Johann Hari: Uncovering if Ozempic is a Miracle Drug or Health Hazard & 3 Things They Do Not Want To Tell About Ozempic

25:14Everywhere, right? So I remember when I learned that, and I learned it quite a while, you know, a few months into taking the drugs it's a disconcerting thing to learn you realize how would i put it it's a much more intimate transformation right something that changes your gut you sort of feel like oh okay that's fine something that's changing your brain and profoundly changing your brain um partly explains why the effect is so powerful why these are so much more effective than all previous diet drugs it also potentially raises some other benefits in terms of benefits for addiction it also raises some other risks around whether it may cause depression because there's a debate about what it's actually doing in your brain.

25:48But for me, it just sort of made me realize, oh, this is a, like I say, a much more intimate change than a lot of people realize, I think, when they start taking it. Yeah, who was it? Was it your nephew who said, where is Johan Hari and what have you done with him? Was it your nephew? My little godson. Your little godson, yeah. It was a while to take him to McDonald's. So I've had a long, my relationship with junk food is probably best typified by one of the low points in my life. I was, I can tell you exactly when it happened. It was 1pm on Christmas Eve, 2009. And I went to my local branch of KFC in East London.

26:24And I went in, I said my standard order, which is so disgusting. I'm not going to repeat it in front of someone. It's got a healthy glow. It was literally a bucket of fried chicken. Trust me, I love a bucket of fried chicken. You look like, you've got such a healthy glow. You're like, you've never eaten a chicken drumstick. I'm plant-based now, but back in the day, that's like that popcorn chicken would have been my jam yeah the guy behind the counter said to me oh johan i'm really glad you're here i was like all right and he went off behind where they fry the chicken and everything and he came back with a massive christmas card in which they'd written to our best customer and everyone had written like personal messages to me and one of the reasons my heart sank is i thought this isn't even the fried chicken shop i come to the most how can this be happening to me.

27:08It was the second lowest moment in my life as an overweight person. The worst was the time that I was fat shamed by the Dalai Lama. But no, there was this moment where, it's not even a joke, by the way. Yes, you need to tell us. I'll tell you the horror of the Dalai Lama all the time. So I'd had this very intimate relationship with this food all my life. And to have it, there were many good things that flow from Tecchio Zenpig for me. And there are many benefits to it, as well as some significant risks. But the weirdest moment for me actually was another moment that happened in KFC. In fact, one of my nephews said to me, a lot of the key moments in your life seem to happen in branches of KFC.

27:49I heard, I was like, that's a good point. But I had a real epiphany about this because what these drugs do is they profoundly interrupt your underlying eating patterns, right? You can't eat the way you did before. And this is something I think people are not being warned about. And I I try to take people through a lot of detail in the book, is you need to be prepared that because of that, a lot of the underlying emotional issues that drive your eating may well come to the surface. So I had this moment for me. I was in Vegas. I was, as you know, I'm writing a book about a series of crimes that have been happening in Vegas that I've been researching for a long time.

28:27And I was researching the murder of someone that I knew and loved. And it was obviously very painful as you can imagine he was an he was an incredible person I was working on this and I just you know felt bad and um I went to this branch of KFC on West Sahara which is one of the grimmest KFCs in the world and believe me I could write a book about all of them and I went in I'm really on autopilot it's just like seven eight months into taking the drugs I I went in and I ordered what I would have ordered a year before right I ordered a bucket of fried chicken and I had a chicken. And I wasn't even really thinking about the eating or anything.

29:02I was, and I had a chicken drumstick and I looked at this bucket and I thought, I can't eat this. Right. Like I would throw up if I tried to eat this. And I remember Colonel Sanders was on the wall and it was like, he was looking at me going, Hey, what happened to my best customer? And I'm thinking, Oh, you're just going to have to feel your feelings. Right. And essentially, if you look at the scientific evidence, there's scientific evidence for five reasons why we eat. One of them is the obvious one to sustain our bodies. And I would have told you before I started taking this drug, that was why I ate.

29:33Right. But here I am. Then I ate maybe 3 ,200 calories a day. Now I around 1 ,800. So all that other eating was doing something else. Right. And I go through the, the, the, the four psychological reasons, uh, why we eat that obviously applies differently to different people. And those things kind of get surfaced. And I remember going to one of my closest friends when i got back from vegas and saying to her i've got to stop taking this i can't take it this is too upsetting and she said to me johan stop taking it if you want to that's fine but you need to know these drugs are not causing this issue this issue was there all along in this case what they're doing is giving you an opportunity to deal with those issues in a better way than drowning your feelings in saturated fats right and that's been a bumpy uh transition although I'm glad I stuck with it, although lots of people I respect the fact they don't.

30:27Walk me through why people don't. What was their reasoning? What were they struggling with so much? I think there's a lot of things people struggle with with the drugs, but in relation to that, I'm sure we'll get into lots of them, but if we think about this specific one, if you want to think about the benefits and risks of these drugs when it comes to obesity, I actually think it's quite helpful to look at a parallel area of science. We've only been giving these drugs to people for obesity for a couple of years, but there's a parallel area of science that can help us to think about the benefits and I think some of the answer to your question so and it's bariatric surgery right up to now it's been very hard without some kind of external intervention to lose huge amounts of weight and keep it off clearly you did it there are lots of people who do it but it's actually a surprisingly small percentage of the people who try it succeed I go through why in the book and that reasons are really important so actually the most effective way up to now has been bariatric surgery things like, you know, stomach stapling, gastric sleeves.

31:23Bariatric surgery is a horrific operation. It's really grueling. You know, one in a thousand people die during operation. It's no joke, right? But the reason people put themselves through that is because of the extraordinary benefits to their health afterwards. If you have, now bear in mind, they were severely obese at the start, otherwise you wouldn't qualify for the surgery. But if you, if you have this surgery in the seven years that follow, you are 56 % less likely to die of a heart attack. You are 60 % less likely to die of cancer. You are 92 % less likely to die of diabetes related causes.

31:58In fact, it's so good for your health that you're 40 % less likely to die at all in that seven year period, right? And we know similarly that these drugs are moving us in a similar direction. So if you take these drugs and your BMI is higher than 27 at the start, you are 20 % less likely to have a heart attack or stroke, right? In the years that follow. I was going to say it's close to my heart. It is literally close to my heart, right? But you also, when you look at bariatric surgery, begin to see some of the drawbacks. And I think the key to what you're asking might be there. So one of the things that I think is really shocking is if you have bariatric surgery, your suicide rate quadruples in the years that follow right it's still quite a low risk most people have bariatric surgery glad they did it but quadrupling that's that's that's a big effect right just think why would that be what's going on i think there's lots of things going on there some of it is actually the after effects of the surgery are pretty onerous some of it is you can't comfort you anymore so that pain comes to the surface um some of it is a lot of people who are overweight kind of think well if only i was thin my life would be really great.

33:06It's that magic pill. Exactly. And they lose the weight and, you know, your husband's still an asshole and you still hate your job. And I think there's also some, I'll give an example of a really deep psychological issue that I think is surfaced in some cases by these drugs and bariatric surgery. Something I learned about from a wonderful man who you should have on actually, um, called Dr. Vincent Felitti. It was really hard for me to learn about this. So Dr. Felitti was a doctor in San Diego in the early 1980s. And he was approached by Kaiser Permanente, the big not-for-profit medical provider in California.

33:40And they said, look, we've got a problem. We don't know what to do. Please help us. A problem they had was that obesity was hugely rising. In fact, it was very low by our standards, but it was rising. And they said, look, nothing we do works. We give people, you know, diet plans. We give them personal trainers. It's not working. Can we give you a load of money and just do blue skies research, figure out what the hell we should do? So Dr. Felitti took the money and was like, oh, what can I do? So he started working with 200 severely obese people, people who weighed more than 300 pounds and had for a long time.

34:08And he's like, what could I do? And he had an idea that sounds, and in fact is kind of dumb. He said, what would happen if really obese people literally stopped eating and we gave them like, you know, vitamin C shots so they didn't get scurvy or whatever, would they just burn through the fat supplies in their body and get down to a healthy weight? So with a ton of medical supervision, they did it. And incredibly at first it worked. There was a woman who I'll call Susan, not her real name, who went down from being more than 400 pounds to 138 pounds, staggering transformation. And, you know, her family are calling the doctor and saying, you saved her life.

34:44She's thrilled. And then one day, um, she cracked, she went to KFC or I think that's projection. She went to somewhere and, you know, started hugely overeating again and quite quickly got back to a dangerous weight. And Dr. Folletti called her in. He said, Susan, what happened? What happened? And she looked down. She was really ashamed. She said, I don't know. I don't know. He said, well, tell me about the day you cracked. Did anything in particular happen that day that didn't happen some other day? It turned out something had happened that day that had never happened to Susan. She was in a bar and a man hit on her, not in a nasty way, in a nice way.

35:24and she felt completely freaked out and went and started eating. That's when Dr. Felitti asked her something he'd never thought to ask her before. He said, Susan, when did you gain your weight? In her case, it was when she was 11. He said, well, did anything happen when you were 11 that didn't happen when you were nine or when you were 14? Anything in particular happened that year? And she looked down and she said, well, that's when my grandfather started raping me. Dr. Felitti interviewed everyone in the program He discovered that 60 % of the women Had made their extreme weight gain In the aftermath of being sexually abused or assaulted And at first he was like What's going on?

