How Ozempic Changes Our Bodies, Minds, and Economy — With Johann Hari

0:00After spending a year plus on Ozempic and interviewing its inventors and critics, our guest today shares how the drug might reshape our relationship to food and our economy. All that and more is coming up right after this.

0:44Welcome to Big Technology Podcast, a show for cool-headed, nuanced conversation of the tech world and beyond. Today, we're diving into health, specifically about Ozempic and the other range of weight loss pills, weight loss medicine, that's starting to make its way into our society and do it fast and change, really change our relationship with food and change our economy effectively. We're going to talk about how that's going to happen and then also the pros and cons of these drugs. We're joined today by Johan Hari. He's a New York Times bestselling author, and his new book, Magic Pill, The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs, is out in any bookstore you could hope for.

1:23And I've read it. It's a terrific book. Johan, welcome to the show. Oh, I'm really excited to be with you. Thanks so much. We're going to talk a little bit about the effects of the economy, but I really want people to understand sort of what this drug does and what it's up against. The way that I think we should do that is talking about the Cheesecake Park or the Cheesecake Rats. It's an example that you have in your book about basically the way that the food industry addicts us to food that's not really good for us. And there's this story about the rats that basically find themselves gorging themselves on cheesecake and can't stop that, you know, my wife and I have now started to take in.

2:01We've started to, when we're eating dessert nonstop, we just look at each other and we're like, oh no, Cheesecake Rats. So what is the Cheesecake Rat in the Cheesecake Park? Well, we're in this incredible position. 47 % of Americans want to take these new weight loss drugs because they produce an incredible amount of weight loss that I'm sure we're going to unpack. And in a way, when you first hear that, it seems like a kind of mind-blowing moment. The first time in human history that almost half of us would want to take a drug in order to stop ourselves from eating, right? So you think, well, how did we get here?

2:34What happened to us? and actually understanding how we got here is very important to understanding the later question of how these drugs work and I guess the way I would get into explaining the experiment you're alluding to is I would say to everyone just stop for a moment pause this podcast and google something for me google photographs of beaches in the United States in the year I was born 1979 and just look at them for a minute and then come back. So you will have noticed about those beaches something that seems really strange to us. Everyone in those pictures pretty much looks to us like what we would call skinny, right?

3:13Or jacked. And you look at it and go, well, where was everyone else on the beach that day in 1979? But it turns out that's just what Americans look like in 1979, right? Obesity was extremely low in the year I was born and it has exploded in my lifetime. Between the year I was born and the year I turned 21, obesity doubled in the United States. And then in the next 20 years, severe obesity doubled again. So we're in this bizarre situation. You have human beings exist for about 300 ,000 years and obesity is very rare. And then from looking at you, I'm guessing you're pretty similar age to me. In our lifetimes, obesity exploded.

3:53Why? What happened? We know the answer, the most important part of the answer. Obesity explodes everywhere that makes one change. It's not where people suddenly lack willpower or become lazy. is where people move from mostly eating a diet based on whole fresh foods that they prepare on the day they eat them to mostly eating a diet of processed and ultra processed foods which are constructed out of chemicals in factories in a process that isn't even known as cooking it's called manufacturing food and it turns out this new kind of food that's built out of chemicals affects us in a completely different way to the whole fresh foods that human beings ate their 300 ,000 years before that.

4:37And one of the ways it affects us, one of the most important ways, is processed and ultra-processed food undermines our ability to ever feel full, our ability to ever feel we've had enough and then want to stop eating. And I go through loads of evidence for this in my book and the many different ways in which processed food has this effect on us. But you allude to an experiment that to me just totally nailed the effect. I nicknamed it Cheesecake Park. That's not the official title. This is an experiment that was done by a brilliant scientist named Dr. Paul Kenny, who's the head of neuroscience at Mount Sinai in New York.

5:12And Dr. Kenny grew up in Dublin in Ireland, and he moved to the United States in the 90s to San Diego to continue his scientific research, to do his PhD, in fact. And he quickly noticed, huh, Americans don't eat like Irish people did at the time, right? They ate, Americans at the time ate much more, but now obviously, ate much more processed and ultra processed foods. And like many good immigrants, Dr. Kenny assimilated and quite quickly became, you know, gained a huge amount of weight. He then gained 30 pounds in a year or two. And he started to feel like this food he was eating wasn't just affecting his gut.

