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Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight
From the New York Times bestselling author of The End of Overeating comes an illuminating understanding of body weight, including the promise—and peril —of the latest weight loss drugs.
The struggle is universal: we work hard to lose weight, only to find that it slowly creeps back. In America, body weight has become a pain point shrouded in self-recrimination and shame, not to mention bias from the medical community. For many, this battle not only takes a mental toll but also becomes a physical threat: three-quarters of American adults struggle with weight-related health conditions, including high blood pressure, heart disease, and diabetes. We know that diets don’t work, and yet we also know that excess weight starves us of years and quality of life. Where do we go from here?
In Diet, Drugs, and Dopamine, former FDA Commissioner Dr. David A. Kessler unpacks the mystery of weight in the most comprehensive work to date on this topic, giving readers the power to dramatically improve their health. Kessler, who has himself struggled with weight, suggests the new class of GLP-1 weight loss drugs have provided a breakthrough: they have radically altered our understanding of weight loss. They make lasting change possible, but they also have real disadvantages and must be considered as part of a comprehensive approach together with nutrition, behavior, and physical activity.
Critical to this new perspective is the insight that weight-loss drugs act on the part of the brain that is responsible for cravings. In essence, the drugs tamp down the addictive circuits that overwhelm rational decision-making and quiet the “food noise” that distracts us. Identifying these mechanisms allows us to develop a strategy for effective long-term weight loss, and that begins with naming the elephant in the room: ultraformulated foods are addictive. Losing weight is a process of treating addiction.
In this landmark book, one of the nation’s leading public health officials breaks taboos around this fraught conversation, giving readers the tools to unplug the brain’s addictive wiring and change their relationship with food. Dr. Kessler cautions that drugs, on their own, pose serious risks and are not a universal solution. But with this new understanding of the brain-body feedback loop comes new possibilities for our health and freedom from a lifelong struggle.
Eye-opening, provocative, and rigorous, this book is a must-read for anyone who has ever struggled to maintain their weight—which is to say, everyone.
The struggle is universal: we work hard to lose weight, only to find that it slowly creeps back. In America, body weight has become a pain point shrouded in self-recrimination and shame, not to mention bias from the medical community. For many, this battle not only takes a mental toll but also becomes a physical threat: three-quarters of American adults struggle with weight-related health conditions, including high blood pressure, heart disease, and diabetes. We know that diets don’t work, and yet we also know that excess weight starves us of years and quality of life. Where do we go from here?
In Diet, Drugs, and Dopamine, former FDA Commissioner Dr. David A. Kessler unpacks the mystery of weight in the most comprehensive work to date on this topic, giving readers the power to dramatically improve their health. Kessler, who has himself struggled with weight, suggests the new class of GLP-1 weight loss drugs have provided a breakthrough: they have radically altered our understanding of weight loss. They make lasting change possible, but they also have real disadvantages and must be considered as part of a comprehensive approach together with nutrition, behavior, and physical activity.
Critical to this new perspective is the insight that weight-loss drugs act on the part of the brain that is responsible for cravings. In essence, the drugs tamp down the addictive circuits that overwhelm rational decision-making and quiet the “food noise” that distracts us. Identifying these mechanisms allows us to develop a strategy for effective long-term weight loss, and that begins with naming the elephant in the room: ultraformulated foods are addictive. Losing weight is a process of treating addiction.
In this landmark book, one of the nation’s leading public health officials breaks taboos around this fraught conversation, giving readers the tools to unplug the brain’s addictive wiring and change their relationship with food. Dr. Kessler cautions that drugs, on their own, pose serious risks and are not a universal solution. But with this new understanding of the brain-body feedback loop comes new possibilities for our health and freedom from a lifelong struggle.
Eye-opening, provocative, and rigorous, this book is a must-read for anyone who has ever struggled to maintain their weight—which is to say, everyone.
400 pages, Hardcover
Published May 13, 2025
110 people are currently reading
1217 people want to read
About the author
David A. Kessler
15 books76 followers(David Kessler is also the name of another author, a hospice expert who worked with Elisabeth Kübler-Ross, although David A. Kessler did co-author a book on elder care.)
David Aaron Kessler is an American pediatrician, lawyer, author, and administrator (both academic and governmental). He was the Commissioner of the Food and Drug Administration (FDA) from November 8, 1990 to February 28, 1997, and has subsequently held administrative and academic posts at Yale and the University of California at San Francisco.
More information is available at Wikipedia.
David Aaron Kessler is an American pediatrician, lawyer, author, and administrator (both academic and governmental). He was the Commissioner of the Food and Drug Administration (FDA) from November 8, 1990 to February 28, 1997, and has subsequently held administrative and academic posts at Yale and the University of California at San Francisco.
More information is available at Wikipedia.
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Displaying 1 - 30 of 101 reviews
August 12, 2025
3.75 stars
Overall a good book with a lot of information. I appreciated its wholistic approach (like for example recognizing that BMI wasn’t created to be used as it is currently and that it only took into account male bodies when it was created) and the authors avoidance of shaming. It definitely had interesting insights on the function of these new and vastly popular GLP-1 weight loss drugs (the nausea/sickness is a way the medication works to make eating less desirable and thus people are reducing energy/calorie intake, but that side effect is also one of the main reasons people discontinue usage). While it does seem that overall Kessler is in favor of the drugs (and has taken them himself), he raises important questions about the pharmaceutical and insurance industries promotion of these being lifelong commitments and further points out that the FDA does not have data for the efficacy and/or side effects for these drugs over extended time periods. Another interesting tidbit was how new classes of these drugs are being rolled out that may cause weight loss similar to bariatric surgery, but essentially put people in a starvation state because of their reduced caloric energy intake and thus can cause nutrient and vitamin deficiencies. While this book does provide insight on the GLP-1 drugs, I think it also was a snap shot in time type picture of the obesity crisis in America and calling out of food-addiction and hyper processed foods.
NOTES:
Calorie dense foods are always abundant in our modern world, not scarce which is what we are biologically wired for.
The hedonic and homeostatic systems work in tandem.
The highest weight you achieve becomes the new goal of the homeostatic system (set point theory). So your body fights against weight loss.
"Waste circumference should be half or less than half one's height" for optimal health & reduced risks
BMI with waist circumference measurement is best indicator for future health problems (like cardiovascular disease etc).
Visceral fat measurements with dexa scan
“The entire modern food industry is colluding to deregulate your appetite in ways that have a harmful impact on your health” (5:47).
Although lifespans increased by a decade health span has only increased by 3yrs for men and 2yrs for women. (5:54)
“The CDC, the American College of sports medicine, and many other health organizations recommend regular aerobic activity every week as necessary for cardiovascular health as well as two sessions of total body strength training” (6:56).
“…adequate protein 25-30g per meal, fiber at least 25g per day for women and 30g per day for men…” (7:08).
“Processed meats [like frozen chicken nuggets] damage human health and should be avoided, regardless of weight loss approach or goals for this reason” (7:36).
“The key factor is eating the food in an unprocessed or minimally processed state” (7:40).
“Eating whole foods and avoiding highly processed foods must be a central tenant of any health promoting nutritional therapy plan” (7:41).
“We need a shift away from the old school caloric reduction gimmicks to achieving energy deficits by limiting addictive foods. We need to increase the foods that satiate. And do so on the foundation of a healthy diet. Limit consumption of ultra formulated foods. Increase whatever makes us feel full, including increasing fibers fats and proteins” (7:46)
“Improving diet quality can have benefits on cardio-metabolic risk, independent of body weight” (7:48).
Low carb low glycemic diet to help insulin resistance
Detect insulin resistance & glucose responses via simpler indicators like waist circumference, blood triglycerides, and glucose levels (8:06).
- waistline over 40inches in men and 35in in women, a fasting triglyceride level 150mg/dL, and a fasting glucose level over 100mg/dL are signs of insulin resistance. (8:07)
- Dieting strategies for managing insulin resistance share similarities with those for managing type 2 diabetes (think low glycemic index and moderate carbohydrate)
In one study a Mediterranean diet helped more people sustain their weight over six years than low carb or low fat diets. (8:39)
- Mediterranean diet doesn’t address portion size or satiety
“Hydration is important because if you’re dehydrated the feeling of hunger is greater and comes quicker” (8:44)
Healthy diet = “In general such a pattern should emphasize a moderate intake of lean protein, be plant predominant, focus on low glycemic carbohydrates, and minimally processed foods, include healthy fats, and avoid extreme caloric restriction” (8:47).
“Perfection is not a requisite for managing weight and reducing visceral adiposity. The goal is to limit the harm the best we can. We all encounter tremendous numbers of food that stimulate the addictive circuits. Any positive incremental change is beneficial” (9:09).
Overall a good book with a lot of information. I appreciated its wholistic approach (like for example recognizing that BMI wasn’t created to be used as it is currently and that it only took into account male bodies when it was created) and the authors avoidance of shaming. It definitely had interesting insights on the function of these new and vastly popular GLP-1 weight loss drugs (the nausea/sickness is a way the medication works to make eating less desirable and thus people are reducing energy/calorie intake, but that side effect is also one of the main reasons people discontinue usage). While it does seem that overall Kessler is in favor of the drugs (and has taken them himself), he raises important questions about the pharmaceutical and insurance industries promotion of these being lifelong commitments and further points out that the FDA does not have data for the efficacy and/or side effects for these drugs over extended time periods. Another interesting tidbit was how new classes of these drugs are being rolled out that may cause weight loss similar to bariatric surgery, but essentially put people in a starvation state because of their reduced caloric energy intake and thus can cause nutrient and vitamin deficiencies. While this book does provide insight on the GLP-1 drugs, I think it also was a snap shot in time type picture of the obesity crisis in America and calling out of food-addiction and hyper processed foods.
NOTES:
Calorie dense foods are always abundant in our modern world, not scarce which is what we are biologically wired for.
The hedonic and homeostatic systems work in tandem.
The highest weight you achieve becomes the new goal of the homeostatic system (set point theory). So your body fights against weight loss.
"Waste circumference should be half or less than half one's height" for optimal health & reduced risks
BMI with waist circumference measurement is best indicator for future health problems (like cardiovascular disease etc).
Visceral fat measurements with dexa scan
“The entire modern food industry is colluding to deregulate your appetite in ways that have a harmful impact on your health” (5:47).
Although lifespans increased by a decade health span has only increased by 3yrs for men and 2yrs for women. (5:54)
“The CDC, the American College of sports medicine, and many other health organizations recommend regular aerobic activity every week as necessary for cardiovascular health as well as two sessions of total body strength training” (6:56).
“…adequate protein 25-30g per meal, fiber at least 25g per day for women and 30g per day for men…” (7:08).