36:00It doesn't make any sense And Susan explained it to him really well She said overweight is overlooked And that's what I need to be Right? Clearly obesity for women Has a protective sexual function You are somewhat It can still happen of course But you are less likely to be sexually assaulted if you gain a lot of weight. And so for Susan, losing a huge amount of weight made her really frightened and feel really vulnerable and brought her back to that terrified place of abuse. Now, there's lots of psychological things that go on. That's only one of many. But I think, and of course, it can give you an opportunity to deal with those feelings, right?

36:37But again, it gives you a sense of like the incredible psychological complexity of what's really going on here can kind of come to the surface in complicated ways. Parking shouldn't slow you down. ParkWiz gives every driver a shortcut. Book ahead, save up to 50%, and skip the hassle of circling the block. Park smarter, park faster. ParkWiz. Download the ParkWiz app today and save every time you park. This is Jason Timp from Hoops Tonight. Toyota is moving forward to a more sustainable future by giving you the freedom to choose from an incredible lineup of trucks, now available in both gas and hybrid models, including the legendary Tacoma, the powerful Tundra, both available with the iForce Max hybrid powertrain and backed by Toyota's legendary reputation for reliability.

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38:02Equal housing opportunity. yeah and what's interesting about that is no matter what the psychological reason may be you're almost dealing with that feeling for the first time in three or four decades so it almost feels like a new feeling would that be fair enough to say it almost feels like what i mean by that is there are certain feelings and thoughts that we've had since we were young and we found ways to cope with them but if this is something that you've been able to kind of put aside for 10 20 30 years and all of a sudden now that this is blocking something which is giving rise to that it almost feels like wow i haven't learned how to deal with this for a long time with that that's really right i think it's i think you're right it's even worse than a new feeling it's a buried feeling right and obesity is so laden with shame and the cruelty in this culture towards you know which i've experienced to some degree but women get it much much worse if you have a bmi higher than 35 and you're a woman 42 percent of those women get insulted literally every day right and i really wanted to think this through because i I was very conscious that we've made so much progress in this culture.

39:19I mean, we were nowhere near where we need to be, but we've made some progress. I think about this, and one of the things I really worry about in relation to these drugs, I think it's really distilled in a moment, probably the worst moment in the whole writing of the book for me. So I've got a niece called Erin, who's 19 now, but in my head she's fixed as a six-year-old. She's the baby of my family. She's the only girl. She's the youngest of my brother's sister's children. But one day I was FaceTiming with her after I'd been taking the drug for a while. And she was sort of praising me in a teasing way.

39:46She was like, oh, I never knew you had a jaw. I never knew you had a neck. And I was kind of preening. And then she looked down and she said, will you buy me some Ozempic? And I laughed because I thought she was kidding. And I realized she wasn't. And she's like a perfectly healthy weight. She always has been. And I thought, I've undone all the messages I've ever tried to give her. Right? about valuing yourself, about... And I thought, you know, she's grown up seeing a broader range of body types in female celebrities than we ever grew up with. Of course you are. And now all of those women pretty much are bone thin, right?

40:28And I really wanted to think this through because I think there's two categories here which are quite different. There's overweight and obese people who are taking these drugs to get down to a healthy weight, right? Now, they're still incurring the 12 big risks that I write about in Magic Pill. there's still a lot to discuss there but i think there's a lot to defend there then you've got people who are already a healthy weight or indeed skinny who are taking them to be super skinny now i don't judge those people we live in a culture that makes women feel shit about their bodies whatever they do and there are tremendous pressures on them and i i don't judge where those women are coming from at all but they're incurring all the physical all the 12 risks for none of the benefits right i mean well rather for aesthetic benefits but not health benefits and in fact they're endangering their own health um in all sorts of complicated ways to give an obvious example as you age you naturally lose muscle mass muscle mass is the total amount of soft tissue in your body that you need to like get out of a chair walk the walk up the stairs whatever it might be so as you age you naturally lose muscle mass from the age of 30 depressingly um so if you're going into the aging process already with quite low muscle mass which people who've taken the drugs to be super skinny likely will be it could cause you real problems when you're older you know you'll be much less mobile.

41:42You'll find it harder to walk up the stairs. You're at risk of a condition called sarcopenia, which means poverty of the flesh. It's where basically you just can't do much because you're quite physically weak. So I think we've got to distinguish between those two things. And then we've got to think about also what this means for body positivity and how we think about it in relation. That was a particular person who helped me to think about that. I could tell you a bit about her if you like. Yeah, please. So there's this woman. You probably remember her, Jay, because we're from the same place. So when we were kids, you only ever saw fat people on television as the butt of a joke, right?

42:15Particularly overweight women, right? It was vicious. And the first person I ever saw challenge that, I remember it blew my mind. It was on Kilroy, which people don't know. It's like a, if you imagine a kind of dollar store version of Ricky Lake, right? The first person I ever saw challenge it was this woman called Shelley Bovey, who basically introduced body positivity to Britain. She was the first person to ever talk about this and write about it in Britain on a big public stage. So I went and tracked her down because I really want to think this through with her. She's 76 now. And her story, I think, really helps her to think through the complexity of this.

42:47So she grew up in a kind of big working class town in Britain called Port Talbot. I guess the equivalent in the US would be like Scranton. She was, as she would put it, the only fat girl at her school. This was the 1960s. and one day after class her teacher said to her bovie stay behind i need to talk to you so she's sort of sitting there thinking hey what did i do and she goes up to the teacher and the teacher said you're much too fat it's disgusting go see the school nurse she'll sort you out so completely thrown she goes to see the school nurse and the nurse says why are you here she said well the teacher says i'm too fat and the nurse said take off your clothes i'm going to look at you.

43:25And the nurse looked to her and said, oh, disgusting. You're too fat. And just berated her. Said, you're greedy. You're a pig. Eat less. And Shelly, completely thrown, kind of leaves. She was soaking up this kind of abuse the whole time, right? Girls were constantly saying to her, thank God I don't look like you. And really, her whole life, she's soaking up this abuse. When she got pregnant, she went to the doctor. First thing the doctor said was, shouldn't be pregnant when you're as fat as you are. When she gave birth, she had a very painful birth, difficult birth. She's lying there covered in blood.

43:54And the midwife said to her, you know, you really need to lose some weight. And when her baby wouldn't attach, he wasn't feeding properly. She went to the doctor. The doctor said, what are you trying to do? Make the baby as fat as you are. Overweight and obese people are soaking this up all the time. And most of them just internalize it. Shelly told me she had never looked at her body naked. Even in the shower, she would sort of wash herself but not look because she felt such hatred for her own body and one day she learned in the US there was this movement which at the time called itself fat pride there's still some people who use that term now we would probably call it more body positivity who just said why are we taking it this is like this is just cruelty this is like racism or homophobia or sexism just no we're not going to be taught treated like this you're not going to get to talk to us like that and so she wrote the first ever book advocating for body positivity still stands up now brilliant book called The Forbidden Body, in which she argued against the stigma.

44:50And when I tracked Shelley down, she stressed to me she's really proud of everything she said about stigma. And I think she's 100 % right to be. Stigma, A, is just a form of bullying, and B, makes the problem much worse. Lindy West, who's a brilliant body positivity advocate, said, people don't take good care of a thing they hate. If you make people hate their bodies, it doesn't make them take better care of them but something happened to shelly next i think if we're going to be truthful and compassionate we have to talk about shelly was very overweight she was not yet 50 and she was losing the ability to walk and so she had to be in a wheelchair and she went to a doctor and her doctor said well because of your weight because the strain that's putting you've got problems with your heart and shelly felt this profound dilemma because she was so proud of everything she said about stigma.

45:42At first she thought, well, I want to talk about these health challenges, but is this contradictory? There was at the time a newsletter in Britain called Fat News, which was like a body positivity newsletter. And she wanted to write about this. And they said, no, no, that's not what we want. We're here to tell the positive news. And she said, but don't, if we love ourselves, don't we want to tell the whole truth? And she felt really conflicted about this. And for a long time, she felt like it was either or, either you're against stigma or you're in favor of reducing obesity where you can. but you know she then and she's the first to acknowledge this is extremely hard to do but she lost a lot of weight through dieting she went from being unable to walk to being able to run um her health massively improved her heart problems went away which tends to happen when you reverse obesity like when we talked about with the bariatric surgery and shelly i thought put it to me in a really wise way she said it's not either or it's both and if you love someone who's obese, as everyone watching will, I'm pretty sure you want to protect them from two things.

46:41You want to protect them from cruelty and bullying. And you want to protect them if you possibly can from the more than 200 diseases and health complications that are made much more likely by being overweight or obese. And I was kind of shocked when I, you know, I looked at the science of this with an open mind. I'm very happy to challenge scientific consensus. I've done it before in my previous books, but when you look at the scientific evidence, and I was trained to assess scientific evidence at Cambridge University, I was kind of taken aback by how bad obesity is for your health on average.

