177. Are Food Giants The New Big Tobacco?

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1:48Hello and welcome to The Rest is Money with me, Robert Peston. And me, Steph McGovern. And today we are joined by Dr. David Kessler. He is a former commissioner of the US Food and Drug Administration. He's known for things like accelerating drug approvals, battling with tobacco firms and introducing standardized nutrition fact labels on food as well. He's had really high profile public health roles, including advising President Biden during the COVID pandemic. So he's a man who knows a lot about public health, the cost of it, the problem of it. He's written a book, Diet, Drugs and Dopamine. We're going to talk to him about that, but there's loads we want to ask, isn't there?

2:29Yeah. And I think the big theme is the epidemic. We've seen it in America. There's a big problem here of obesity. And this is such an important subject because it's destroying the quality of people's lives. It's increasing costs for our health services. We had this period of people getting healthier, living longer. But actually, there's a lot of information showing that throughout the West, actually, that progress in terms of health is going into reverse. So the big issues that we want to put to David Kessler are, why do we have this epidemic? He has this idea that at the heart of it is our addiction to what many people call ultra-processed foods.

3:16He sees them differently. He calls them ultra-formulated foods. So there's a big question about how much the big food companies are really at fault and doing us harm. We need to do about that. And then, of course, there is that other modern obsession, which are these weight loss drugs, the ones made by Eli Lilly and Novo Nordisk. We know them by the names of Wegovi. Manjaro. You know, so much of relevance to all of us to discuss with David Kessler. David, we are really excited to chat to you because obesity and the problem of it both from a public health and economic point of view is something we talk about a lot.

3:56It's something that's in the press all the time. Everyone's obsessed with what I call the fat jabs. Everyone's obsessed with how we solve the problem of obesity. You've written this great analysis of it off the back of a long career in public health. Can you just set the scene for us in terms of how big of a problem obesity is and what that kind of problem looks like. In the United States, only about 8 % of the population are metabolically healthy. Wow, 8%. 8%. What does that mean? If I told you that I can identify what was at the cause of cardiac, kidney, metabolic disease, many forms of cancer, about a dozen, even some of the neurodegenerative diseases.

4:45If I can tell you we now know what that cause is, and that is brewing, we're facing an epidemic. We always knew that weight wasn't good for us. And the problem is not weight. Let's be very careful up front. The problem is what I call sick fat or toxic fat, visceral adiposity, visceral meaning abdominal, central. In our waist, the fat that's metabolically active, not the fat in our arms or in our thighs, but the fat that leaks out these free fatty acids, these cytokines, using scientific terms, dipokines, these inflammatory molecules that lead to this inflammatory soup that bathes our organs where fat is going into our liver, into our pancreas, into our heart.

5:38And we know the cause. I mean, the cause are these excess calories, this rapidly absorbable glucose from these ultra formulated foods. But the fact is that over the last four or five decades, certainly the American body, and I think the UK body is following, I mean, is ill in the vast majority. We're facing an epidemic of this cardiac, kidney, metabolic, diabetes, diseases, and it's starting in children. And can I just ask, this is a sort of contextual question. We've seen something quite shocking in a rich country like America, you know, declining life expectancy. But in terms of life expectancy of high quality years, if you were to put this, for example, aside, you know, the epidemic of fentanyl use or these appalling morphine-like drugs and other kinds of addiction, where would you rank this as the cause of American ill-hackling?

6:41health. It's right up there. I had the privilege of dealing with tobacco, the great public health success of the last century. We rid ourselves primarily, I mean, of tobacco, not fully, but we should be living longer. We have lipid-lowering drugs, right? We have personalized drugs for certain forms of cancer, yet it may not affect your lifespan, but I can assure you that five or so of those more senior years will be spent in disability because of this cardiac, kidney, metabolic diseases. They were unprepared to deal with this epidemic and the cost. I mean, you're dealing with trillions of dollars in healthcare costs because this visceral adiposity is causing this cardiometabolic disease.

7:36All our medical expenses will pale in comparison because we're seeing this visceral adiposity, it's lifetime, it's cumulative, and it begins as a pediatric disease and it's being incubated now from the beginning and the cause is this ultra-formulated foods. Yeah, so whose fault is this then? Why don't you answer that? Is it the food companies? Is it our fault? If you're talking about it in children, then is it a parent's fault? Should we be responsible for our own health So ultra-formulated foods are addictive. Yeah. And can you just explain why you say ultra-formulated rather than ultra-processed, which is the term that more people know?