5:47It was affecting his brain. It was affecting how he felt and what he wanted. So he designed this experiment to test it. He raised a load of rats in a cage. and all they had to eat was the kind of natural whole foods that rats evolved to eat over thousands of years. And when that's all they had, the rats would eat when they were hungry and then they would stop when they were full. They had some kind of natural nutritional wisdom that said, hey guys, you've had enough now. They never became overweight. They never became obese. Then Professor Kenny introduced them to the American diet, the stuff I've been eating all my life too he fried up some bacon he bought some snickers bars crucially he bought a load of cheesecake and he put it down alongside the healthy food and the rats went apeshit for the american diet i don't know if rats can go apeshit if that's a mixed yeah no you can the rats went crazy for the american diet they would dive into the cheesecake and eat their way out and emerge just completely slicked with cheesecake they ate and ate and ate and ate the way dr kenny put it to me was within a couple of days they were different animals.

6:54That kind of natural nutritional wisdom that they'd had when they had the kind of food they evolved for vanished and they all became severely obese. Then Professor Kenny tweaked the experiment again. He took away all the American food in a way that feels to me pretty cruel as a former KFC addict and he left them with nothing but the healthy food they'd evolved to eat that they'd had when they were growing up. And he was pretty sure he knew what would happen. He thought they would eat more of the healthy food than they had before. And this would prove that exposure to junk food expands the number of calories you eat in a day.

7:29That is not what happened. Something much weirder happened. Once they'd had the American diet and it was taken away, they refused to eat the healthy food at all. It was like they no longer recognised it as food. They would rather starve than eat that food. It was only when they were literally wasting away that they finally went back to eat it. Now, I would argue we are all living in a version of Cheesecake Park now. We are living in an environment from when we're very young, where we're fed foods that physically change us and undermine our ability to ever feel full and know when to stop eating.

8:04And it's not the only thing going on, but it's the key reason why we have this huge obesity crisis and why there is such enormous demand for these new weight loss drugs. Yes. I feel like whenever I'm just like about to finish a pack of cookies in one sitting, I'm just like, oh yeah, here I am. Cheesecake rat. And I'm curious how they've been able to engineer the food to, I mean, obviously we're going to talk about Ozempic as an answer to this, but before we get into that, how have they been able to engineer the food to make us never feel full, is it intentional or is it just a byproduct of the type of food that exists when it's manufactured, as you mentioned, versus whole foods?

8:46I think the honest answer to your question is a bit complicated. What's definitely not happening is they're not like James Bond villains going, how can we make everyone as obese as possible? That's not happening, right? That would be a stupid way of thinking about it. It's in some ways much more simple. If you're the head of a KFC, Kraft, any of the food companies, you have a fiduciary responsibility to your shareholders to maximize profit. So how do you maximize profit as a food company? You sell as much food as possible, right? So they are constantly figuring out ways to maximize the amount we eat, right?

9:22So if there's two foodstuffs, one that makes us feel full and we stop eating after having half of it and one that makes us want to eat five packs of it, they're going to go for the one that has five packs of it. And I don't blame those individual companies. I mean, they do things that are unethical, like employ lobbyists to rig the rules or advertise to children. There are certainly lots of things I would condemn about them. But actually, it's the job of the rest of the society to regulate those companies, right? Those companies are doing what those companies are meant to do. The democracy needs to do what it's meant to do and regulate them to prevent them from harming our children and screwing up our bodies and harming our health.

9:56There's lots of ways in which processed food undermines our sense of fullness, some of which are not by design. So, for example, processed food has a very low amount of protein in it. On average, of course, there's some processed foods that have high protein, but on average as a class, processed foods have quite low levels of protein. There's a brilliant scientist at the University of Sydney called Professor David Raubenheimer, who's done a lot of research on this. He's shown, we all know we have hunger for calories, obviously, we all know that. But your body also has a hunger specifically for protein, because your body knows you need protein to do things like build your bones.

10:33So if you think about, if you have a diet that's dominated by processed foods, as mine has been almost all my life, your body needs a certain amount of protein. If you're eating processed foods which are low in protein, you have to eat a lot more of those processed foods to get the amount of protein your body needs. He's done lots of experiments that show this. If you give people low protein food, they will eat a lot more of it to meet their body's underlying hunger for protein itself. There's loads of factors like that going on here with processed and ultra processed food. I go through them in the book, which explain why it leads us to so massively overeat and why it so profoundly undermines our sense of satiety, our sense of being sated, of having had enough and not wanting more.

