Why It’s Not Your Fault: The Hidden Science Behind Food Addiction
GLP-1 agonists can suppress appetite and drive dramatic weight loss, but what happens when the prescription ends? Former FDA commissioner explains all.
GLP-1 agonists can suppress appetite and drive dramatic weight loss, but what happens when the prescription ends?
Today’s Live Well Be Well episode features Dr. David A. Kessler — a former FDA commissioner, dean at Yale, and a leading voice on nutrition, addiction, and public health.
Glucagon-Like-Peptide-1 Agonists, like Ozempic, are one of the hottest topics of today. About 1 in 8 Americans have taken a GLP-1 drug at some point in their life, according to KFF Health. These drugs can result in dramatic weight loss because they delay the emptying of food from the stomach, which keeps people full for longer periods of time. In addition, they act on hunger centres in the brain to prevent and curb cravings.
There are, however, risks with any medication. In the UK, over 100 deaths and more than 500 hospitalisations have been reported following GLP‑1 use, highlighting the importance of understanding the risks as well as the potential benefits.
Are we using them effectively, or are they too readily available without the long-term vision of what happens once one comes off them?
Dr. Kessler reminded me that when it comes to food, weight, and health, it’s not about willpower — it’s about biology. The circuits in our brain that evolved to keep us alive in times of scarcity are now constantly triggered in today’s world of abundance. What stayed with me most from our conversation wasn’t just the science he shared, but the way he reframed some of the struggles many of us silently carry.
And that’s the crux of it: it’s our environment, not our weakness, that’s often at fault, and do these drugs provide some relief to that?
We explored the idea that ultra-formulated foods are addictive, designed to hijack our brain’s reward systems, making us crave more, want more, and feel powerless to stop. He said it plainly:
“That regain is nothing more than relapse.”
In this week’s Live Well Be Well episode, David opens up about his own journey — his weight struggles, his use of GLP-1 medications, and his hope that these tools can offer people a way to change their relationship with food, not just chase short-term fixes.
But he also offers a caution: quick fixes without addressing the root cause — without tackling that food environment, those neural circuits, the side effects we should all be aware of and our emotional connection to food — won’t lead to lasting change. As he said:
“There is nothing wrong with saying, I can’t do this alone. I need help.”
This conversation is one I hope sparks compassion for yourself, for those navigating these challenges, and for the bigger systems that shape our choices.
My personal insights and takeaways
1. Not All GLP‑1s Are the Same
“There are a number of GLP‑1 drugs. Some are combined with other hormones like GIP. Different formulations and doses can have different effects and side effects.”
Reflection: It’s easy to lump all GLP‑1 medications together, but Dr. Kessler highlights that these drugs vary — from single GLP‑1 agonists like semaglutide (Ozempic, Wegovy) to combination drugs like tirzepatide (Mounjaro, Zepbound). This matters because efficacy, side effects, and how the drug interacts with our biology can differ depending on the formulation. Being informed about the type of drug prescribed is key to using it safely and effectively.
2. The Brain’s Role in Weight Struggles
“Obesity is not just a disease of the body, but of the brain.”
Reflection: Let’s shift the narrative from blaming willpower to understanding biology. It reminds us that weight challenges often stem from deeply ingrained neural circuits that govern reward and craving. The dopamine effect is largely at play here.
3. Rewiring Cravings Through Nausea
“They push you to the edge of nausea — that’s how they tamp down the addictive circuits.”
Reflection: GLP-1 drugs engage aversive circuits in the brain, making overeating physically uncomfortable and helping counter the pull of addictive foods. Think of it as if you experienced food poisoning - it is a similar sensation.
4. GLP-1s Work Because Biology Drives Obesity
“These new anti-obesity drugs show that it’s biology, not willpower, driving this crisis.”
Reflection: This science changes the narrative: obesity is a condition of biological wiring, not a personal weakness.
5. The Brain Addictive Nature of Ultra-Processed Foods
“Ultra-formulated foods are addictive — they capture attention, trigger the reward centres, and hijack our circuits.”
Reflection: Awareness is the first step. Seeing these foods for what they are — engineered to hook us — helps us take back control over our choices.
6. Not a Cosmetic Quick-Fix
“These drugs are approved to treat health — to reduce visceral fat, improve metabolic markers, and prevent cardiac disease. They’re not meant as a cosmetic tool.”
Reflection: GLP‑1 treatment should target metabolic support for people with a high BMI, not aesthetics. Dr. Kessler stresses that cosmetic use is using a powerful medical tool outside its intended scope.
7. The Hidden Danger of Malnutrition
“Many people are eating probably less than 1,000 calories — that’s malnutrition.”
Reflection: GLP-1 drugs can dramatically reduce intake, so medical and nutritional support is critical to avoid harmful deficiencies. In practice, anyone consuming under 1000 calories a day would be considered in semi-starvation.
8. GLP-1s aren’t a Magic Bullet
“There’s no magic to these drugs. They need to be taken under good care.”
Reflection: GLP-1s are a tool, not a standalone solution. Success depends on comprehensive support, including nutrition, emotional health, and lifestyle changes. They can be a helpful gateway into helping create sustainable habits, but if this isn’t focused on when they are actively being used, you will slowly regain the weight once you stop.
9. The True Health Risk isn’t Weight Itself
“It takes a team approach. This is not something you want to wing.”
Reflection: Sustainable change rarely happens in isolation. This is not a magic pill. Once you start the drug again, those old circuits will kick straight back into action. Cravings come back and weight is regained. Collaboration with professionals — from doctors to dietitians — is essential to provide the structure and safety we need.
10. The Key Question: Risk vs. Benefit
“The real question you have to ask yourself is: are the risks acceptable in light of the benefits?”
Reflection: GLP-1s can reduce heart, kidney, and diabetes risk — but come with side effects, including GI distress, fatigue, and rare complications.
11. GLP-1s Don’t Change Food Environments
“Why am I taking a drug to control my visceral adiposity… when it’s the food that’s making me sick?”
Reflection: These medications can help individuals to start their weight loss journey by numbing out the dopamine-rich food environment we live in, but tackling the root cause — our obesogenic food supply — remains essential for lasting change.
What are your thoughts? This is such a topical conversation right now - maybe you know someone on GLP-1 drugs, you are on them yourself. I’d love to know your thoughts around this and where you see the future lies.