The Incredible Upsides and Disturbing Downsides of the New Weight Loss Medications
Today, we speak to Johann Hari, author of the new book The Magic Pill. The new weight loss medications such as Ozempic and Wegovy have been exploding in popularity over the past couple of years. Unlike dieting, these drugs can cause rapid weight loss with seemingly little effort from the person taking them. However, they also come with a wide array of risks that don't often get discussed. What are the implications these medications have for people with eating disorders? Why are they associated with drastic muscle mass loss? Why are some scientists warning about their affect on depression? Obesity has many risks, but so do these medications. Today, we discuss the complex calculation posed by the new weight loss medications.
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Juna Just a quick warning. There are curse words in today's episode, but there's not many and there's a lot of good information. Eddie, there is something that we talk about in almost every episode.
Eddie It's my favorite one. Exercise.
Juna Actually, no. Oh, that was a good guess. That was a good guess.
Eddie All right, well, what is it, then?
Juna Okay. Ready? 0000. That picture, you know, it's a ZenBook.
Eddie You notice I did not join it, I don't.
Juna Why did you not sing the song? You love me, I hate you. Let me drive the.
Eddie Oh word.
Juna Yeah, the oh word. Okay, so I'm not sure what your experience has been, but I have a couple of friends that are pharmacists and they are saying that, like, literally all their job is now is basically prescribing these GLP one inhibitors, which are these new weight loss medications?
Eddie I don't know about the pharmacist, but you cannot go to a medical conference without hearing several talks about these drugs.
Juna Right? It seems like these drugs are everywhere. And I remember when I first heard about them, I was like, these are either a godsend, like a miracle magic pill key word for later on in this episode, or we don't know something about them. And we're all going to be screwed in like 20 years or.
Eddie A lot sooner.
Juna Or a lot sooner.
Eddie So these drugs actually came out almost 20 years ago, but they really hit the market. Oh, it's like two years ago. And I thought, all right, maybe they do work. Maybe they really are a magic pill as we'll discuss. Yeah. What happens to that. Oh I don't know. Multi-billion dollar industry of diet and exercise. Like I.
Juna Know I was.
Eddie Like, shut it down.
Juna What's going to happen? And then guess what guys? They all pivoted. Now they're all prescribing medication.
Eddie So that's what we call Weight Watchers now. Yeah. For 70 years. We teach you the counterpoint. All in this together. Click here for your GLP one agonist.
Juna It's crazy. So I think these drugs bring up a lot of really important questions because they do have incredible benefits. And they also have a lot of risks. And I think a lot of the time we don't hear a balanced conversation of both. So I'm very excited for today's episode. On today's episode, we're talking everything you need to know about the new weight loss medications. What are the upsides, what are the downsides, and should you be on them? I'm Juna Gjata.
Eddie And I'm Doctor Eddie Phillips, associate professor at Harvard Medical.
Juna School. And you're listening to food. We need to talk. The only podcast that you can safely take every week for the rest of your life with no side effects. Today we are speaking to Johann Hari, who is author of multiple bestselling books including Stolen Focus and Lost Connections, and his new book. And the reason that we are speaking to him today is called Magic Pill. The extraordinary benefits and Disturbing Risks of the new weight loss medications. Johann, thank you so much for coming into the studio today or not coming to the studio. Thank you so much for joining us today.
Speaker 3 All right. I'm so happy to be with you. Thanks for having.
Juna Me. You've had me all frazzled, Johann. We've been having too much fun with Johann off my guys. So now we're all frazzled. We're sorry. I'm Mike.
Johann That's my goal. To dazzle you. So much joy and capable of speech.
Juna And right then, we'll just forget to ask our questions. So, Johann, I'm a huge fan. I'm so excited to actually get to talk to you. And the first thing I want to ask you is, I want you to start with the story of how you first encountered the GLP one inhibitors with the Hollywood party. I just think it's a great story, and it's very telling about what was going on basically before the rest of the public was aware of it.
Johann Oh my God, it was this really weird moment. It was the winter of 2022, and it was that moment when the world was opening up again. We'd all been shut away for so long, and I got invited to a party and I was like, oh, parties. I remember them, they used to relax and I was them. So I said, yes. And this party was at the home of a Oscar winning actor. I'm not saying that just to namedrop slightly to namedrop, but there was a reason for telling you that. Just so I was in a neighbor. I was in a neighbor on the way there, and I suddenly felt kind of awkward and self-conscious because I'd gained quite a lot of weight during lockdown, and I was quite fat at the start, and I kind of thought of that a bit schlubby and embarrassed. And then I suddenly thought, wait a minute, almost everyone I know who's gained weight during lockdown, this party is going to be really interesting because I'm going to see what these Hollywood stars would like. A bit of flab on them. This is going to be super interesting. And I arrived and it was the weirdest thing. Everyone was skinny. And I don't just mean, I mean obviously the Hollywood stars, the skinny. I mean, everyone was like markedly thinner than they had been at the start. In fact, everyone like their own kind of Snapchat filter. They were like clearer and thinner and sharper. And not just the actors like those people I'd known before the screenwriters, everyone's partners, the agents, just everyone was really thin. And I was like, wow. And I a bit thrown and I bumped into a friend of mine on the dance floor. And I said to her, wow, it looks like everyone really did take up Palazzos during lockdown. And I'm. And she laughed and I must have done a puzzled look. I didn't know why she was laughing and she pulled up on her phone. An image of an exam pig pen. And that was when I learned that existed. Wow. Obviously, I learned in the next few days that we've got a new kind of weight loss drug that works in a totally new way, based on an incredible scientific breakthrough, which, you know, means that if you take as and pick over coffee within a year, the average person will lose 15% of their body weight. If you take Jaro, which is the next in this class of drugs, you lose on average 21% of your body weight. And if you take triple G, which will be available next year, the next in this class of drugs, you lose on average 24% of your body.
