#783 - Johann Hari - Is Ozempic A Miracle Weight Loss Drug Or A Secret Killer?

24:30I'm going to give it up. I'm weirdly for me and I want to stress I know I'm an outlier. It had the opposite effect, but for a slightly weird reason. So I grew up eating shit, right? And I ate huge amounts of shit. And I grew up in a, we've talked about this before, but I grew up in a family where there's a lot of addiction and mental illness and kind of craziness. And I realize now looking back, I never really ate for like much very little of my motivation and eating, not nothing, but little of my motivation in eating was actually the pleasure of the flavor and the texture. I was eating to kind of stuff myself, to calm myself down, to manage my emotions.

25:08I wasn't not totally consciously, not totally unconsciously either, but you know, and with these drugs, what happened to me, I remember going out for dinner with a friend of mine, and she said to me, after I started taking them and saying to me, it's always been a bit weird eating with you, because you eat so fucking much, so fast, but you don't really seem to enjoy it very much. Now you're eating so much more slowly, you do actually look like you're enjoying your food. So for me, I've actually gone from very low pleasure in food to a little bit of pleasure in food, right? I think that's something that people don't often think about that many people don't eat food to enjoy the process.

25:43They do it to just have that sense of being full in that stomach. So almost like, you know, topping off your esophagus with a little bit more food in the end. And that's kind of the sensation that they're chasing. Totally. And it was fascinating to go through. So in the book I explain, it's actually five reasons why we eat. Only one of them is the one that is the most obvious, which is feeding your body, right? Like staying alive, the need for sustenance. Actually, and I realized how little of my eating was about that. I mean, I used to eat 3 ,200 calories a day. Now I eat about 1 ,800. I would have sworn I ate that food to sustain my body, but here I am, you know, better than I was, right?

26:19still living. Exactly, certainly not dead, right? So what else is going on? And one of the really interesting things is when the fascinating things about these drugs that I was not prepared for is because they interrupt your eating patterns so radically, you can't carry on eating the way you did before. What they can do for some people, not everyone, is they bring to the surface the underlying psychological drivers of why you were eating, right? Now that That can be a good thing, it can come to the surface and you can deal with it. But at first it's quite painful. So I remember very vividly a moment I had an epiphany about this.

26:56It was seven months into taking the drugs and I was in Las Vegas. As you know, I'm writing a book about a series of murders that have been happening in Vegas, they've been researching for a long time and I was researching the murder of someone that I knew and loved. So, you know, it's pretty unpleasant thing to do. So I had a rough day and totally on autopilot, I went to a KFC, I've been to a thousand times. for people in Vegas, it's the KFC on West Sahara, which I maintain is the grimace KFC in the whole world, and believe me, I've been to very many of them. But anyway, and I went in and I ordered, what I would have ordered a year before, just a bucket of fried chicken, right?

27:28And I sat there and I had a chicken drumstick, and suddenly I looked at this chicken and thought, fuck, I can't eat this. I'm just gonna have to feel bad, right? And Colonel Sanders was on the wall there, like he's in all KFCs, and it's like he was looking down at me going, Hey buddy, what happened to my best customer, right? So it definitely surfaces these strange and unexpected emotions. Now that can be very dramatic. We know. So one of the best ways of thinking about what these drugs do for us, both the benefits and the risks, is actually to look at a parallel area of science, I think. These drugs have only been used for obesity for a couple of years.

28:04We've got a fair bit of evidence, but we'll know a lot more as the years pass. But actually, it's a very good comparison point, I think, not perfect, but good, which actually bariatric surgery. So up to now, it's been hard, certainly not impossible, but it's been hard to lose a huge amount of weight very quickly and keep it off sustainably over the long term, right? The best comparison point is bariatric surgery, things like stomachs, stapling, stomachs, gastric sleeves, that kind of thing. So we can look at, well, what happens to people when they have bariatric surgery? Now, some of it is negative.

28:34Think about what we just said about comforting and the other psychological factors. We know that if you have bariatric surgery, your suicide risk almost quadruples in the years that follow. Quite shocking right now, I think that's that maybe some of it is that the surgery is actually pretty rough and you have horrible physical effects afterwards for some people. That'll be a factor for some of them. But I think most of it is, look, by definition, if you needed bariatric surgery, you were severely overweight. So you were very heavily eating. a very large number of those people will have been using food to numb their emotions or comfort themselves or regulate their emotions.

29:10And if that's taken away from you, you can't do that after bariatric surgery. For a lot of people that will at least for a while manifest as just profound psychological distress. But you also see if you look at bariatric surgery, the staggering benefits, right? So it's a really rough operation. One in a thousand people died during the operation, right, it's no joke. But if you survive it, why does anyone do it? It's because the benefits of reversing or reducing obesity for your health are staggering. If you have bariatric surgery, in the seven years that follow, you are 56 % less likely to die of a heart attack.

29:48You are 60 % less likely to die of cancer. You are 92 % less likely to die of diabetes -related causes. And you are, it's so good for your health that you're actually 40 % less likely to die of anything at all. Right, that's how good it is for you. So you begin to see, again, that very difficult cost -benefit analysis, right? You get huge benefits to your health from reversing obesity, but there's psychological costs, and there are also costs with these drugs, physical risks, and dangers that you don't get with bariatric surgery. What about the people who say, this is all bullshit? Can't you just diet and exercise?

