Big Technology Podcast - How Ozempic Changes Our Bodies, Minds, and Economy — With Johann Hari

Episode Date: September 4, 2024

Johan Hari is a New York Times bestselling author and has a new book, Magic Pill, about his experience with weight loss drugs. Hari joins Big Technology to discuss the impact of Ozempic on our relationship with food and the economy. Tune in to hear how these medications work, their benefits, and their potential risks. We also cover the science behind these drugs, economic implications, and ethical considerations. Hit play for an in-depth conversation on the future of weight loss drugs and their broader societal effects --- Enjoying Big Technology Podcast? Please rate us five stars ⭐⭐⭐⭐⭐ in your podcast app of choice. For weekly updates on the show, sign up for the pod newsletter on LinkedIn: https://www.linkedin.com/newsletters/6901970121829801984/ Want a discount for Big Technology on Substack? Here’s 40% off for the first year: https://tinyurl.com/bigtechnology Questions? Feedback? Write to: [e-mail]

After spending a year plus on OZempic and interviewing its inventors and critics, our guest today shares how the drug might reshape our relationship to food and our economy. All that and more is coming up right after this. Welcome to Big Technology Podcast, a show for cool-headed, nuanced conversation of the tech world and beyond. Today, we're diving into health, specifically about OZempic and the other range of weight-loss pills, weight-loss medicine, is starting to make its way into our society and do it fast. change, really change our relationship with food and change our economy effectively. We're going to talk about how that's going to happen and then also the pros and cons of these

drugs. We're joined today by Yohan Hari. He's a New York Times bestselling author and his new book, Magic Pill of the Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs is out. In any bookstore you could hope for and I've read it. It's a terrific book. Yohan, welcome to the show. Oh, I'm really excited to be with you. Thanks so much. We're going to talk a little bit about the effects of the economy, but I really want people to understand sort of what this drug does and what it's up against. The way that I think we should do that is talking about the cheesecake park or the cheesecake rats. It's an example that you have in your book about basically the way that the food industry addicks us to food that's not really good for us. And there's this story about the rats that basically find themselves gorging themselves on cheesecake and can't stop that, you know, my wife.

and I have now started to take in, we've started to, when we're eating dessert nonstop, we just look at each other and we're like, oh no, cheesecake rat. So what is the cheesecake rat in the cheesecake park? Well, we're in this incredible position. 47% of Americans want to take these new weight loss drugs because they produce an incredible amount of weight loss that I'm sure we're going to unpack. And in a way, when you first hear that, it seems like a kind of mind-blowing moment. The first time in human history, that almost half of us would want to take a drug in order to stop ourselves from eating, right? So you think, well, how did we get here? What happened to us? And actually, understanding how we got here is very important to understanding the later question

of how these drugs work. And I guess the way I would get into explaining the experiment you're alluding to is I would say to everyone, just stop for a moment, pause this podcast, and Google something for me. Google photographs of beaches in the United States in the year I was born 1979 and just look at them for a minute and then come back. So you will have noticed about those beaches, something that seems really strange to us. Everyone in those pictures pretty much looks to us like what we would call skinny, right, or jacked. And you look at it and go, well, huh, where was everyone else on the beach that day in 1979? But it turns out that's just what Americans look like in 1979, right? Obesity was extremely low in the year I was born and it has exploded in my

lifetime. Between the year I was born and the year I turned 21, obesity doubled in the United States and then in the next 20 years severe obesity doubled again. So we're in this bizarre situation. You have human beings exist for about 300,000 years and obesity is very rare. And then from looking at you, I'm guessing you're pretty similar age to me. In our lifetimes, Obesity exploded. Why? What happened? We know the answer, the most important part of the answer. Obesity explodes everywhere that makes one change. It's not where people suddenly lack willpower or become lazy. It's where people move from mostly eating a diet based on whole, fresh foods that they prepare on the day they eat them, to mostly eating a diet of processed and

ultra-processed foods, which are constructed out of chemicals in factories and a process that isn't even known as cooking. It's called manufacturing food. And it turns out this new kind of food that's built out of chemicals affects us in a completely different way to the whole fresh foods that human beings ate the 300,000 years before that. And one of the ways it affects us, one of the most important ways, is processed and ultra-processed food undermines our ability to ever feel full. Our ability to ever feel we've had enough. and then want to stop eating. And I go through loads of evidence for this in my book

and there are many different ways in which processed food has this effect on us. But you allude to an experiment that to me just totally nailed the effect. I nicknamed it Cheesecake Park, and it's not the official title. This is an experiment that was done by a brilliant scientist named Dr. Paul Kenney, who's the head of neuroscience at Mount Sinai in New York.