Juna Oh my God.
Johann And as soon as I learned this, I felt this incredible mixture of feelings because the first thing I thought was, well, this could save my life because I was about to turn 44, which is the age my grandfather was when he died of a heart attack. Loads of the men in my family get fat and die of heart disease. My dad had terrible heart problems that didn't kill him. My uncle died of a heart attack. I knew then the obesity makes it much more likely you'll get heart disease, along with actually over 209 diseases or complications that either causes them or makes them significantly worse. So I thought, wow, if we've got a drug that really can reduce or even reverse obesity. Let's go have a big deal for health. But I also immediately thought, wait a minute, this sounds way too good to be true. Is there such a thing as a free lunch when it comes to your health? I guess in this case it would be a smaller free lunch. Like, can this be what it appears to be? I immediately was worried about all sorts of things eating disorders, what it would mean for the progress we made. My body positivity. Just so many things. So really, to get to the bottom of this conflicted feeling I had, I took a Zen pic and I went on this bike journey from Iceland to Minneapolis to Okinawa to interview the leading experts on these drugs, the biggest defenders of the drugs, people who've been involved in their development, the the biggest critics of these drugs, people who've been affected by this debate one way or another. And it was a really fascinating journey to try to explore what this is going to mean for all of us. And this is coming for all of us, right? 47% of Americans want to take these drugs now, and that's before the price comes down and before most people know someone who's taking them. Right. So this is going to have an explosive effect on the culture all around us, whether you're interested in taking these drugs or not. So I really hope you know, my book is a chance for us to really take a beat and think through this, this stunning scientific revolution, how it's going to affect us for good and for bad as it's hitting us.
Eddie Can we just sort of start with what the medicines were originally intended for, which was for diabetes? And listening to my colleagues who specialize in taking care of diabetes, they say, like, they really work well. And this is life changing for people with a known disease, diabetes. And of course, obesity is also a disease, but they were originally intended for that. And I think the the scene that you described that this Hollywood party was, I imagine, people taking it for weight loss and not not exclusively for diabetes.
Johann They weren't actually intended for anything. They'd be discovered by accident. And it was discovered that they had two effects that you're right, that the first effect that was discovered was on diabetes. I interviewed, in fact, the man who discovered him, he made this breakthrough brilliant scientist called Daniel Drucker. Working very close to where you guys are actually at Brigham Hospital in, in Massachusetts. So he discovered if you eat something now, it doesn't matter what it is. Your pancreas will produce a hormone called GLP one. And GLP one has several effects. Firstly, we know that GLP one stimulates the creation of insulin. Of course, as soon as that was discovered, they realized, well, this could have huge implications for people with type two diabetes who have a problem with making insulin, which is why it was quite rapidly developed into a diabetes medication that's been used now for, well, but getting up to 19 years and a few months. But it was also discovered pretty soon afterwards that it had another effect. So we now know that GLP one is part of your body's natural mechanisms going, hey guys, you've had enough. Stop eating is part of the brakes on eating, the natural brakes on eating, but natural GLP one only sticks around your system for a few minutes and then it's washed away with these drugs. Do is they inject you with an artificial copy of GLP one, but instead of sticking around for a few minutes, they stick around your system for a whole week, which has this incredible effect, right? I'll never forget the second day I was taking as mpeg. I woke up, I was lying in bed. And I thought, oh, I feel something strange. What is it? And I couldn't figure out what it was that I was feeling. And it took me. A few minutes to realize I had woken up and I wasn't hungry. It never happened to me before. I used to wake up with a kind of raging hunger when I went on autopilot. I went to this diner just up the street where I live when I'm in London, which is about half the year, and I went in and I order what I used to order every morning, I'm slightly embarrassed to say, which is a huge chicken mayo sandwich with less chicken, lots of mayonnaise in it. And normally I would wolf that down and I would still want some potato chips. And I had like 3 or 4 mouthfuls of this sandwich and I just didn't want any more, I felt full. And that was really how it felt from then on. Because these drugs have given you this artificial copy of GLP one, the signal that you're full. You feel really full really quickly and you just don't eat. So it's very different to experience of dieting. Obviously, like every person in the world, I tried dieting and we're dieting. You you find ways to override your hunger. That's not the case with these drugs. You don't feel hungry very much and your hunger is very easily satisfied. It was a very weird feeling. I actually realized now, in retrospect, because I had a diet that was overwhelmingly consisted of processed and ultra processed foods, which undermine your ability to feel full. I'm sure we'll explore that, but I don't think I ever really felt full in my life. Before. I'd felt starved. I felt so stuffed I couldn't eat anymore. But having the kind of pet that satisfied, fulfilling, or if I had it was very rarely so. It was a very dramatic effect very quickly. It's why, you know, taking them per year. I lost 42 pounds. It was really dramatic. So the effects of these drugs are really quite significant.