30:25Yeah, I mean, I kept thinking that to myself the whole way through. I remember a few months since I was taking them. I was having dinner with my friend Dave. He was eating a massive chicken schnitzel and I would talk into him about benefits and risks, right? I'm like, ah, this benefits the drugs, benefits of risks and Dave said, well, the fuck you talking about, you know, I had this a third option. I've seen you do it. Go on a fucking diet, right? Like exercise. I've seen that when you do that, you lose weight. And, you know, I had done that many times and it had worked, right? So I spent a lot of time looking at the science and dieting and what we actually know about it.

30:59So a few things we know for sure. If you understand the laws of physics, you know this is true. If you burn more calories than you consume, you will lose weight, right? No one to speak or no sensible person to speak to that, right? So you hear that and yet you look at the evidence, most people on diets over time do not lose weight and you're like, what's going on here. So I went to the leading expert on diets in the world from my point of view, brilliant professor called Tracy Mann, who's in Minneapolis, who's done, I think, some of the most important and cutting edge research on effects of diets, particularly on the long term effects of diets.

31:30And when she started to study this in the year 2000, the science was very clear and gave very solid advice. Dietists work. So she looked at this and there were many thousands of studies demonstrating this, but she noticed something a bit weird about these studies. These, they followed people for three months. So you massively cut back your calories, exercise more, you lose a shitload of weight. And at the end of those three months, it just assumes, well now you live happily ever after at this lower weight. And there were, you know, a few thousand studies that also looked to people for six months and they found broadly the same thing.

32:03But Professor Maum was like, well I know quite a lot of people have been on diets in a while down the line there, fatter than they were at the start, what's going on here? So she looked at, well what are we, what do we know? about people who diet felt like longer than that for like two years for example. At the time there were 24 studies on that and when she looked at their results it was completely different. If you diet for two years you are at the end of it two pounds lighter than you were at the start which is not nothing is statistically significant but it's shockingly low right so it's like well what's going on there what's happening.

32:3810 grams per week or something across the space of two years. Exactly. It's not a lot, right? She's like, what's going on here? And to understand this broad diet, when you look at the wider evidence, there is a small subsection of people who diet and at least significant amount of weight and keep it off. I've got someone very close to me and my family like that. Everyone knows someone like that. But the evidence is pretty clear as well. In the longer term, they are statistical outliers, right? They exist. the very real is certainly worth trying to be one of those people, but there are about 10 to 15 % of people who try dieting, and pretty much every fat person has tried dieting, though it's very rare you get when it hasn't.

33:21So what's going on with the others, right? What's happening? And to dig into this, I mean to be loads of experts on it, and this is contested, much debated, but I think the evidence is pretty clear around one set of things.

33:38So People were pretty sure they knew the science of this. They thought that when you were born, you had what was called a biological set point that determined your weight. Basically, your genes say what you're gonna be, and you know, you can go a little bit above it or a little bit below it, but not by much, right? If you think about your body temperature, you get a good analogy, right? Your body really wants you to be whatever it is, 40 degrees centigrade, right? It fixes your temperature at that. If you go above it, so you go to the Sahara Desert, it will make you sweat like a fucker to bring your body temperature down, it will make you crave shade.

34:11If you go below it, like you go to the Arctic, it will make you shiver like a thucker to get your weight back up. Your body works extremely hard to keep you at that biological set point for your temperature. And they thought there was something similar for weight. You can try and go outside it, but your body will fight to bring you back to that set point. But then the obesity crisis happened and the whole thing went out the window because if you had a fixed set point from birth, how could it be that obesity more than doubled in 20 years, right? It makes no sense. But then what scientists began, some scientists like Professor Michael Lo began to argue, it's something a bit different.

34:45You do have a biological set point, but as you gain weight, your biological set point rises. So let's imagine that you gained like three stone now, Chris. Right, please don't. It would be a tragedy for Gays of the world over. But if you did, your brain in this theory would then fight to keep you at that higher weight. And there's lot of evidence for that. We know that if you gain weight and try to lose it, your metabolism slows down, so you burn calories more slowly, you crave more sugary fatty salty foods at your moral lethargic so it's harder to exercise. These things are not impossible, you can overcome them, but it's a whole strain of obstacles.

35:24And the evidence for that is really clear, particularly metabolic slowdown, but I remember scientists kept explaining that to me, and after a while I said to a load of them. This doesn't ring true to me because why would evolution endow us with such a maladaptation? That's obvious. Why would evolution make us want us to be really, really fat when that kills you? And Professor Lowe and lots of other people explained to me, you've got to think about the circumstances where human beings evolved. In the circumstances where human beings evolved, the situation we now live in, where there are just a massive number of abundant excess calories all around you all the time for your whole life never happened, right?