47:15Of course, there are exceptions. My mother smokes 70 cigarettes a day. She's alive and well at the age of 78, but she's an outlier. I mean, even think about something as simple as diabetes, right? I'm really embarrassed to say this, but I thought if you'd asked me a couple of years ago, okay, I knew that obesity makes diabetes much more likely. If you're obese when you're 18, you have a 70 % chance of becoming diabetic in your life. But I thought, okay, that's not good. But as long as you've got good health insurance and you get insulin, you're basically like everyone else. A diabetic with insulin is like me or you.

47:45That's not true at all. When I interviewed the leading doctors who are leading people who treat diabetics, when you look at the scientific evidence, diabetes knocks 15 years off your life on average. It's the biggest preventable cause of blindness in this country. More people have to have a limb or extremity amputated because of diabetes in the US than because they got shot. And you will have noticed a lot of us get shot, right? In fact, the effects are so bad that one of the leading doctors in Britain who treats diabetics, Dr. Max Pemberton, said to me, if you gave me a choice between becoming diabetic or becoming HIV positive, I would choose to become HIV positive.

48:20Because if you're HIV positive and you get treatment, you live as long as everyone else that is not true of diabetics type 2 diabetics you you're you you have a shorter life and you're much more likely to have a terrible last few years where you're blind or you're horribly you know your body is mutilated um and i found that so frightening to take on and i'm conscious that loads of people hearing that will experience that and it is very painful it is extremely painful to hear and it's an extremely painful truth and we have to communicate it with great compassion and love and not as concern trolling or, and I hate even saying it because you can see how it gives ammunition to the bullies in a way, because they use that as like, oh, babe, I'm just worried about your health.

49:04I get that. But Shelly really taught me, yeah, she put it, we have to live in reality and we have to be as compassionate as we can within that reality. We have to do both, right? And I'm conscious this is a long answer, but I'll just give you an example of one other person helped me to think about this. There's a brilliant guy interviewed called Jeff Parker. He's a 67 year old retired lighting engineer in San Francisco. And Jeff a couple of years ago was very severely overweight. He was finding it painful to walk. He had gout, he had liver problems, kidney problems. He was taking fistfuls of pills every day.

49:38And he started to take Manjaro, which is one of the new weight loss drugs. And he lost a lot of weight. All his health problems went into remission. He was, doctor almost took him off the pills. Now he walks his dog over the Golden Gate Bridge every day, he said, you know, I feel like I'm going to enjoy my retirement now. I don't think we can say to someone like Jeff that that improvement is not meaningful, right? There are many, maybe the risks of the drugs will outweigh that benefit to him and for others. That's a real possibility. It's why I put a lot of weight on the 12 risks of these drugs in the book.

50:10But I do think we have to acknowledge that a lot of people who do successfully reverse their obesity, which is much easier to do now than it's been before, do experience a massive improvement in the quality of their life. I do think we're not being honest with people if we don't explain that as well. Thank you for going into that, actually. It was a very thoughtful answer. And those stories give us an entryway into the psychology and the mind of so many of us and what we're all struggling with. With Shelley, I'm intrigued. How is she now perceived by her community that she was the face for having now dieted lost weight it sounds like and may appear different visually how is she now perceived and how does she feel about reconnecting with that community and talking about it with them so as she would say there's a she speaks for herself much better than i can so i don't want to too much ventriloquize her but uh she's a very articulate person i think it's really complicated and i understand why it's complicated some people saw her as a sellout.

51:13And I think Shelley's attitude was, what kind of body positivity would it be that would shame me for keeping my body alive? And there's a big division going on now among body positivity advocates, where they have many good arguments, and it's worth stressing. So if we think about the history of diet drugs, think about the 70s, right? One of the things that one of the first things the fat pride movement did was point out, so there were diet drugs in the 70s that were amphetamines, right? They're hugely popular. There were staggering figures, like more than 10 million amphetamine prescriptions were written in 1970 in this country for weight loss, right?

51:48And it turns out taking loads of speed to lose weight, not a good idea. Who knew? And they had to be taken off the market because it screws you up, right? Partly because you develop tolerance to these drugs, you have to take higher and higher doses to get the same effect. And if you're taking really high doses of speed, as anyone who knows any recreational drug users will know, don't end so well for you. You know, skinny but psychotic is not a great trade-off. Definitely. But maybe for some people it is, but not for me. And so a lot of the fat pride movement very presciently warned at the time, you know, this is really going to screw people up.

52:20Don't do it. Right. And they've been entirely vindicated by that. And it may be, and I think there's a significant chance of this. I don't think it's the most likely option, but I do think it's a significant chance that they'll be vindicated on these drugs as well going this is a big risk right for me especially with the history of my own family what i felt i had to do was weigh two risks and i think that's what most people watching and listening will will this will be the position they're in realistically i was going to remain obese i tried dieting many times i always ended up fatter than I was at the start.

52:58I tried insane and intense diets. I'd gone to diet camps in Austria where they give you tea for a week. I'd done it all, right? Realistically, I was going to carry on being obese to some level. So for me, the choice was what are the risks of continuing to be obese versus what are the risks of these drugs? That is not an easy calculation. There's a lot we don't know. We're learning more and more. There's a lot of detail in the book that I think people don't know about. It's a hard calculation. And I don't know if I've made the right choice for myself. So it may well be there's a significant chance that they will, that their caution about this will be vindicated.

53:38And they're right that, they're also right to say, it's clearly not the case that we're only taking this to deal with health problems, right? And that's true of me as well. There's a significant amount of just relief from the stigma of being fat. Vanity. I like being thinner, right? Because of the culture we live in. Some of that is the health benefits and the risk to my heart, of course. But some of that isn't. A big part of it isn't. We've got a level with people about that. So it's possible that they'll be vindicated. And even if they aren't, we've really got to understand where it comes from if you are soaking up abuse your whole life that cruelty that bullying i totally get you know there's an analogy i always think of which is i'm gay the height of the age crisis when doctors explain to gay men look because of the nature of anal sex and because gay men tend to have a lot more sexual partners than other sexual combinations, this is going to affect gay men much worse than other communities.

54:46So they wanted to, you know, shut down the bathhouses in San Francisco, really warn people, say, while we don't know, you shouldn't have sex, right? And a lot of gay men were like, our whole lives we've been told our sexuality is disgusting, we're diseased, we're evil. And now you come along and tell us this as well. We're going to carry on going to the bathhouses. We're going to carry on. And I get where they're coming from. I might well have been like that myself at the time. But now we realize looking back, well, you have to separate the stigma from the scientific advice, right? There was, I'm sure there were lots of homophobes picking up those arguments and bullying gay people.

55:18Exactly. But equally there was the scientific reality, which is it was much more likely to affect gay people. And lots of those people who refuse that advice, tragically, are not here now because they refused it. So I think, and that doesn't mean that I stand over those people and go, what fools? I totally get it. But I do think we have to, as Shelley says we have to separate out two things we have to separate out the stigmatizing cruel things that are said from things that are just physical think about think about cancer right the leading cancer group in Europe Cancer Research UK explain if you carry excess weight in your body it doesn't just sit there it's not inert it's active right it sends signals through your body and one of those signals is for your cells to divide more rapidly which can cause cancer this is why obesity is one of the biggest causes of cancer in the developed world, right?

56:06That's true even if we got rid of all the stigma in the world, which we passionately should fight to do, it's still going to make you more likely to get cancer, right? We can't... That's not something we can undo with an argument. and therefore we do need to think about this also though i'm very conscious the most important thing we've got to do so people like me are in a shitty trap right you've got to choose risky medical condition risky drug but that is not inevitable and we should not tolerate that being the choice for our children right japan for example right um i can explain how they did it but the key thing to understand is the way one expert put it for me a brilliant man named professor michael lowe at or university in Philly is processed and ultra processed foods dug this hole.

56:51They stole our satiety and the drugs fill it in. The way he put it was, so you've got to see that these drugs are an artificial solution to an artificial problem, right? So we've got to pull back. In addition to the dilemma about the drugs for people like me, we've got to pull back and go, how did we get here? And how do we make sure the next generation of kids are not in that position? And absolutely, this is the dilemma a lot of us fix, but it doesn't have to be the dilemma for our children and grandchildren. And I went to places that have solved this dilemma that show us the way out. So that's the kind of broader argument, which I think is so important to stress as well.

57:24Yeah, absolutely. Before we get to Japan and before we get to those, so the Barclays Bank produced a report to guide investors, and it told them to get out of investing in fast food and ice cream, because those markets are going to tank. Financial advisors are also expecting a decline in the demand for knee and hip replacement. But when you look at investment, I found that fascinating. I'm like, do I believe that fast food is growing or is shrinking? And while I see the rise of organic vegetables, while I see, but still expensive, while I see the rise in people proposing a largely plant-based diet, if not full, but a larger plant-based diet, again, more expensive, harder to access, may be difficult to know what to do.

58:11I don't see fast food shrinking as an industry. Did you see that? Are you seeing that through your research? Were you seeing investment shift and redirect? Or is that a myth as well? Krispy Kreme stock is down. The head of Nestle, Mark Schneider, has been making very nervous noises about their ice cream and confectionery market. So we've got to look at the longer term trend. 47 % of Americans say they want to take these drugs. and there's a big access question at the moment but eight years from now a zempic goes out of patent at that point it will be a daily pill and it'll cost about a dollar a day i would anticipate 47 is an underestimate for how how how many people will take it provided some of the 12 big risks that i wrote back in the book don't blow up which is a real problem yeah i think about jeff parker the guy i just talked about in san francisco everyone like jeff becomes a walking advertisement for the drug everyone goes what happened to jeff he looks completely different my god he's so much healthier so you can see how it creates a huge growth effect.

