Johann Hari

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1:23with Nihal Arthanaike. Hello and welcome once again to the Headliners podcast. That's with me, Nihal Arthanaike. Today I'm joined by the journalist and author Johan Hari. His new book is a comprehensive exploration of probably the most talked about drug of the moment. The talk at all dinner parties. Which is ironic, given what the pill is for. I'm talking about weight loss drugs, known to you and I as Ozempic and Wagovi. Other brands, of course, are available. Hari's new book is called The Magic Pill and discusses the benefits and the risks of this new phenomenon. It is a balanced, nuanced, evocative and at some times provocative look at this industry, which is set to be worth billions and billions of pounds.

2:15We spoke about his research, his interviews with scientists and patients. we also examined the broader cultural and ethical considerations as well as learning about his own personal journey with this particular drug. So what we need to do now is think very carefully about how we proceed and what I hope the book is is a chance to sort of pause at this moment to really think this through because, you know, it changes how you feel about yourself it brings up all sorts of psychological issues it changes, have massive implications for the healthcare system for the food industry i mean just across the board this is one of the biggest changes that will happen in our lifetimes and it can be a great gift to us and a great moment of liberation it has been for me so much of this will be really thought-provoking as i can imagine if it's not you there'll be someone in your life that will be taking one of these drugs either now or in the years to come.

3:21How difficult was it for you to write a book whereby you were conflicted throughout it? I mean, Stolen Focus was so useful and so eye-opening to me. But this book magic pill comes with so much conflict as you vacillate between ah is it should i how should i feel about this it's a really good question i was trying to figure this out for myself because we're at this staggering moment right i've noticed in the british press we're still getting people talking about the new weight loss drugs as a fad or a craze and the first thing people need to understand is this is not a fad this is not a craze there has been a staggering scientific breakthrough as one of the scientists who worked on the drug said to me we have cracked the code of what controls human appetite right so we now know how to massively dial down people's hunger and lead to extraordinary amounts of weight loss and that is going to have massive implications for everyone listening to this whether you're overweight or not you know barclays bank commissioned this very sober-minded analyst Emily Field to look at these drugs the science around them to figure out what it's going to mean for their future investments she came back and said if you want a comparison for what this means you're going to have to look at the invention of the smartphone right for the implications this will have for the society my prediction is it seven years from now this will be a daily pill it'll be around a pound a day and half the people in Britain will be taking it that is going to have such an explosive effect on people like me who've been overweight or obese a lot of our lives, but actually on everyone, right?

5:09And I felt very conflicted because this is such a fraught subject. We come at being overweight or obese with such feelings of failure, shame, anger. I definitely felt that. The reason we need to go on this journey, right? You know, I ended up traveling all over the world from Iceland to Minneapolis to Japan to interview the leading experts on these drugs, the biggest defenders of the drugs, are the biggest critics of the drugs, is because this is an incredible moment for all of us, right? It's going to have incredibly positive effects. It's going to have some incredibly negative effects and everything in between.

5:45And I really think at the moment of the beginning of this scientific revolution, what I hope my book Magic Pill is, is a moment when people can pause and go, okay, what does it feel like to take these drugs? Obviously, I took Ozempic. I'm still taking it nearly two and a half years on. What does it feel like to take these drugs physically? What does it feel like to take them psychologically? What is it going to mean for all of us? What are the benefits? What are the risks? Because we're just at the beginning of this now. And so, yeah, that conflict was so intense for me because this is such a charged and difficult topic for all of us.