36:06Or would have been extraordinarily rare. It certainly would have lasted over your whole life, right? So evolution didn't prepare us for this scenario because it never happened for the first 300 ,000 years we existed. What evolution prepared us for is a very different situation that existed frequently, which was the risk of famine, right? So you weren't a risk of being surrounded by calories, excess calories the whole time. You were at risk of calories running out at any moment and you being fucked. And you think about a famine. In a famine, the fattest guy at the start will be the last man standing, right?

36:35Timothy Shalamay will die in week one and me at my fattest will cry over his corpse and still be alive a month later, right? So you can see, when you see it from that perspective, the circumstances of our evolution, why, as Dr. Jars -Yo, one of the leading obesity specialists in Britain put it to me, your brain hates it when you lose weight and will fight to drag you back to your highest weight, is preparing you for a famine. But in our case, it's preparing us for a famine that will never come, right? Now, some people argue that in the huge debate about, so I think that's why diets fail for most people, right?

37:08It's interesting to think about, well, what's going on with that minority who do manage to break it? We can talk about that. But for me, that also leads to interesting debate about the drugs because there's a huge debate about, given the drugs work on your brain, we now know that, right? You give the drugs to rodents and then you cut open their brain, what you see is these drugs go everywhere in the brain, right? Every part of the brain. And there's a huge debate about what they're doing in your brain, slightly disconcerting to interview the leading neuroscientist and they kind of go, well, we're not really sure.

37:36Dr. Clemons Bluay at Cambridge University said to me, you know, the brain is the most complex object in the whole universe. It shouldn't surprise you that we don't entirely understand how it works. But one theory, and I stress it, is a theory, and there are other theories just being it, is that what these drugs do is it basically lowers as your biological set point. It's the equivalent to put it very crudely of taking your iPhone back to the factory settings, right? It makes your brain stop fighting to bring you back to that higher weight. Yeah, it's very interesting. I think, you know, it's an easy criticism.

38:09And we've had unlimited number of people on the show talking about the benefits of diet and exercise and digging into the real nuances of exactly how you need to be timing your protein and what's the reps and sets and recovery and periodizing and mess or cycles and stuff. But the research suggests that most people who start diets and try to lose weight through diet and exercise don't. And you know, you can say and many people probably will, these people just need to be less psychologically weak, they need more willpower, they're not working hard enough. They say, but that's a fine rationale narrative to push forward.

38:44but ultimately the evidence doesn't show, I don't know how much you can castigate or shame people into trying to lose weight. I don't know if that's going to work. Yes, is diet and exercise a very reliable root out of this? Yes, would it be best if everybody could do it through that? Yes, but does it seem to be reliable root to it not working over a two year plus time span? Also, yeah. And I kind of get the sense that given that we're in such a novel food environment, and hyper -political process foods, it has become an unfair fight for many people who, perhaps 40 years ago, would have been able to lose weight through diet and exercise, but the environment that they find themselves in now, their particular orification psychology is outgund.

39:31There's a really smart analogy. I mean, actually, what we know is that 40 years ago they wouldn't have become fat in the first place, and if they did, they would have found it easier to get it off. But I think in terms of the willpower argument, I really like how you just frame that Chris. It has a willpower. So there are people who deny that willpower exists or can be used for weight and that just obviously wrong, right? Willpower is a real phenomenon. It exists. Everyone listening will have exercise willpower at some point in their life in relation to food, right? Of course, sometimes you turn down dessert or whatever, even if you're the fattest person in the world, sometimes you say no to something, right?

40:05But the way I began to think about willpower, precisely because it is real and it is important. If the way I think you have to look at wheel power, is the environment in which wheel power operates. I think you just framed it really well. So the kind of fancy way of putting it, the technical term, if you look at what causes obesity and actually lots of other problems like depression, anxiety, a whole load of other things, is what's called the biocicosocial model. It sounds technical, but it's actually very simple. There's three kinds of cause of this problem, like obesity. There's biological causes, right?

40:36your genes can make you more sensitive to these problems. More importantly, there are biological changes that happen as you gain weight, they make it harder to go back like we've been talking about. So there's our biological causes. There are psychological causes that drive eating. We talked about comfort eating, for example. That's just one of them. If you're a man who loses his job, you way more likely to gain weight. And that's partly just feeling like shit, because you've lost your job and haven't got another one, right? And you're a sense of purpose. But there's lots of others. And then there's social causes like the fact that we live in this completely out, as you say, a completely unprecedented food environment.

41:08So you think about the biopsychosocial model explains why we became obese. Where does willpower fit into that? Willpower is one sliver of the psychological component to it. It's very real. People with strong willpower, I really admire them. They deserve a lot of credit. It's a good quality to have as a human being, not just in relation to food, but generally in life. But the way I think of it is it's like an umbrella in a really powerful storm, right? Some people are going to hold that umbrella and they're going to be able to get through the storm and get to their destination and be dry. But because the storm is so bad, because of all these other factors, for most people, the umbrella is just going to break, right?

41:49And you can slag them off and say, you're full, it's your fault, but I don't know that gets us very far. I think you're right that we've got a living reality. We have tried just chiding people for 40 years, right? there will not be a single fat person listening to this, who's not had a million times, someone say to them, use some willpower, your fat. Right? That message is every day, right? If the solution was to just urge fat people to have more willpower and pull themselves together, there wouldn't be a fat person left. In fact, you look at fat women in particular, women with a BMI higher than 35, 42 % of them get insulted every single day.