“Processed meats [like frozen chicken nuggets] damage human health and should be avoided, regardless of weight loss approach or goals for this reason” (7:36).
“The key factor is eating the food in an unprocessed or minimally processed state” (7:40).
“Eating whole foods and avoiding highly processed foods must be a central tenant of any health promoting nutritional therapy plan” (7:41).
“We need a shift away from the old school caloric reduction gimmicks to achieving energy deficits by limiting addictive foods. We need to increase the foods that satiate. And do so on the foundation of a healthy diet. Limit consumption of ultra formulated foods. Increase whatever makes us feel full, including increasing fibers fats and proteins” (7:46)
“Improving diet quality can have benefits on cardio-metabolic risk, independent of body weight” (7:48).
Low carb low glycemic diet to help insulin resistance
Detect insulin resistance & glucose responses via simpler indicators like waist circumference, blood triglycerides, and glucose levels (8:06).
- waistline over 40inches in men and 35in in women, a fasting triglyceride level 150mg/dL, and a fasting glucose level over 100mg/dL are signs of insulin resistance. (8:07)
- Dieting strategies for managing insulin resistance share similarities with those for managing type 2 diabetes (think low glycemic index and moderate carbohydrate)
In one study a Mediterranean diet helped more people sustain their weight over six years than low carb or low fat diets. (8:39)
- Mediterranean diet doesn’t address portion size or satiety
“Hydration is important because if you’re dehydrated the feeling of hunger is greater and comes quicker” (8:44)
Healthy diet = “In general such a pattern should emphasize a moderate intake of lean protein, be plant predominant, focus on low glycemic carbohydrates, and minimally processed foods, include healthy fats, and avoid extreme caloric restriction” (8:47).
“Perfection is not a requisite for managing weight and reducing visceral adiposity. The goal is to limit the harm the best we can. We all encounter tremendous numbers of food that stimulate the addictive circuits. Any positive incremental change is beneficial” (9:09).
This entire review has been hidden because of spoilers.
June 26, 2025
This author is very knowledgeable. This book was really interesting to read. I took my time and just read a little every day. If you have ever been curious about the new weight loss drugs, healthy living and eating, this is definitely the book for you. The author lays everything out for us in a very easy to understand way. He doesn't offer his own opinions as to what he thinks is the best way for you to achieve your healthy weight, but does give you all the information you need to make that decision for yourself. He also explains how we do not know the long term effects of taking the new weight loss drugs because they're so new to the market. But sometimes the benefits could far outweigh risks for some people. Another thing I found interesting was reading that these drugs can make food seem undesirable and make people not even want the food. Which means they are in a very strict calorie deficit, and puts them at risk for malnutrition….which in the long run could be risky to their health.
Overall, I found this to be very informative, just out of curiosity. I have never had the need to use these drugs myself, but I still found the information had answered my questions that I often wondered about.
Thank you to the publisher for the gifted copy . All opinions are my own!
Overall, I found this to be very informative, just out of curiosity. I have never had the need to use these drugs myself, but I still found the information had answered my questions that I often wondered about.
Thank you to the publisher for the gifted copy . All opinions are my own!
May 8, 2025
In Diet Drugs and Dopamine, former FDA commissioner David A. Kessler delivers a deeply researched and eye-opening exploration of one of the most pressing health issues of our time: the collision of modern food systems, addiction science, and the pursuit of weight loss.
Kessler unpacks the peril of living in a society engineered for overconsumption—where ultra-processed foods dominate our plates and our physiology is no match for the dopamine-driven lure of abundance. He makes a compelling case that what we often frame as personal failure is, in fact, a biologically and socially rigged game. The result? A public health crisis marked by skyrocketing rates of obesity, food addiction, and poor metabolic health.
Timely and balanced, the book also provides a nuanced analysis of the new wave of weight loss drugs like GLP-1 agonists. Kessler acknowledges their promising potential for reducing weight and improving metabolic markers, but he’s clear: these drugs are not a magic bullet. Instead, they are just one tool—possibly a life-changing one—for a condition shaped by biology, behavior, and a broken food environment. He also sounds a cautionary note on the growing pharmaceutical pipeline, urging greater regulatory oversight and long-term safety studies.
Whether you’re a clinician, policymaker, or simply someone navigating your own relationship with food and health, Diet Drugs and Dopamine is an essential, sobering, and ultimately empowering read.
Thank you to the author, publisher and NetGalley for the opportunity to read an advance copy of this book in exchange for an honest review.
Kessler unpacks the peril of living in a society engineered for overconsumption—where ultra-processed foods dominate our plates and our physiology is no match for the dopamine-driven lure of abundance. He makes a compelling case that what we often frame as personal failure is, in fact, a biologically and socially rigged game. The result? A public health crisis marked by skyrocketing rates of obesity, food addiction, and poor metabolic health.
Timely and balanced, the book also provides a nuanced analysis of the new wave of weight loss drugs like GLP-1 agonists. Kessler acknowledges their promising potential for reducing weight and improving metabolic markers, but he’s clear: these drugs are not a magic bullet. Instead, they are just one tool—possibly a life-changing one—for a condition shaped by biology, behavior, and a broken food environment. He also sounds a cautionary note on the growing pharmaceutical pipeline, urging greater regulatory oversight and long-term safety studies.
Whether you’re a clinician, policymaker, or simply someone navigating your own relationship with food and health, Diet Drugs and Dopamine is an essential, sobering, and ultimately empowering read.
Thank you to the author, publisher and NetGalley for the opportunity to read an advance copy of this book in exchange for an honest review.
June 18, 2025
Ok, I wanted to really like this book but unfortunately it was not for me. Its argument was unfocused, mechanically went through the pros and cons of every topic, and I don’t feel like I came out of this with much more knowledge than I had when I began.
The sections on insulin resistance and glucose levels were interesting, but also topics I felt like I already knew about to the same degree that this book goes in depth. Ditto for the sections on GLPs, GLP/GIP dual agonists, and the trials of triple agonists like retatrutide. There were sections about the mechanisms of each which were really interesting and enjoyable, and were probably the highlights of my reading experience.
I think this book especially suffers when it goes through lifestyle diets like plant based, keto, mediterranean, and intermittent fasting and just touches on each of these topics briefly without any ascertainable larger goal when doing so. I understand many people are looking to books such as these for lifestyle advice, and not a glimpse into the current science and political climate surrounding the topic, but it felt very surface level. Nice to add references to people needing access to nutritionists and the like for personalized advice, but lacked mentioning the lack of accessibility (whether real or perceived) that leads many people are turning to online teleheath companies and the internet for these drugs and nutritional advice.
Lastly, I was exhausted by the emphasis on ultra processed foods (UPFs). Perhaps because UPFs run so closely to MAHA-types and pseudoscience nutrition, it felt fatiguing to continually hear Kessler opine about the “food industry” and “pharmaceutical industry” which just felt more like subtle fear mongering. Towards the end of the book, discussions relating food addictions to other addictions such as alcohol were really thought provoking but also ultimately fell flat as he struggles to relate how different ways of treating addiction may struggle treating food addiction.
Overall, I think the book suffers from lack of decisiveness regarding new weight loss drugs and the balance between personal choices and various industry’s goals. I don’t agree with a significant number of the policy proposals contain herein, but I do appreciate that for many who have not been particularly interested in these topics already that this can be a good starting point and demystify the allure.
The sections on insulin resistance and glucose levels were interesting, but also topics I felt like I already knew about to the same degree that this book goes in depth. Ditto for the sections on GLPs, GLP/GIP dual agonists, and the trials of triple agonists like retatrutide. There were sections about the mechanisms of each which were really interesting and enjoyable, and were probably the highlights of my reading experience.
I think this book especially suffers when it goes through lifestyle diets like plant based, keto, mediterranean, and intermittent fasting and just touches on each of these topics briefly without any ascertainable larger goal when doing so. I understand many people are looking to books such as these for lifestyle advice, and not a glimpse into the current science and political climate surrounding the topic, but it felt very surface level. Nice to add references to people needing access to nutritionists and the like for personalized advice, but lacked mentioning the lack of accessibility (whether real or perceived) that leads many people are turning to online teleheath companies and the internet for these drugs and nutritional advice.
Lastly, I was exhausted by the emphasis on ultra processed foods (UPFs). Perhaps because UPFs run so closely to MAHA-types and pseudoscience nutrition, it felt fatiguing to continually hear Kessler opine about the “food industry” and “pharmaceutical industry” which just felt more like subtle fear mongering. Towards the end of the book, discussions relating food addictions to other addictions such as alcohol were really thought provoking but also ultimately fell flat as he struggles to relate how different ways of treating addiction may struggle treating food addiction.
Overall, I think the book suffers from lack of decisiveness regarding new weight loss drugs and the balance between personal choices and various industry’s goals. I don’t agree with a significant number of the policy proposals contain herein, but I do appreciate that for many who have not been particularly interested in these topics already that this can be a good starting point and demystify the allure.
July 18, 2025
David A. Kessler is an American pediatrician and lawyer with extensive public policy experience, having served as FDA administrator from 1990-1997, and having served in prominent roles in the Biden administration related to COVID pandemic response. In his 2025 book Diet, Drugs, and Dopamine, Dr. Kessler tackles a number of issues - the obesity crisis in many Western countries including the US, the metabolic health risks of overweight and obesity, ultra-processed foods, various methods to alter body weight including dietary changes, surgery, and most recently, GLP-1 drugs, and the short- and long-term efficacy of various methods of weight reduction. Dr. Kessler is transparent about his own struggles with his weight, and is candid about his own use of GLP-1 drugs. I also appreciated his interviews with other health professionals who've struggled with their weight (as someone in this category myself). Knowing the science and health risks of overweight and obesity and consistently maintaining a lifestyle and dietary habits that obviate these risks are two separate challenges.
Overall this is a very dense and often discouraging read (discouraging in that the problems Dr. Kessler explores are quite glum with no easy solutions). I was struck by a few statistics in the book, such as that only 20% of Americans are metabolically healthy (the other 80% of us are diabetic or have some loss of insulin sensitivity), and that most Americans consume the majority of their daily caloric intake between 6 PM and midnight. That being said, this book can read like an information dump that's a bit unfocused in terms of its target audience. It's unclear to me if Dr. Kessler aimed this book at generally audiences, since he gives a lot of general health advice as a doctor advising their patients would (I think laypeople would find this too technical and jargon-laden), or at health professionals (where the technical jargon would be generally well-understood, but the sheer breadth and depth of information would be overwhelming). I think the root of this issue is trying to tackle so many problems with one book. I would recommend this as a supplemental resource to those interested in nutrition, obesity, and weight management, but I'll recommend some more narrowly-focused books below.
