances that affect the reward circuits,\u201d he says. So, too, increasing our \u201chypersensitivity\u201d to cues \u2014 be that hearing someone crunch crisps, boredom, upset \u2014 becoming locked in a pattern of craving, preoccupation, bingeing, withdrawal (for every high, there\u2019s a dopamine low) and, often, self-loathing.<\/p>\n \u201cFifty years ago, I think I would have been a smoker,\u201d he says. Now, he declares, UFF \u201cis our new cigarette\u201d. And he should know. As head of the FDA under George W Bush, and then Bill Clinton, Kessler took on the tobacco industry. (In Diet, Drugs and Dopamine his summary of their manipulative marketing and lies while knowing their products were killing people shocks anew.) It\u2019s a brutal metaphor \u2014 is UFF that bad? \u201cLook at the profound, profound harm it\u2019s caused,\u201d he replies.<\/p>\n I\u2019m keen to know what he does now to maintain good health. He stresses that weight-loss drugs are only one tool. But crucially they facilitate a critical perceptual shift. \u201cI used to look at these large portions of food and that was my friend. I look at that stuff now and I go, \u2018That\u2019s disgusting,\u2019\u201d he says. <\/p>\n One of his old haunts was a customised ice-cream sandwich place. Kessler would pile on M&M cookies, chocolate chips and sweets. After using GPL-1 he visited. He wasn\u2019t tempted. \u201cI don\u2019t find certain foods as appealing. Again, there\u2019s no magic. Those foods were sitting in my stomach for much longer periods of time.\u201d<\/p>\n Importantly, he started exercising \u2014 in particular, weight training. \u201cIf you\u2019re losing a significant amount of weight, you\u2019re not just losing visceral fat, and you\u2019re not just losing total body fat, you\u2019re losing muscle.\u201d By increasing muscle mass, strength training helps maintain a lower \u201cset point\u201d weight. \u201cWalking is not enough,\u201d he says.<\/p>\n We can boost satiety through nutrition, of course. Kessler describes pre-1936 Sardinian fare, one example of a Mediterranean-style diet. Food was often scarce, but what people ate (vegetables, legumes, goat\u2019s milk, cheese, lard) was high in fibre, protein and fat, and wasn\u2019t rapidly absorbed, so it was satiating. Kessler says that GLP-1 drugs mimic the natural effects of a high-protein diet. He mentions yoghurt, quality carbs and whole foods such as almonds.<\/p>\n