42:29So the issue here is not the lack of insults, or even the lack of well -man and advice about willpower. And I was actually separate that because there is genuine well -man, there is shaming and stigma and all of that. Actually, lots of people are just genuinely kindly, so my friend Dave wasn't being a cunt when he said, Dianne, he's a lovely guy, right? He was being nice. So I don't like it. So all of that advice is just stigma. It's actually not. A lot of it is very well -maned. And a lot of it is useful. Right? There's some truth in it, but it's one truth among a much more complex picture. The only thing I object to about that advice is if you act like it's everything that's going on, it's not everything, right?

43:08It's one small part of a bigger picture. Talk to me about how GLP1 agonists have effects on other behaviors, addiction, drugs, behavioral stuff, screen time, does stuff. This is massively contested of all the areas that I write back in the book. This is the one where there's the least agreement and that's saying something because there's a lot of debate about almost everything attached to these drugs. There's one thing we know for sure, these drugs have an extraordinary effect in animal studies on reducing the consumption of alcohol, cocaine, heroin and ventanil. So I interviewed the scientists who've done the cutting edge research on this, give you an example, brilliant scientist at the University of Gothenburg in Sweden, called Professor Elizabeth Yelharg, has done cutting edge research on this for 10 years now.

43:54So what you do is you get a load of rats, I turn that rats fucking love alcohol, right? They drink it, they're wobble about their cage, they look very happy. And so she gets these rats and gets them to use alcohol for quite a long period of time until eventually their, you know, their cage looks like a really rough dive bar in North Las Vegas. And then she comes along and injects them in the naper their neck with a GLP1 agonist. And what happens is that alcohol consumption massively of leuropathic acid, which is a very rough term, but the closest you'll get to an alcoholic in a rat are the ones who cut back the most.

44:35But at first, with these studies, people thought, okay, maybe it's, obviously, we know these drugs reduce your desire for calories. Maybe it's because alcohol has a caloric component that, you know, that's why the rats drink less. So this was tried with drugs that don't have any calories in them. So Professor Patricia Griggson, who's the head of neuroscience at Penn State University, who I interviewed, did this with rats with heroin and fentanyl. Again, massive decline in them using those drugs, self -administering those drugs. Ditto, Dr. Greg Stamwood at Florida State University, did cocaine with mice, got the co -load of mice to use loads of cocaine, I imagine they went on long boring monologues, gave them GLP1 agonists, 50 % reduction.

45:25And one of the things that's really striking about this as Professor Heath Schmidt put it to me is what's crazy is it works with all drugs. That's very unusual. We have treatments for methadone, that reduces heroin use, whatever, but to have something that seems to reduce all drug use across the board, that is unprecedented. The human research on this is interesting. So we have a lot of anecdotal evidence. So, for example, I introduced you to interviewed a woman called Tracy in Mental Health Nursing Canada, who had been a very heavy, um, shared a problem. She basically broke up from her ex -boyfriend and went on a kind of spending binge.

46:03So she would obsessively like, by clothes she wouldn't wear, by book she'd never read, she was just spending, she got that real, you know, rush from clicking by, by, by. She started taking her as an MP for her weight and just noticed all this compulsive shopping went away. So lots of doctors are having lots of patients report similar things. The actual studies in humans we have so far are very small and they're a bit of a mixed bag, surprisingly, and a bit disappointing, actually. So we know they do reduce cigarette smoking, but only if you combine them with a nicotine patch. No one knows why.

46:37We know they do reduce alcohol consumption, but only in people who had a drinking problem in the first place. There's a shitload of studies going on now, looking at these drugs in addiction. So we'll know a lot more soon, but the most optimistic way of interpreting this, and we should say it with a lot of skepticism, this is quite speculative, but if you want it to be really optimistic, some people looking at this evidence say, actually, this isn't a weight loss drug. This is a drug that boosts self -control across the board. Now, we need a lot of evidence to back that up. That's a big claim, but I wouldn't rule it out.

47:14It's not impossible. It's likely, but it's not impossible. I have a friend who is a huge, huge evangelist for all of the GLP ones. He's on this, is it Tezepotide? I think it's... Tezepotide, yeah, which is the second generation. And he told me a couple of weeks ago, So it turns out that willpower is just a drug and the dosage is around about 0 .5 milligrams per day. So he's seen fantastic returns, I guess, from taking it. But talking about the light side, what about the dark side? What are the main risks of taking these things? Well, there are 12 big risks I go through in the book, but I'll give you an example of one.

47:53So when you talk to experts about the safety of these drugs, the first thing most of them say is a very good point that should give people some level of reassurance. They say, look, actually, we've got loads of evidence about what these drugs do to people because diabetics have been taking them for 18 years. So for people who don't know, in addition to having these effects on your appetite, these drugs also stimulate the creation of insulin, which is obviously what diabetics, both type one and type two, need. So 18 years ago, we started prescribing them all over the world, you know, hundreds of thousands of diabetics have been taking them.

