Epsiode 233: Dr. David Kessler - Diet, Drugs and Dopamine

Dr. David Kessler is a renowned pediatrician, lawyer, public health advocate, and former Commissioner of the U.S. Food and Drug Administration (FDA). A graduate of Amherst College, the University of Chicago Law School, and Harvard Medical School, Dr. Kessler has spent his career at the intersection of science, policy, and consumer protection.

He served as Dean of the Yale School of Medicine and the University of California, San Francisco Medical School, and most recently held the role of Chief Science Officer for the White House COVID-19 Response Team.

Dr. Kessler is the acclaimed author of several influential books including the New York Times bestseller The End of Overeating, Fast Carbs, Slow Carbs, and his latest work, Diet, Drugs & Dopamine: The New Science on Achieving a Healthy Weight. His writing and research have been pivotal in shifting the public health conversation from willpower to biological understanding—especially regarding food addiction, the manipulation of hyper-palatable foods, and the role of dopamine in modern eating behaviors.

A true trailblazer in the field, Dr. Kessler has dedicated decades to unraveling the powerful science behind why we eat the way we do—and how we can reclaim our health in a world of ultra-processed foods.

Dr. Kessler shares his personal journey with weight regain and the "aha moment" that led him to call it what it is—addiction. He explores the role of GLP-1 medications, the dark side of food addiction, and how we must move beyond willpower to tackle this epidemic with compassion, science, and actionable tools.

🗝️ Key Takeaways

🔥 Addiction, Not Just Overeating
In The End of Overeating (2009), Kessler avoided the term "addiction." Now, in Diet, Drugs & Dopamine, he boldly names it. Cue-induced wanting, craving, and relapse are the neurobiological hallmarks of addiction—and they're present in our relationships with ultra-processed food.

⚖️ GLP-1 Medications: One Tool, Not a Cure
GLP-1s (like Ozempic, Wegovy) tamp down cravings by delaying gastric emptying and triggering aversive circuits (feelings of fullness, even nausea).
They work only while you’re on them—and can change your relationship with food—but they are not a magic bullet. The real value? These drugs prove this is biology, not a moral failing or lack of willpower.

💥 Addiction Is in the Brain—And It’s Working Too Well
Food addiction isn't a sign of dysfunction—it’s our reward circuits doing exactly what they were designed to do in a world of hyper-palatable foods.
The issue lies in environmental mismatch—evolution designed us for scarcity, but we now live in abundance.

🧬 It’s Not About Weight—It’s About Health
Kessler emphasizes toxic visceral fat as the real danger, not body size.
This fat is metabolically active and causal in diseases like heart disease, diabetes, cancer, and neurodegenerative conditions.

🔄 Weight Regain = Relapse
Most people regain lost weight not because of laziness, but due to metabolic adaptations and craving relapse. Recovery must focus on sustainable behavior change and addressing addictive circuits.

🤝 Bridging the Gap Between Food Addiction & Eating Disorder Communities
Kessler supports the inclusion of Ultra-Processed Food Use Disorder in the DSM and ICD.
Compassion and shared understanding are key to breaking down stigma and offering effective, united treatment approaches.

🧰 Lifestyle Management & Long-Term Tools
GLP-1s may be a biological bridge, but long-term success requires:
Nutrition education
Emotional regulation and distress tolerance
Culinary skills and food sovereignty
Community, support, and behavior change strategies

💡 Final Wisdom from Dr. Kessler
“Once you lose the weight, that’s when the real work begins.”
“There’s no shame in using the tools that work. But we need to use them wisely, and not in isolation.”

Follow Dr. Kessler: Twitter @DavidAKesslerMD

The content of our show is educational only. It does not supplement or supersede your healthcare provider's professional relationship and direction. Always seek the advice of your physician or other qualified mental health providers with any questions you may have regarding a medical condition, substance use disorder, or mental health concern.