59:08So you're right, at the moment, we've got two trends. We've got the ongoing explosion of fast food, which is, you know, blowing up and blowing up and is implanted in us from the moment we're born. More three-year-old children in this country know what the McDonald's M means than know their own last name. More people in the world recognize the McDonald's M as a symbol of McDonald's than recognize the cross as a symbol of Christianity, right? So this is really deep in our consciousness. So you've got that huge explosion of fast food, which is growing and growing and growing. And you've got huge numbers of people who want to take these drugs.

59:40Now, one of those trends is going to win, right? So as more and more people take the drugs, we're already seeing the effects. And I think in a way, some of the best predictors are the financial markets. Jefferies Financial, just a big report for the US airlines, saying you're going to have to spend a lot less money on jet fuel pretty soon because a lighter population takes less jet fuel to fly. there's um even just like crazy little things there's been a huge run on jewelers in los angeles um because people's fingers have shrunk so much that they need their wedding bands refitted or think about you mentioned the hip and knee replacements companies that manufacture knee and hip replacements the joints for them their stock is going down because the main driver of knee and hip replacements is obesity and if there's a lot less obesity there's going to be a lot fewer knee and hip replacement operations so i do think we're we're you're right the trend you're seeing, which is the growth of fast food, which only more and more, I mean, thank God when I was a child, you couldn't just push a button on a device and they'd bring McDonald's to you, you had to actually leave your house at least.

1:00:40Can't imagine how overweight I would have become if that had been the case. That trend is driving the other trend as well, right? So they're densely interconnected. Parking shouldn't slow you down. ParkWiz gives every driver a shortcut. Book ahead, save up to 50 % and skip the hassle of circling the block. Park smarter, park faster. ParkWiz. Download the ParkWiz app today and save every time you park. This is Doug Gottlieb for the Doug Gottlieb Show. The Toyota Tundra and Tacoma are designed to outlast and outlive, backed by Toyota's legendary reputation for reliability. Get into Tundra with available iForce Max hybrid engine, delivering exceptional torque and towing capacity.

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1:01:56Take financial possession of your apartment by December 31st, 2025 and save. Discover more at brightviewseniorliving.com. Equal housing opportunity. It's also a big question comes out as, and like you keep saying, like you keep saying, we don't know enough. And I want to talk about the risks now because we've talked about somewhat of how we've got here, the challenges that we're facing mentally, psychologically, societally into why we're in this situation in the first place. But what's fascinating to me is, are a lot of the 12, big 12, which I want to dive into, the big 12 risks and the issues with the drugs, are a lot of them more long-term than short-term?

1:02:40And based on your own personal experience, are the short-term ones tolerable and the long-term ones, the ones that we would consider intolerable and complicated? So I would distinguish between the well-known side effects and these 12 big risks. So there's things like nausea. Almost everyone who takes these drugs feels nauseous at first. Throughout the day? No. Different people have different experiences. So some people have horrible experiences. I interviewed someone called Sunny Newton in Vermont who, you know, she had like, she said it was like there was an alien living inside her and it was like thrashing about and she just wanted to vomit the whole time.

1:03:11I mean, that's rare, but not unheard of. I mean, in the clinical trials, about 5 % of people did just stop because the nausea was so bad. For me, it was like, it was mild. It was like when I would get on the bus or something, I would get a little bit of exaggerated travel sickness. But like, if I'd got that feeling just randomly on a normal day, it wouldn't have stopped me going about my day. It just would have been a bit unpleasant. And after a few months, generally you get it worse the day you take it or the day after and then you're okay for the rest of the week and then again you inject yourself and it gets and and the uh regularity of injecting yourself is it the same for everyone or can you accelerate the dose is there a slower version yeah i mean i should just say because a lot of people get horrified by injection and i am a complete worse i'm the kind of person who when you give me a blood test i like i don't want to look at it i literally look away and say like you know do katie perry songs to pretend it's not happening but um and my singing is not pleasant But it's an EpiPen.

1:04:11It's the tiny, and I wish someone had told me at the start, I didn't know this at first, you can inject yourself in the leg or the stomach. And for some reason, the idea of injecting in your stomach seems to be so horrifying. And for the first month I was injecting in my stomach, it was like, ah, and actually the leg is just the same. I mean, it's literally like the tiniest scratch. It's like a mosquito bite. But are there different doses? Yeah, so everyone starts at 0.25 milligrams is to get you used to the nausea. And the effect is quite mild. And most people go up and up and up. So generally you go up to one milligram.

1:04:42You can go as high as 2.4 milligrams. It would depend on your level of obesity. I think a lot of people are on too high a dose. And who's advising you on that dose? I mean, the official guidance from Novo Nordisk and Eli Lilly, the companies that own it, is, you know, build up to one milligram and then you can go higher if you need greater effects. Because you're self-medicating. You're not self-medicating. I mean, part of the problem is people are buying it online and not actually getting it from a doctor. And that's a really big problem. And that particularly relates to probably my single biggest worry about these drugs.

1:05:12There's a lot, but the thing I'm most concerned about, not for myself, but for the society, is eating disorders. We went into the pandemic with an unprecedentedly high level of eating disorders, probably because of social media and what it's doing to young girls. You'll interview my friend, Jonathan Haidt. He can tell you much more about that and everyone should read his brilliant, amazing work. Then during the pandemic, eating disorders went up even further, which is mind-blowing and what these drugs do is they give you an unprecedented tool to amputate your appetite right and anyone who knows anyone who's got eating disorders imagine i'm sure you do pretty much everyone does they're in a conflict there's the psychological part of them that wants to starve themselves for complex reasons created by the sick culture we have mostly and then there's the biological part of them that wants to live and wants to eat and what these drugs do is they you know if you take them and you're you're in that position they massively empower the part of you that wants to starve yourself so i am and people like dr kimberly dennis who's one of the leading eating disorders experts in britain another person you should interview very wise and brilliant person are really worried about this right my biggest fear is that we could have an opioid like death toll of huge numbers of young girls and unfortunately these disorders do mostly affect young girls whether there are of course some young men and boys i mean i'm really really worried about that.

1:06:35Now, there are things we could do right now, as Dr. Dennis says, we need to, I got them on Zoom, you know, when I got them in Britain initially, in Vegas, I had to go in person. They're meant to check your BMI on Zoom. I mean, good luck with that. Yeah, basically, you are very visibly not eligible for these drugs, right? You clearly have a BMI lower than 27. And yet, I have no doubt you could go on Zoom, literally, your lovely team here could arrange in half an hour, we get a zoom call and you would get it delivered in the, you know, biked over to you today. Right. We need to stop that. As Dr.

1:07:09Dennis says, we should only have in-person prescription and the in-person prescription should be done by doctors who are given clear guidance about how to spot eating disorders and how to prevent the prescription of these things to eating disorders. It's not perfect. People might still buy it online, but it would, it would put at least some barrier that between these drugs and people who should not be getting them at the moment, there is basically no barrier. Is that one of the big risks? Yeah, massive. I mean, if you said to me, what are the risks that most, that's the risk that most worries me for the society.

1:07:40The one that most worries me for myself is quite different.

1:07:49So how would I put it? It's weird, I feel a wave of anxiety as I say it. We don't know the long-term effects of these drugs at all. No one knows. We know they're chronically activating key parts of your brain. so a brilliant expert called Dr Greg Stanward who works on these drugs at Florida State University said to me now he stressed to me he's broadly in favor of these drugs he's considering taking them himself but as a responsible scientist he has to warn people so he gave an analogy I want to be clear he's not suggesting these drugs will have this effect but it's an analogy that helps us to think about it if you look at anti-psychotic drugs if you go back to when they were first given to people in the late 1950s.

1:08:29At the time, doctors judged that the benefits outweighed the risk. It's always been controversial, but they judged that. So loads of people were given antipsychotics for really long periods of time. And it was only, what, 40, 50 years later that they discovered if you take these drugs for decade after decade, you are much more likely to get dementia, Alzheimer's, in fact, all forms of dementia are much more likely. It's not that the doctors were being negligent in the 1950s you just how you couldn't know that right you had to have people taking it for a really long time to know that what could these drugs do over the long term we don't know right um now against that dr sean alivi a brilliant obesity specialist at tulane school at tulane university school of medicine in new orleans said to me well look we don't know the long-term effects of these drugs we do know the long-term effects of obesity and they are very serious.

1:09:22But, you know, I'm 45, right? If you stop taking the drugs for almost everyone, they stop, you just go back to where you were before. And there's a big debate about that. But for most people, that seems to be happening. So I'm assuming I'm going to be taking these drugs for 40 years. That's anxiety provoking. I asked Dr. Clémence Bluet, who's one of the leading obesity specialists at Cambridge University. So what brain areas do these drugs activate? And she talked me through it, the hindbrain and so on. I said, well, what else do those areas of the brain do? She said, oh, well, they memory processing, taste processing, gut motility, like not, it's me speaking now, but not trivial things, right?