11:17Right. And it's interesting how you talk about this is what the companies are meant to do, and it's the job of societies to regulate them. And that's why I think this is almost as much of an economic story as a health story, because you do have these food companies processing food, manufacturing food in a way that make people not feel full and eat as much as possible. So it's one big industry. And then you have the pharmaceutical industry on the other side with their answer and something that can effectively deliver to their shareholders. and that is Ozempic. And not just Ozempic, but a full family of new drugs that is going to help people feel a little bit more full.

11:53So you're on it for a year and five months to date. Can I say one thing about that? Because you're not doing this, but I just want to be clear. Sometimes that link that you're presenting is presented as an intentional link, right? You've got the food companies making us fat and then the pharmaceutical companies stepping into profit as if they're kind of acting in concert or in collaboration. I want to be clear, that is not the case, right? That's not how competing forces work in a capitalist economy. It's just a misunderstanding of what's going on, right? But you're absolutely right. As Professor Michael Lowe put it to me, who's a brilliant expert on hunger at Drexel University in Philly, been researching this for 40 years, he said, these new weight loss drugs are an artificial solution to an artificial problem, right?

12:39These processed and ultra-processed foods created this extraordinary hole of hunger inside most of us. 67 % of the calories the average American child consumes in a day come from processed and ultra-processed foods. Staggering figure, right? And what these drugs do, and I'm sure we're going to get into how, is they artificially boost your sense of satiety, your sense of fullness. To a degree that is bizarre to me, Like, I realize now I had never felt full until I took Ozempic. Not really. I'd felt stuffed, but that was different to feeling full, right? I'd never really felt sated. Perhaps that's an overstatement.

13:20I had rarely felt sated until I took Ozempic in a way that I now feel sated every day, right? So, yeah, this has been a really profound effect. Yeah, and so I'm curious to hear, you know, we hear a lot about the studies, but you like have looked at the scientific literature and also have taken the pill or the, sorry, the drugs. It's an injection, right? It's pills for some people, but yeah, mostly injections at the moment. Right. So talk a little bit about how Ozempic counters this insatiable hunger that we end up being left with from processed foods. And what's your experience like been like in the year and five months that you've used Ozempic?

13:58Well, so if you ate something now, it doesn't matter what it is, after a little while your pancreas will produce a hormone called GLP-1 along with some other hormones. And GLP-1 is basically your body's natural signals going, hey buddy, you had enough, stop eating, right? It's the brakes. But natural GLP-1 only stays around in your system for a couple of minutes and then it's washed away. What these drugs do is they inject you with an artificial copy of GLP-1 that instead of sticking around for a few minutes, sticks around in your system for a whole week, which has this incredible effect. I'll never forget, second day I took a Zen pic, I was lying in bed, just behind where my laptop is now, if I turn my laptop around, you'd see it.

14:40And I woke up, and I thought, huh, I feel something strange, what is it? And I couldn't locate what it was, what I was feeling. And it took me about five minutes to realise I had woken up and I wasn't hungry. That had never happened to me before. And I went to this diner just up the street that I used to go to every morning. I'm slightly embarrassed to say I ordered the thing I used to get every day, which was a huge chicken mayo sandwich with loads of chicken and mayonnaise in it. And normally I would eat that really quickly and I would still want some potato chips. And I had like three, maybe four mouthfuls of this sandwich and I was full.

15:23I just didn't want any more. And that's how it was from then on. I just felt very full, very fast. So what these drugs do is they hugely boost your sense of satiety. And it's really important for people to understand, this isn't a gimmick, this isn't a fad, this isn't some new fad diet drug. This is a profound scientific breakthrough. As one of the scientists who played a key role in developing these drugs said to me, we've cracked the code of what regulates appetite and it's simulating and manipulating gut hormones, right? There are all sorts of gut hormones that are created when you eat. If you inject people with artificial copies of those gut hormones, you massively reduce the amount they eat.

