Hosts
Derek Thompson
Derek ThompsonAbout the episode
Americans are unusually overweight and chronically ill compared to similarly rich countries. This episode presents a grand, unified theory for why that’s the case. Our food environment has become significantly more calorie-rich and industrialized in the past few decades, sending our obesity rates soaring, our visceral fat levels rising, and our chronic inflammation surging. The result is an astonishing rise in chronic illness in America. That’s the bad news. The good news is that GLP-1 drugs, like Ozempic and Zepbound, seem to be astonishingly successful at reversing many of these trends.
This episode blends two interviews with Dr. David Kessler and Dr. Eric Topol. Kessler was the commissioner of the Food and Drug Administration under the Bush and Clinton administrations, from 1990 to 1997. He helped lead Operation Warp Speed in its final months. He is the author of the book Diet, Drugs, and Dopamine. Topol is a cardiologist and the founder and director of the Scripps Research Translational Institute. He is the author of the book Super Agers.
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Summary
In the following excerpt, Derek lays the foundation for a larger discussion on why Americans have higher rates of obesity and chronic illness than people in comparable countries, starting with input from David Kessler.
Derek Thompson: Today, a grand theory of health and chronic disease in America. In the last few weeks, I’ve had two conversations with doctors that really struck me: one with David Kessler and another with Eric Topol. And in this episode, I’m merging those two interviews into one show, because the two doctors and I, we ended up talking about the same thing: diet, toxic fat, inflammation, chronic disease. And I came away from both conversations with this kind of grand hypothesis kicking around in my head: a way that Western diets lead to Americans being the sickest people in the Western world, in large part because of the way that what we eat turns into fat, which turns into inflammation, which leads to chronic disease. So what you’re going to hear today is three people working together to build this grand theory up from the ground level. But first, some facts.
For many decades, the U.S. has had higher rates of obesity and chronic illness than similarly rich countries. It’s not just the poor among us. Rich Americans die from heart disease more than similarly rich Europeans. In fact, every income group, every ethnic group and education group that reaches the age of 50 here in America arrives at that stage of their life more heavy, more unhealthy, and at higher risk for serious heart disease or metabolic diseases, like diabetes. In fact, according to the NIH, Americans who [seem] to have won the genetic and socioeconomic and behavioral lotteries—these are Americans who don’t smoke, who are insured, college-educated, rich—are still in worse health than similar groups in comparison countries.
Well, you might just say, let’s just blame Americans. This is always an easy thing for pundits to do. Let’s just judge people for eating like crap, for not walking enough, for not keeping up with their health insurance payments or their medicines, for not taking care of their bodies. It’s very easy to judge, very satisfying for some. But I’m not sure this blame game is very useful. While mysteries abound in health, the reason why Americans have such a high rate of obesity is, in fact, not a total mystery. Americans at every age and income simply eat more calories.
David Kessler: I gained weight and lost it repeatedly over my lifetime. I mean, I have suits in every size. And I would gain the weight, and then eventually I would decide to lose it. I would lose it. I thought I was done. I would go on with my life only to gain it back.
Thompson: That’s Dr. David Kessler. He was the commissioner of the Food and Drug Administration under the Bush and Clinton administrations between 1990 and 1997. He helped to lead Operation Warp Speed in its final months. By all accounts, this is a man of very high conscientiousness, ability, intelligence, responsibility. But for Kessler, questions of diet and weight and obesity hit very close to home.
Kessler: Why was I gaining it back? What is this mystery about weight that has not been understood? And, I mean, why do we just keep on gaining it back? Why can’t I control it?
Thompson: When he turns the spotlight inward, Kessler recalls that he used food to quash every emotion.
Kessler: Certainly for me, if I observe when I ate, I ate to calm myself down. I ate to increase my focus. I mean, I ate through the day. If I pass that refrigerator, I mean, just the refrigerator itself was a cue. I mean, I was grazing through the day.
Thompson: Now, he’s spent years, decades really, thinking about the relationship between our bodies and our food environment. Why do Western countries, especially the United States, have so much obesity and obesity-related disease? For Kessler, the answer goes back a bit. Way back a bit.
Kessler: Thousands of years ago, the food environment was characterized by scarcity. In order to survive, our brains evolved to be able to focus our attention, to gain our attention on that energy-dense food. That’s how we survived. I mean, if you were a bird and you were flying over and you needed to identify sustenance and energy, your brains were wired. And this evolved through the species.
This excerpt has been edited and condensed.
Host: Derek Thompson
Guests: Dr. David Kessler and Dr. Eric Topol
Producer: Devon Baroldi