The bottom line: there is something fundamentally wrong and broken with a country's food culture that's worked for decades to make food addictive and irresistible coupled with a multibillion dollar industry for weight loss and a pharmaceutical system that touts its drugs as magic cures, but only if you take said drugs for the rest of your life.
Further reading:
GLP-1s in the scheme of weight loss cures: Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs by Johann Hari
Ultraprocessed foods: Ultra-Processed People: The Science Behind Food That Isn't Food by Chris van Tulleken, MD, PhD
Intermittent fasting: The Obesity Code: Unlocking the Secrets of Weight Loss by Jason Fung, MD
Weight maintenance: Refuse to Regain!: 12 Tough Rules to Maintain the Body You've Earned! by Barbara Berkeley, MD
My statistics:
Book 217 for 2025
Book 2143 cumulatively
Overall this is a very dense and often discouraging read (discouraging in that the problems Dr. Kessler explores are quite glum with no easy solutions). I was struck by a few statistics in the book, such as that only 20% of Americans are metabolically healthy (the other 80% of us are diabetic or have some loss of insulin sensitivity), and that most Americans consume the majority of their daily caloric intake between 6 PM and midnight. That being said, this book can read like an information dump that's a bit unfocused in terms of its target audience. It's unclear to me if Dr. Kessler aimed this book at generally audiences, since he gives a lot of general health advice as a doctor advising their patients would (I think laypeople would find this too technical and jargon-laden), or at health professionals (where the technical jargon would be generally well-understood, but the sheer breadth and depth of information would be overwhelming). I think the root of this issue is trying to tackle so many problems with one book. I would recommend this as a supplemental resource to those interested in nutrition, obesity, and weight management, but I'll recommend some more narrowly-focused books below.
The bottom line: there is something fundamentally wrong and broken with a country's food culture that's worked for decades to make food addictive and irresistible coupled with a multibillion dollar industry for weight loss and a pharmaceutical system that touts its drugs as magic cures, but only if you take said drugs for the rest of your life.
Further reading:
GLP-1s in the scheme of weight loss cures: Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs by Johann Hari
Ultraprocessed foods: Ultra-Processed People: The Science Behind Food That Isn't Food by Chris van Tulleken, MD, PhD
Intermittent fasting: The Obesity Code: Unlocking the Secrets of Weight Loss by Jason Fung, MD
Weight maintenance: Refuse to Regain!: 12 Tough Rules to Maintain the Body You've Earned! by Barbara Berkeley, MD
My statistics:
Book 217 for 2025
Book 2143 cumulatively
Read
November 8, 2025No rating because I DNF about one-third through.
This book illustrates once again that knowing science, doing science and writing science are three different skillsets. No one could argue about Dr. Kessler's credentials. And yet the book is a disappointment. To start with, the focus, at least in the third that I read, struck me as reductionist. It's all about how ultraprocessed foods activate the reward pathways in the brain (the "dopamine" of the title) and how overeating is an addiction. Well, that's nothing new. Shifting the blame from "you don't have enough willpower to control your eating" to "sugary/salty/fat snacks are as addictive as crack cocaine" may have some value in decreasing personal feelings of guilt and societal stigmatization. On the other hand... what about sedentarism? What about the simple fact that eating healthy often means: spending a lot of money and time? I was slightly irritated by the repeat statement that on average people gain 1 or 2 lbs per year in adulthood. Mmm, that may be true for men, but most women know that weight gain happens in 2 spurts : the post-baby pounds you can't shed, and the 10 pounds that settle around the waist during menopauze. It's possible that these topics were explored in more detail in later chapters, but I had lost interest by then.
Another aspect is that the book is simply not easy to follow. It struck me as the slightly logorrheic outpourings of someone who knows a lot (as also illustrated by the extensive bibliography) and wants to share it all, but can't order his thoughts. The arguments are unfocused and repetitive. Ultraprocessed foods are addictive, so it's all about the reward pathways. No, actually it's about gastric emptying and satiety (as illustrated by the mechanism of action of the GLP-1 drugs). No, actually, it's about your metabolism adapting to dieting. Round and round we go, with numerous professors being called upon to provide ponderous quotes of the type "X is involved with Y, which leads to Z". We jump from personal anecdote to rat experiments to long-term follow-up studies of diet interventions and back.
I also have to say that the book exuded a bit of the gloom-and-doom that I usually associate with geneticists and their genetics-is-destiny view of the world. "Our bodies, appetite and metabolism evolved to store fat, and whatever you do, you will revert back to that, especially because we are surrounded by obesity-promoting foods. The only solution are GLP-1 drugs that work miraculously but essentially make you nauseous." That seems to be the message in a nutshell (again, of the first third of the book). If that doesn't send you off to your fridge for some consolatory ice cream, then I don't know what would.
This book illustrates once again that knowing science, doing science and writing science are three different skillsets. No one could argue about Dr. Kessler's credentials. And yet the book is a disappointment. To start with, the focus, at least in the third that I read, struck me as reductionist. It's all about how ultraprocessed foods activate the reward pathways in the brain (the "dopamine" of the title) and how overeating is an addiction. Well, that's nothing new. Shifting the blame from "you don't have enough willpower to control your eating" to "sugary/salty/fat snacks are as addictive as crack cocaine" may have some value in decreasing personal feelings of guilt and societal stigmatization. On the other hand... what about sedentarism? What about the simple fact that eating healthy often means: spending a lot of money and time? I was slightly irritated by the repeat statement that on average people gain 1 or 2 lbs per year in adulthood. Mmm, that may be true for men, but most women know that weight gain happens in 2 spurts : the post-baby pounds you can't shed, and the 10 pounds that settle around the waist during menopauze. It's possible that these topics were explored in more detail in later chapters, but I had lost interest by then.
Another aspect is that the book is simply not easy to follow. It struck me as the slightly logorrheic outpourings of someone who knows a lot (as also illustrated by the extensive bibliography) and wants to share it all, but can't order his thoughts. The arguments are unfocused and repetitive. Ultraprocessed foods are addictive, so it's all about the reward pathways. No, actually it's about gastric emptying and satiety (as illustrated by the mechanism of action of the GLP-1 drugs). No, actually, it's about your metabolism adapting to dieting. Round and round we go, with numerous professors being called upon to provide ponderous quotes of the type "X is involved with Y, which leads to Z". We jump from personal anecdote to rat experiments to long-term follow-up studies of diet interventions and back.
I also have to say that the book exuded a bit of the gloom-and-doom that I usually associate with geneticists and their genetics-is-destiny view of the world. "Our bodies, appetite and metabolism evolved to store fat, and whatever you do, you will revert back to that, especially because we are surrounded by obesity-promoting foods. The only solution are GLP-1 drugs that work miraculously but essentially make you nauseous." That seems to be the message in a nutshell (again, of the first third of the book). If that doesn't send you off to your fridge for some consolatory ice cream, then I don't know what would.
June 5, 2025
This book was mainly about GLP-1 drugs. He should have put it in the title. The was a sprinkling about how hard it is to lose weight and easy it is to put the pounds on. Of course, there lots of preaching about the evils of ultra processed foods. Although, the definition of ultra processed food can be hard to pin down. There is one very slim chapter about behavioral training to help people lose weight. I mainly skimmed the book. I would slow down from time to time I caught sight of something interesting. This book put me to sleep several times. A two-page bright spot is the author talking to someone I work with.
December 4, 2025
Kessler has an interesting take on GLP-1's and weightloss/behaviors around food. Kessler knows the ins/outs of policy and the business side of healthcare from his time with the FDA. He also experiments with the drugs himself and reports his own findings. I totally agree with Kessler as there need to be more guidelines and structure with mass rollout of these weightloss drugs. Additionally long term research of the effects of these drugs mostly remain unknown. But skinny at any cost, right?🤨
June 3, 2025
my dad told me to read this. i feel like i want to go eat some cookies out of spite
August 13, 2025
I thought this book was very informative about the relationship between eating, dopamine, and addiction. Our foods have become so processed that we don’t have nutrients and we look for quick hits through salt, sugar, and fat now.
What I love what the honesty of the author and his use of GLP1. GLP1 is seriously a game changer in the name of food addiction. I myself am a huge fan, and if done right (protein! fiber! Veggies! Water!) it can change lives. However, if you don’t use them the healthy way, you can get sick.
I think this book is great for those looking to use weight loss meds or even those with food addiction.
I found some parts of this book to be a bit repetitive, but overall this book was informative and I love how open the author is about his experience. Thank you Flat Iron Books & Net Galley for an advanced copy of this book.
What I love what the honesty of the author and his use of GLP1. GLP1 is seriously a game changer in the name of food addiction. I myself am a huge fan, and if done right (protein! fiber! Veggies! Water!) it can change lives. However, if you don’t use them the healthy way, you can get sick.
I think this book is great for those looking to use weight loss meds or even those with food addiction.
I found some parts of this book to be a bit repetitive, but overall this book was informative and I love how open the author is about his experience. Thank you Flat Iron Books & Net Galley for an advanced copy of this book.
August 27, 2025
My nomination for nonfiction book of the year! By now, it's not too surprising to know that Ultra Formulated Food containing salt + fat, salt + sugar, salt + carbohydrates (sometimes, cleverly all three) and newer, bizzaro formulations were deliberately created to activate our neural addiction circuits. I'd spill the beans on the author's answer to reversing accelerating rates of diabetes 2, fatty livers and visceral fat now even accumulating in our kidneys, but the comprehensive character of his blue-ribbon deserving book is also a worthy reward. Though, I listened to the audiobook version, no doubt the paper versions have their own set of benefits.
September 26, 2025
Cannot recommend. It is scientifically dense, too much so for the average reader versus a scientist. Not much new, rather a recitation of all the diets in the universe, except promoting the new weight loss drugs. Even then he points out how little we know of their long term effects. If you have never read a book like this you will get bogged down and just decide to take Ozempic or some such. If, like me, you have read too many of them, you will be bored by most of it. There are some new parts but too much sand to sift through for the few nuggets of gold for most. However if you are thinking about taking one of the new diet drugs/GLP-1 inhibitors then I recommend you slog through this book to help in your decision making. It is important.
June 2, 2025
DNF. Redundant and boring and nothing I didn't know more or less from reading other sources abs keeping up on the literature in this area.
June 15, 2025
Highly recommend to anyone that is curious about healthy living and eating. This book is a deep dive into diet culture, including the recent trend of weight loss drugs. I enjoyed learning about the various topics this book covered, including how food overconsumption is an addiction. The author did not cast any judgment on the various options for weight loss, but instead provided a full overview of what each one entailed and discussed the likelihood of maintaining a healthy weight after stopping the weight loss drugs.
Thank you to Flatiron Books and NetGalley for the gifted copy of the ebook of this ARC.
Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight
Thank you to Flatiron Books and NetGalley for the gifted copy of the ebook of this ARC.
Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight
September 7, 2025
This was jam-packed with lots of information and it was an interesting read — particularly as someone who has struggled with her weight and has used GLP-1 drugs to help with weight loss in the past. The author does a great job of addressing every aspect of why it’s so hard for everyone to lose weight nowadays, and he even brings his own experience into it. He also dives into how the world works against those trying to maintain healthy weight.
Only thing was this was super, super dry. Painfully so at times. It felt like reading a textbook.
Only thing was this was super, super dry. Painfully so at times. It felt like reading a textbook.
October 18, 2025
This was not for me. It came across as a huge advertisement for GLP-1s. I think this drug is helpful considering the global obesity epidemic. However, long term effects are not known and that gives me pause.
I will say though, that I loved the science, the studies and the research. That part was fascinating and kept me in. So I added a star for that.
I will say though, that I loved the science, the studies and the research. That part was fascinating and kept me in. So I added a star for that.
August 31, 2025
Weight loss is very multi-faceted! Fascinating
August 13, 2025
This is not a weight-loss book. Rather, it's an overview from former FDA Commissioner David Kessler (no relation) on the current medical understanding of nutrition and dieting, the widespread problem that he calls food addiction, and the new class of GLP-1 drugs like Ozempic which seem promising to help treat it. The author shares that he's struggled to maintain an ideal weight and resist certain cravings his whole life, and that he's recently achieved results with such medications himself, although he has misgivings about their understudied long-term effects.
The arguments laid out in the text sound generally reasonable to my layman's read, though I note that the writer fudges a bit on the exact science of 'food addiction.' That is, he regularly cites experts on addiction, describes an aspect of our modern western diet, and then concludes that the latter should qualify as an example of the former, with no indication that anyone he's consulted has necessarily signed off on that designation. In the process, I suspect he's rather overstating the case against ultra-processed foods beyond what a consensus of the research community would perhaps support. There certainly doesn't appear to be any large-scale movement calling for the sort of nutritional packaging reforms that he suggests, interesting as it is to hear him comparing food companies to the cigarette manufacturers he helped better regulate in the 1990s.
Nevertheless, the addict language does feel like a helpful framework for conceptualizing snacking and other unwanted consumption behaviors, and I could see the establishment wisdom catching up to him there at some point. The volume has plenty of information to assist readers in making informed choices about their own caloric intake, including descriptions of how a few popular dieting plans function in the body and the reminder that sleep regulation is an important part of feeling properly satiated by whatever we eat. I also appreciate that a distinction is drawn between excess weight as a medical concern of fatty tissue surrounding a person's internal organs and the faulty idea that particular sizes / shapes / problematic calculations like BMI are inherently unhealthy.
Overall it's not a bad job, even if the repetitive matter-of-fact prose leaves something to be desired. (A sample passage: "This genetics test did not help me understand why I have a difficult time controlling my weight. Could a different genetics test help me better understand why I have a difficult time controlling my weight?") Get an editor, Kessler!
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The arguments laid out in the text sound generally reasonable to my layman's read, though I note that the writer fudges a bit on the exact science of 'food addiction.' That is, he regularly cites experts on addiction, describes an aspect of our modern western diet, and then concludes that the latter should qualify as an example of the former, with no indication that anyone he's consulted has necessarily signed off on that designation. In the process, I suspect he's rather overstating the case against ultra-processed foods beyond what a consensus of the research community would perhaps support. There certainly doesn't appear to be any large-scale movement calling for the sort of nutritional packaging reforms that he suggests, interesting as it is to hear him comparing food companies to the cigarette manufacturers he helped better regulate in the 1990s.
Nevertheless, the addict language does feel like a helpful framework for conceptualizing snacking and other unwanted consumption behaviors, and I could see the establishment wisdom catching up to him there at some point. The volume has plenty of information to assist readers in making informed choices about their own caloric intake, including descriptions of how a few popular dieting plans function in the body and the reminder that sleep regulation is an important part of feeling properly satiated by whatever we eat. I also appreciate that a distinction is drawn between excess weight as a medical concern of fatty tissue surrounding a person's internal organs and the faulty idea that particular sizes / shapes / problematic calculations like BMI are inherently unhealthy.
Overall it's not a bad job, even if the repetitive matter-of-fact prose leaves something to be desired. (A sample passage: "This genetics test did not help me understand why I have a difficult time controlling my weight. Could a different genetics test help me better understand why I have a difficult time controlling my weight?") Get an editor, Kessler!
Like this review?
--Throw me a quick one-time donation here!
https://ko-fi.com/lesserjoke
--Subscribe here to support my writing and weigh in on what I read next!
https://patreon.com/lesserjoke
--Follow along on Goodreads here!
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--Or click here to browse through all my reviews!
https://lesserjoke.home.blog
November 15, 2025
DID NOT FINISH
Stopped at around 50%.
We found this book to read largely like an extended case for GLP‑1 weight‑loss drugs rather than a balanced, evidence‑first exploration of obesity and treatment trade‑offs. By the halfway mark the narrative had settled into sustained advocacy, and the critical appraisal and long‑term perspective we expect from a sober treatment of this topic were often missing.
Why we stopped:
We stopped because the tone skewed promotional: enthusiasm for GLP‑1 therapies repeatedly outpaced careful discussion of long‑term safety, comparative effectiveness, and practical trade‑offs. We wanted a methodical, skeptical review that weighs benefits, harms, access, and alternatives; instead the book leaned toward persuasion.
Bright spots:
- Industry history: Useful tracing of how food companies borrowed tactics from tobacco to engineer more addictive products.
- Therapy realism: A clear acknowledgment that Cognitive Behavioral Therapy has limited efficacy for many people.
Who this is NOT for:
Not for clinicians, patients, or advocates seeking a dispassionate, methodical guide to obesity treatment. This is not a book we would give to anyone who needs a rigorous, balanced primer.
Final takeaway:
Contains a couple of useful insights, but overall reads like an advertisement for GLP‑1 drugs; not a resource we’d recommend.
*Thanks to Copilot for helping us craft this review*
Stopped at around 50%.
We found this book to read largely like an extended case for GLP‑1 weight‑loss drugs rather than a balanced, evidence‑first exploration of obesity and treatment trade‑offs. By the halfway mark the narrative had settled into sustained advocacy, and the critical appraisal and long‑term perspective we expect from a sober treatment of this topic were often missing.
Why we stopped:
We stopped because the tone skewed promotional: enthusiasm for GLP‑1 therapies repeatedly outpaced careful discussion of long‑term safety, comparative effectiveness, and practical trade‑offs. We wanted a methodical, skeptical review that weighs benefits, harms, access, and alternatives; instead the book leaned toward persuasion.
Bright spots:
- Industry history: Useful tracing of how food companies borrowed tactics from tobacco to engineer more addictive products.
- Therapy realism: A clear acknowledgment that Cognitive Behavioral Therapy has limited efficacy for many people.
Who this is NOT for:
Not for clinicians, patients, or advocates seeking a dispassionate, methodical guide to obesity treatment. This is not a book we would give to anyone who needs a rigorous, balanced primer.
Final takeaway:
Contains a couple of useful insights, but overall reads like an advertisement for GLP‑1 drugs; not a resource we’d recommend.
*Thanks to Copilot for helping us craft this review*
This entire review has been hidden because of spoilers.
Read
June 6, 2025The following book reviews have been shared by Text Publishing, publisher of Diet, Drugs and Dopamine:
‘Invites readers to lay down their assumptions and be open to new ways of thinking about obesity…What he says is compelling—but the real question is what each of us chooses to do about it.’
Conversation
‘Who could be better suited and more trustworthy than former FDA commissioner Dr. David A. Kessler to doggedly sort through the scientific evidence, cut through the hype, and bring us to a better understanding of our own body weight? Diet, Drugs, and Dopamine is eye-opening, beautifully crafted, full of practical insights, and a great read.’
Abraham Verghese, New York Times bestselling author of The Covenant of Water
‘A brilliant and incisive examination of one of our country's most vexing health challenges. Dr. Kessler’s sharp scientific analysis cuts through the fog of confusion surrounding weight loss and offers a practical, sustainable pathway to better health. It is no surprise he is one of the great medical and public health leaders of our time.’
Vivek H. Murthy, MD, 19th and 21st Surgeon General of the United States and New York Times bestselling author of Together
‘Diet, Drugs, and Dopamine is a tour de force and reflects a clarity of thinking on many controversial issues from food restricting to intuitive eating, body positivity to toxic fat, and GLP-1 agonists as a possible revolutionary tool to combat obesity. There’s even a section on menopause! This book is the definitive scientific source on food addiction.’
Anna Lembke, MD, New York Times bestselling author of Dopamine Nation
‘Dr. Kessler forensically dissects the weighty topic of obesity for all to understand. This is fascinating and essential reading for all.’
VADM (Ret) Richard Carmona, MD, MPH, FACS, 17th Surgeon General of the United States
‘A beautifully rendered and illuminating exploration of the disease of obesity that will change not only how we understand our health but also how we understand one another.’
Siddhartha Mukherjee, MD, New York Times bestselling author of The Emperor of All Maladies
‘A great read! Really excellent stuff. Kessler brilliantly walks the tightrope between the hype and the criticism around the new weight loss drugs—weaving personal stories with superbly accessible science. An important and illuminating book.’
Chris van Tulleken, author of Ultra-Processed People
‘Invites readers to lay down their assumptions and be open to new ways of thinking about obesity…What he says is compelling—but the real question is what each of us chooses to do about it.’
Conversation
‘Who could be better suited and more trustworthy than former FDA commissioner Dr. David A. Kessler to doggedly sort through the scientific evidence, cut through the hype, and bring us to a better understanding of our own body weight? Diet, Drugs, and Dopamine is eye-opening, beautifully crafted, full of practical insights, and a great read.’
Abraham Verghese, New York Times bestselling author of The Covenant of Water
‘A brilliant and incisive examination of one of our country's most vexing health challenges. Dr. Kessler’s sharp scientific analysis cuts through the fog of confusion surrounding weight loss and offers a practical, sustainable pathway to better health. It is no surprise he is one of the great medical and public health leaders of our time.’
Vivek H. Murthy, MD, 19th and 21st Surgeon General of the United States and New York Times bestselling author of Together
‘Diet, Drugs, and Dopamine is a tour de force and reflects a clarity of thinking on many controversial issues from food restricting to intuitive eating, body positivity to toxic fat, and GLP-1 agonists as a possible revolutionary tool to combat obesity. There’s even a section on menopause! This book is the definitive scientific source on food addiction.’
Anna Lembke, MD, New York Times bestselling author of Dopamine Nation
‘Dr. Kessler forensically dissects the weighty topic of obesity for all to understand. This is fascinating and essential reading for all.’
