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The cover of Dr. David A. Kessler’s new book Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight is evocative. It features a delicious-looking piece of chocolate cake topped with creamy icing and chocolate chips. Plunged straight through the center of this delicacy is a drug injection vial. The book centers around the latest class of weight loss drugs, glucagon-like peptide-1 or GLP-1’s like Ozempic and Zepboud – their power as a tool against the excess fat that’s making Americans sick – and how to use them safely in conjunction with diet and exercise. And as someone who’s tried a GLP-1 drug I can tell you the visual metaphor is right on the nose. Like a needle through a piece of cake, intensely appetizing but bad-for-you foods are suddenly rendered utterly unappetizing (or at least that's how it was for me).
The drugs work by slowing down the rate at which food leaves the stomach and enters the small intestine. That makes you feel full faster, so you eat less. For many, it brings on a feeling that Kessler describes as “the edge of nausea,” – similar to how you feel after eating a bit too much at Thanksgiving dinner. Except with GLP-1’s it comes on with a relatively small portion. That sort of mild discomfort – which can devolve into real GI distress if you indulge – serves as a deterrent especially against foods high in sugar and fat.
That may sound like harsh medicine. But these drugs are powerful tools in a country where three quarters of adults struggle with weight-related chronic health conditions, Kessler argues – and they’ve succeeded where diets and other weight loss methods have failed. “They have changed the landscape of weight loss,” says Kessler. "They provide us with an opening to reverse this epidemic of chronic disease.”
In the book, Kessler presents GLP-1’s as an effective weapon against what he calls “ultra-formulated foods” – foods high in sugar, salt and fat that he says have been engineered to manipulate the brain’s reward system, activating the same reward centers that addictive drugs do.
Kessler, who has served in several high-level public health roles including commissioner of the Food and Drug Administration and Chief Science Officer of the White House COVID-19 Response Team, spoke with me about his personal struggle with weight and experience on a GLP-1 drug, as well as some of his hopes and concerns around the medications.
Here are some of the big take-aways from the book and our conversation:
Being at an unhealthy ‘weight’ isn’t actually about the number on the scale
While BMI or body mass index has long been used to measure obesity, Kessler is among a growing number of scientists who say it’s not a helpful indicator of health. Rather visceral fat, which is found in and around abdominal organs including the stomach, liver and intestines, is the driver of metabolic disease, says Kessler.
You can figure out whether you’re carrying a risky amount of visceral fat by measuring your waist circumference, Kessler says. A circumference greater than 40 inches in men, or 35 in inches in women is a rough indicator. You can also calculate your waist-to-hip ratio, or try a body composition scan.
On these drugs, good medical care is key
It's important to work with a physician who can help you find the right drug at the right dose, and help you manage side effects like nausea, vomiting, and diarrhea. It could be your general practice doctor or an internist, says Kessler. An obesity medicine specialist, he says, is ideal, though finding one can be tough. And since taking this drug will change your eating habits, Kessler recommends consulting with a dietician or nutritionist in addition to your doctor.
Know the risks, including those that aren’t on the label
Kessler worries about people taking the drugs going too far in the other direction – from overeating to malnutrition.
He says drugmakers should do more to inform patients about the risks of developing eating disorders, and about gastroparesis – a chronic condition where gastric emptying slows down significantly.
It’s also common to lose some muscle mass along with fat while on GLP-1s, which can be problematic, Kessler writes. One study he cites in the book showed that 40% of the weight loss in patients on once-a-week injections of semaglutide came from lean body mass. And about a third of that was muscle. That’s a reason to keep on top of your nutrition and strength-training while on these drugs, he writes, ”especially for older people like me, who are [already] susceptible to muscle loss.”
Get more insights from Dr. Kessler, including essential foods for a GLP-1 diet, and what happens when people go off GLP-1s.
Are you on a GLP-1 drug for weight loss, or have you tried one or more in the past? Tell us about your experience, and we may share it in a future edition of this newsletter. Write to us at shots@npr.org. |
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The House has voted to defund public radio.
The House has voted to claw back all federal funding for public media, and the proposal now moves to the Senate. We’re running out of time to protect public radio’s essential news, music, and emergency broadcast services to communities across the nation. But you can still stand up for public radio.
Spend 10 seconds at the link below. The consequences of this vote fall directly on the Americans who rely on local, independent stations serving communities across the country. Don’t abandon them now.
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Recently a friend and I were bonding over our shared love of a foot massage spa in the area called “Happy Feet.” “Ah, the sound of pounding flesh!” my friend remarked wistfully.
But you don’t necessarily need a foot rub or special inserts to relieve aching feet. Physical therapy professor Irene Davis wants to empower you to make your feet happier in the comfort of your own home. "People have these amazing muscles in their feet," Davis says. "They actually have the ability to increase the strength and capacity of their feet, which can help with the pain."
NPR’s Life Kit spoke with foot care experts about moves that can help you put your best foot forward. You can work your “foot core” by raising your arch and squeezing. Increase blood flow by pressing the underside of your toes up against a wall. Or “hold hands with your feet” and circle your ankles for a pleasant stretch.
Find more foot workout tips and video demonstrations here.
ICYMI: Want to reduce soreness after a workout? Make time for this 4-step routine |
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We hope you enjoyed these stories. Find more of NPR's health journalism online.
All the best,
Andrea Muraskin and your NPR Health editors |
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