1:10:02So for me, that was of the 12, that was the one where I thought, shit. So I'm trying to think of a more eloquent way to say shit, but that was, yeah. Yeah. What's the debate you were saying there about the idea of, if you stop taking these drugs, you go back to the same way you were? What's the debate? So we don't have that much research on it. What the drug companies say is these drugs are like statins. You take statins, it lowers your cholesterol. If you stop taking statins, your cholesterol goes back to what it was. The drugs are not a cure, they're a treatment, an ongoing treatment, right?

1:10:34So they say these drugs are like that. Now, they have a vested interest in saying that. They want you to carry on buying the drugs forever. It would not be good news for them if they discovered that actually you can take the drugs for a short time stop and then you'd stay at the lower weight some people this is anecdotal because we don't have any research on it yet other people are studying it so we'll know in a while like i'll give you an example someone i know took manjaro lost loads of weight interrupted their relationship with junk food started exercising a lot in a way they felt too embarrassed to do when they were obese and has now stopped and seems to be maintaining that lower weight so how many people will there be like that?

1:11:12We don't know. I mean, the early studies we have, we're just looking at if you take it and then stop. But what about motivated people who change, use it as a tool to promote change? We just don't know. How long does it take to measure for us to realize how long do you need to be on it for to have those long-term implications? Like how long will we have to study, research and measure? I mean, when you talk about the medium term effects, I guess it's important to be balanced about this because it's a complicated truth. So a lot of people, a lot of the experts will say, and these are really good scientists and it's a good point, actually we know loads about the medium-term effects of these drugs because diabetics have been taking them for 18, nearly 19 years, right?

1:11:52So for people who don't know, these drugs, in addition to having this effect on your appetite, also stimulate the creation of insulin, which is what diabetics, both type 1 and type 2 diabetics, are lacking. It's why it's a diabetes treatment. And so actually we've got 18 years of data on diabetics. I mean, I'm putting it more crudely than they would, but if the drugs made you grow horns, the diabetics would have grown horns by now, right? And that's a good and important point, and it should give people some degree of security. But some other people say, some other leading experts say, well, hang on.

1:12:28If we're going to base a lot of our confidence on these drugs on the diabetics, let's dig a bit deeper into the diabetics. So to give an example, there's a brilliant scientist called Professor Jean-Luc Fayy, who's at the University Hospital in Montpellier in France. And he was commissioned by the French Medicines Agency to look at the safety of these drugs for the French market. And so he started looking at what's called the preclinical research, which is on animals. And something really took him aback, which is if you give these drugs to rats, they're much more likely to get thyroid cancer. And he's like, huh, OK, let's do some digging.

1:12:59So what he did is they have very, very good medical databases in France. he compared a large number of diabetics who'd been taking these drugs between, I think, 2006 and 2012 with a large number of diabetics who were similar in every other way but hadn't taken these drugs. And what he calculated with his colleagues was if he's right, and it's highly contested, these drugs increase your thyroid cancer risk by between 50 to 75%. And he said to me, well, you've got to understand what it doesn't mean. It doesn't mean if you take the drugs, you have a 50 to 75 % chance of getting thyroid cancer. If that was the case, we'd be having bonfires of Ozempic all over the world.

1:13:36What it means is, if he's right, whatever your thyroid cancer risk was at the start, these drugs increase it by 50 to 75%. Now, thyroid cancer is an overall low risk. 1.2 % of people get it in their lives. 82 % of them survive. So it's a relatively, but it's a big increase in a small risk, right? And I'm very conscious that, A, that you've got to weigh that against just the cancer risk of continuing to be obese. But also, one of the things that really worries me about that is you think about the history of diet drugs. Very often, they began to unravel based on small warnings. So if you think about there was a diet drug in the 90s called fen-fen, the most popular diet drug ever before a Zenpik.

1:14:21So if you look at how it was a combination of two drugs, it was an appetite suppressant called flexfluramine and an amphetamine called fentramine. And it really worked. People who took it got the same level of weight loss as people get on a Zenpik. And people talked about it in a very similar way. Front page of Time magazine was the new miracle weight loss drug, right? Very similar. In 1995, there were 18 million fen-fen prescriptions in this country. It was huge. and then it was discovered a small group of doctors in a in a practice in fargo in north dakota noticed huh um a lot of people using this drug in our practice seem to be uh having trouble breathing wow and so they raised what's called a safety signal it was then investigated it turned out these drugs caused in a lot of people something called primary pulmonary hypertension in a horrific condition where the blood vessels in your lungs contract and you can't breathe it it kills you and it can kill you and if not you're on oxygen the rest of your life it's horrendous so it obviously got withdrawn from the market led to the biggest um payout in the history of pharmaceutical industry 12 billion dollars actually emerged the drug companies had known about this risk all along you look at the stuff the drug companies you know one of the leaked one of the documents that was presented at the civil case was just someone saying, one of the people at the drug company saying, oh, am I going to have to spend my retirement writing compensation checks for silly fat women with lung who can't breathe?

1:15:54I mean, horrendous, right? Now, I want to stress Eli Lilly and Novo Nordisk. I'm very happy to criticize drug companies. I do it a lot, but they are not shysters like those people were. They are reputable drug companies. there's no reason to believe that they're like that but i'm conscious that small things could lead to the whole thing unraveling we need to be vigilant i'm alert to that um it's why if you have thyroid cancer in your family i mean i was gonna say i recommend it doesn't really matter why i recommend the fda recommends don't take the drugs it's not a good idea um are there any others in that line oh loads yeah i mean yeah i mean i would there's all sorts of things all sorts of categories of people I would say shouldn't take it.

1:16:37If your BMI is lower than 27, don't take it. You're incurring all the risks for none of the benefits. If you have thyroid cancer in your family, if you have history of eating disorders, there's a whole array of people who should not be taking it, who currently are taking it. Another big one, which obviously doesn't apply to me, is if you think you might get pregnant. So one of the things that really worries me is we have really no data on what it does to people who are pregnant. Obviously, you're told to not take it if you think you might get pregnant, but people get pregnant in all sorts of ways that you don't expect.

1:17:12So we know rats, when they're given semaglutide, the active component, are much more likely to have children with birth deformities, fetuses with birth deformities. Dr. Stanwood, who I mentioned before at Florida State, said to me, again stressed he's broadly confident but has to alert people to potential concerns because he's a very responsible scientist he said to think about this you might want to look at um the long-term research on mothers who are exposed to contaminants when they're pregnant so think about for example mothers who are exposed to lead this happens scandalously frequently in this country because a lot of poor people still live in housing that still has lead in it and still get water from, we know about Flint, Michigan, but actually in lots of places get water from pipes that are made of lead.

1:18:00It's insane that in the richest country in the world we allow that, the poisoning of children. But anyway, if you look at mothers who are pregnant and get exposed to lead during pregnancy, actually their babies look like all the other babies. It seems like there's no difference. But when those kids get to be 12, 13, we know that they have less impulse control. They're more likely to have attention problems. So it seems to have affected their developmental trajectory, even though that wasn't immediately obvious at first. Could that happen with these drugs? Yes. I mean, it might not. It might affect their trajectory in a positive way.

1:18:30We don't know. Maybe they'll be less likely to become obese. It could have a protective effect on that. But it's just disturbing when you look. It's a really weird feeling to go all around the world interviewing these leading experts, sit with them, and to realize, oh, this is an experiment on millions of people and I'm one of the guinea pigs. Shit, right? It's a weird feeling, right? Yeah, it's amazing. And it makes me angry that we've been put in the position where we have to make these choices. Like I say, there are countries that don't have to make these choices because they didn't allow their population to be f***ed up with processed and ultra processed food in the first place.

1:19:02And that pissed me off. Yeah, yeah. What has been the most horrific ozempic story so far? Most horrific ozempic story? Well, I interviewed people who've gone through rough experiences. There's a, I want to stress, this is very rare, but there's a condition called pancreatitis, which is excruciatingly painful. it's basically where your pancreas doesn't work properly. Doctors compare the pain of pancreatitis to being stabbed. And it makes you nine times more likely to get pancreatitis when you take these drugs. So pancreatitis is very rare, but it's obviously a huge increase in this very rare thing.

1:19:34I interviewed a woman called Michelle Stasiak, who lives in Myrtle Beach in South Carolina, which is a place I only thought existed in country songs until I interviewed her. And Michelle said to me, you know, she went for a Zen pic for weight loss. The doctor said, I don't know if this is rare side effects. One of those pancreatitis. She said, no, my luck, I'll probably get it. And she started taking it, lost loads of weight. Six weeks later, she went to visit a daughter in Pittsburgh. And she woke up, she said, in the most excruciating agony she'd ever been in. She felt like she was being stabbed all over her body.

1:20:04And she was rushed to hospital. And they identified pancreatitis. And the first thing they said was, are you an alcoholic? She said, no. Then they said, are you taking a Zen pic? She was like, yes. So that was probably the person. Michelle said to me, you know, I've had children. It was much worse than the pain of childbirth, right? So, which thank God you and I will never have to go through. But unless you've got something you want to announce, Jay. But there's some real horror stories. And most people are not having these horror stories. Most people are having, I want to be responsible. Most people's experience is more like Jeff Parker or Oprah than it is like, you know, Michelle.