VADM (Ret) Richard Carmona, MD, MPH, FACS, 17th Surgeon General of the United States
‘A beautifully rendered and illuminating exploration of the disease of obesity that will change not only how we understand our health but also how we understand one another.’
Siddhartha Mukherjee, MD, New York Times bestselling author of The Emperor of All Maladies
‘A great read! Really excellent stuff. Kessler brilliantly walks the tightrope between the hype and the criticism around the new weight loss drugs—weaving personal stories with superbly accessible science. An important and illuminating book.’
Chris van Tulleken, author of Ultra-Processed People
Read
July 18, 2025In "Diet, Drugs, and Dopamine", Dr. David A. Kessler redefines how we should think about weight loss, health, and body fat. For years, people struggling with their weight have been told that self-discipline and exercise are the keys to success. But despite endless diets, fitness plans, and calorie-counting regimens, the overwhelming majority of Americans still battle obesity and its related health issues. This book challenges the conventional wisdom and argues that our weight struggles are not the result of personal failure but a complex interaction between biology, food environment, and brain chemistry. Kessler invites us to stop blaming ourselves and instead understand the true science behind why weight loss is so hard—and what we can do about it.
One of the central messages of the book is that obesity is not simply about eating too much or moving too little. It’s a condition driven by disrupted hormonal signals and faulty brain pathways that regulate hunger, fullness, and fat storage. Our bodies are designed to maintain a set point of weight through homeostatic processes, but in people with obesity, this system is out of balance. These individuals experience changes in how their bodies store fat, how their brains respond to food, and how their metabolism functions over time. These aren’t temporary effects; they are biological patterns that actively resist weight loss. In fact, major weight loss often triggers the body to fight back by slowing metabolism, making it harder to keep the weight off. For example, contestants from a well-known reality show who lost large amounts of weight through extreme exercise and diet saw their metabolism crash significantly, forcing them to burn hundreds fewer calories than expected just to maintain their new weight.
The book also sheds light on the outdated and misleading nature of tools like the BMI, which fails to distinguish between fat and muscle. A person with high muscle mass could be labeled obese despite having minimal health risks, while someone with lower muscle but high visceral fat might go unnoticed. The real issue isn’t body weight alone, but the composition of that weight—particularly the ratio of fat to muscle and where that fat is stored. Visceral fat, which surrounds internal organs, is particularly dangerous. It’s not only hard to see but it also releases inflammatory chemicals that promote chronic disease. This kind of fat interferes with hunger regulation in the brain, causing people to eat more than they need and crave unhealthy foods. Over time, this creates a feedback loop: more visceral fat leads to worse hunger signaling, which leads to overeating, which causes even more visceral fat.
Food itself is a major player in this story. According to Kessler, our modern food landscape is filled with products designed to exploit our biological vulnerabilities. Ultra-processed foods—those loaded with refined sugars, fats, and salt—flood the brain with dopamine, triggering the same reward pathways that are activated by addictive drugs. These foods aren’t just unhealthy; they’re engineered to keep us coming back for more. And unlike substances like nicotine or alcohol, they are everywhere—on every street corner, in every convenience store, often disguised as healthy choices. Because they contain substances our bodies genuinely need, like glucose, it becomes even harder to say no. But we weren’t designed to handle the concentrated doses of sugar and simple carbohydrates these foods deliver, and as a result, our brains and bodies become rewired to depend on them.
But all is not lost. Kessler explores how new medications, especially GLP-1 agonists like Ozempic and Mounjaro, are changing the landscape of weight management. These drugs mimic a hormone that regulates insulin, slows stomach emptying, and signals fullness to the brain. What makes them revolutionary is their long-lasting effect and targeted action: they help people feel satisfied with less food and reduce the intense cravings that make dieting difficult. For the first time, weight loss medications are showing sustained, significant results, with patients losing 15 to 20 percent of their body weight or more. They are not, however, a cure-all. They don’t address the emotional and behavioral patterns that often accompany overeating, nor do they automatically promote healthy food choices.
This is where dietary strategies come back into play—but with a smarter approach. Rather than simply reducing calories, Kessler advocates for a focus on food quality. Whole foods, especially those with intact cellular structures, digest more slowly and prevent the glucose spikes that trigger hunger and cravings. For instance, eating a whole apple provides fiber and slows sugar absorption, unlike applesauce or juice, which flood the bloodstream with glucose. Protein is especially important—it requires more energy to digest, keeps blood sugar stable, and supports muscle maintenance during weight loss. Carbohydrates aren’t forbidden but should be timed with physical activity so that the body uses them for energy instead of fat storage. This is about retraining your body and brain to respond to food in healthier ways.
Equally important is understanding the emotional relationship many people have with eating. For many, food becomes a source of comfort, distraction, or even self-punishment. Cognitive behavioral therapy can help people examine the feelings that lead to overeating and reframe their responses. Instead of reacting to stress, boredom, or sadness by eating, individuals can learn to pause, recognize their triggers, and choose a healthier response. This level of insight isn’t something a drug can deliver—it comes from reflection, intention, and sometimes professional guidance. Delay discounting, a psychological concept that explains why we choose short-term pleasure over long-term gain, also plays a role. A cookie today seems far more appealing than the abstract idea of avoiding diabetes in the future. But by making the consequences of poor health more concrete and immediate—such as through visual reminders, journaling, or even cost calculations—we can begin to shift our decision-making in favor of long-term well-being.
Ultimately, the book is not an argument for choosing one strategy over another. It’s a call to integrate every available tool—medicine, nutrition, behavior change, and psychological insight—into a flexible, personalized approach to weight management. The goal isn’t to chase an arbitrary number on the scale, but to improve quality of life, prevent disease, and restore control over eating and health. GLP-1 drugs may give people a head start, but long-term success still depends on addressing the habits, beliefs, and environments that shape how we eat and live.
In conclusion, "Diet, Drugs, and Dopamine" presents a nuanced and science-based view of weight loss that reframes the issue as one of biology, not character. By unpacking the complex interplay of hormones, brain signals, processed food addiction, and emotional eating, Kessler provides a roadmap for achieving a healthier weight without shame or unrealistic expectations. Medications like GLP-1 agonists are powerful tools, but their true value lies in the breathing room they create—space for people to rebuild healthier habits, rewire their cravings, and pursue sustainable change. This book is a powerful reminder that while biology may shape our challenges, it can also illuminate the path forward.
One of the central messages of the book is that obesity is not simply about eating too much or moving too little. It’s a condition driven by disrupted hormonal signals and faulty brain pathways that regulate hunger, fullness, and fat storage. Our bodies are designed to maintain a set point of weight through homeostatic processes, but in people with obesity, this system is out of balance. These individuals experience changes in how their bodies store fat, how their brains respond to food, and how their metabolism functions over time. These aren’t temporary effects; they are biological patterns that actively resist weight loss. In fact, major weight loss often triggers the body to fight back by slowing metabolism, making it harder to keep the weight off. For example, contestants from a well-known reality show who lost large amounts of weight through extreme exercise and diet saw their metabolism crash significantly, forcing them to burn hundreds fewer calories than expected just to maintain their new weight.
The book also sheds light on the outdated and misleading nature of tools like the BMI, which fails to distinguish between fat and muscle. A person with high muscle mass could be labeled obese despite having minimal health risks, while someone with lower muscle but high visceral fat might go unnoticed. The real issue isn’t body weight alone, but the composition of that weight—particularly the ratio of fat to muscle and where that fat is stored. Visceral fat, which surrounds internal organs, is particularly dangerous. It’s not only hard to see but it also releases inflammatory chemicals that promote chronic disease. This kind of fat interferes with hunger regulation in the brain, causing people to eat more than they need and crave unhealthy foods. Over time, this creates a feedback loop: more visceral fat leads to worse hunger signaling, which leads to overeating, which causes even more visceral fat.
Food itself is a major player in this story. According to Kessler, our modern food landscape is filled with products designed to exploit our biological vulnerabilities. Ultra-processed foods—those loaded with refined sugars, fats, and salt—flood the brain with dopamine, triggering the same reward pathways that are activated by addictive drugs. These foods aren’t just unhealthy; they’re engineered to keep us coming back for more. And unlike substances like nicotine or alcohol, they are everywhere—on every street corner, in every convenience store, often disguised as healthy choices. Because they contain substances our bodies genuinely need, like glucose, it becomes even harder to say no. But we weren’t designed to handle the concentrated doses of sugar and simple carbohydrates these foods deliver, and as a result, our brains and bodies become rewired to depend on them.
But all is not lost. Kessler explores how new medications, especially GLP-1 agonists like Ozempic and Mounjaro, are changing the landscape of weight management. These drugs mimic a hormone that regulates insulin, slows stomach emptying, and signals fullness to the brain. What makes them revolutionary is their long-lasting effect and targeted action: they help people feel satisfied with less food and reduce the intense cravings that make dieting difficult. For the first time, weight loss medications are showing sustained, significant results, with patients losing 15 to 20 percent of their body weight or more. They are not, however, a cure-all. They don’t address the emotional and behavioral patterns that often accompany overeating, nor do they automatically promote healthy food choices.
This is where dietary strategies come back into play—but with a smarter approach. Rather than simply reducing calories, Kessler advocates for a focus on food quality. Whole foods, especially those with intact cellular structures, digest more slowly and prevent the glucose spikes that trigger hunger and cravings. For instance, eating a whole apple provides fiber and slows sugar absorption, unlike applesauce or juice, which flood the bloodstream with glucose. Protein is especially important—it requires more energy to digest, keeps blood sugar stable, and supports muscle maintenance during weight loss. Carbohydrates aren’t forbidden but should be timed with physical activity so that the body uses them for energy instead of fat storage. This is about retraining your body and brain to respond to food in healthier ways.
Equally important is understanding the emotional relationship many people have with eating. For many, food becomes a source of comfort, distraction, or even self-punishment. Cognitive behavioral therapy can help people examine the feelings that lead to overeating and reframe their responses. Instead of reacting to stress, boredom, or sadness by eating, individuals can learn to pause, recognize their triggers, and choose a healthier response. This level of insight isn’t something a drug can deliver—it comes from reflection, intention, and sometimes professional guidance. Delay discounting, a psychological concept that explains why we choose short-term pleasure over long-term gain, also plays a role. A cookie today seems far more appealing than the abstract idea of avoiding diabetes in the future. But by making the consequences of poor health more concrete and immediate—such as through visual reminders, journaling, or even cost calculations—we can begin to shift our decision-making in favor of long-term well-being.
Ultimately, the book is not an argument for choosing one strategy over another. It’s a call to integrate every available tool—medicine, nutrition, behavior change, and psychological insight—into a flexible, personalized approach to weight management. The goal isn’t to chase an arbitrary number on the scale, but to improve quality of life, prevent disease, and restore control over eating and health. GLP-1 drugs may give people a head start, but long-term success still depends on addressing the habits, beliefs, and environments that shape how we eat and live.