6:21So my wife told me I should take a Zempic. And I said to her, no, I'm going to change my lifestyle. Right. So I am definitely under the cloud of pre-diabetes. I have been before and I've reversed it. And I've cut out white bread, white pasta, white rice. I've seen my weight drop off. And I was very much of the attitude that I have to change something in myself. But I was never obese. I'm overweight. But I wasn't obese. Just talk me through the conversation you had with yourself before you decided to take this drug. You know, I plunged in very quickly. the first time I heard about these drugs I immediately felt this conflict which was on the first hand I thought if we really have got drugs that can now reduce or reverse obesity that could literally save my life 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 get heart problems including my dad um so I thought wow this could be incredible but I also thought this sounds too good to be true can it really be right uh isn't it better to do it through diet and exercise which of course like every fat person in britain i tried many times um so i had this this very intense dialogue and actually the first step i took was i thought right i'm just going to take them and see see what it's like right so actually i jumped i didn't have a huge i had conflict before i took them but i didn't have a huge internal dialogue i was like okay let's just do this and i will never forget so I took a Zen pick I never forget two days after I started taking it I woke up and I was lying in bed and I had I woke up and had this unfamiliar feeling and I couldn't figure out what it was and I suddenly realized I had woken up and I wasn't hungry like most mornings what would get me out of bed was being hungry and I went to there's this cafe just up the road from where I live and I went in and I ordered what I used to order every morning which I'm embarrassed to say was a giant chicken bat with loads of mayo in it and normally I would wolf that down and I would still want some crisps and that morning I had like three mouthfuls and I was just full I didn't I didn't want anymore and I remember the Tatiana the woman who runs the cafe shouting after me as I left are you okay because like I never left food right um and that was how it was from then on, what the drugs do is they massively dial down your hunger.

9:08So you're not taking a Zen pic, right? 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. And GLP-1 is part of your body's natural systems, just going, hey, Nahal, you've had enough, stop eating. But natural GLP-1 only stays 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 staying in your system for a couple of hours, stays in your system for a whole week. So what it means is when you start to eat like I did in that cafe, it's like trying to drive the car with the brakes on already, right?

9:47You're just not very hungry. So it's not like the experience of diet. Dieting is when you're hungry, but you find a way to not eat, right? You distract yourself, you just power through it, use your willpower, whatever it is, right? We've all been there. This is not, it's why I think it's slightly misleading that they're often called diet drugs it's bizarre because you don't experience the feeling of being hungry and denying yourself you just are dramatically less hungry which is why you know the average person taking a zempic loses around 15 percent of their body weight in the first year with munjaro which is the next in this class of drug they lose on average 18 percent and with the new ones that are becoming available people lose 24 percent of their body weight on average which is only just below bariatric surgery so for me it was more about just jumping into the experience and then going on the big journey to figure out, wait a minute, what's really going on here?

10:35What does this mean for us, right? What does it mean for our body's need for fuel? This is really important. So obviously you need nutrition. And a lot of people are taking very high doses of these drugs. I go through in the book, in addition to the enormous benefits of these drugs that I'm sure we'll unpack, there are 12 quite significant risks. And one of them is malnutrition. A lot of people, I've got a relative who's taking these drugs like me, and she was just going like days without eating. And her kids were having to sort of remind her to eat. And she was definitely on too high a dose if that's happening.

11:14And it's very easy to go on too high a dose and just actually effectively amputate your appetite. So weirdly for me, my nutrition is better now and I enjoy food more now. one of the things I realized when I started taking these drugs is how little of my eating was actually about enjoying food right some people overeat because they just love food they're foodies it's a pleasure to them for me I was kind of stuffing myself to calm myself down to soothe myself all sorts of things and actually what you when you're taking these drugs you have to eat much more slowly uh you can't stuff yourself you would be sick and eating much more slowly really gave me a lot more pleasure in food actually but a lot of people are experiencing a lot of pleasure in food or malnutrition so those are if that's the case you're you're taking too high a dose let's talk about the microcosm of your mother's and your father's attitude to food and then how that becomes a kind of macro way in which society views food so just start with your father's upbringing and attitude to food yeah this is one of the weird things that happens when you take these drugs you start to see the reasons why you ate in the first place right why you overate my dad's from a little village in switzerland uh which was literally at the time he was growing up the healthiest place in the whole world you know he he grew up his entire childhood he ate literally nothing but fresh whole food that was prepared on the day and there was no obesity in that village none he didn't ever see an obese person until he came to britain when he was in his 20s so he grew up with his attitude and he met my mom who was from a working class scottish background uh which i think it's fair to say love to everyone in scotland not the healthiest food culture in the whole world my mom definitely did know obese people when she was growing up and my mum and my grandmother who raised me um you know my my my nan's idea of a good meal was like a pile of chips right the happiest day of my grandmother's life was the day we got a microwave and discovered mccain's microchips i don't know if anyone remembers these which are like just microwaveable chips chips but you don't have to make them i remember such joy uh and so my parents were conflicted and clashed over many things one of the things they really conflicted about was the the way me and my brother and sister ate.