Juna So Johann, I really wanted to have you on, partially because I feel like you bring this really personal perspective. A lot of other people we've interviewed about Ozempic and stuff are just doctors who prescribe them, which, yes, is a good perspective to have. But I just think having like the personal perspective as well, especially as someone who's grown up struggling with weight, like when I was in college, I was obsessed with basically losing weight. And I remember when I first heard about the drugs, all I was thinking was like, oh my God, what's going to happen to all the people that basically like people with eating disorders who are just dying to lose weight? If I were in college and these drugs had come out and like I was by BMI standards, I was overweight in college, but I wasn't in the obese category. But if I had known that these drugs existed, I would have like bent over backwards to get to them as fast as possible. Like, I would have lied to my doctor, I would have done whatever. I would have gotten a new doctor, whatever it took to be able to get access to these drugs. So I was wondering, when you were interviewing all these experts, were people worried about the effect it would have on people who are abusing them for weight loss? Or was the reaction generally very excited that they had found this new drug that would help so many people?
Johann Yeah, I think it's really important what you just said. So in the book I go through, you know, the subtitle, like you said, is the extraordinary benefits and Disturbing Risks of the new weight loss drugs. The way I think of these drugs, this is slightly hyperbolic, but only slightly that a tool that is so powerful that almost like fire right now, fire is a great tool. If I use it to warm up my house, it's a terrible tool. If I use it to burn down your house, and these tools are so powerful, they will have incredible uses for good and for bad. You know, the book is called Magic Pocus. There's three ways these drugs could be magic. The first is the most obvious. They could just solve the problem of obesity. Right. And I got to tell you, there are days when it feels like that. My whole life I've massively over eaten. Now, once a week I do a tiny little job into my leg. I don't overeat anymore. It's incredible. It feels like magic. The second way it could be magic is much more disturbing. In the book, I go through the 12 significant risks associated with these drugs. It's possible that over time, these risks will outweigh the benefits of these drugs. I think there's some chance of that. So in that sense, it could be magic in a in a much more disturbing way, it could be like, like a conjurer who shows you a card trick while picking your pocket. Right. The third way it could be magic is, I actually think, the most likely think about the stories of magic that we grew up with. I would be a good example. Think about Aladdin. You find the lamp, you rub it, the genie appears. He grants your wishes and your wishes come true, but never quite in the way you expected, right? It always has these unpredictable effects and there are lots of incredibly positive effects. So people like me or obese and have heart disease in the family, I suspect these drugs are saving my life. Certainly they're saving a lot of people's lives. And I think you've gone to of the 12 big risks, you've gone to the one that I'm most worried about for the society. I'm not worried about it for myself, but for the society which is eating disorders. So I'm guessing pretty much everyone listening will have known someone with an eating disorder. Think about anorexia. Someone is sick. There's a conflict going on within them. There's the biological part of them that wants to live and therefore wants to eat. And then there's the psychological part of them that for complicated reasons, we can go into, wants to stop themselves. And what these drugs can do is massively empower the psychological part of you that wants to starve yourself over the biological part of you that wants to eat. I mean, if you take these drugs at a high enough dose, they just amputate your appetite. That's why Doctor Kimberly Dennis is one of the leading eating disorders specialist in the US. Each time around, great. A wonderful person says, you know, these drugs are rocket fuel for eating disorders. And she's already seeing that in a clinical practice. And lots of other people treating eating disorders are saying that. I've been saying that to me as well. We don't have to speculate about this. By the way, in the early 1990s, there was a whole congressional inquiry into actually a much less powerful diet drug in the early 90s where many thousands of young women got really bad problems because they were taking it and using it. So, yeah, I am very concerned about this. My fear is if we don't regulate these drugs, we could have a kind of opioid like death toll of young girls is over. Many young girls. You get this problem of, say, some boys, some older women, but mostly young girls that we can have an opioid like death toll of many, many young girls who starve themselves to death using these drugs, who would not have been able to without them. Now there's something we can do immediately to massively reduce that risk entirely prevent it, but which she should reduce it. So the prescribing guidelines for these drugs are very clear. You should only be given these drugs if you have type two diabetes or your overweight or obese, you've got a BMI higher than 27. In practice, I guarantee that anyone listening, even if your BMI is well below 27. Could get these drugs today. Right by the moment, they've been prescribed on them.
Juna Oh my God.