48:24So what are the experts say, look, if these drugs had some terrible short or medium term effect, we would know by now. If they gave you horns, the diabetics would have horns by now, right? But what, some other ex, and that's a very good point. There's a lot of legitimacy in that point. But what some other experts said, okay, if we're going to base our conviction on the safety of the drugs largely on the diabetics, let's dig a little bit more into what's actually going on with the diabetics. So I'll example, there's a brilliant scientist, co -professor Jean -Luc Feille, who's at the University Hospital in Montpellier in France, who I interviewed.

49:01He was commissioned by the French medicine's agency to investigate the safety of these drugs for the French market. So he looked at the, what's called the pre -clinical evidence, the experiments on animals first, and was quite taken aback by something, which is if you give these drugs to rats, you really significantly increase their risk of thyroid cancer. And we know that you have GLP1 receptors, not just in your gut and in your brain, but in your thyroid. So there's a plausible mechanism of causation there that, oh, if you're fucking with GLP1, you might fuck with your thyroid, right, to put it in slightly unscientific terms.

49:36So he went to the French medical databases. They have really good medical databases because you basically can't opt out of them in France. They don't have the criminal here, but he compared diabetics he'd been taking these drugs between I think it was 2006 and 2016 if I remember right, with a comparable group of diabetics, it was similar in every other way but had not taken these drugs. And what he found at first is pretty eye catching. He calculated with his colleagues, if you take these drugs, you are increasing your thyroid cancer risk by between 50 to 75%. Now he said to me, don't misunderstand that.

50:16That doesn't mean if you take the drug, you have a 50 to 75 % chance of getting thyroid cancer. If that was the case, we'd be having bomb fires of ozampic all over the world. What it means is, whatever your thyroid cancer rate was at the start, if he's right, and this is highly disputed, it will increase by 50 to 75%. Now, thyroid cancer is fairly rare. 1 .2 % of people get it in their life. 84 % of them survive it. Nonetheless, it's a pretty big increase in a relatively small risk. But against that, you have to weigh in this, always cause back with all these risks. To what is the cancer risk just from being obese and continuing to be obese?

50:55I have to say, have all the things I learned for the book. I'm a bit embarrassed to say this. The thing that most shocked me was the thing I thought I had known since I was a little boy. I'm pretty sure at any point in my life if you'd said to me, if you're obese is it bad for your health, I would have said yes, right, from when I was like five or something. but I was stunned by the evidence for how bad obesity is for your health or just being overweight never mind obese, right? So think about it in relation to cancer. As cancer research UK, the biggest cancer charity in Britain explains, if you carry excess weight, it doesn't just sit there in your body, it's not a nerve, it's active, it's send signals throughout your body, and one of the signals that consent is for cells to divide more rapidly, which can cause cancer.

51:40This is why obesity is in fact one of the biggest causes of cancer in the United States and Britain, right? But it's quite shocking in the figures when you look at them. And that's just one of an enormous array of effects of obesity. So whenever you're looking at the risks of these drugs and that thyroid cancer is a very alarm, risk is alarming and it's why if anyone is listening, if you have thyroid cancer in your family, I don't think you should take these drugs. If you have any reason or certainly if you've had thyroid cancer before you definitely shouldn't. Anyone who has any reason to believe that at risk of that, I would say it should weigh very heavily on you that risk.

52:18But again, you've got to weigh it against the, what for a lot of people realistically will be the risk of obesity. As Dr. Shawna Levy, who's an obesity specialist at Tilaean University School of Medicine in New Orleans said to me, you know, we don't know the long -term risks of these drugs, but we do know the long -term risks of obesity and they are shocking.

52:38I think I'm writing saying that rats on mice have a special type of receptor on their thyroid as well, so that some of the studies that are done on them aren't necessarily portable across onto humans in the same way. That was something that I learned while I was away a couple of weeks ago. What about muscle mass? What does it do to muscle mass? This is a really big issue. So any form of weight loss on average causes a loss of muscle mass. Weirdly that hasn't happened with me, but I think that's because my muscle mass was so the fuck in puny at the start that will get you in the gym will get you.

53:08You'll law me there, Chris, you're the one of few people who could. So what we know is most people shed muscle, I know you know, it's much better than I do, any form of weight loss generally causes a loss of muscle mass, which is the totalling out of soft tissue in your body. Obviously you need it for things like climbing the stairs, getting up out of the chair, you know, movement. And we know that this is risky. It's not that risky if you're in your 30s or 40s, but as you age, you shed quite a lot of muscle mass each year. If you're going into the ageing process with depleted muscle mass, low levels, it massively increases the odds that as you age, you'll develop a condition called sarcopenia, which means poverty of the flesh, which is basically where you just can't fucking do anything.

53:49You can't climb the stairs, you can't get out of a chair on your own. You're much more likely to fall over. If you do fall over, you're much more likely to die. And this is particularly why, because I would argue this or two categories of people here. I mean, this is a very broad brush statement, but there's people who are, like that guy Jeff Parker, I mentioned in San Francisco, there's people who are overweight or obese who are taking these drugs to come down to a healthy weight. I think that's very defensible, although plenty of people in that position look at the other 11 risks and think, well, it's not worth it for me.