8:20So ultra-processed deals with, I think, preservatives, emulsifiers, stabilizers. The addictive elements are that perfect trifecta of fat, sugar, and salt. Fat and sugar, fat and salt, fat, sugar, and salt. We put them on every corner. We made them available 24-7. We made it socially acceptable to eat any time. I mean, food, just like nicotine, I mean, it's very powerful. It could change how we feel. I used food. I turned around. I had the privilege of co-leading Operation Warp Speed. COVID was an intense period of time for all of us. I found myself some 40 pounds heavier after working 18 hours, seven days.

9:03So that was just because you're working on trying to prevent the spread at the time. But how did you manage to put on so much weight? So, again, just sitting at my computer, 676 million vaccines, distributing that in the States, you know, free, within five miles, an intense period. You know, it's how I use food. So you're just snacking the whole time to keep your energy levels up. I'm grazing. To give energy levels up. It's 10 o 'clock at night. I know I have another three, four hours of work. I need to increase my focus. I need to cognitively, you know, I'm using food to change how I feel. I'm using it either, you know, to calm myself or stimulate myself or increase my attention.

9:47You know, you know, was this the only time of your life when you have sort of had a an abusive relationship with food, do you think? Only this time? No. I mean, I can tell you, I mean, I was, you know, a science nerd. I mean, I went to med school in order to be able to work, to be able to study, to be able to do my writing. I'd work three, four o 'clock in the morning. And I mean, it kept me going. I used food. And this is the key. We say, you know, substances that are addictive are psychoactive. What do we mean by psychoactive? They can change how we feel. So if I were born two, three decades earlier, I would have been a smoker.

10:24Watch how somebody smokes. When do they smoke? When do they pick up a cigarette? And why do they pick up a cigarette? They picked up a cigarette to change how they felt, to calm themselves. to stimulate themselves, to deal with boredom, right? Watch how I use food. I wasn't using food for fuel, but that fat, sugar, and salt is very psychoactive. It affects the reward circuits. Because your book's called Diet, Drugs, and Dopamine. Explain the role of dopamine. So I'm using that as a signifier for the reward circuits of the brain. And those reward circuits of the brain evolved to basically focus our attention on the most salient stimuli in our environment.

11:08So back millennia, when food was scarce and the species had a fine food in a scarce environment, what grabbed our attention? I mean, anything that can change how I feel, anything that was salient, so energy-dense, highly palatable foods, right, were in essence the first addiction. We think of addiction as something that is for the weak. It's for this downtrodden. But in fact, these circuits evolved to focus our attention on certain stimuli. I mean, if I were a bird flying over and I needed to identify food, our nervous system goes, identifies the most salient stimuli in our environment. what that substance is can change by the individual but i would use food to make me feel better and that was from when i was a kid and and that's why it's really interesting with these fat jabs these glp ones is that they essentially they work by breaking addiction you got it yeah i mean you lost what four over four storms you know so i i gained 40 but i lost 60 yeah i mean and that's incredible but but understand what the book is really about is about cracking food addiction how much did you spend on new suits i have suits in every size i feel seen in this episode i'll tell you that i mean it's really about food addiction yeah i mean ultra formulated foods right are addictive the glp1 drugs let's talk about them yeah can be used to tamp down that addiction you say it makes you almost feel nauseous when you think about food is that right You've not tried these things.

12:51I'm not, but I'm contemplating it because everyone's on them. So everybody's thinking about, is this drug right for me? Yes, totally. So understand, I don't want to do medical advice. I mean, on a podcast. Yeah. So that disclaimer. But let's understand how this works. Yeah. Ultra-formulated foods trigger the reward circuits of the brain. I want them. Let's just understand the elements of addiction. It's Q-induced wanting. What do I mean? There's a Q. There's a time of day. It stimulates thoughts of wanting. If you can have the food, if it's accessible, you're fine. You just eat it. But if you try to withhold that food, not eat that food, then you have this craving.

13:31And then you have this relapse, right? So you have Q-induced wanting. You have craving. You have relapse. And in terms of food and weight, for me, that relapse would be I would lose weight. I thought I was done, right? And then I would regain the weight. And why was I regaining the weight? Because these addictive circuits were still there. And so, I mean, I lost the weight, gained it back, and no one told me that the hard part really begins after I lose the weight because the addictive circuits are there. So, we have ultra-formulated foods that are addictive. What do the GLP-1 drugs do? What do these jabs do?