13:43So I was growing up in Edgware in North London. And this was a period of the explosion of processed food and the massive rise in obesity. I think we're the same age in a whole, roughly. When we were born, 6 % of British people were obese. It's now 27%. Never happened in human history, explosions of obesity like this. and my dad was just enraged by the way I ate he was horrified and enraged he goes this is not food so I had this sort of um weird dynamic where you know I grew up with uh I grew up with the kind of crappy food that everyone was increasingly eating uh and it was having the effect it has on lots of people which is it undermines your ability to feel full and know when to stop and leads you to be overweight or obese.

14:37And at the same time, I had my dad trying to deny that to me, which was a kind of wise insight that he didn't act on wisely. And had my grandmother smuggling me unhealthy food. So I was experiencing that as love. So these sort of psychological dynamics kind of come to the fore when you start to take these drugs. You sort of start to think about what was really going on with my eating all along, right? You go into terrifying detail, and it's not dissimilar, of course, to Henry Dimbleby's book, Ravenous, in what ultra-processed food is, and actually how, really even calling it food. I mean, that word is doing a lot of heavy lifting there, isn't it?

15:23In both senses. Yes, it is. I mean, it is quite extraordinary. Do you think it's an overstretch to say that in 10 years' time, we'll think about this food in much the same way as we think about cigarette smoking now? Yeah, I think that's exactly right. You know, one of the questions I was asking myself when I started taking a Zen pick and was seeing how many people want to take these drugs, you know, half of all Americans now want to take them and we'll be there pretty soon. Partly because every person who takes them then becomes a walking advert for them. It's like, wow, what happened to Bob, right?

16:03I start to ask myself, how did we get, this seems so crazy. How did we get to the point where half of us want to drug ourselves to eat less? Like what happened to us? And an amazing scientist I interviewed in Philadelphia, Michael Lowe, Professor Michael Lowe, said to me, these drugs are an artificial solution to an artificial problem. right? The food we eat has profoundly undermined our ability to ever feel full. And what these drugs do is they give you back your sense of fullness. I realized I had never really felt full until I took these drugs. I had felt so stuffed I couldn't eat anymore, but that is not the same as feeling full and sated and satisfied.

16:43And if you understand why, so I go through in the magic pill, the seven reasons why the food we eat is leading us to overeat this process and ultra processed food which means just food that's built in factories out of chemicals in a process that isn't even called cooking right it's called manufacturing food and everyone listening your grandparents or if you're slightly if you're our age or your great-grandparents if you're a bit younger never had one mouthful of processed or ultra processed food because it did not exist this is a totally new thing and if you want to understand what that's doing to us i go through a lot of the science but there's an experiment that to me just completely nails it, done by a scientist I interviewed called Professor Paul Kenney, who's at Mount Sinai in New York.

17:24It's a very simple experiment. He 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 that rats evolved to eat over thousands of years. When that's all they had to eat, the rats would eat when they were hungry and would stop when they were full. They had some kind of natural wisdom that said to them, hey, you've had enough. They never became overweight or obese. Then Professor Kenny introduced them to the American diet. He fried up a load of bacon. He bought a load of Snickers bars. He bought a load of cheesecake and he put it in the cage next to the healthy food.