54:21But that's very defensible. Then you've got people who are already a healthy weight or in fact are underweight, who are taking it to be super skinny, right? We can all think fill in name of famous actress here, right? Think about people at that party I went to none of them were obese right at the start far from it. They are particularly incurring this muscle mass risk that won't show up now but it could really post problems for their health as they age and it could create a kind of ticking time bomb problem population, you know, half the people are taking these drugs, that could have a real problem when people are aging if they're taking two higher dose or they're taking it to be super skinny.

55:04What do you think the introduction of these drugs means in a world where people are more concerned with their appearance than ever before? It's complicated question. The worst moment for me when I was working on the book was a moment with my niece. So she's she's I can't but I can't bet to say that she's 19 years old now But she's the baby in my family. She's the only girl in her generation So in my head she's fixed as a six -year -old right whenever she has a boyfriend I always want to go get away from her you fucking pido, but they're always like oh, she's not a woman now and And one day I was saying I met four or five months have taken the drugs maybe I was face timing with her.

55:44She was in a pub in Liverpool and And, you know, she was kind of teasing me, going, I never knew you had a neck before, yo, I never knew you had a jaw, right? I was saying I looked good and I was kind of preening. And then she looked down and she said, well, you buy me some ozempic and I laughed because she's like a perfectly healthy way. And suddenly I realized she meant it. And I thought, fuck, what am I doing here, right? At my counteracting all these messages I've given her since she was a little girl. And we know if you change the kind of the body, the beauty norms, particularly women are vulnerable to this or men are vulnerable in a different way because men generally want to become bigger rather than more than women.

56:26Bigger X, yeah. Exactly. Which certainly of course, as you know, very well has all sorts of problems that you've discussed with your podcast, but that's a different thing, right? So set that aside for a minute. I'm not worried that these drugs will affect that. other than the PENCH and the thing that's going to be about in relation to that, with girls. So I think for example, a really weird fact, between 1966 and 1968, the percentage of girls who thought they were fat exploded. Pcentral girls who are unhappy with their bodies, so that's a very short amount of time. They're like, well, what happened between 1966 and 1968?

57:00What happened is there was a famous model named Twiggy, who was just naturally extremely anything, who was sort of presented as like the face of beauty, the face of the 60s. And suddenly people looked to her and were like, well, shit, I don't look like Twiggy, I don't like my body, right? So we know when a body norm changes, a beauty norm changes, it can change, when it changes how people feel about their bodies, right? So I'm really worried for young girls in particular about what, I think about just even like my niece, all the actresses she likes or pop stars who were a little bit kind of broader range of body types, they're all fucking bone thin now and by the way they all claim that they're doing Pilates or you know I don't know maybe there's been an outbreak of dysentery in Malibu or something but you know the what's that doing?

57:50I mean the biggest worry I have if you said say this is not a worry I have for myself but if you said what is my single biggest worry out of the 12 for these drugs. My biggest worry is what it'll do with eating disorders, right? So even before the pandemic, we had the highest level of eating disorders in the history of the United States and Britain. And then during the pandemic, it actually rose. That's obviously overwhelming the young girls. It is some young voice, but it's mostly young girls. We're in complex range of reasons, but I would say social media, loneliness, whole road is that range of things.

58:24People should read my friend Jonathan Heitz excellent book, The Anxious Generation for more insight on that. But what these drugs do, anyone who's known anyone with an eating disorder knows, they're in a conflict. There's the psychological part of them that wants to starve themselves and there's the physical part of them in their body that wants to stay alive and eat. And what these drugs do is give you an unprecedented tool to amputate your appetite, right? This is why eating disorders experts are extremely worried about people like Dr. Kimberley Dennis, one of the leading eating disorders experts in the US way interviewed.

59:01I extremely worried about, you know, this could produce an opioid -like death toll of very large numbers of young girls who would not have been able to kill themselves without these drugs. Now, there's something we can do to massively reduce that risk, which is at the moment, anyone listening, you can just go online and get these drugs on zoom. You see a doctor on zoom. Well, that's how well is a doctor able to assess your BMI on zoom, not very, right? So, Dr. Dennis argues, I think very persuasively, you should only be able to get these drugs from in -person appointments with doctors who are trained in spotting eating disorders.

59:37Obviously, if you have a BMI lower than 27, they should not give it to you. And if they suspect you have an eating disorder, they shouldn't give it to you. access malnutrition. That's a brilliant way of putting it. That's exactly right. And malnutrition is a huge, huge risk here. That's exactly correct. What happens if you stop taking it? There's a bit of debate about this and we don't have a lot of good evidence. It looks like you regain all the weight pretty quickly. There does seem to be a subsection of people who use it to interrupt their habits, develop new habits, then come off the drug and remain at a lower weight.