14:07There's no miracles, right? But the way they work is they delay gastric emptying. So, your stomach doesn't empty food as quickly. So food stays in your stomach longer. Now, when have you experienced that, right? We've all experienced that. If you have the flu and you're ill, you lose your appetite. I mean, you know, when food stays in your stomach, I mean, you just don't want to put more food in that stomach. Food poisoning. When food, you know, the GI tract stops moving because, I mean, there's this, in essence, this toxin in there and it shuts down, right? Food stays in there and you have this sort of spectrum, this spectrum of fullness, satiety, then there's Thanksgiving fullness, day fullness, and then I can push you to the edge of nausea, but then I can push you over that edge of nausea into outright distress.

15:06Now, that's the gut and the brain working, but what's strong enough to overcome the addictive circuits? It's these aversive circuits. If I make you take you to the edge of nausea. And that's what these drugs do. That's what these drugs do. Yeah. Now, they have effects on other organs. There's receptors throughout the bodies. But you have this counterbalancing. It's very important these drugs are used under good care. This notion, just get them on the internet, take the jab, that is no way to take this. I mean, these have to be done under supervision. It has to be a shared relationship, good care with a dietician, with a physician, getting that dose right.

15:46But look, the problem is - And don't take them forever. Well, that's the big problem. That's the big problem with them. In the States, the latest data shows that people are on this for eight to nine months. So if you're on these for eight to nine months, you're going to lose weight. They're going to deal with the addiction. They're going to tamp down that addiction for eight to nine months. When you go off them, what's going to happen? It's not going to tamp down the addiction. You're going to gain weight back. And are people gaining weight back? People show you gain back two-thirds, three-quarters after taking these drugs.

16:19So we're going to spend thousands of dollars getting this weight off, and then you're going to turn around and people are going to go off this drug, right? And they're going to gain it back, and we're going to go in three and five years, go, this is one big national failure. You know, my old agency, the U.S. Food and Drug Administration, to prove these drugs without data on how these drugs are going to be used in the real world. The premise of the pharmaceutical companies is take these drugs forever. That's the model, of course, they want. Yeah, of course. If these drugs are going to cause this nausea or this edge of nausea, if they're going to be expensive, here's the key.

16:54You have to learn how to use these drugs to change your relationship with food. If you can do that, if you can condition yourself, if my stomach is full and I don't want to put anything more in there. I don't want to put this high fat, large portions. I learned to eat healthy. Now, can you carry that over when you're off these drugs? Or can you carry that over for a period of time to change your relationship with food? And then if you need the drugs again, look, there should be no stigma. I mean, there's nothing about using these drugs. I mean, if I'm born with less of these hormones that shut down appetite and you're fortunate not to have a problem with society, I have a problem with society, there's nothing to be ashamed of or stigma because I need biological help on that satiation.

17:44These addictive foods take away any sense of satiation, right? Look, there's something very wrong with this picture. You have one industry making billions of dollars. Do you have another industry also making billions of dollars, reversing what that first industry does? This is the joy of capitalism. If you were from another planet and you saw this, you would say, go fix that first problem. The reason I wrote this is changing the food environment is not going to happen overnight. Can I just ask you one final question, though, on the weight loss drugs? We've got these essentially two sort of big brands.

18:21We've got the Novo Nordisk original ones, the Wegovis, and then we've got the Monjaro, the Eli Lilly. The Eli Lilly one apparently works through two channels versus one for Novo Nordisk. What does that mean? No one fully understands the biological reasons why these are different. I mean, the Lilly drug uses not only a GLP-1, but a GIP, Ingrid. Scientists are debating the effects of that. Some believe that the GIP, it tamps down the GI adverse events so you can get the dose higher. It may make the nausea a little less. We do know in head-to-head trials that the Lilly drug, again, please understand, everybody knows in Washington and the States, I'm the last one to shill for the pharmaceutical industry.