16:07It's why I went from eating 3 ,200 calories a day to about 1 ,800. It's why I lost 42 pounds in the first year. It's a dramatic effect. The average person who takes Ozempic and Wigofi, they're the same thing with different labels, loses 15 % of their body weight in a year. With Munjaro, so Ozempic and Wigofi work on one gut hormone, GLP-1. Munjaro works on two gut hormones. It's GLP-1 and GIP. the average person who takes that loses 21 % of their body weight in a year and for Triple G which will be coming online probably next year which acts on three gut hormones the average person loses 24 % of their body weight which is only slightly below bariatric surgery and there are now more than 200 of these drugs in development because we know there's over 40 gut hormones that affect appetite so this is a staggering breakthrough through, which will have staggering effects on human health, how we move, how we look, on the economy.

17:10You mentioned this at the start, but Barclays Bank commissioned a very sober-minded financial analyst, Emily Field, to go away and look at these drugs to guide their future investment decisions. Do they have any implications for our future investments? And she came back and said, if you want a comparison for what these drugs are going to do, you've got to look at the invention of the smartphone. And I think she's absolutely... It's the iPhone in some ways, but sorry, go ahead. Explain how. In some ways, I think it's bigger. I mean, this is the biggest cause of death in the United States. Professor Gerald Mann at Harvard calculates that obesity and food-caused illnesses cause 680 ,000 deaths every year in the United States.

17:50We don't usually think of it that way, right? Maybe your aunt died of cancer. You don't think she was killed by obesity, but obesity massively increases the risk of cancer. Maybe your uncle died of a heart attack. You think, oh, he had a heart attack, but you don't realize obesity, or we know it, but we don't quite put it together as often. Obesity massively increases the risk of heart disease. But obesity increases over 200 known diseases and complications, either causes or increases. Basically everything we fear from stroke to dementia. this is an opportunity to radically reverse that thing that is the biggest killer in our society by far I mean almost 10 times more people are being killed by obesity than by gun violence for example and rightly we talk about gun violence a lot you know compare that to how little we talk about obesity gun violence is such a good comparison because there's a lot of gun violence in the U.S.

18:45worldwide but I guess no one does it like we do here unfortunately only the Brazilians are matching you. Yeah. Yes. So, but there's a very strong lobby that says, yeah, you know, a lot of people get killed, but this is important for our businesses and in the U S at least, and I think worldwide business really holds sway. And I was speaking with someone, I was an entrepreneur in the pharma industry right before we got on. And there's what this person said, told me 60 % of the US GDP is consumption. So what happens when, and by the way, these are the stats you gave me. You have 40 % of people in the US that are obese.

19:27Two thirds of people are overweight. What happens when these people start consuming less than half in the food alone, right? Food, because it might extend beyond food. What happens when these people are consuming less than half of the food that they were eating before. And even Walmart, this person told me, has in their board meeting discussed the effects and their concerns. So you have concern with food, concern with retail. I guess like, are we being set up for, and you know, I kind of said we have, you know, food versus pharma, but really, you know, are we being set up for like a pretty big fight that between, let's say, you know, this effectively an economy that relies on consumption and the pills that might stop consumption?

20:11Are we being set up for an NRA-style battle here where you're going to have folks for the food rights or whatever it is against people for a safer future? Yeah, well, the Washington Post has reported that the big food industry is already funding body positivity, pushbacks against some of this. I mean, covertly, just like the cigarette companies covertly funded denial about lung cancer and just like the oil companies, covertly for many decades funded global warming denial. Yeah, I think we are. And there's going to be a huge tension there. And just the economic consequences are just, already we're seeing so many of these kind of unpredictable effects.

20:57I mean, think about, you mentioned the food companies, the head of Nestle, Mark Schneider, has been making very nervous noises about their confectionery Dunkin' Donuts. you know um sorry krispy kreme donuts rather um forbes magazine uh interviewed a load of experts who said that their stock was being downgraded and then their stock still i mean yeah because those empty goes right after their target market exactly exactly i mean literally i was their target market at least two of my chins are due to dunk your doughnuts and now i don't eat it anymore right yeah the loss of my customer loan must have caused some of that plunging stock value um yeah and just think about the unpredictable cascading effects um jeffrey's financial just did a big report about a year ago to the American Airlines saying you're going to have to spend a lot less money on jet fuel pretty soon because it takes so much less jet fuel to fly a radically thinner population.

