Are cookies and french fries new cigarettes? And soft drinks, breakfast and ice cream the new opioids?
In his new book, “Diet, drugs and dopamine: the new science of achieving healthy weight” (Flatiron books), the former FDA commission They describe, it has been designed with the purpose of being designed by great foods to be addicted. He calls them “ultra -formed” instead of “ultraprocessed” to highlight the deliberate intention by food manufacturers. As a result, 41.9% of adults in the United States fight with obesity, he says. And by 2030, he projects that approximately half of us will.
It is a “health catastrophe,” says Kessler, “who has reached its vertex at all levels.”
The help of the shelf is a well -being column where we interviewed researchers, thinkers and writers about their last books, all with the aim of learning to live a more complete life.
Toxic or visceral fat, which means fat around our internal organs, has led to an increase in diseases and conditions such as type 2 diabetes, arthritis, blood clots, hypertension, cardiovascular disease, dementia, stroke and certain cancers.
LP-1 weight loss drugs, such as Wogovy and Zepbound, have helped millions of people throw weight and stop food cravings. But they create additional health problems, says Kessler, and there are still enough accumulated scientific data to talk about their effectiveness or long -term safety.
It is an issue with which Kessler is intimately familiar. He has fought against food addiction from childhood, growing in New York, and his addiction shot at the University and the School of Medicine when sandwiches and chicken wings were their rewards for studying a lot. Since then it has had problems handling the side effects of GLP-1 drugs. To reverse the obesity crisis, says Kessler, we need to better understand addiction in itself: how ultraprocessed foods take over our rational brain. We must also create a new paradigm for addiction, says Kessler, since the current one sees addicts through the lens of weakness.
In his book, Kessler urges us to recognize that obesity is a chronic condition that must be treated as such.
The Times spoke with Kessler about healthy weight loss strategies for long-term guidelines to use LPG-1 safely, the body's positivity movement and improve useful life.
This interview has been condensed and edited by clarity.
Dr. David A. Kessler.
(Joy Asico Smith)
In the book, you talk about “the elephant in the room” when it comes to fighting in weight loss today. What is it?
We have not been able to recognize how difficult it is to escape the attraction of food addiction and overcome the built -in reward response of our brain to these ultra -forming foods that flood our food supply. I am not talking about cocaine or amphetamines that excessively kidnap dopamine circuits. But addictive circuits are part of all of us. We are all connected to focus on the most prominent stimuli in our environment. And for many of us, those stimuli are these ultra -formulated foods. The food is very, very powerful to change how we feel. It is not a matter of willpower. Our bodies have experienced an insidious decrease in the last half century. And that has been caused by this endless consumption of foods that can trigger addictive circuits.
How can we “calm the noise”, as you say, around food addiction?
It is the interaction between stimuli in our environment and our brains. Change our environment, and we can significantly change what is happening in our brains. [Environment] It is all out of our bodies with which we interact, from the moment we wake up until the moment we sleep. What you put on your TV, what fast food restaurants on the way to work, we are constantly being indicated. Then you try to eliminate the signals. Or change your environment. Many of us do not have the opportunity to abandon our environment. And the food industry is not prone to change its behavior in the short term. But now we have pharmaceutical aid to help reduce that. The effect of these LPG-1 [weight loss] Drugs about the noise of food, that is the great discovery.
GLP-1 medications can lead to serious medical conditions that concern you. They are, And what should doctors and pharmaceutical companies be doing differently?
The fact is that the only way in which it will lose weight, be it drugs, diet or surgery, is to have an energy deficit. [GLP-1s] They are very effective for you to consume less. But some people are eating less than 1,000 calories per day. There are people eating 600, 800 calories. It must be under medical care or run the risk of malnutrition. The food remains in its intestine for longer and that delay in gastric entry [called gastroparesis] It can cause its own set of symptoms, as well as metabolic consequences, such as hypoglycemia, low blood sugar level and other metabolic states. All result from malnutrition.
Many doctors who are prescribing this are not well trained in obesity or nutrition medicine. And it is very important, if possible, that a team of health professionals, including a dietitian, is available. There is no doubt that [drug companies] I need to do a better job when studying real world data. How to use these drugs, how to safely get these drugs, is a key issue. It is necessary that there is a better labeling around gastroparesis and the risks associated with these medications.
(Flatiron / Joy Asico Smith books)
Most people will not be in LPG-1 for life because they are expensive and have adverse effects, you say. However, leaving drugs, most people recover weight. So what is the long -term solution?
The question is about intermittent use: can I use these medications to get my weight? So, can I use them, intermittently, throughout life? But we still have no data that [if] That is safe. But you can use these drugs to condition yourself to learn to eat differently. Like now very different, I don't want to put large amounts of food in the stomach. I have conditioned myself not to do that. How long will that last, we'll see. Then you need a range of tools. That can vary from nutritional therapy to behavioral therapy and physical activity, and will vary for the individual. There is no tool that works during the duration. Pharmacological tools are just a tool, it is the entire toolbox that must be available. But the most important thing is to recognize that this is a chronic condition that needs continuous attention, even after losing weight.
Achieve healthy body weight begins with the understanding of addiction, you say, not necessarily the old advice to “Eat less and move more.” Why is this so important?
The definitive answer is 'Eat less and move more.' But we cannot do that due to the physiological and addictive circuits: they get in the way. We have to understand that addiction is not just about weak and oppressed. It is part of all of us, those circuits. We cannot overestimate the amount of stigma, shame and anguish that many feel because they have not been able to control their weight. They feel that it is their fault, they do not like themselves and society has created all these prejudices tied to it. Simple recognition [that] Our brains are not completely under our control when it comes to these dense energy foods is a very important step.
There is a delicate balance between the body's positivity movement, which encourages people to accept their bodies as they are, and the health crisis that is obesity, what you say is a root cause of many diseases. How do we suggest that we sail that?
That movement did a lot of good: he removed his shame, eliminated stigma. But it was at a time when we had no 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 do not feel comfortable with the amount of morbidity and mortality associated with visceral fat and saying that we should not do something about it.
(Maggie Chiang / For the Times)
As a former FDA Commissioner, what keeps you awake at night?
The recognition that visceral fat is causal in a variety of heart disease that increase real disability in the older years. I think we are not prepared to handle that. We have only woken up to the fact of this toxic this visceral fat.
Take food
Of “Diet, Drugs and Dopamina”
[Also]Trump's greatest achievement, in the first term, was Warp speed. And I was part of this from January 2021. The reason we could do what we did, and obtain those vaccines developed, produced and distributed safely, was because there were institutions within our federal government: the [National Institutes of Health]he [U.S. Food and Drug Administration]he [Center for the Biomedical Advanced Research and Development Authority]he [Centers for Disease Control and Prevention]. These institutions had enormous experience and resources. And yes, we had to assemble it; Yes, we had to do things differently. But we were able to build on that infrastructure. Now they are destroying that infrastructure. I don't understand.
To end in a positive note: how much weight loss really decrease Future risk of disease?
The remarkable thing is that relatively small quantities can have significant effects. If you want to reverse certain conditions, that would require more weight loss. But almost any weight loss will add clinical benefits and will be useful to reduce cardiometabolic risk.