In conclusion, "Diet, Drugs, and Dopamine" presents a nuanced and science-based view of weight loss that reframes the issue as one of biology, not character. By unpacking the complex interplay of hormones, brain signals, processed food addiction, and emotional eating, Kessler provides a roadmap for achieving a healthier weight without shame or unrealistic expectations. Medications like GLP-1 agonists are powerful tools, but their true value lies in the breathing room they create—space for people to rebuild healthier habits, rewire their cravings, and pursue sustainable change. This book is a powerful reminder that while biology may shape our challenges, it can also illuminate the path forward.
December 10, 2025
I'm a Dietitian with years of experience working with folks all along the spectrum of appetite dysregulation and so far, this book is unhinged.
I'm only at the end of chapter 2 but hoping it gets better. Has anyone else noticed that the author has interviewed at least 10 "experts" so far but none of them are nutrition or metabolic experts?
First - the only study he referenced that defines the "harm" of UPF's is actually a terribly designed study in which two different groups are given different meals that do not evenly remotely resemble one another. The UPF group is not given the UPF version of the control group. He uses their weight gain as evidence of the "addictive" properties of UPF's when the UPF's provided are simply high in sugar, fat, and low in fiber. Their influence was metabolic, not addictive.
So far, this book equates very normal experiences of hunger to food addiction, and uses the personal experiences of self-proclaimed food addicts and providers that have no nutrition training. Additionally - he discounts the medical community for being hesitant to use the term "food addiction". Yes - that is because it is a very difficult experience to define that the current body of evidence does not support. That is not denial of folks lived experiences- that is responsible caution and simply the process of scientific studies.
The author equates the "highs and lows" experienced in "response" to UPF consumption as addiction, when it is simply a normal metabolic response. When our blood sugar is low, increased dopamine mobilizes us to seek out food, and the experience heightens as it gets lower. The reason we tend to crave UPF's - such as his example of the cookie - is because they are typically high in sugar and are therefore the most reliable option to resolve your blood sugar. Your body knows this, and that's why it obsesses over such foods. That is not an "addictive" response - it is an adaptation to prevent starvation that the majority of people who experience extremely low blood sugar or malnutrition will experience. It is not UPF's that are causing this cycle - it is simply present in the cycle because it was easily accessible in his house.
The odd part - is that the author goes on to state that blood sugar is part of the equation, and stabilizing his blood sugar helped. But then goes back to blaming UPF's and the nature of addiction as opposed to addressing that it is just a normal part of hunger... still trying to wrap my head around this logic. Again, he is conflating normal hunger and blood sugar shifts to addiction, when if he were "addicted", resolving his blood sugar would not have helped. He mentioned that the craving was still slightly there but not as intense... of course because he was stabilized his blood sugar on a high - protein, low-calorie diet. It's the low calorie diet that is causing the continuation of cravings... NOT the history of consuming UPF's.
Also... him and a psychiatrist? he interviewed state that if you eat UPFs consistently you will experience anticipation for it sooner and more intensely... yes - this is common for any foods that destabilize your blood sugar because you experience highs and lows. If you ate highly processed protein bars and products your wouldn't have the same problem, but would still be eating UPF's. Additionally - eating any food consistently helps your brain remember the amount of dopamine it will get - you can experience anticipation for foods you have a memory of, not those you won't. Additionally - ghrelin (the hunger hormone) research has shown that is not exclusively produced in response to low blood sugar or an empty stomach - but temporal memory. Therefore - your body remembers your meal routine and tells you to be hungry at that time. The authors cookie routine was partially influenced by this memory.
A central theme in the book so far is that dopamine is related to addictive disorders and because dopamine is made in response to food seeking, any associative behavior is therefore an addictive response and therefore bad. One being impulsivity. *SIGH* Ghrelin, THE hunger hormone that has nothing to do with this supposed "addictive" cycle also increases impulsivity and heightens psychomotor activity. Again - he is conflating addiction with NORMAL hunger. (And although this was not addressed in the book - if you are confused, ghrelin - the hunger hormone - is inversely related to BMI).
ALSO - he interviews a psychiatrist to who says that the "conflict" one experiences when they eat a UPF in response to a craving that they don't want to respond to, creates a negative emotional experience after eating the food. ACTUALLY - this can be explained in multiple ways : 1. Dip in blood sugar 2. Dip in serotonin/dopamine 3. Research shows that this "negative" association can be created by any internal "conflict" with food - regardless of the food. I.e. That is not unique or caused by UPF - but the cognitive dissonance within the eater, that is then assigned to the food. It could literally be lettuce if you wanted it to be (and from my years of experience working with folks with food conflicts, this is true).
The part that KILLS ME - is that he ends the chapter stating that "the maladaptive part of the brain that occurs because of addiction doesn't take place because the brain is not working properly, but because it is working too well". OMG. This sentiment is unhinged on so many levels. Appetite regulation - is so complex. The brain is complex. The body is complex. Again - I've worked with folks all along of appetite dysfunction. The folks that TRULY, struggle long-term food compulsions typically have unique dysfunctions *outside* of this supposed "addictive" cycle. Their body is not "trying" to eat more - it is confused by another overwhelming, overpowering signal. Conflating this to both "food addiction" with it's cause being "UPFs" is reductionist, irresponsible, and reflects the authors general lack of knowledge of the body.
General advice: Avoid health books written by people (including doctors) who are "doing their own research" rather than having done the research themselves. Additionally, the concept of food addiction and the research on UPFs are both in their infancy. That being said, conflating the two is kind of crazy. That's why he has primarily had to use anecdotal evidence to support his claims as opposed to any body of evidence.
I'm only at the end of chapter 2 but hoping it gets better. Has anyone else noticed that the author has interviewed at least 10 "experts" so far but none of them are nutrition or metabolic experts?
First - the only study he referenced that defines the "harm" of UPF's is actually a terribly designed study in which two different groups are given different meals that do not evenly remotely resemble one another. The UPF group is not given the UPF version of the control group. He uses their weight gain as evidence of the "addictive" properties of UPF's when the UPF's provided are simply high in sugar, fat, and low in fiber. Their influence was metabolic, not addictive.
So far, this book equates very normal experiences of hunger to food addiction, and uses the personal experiences of self-proclaimed food addicts and providers that have no nutrition training. Additionally - he discounts the medical community for being hesitant to use the term "food addiction". Yes - that is because it is a very difficult experience to define that the current body of evidence does not support. That is not denial of folks lived experiences- that is responsible caution and simply the process of scientific studies.
The author equates the "highs and lows" experienced in "response" to UPF consumption as addiction, when it is simply a normal metabolic response. When our blood sugar is low, increased dopamine mobilizes us to seek out food, and the experience heightens as it gets lower. The reason we tend to crave UPF's - such as his example of the cookie - is because they are typically high in sugar and are therefore the most reliable option to resolve your blood sugar. Your body knows this, and that's why it obsesses over such foods. That is not an "addictive" response - it is an adaptation to prevent starvation that the majority of people who experience extremely low blood sugar or malnutrition will experience. It is not UPF's that are causing this cycle - it is simply present in the cycle because it was easily accessible in his house.
The odd part - is that the author goes on to state that blood sugar is part of the equation, and stabilizing his blood sugar helped. But then goes back to blaming UPF's and the nature of addiction as opposed to addressing that it is just a normal part of hunger... still trying to wrap my head around this logic. Again, he is conflating normal hunger and blood sugar shifts to addiction, when if he were "addicted", resolving his blood sugar would not have helped. He mentioned that the craving was still slightly there but not as intense... of course because he was stabilized his blood sugar on a high - protein, low-calorie diet. It's the low calorie diet that is causing the continuation of cravings... NOT the history of consuming UPF's.
Also... him and a psychiatrist? he interviewed state that if you eat UPFs consistently you will experience anticipation for it sooner and more intensely... yes - this is common for any foods that destabilize your blood sugar because you experience highs and lows. If you ate highly processed protein bars and products your wouldn't have the same problem, but would still be eating UPF's. Additionally - eating any food consistently helps your brain remember the amount of dopamine it will get - you can experience anticipation for foods you have a memory of, not those you won't. Additionally - ghrelin (the hunger hormone) research has shown that is not exclusively produced in response to low blood sugar or an empty stomach - but temporal memory. Therefore - your body remembers your meal routine and tells you to be hungry at that time. The authors cookie routine was partially influenced by this memory.
A central theme in the book so far is that dopamine is related to addictive disorders and because dopamine is made in response to food seeking, any associative behavior is therefore an addictive response and therefore bad. One being impulsivity. *SIGH* Ghrelin, THE hunger hormone that has nothing to do with this supposed "addictive" cycle also increases impulsivity and heightens psychomotor activity. Again - he is conflating addiction with NORMAL hunger. (And although this was not addressed in the book - if you are confused, ghrelin - the hunger hormone - is inversely related to BMI).
ALSO - he interviews a psychiatrist to who says that the "conflict" one experiences when they eat a UPF in response to a craving that they don't want to respond to, creates a negative emotional experience after eating the food. ACTUALLY - this can be explained in multiple ways : 1. Dip in blood sugar 2. Dip in serotonin/dopamine 3. Research shows that this "negative" association can be created by any internal "conflict" with food - regardless of the food. I.e. That is not unique or caused by UPF - but the cognitive dissonance within the eater, that is then assigned to the food. It could literally be lettuce if you wanted it to be (and from my years of experience working with folks with food conflicts, this is true).
The part that KILLS ME - is that he ends the chapter stating that "the maladaptive part of the brain that occurs because of addiction doesn't take place because the brain is not working properly, but because it is working too well". OMG. This sentiment is unhinged on so many levels. Appetite regulation - is so complex. The brain is complex. The body is complex. Again - I've worked with folks all along of appetite dysfunction. The folks that TRULY, struggle long-term food compulsions typically have unique dysfunctions *outside* of this supposed "addictive" cycle. Their body is not "trying" to eat more - it is confused by another overwhelming, overpowering signal. Conflating this to both "food addiction" with it's cause being "UPFs" is reductionist, irresponsible, and reflects the authors general lack of knowledge of the body.
General advice: Avoid health books written by people (including doctors) who are "doing their own research" rather than having done the research themselves. Additionally, the concept of food addiction and the research on UPFs are both in their infancy. That being said, conflating the two is kind of crazy. That's why he has primarily had to use anecdotal evidence to support his claims as opposed to any body of evidence.
May 27, 2025
On a long bus trip, I had the valuable company of this important new book by a authoritative, respected, empathetic voice who knows of which he speaks.
Take my word for it, make time for this book!