Johann Go on. Zoom. You know, they're meant to check your BMI. It's very hard to check someone's BMI on zoom. Frankly, a lot doctors aren't even bothering to make a pretense of it. Oh, my. If I think about when I got them right. So I initially got them in here in Britain. As you can tell from my weird Downton Abbey accent, I am British. But the. So I was taking them for maybe three months, maybe a little bit longer, I forget in Britain. And then I went back to Las Vegas, where I spent a lot of the year. I'd run out of this place I had in Britain. So I went to a place in Vegas that I is prescribing. And now by that time I was below, I wasn't overweight anymore because the drugs had such a powerful effect. But they didn't ask me that. I went in, I wasn't overweight and they gave me the drugs. Right? So, oh, I can see how easy it is to get them. And that is really, really alarming and could have catastrophic effects as well as, of course, the beneficial effects many other people.
Juna And do you think right now that they are being overprescribed? Because I have a couple of friends that are pharmacists and like I remember them saying, like everybody is coming to get them, like everybody's coming to the pharmacy. We can't keep them in stock. It's crazy. And I just know they've been coming up in conversation everywhere. So I know in Hollywood, like Hollywood movies that have everybody else in the sense that like, they already had it two years ago. Overprescribed but do you think that right now it's being overprescribed just in the general population?
Johann I think they're being simultaneously overprescribed and under prescribed because they're getting too often, getting to the wrong people. So, you know, I was just talking to one of the Real Housewives of New Jersey on a TV show, and she was saying, oh, we're all on it right now. None of them were. I mean, far from they were all were far from being obese. Right? They were already skinny at the start. Right? So you've got a situation where the Real Housewives of New Jersey get to be super skinny, while the real schoolchildren of new Jersey get to get diabetes at the age of 12. Right. So you've got simultaneous overand under prescription. There's a huge distinction between overweight and obese people who are taking them to get down to a healthy weight. I think that's very defensible, although there are still those 12 significant risks. I think for many people that's the right decision. Then you've got people who are already healthy, weight or indeed skinny who are taking it to be super skinny. Now, I don't judge any of the people who do that, and I'm conscious of my man telling you this, and you don't need me to mansplain it. But women in this culture, made to feel like shit about their bodies, no matter what they do. And I understand as much as a man can. I think that. Horrendous. Precious. I'm not criticizing or judging anyone who makes that choice, but I would. I would want to warn them that they are incurring significant health risks. Firstly, they are taking on all the 12 risks associated with the drugs without the countervailing benefit of, you know, reducing or reversing obesity. And they're taking on other risk as well. So give an example of one. One of the most important determinants of health as you age is your muscle mass, the health of your muscle mass, the total amount of soft tissue you have in your body, which is essential for really basic things like getting out of a chair, climbing the stairs or whatever. And you naturally lose muscle mass as you age. Indeed, you lose 8% of your muscle mass per decade starting when you're 30, which is very depressing for someone who's 45. So, you know, we all naturally lose muscle mass, but when you lose a lot of weight through anyway, through these drugs or any other method, you don't just lose fat mass. You usually lose a lot of muscle mass as well. So if you're going into the aging process with a artificially low amount of muscle mass because you're taking these drugs, that won't cause particular problems when you're in your 30s and 40s, as you age, or in your 60s or 70s or 80s, you're at risk of being much more fragile and much more physically incapacitated. You're at risk of a condition called sarcopenia, which means poverty of the flesh. So you could have really struggled with things like getting out of a chair, climbing the stairs. You're going to be much weaker. So the risk is that we're setting up with those people, with people who are taking it to be super skinny, a kind of time of people who will be much more frail and fragile as they age, and much less able to do anything as they get older, as adults. Yeah.
Eddie So, you know, how are you familiar with any data comparing a group of people who lose weight through the more traditional diet and exercise versus taking ozempic? And you could use a GLP one agonist and lift weights to at least mitigate the loss of lean mass of the muscle mass. But I'm not familiar with data about this. I don't know if that's.
Johann Yeah. So my understanding from entering the experts is that this doesn't cause more loss of muscle mass than any other form of weight loss. It's just that these drugs give you such a dramatic amount of weight loss. And unlike other forms of weight loss, it's sustained weight loss. I mean, of course, there are some people who, through diet and exercise, leeches amounts of weight and keep it off over the long term, but they're surprisingly rare. It's only about 15% of people who are able to do that for reasons we can unpack. So it's not that these cause more muscle mass loss than other weight loss methods, it's just that this is a more sustained and usually a more dramatic form of weight loss than the other ones.
Eddie We're going to take a brief break. And we're back with Johann Hari, author of The Magic Pill.
Juna Can we talk about another risk that I feel like I've seen, at least in people that I know that have taken these drugs? And I don't know if this has been your experience, Johann, but I know a few people personally who have gotten prescribed them and they were overweight. I don't know if they were obese, but they were definitely overweight. And something I've noticed is that I'm worried about them being malnourished because they will often eat, like one meal a day that's like 500 calories. I think it'll be like two eggs, and that's all they eat the whole day. And I'm like, I want to scream like, oh my God, you have to eat. Like, even if you don't have an appetite, like you have to eat some vegetables, like you have to eat something because I'm worried that like because the natural signals of your appetite are gone, that people just aren't going to eat enough, period. They're not getting enough nutrients.