1:20:43Yeah. But that's now. 20 years from now, 30 years from now, 40 years from now, we don't know what the picture will be, which puts us in this difficult position. So we've got some questions from the team that I wanted to refer to. Hello, team. This is the team. So what is your view on when a Zempic should be used for kids, if at all? For me, the debate about a Zempic for kids threw open the whole thing for me because for so many reasons, because it's when you look at kids that you realize how this is a crisis created by the fast food industry, right? And by processed food industry and by the fact that we as a society have allowed that industry to poison our kids, right?

1:21:29Think about where we are in Brooklyn. Try walking around Brooklyn with a kid and them not seeing ads the whole time saying, you don't feel good? Hey, stuff your face with that shit, right? The first thing I want to say is this is a crisis created by them and we need to stop them doing that and we can do that and I went to places that have done it but given that's where we are I think people are in a really tough position because there's so I'm very sympathetic to both sides of that debate so for example I interviewed a really lovely woman called Deborah Tyler who's a nurse in Connecticut um her daughter was very severely obese from when she was very young and um she took her daughter to the doctor when i think she was eight and the doctor said she had liver problems and she's like you imagine when you're being told your child has liver problems at the age of eight and she faced this agonizing decision about whether to put her daughter on ozempic and in the end she decided to do it um and her daughter's liver problems have gone away so i have a lot and she's still are very agonized about it.

1:22:33All the problems are accentuated when it comes to children. I mean, there are benefits. Dr. Giles Yeo, who's one of the leading experts at Cambridge University on obesity, explained to me, if you are obese when you're a child, it is very hard to become unobese. I mean, you're unusual, right? It happens. You're proof of that. There are other people proof of that, but most people don't, right? It's really partly because as you become obese, all sorts of changes happen in your brain that make it very hard to go back that I go through in the book. So there's a case for dealing with it early, right?

1:23:06And we know childhood obesity, I mean, has really devastating impacts on your health throughout your life and radically shortens your life on average. There are other people I have a lot of sympathy for, like Professor Dan Cooper, who's at UC Irvine, who say, well, A, and I can't believe anyone would disagree with this, we need to deal with the underlying causes, but the environmental factors, but B, children are not miniature adults, right? This could affect children in different ways. For example, one of the things children use calories for is bone mineralization. And if you don't have enough calories, maybe your bones don't form properly, maybe they'll become osteoporotic as they get older.

1:23:44So it's really complicated. Novo Nordisk is currently doing a trial on giving these drugs to children as young as six years old. It turns my stomach. it's a sign of a sick society that we've reached this point we need to fix the society but if you're trapped in the choice that deborah tyler is trapped in honestly i think i would probably do what she's done and i would feel as anguished as she does about it so this came up with what you just mentioned now like what is your view on uh oprah's zempic special and what were the benefits and some of the challenges that came from it on people's perspectives so i can't think dispassionately about oprah right like i know everyone loves oprah and kind of oh we love oprah oprah is one of the two or three humans alive who has most influenced me like when i was a kid you remember this when we were kids i remember it so vividly the oprah show would be on at 5 p.m on channel four right and no one in britain when we were kids spoke like oprah right no one spoke about their no one spoke about their emotions no one spoke about in this extraordinary and profound way that oprah does and i really think And one of the reasons I get unwell with Oprah, I think, is because I've so internalised her voice that I sort of, I mean, clearly as a British person, you can't talk like Oprah, but like, well, clearly no one can talk like Oprah, but you know what I mean?

1:24:56Like, so I can't think dispassionately about it because I love her so much and I'm weirdly friends with her, which is like still to me the most surreal. Whenever she emails me or texts me and my friend, I'm always like, shut up, everyone. Oprah needs us. Be quiet. But I thought her special was incredible. um I cried a lot my friend for the minute it started I cried and my friend said thank god Oprah has not brought her show back because if you had this emotional reaction every day you'd be in a psychiatric hospital because just seeing Oprah in front of an audience made me emotional but um I thought it was amazing and I think part of it made me really sad because you think about how much Oprah has given us right how much she's given to the culture people forget you know I mean even just think about the incredible work she did on breaking the taboos around sexual abuse right where what she's done is incredible and i could list like 15 things like that that oprah's done that have transformed the culture and you think all that time she was doing that and rising she was being bullied in the most hateful ways i really recommend people watch and this is someone else who i admire and was a damaged person so i don't want to say this in a spirit of judgment but you can watch it on youtube it's an interview between Oprah and Joan Rivers from, I think, 1985.

1:26:15And I'll preface this by saying, A, Joan Rivers was the funniest comedian I've ever seen. And B, Joan Rivers was someone who hated her own body and was at war with her own body. So she's externalizing something that's an internal, horrifying battle. But it's viscerally shocking when you watch it now. She says to Oprah something like, I haven't watched it in a long time, so I'm going to get the exact wording wrong. but she says something like, you can't be this fat. You need to lose weight. And it's not said as a joke. It's not framed as like, I mean, it would be acceptable as a joke, but it's not even framed as a joke.

1:26:48And you can see Oprah just gets, looks really thrown and makes some joke about herself because what else could she do? But you think, God, that's the Tonight Show. They're on the Tonight Show, right? That's because Joan was the guest host. How many people watch that? 25 million people? That's being brutally shamed in front of 25 million people. You think Oprah's carrying that the whole time she's torturing herself you know that famous the famous image of her with the you know the thing that represents as much fat as she's lost and you think god i feel so sad if you even if you're oprah you get tortured about it right you just you just realize so to see her overcome that and see her looking so well and to see her given a space beyond that stigma i found incredibly moving but that's tied up for me with so many other feelings about oprah that i can't really yeah you know no for sure and do you feel like some of that stigma is now going the other way too right oh you lost weight because of ozempic so then that stigma creeping in have you i think what's happening is a complicated thing just like the drugs interrupt the way we eat and bring to the surface these emotional feelings we didn't know were there i think culturally ozempic is leeching out some deep underlying ideas about obesity so for example I'm a feeling experiencing them to myself.

1:28:07When I was taking the drug, I kept thinking, I'm cheating. I'm doing something wrong. I think that's really weird. One of my best friends takes statins, right? To lower his cholesterol. I've never once thought cheating to get lower cholesterol than me, you'd think I was crazy if I said that, right? I said, it's really weird what's going on here. And I think it lies with, I looked a lot into the history of obesity and how we talk and think about it. So if you look back in the sixth century, the Pope, Pope Gregory I, was the first one to lay out the seven deadly sins. and one of them is gluttony and it's always depicted with like some hugely fat person pigging out it's very deep in our kind of psyches to think of obesity as a sin right and one of the ways you know that is what are the forms of weight loss we admire there's basically only one form and it follows the classic catholic pattern of like the sinner you're a sinner you've got to be tormented, you've got to go through hell and purgatory, and then we'll forgive you.

1:29:03So think about that game show, The World is called The Biggest Loser, repulsive and wicked show, in my view. But it's where people haven't seen it, people are very unwell, very seriously overweight, are humiliated, made to take part in very extreme and in fact, dangerous forms of exercise and starve themselves. And whoever loses the most weight is the biggest loser and therefore wins. it's like oh yeah if you torture yourself and go through agony then we'll forgive you for your sin then we'll go well done good job joe right but i think one of the things that's weird with those them because it's so easy right so it's like i think a lot of people look at it and go well you haven't paid for your sin right you haven't suffered if you suffer we might forgive you suffer with bariatric surgery it's kind of i also think it underlies you think about cheating right In this culture, which makes it so easy to overeat and be obese and so hard to be healthy, lots of people are making daily sacrifices to not gain weight, particularly women.

1:30:04They're starving themselves. They're denying themselves. They're going hungry. They're doing extreme forms of exercise. And I think to them, people like me must look a bit like Lance Armstrong looks to a cyclist. It's what you, you bastard. I work so hard for this and you just inject yourself once in the Lego week and you get the same benefit as me. Screw you. I can see where that impulse comes from. And I think we have to acknowledge those feelings are there. They were there in me. They're there in everyone. I think it's, you can't live in this culture and not absorb those ideas at some level.

1:30:37But then we have to say, okay, well, A, I don't think obese people are sinners. I think we're typical products of this environment. And I'd hope we can move beyond the ideas of a sixth century pope but also in terms of being in a race and competing against each other well we are competing but it's not me against you it's all of us against the forces driving up obesity which are the processed food industry if we reframe it that way we can get out look we live in a as you know very well a toxic age where you know every conversation turns toxic very quickly partly because of social media algorithms which prioritize negativity all sorts of factors that are going on if we want to have a non-toxic conversation about obesity and about a zempic i think we've got to acknowledge those ideas about sin and cheating are there and then we've got to move beyond them well said well said yeah i wonder whether you saw did you dive into any research on investors in fast foods and weight loss drugs did you find any patterns between i didn't but i'd be surprised if and there was some reporting in the washington post which i only read briefly so i don't want to get it wrong but if i remember rightly i suspect i don't know this but i suspect the fast food industry will soon be funding anti-isempic propaganda just like the um tobacco industry used to fund you know claims that smoking isn't bad for you did for years and years or like the oil industry still funds claims that global warming isn't happening or is actually a good thing or you know i would be amazed if that isn't i mean they're going to lose a lot of money and they are some of the most profitable companies in the whole world so i'd be i suspect they're already doing it but i don't know yeah yeah no it's an interesting to think about because i feel like we part of our part of the environment we all live in is somewhat of an illusion and ignorance of not understanding who's behind the narrative storytelling but you know when fast food first came around how did everyone not go wait a minute this is going to ruin the world like how did we not do that or when as you said we're trying to find artificial solutions to artificial problems and now that we're living in an artificial world it's like well where did we allow that to happen and i want to talk about japan in that vein because that was a place where you found that at least tried to deal with this in a much healthier smarter way this completely blew have you been to japan so that's number one on my list right now okay if there's one thing you take away from this conversation.

