For decades, the world has watched Oprah Winfrey’s very public battle with her weight, as she yo-yoed between sizes, inspiring admiration with every pound she lost and ridicule when she gained it back. Winfrey, who has always spoken candidly about her weight and health struggles, says it wasn’t until recently that she felt liberated from toxic diet culture.
Part of her transformation was going on a GLP-1. But the other part was gaining insight into the science of obesity, in part, thanks to meeting Ania M. Jastreboff, MD, PhD, a physician-scientist and founding director of the Yale Obesity Research Center. The result is their new book, Enough: Your Health, Your Weight, and What It's Like To Be Free, in which the two teamed up to provide some much-needed insight on how to reframe the conversation around obesity and the ever-expanding roster of drugs that can effectively treat the disease.
The book is at once an evidence-based guide and a poignant account of the heartbreak of navigating life in a world that views excess weight as moral failing and weakness. SELF spoke with Dr. Jastreboff about what science still needs to understand about obesity and GLP-1s and her powerful collaboration and friendship with Oprah. “I don’t know anybody else who has that much conviction and grit,” Dr. Jastreboff tells SELF.
SELF: In your book, you write that a person’s weight is determined by their “enough point.” What does that mean?
Dr. Jastreboff: Eons ago, our bodies figured out that in order to survive, they had to store fuel. And the way that they store that fuel is as fat. So how does our body do this? How does it know how much fat to store? There are nutrient-stimulated hormones in the body, and they inform our brain, I’m hungry, I’m full, I’m storing this much energy, I’m storing this much fat. And then our brain sets the enough point.
So if that’s our beautiful biology, then why do nearly half of Americans have obesity? It’s because of the obesogenic environment, which has ultraprocessed food, lack of sleep, lack of physical activity, lots of stress, and medications that cause weight gain as a side effect. And all of these different things push up the enough point on a population level, meaning that most people are carrying or storing more fat than is healthy or needed. How we think [GLP-1s] work is that they recalibrate and lower the enough point. As your enough point is lowered, the weight follows.
In the book, you talk a lot about “food noise.” What is it?
Food noise is described as persistent, pervasive, disruptive thoughts of food. Food noise occurs when someone is living below their enough point. Caloric restriction does not lower your enough point. A person might experience weight loss, but that does not treat the biology of obesity or recalibrate or lower your enough point. Their brain thinks, Oh my goodness, you are going to starve. You need to eat more high-calorie foods and you need to eat more fat and sugar. And so food noise is a manifestation of that biology. It basically says, eat more and crave these different foods, and I’m going to do everything that I can so that you survive and that you get back up to storing enough energy and you have enough fat.
How did you come to write a book with Oprah?
We were eating together and she turned to me and said, “You should write a book and I will help you.” And in that moment, I thought this could help millions of people who struggle with obesity, who have obesity. And so the answer was clear. So this book was her idea, and I’m so grateful that she thought of it and that she pursued it.
As a leading expert in the field of obesity medicine, what new developments might we see with treatments?
Within just the last few years, we’ve seen these marked improvements in health with treating obesity. So the studies have been looking at heart disease, heart failure, diabetes, type two diabetes, obstructive sleep apnea. And what we’re seeing is that treating obesity with these new, highly effective medications improves health. It mitigates and treats these diseases.
There are weekly injectables currently, and more in development. There are monthly injectables in development. There are oral medications, daily oral medications. One has been FDA-approved and another one is under review. Currently, the focus has been on these hormone-based therapies. GLP-1 receptor agonists are part of that group of medications and part of that class of medications. But there are many other classes of medications that are being explored. And just as there are over 200 medications for the treatment of type 2 diabetes or for the treatment of diabetes, there will be hundreds of medications for the treatment of obesity. And I think that's incredibly exciting for our patients. There’s not one type of obesity. There are many types of obesities, and we need to be able to offer treatment to our patients that specifically help them.
What do you mean that there are many types of obesities?
We are in our infancy of understanding obesity biology. We don’t know on a molecular level, on a cellular level, how the enough point is set. And we’re in our infancy in terms of understanding the different types of obesities. What we do know is that some patients who take these medications don’t respond, meaning they don’t lose weight.
The reason for that is likely that the person who’s not responding to the medications has a different type of obesity that needs a different form of treatment, a medication that targets a different mechanism, a different biology. So a lot more work needs to be done to help us to understand that genetics likely plays a critical role in that. We all are genetically different and predisposed to respond to our obesogenic environment in different ways. And so just as there’s not one type of diabetes or one cause for high blood pressure, there’s not one type of obesity. We just don’t know what the different subtypes are yet.
What is the key message of your book that you want readers to take away?
Treating obesity is about improving and optimizing health. Obesity is linked to over 200 related diseases including type 2 diabetes, heart disease, and at least 13 types of cancers. So treating obesity prevents—or treats—over 200 obesity-related diseases or weight-related diseases, and the transformational aspect is that we are improving the health and the lives of so many people and improving the health of our nation and hopefully the world.
The key thing is that knowing and understanding this biology begins to help us shift away from the shame and blame that patients and people with obesity have so unfairly and unjustly faced their entire lives for a disease that is not their fault. And Oprah has faced this shame and blame so publicly and has bravely and vulnerably continued to share her story. And that’s what she’s doing in this book. And I’m so grateful that she’s giving people with obesity such a voice and such a gift.
This conversation has been edited and condensed for length and clarity.
Related:
- Why I'm Choosing Not to Take GLP-1s, Even Thought Everyone Expects Me to
- The 5 Worst Things You Can Do While Taking a GLP-1 for Weight Loss
- Can You Get Addicted to a GLP-1?
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