Johann Yeah, this is a really big problem. It's one of the 12 risks that I talk about in my book, Magic Pill. The people you're describing. And this actually happened to one of my closest relatives. She was taking it, and she was just literally forgetting to eat, you know, her kids were having to remind her. It was very alarming. And of course, as we know, malnutrition. Having very low level of nutrients is catastrophic for health. Part of the problem here is we're telling everyone to take the same dose, right? Or pretty much everyone is advised to build up to one milligram. Now, for some people, it won't be high enough if you're severely obese. For other people, it's way too high. So I think we're going to have more subtle guidance on dosing. I also think a lot of doctors are now doing this. I think rightly, I think this should be standard practice. Everyone is given these drugs should also be given an eating plan to make sure they don't fall too far below the required number of calories. I also think everyone in line with what you just said should be given guidance to do weightlifting. Otherwise the muscle mass can drop too low. So I think it's important for us to stress as well, because we're rightly talking about some of the risks here. And there's lots more, some of which are also alarming to anyone who is overweight or obese. The truth is, you face two sets of risks. There are the risks of obesity and there are the risks of these drugs. And you've got to weigh them. And that is not an easy thing to weigh. And I don't think there's a one size fits all set of advice. It's why I would really recommend you go through the risk. The list of the risks of obesity in my book, and the list of the risks of the of these drugs in my book, and see which ones apply to them, because I think we need a more personalized way of thinking about this. But I have to admit, the thing that most shocked me in the research for the book, I'm really embarrassed to say this is the thing I thought I'd known since I was a little boy. Which is how bad for you being overweight or obese is, I guess at any point since I was seven, if you'd asked me that, I would have said, well, yeah, being overweight is not good for you. I was stunned by the evidence of how bad the obesity is on average. Doesn't mean anyone should be stigmatized. It's no one's fault. We're going to. I sure. Why? Obesity has risen. And it's not because people were weak or greedy or any of that. But the scientific evidence is very clear. Like I mentioned before, you know, being overweight or obese makes you more likely to get or makes more severe over 209 diseases or conditions. Pretty much all the things we fear are made significantly more likely by obesity, cancer, dementia, stroke, even. Think about something which I doubt there's a single person listening who doesn't know that obesity makes you more likely to get type two diabetes. Again, I'm embarrassed to say if we've been done this interview two and a half years ago and you'd ask me about diabetes, I would've said, well, it's not good to get diabetes, but as long as you get good health care, if you're diabetic, you're pretty much like everyone else, right? So I would thought someone with type two diabetes who gets insulin is like you or me, right? That's not true at all. From looking at the best scientific evidence about diabetes and interviewing leading diabetes experts, you know, diabetes is the biggest preventable cause of blindness in the United States. More Americans have to have a limb or extremity amputated every year because of diabetes than because they got shot. And you will have noticed a lot of us get shot. And if you're obese when you're 18, you have a 70% chance of getting diabetes in your lifetime. And that's just one of the 200 effects of being overweight or obese. So if you are overweight or obese, clearly the first recourse should be you should try diet and exercise as a method of weight loss. Right. Because that's much less risky than these drugs. Frankly, I've never met an overweight person who didn't try diet and exercise. Sadly, in the current obesity environment in which we live, they mostly fail for people, but everyone should try them. If they don't, then we're in a trap, right? And these drugs are our trap door now. They are a risky, rusty trap door. Some of us should go through them, some of us shouldn't. But we've got to level with people about how risky remaining in the trap is.
Eddie To my mind, you're you're walking the fine line of that which I do as a as a physician, which is I have a medication that could help manage your diabetes as you're, as you're saying. And that's the best we can do. If you really do lose weight, lift weights, etc., you can reverse diabetes. That's kind of a rare individual, but that's available to folks, and yet they have side effects. I'm listening to the discussion about obesity, which is a chronic illness, and thinking about my patients that come in and they have high blood pressure, and that's really bad. And we can cite all of the risks for stroke, etc., from having high blood pressure. And we can give them medicine. So what's interesting is that then they come back a few months later and they if you get them to chat or you just look at their pharmacy records, say they're not taking those medicines, why? Well, you know, that pill you gave me is making me feel lethargic and I don't have the energy and I'm impotent. And the hypertension, you really don't feel until you have a problem with it. So I'm just trying to sort of draw a parallel here. That's another chronic illness. We have medications that have side effects. And yet we are, you know, have campaigns about getting people to take their diabetes medications, their hypertension medications. What's what's the difference here? I mean, and and you can see the difference. You take this stuff and you're you're manifesting its efficacy. That's I guess the good side of the GLP one I guess this.