You may wish to get the hard copy and make notes useful to you. (Audible's edition has the author narrating the first and last chapters btw. )
Whichever edition is a cascade of information, important whether you are simply curious to know more about the hubbub of these GLP-1 medications, addicted to the American diet of the ultraformulated foods driving many to unhealthy patterns, considering taking this medication yourself...
The book cites a range and depth of research behind the author's conclusions but the beauty of the book is him sharing his personal experience(s) with food, triggers, weight gain and loss. He is clear-eyed about the risks of taking the meds (and of not taking them.)
Finally, if you aren't YET convinced to get the book, then take some time to consider the additional resources:
https://www.washingtonpost.com/wellne...
https://www.nytimes.com/2025/05/07/op...,
Politics & Prose interview/book talk with Dan Diamondhttps://www.youtube.com/watch?v=JMwkI...
Katie Couric on YouTube: https://www.youtube.com/watch?v=7QGD0... .
Take my word for it, make time for this book!
You may wish to get the hard copy and make notes useful to you. (Audible's edition has the author narrating the first and last chapters btw. )
Whichever edition is a cascade of information, important whether you are simply curious to know more about the hubbub of these GLP-1 medications, addicted to the American diet of the ultraformulated foods driving many to unhealthy patterns, considering taking this medication yourself...
The book cites a range and depth of research behind the author's conclusions but the beauty of the book is him sharing his personal experience(s) with food, triggers, weight gain and loss. He is clear-eyed about the risks of taking the meds (and of not taking them.)
Finally, if you aren't YET convinced to get the book, then take some time to consider the additional resources:
https://www.washingtonpost.com/wellne...
https://www.nytimes.com/2025/05/07/op...,
Politics & Prose interview/book talk with Dan Diamondhttps://www.youtube.com/watch?v=JMwkI...
Katie Couric on YouTube: https://www.youtube.com/watch?v=7QGD0... .
September 13, 2025
I think there was some good information in this book, but is kind of all over the place - does it want to be about what we know about dopamine, food addiction, and managing glucose, or does it want to be about how GLP-1 drugs are simultaneously the best and worst things ever, or does it want to be about how the FDA should be much more strict about what ingredients actually do rather than simply that they exist?
August 14, 2025
If you've grown up in the United States, you've probably known someone (or faced yourself) the woes of the weight loss industry. From the Atkins diet, to the weird 1950s wine diets that pop up on Reddit every once in a while, to the empire of pharmaceuticals past and present (diet tea? really?) that promise to fix all your woes, weight is a heavy subject and a multi-billion dollar industry in this country (and many other developed countries), causing financial, emotional, and societal devastation - and the problem will only continue to get worse. With the advent of a new and so far promising drug on the market - the GLP-1 inhibitors - the conversation about weight and its many tributaries has circled back to public attention, prompting a new generation of sufferers to seek out more information on weight loss and what can be done to change it in a healthy, safe, and long-lasting way.
Former FDA Commissioner Dr. David A. Kessler tackles this overwhelming topic in "Diet, Drugs, and Dopamine", breaking down the many facets of weight, its origins, the struggle of the gain/loss cycle, and the latest research and discussion about pharmaceuticals into bite-sized chunks. Kessler also discusses his own struggles with weight over the decades, bringing a human approach to a topic which is still stigmatized in a society which sees weight gain and health struggles as a personal and even moral failure. From the biophysiological course of cravings and satiety to the history of food development and its impacts on consumers today, Dr. Kessler covers the wide spectrum of weight loss, providing insight, education, suggestions, and tools for readers to learn more about their own weight loss journey, the state of weight-related healthcare in the United States (and beyond), and how to approach weight management and improved health in their own daily lives.
When I started rotations a few years ago, the topic du jour of every single specialty was the seemingly magic drug that was Ozempic - the incredible injectable that was transforming weight loss across the country (for a price, of course). With so many opinions and thoughts floating around about Ozempic and the cultural/health implications of major weight change (which I hadn't thought about at length personally for years, probably since low-rise jeans finally fell out of fashion), I was really glad to see this book on shelves for a thorough perusal. I thought that this book did a fantastic job of taking an incredibly broad and complex topic and breaking it down into more succinct chapters, with headers that could also be individually referenced if one had a special interest or needed a refresher in between reading the entire book. The writing here as engaging and completely accessible (but still interesting) for those inside and outside of healthcare, which I also appreciated.
What was pleasantly surprising in this book was a deeper discussion about the food industry, "ultra-processed" foods, and the ways in which the United States has created a culture of favoring the profitable at the expense of what is actually good/beneficial for health. I thought covering this aspect of the healthcare/food industry was a great way to tie together bigger discussions about biology and the pharmaceutical industry, and that all of this was threaded through with the author's personal anecdotes and struggles with weight maintenance made it all the better. I also appreciate that while the author offers suggestions for overall weight/health improvement, he also acknowledges the barriers to access and that there is not a one-size-fits-all solution for improved outcomes, especially in the absence of federal-level changes to how we approach food and drugs in this country. Overall, I think anyone who has an interest in GLP-1 inhibitors, the healthcare/food industry in the United States, and potentially making changes to their own health would find something to enjoy in this book, and I will be recommending it for my readers in my medical series!
Former FDA Commissioner Dr. David A. Kessler tackles this overwhelming topic in "Diet, Drugs, and Dopamine", breaking down the many facets of weight, its origins, the struggle of the gain/loss cycle, and the latest research and discussion about pharmaceuticals into bite-sized chunks. Kessler also discusses his own struggles with weight over the decades, bringing a human approach to a topic which is still stigmatized in a society which sees weight gain and health struggles as a personal and even moral failure. From the biophysiological course of cravings and satiety to the history of food development and its impacts on consumers today, Dr. Kessler covers the wide spectrum of weight loss, providing insight, education, suggestions, and tools for readers to learn more about their own weight loss journey, the state of weight-related healthcare in the United States (and beyond), and how to approach weight management and improved health in their own daily lives.
When I started rotations a few years ago, the topic du jour of every single specialty was the seemingly magic drug that was Ozempic - the incredible injectable that was transforming weight loss across the country (for a price, of course). With so many opinions and thoughts floating around about Ozempic and the cultural/health implications of major weight change (which I hadn't thought about at length personally for years, probably since low-rise jeans finally fell out of fashion), I was really glad to see this book on shelves for a thorough perusal. I thought that this book did a fantastic job of taking an incredibly broad and complex topic and breaking it down into more succinct chapters, with headers that could also be individually referenced if one had a special interest or needed a refresher in between reading the entire book. The writing here as engaging and completely accessible (but still interesting) for those inside and outside of healthcare, which I also appreciated.
What was pleasantly surprising in this book was a deeper discussion about the food industry, "ultra-processed" foods, and the ways in which the United States has created a culture of favoring the profitable at the expense of what is actually good/beneficial for health. I thought covering this aspect of the healthcare/food industry was a great way to tie together bigger discussions about biology and the pharmaceutical industry, and that all of this was threaded through with the author's personal anecdotes and struggles with weight maintenance made it all the better. I also appreciate that while the author offers suggestions for overall weight/health improvement, he also acknowledges the barriers to access and that there is not a one-size-fits-all solution for improved outcomes, especially in the absence of federal-level changes to how we approach food and drugs in this country. Overall, I think anyone who has an interest in GLP-1 inhibitors, the healthcare/food industry in the United States, and potentially making changes to their own health would find something to enjoy in this book, and I will be recommending it for my readers in my medical series!
May 13, 2025
Diet, Drugs, and Dopamine by David A. Kessler, M.D.
If you are ever considering using one of the new class of GLP-1 weight loss drugs or you have had a medical professional suggest you do so, this book could help you decide whether the risks are worth it to you. I don't have a use for this drug in my life but my fascination with nutrition and how the body handles food, using it to both help and harm the body, got a boost of information from what I learned here. I feel like this book is mostly pro GLP-1 weight loss drugs because the drugs can be lifesaving for those who have no other options. But as we learn of the things that they can do to help the body, we also get something similar to the miles long drug fact sheets of side effects and risks similar to what comes with prescription drugs, except this book makes the information easier to understand and more interesting than those dry fact sheets.
These drugs can be deadly, bring on lifelong disabilities, and can have side effect that have most people quitting them within a short time. Which is a problem when these drugs fall in the area of “forever” drugs that are supposed to be taken for the rest of one's life. They only work while you are taking them and once you stop taking them you are right back where you started. The book does mention some have had success with an on again, off again approach to the drugs but I would think that kind of approach could have it's drawbacks, too.
When used the way the drugs are supposed to be used, during the "getting to ideal weight period" a person can be in a state of starvation or semi starvation which is devasting to the body. Yet this process might be necessary for very critical health issues such as fatty liver disease, diabetes, or morbid obesity. Even once one has reached maintenance and the drugs are adjusted to keep a person from losing more weight, it can be a challenge to stay healthy since the drugs take away the desire to eat and/or have side effects that make eating unpleasant. Malnutrition can be a problem without supervision.
Some doctors do not inform their patients well enough about the risks of the drugs so picking a doctor who understands the drugs and is willing to share all sides of the benefits and perils of taking the drugs is very important. An informed patient is the best kind in my opinion although I know I frustrate some doctors by all the questions I have and because I expect to be totally involved in my health care choices. This book really lays facts out there to allow one to know that this type of drug needs to be considered very carefully and with all the facts at hand. The drugs have done good things for many people who had no other option although the very long term side effects can't be known yet since the drugs are still so new to the market.
So many other things need to be heeded when using these drugs but then that is true for those who don't use the drugs. Maintaining a healthy weight and maintaining a healthy attitude to food is a lifelong necessity if we are going to have healthy bodies. Physical activity is necessary as it the best mindset to not letting food control everything we do. The book explains the emotional, mental, and physical side of finding the right balance we need to be and stay healthy and for some people that can only come with the help of a certain type of drug.
Publication May 13, 2025
Thank you to Flatiron Books and NetGalley for the gifted copies of both the print book and the ebook of this ARC.
If you are ever considering using one of the new class of GLP-1 weight loss drugs or you have had a medical professional suggest you do so, this book could help you decide whether the risks are worth it to you. I don't have a use for this drug in my life but my fascination with nutrition and how the body handles food, using it to both help and harm the body, got a boost of information from what I learned here. I feel like this book is mostly pro GLP-1 weight loss drugs because the drugs can be lifesaving for those who have no other options. But as we learn of the things that they can do to help the body, we also get something similar to the miles long drug fact sheets of side effects and risks similar to what comes with prescription drugs, except this book makes the information easier to understand and more interesting than those dry fact sheets.