19:15Totally. I was pretty harsh. I mean, again, great discoveries, great breakthroughs. These are important drugs. They change the landscape. People should have access to them. They have to be taken under care. And I don't want to be sitting here touting one over the other, but there's no doubt that the Lilly drug does achieve greater weight loss. Now, the drug companies are looking for even stronger drugs. Now, here's my concern. These drugs work, and let's just put another basic fact. these drugs work by getting people to eat less now we've always said eat less move more right and it didn't work it didn't work because there were addictive circuits and no one could do it so these drugs help you do it but when we talk about eating less and the companies don't put this the fact is when i talk to clinicians and you know in the best data i can see some patients are eating less than a thousand calories a day some are eating as low as 600 calories a day which is not good well if you want to lose weight but you have to do that carefully because i mean that is semi-starvation yeah right there's no way to get around the fact if you want to lose weight you're going to have to eat less but if you're going to take someone down i mean into that caloric range you have to do it carefully you have to do it under supervision and that's not really happening though like i know a lot of people on this drug um on the various different ones of them who are lying to the people doing the analysis of whether they should get their next round of them they're giving them fake weights and sending fake pictures of themselves and things like that so there's there's a weird kind of addiction to the the jabs as well isn't there now so let's not be judgmental oh no i'm not judging me people are entitled to yeah right i mean they can make their own judgments i'm not here to do that but this is not about weight this is about health that's part of the problem is a lot of people are seeing this as weight they see it as weight and they're losing visceral adiposity and they're changing their metabolic parameters and their blood lipid profiles and their hypertension and their insulinemia right the level of insulin levels all decrease and decreasing visceral adiposity that just is going to make everyone healthier so if it decreases is visceral adiposity that's sick fat i'm all for it using it for weight is in a different department my focus is on health there is still loads more we want to ask you uh david so sit tight for a couple of minutes while we go to a quick break this episode is brought to you by nsni the home of premium bonds premium bonds are the more exciting way to save instead of earning interest every£1 saved gives you the chance to win tax-free prizes in the monthly prize draw.

22:03From a day making£25 to an amazing£1 million. There are two£1 million jackpots each month, plus millions of other smaller prizes. And because NS &I is backed by HM Treasury, all your savings are 100 % secure. Join the millions of people already saving with premium bonds. There's a minimum investment of£25. NS &I Premium Bonds, where saving can mean winning. Find out more about premium bonds at nsni.com. We started by talking about the pernicious impact of these ultra-formulated foods, the ones that are so addictive. Is the science now so clear that not only do the big manufacturers of this stuff have a moral responsibility to behave differently.

22:57But actually, in terms, so are we going to see the equivalent of the class actions we saw against tobacco companies? If these huge multinational food producers are producing stuff, knowing that it is harmful for us, you know, should we all be ganging together and taking them to court and saying, you're behaving in a totally irresponsible way and we all deserve compensation. I was involved in doing the investigation into tobacco in the States. We led that and what the companies knew. There were laws, there were regulations, there was a chipping away. In the end, those are all tools. There are taxes on foods, right?

23:45There are regulations, there's labeling, there's lawsuits. But are these businesses behaving irresponsibly? That's fundamentally my question. But what's really changed in tobacco? How do we succeed in tobacco? Was it the lawsuits? What was it that changed in tobacco that led to the great public health success that we've had? I mean, in my parents and my grandparents' generation, the tobacco companies hired the psychoanalyst AA Brill to come up and identify the cigarettes as torches of liberty, symbols of freedom. They equated it with the march for emancipation. I mean, for women down Fifth Avenue in the 1920s, 1930s, it was sexy, it was adventuresome, right?

24:32It was the cowboy. Those were all associations with cigarettes. And again, a very powerful psychoactive substance that changed how people feel. What did we do in the end? We demonized the industry, no question. They were the evil industry. But we changed how people perceived the cigarette. It was no longer this positively valent substance. It was this critical perceptual shift that got people to see tobacco differently. And it was negatively valent. So people started seeing it as a deadly, disgusting product. If something's addictive and I see it as positively valence, I'm going to move toward it.

25:08If something is psychoactive, but I view it as negatively what I'm going to do, I'm going to view it as deadly and disgusting and I don't want it. In the end, use whatever tools you want. We have to change our perception. Our own mindset. Do I want that ultra formulated food? Do I want that stuff in the center island? When I look at that, is that going to really satisfy me or is that just going to stimulate me and get me to want more? What do I want? You can use lawsuits to affect that. You can use regulation to affect that. But it's that change in perception. But in fewer communities that I spend a lot of time in, you see that the convenience food, ultra formulated food, often is the cheapest.

25:52It's the fastest to get. The food from the local fish and chip shops here, I see people spend one pound, the equivalent of less than$2 to buy a bag of chips. It's the hot food. It might be the only meal they get that day. So for them, there isn't that choice of being able to, or they think there isn't. But understand what that food is doing. It's not even food. That processing, that formulation took out any structure. Take a blueberry. I mean, you have a structure, right? It has some sweetness, but it's slowly released because, I mean, there's fiber, right? I mean, there's a structure to that food.