21:45And bear in mind, this is the case now when these drugs are extraordinarily expensive in the United States. But eight years from now, Ozempic goes out of patent. At that point, it will be a daily pill. It will be a dollar a day. If the 12 big risks that I warn about in relation to these drugs don't bear out or are not super bad, then my prediction is that more than half of the population will be taking them when it's a daily pill that's a dollar a day. The effects on the economy and the society at that point are enormous. You know, my book is called Magic Pill because there's three ways these drugs could be magic, right?

22:19The first is the most obvious. It could just solve the problem, right? And there are days when it feels like that. I've got to be honest with you. My whole life I've overeaten. Now, once a week, I inject myself in the leg, I don't overeat anymore. It feels like magic. The second way it could be magic is more disturbing. It could be like a magic trick. It could be like a conjurer who shows you a card trick while picking your pocket. It could be that over time, the 12 big risks associated with these drugs that I describe in the book outweigh the benefits. I do not rule that out. That is perfectly conceivable.

22:50But the third way it could be magic is to me actually the most likely. If you think Think about the classic stories of magic that we grew up with as kids, like Aladdin, say. How do they go? You find the lamp, you rub it, the genie appears, your wish is granted and your wish comes true, but never quite in the way you expected. There's all sorts of unpredictable effects. And I think we're going to see that. Some of them will be enormous. Some of the anticipated and indeed proven positive effects are enormous. Think about the effects on heart disease. reduces your risk of heart attack or stroke by 20%, right?

23:25That could well save my life. I'm older than my grandfather ever got to be. He died when he was 44 of a heart attack. Loads of the men in my family have heart problems. My dad had terrible heart problems. My uncle died of a heart attack. For people like us, it could be transformative. At the other end of the spectrum, for people with eating disorders, I really fear it will be lethal. I can go into more detail on that if you want, but I think we could have an opioid-like death toll of young girls who use these drugs to starve themselves. It's one of the reasons we need to tighten the regulation around these drugs urgently.

23:54So, you know, we came up with the smartphone comparison, or rather the Buckley's analyst did. If we'd been talking in 2007, I think it was April 2007, when Steve Jobs first unveiled the iPhone, we would not have been able to predict TikTok and Me Too and, you know, DoorDash and all these things that have transformed our lives, right? But here we are. They've changed our societies profoundly. And I think these drugs are going to, it's not hyperbole to talk about these drugs in the same breath. Yeah. And I think it bears repeating. I mean, 60 % of an economy consumption. And if there's a president that allows GDP to be flat, they get thrown out of office.

24:37This country, the world doesn't tolerate negative growth. But we're looking negative growth in the face. And I try to not be like, I mean, I'm definitely trying not to be conspiratorial. But like, how is society like there? It just seems like there are powerful forces that are going to really come in opposition to this stuff. And you can't say right now. You've got the food industry and you've got pharma. So yeah, there'll definitely be friction between those two forces going forward. Let me talk a little bit about how we might happen, how it might happen in the short term. I mean, you mentioned that 2030 is when the patent comes off of Ozempic.

25:11But actually in China, that patent's off now. And there are compounding pharmacies that are effectively putting Ozempic together on their own, sort of off-label. Maybe they add B12 in to say, okay, it's actually something different. And that's where lots of people are getting this drug from. And the only reason that they're able to get it from these compounding pharmacies is because Ozempic right now is on some sort of shortage list, which means that they're able to get it from these supply chains. or from these supply chains. And there's a chance within the next couple of years that it's going to be removed from those shortage lists.

25:47And I'm sure the food industry and all the, you know, anyone who's concerned about GDP would want it removed, even though like it's not going to be good for global health. So what do you think is going to happen on that front? And how impactful do you think it might be if you have, let's say, millions of people taking effectively the same drug as Ozempic And then all of a sudden it goes from an affordable drug to what it is now, if you want to get it like name brand, which is$1 ,300 a week. It's$1 ,300 a month. But yeah, the... $1 ,300 a month, yeah. Just to, I would just pull back for a moment.

26:25I think it's a really important question. I would just pull back for a moment and say, I guess, a few things. The first is a question of drug prices. As you can tell from my weird Downton Abbey accent, I'm in fact British and I spend a lot of my time in the US, a lot of my time in Britain. And I've got to tell you, it constantly stuns me the degree to which Americans are ripped off when it comes to drug prices. So I buy my Zen pick here in Britain. It's the equivalent of$250 a month. When I've had to get it in Vegas a few times, it's like$1 ,000 a month, right? It doesn't magically transform as it crosses the Atlantic.