1:00:15But people have only been using this for obesity for a couple of years. We basically don't know What the drug companies are saying and very mind they obviously have a strong vested interest and wanting you to take it forever because They get more money than more you buy They say it's like blood pressure medications. It's like statins. They work as long as you take them You stop taking them they stop working that does seem to be the case for most people. I wonder how many people are going to be confronted with a bit of an existential crisis when they lose a ton of weight by taking these drugs and it's revealed to them that being overweight wasn't the root of all of their psychological problems because you're now skinny but still miserable.

1:00:58That's a really important question. Correll LaRue, I mentioned before, I think, a brilliant expert in a bariatric, he's also done a lot of work on bariatric surgery. He said he thinks that's one of the reasons why the suicide rate goes up so much up to bariatric surgery, that a lot of people imagine what's wrong with my life is that I'm fat and if I was thin, I'd be okay. And then they lose all this weight and their husband's still a prick and their job's still shit and their life isn't what they wanted it to be. And it's their sports to confront, oh actually, while this may, well obviously have benefits for their physical health, it's not resolved or these problems magically, right?

1:01:35I do think there's a lot of truth in that. What about women who are either going to become pregnant, trying to become pregnant, are pregnant, is there dangers for them? Yes. So what we know, again, in animal models, is rats who get pregnant when taking these drugs or given these drugs in the case of rats are much more likely to have children with birth to form a tease. You're advised to not take these drugs if you're trying to get pregnant, but of course some people will just accidentally get pregnant or whatever. I'm worried, I'm quite worried about that. And it could be that there's some immediate short -term effect, but that seems unlikely because it would have probably shown up in the diabetics by now.

1:02:16What people like Dr Greg Stan would at Florida State University are concerned about. And he stressed this is speculative because by definition we don't know. He said, he has some concern that there may be a parallel. Look at what happens to pregnant women who are exposed to environmental or contaminants like lead, for example. When their babies are born, their babies appear to be like everyone else. But when their kids get to go through, they become adolescent, they seem to have poorer regulation control, poorer attention, that it turns out that that exposure to lead in the womb has had an effect on them, that only emerges later.

1:02:55He said, and he stressed it was speculative, but he said he is concerned we should keep an eye on the possibility that will be the case. Well, I mean, the natal environment is every time that I learn something about it, it blows my mind. Robert Sapolsky did this great study where I think some of his colleagues looked at women who enter poverty during pregnancy. Poverty is a very reliable source of stress. And it's crazy. The other thing to consider is if a woman is pregnant with a female, she is also pregnant with every egg that that female fetus is ever going to be able to produce. So you were inside of your grandmother at one point, which I'm sure is something you've thought about a lot.

1:03:39Exactly. Yeah. He told you my web browser. He told you my porn hub search history. But yeah, you know, the cascade sort of carries and yeah, it's a concern. It really is. So where did you come into land with this? After taking yourself, after speaking to experts, after looking at the state of our diet and ultra -process foods and science and all the rest of it, how have you come to weigh the scales of the GLP ones? Yeah, the book is called Magic Pilka. There's kind of three ways these drugs could be magic. They could just solve the problem, right? In a way that is so swift that it feels like magic.

1:04:17And I've got to tell you, Chris, there are days it feels like that. My whole life, I've eaten way too much and I've eaten shit. And now I inject myself once a week in the leg, a tiny little mosquito bite -like feeling and I radically less and I eat differently. That feels like magic, right? The second way in which it could be magic is it could be like a magic trick and illusion. It could be like a magician who shows you a great card trick while picking your pocket. It could give you these benefits but fuck you over in the longer term. I don't rule that out. The third way actually is the most likely.

1:04:50If you think about the classic stories about magic that we grow up with. Think about Aladdin, right? You find the lamp, you rub it, the genie appears, and you get to make your wishes. And your wishes come true, but never quite in the way that you expected, right? Think about Fantasia. You unleash the magic and it runs away from you in all these unpredictable and chaotic ways. I think it's probably going to be like that. It probably can have some good stuff as in bad stuff. In terms of personal to gone all over the world, to have interviewed all the leading experts to learn so much, doing what we haven't covered, and still not be able to give you all my other books.

1:05:33I've kind of come to a conclusion, like, well, dear reader, I think we should do the following, you should do the following three things, and it's a society, we should do the following five things, and here's the stuff we can do, and here's how we can solve this problem. I don't really feel like that. I end the book by talking about five possible scenarios for how this could turn out now. And they really range very widely from the super pessimistic. This could be like Fenn Fenn the 90s disaster drug. We could discover some catastrophic effect. I don't think that's likely but I don't think you can rule it out.

1:06:02Or it could be that the drugs work in the long term, the benefits outweigh the risks. We get them to everyone who needs them. That's a big shift because at the moment only tiny numbers of rich people can get them. And crucially, they fucking wake us up to go how do we end up with this? How do we end up having to choose between a risky drug and a risky medical condition? Is this what we fucking want for our children? Or shall we look at Japan where they never had an obesity crisis and there is no market for these drugs because almost nobody is obese, right? And I went to Japan, I learned how they did that.