26:31Take that blueberry, put it in a blueberry muffin, concentrate it, put flour and sugar around it. The absorption of glucose is so rapid that it overwhelms the metabolism. It increases the level of what, I'm going to use a technical term called hyperinsulinemia. But in essence, this pre-diabetes, this metabolic chaos, stimulates certain forms of cancer, other inflammatory conditions. We have an epidemic. Those processed substances, I mean, it's not even food. It's just overwhelming our metabolism. We have an addictive circuit getting us to eat more, but as it goes into our GI tract and it gets absorbed, there are the metabolic consequences of this.

27:11You pointed out that we got to a stage where the likes of Philip Morris were regarded as sort of evil. Is there, in your view, If you look at the sort of Nestle's and the Mondelez's, have they manipulated public opinion in the same cynical way as the tobacco companies? So there's a chapter in the book where I went to the great academic Richard Poley, who was the expert on tobacco advertising and the manipulation of public opinion, who knew nothing about food, but it studied tobacco and how the tobacco industry did all its virtues, what they call virtue signaling. They tell you the good. So I asked him, do me a favor, go look at the food advertising.

27:58He looks at the food, Tony the Tiger, and it's the same thing. The food companies have manipulated us in precisely the same way. Look, processing, 1940s, 1950s, we learned to be able to ship food over longer distances, more shelf stable. You didn't have to cook everything in your house. You didn't have to spend hours doing that. That processing initially was seen as good. But what did they do? They loaded into that process those substances, fat, sugar, and salt. They identified the bliss point and no one understood what it was doing to our brains and the addictive side. But no one asked what's the biological consequences of this rapidly absorbable glucose that's leading to this hyperinsulinemia.

28:41So we had in the UK, we had like a sugar tax that came in in 2018. So this was essentially an additional cost on drinks with sugar in. What happened was, I think it was something like half of manufacturers reduced their sugar, but they used other sweeteners instead. So now you've just got a case of most drinks that soft drinks, kids or whoever drink, doesn't have the sugar in, but it's got this. You're defining an addiction. You can't get around it. Yeah. But they're going to substitute one thing for the next. So it's hard for consumers because consumers would go, oh, well, I'm going to pick the less sugary option.

29:19this is healthier, but it isn't, is it? In the addiction world, that's just called harm reduction. There are advantages, right? I mean, not separating the addiction. I mean, you see it now in vaping. You can give the nicotine, but you don't have the baggage and the amount of lung cancer, but you have other harms that are associated with it. So it's complicated. But look, we have to realize what's triggering this. There's an addiction. We have to realize how there are drugs that can help behavior therapy, nutrition therapy, physical activity. There's no end game with these drugs. If you want to go on them, understand you're going to have to do this for the long-term.

29:58Obesity, weight, these are chronic conditions causing chronic conditions, right? And you're going to have to have a plan for the long haul. Let's celebrate the good stuff. Finally, finally, we can re-reclaim our health. You know, you were saying obviously you had this kind of situation where you were you'd become addicted to the food particularly when you were doing the stressful covid stuff have you come off the i've gone off i've gone and how are you managing to you need to use a toolbox of things because first of all i mean human nature i mean any one thing i'm going to get bored it's only going to work for so long can i ask you a question though about um using one of these weight loss drugs.

30:40I love food, right? It's one of the great joys in life is eating. Do you lose the love of eating if you're on these drugs? It's complicated. It doesn't take away taste. It doesn't have to take away pleasure. But obviously it takes away some of the reward aspect of it because that's the addiction. You change what you want. You don't want to put certain foods in your stomach. I can put some food in my stomach and enjoy it, but I can't put a lot of foods. I can't put, you know, high fat, sugar. Well, I've tried to train myself not to do that. But there is also - No, no, no, no. You try to train yourself to do that.

31:15Yeah. Over the years, yeah. Right. So the real question that I'm fascinated by, you ever struggle with your weight? Not really. Oh, I do. God, it's a living hell. But he's the one I want to study. Yeah. Right? Because what's he done? I mean, you're not the default, but the rest of us are the default. Yeah, yeah. Right? So what is it about you? How do you maintain your weight? Is it something else that grabs your addictive circuits? I've got so many addictions, I don't even know where to start. You've conditioned yourself. I mean, just talk about it. Not to put you on the spot, I know you get to ask the questions.