1:33:03Go to Japan. Go to Japan. I expected it to be great and it massively exceeded my expectations, but it's completely amazing. I'll give you a list of things to do. So Japan is really important because some people say about these drugs, look, if a country gets to be rich, people are going to have more food than they can eat. Obesity is just inevitable, right? And therefore these drugs become inevitable. But actually Japan is the third richest country in the world, in the history of the world. and now is the third rich country in the world. And they have almost no obesity at all. 42.5 % of Americans are obese.

1:33:36It is 4 % of people in Japan, right? There's almost no childhood obesity in Japan. I went to a school in Tokyo, typical middle-class school, went to several schools. It's the weirdest thing, walking around a school with a thousand children and there being not one overweight child anywhere. It's weird if you're used to going to British and American schools. So I wanted to understand, how did Japan do it? Because I remember, first I read about, you know, a Zen pick has been approved in Japan, and there ain't any sales, because there's no one to take it, right? Almost nobody. It's a tiny, tiny market for it.

1:34:13And it's kind of weird that we expect Japanese people to look like sumo wrestlers. It would be like expecting an American to look like a bald eagle. and at first i thought it must just be that japanese people won the genetic lottery right but that's not true we know that because um in the late 19th century lots of japanese people moved to hawaii i was just there and they've been there ever since and japanese hawaiians are almost as overweight as other hawaiians so and it's not that their genes suddenly mutated in 120 years since so something else is going on right there's something in the environment that's that's driving up obesity in our societies and hasn't in Japan.

1:34:48And there's so many fascinating things about this. I went to, the most important to understand is Japan deliberately created an environment in which it is hard to get fat and hard to eat badly. If you go back to the 1920s, Japanese people had one of the worst diets in the world. They only ate protein on average once a week, right? They were quite unwell. They had poor life expectancy. And the Japanese government at the time deliberately transform the society not for a good reason it's because they were they wanted to have an army to go and invade the rest of Asia so we all got our motives for weight loss not the best one uh but you know whatever it worked right and they and and they deliberately created this new new diet and this new way of being which is now continued in policy in Japan um so I went to a school like I say in Tokyo to see how to how does it begin there's lots of layers at which they do this and I was greeted at the door by a woman called Harumi Tatibe who's the nutritionist at this school, Koenji school.

1:35:45Every school by law in Japan has to employ a professional nutritionist. It's a difficult qualification to get, it's three years on top of your teaching qualification. Your job is to design the food that the kids eat, by law the kids can't bring packed lunches, they have to eat what's prepared there and they can only, that food has to be fresh, prepared on the day and have no processed ingredients at all. And then they use this healthy food, which has to contain all the food groups every day to educate the kids about how to make their bodies healthy. So, you know, they're eating this food and Japanese people love food.

1:36:21It's not a place where people deny themselves food. They love it, right? So I'm with this group of kids. They're eating the school lunch, which literally is more like something from Nobu than like anything we ever ate at school, right? And they're eating it. And And I said to these kids through my translator, Chie, I said to these kids, I'll never forget it. The class I think of in particular, there were nine, 10 year olds. I said, what's your favorite food? The first kid said broccoli. I love broccoli. I was like, okay, little freak. So to the next kid, what's your favorite food? She said white fish.

1:36:52I said to the next kid, she said, oh, boiled white rice. And I turned to Chie and I said, are these kids trolling me? Right. Their favorite foods are broccoli and what? At Chie, like all Japanese people could not understand why I was puzzled. and said, well, what do you mean? We teach our kids to eat healthy food. Don't you do that? And every food group they have, they have a rope, a colored rope. So they like, when they're eating the calcium, she yells at the white rope. She goes, this is calcium. What does it do? And someone yells at it, makes your bones strong. And she goes, the red rope, this is carbs.

1:37:22What do they do? Give you energy. And she ties the ropes together in every lesson. And that's a rounded meal that you should have in every meal, right? So they teach kids from a very young age how to nurture their bodies. And I was with these kids and I couldn't help, I couldn't resist the temptation. I pulled up on my phone videos of British and American school meals. And these kids reacted like I had shown them an ISIS beheading video. They like screamed. They were like, what are they said to me? Where are the vegetables? I said, there are no vegetables. They said, where's the salad? I said, there is no salad.

1:37:54They were just completely, it was very touching. One little girl put her hand on my shoulder and said, I'm worried about you. It was completely adorable, right? It begins there. And then all through the society, there are measures taken to make processed food. You can buy it if you want to, but it's very much a minority pursuit. It exists, but it's a tiny part of the Japanese diet, overwhelmingly fish, fresh food, vegetables. Most people eat fresh food that's prepared on the day. And I think probably the most moving conversation I had for the whole book was in Okinawa, which is an archipelago of islands in the south of Japan, where I really saw what you win if you get this right.

1:38:37So Japan has the longest life expectancy in the world. Women live to be 88, men, I think it's 82. But not just that, they have the healthiest lifespan in the world. So the average British person is in poor health. I think it's 16 years before they die. In Japan, it's like a few years. So it's a very different relationship. And so I went to this place that it sounds almost mythical. It's called Ogimi. It's the oldest village in the whole world. It has 215 houses and 192 have someone older than the age of 90 living there. And I went there and I went to, they've got this little community center. And the first person I met, the first woman who walked through the door, was a 102-year-old woman called Matsu Fukuchi, who walked there on her own from her home down the hill.

1:39:23And she said, I can't stay long because I'm looking after my son who fell off the roof fixing it the other day. I was like, Jesus, how old is your son? But okay. Um, and we sat down and we talked and she talked about how much she loved life. It was volleyball season. She was been watching her great grandchildren play volleyball. She actually loved volleyball. You could see how much joy she took in life. Talked to all these old women. And then someone put on some old, um, Okinawa music and she put on a kimono and she started dancing. And so I start dancing with this 102 year old woman. And I thought, wow, you were born before they started doing radio broadcasts in Japan.

1:40:00And here I am dancing with you and recording it on my iPhone. That's what you get if you solve obesity. You don't get destroyed. Clearly not everyone will live to be 102, but you don't get your knees destroyed and your heart destroyed. You get to live and you get more years of joy and more years of laughter and more years of dancing. That's what we get if we solve this crisis. And it is within our grasp to solve it. These drugs are one tool. They are a difficult and controversial tool. And I'm not sure I've made the right decision to carry on taking them. It was the heart benefits that did it for me.

1:40:36But we absolutely can deal with this wider crisis. They've done it in Japan. Think about smoking, right? When we were kids, people smoked everywhere. People smoked on the subway. People smoked on the bus. People smoked on the plane. Doctors used to smoke while they examined you. I remember it happening. There's a photo of me and my mother where she's breastfeeding me when I'm a baby, obviously, smoking and resting the ashtray on my stomach. And when I found this photo a few years ago, I thought she'd feel guilty. I showed it to her. She said, you were a difficult baby. I needed that cigarette, right?

1:41:06But you think about how normal that was then, right? Now, if you saw that, you'd call the police, right? We've gone from, you know, more than 50 % of people were smokers when we were kids. It's now 12%. You very rarely see a young person smoking cigarettes now. Okay, we've got an issue with vaping, but you know, that's an enormous transformation that's happened in our lifetimes through concerted action, right? We can do the same with food. We can free future generations from this shitty choice. Japan showed me you can do it with joy, right? Japanese people aren't sitting there being miserable.

1:41:35They love food. Their food is great. I've never eaten better than in the two and a half weeks I was in Japan, right? Literally never, right? It's not about depriving yourself. It's about making better choices and empowering everyone to be in an environment where we can make better choices. Do they still have a stigma around body shape, size, weight, and all of that as well? Yeah, this is one of the complexities. So I don't want to shy away from it. Japanese people are horrifically stigmatizing towards overweight people. And that informs some of their policies, which are just so strange to us that they sound like a kind of just bizarre parallel universe.

1:42:10let's give you an example so 2008 they had their obesity level went up by like 0.4 percent and they had a massive like national freak out and it was like this huge debate in japan what was it i was from like you know i can't remember it was literally for something like three percent to 3.4 percent or something like saying that like we wouldn't even notice in in the u.s if that happened right um and then this huge debate and they introduced something that i frankly just when i read about it thought this can't be true it's so called the metabo law it's named after metabolic syndrome which is a kind of combination of problems you can get when you're obese this has very bad health effect so they introduced this rule i actually can't even say it without like it just sounded insane in japan every single employee once a year has to be weighed by their employer if your weight has gone up you have to by law drop a plan with your employer to bring your weight down and a company overall has to report its weight levels to the government.

1:43:12And if your overall workforce got fatter, you can be fined by the government. Right. So it's like, how can this work? So I went to this company that does it. Uh, I mean, every company does it, but this is a company that agreed to show me partly because they manufacture, uh, products to keep you healthy. So they, they can't want people to know about it. And they're super nice people, but it was freaky. So you arrive, the first thing you see when you arrive at work is a face recognition thing. It says, hi, Jay, you walked 1 ,300 steps yesterday or whatever, because you have to wear a Fitbit equivalent of Fitbit.