These drugs can be deadly, bring on lifelong disabilities, and can have side effect that have most people quitting them within a short time. Which is a problem when these drugs fall in the area of “forever” drugs that are supposed to be taken for the rest of one's life. They only work while you are taking them and once you stop taking them you are right back where you started. The book does mention some have had success with an on again, off again approach to the drugs but I would think that kind of approach could have it's drawbacks, too.
When used the way the drugs are supposed to be used, during the "getting to ideal weight period" a person can be in a state of starvation or semi starvation which is devasting to the body. Yet this process might be necessary for very critical health issues such as fatty liver disease, diabetes, or morbid obesity. Even once one has reached maintenance and the drugs are adjusted to keep a person from losing more weight, it can be a challenge to stay healthy since the drugs take away the desire to eat and/or have side effects that make eating unpleasant. Malnutrition can be a problem without supervision.
Some doctors do not inform their patients well enough about the risks of the drugs so picking a doctor who understands the drugs and is willing to share all sides of the benefits and perils of taking the drugs is very important. An informed patient is the best kind in my opinion although I know I frustrate some doctors by all the questions I have and because I expect to be totally involved in my health care choices. This book really lays facts out there to allow one to know that this type of drug needs to be considered very carefully and with all the facts at hand. The drugs have done good things for many people who had no other option although the very long term side effects can't be known yet since the drugs are still so new to the market.
So many other things need to be heeded when using these drugs but then that is true for those who don't use the drugs. Maintaining a healthy weight and maintaining a healthy attitude to food is a lifelong necessity if we are going to have healthy bodies. Physical activity is necessary as it the best mindset to not letting food control everything we do. The book explains the emotional, mental, and physical side of finding the right balance we need to be and stay healthy and for some people that can only come with the help of a certain type of drug.
Publication May 13, 2025
Thank you to Flatiron Books and NetGalley for the gifted copies of both the print book and the ebook of this ARC.
November 17, 2025
David A. Kessler, MD, argues that today’s food environment is engineered to overstimulate the brain’s reward pathways—particularly dopamine—making it easier to overeat and harder to stay at a healthy weight. He explains how highly processed foods, created to reach “bliss point” combinations of sugar, fat, and salt, act like addictive substances by triggering cravings and reinforcing habitual eating patterns. Dr. Kessler stresses that this isn’t about weak willpower; it’s about a biological response to foods intentionally crafted to keep us coming back for more.
The book also offers practical strategies to help readers regain control. Dr. Kessler emphasizes the importance of reducing exposure to hyperpalatable foods, establishing structured eating routines, choosing whole and minimally processed ingredients, and becoming aware of environmental cues that trigger overeating. The inclusion and detailed analysis of new weight loss drugs, along with the author’s personal experience, are very informative.
The main message is empowering—understanding how dopamine-driven reinforcement works, people can reshape their food environment and behaviors to promote healthier, more sustainable eating patterns. The book is divided into four parts: Part I: Addiction; Part II: The New Understanding of Energy and Weight; Part III: The Path to Sustainable Weight Loss; and Part IV: The Road Ahead.
The author includes quotes from sources instead of merely summarizing information. If you are considering or currently using an anti-obesity drug, you will find Dr. Kessler’s personal account of deciding, taking, and stopping a GLP-1 regimen very useful. His perspective, both as a doctor and as a patient, is very enlightening.
The text is scientifically dense and may become overwhelming for some readers. If you have no interest in learning more about GLP-1 drugs, you may end up skimming several sections.
The book also offers practical strategies to help readers regain control. Dr. Kessler emphasizes the importance of reducing exposure to hyperpalatable foods, establishing structured eating routines, choosing whole and minimally processed ingredients, and becoming aware of environmental cues that trigger overeating. The inclusion and detailed analysis of new weight loss drugs, along with the author’s personal experience, are very informative.
The main message is empowering—understanding how dopamine-driven reinforcement works, people can reshape their food environment and behaviors to promote healthier, more sustainable eating patterns. The book is divided into four parts: Part I: Addiction; Part II: The New Understanding of Energy and Weight; Part III: The Path to Sustainable Weight Loss; and Part IV: The Road Ahead.
The author includes quotes from sources instead of merely summarizing information. If you are considering or currently using an anti-obesity drug, you will find Dr. Kessler’s personal account of deciding, taking, and stopping a GLP-1 regimen very useful. His perspective, both as a doctor and as a patient, is very enlightening.
The text is scientifically dense and may become overwhelming for some readers. If you have no interest in learning more about GLP-1 drugs, you may end up skimming several sections.
October 22, 2025
Main ideas:
-Visceral fat drives negative health outcomes more than just being overweight
-Appetite, not willpower, drives long-term success or failure
Beyond that, the book didn’t do much for me. It was repetitive, overly focused on GLP-1 medications (probably 80% of the content), and didn’t offer any practical takeaways. I also don’t remember exercise being mentioned at all, which feels like a big omission.
Reading this was a good opportunity to reflect on my weight loss this year - I've lost what I consider a lot of weight and am really proud of it. My feet and calves don't hurt anymore, I have more energy, and feel more confident in myself that I was able to set and stick to a big goal. I had accepted that I would always be heavier than I wanted to be since I wasn't willing to suffer my way to a lower weight, and that led me to the same conclusion this book makes: appetite, not willpower drives sustainable healthy eating.
I decided I was willing to sacrifice, but not suffer. That meant fewer sweets, no more endless snacking on chips and cheese, and even accepting some hunger – but not starving myself or feeling miserable or deprived. I still ate cronuts and cheesecake, but less. That mindset along with counting calories gave me the framework and data to realize how much better I felt filling up on foods high in protein/fiber and fruits/vegetables. I even learned to enjoy foods that are objectively not good (egg whites, TVP, boring healthy crackers). Focusing on how to satisfy my appetite in healthy ways has given me tools to hopefully stay healthy for the rest of my life.
Anyways, I give this book some credit for scientifically demonstrating the main conclusion I came to through experimentation. But it was otherwise not interesting to me.
-Visceral fat drives negative health outcomes more than just being overweight
-Appetite, not willpower, drives long-term success or failure
Beyond that, the book didn’t do much for me. It was repetitive, overly focused on GLP-1 medications (probably 80% of the content), and didn’t offer any practical takeaways. I also don’t remember exercise being mentioned at all, which feels like a big omission.
Reading this was a good opportunity to reflect on my weight loss this year - I've lost what I consider a lot of weight and am really proud of it. My feet and calves don't hurt anymore, I have more energy, and feel more confident in myself that I was able to set and stick to a big goal. I had accepted that I would always be heavier than I wanted to be since I wasn't willing to suffer my way to a lower weight, and that led me to the same conclusion this book makes: appetite, not willpower drives sustainable healthy eating.
I decided I was willing to sacrifice, but not suffer. That meant fewer sweets, no more endless snacking on chips and cheese, and even accepting some hunger – but not starving myself or feeling miserable or deprived. I still ate cronuts and cheesecake, but less. That mindset along with counting calories gave me the framework and data to realize how much better I felt filling up on foods high in protein/fiber and fruits/vegetables. I even learned to enjoy foods that are objectively not good (egg whites, TVP, boring healthy crackers). Focusing on how to satisfy my appetite in healthy ways has given me tools to hopefully stay healthy for the rest of my life.
Anyways, I give this book some credit for scientifically demonstrating the main conclusion I came to through experimentation. But it was otherwise not interesting to me.
September 19, 2025
Dr. David Kessler brings a myriad list of scientific credentials and experience to this book. A pediatrician, he has served as dean of medical schools at Yale and the University of California, San Francisco, in addition to acting as chief science officer of the White House COVID-19 Response Team and commissioner of the US Food and Drug Administration under two presidents, he is a graduate of Harvard Medical School. More importantly, he explains his own struggles with losing weight. He explores the new class of GLP-1 weight-loss drugs and how this offers a breakthrough in understanding weight loss. He offers insight on how parts of the brain are responsible for food cravings. He gives a thorough and comprehensive look at weight gain as affected by addictive ultraformulated foods. He looks at weight loss in a context of addiction. He also dives in-depth into the disadvantages of today's new weight-loss drugs. I found the last part especially interesting when he takes on obesity in relation to insurance companies and society's ideal of thinness. However, like many male doctors and weight-loss writers, I felt he slighted the true problems women face differently than men. For one, they experience pregnancy, many of them and the effect this can leave on a woman's body. Women are chastised by society over weight much more than men. They also tend to be primary cooks in a family, which can cause difficulty when trying to lose weight . Overall, I found this to be an invaluable book to read to explain how the new weight-loss drugs are affecting all of us and what to watch out for when selecting to take these drugs.
June 1, 2025
Thanks to NetGalley and the publisher for providing me with an electronic ARC so that I could provide my own opinion.
After finding "The End of Overeating" fascinating and eye-opening, I was eager to read David Kessler’s latest, and I wasn’t disappointed. "Diet, Drugs, and Dopamine" is divided into four well-structured sections—Addiction, The New Understanding of Energy and Weight, The Path to Sustainable Weight Loss, and The Road Ahead, plus a thoughtful epilogue that I read first. Kessler brings clarity and honesty to complex issues, which I appreciate.
The book is informative and timely, especially as we confront a broken food system and rising reliance on GLP-1 medications for weight management. While I understand these drugs may be life-changing for some, it saddens me that our culture and economy have made them necessary at all. I believe strongly in supporting health through natural means—good sleep, movement, real food, stress management—but I also recognize that for some, medication may be necessary.
That said, the book’s tone does seem a bit too favorable toward GLP-1s for my comfort. Still, this is a thoughtful and important read that offers a great deal to reflect on, especially in 2025, when federally funded institutions are being dismantled and those that remain are being staffed and/or led by unqualified individuals.
I encourage anyone who wants to know more about food and health, especially as it relates to weight, to read this.
After finding "The End of Overeating" fascinating and eye-opening, I was eager to read David Kessler’s latest, and I wasn’t disappointed. "Diet, Drugs, and Dopamine" is divided into four well-structured sections—Addiction, The New Understanding of Energy and Weight, The Path to Sustainable Weight Loss, and The Road Ahead, plus a thoughtful epilogue that I read first. Kessler brings clarity and honesty to complex issues, which I appreciate.
The book is informative and timely, especially as we confront a broken food system and rising reliance on GLP-1 medications for weight management. While I understand these drugs may be life-changing for some, it saddens me that our culture and economy have made them necessary at all. I believe strongly in supporting health through natural means—good sleep, movement, real food, stress management—but I also recognize that for some, medication may be necessary.
That said, the book’s tone does seem a bit too favorable toward GLP-1s for my comfort. Still, this is a thoughtful and important read that offers a great deal to reflect on, especially in 2025, when federally funded institutions are being dismantled and those that remain are being staffed and/or led by unqualified individuals.
I encourage anyone who wants to know more about food and health, especially as it relates to weight, to read this.
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