Johann Yeah. Professor Carol LaRue, he worked on these drugs, said to me, there's two kinds of drugs. There's drugs that have side effects, and there's drugs that don't work. And it's a really pretty much important point. But I think he's absolutely right about that. So I would distinguish between two things. That's the side effects of these drugs which are fairly well known. But for some people they're initially horrible nausea, diarrhea generally that goes away over time. But there's a small minority firm. It doesn't. And they have to stop the drugs. But for most people it does go away. Over time. They went away from me quite quickly. And then there's the sort of 12 risks which I put in a slightly different bucket. But I think you're totally right. If we want to think about, you know, you're talking about in the case of high blood pressure, you're trying to get the individual to compare the risks of the condition versus the rest of the drugs. Right. It's a fairly standard thing in medicine, obviously, that you'll be encountering all the time. I think if we want to think about the benefits and risks of these drugs, it can actually help to think about a parallel area of science. So up to now, it's been really quite hard to lose weight and keep it off again. I can explain why, but actually, I think the best comparison point for thinking about benefits and risks of this is to look at bariatric surgery, which has been the most reliable way up till now, to lose huge amounts of weight and keep it off. So I'm talking about things like gastric bands, stomach stapling. People are familiar with this by now, right? So what do we know about bariatric surgery? We know a few things. Firstly, that it's a horrible, grim operation. 1 in 1000 people dies during the operations. It's no joke, right? But why do people put themselves through that? They put themselves through that. Because if you massively reduce or reverse obesity, you get a staggering improvement in health. In the seven years after bariatric surgery, you are 56% less likely to die of a heart attack. You are 60% less likely to die of cancer. You are 92% less likely to die of diabetes related causes. In fact, it's so good for your health you're 40% less likely to die at all in those seven years, right? Extraordinary. And we now know with these drugs they are moving you in a similar direction. So if you take these drugs like Ozempic and we're going by and you start with a BMI higher than 27, you are 20% less likely to have a heart attack or stroke in the next two years. So obviously something very close to my heart. Literally, literally close to my heart. Ever think of it, right? But it's interesting to also think about some of the downsides of bariatric surgery, which also seem to be manifesting with these drugs. So. This will sound really strange at first. If you have bariatric surgery. In the years to follow, you're almost four times more likely to commit suicide. It's still a relatively low risk because of the massive increase, right? And I was trying think about this. And. It really relate to something I wish I had known before I took these drugs. So for the first six months I was taking them. It was really weird. I was getting what I wanted. I was losing loads of weight. My back pain went away. My neighbor's gardener kept taking on me. Loads of good things happen. But. Weirdly. I didn't actually feel better. I actually felt emotionally slightly worse, and I was learning that, and this is contested. But some scientists are concerned that some people. Seem to be developing depression or even suicidal feelings when they take these drugs. This is why there's an FDA warning on the drugs in relation to this. Now, I wasn't that bad. I wasn't depressed or suicidal, but I did feel emotionally muted. Okay, maybe this is just a coincidence. Maybe this is other stuff going on in my life. This bit about why that might be happening. So it's increasingly clear that these drugs don't work primarily on your gut. They work primarily on your brain. You have GLP one receptors not just in your gut, but in your brain. So maybe this is a brain effect. I can go more into that. But I actually think for me and for many people, it was something much more basic and something much more easy to understand. And I had a real epiphany about it in a branch of KFC in Vegas. It was seven months into taking the drugs. I was in Vegas because I'm writing a book about a series of crimes that have been happening there. I've been researching for a long time, and I was investigating the murder of someone that I knew and really loved. So it was very hard, as you can imagine, and really on autopilot. I went into the people in Vegas. There's a branch of KFC on West Sahara that's one of the roughest kfcs in the whole world, I love it. And I went in and I ordered what I would have ordered before I was taking a sample. I ordered a bucket of fried chicken, and I had one of the chicken drumsticks, and I. I suddenly thought, I can't eat this when you're on a pick, you can't overeat. Imagine I came to you after you had a massive Thanksgiving dinner and I said, hey, great news, I got your bucket KFC you just on. Oh, take it away from me. That's how you feel on his epic quite quickly right? And I remember thinking, you know, when you have a kind of insight and it comes to you so clearly that it almost feels like someone else has said it to you. I thought. Oh. You're just going to have to feel about that. And I realized in that moment, you know, I go through in the book the five reasons Why we only one of them is so obvious. One, to get nutrition to sustain your body. Right. The rest are all psychological. I realized to me that I had some awareness of this before. I don't want to overstate it, as if I was purely an epiphany in that moment, but. I realized I grew up in a family with a lot of addiction and craziness, and from when I was very young. One of the ways I would calm myself, I would numb myself, was by stuffing myself, by deliberately overeating. And I couldn't do that on these drugs anymore. So what these drugs do is they radically interrupt your underlying eating patterns. Which is obviously a good thing. That's why you lose so much weight. But but what it can also do. Is bringing to the surface some of the deep underlying reasons why you overate in the first place. Again, that can be a good thing, right? There are better ways for me to deal with sadness about my friend's murder than Colonel Sanders. But, but. That. It was a difficult and bumpy transition. And so what I hope the book is partly a guide to is obviously how these drugs work, but. How they make you feel not just physically but also psychologically, which I think is a really important, underexplored area about this. The overeating is doing a job for many of us, right? A really important job in addition to harming us. And I think that's something that needs to be with a great deal of sensitivity, kind of unpicked and explained to people.