17:57And the rats went crazy for the American diet. They would literally dive into the cheesecake and eat their way out and just emerge completely smothered in cheesecake. And they ate and ate and ate and ate. that natural wisdom they'd had when they had the kind of food they evolved for completely disappeared within a couple of weeks they were all obese and began to become quite sick then professor kenny tweets the experiment and it feels a bit cruel to me as a former kfc addict he took away all the american food and left them with nothing but the healthy food that they had before and he wasn't 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 this kind of food increases the calories you eat that is not what happened now what happened is much weirder 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 recognized it as food and they would literally wait until they were starving until they reluctantly went back and ate it now i would argue we are all living in a version of that experiment right we are eating these foods that bear no relationship to what we evolved to eat that hack our evolution and lead us to massively overeat.

19:13If you want to know how big a change that is, I'll just say to everyone listening, Google a photograph of a beach in Britain in the year you were born. I was born in 1979. Just look at it online. Choose any beach in Britain. Look at the pictures of it. You look at it and go, this is really weird. They don't look like us. Everyone appears to be what we would call skinny or pretty ripped actually. This is weird. Was it a skinny person convention in Eastbourne in 1979? No, that is what British people look like. That is what British people had always looked like, right? It's literally in our lifetimes that this new kind of food explodes.

19:49It's why obesity in the entire world has more than tripled. This happens everywhere where people move from eating fresh whole foods that are prepared on the day to mostly eating processed and ultra processed foods so the way i began to think of it is we have been raised in a trap right these drugs are a trap door now they're a trap door with flaws to be sure and great benefits as well but when you approach this with such shame as almost everyone who's overweight and obese does remember it's not your the difference between that beach in 1979 and a beach in britain today is not that we all suddenly lacked willpower, or we became weak, or we became...

20:27That's not what's happened here, right? There wasn't a sudden collapse in willpower in our lifetimes. There was a transformation in the food supply system in our lifetimes. And that is what's caused this explosion of obesity in this public health crisis. And that is what happens everywhere in the world where they make that shift, right? Is there any provable link between the companies that manufacture this food and the companies that provide a solution in terms of the type of drugs we're talking about today. And I know that people have put this forward. I don't believe that's the case. It's not how capitalism works.

21:06You've got one factory that pumps pollution into the river and a company further down the line that makes money cleaning up the river. They don't need to cooperate. I think it's too conspiratorial. That's not how capitalism works. If you're the head of KFC, it's not your problem if people become obese, right? Not your issue. It's not that they're cooperating, if anything, they're competitors, right? If I was the head of KFC, I'd be really worried right now. Indeed, we know the people who make fast food are really worried. It's going to be really bad for those food companies if there's a move to these drugs as is happening.

21:41How are they then future-proofing themselves if the future is we don't need these foods anymore? Yeah, I mean, I don't care. Screw them. They screwed us up. You know, more three-year-old children know what the McDonald's M means than know their own last name, right? Before we even know who we are, they have pumped us with propaganda saying, you don't feel good, we've got the answer. If I think about my nephews and my godsons, they were screaming for Happy Meals when they were very, very small. So, yeah, they screwed us over. It's like asking me, how worried are you for the future of the tobacco companies?

22:17They'll be fine, right? But they're not my worry at this moment. No, you're not wasting one iota of sleep on those companies. Let's talk about Japan, because this is one country where the need for these drugs is probably less than any other country on planet Earth. Why? so japan is fascinating it's the only country that got rich without getting fat japan has four percent obesity which is only slightly higher than it had before the invention of processed food it's incredible it's the same level of obesity as somalia so i went to japan i took one of my godsons who's really struggled with his weight because we wanted to see well what's what's going on here right it was really fascinating so japan has taken all sorts of concrete steps to prevent their population becoming obese.

23:12So we went to this school in Tokyo, went to quite a few schools, but I'm thinking one in particular. It's a middle-class school. It's got about a thousand kids in it. And I've got to tell you, Nahal, it's really weird, right? I was shown around this school by a woman called Harumi Tatibe, who's the school's nutritionist, because every school in Japan has to employ a professional nutritionist. Being shown around by her and looking at these kids and suddenly realising there was not a single fat child at that school, right? I'm looking at them thinking, where are they, right? You think, well, how suddenly?