1:43:44And then it says you were number 121 in the company. By the way, Susie, who sits two desks away from you, hasn't weighed herself this week. Tell her to weigh herself. You're like, whoa. So you're encouraged. It's not required, but you're encouraged to take a photograph of every meal you take and post it. So you can literally go, oh, I wonder what Bob who sits next to me ate yesterday. And you can look at it all. It's just bizarre. And I was interviewing people there. So I interviewed the boss, who's this 58 year old man, I have to say incredibly hot boss. And he was like talking about, yeah, this is, you know, this is great.

1:44:21It's really good for everyone. And I was interviewing the employees and they would go, yeah, this really helps me be healthy. And I would kind of go, right so if you did this in the US or Britain we would burn the office building down and they genuinely didn't understand what I'm saying they would kind of go well why they just it was it really was a moment I thought like a profound cultural chasm right I thought this is you're not like us and we're not like as in we can't yeah yeah just as they can't understand us we can't understand that exactly so there are lots of things about the Japanese model I definitely would not I mean we couldn't integrate that even if we wanted to but I if we could I wouldn't want too so there's lots of things about the japanese model we can't integrate including just shame right it's a very particularly to women who are overweight it's really brutal the shaming there so yeah there's lots of things we wouldn't want to integrate and lots of things we would yeah yeah it's one thing that has stayed with me as we've been on this beautiful journey together today i feel like we've you know i've learned so much from you i learned so much from the book i i really want people to read the book to dive into it we've kind of nicely kind of visited different chapters and in different sections and sides of the book.

1:45:28But there's one thing that stayed with me and it's this idea of even after being on Ozempic, if people are unable to change their eating habits, even though they're satiated quicker, does that not necessarily double up on the health problems too? So it inevitably changes your eating patterns in one key way that you eat much less, right? But an issue, and this was definitely true of me for the first six months, is, to put it crudely, I was eating smaller portions of the same old chicken. That's what I mean, yeah. Yeah, so I was going to McDonald's, but instead of getting like a large Big Mac meal and nine nuggets, I was getting a hamburger, right?

1:46:05And that's a move in the right direction, but still very imperfect. As Robert Kushner, one of the scientists who was involved in the studies about these drugs, explained to me, look, there's an issue about nutrition just separate to weight. If you're eating food that doesn't give your body what it needs, even if you're not obese, that's still really bad for you, right? So for me, it made me realize I had to do, I'm super embarrassed to say it, but I didn't know how to cook. I didn't know how to do really basic things. I learned that partly because I realized I had to make that change. But you could, I could have just carried on eating smaller portions.

1:46:36And frankly, I'm on the road at the moment. I am eating smaller portions to say, oh shit, this morning I had a - Travel is impossible. Travel is really tough. Or even try living in Las Vegas. Not ideal. But you're worried about portion size in this country generally, you want to try Vegas. But yeah, so yeah, the issue you're pointed to is real. I mean you're still moving in a positive direction but it can leave you yeah far from from the ideal position yeah yeah absolutely yeah and it's been such a joy talking to you today deeply insightful I appreciate the honesty of just what a challenging nuanced layered subject matter this is and I feel your analysis research and thought through it is actually so so so helpful in that if people are confused in their decision making for themselves their family I think you've at least given them every angle possible to think about, which is I think somewhat sometimes what's missing, right?

1:47:32Sometimes we are just presented a binary angle, which is where we started. And now we're ending today feeling like we can look at this from 12 different angles and 12 different points of view. We end every episode of On Purpose with a fast five or a final five. These have to be answered in one word to one sentence maximum. Okay, this is very hard for me as you can tell. I'm going to do my brutal. These are your final five. You should have someone to, your colleague should taser me if I go beyond the sentence, right? We should, we should wire you up. Exactly. The first question is, what is the best health advice you've ever heard or received?

1:48:04It's what Lindy West said that I quoted before. You can't, it's hard to treat well an object you hate. You've got to learn to love your body. That's great advice. I love that one. Second question. What is the worst advice, health advice you've ever heard or received? I went to an Austrian diet clinic in Klagenfurt where they made me eat nothing but tea for like days and days and days. Yeah. Not good advice. Yeah. Just tea. How did that end up? Tell us. I want to know more. Well, I was surrounded by people. I would go like, so there were people there who'd been there for like three weeks and they were on the tea diet.

1:48:40And I said, how do you feel? And they said, terrible. I was like, yeah, you're going to die. Get out of here. I felt like Jack Nicholson who walked over the cookbook. Get out of here. It's amazing. He's got to buy a brat first up the road. Question number three. What's something that surprised you about this journey that you went on with The Magic Pearl? How hard it is. How complicated. I'm not normally such an even-handed person. It's really complicated. And that surprised you. You thought it would be a lot more clear-cut. I thought every other book I've ever written, I've come to a more firm conclusion at the end than this.

1:49:13You know, with this, it's sort of like, you've really got to go down the list of the risks and benefits for yourself. and it will really help you to know all these risks and benefits. But I can't tell you at the end, and now, dear reader, do it, or don't do it, or do these things. I'm completely failing at these one sentence. No, no, no, it's great. I'm asking you. You're too permissive, James. Yes, exactly. Angry face when I go to be on one sentence. Question number four, if you had to ask people to reflect on three things while they're making their decision, there are many things in the book that they need to read and study, but three things while they're reading the book that you'd like them to reflect on as they're making their own decision what would they be that are not related to bmi or some of those more tactical element and not tactical those tangible elements you shared with us earlier think about what your relationship with food was in your family when you were a child because all sorts of issues around that will come to the surface which we haven't touched on but it's really important number two is think about how important pleasure in food is for you because a lot of people experience a huge reduction in it although I didn't.

1:50:15A lot of people do. Number three is these drugs might be significantly reducing addiction. This is hugely contested, but there are serious scientists who think they are. And that's the whole dimension we need to think about, not just food addiction, but actually like cocaine addiction, fentanyl addiction across the board. Those would, I guess, be the three things that we haven't covered that would be the things, I mean, there's about a hundred things from the book. Yeah, exactly. Yeah. Okay, great. Fifth and final question. If you could create one law that everyone in the world had to follow what would it be oh one law can i get rid of a law oh can the law be yeah you'd be the first person to do i love it the law i would get rid of would be the criminalization of addiction you know a lot of addiction in my family um punishing people who've got addiction problems makes the problem worse most of the money we spend on drug policy in this country is shaming humiliating and literally caging people with addiction problems in portugal when they took all that money they spent on putting people in prison shaming them and humiliating them and spent it instead on like helping them addiction massively fell overdose deaths massively fell we could do the same and we'd get the same results.

1:51:30So it would be, I guess, take the current law on criminalizing addiction and drug use more generally and transfer all that money to helping people instead. Brilliant. You're the first person ever to get rid of a law. Great. Happy days. I'm not normally so libertarian, but there we go. Everyone, the book is called The Magic Bell, The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs. Johan Hari, thank you so much. Make sure you go and grab and order a copy right now. I really, really want this. Make this the book of your book clubs, the book that you're reading with your friends, your family.

1:52:04I think it will, as Johan said, there's so many parts of it that we didn't even get to cover. I hope you'll come back and we'll dissect it a second time. But I really believe that this book is so significantly important at this time, especially, and especially for the younger generations to follow. So highly, highly recommend Magic Pill. Thank you so much. Such a pleasure. Thank you. I really mean it. I feel quite emotional hearing you say that. Thank you so much. I really mean it. I think there's so many things, like you said, that we still haven't covered. And I hope you'll come back to do those.

1:52:34Anytime. Because, yeah, I think this is, it's the biggest thing right now. And especially with the way you've dived into it, when you're talking about just the amount of stigma there is from day one. And it seems to never go. Like you said, even with Oprah, right? It's like whether you're here or you're here. it's like that experience of that stigma doesn't disappear and so if you're living with that for your whole life and it was created by a system that that needs to be addressed and i think you're addressing in a in a really deep and profound way so thank you i think i meant to say my lovely publicist is in the corner so she'll taser me if i don't say this um the anyone who wants to know anything more about the book can go to magic pill book.com they get the audio book which i read the ebook a physical book um and i think i meant to say you can get it from good bookshops or good bookshops but you could also get it from shitty bookshops as well you can get many bookshop at all yeah i've never understood that statement i know it's like a weird it feels weirdly like we don't have like a quality test so let's go order some kfc on uber eats we got some for you i hope that served you and amazing thank you so much i hope you felt of course it was amazing You got to share what you wanted to share.

1:53:48Oh, thanks everyone. Thank you. If you love this episode, you'll enjoy my conversation with Megan Trainor on breaking generational trauma and how to be confident from the inside out. My therapist told me stand in the mirror naked for five minutes. It was already tough for me to love my body, but after the C-section scar with all the stretch marks, now I'm looking at myself like I've been hacked. But day three when I did it, I was like, you know what? Her thighs are cute. Parking shouldn't slow you down. ParkWiz gives every driver a shortcut. Book ahead, save up to 50%, and skip the hassle of circling the block.

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