Eddie How different is that than the individual? Well, still millions of people are smoking. Horrible thing to do to your body. And then we can give people, nicotine replacement, etc. we can help them get off the cigarets. And then you ask them a little while later, how are you doing? They go, well, I'm using the nicotine replacement. I'm not smoking. And but then kind of the level that you're going to your hands say, well, how's your life going? I go, First of all, I don't know what to do with my hands. You know, I used to like, light up when I was anxious, etc., writing, you know, but stressed. So I'm at a loss because I don't have that stress relief. I've lost my friend group, which is basically the folks that find themselves outside of the office building 4 or 5 times a day to light up, and they're sort of like rooting around saying, you know, I need something to do here, and don't tell me to eat carrot sticks. You know, that's not going to be sufficient. So how different is it for folks that are using eating to manage stress or. Yeah, it's it's it's also social thing. I imagine if you went with a buddy to eat, a bucket of KFC, you'd have some. How long does it take to eat a bucket of KFC? You'd have some time together.
Johann It takes me. You're not. You're not going to be. I understand your general plan, Yeah. I think there's so much in this question. It actually points to a lot of the things that I think people need to know. Smoking is also a cause I question very closely about. My mother smokes 70 cigarets a day. She's the only person I know who wears nicotine patches and smokes 70 cigarets a day. This is an amazing photograph of me and her when I'm a baby, where she's breastfeeding me, smoking and resting the ashtray on my stomach. And when I when I discovered this photo a few years ago, I thought I should feel guilty. I showed it to her. She said she's Scottish. She said you were a fucking difficult baby. I needed that cigaret. So this is very close to my heart, but I actually, this is it. There's so much in this. I think you're of course, right that the psychological mechanism is very similar. But I also think there's a deeper thing here, a deeper analogy with smoking that I really think it's worth us thinking about. So I would just say to everyone listening. I would ask everyone to pause this podcast and Google something for me for a moment. Just Google photographs of beaches near where you live. I don't know if you live near Myrtle Beach or Miami Beach or Santa Monica. Just Google photographs of those beaches in 1979, the year I was born, and then come back, right? If you've done that, what you will notice is something really strange. If you look at those photographs, they look really weird to us because pretty much everyone in them look skinny or jacked. Right? You look and go, This is weird. Where was everyone else? Was it like a skinny person convention in Myrtle Beach that day? And then you look at the figures. That's what people looked like in 1979, the year I was born. Between the year I was born, in the year I turned 20. Obesity more than doubled in the United States. And then in the next 20 years, severe obesity more than doubled again. And you think it's really weird, right? Human beings exist for between 300 and 350,000 years, and our modern form and obesity exist, but it's exceptionally rare. And then. Essentially in my lifetime. It blows up. Why would that be? What happened? We know what happened. This change happens everywhere in the world. That makes one change. It's where people move from mostly eating a diet of whole fresh foods. They prepare on the day to mostly eating a diet of processed and ultra processed foods, which means foods that are constructed out of chemicals in factories in a process that isn't even called cooking. It's called manufacturing food. And it turns out this new kind of food which never existed before. Everyone listening. Your great grandparents, never a single mouthful of this food. This new kind of food affects our bodies in a completely different way to the old kind of food. And there's loads of reasons why go through the seven reasons Why in the book, but to me, the core of it was really distilled in an amazing experiment that I've nicknamed Cheesecake Park. Not the official name of it. It was carried out by brilliant scientist who you've had on your show. I know Doctor Paul Kennedy, who's the head of neuroscience. Great man, wonderful human being. He's the head of neuroscience at Mount Sinai in New York. It's a very simple experiment. Doctor Kenny got a load of rats, and he raised them in a cage. And all they had to eat was the kind of natural whole foods the rats evolved over thousands of years. And when that's all they had, the rats would eat when they were hungry and stop when they were full. So they had some kind of natural nutritional wisdom when confronted with the food they evolved to eat. That just said to them, hey guys, you've had enough. Stop eating now, right?
Juna Right.