23:47Initially you think, oh, that must be that Japanese people won the genetic lottery, right? They must just naturally be thin. But that's not true. We know that because in the 19th century, loads of Japanese people moved to Hawaii and their descendants still live there. And their descendants are almost as fat as everyone else in Hawaii. And genes don't evolve that quickly. So it's not genetic, right? something else is going on so every school in japan by law employs a nutritionist that nutritionist designs the school meals which are all produced on the days nothing is processed not even the paste everything is made from fresh whole ingredients on the day the kids help in the food preparation the kids eat it and the nutritionists use that food to educate them about to like and love healthy food so i'm speaking to these japanese kids i'll never forget this i was with my my translator and so i'm talking to these nine-year-olds as they're eating this delicious food i mean it was more like nobu than anything we ever had at school right and um i said to one of the kids they're about nine they're about nine this class i'm speaking to so what's your favorite food and the first girl said oh i love broccoli and i was like okay who's this little freak got to the next one right so to another kid what's your favorite it's like i love white fish and the next kid said um Oh, I love white rice.

25:00And I turned to my translator, Chie, and I said, are these kids trolling me? They love like broccoli and white rice. And like all Japanese people who I discussed this with, Chie was completely baffled. She said, well, what do you mean? We teach them to love healthy food. This food is delicious. And I couldn't help myself. I pulled up on my phone videos of Jamie's school dinners on YouTube. So I showed them British school dinners from when we were kids, or indeed now. and these kids screamed, right? They were just completely baffled and taken aback. And one of the little girls was just so worried for me.

25:35She was like, this is, they were just genuinely concerned for like British children. It was so touching. So there's lots of things Japan has done but they put all sorts of barriers between themselves and their kids. And what you win from that is Japanese people live longer than anyone else on earth and they are healthier longer than anyone else on earth. I went to in Okinawa I went to the oldest village in the world it's a village where more than 100 people are more than 100 years old and I went to the little community center and I'll never forget I met this woman I was chatting to the old people there who were incredibly physically fit and on the ball and I'll never forget I met this woman who's 102 years old she walked there on her own she told me she told me I can't stay for long because I'm looking after my son who just fell off the roof.

26:21I was like, Jesus, how old is your son? But anyway, and she's like, I've chatted to her. And, you know, she had a great life. He's 102. And they turn on this Okinawa music and all the old people started dancing. And I was dancing with these people who are more than 100 years old. And I thought, wow, this woman was born before they started doing radio broadcasts in Japan. And here I am dancing with her and recording my interview on an iPhone. That is what you win if you solve the obesity crisis. Okay, not everyone needs to be 100, obviously. But you get more years of life, more years of joy, more years of dancing.

26:55You know, obesity is the biggest killer in Britain by a long way. And it renders people hugely disabled as they age. Not everyone, but it makes it much more likely. It happened to my grandmother. It's the biggest, one of the biggest causes of dementia. It's one of the biggest causes of cancer. It's, you know, the degree to which obesity sadly catastrophically harms your health is shocking when you look at the scientific evidence. And we now have a drug that massively reduces or reverses obesity. That's why, you know, for me, this is so close to my heart, well, literally close to my heart. And, you know, if you take these drugs and you started at overweight or obese, within a year, you are 20 % less likely to have a heart attack or stroke.

27:37And that is just one of hundreds of known health benefits for people who are overweight or obese, who take these drugs. So I really saw, obviously, the long-term solution is Japanese, right? Don't allow them to screw up our kids. Don't allow them to screw up our grandchildren. You know, we can do what Japan has done, but in the interim, for people like me, it's too late for me, right? I grew up in this trap. My body and my brain have been changed by lifetime exposure to processed and ultra-processed drugs. For me, I face a harder choice and I hope my book Magic Pill will help other people to decide whether they should make that choice.

28:09And if they do, how it's going to feel psychologically, physically, what the risks are and help them make an informed choice about all of that.

28:31I thought it was also fascinating and it slightly made me nervous as someone brought up in the UK because of how explicit it is as an example of social engineering. But workplace law was changed in Japan. Can you just illustrate that? I want to just preface this by saying I'm not recommending we do this in Britain. Ah, that's interesting. That in itself is interesting because of the way we are so nervous around this idea of social engineering. But it works, right? This works, what the Japanese have done. So what happened is about 20 years ago in Japan, they had a massive panic because obesity went up from like 3 % to 3.5 % or something.