1:06:37That's what I hope will happen, that that final scenario, but I don't really know. If you ask me for purely personal advice and I want to stress I am not a doctor, I'm a journalists, people should talk to their doctors, having looked at all these evidence. And I give this evidence with a, I give this advice with a low level of confidence. So you might want to see me in 20 years for giving it to you. But if your BMI is lower than 27, I would say you definitely shouldn't take these drugs. You're incurring all the risks like to your muscle mass for no benefit that apart from an aesthetic one. If your BMI is higher than 35, if you were someone I loved, I would urge you to take the drugs.

1:07:17Assuming that you've tried dieting and you haven't been able to keep the way off. Because for me, the evidence is so clear that the risk of being obese at that level is so great. Even things like, I'm really embarrassed to say, I didn't know this. Think about diabetes. If you're obese when you're 18, you have a 70 % chance of getting diabetes in your life. But I always thought, all right, it's not good to have diabetes, but if you're either in a country where you get good healthcare, you get given insulin, you're basically like everyone else, right? That is not the case. If I'm interviewing doctors, like people like Dr.

1:07:52Max Pemberton, one of the most high -profile doctors in Britain. Jesus, the facts are shocking. Diabetes knocks 15 years off your life. It is the biggest cause of preventable blindness. More people in the US have to have a limb or extremity amputated because they got diabetes than because they got shot. And you will have noticed, there aren't a shortage of people getting shot in the United States, right? And that's just diabetes. I mean, Dr. Pemberton said to me, as a doctor, if you gave me a choice tomorrow between becoming diabetic or becoming HIV positive, no contest, I'd choose to become HIV positive.

1:08:27If you get HIV and you get treatment, you live as long as everyone else, that is absolutely not the case with diabetes. You die sooner, and you're much more likely to have a horrific last few years of your life where you are blind, dementia, lose a limb, agonized, I mean it's really, and that's just diabetes right? So if you're being my size higher than 35 that would be my advice. If you're being my age between 27 and 35, I think it's a much harder judgment call and I would recommend you go through the risks of obesity in the book, the risks of the drugs in the book, really think about which one is more likely to play out for you.

1:09:08And really what your risk appetite is, right? Different people have different, I have a great respect for people who come to very, one of the things I've really liked about the reaction to the book so far, is some people read the book and go, I really like this book, you've made me be convinced that I must go out and get these drugs tomorrow. Other people have said to me, I really like this book, you've made me convince you'd be fucking insane to take these drugs, right? It's a bit like what was the dress where some people saw it is what are they say? That's a blue and green or the black and gold or whatever.

1:09:33Exactly. I saw it as black and gold right? The it's a bit like that. I'm fascinated by how people read the book and come to completely different conclusions and are absolutely convinced that I shared their secret conclusion all along. So I feel like it makes me feel like I sort of did my job right but there I think we don't know one thing I'm completely confident of is the stakes here are unbelievably high. This is by some measures the biggest cause of death, preventable cause of death. in our societies, right? Gerald Mann, who I mentioned before at Harvard, says obesity and food caused illnesses kill 678 ,000 people in the United States every year.

1:10:10That's all the wars of the 20th century for American soldiers combined plus some, right? Every year. So whether we get this right will determine whether lots of people live or die. I think these drugs are an interesting and important tool. The way I think of it is for a lot of us we're in a trap and this is the rusty, risky trap door we're being offered. We've got to change up the way our society works so we're not in this fucking trap and we can change it so that our kids really won't be in this trap. We can do that. I go through how we can do it. I've been to places that have done it. But for now, we're facing a pretty shitty decision and we've got to think it through in detail.

1:10:51So. Yo Han Hari, ladies and gentlemen, Yo Han, where should people go? They want to keep up to date with everything that you're doing? Oh, if they go to my website, it's johan .nnhai .com. And they want to know more about where to get the audio book, physical book or ebook. You go to magicpillbook .com. I meant to say you can get it from all good book shops, but the truth is you can get it from shipbook shops as well. We don't have like a quality test. But yeah, I'm very glad, if I said this last time I spoke to Chris and it had already happened or not, but I had this really unfortunate moment at the end of a podcast.

1:11:25I must have been a couple years ago, probably before we spoke. I was interviewed by someone, oh it's a here, but it's quite a high profile podcast. And at the end of it, the guy said, what's your Twitter? And I said it. And he said, what's your Instagram? And I said it. He said, what's your Facebook? And I said it. And then he said, what's your Snapchat? And I said, I am a 45 year old man. The only 45 year old men on Snapchat or certainly Peter Files, right? Why else would they be on there? And he didn't laugh at all. And I've got a bad habit if someone doesn't laugh at my jokes, I lean into it more.

1:11:55So I said, you know that TV show to catch a predator where they sort of catfish Peter Files? I said, the next season of to catch a predator should be, they just go up to Adolf Men in the street and say, what is your Snapchat handle? And if they've got one, fucking throw them in the van, right? That's it, immediate imprisonment. He didn't laugh at that. I later looked him up, but he's quite active on Snapchat. So my goal now in all podcast interviews is to get through it without accidentally accusing the host of being a paid afire. Right, so far, so good. Hooray! Congratulations. Thank you so much, Chris.

1:12:23Oh, I appreciate it. I always enjoyed talking to you. You asked really good questions. Thanks, Chris. Thank you.