Johann Then Doctor Kenny introduced them to the American diet. Right? Get ready to salivate. He fried up some bacon. He bought a load of Snickers bars. Crucially, he bought a load of cheesecake, and he put it in the cage alongside the healthy food. And the rats went crazy for the American diet. They would literally dive into the cheesecake and eat their way out and emerge just completely slicked with cheesecake. And they ate an eight and eight and eight. As Doctor Kenny put it to me, within a couple of days, they were different animals. All that nutritional wisdom that they'd had when they had the natural kind of food, they both vanished. And within a few weeks they were all severely obese. Then Doctor Kenny tweaked the experiment again in a way that feels a little bit cruel to me as a former KFC addict. It took away all the American food and left them with nothing but the natural food that evolved for. And it was pretty sure he knew what would happen. They would eat more of that natural food than they had in the past. And this would prove exposure to process and ultra processed foods expands the number of calories you eat in a day. That is not what happened. What happened was much weirder. Once they'd had the American diet and it was taken away. They refuse to eat the healthy food. All it was like they no longer recognized it as food. Oh my God. As Doctor Kenny put it to me, it was only when they were literally starving that they finally went back to eating the healthy food. Now I would argue we are all living in a version. Of Cheesecake Park, right? The, the food we are eating, processed and ultra processed foods are profoundly undermining our ability to ever feel full, to feel like we've had enough and don't need anymore. And what these drugs do is they give you back your sense of fullness, but at a cost. So when you understand it that way, you can see as as Professor Michael Lowe at Drexel University in Philly put it to me, these drugs are an artificial solution to an artificial problem processed in ultra processed foods. Dig that hole for us. Hole of hunger, that insatiable, hollow hunger. And these drugs fill it in. But, like I say, a cost. Now, clearly, the long term solution for that is to make sure our kids do not grow up in that trap. And this is where the smoking analogy comes in, right? So it comes back to question. I think if we could take a contemporary ten year old child back to the United States and Britain when we were ten years old, the thing that would most shock them would be the people smoked everywhere. People smoked, underpaying, people smoked in restaurants, people smoked on the subway, people smoked on game shows. The doctor I remember our family doctor used to smoke while he examined me right now. It would be unthinkable to a contemporary American child or British child, right? Why did that happen? That happened because of a concerted and designed social change. Right now, we can also change how we eat. I went to places that have done it from Japan, where there is literally no childhood. Obesity is statistically zero to the Netherlands, where they massively reduced it to Mexico. There are all sorts of places we can do that. There are concerted strategies to do that for people like me. Look, I've been raised in this trap. I've been eating a predominantly processed and ultra processed foods all my life that I can't individually transform that environment on my own, but we can damn well make sure that doesn't happen to our kids, right? We need to make sure the choice for our kids is not a risky medical condition or a risky set of drugs, right? I really passionately feel that people like me, we are where we are, and we've got to make the choice we've got to make. But we don't have to impose that choice on our children and grandchildren. We really don't.
Juna First of all, thank you so much for sharing a lot. That is so insightful and I really do want to talk to you about Japan and the insights you found when you went there, because it was shocking and we're going to do that over on our bonus episode. But just for this episode, what do you have as your parting words to somebody who is maybe thinking about trying these drugs, and maybe they have struggled with weight for a lot of their lives. What are your parting words to them?
Johann You know, I was so ashamed and embarrassed when I was fat. And. Learning, the science of obesity, and how we live in what's called an obese genic environment, an environment where it's very easy to gain weight and very hard to lose. It really helped me. You know the difference between those people on those beaches in the year I was born and us is not that they were morally good and we're morally bad. So I would I would talk about shame. And I would say you've got a difficult choice now because I think what you've got to compare, like we said before, is the risk of obesity against the risk of these drugs and could look at both sets of risks with really clear eyes. And there isn't an obvious answer. And of course, I should stress I'm not doctor. Your doctor. People should talk to the doctors. I'm a journalist, but based on what I've learned, for example, there's all sorts of people who, even if they are overweight or obese, I would personally, if you ask me, recommend they don't take these drugs. For example, if you have thyroid cancer in the in your family, there's some credible scientists. Although it's disputed or concerned, these drugs may boost the risk of thyroid cancer. I would personally recommend you don't take it in that situation. If you are at risk of getting pregnant or planning to get pregnant. I recommend you don't take these drugs. We know that if you give these drugs to rats and they get pregnant, the significantly more likely to have babies with birth deformities. And there's lots of people I would recommend to take these drugs, but I recommend you go through that list of the risks and benefits for yourself. With as little shame and as much pride in yourself as you can.
Juna Thank you. Johann.
Eddie Thank you so much.
Johann Hurray!
Juna And, Johann, one more thing is that your name is pronounced Johann, even though spelled with a J. And my name is pronounced Yuna. Even though it's also spelled of the J. So twin I once waited.
Johann I once waited for six hours in an emergency room with a broken arm because they were calling for Joanna Harry to come forward. So.
Juna Thank you so much to Johann Hari for joining us on today's episode. You can find his book wherever you get your books or at Magic Pill Book Adcom. We will also link to it in our show notes. If you want to hear the rest of our episode with Johann, where we talked all about how Japan was able to transform your society into a society with virtually no obesity, and how all the children love broccoli. It's crazy. In this crazy episode, you can go to food we need to talk.com/membership or click the link in our show notes. You can find us on Instagram at Food Lead to Talk. You can find me on Instagram at the official Yuna and Yuna data on YouTube and TikTok. You can find Eddie.
Eddie Not taking the job he agonists.
Juna Damn it! Eddie! What? I'm just getting food. We Need to Talk is produced by me and is distributed by PR.
Eddie Our mix engineer is Rebecca Sydell.
Juna We were created by Kerry Goldberg, George Hicks, Eddie Phillips and me.
Eddie For any personal health questions, please consult your health provider to find out more. Go to food. We need to talk ecom. Thanks for listening. Johanna. Harry. Johanna. Harry.
Juna That's so funny. If you want to hear the rest of this conversation with Johann Hari, head to food. We need to talk.com/membership or click the link in our show notes. We appreciate all the support so much. You guys help the podcast. Keep going.