29:21They were like, oh my God, what can we do? And they introduced a series of reforms and one was a law called the Metabo Law, which basically says if you're over the age of 40, this is not a joke. I went to see it happen. If you're over the age of 40, once a year, your boss has to weigh you. They have to report your weight to the government. And overall, and if your weight has gone up, you need to draw up a plan with your boss to bring your weight down. And overall, as a company, if your employee's weight goes up, you get fined by the government. So I was like, when I heard about this i was like how could this possibly be right so i went to this company to see it and it was you i really i never felt such a big culture gap as in that moment because so i would watch this happen and i would say to these japanese people right so if you introduce this law in britain we would literally burn down the office and they again rather like the kids in the in the school they would just go why why it's really helpful it's bad to be overweight like i don't want to be overweight this helps me keep my weight down it was such a bit so they have a much more collectivist culture and much less a culture of individual freedom and individual rights and much more a culture of collective responsibility and group rights it's just a different way of thinking we couldn't do that i mean it would be completely foolish to even moot that in britain because even if you thought it was a good idea and personally i obviously i do believe in individual freedom and that to me is too far an intrusion on individual freedom we should help people to be healthy but i think sort of forcing them to be happy is not wise.

31:04Yeah. But have the Japanese managed to disassociate the idea of being fat or being overweight from an idea of being sinful? No. On the contrary, and this is a difficult thing to point out, and we have to just be honest about it, I mean, Japanese people are extremely fat-shaming. I mean, it's kind of weird that our mental picture of Japanese people, part of it is sumo wrestlers, because I mean, that would literally be like expecting Americans to look like a bald eagle. No, they are brutally fat shaming. So they have very few overweight people, but the overweight people there are, are treated very unkindly.

31:45And again, we wouldn't want that. I mean, and this is complicated because we know shame is not actually a good tool to help people be healthy, right? There's lots of research on this that I write about in the book actually just kind of well firstly if shame worked with fat people there would be no fat people 43 percent of women with a BMI higher than 30 are insulted every day right so you think about that and what that what that means and we know that often if you shame people and make them feel humiliated firstly often they'll overeat in to comfort themselves but also one writer lindy west said you know you don't take good care of a thing you hate right making people hate their bodies doesn't actually make them take better care of it so i think the difficult truth is that stigma probably has a preventative effect in it prevents people from becoming obese which is a difficult thing to say and it doesn't mean i'm in favor of stigma i'm absolutely not but i think once someone has become overweight stigma actually makes the problem worse and makes them feel more humiliated and more ashamed and hate their body more.

32:52So yeah, it's a difficult one when you think about that in relation to Japan. So then what is the correct messaging? Has anyone really worked that out? Because even the word fat by some is seen as problematic. The word obese is seen as problematic. And sometimes that's used to shut down any conversation. you're totally right you've gone to a really what for me was the hardest part of of thinking all this through which is we've made progress in recent years in opposing the bullying of overweight people right and i'm strongly in favor of that you know it's a form of cruelty it's a form of stigma it's mean it doesn't even achieve its supposed goal of helping people lose weight but even if but you don't want people to be bullied, right?

33:48If you look at, I spent a lot of time looking at the fat pride movement or the body positivity movement. I write about an amazing woman called Shelley Bovey who really pioneered that movement in Britain.

34:02I think we've got to be honest. There are, at the core of the fat pride movement, some parts of the fat pride movement, two arguments. The first argument is we need to oppose bullying. and cruelty, firstly, because they're bullying and cruelty, secondly, because they make the problem worse and just stand up to it, resist it. I'm passionately in favour of that. They are absolutely right about that. There are some parts of the fat pride movement, I don't want to overstate it, not all of it, that make a second argument. They argue that, in fact, saying that being overweight or obese causes health problems is itself a form of bullying and stigma and not true.