And Dr. Kenny grew up in Dublin in Ireland and he moved to the United States in the 90s to San Diego to continue his scientific research, do his PhD, in fact. And he quickly noticed, huh, Americans don't eat like Irish people did at the time, right? They ate Americans at the time, ate much more, and now, obviously,

ate much more processed and ultra-processed foods. And like many a good immigrant, Dr. Kenny assimilated and quite quickly became, you know, gained a huge amount of weight. He gained 30 pounds in a year or two. And he started to feel like this food he was eating wasn't just affecting his gut, it was affecting his brain, it was affecting how he felt and what he wanted. So he designed this

experiment to test it. He raised a load of rats in a cage and all they had to eat was the kind of natural whole foods that rats evolved to eat over thousands of years. And when that's all they had, the rats would eat when they were hungry and then they would stop when they were full. They had some kind of natural nutritional wisdom that said, hey guys, you've had enough now. They never became overweight. They never became obese. Then Professor Kenny introduced them to the American diet. The stuff I've been eating all my life too, he fried up some bacon, he bought some Snickers bars. Crucially, he bought a load of cheesecake.

And he put it down alongside the healthy food. And the rats went apeshit for the American diet. I don't know if rats can't go apesh if that's a mixed milk. Yeah, no, you could. The rats went crazy for the American diet. They would dive into the cheesecake and eat their way out and emerge just completely slicked with cheesecake. They ate and ate and ate and ate. The way Dr. Kenny put it to me was,

within a couple of days, they were different animals. That kind of natural nutritional wisdom that they'd had when they had the kind of food they evolved for, vanished, and they all became severely obese. Then Professor Kenny tweet the experiment again. He took away all the American food in a way that feels to me pretty cruel as a former KFC addict, and he left them with nothing but the healthy food

they'd evolved to eat that they'd had when they were growing up. and he was pretty sure he knew what would happen. He thought they would eat more of the healthy food than they had before and this would prove that exposure to junk food expands a number of calories you eat in a day. That is not what happened. Something much weirder happened. Once they'd had the American diet and it was taken away, they refused to eat the healthy food at all.

It was like they no longer recognized it as food. They would rather starve than eat that food. It was only when they were living. literally wasting away that they finally went back to eat it. Now, I would argue we are all living in a version of Cheesecake Park now. We are living in an environment from when we're very young, where we're fed foods that physically change us and undermine our ability to ever feel full and know when to stop eating. And it's not the only thing going on, but it's the key reason why we have this huge obesity crisis and why there is such enormous demand for these new weight loss

drugs. Yes. I feel like whenever I'm just like about to finish a pack of cookies in one sitting, I'm just like, oh yeah, here I am. Cheesecake rat. And I'm curious how they've been able to engineer the food to, I mean, obviously we're going to talk about OZempic as an answer to this. But before we get into that, how have they been able to engineer the food to make us never feel full? Is it intentional or is it just a byproduct of the, type of food that exists when it's manufactured, as you mentioned, versus whole foods. I think the honest answer to the question is a bit complicated. What's definitely not happening is they're not like James Bond villains going, bohaha, how can we make everyone as obese as possible?

That's not happening, right? That would be a stupid way of thinking about it. It's, in some ways, much more simple. If you're the head of a KFC, craft, any of the food companies, you have a fiduciary responsibility to your shareholders to maximize profit. So how do you maximize profit as a food company? You sell as much food as possible, right? So they are constantly figuring out ways to maximize the amount we eat, right? So if there's two foodstuffs, one that makes us feel full and we stop eating after having half of it and one that makes us want to eat five packs of it, they're going to go for the one that has five packs of it.

And I don't blame those individual companies. I mean, they do things that are unethical like employ lobbyists to regular. the rules or advertise to children. There are certainly lots of things I would condemn about them. But actually, it's the job of the rest of the society to regulate those companies, right? Those companies are doing what those companies are meant to do. The democracy needs to do what it's meant to do and regulate them to prevent them from harming our children and screwing up our bodies and harming our health. There's lots of ways in which processed food undermines our sense of fullness, some of which are not by design. So, for example, processed food has a very low amount

a protein in it. Much on average, of course there's some processed foods that have high protein, but on average as a class, processed foods have quite low levels of protein. It's a brilliant scientist at the University of Sydney called Professor David Raubenheimer, who's done a lot of research on this. He's shown, we all know we have hunger for calories, obviously, we all know that. But your body also has a hunger specifically for protein, because your body knows you need protein to do things like build your bones. So if you think about it. about if you have a diet that's dominated by processed foods, as mine has been almost all my life, to get your body needs a certain amount of protein. If you're eating processed foods which are low in

protein, you have to eat a lot more of those processed foods to get the amount of protein your body needs. He's done lots of experiments that show this. If you give people low protein food, they will eat a lot more of it to meet their body's underlying hunger for protein itself. There's loads of factors like that going on here with process and ultra-processed food. I go through them in the book, which explain why it leads us to so massively overeat and why it's so profoundly undermines our sense of satiety, our sense of being sated of having had enough and not wanting more. Right. And it's interesting how you talk about this is what the companies are meant to do and it's the job of societies to regulate them. And that's why I think this is almost as much of an

economic story as a health story. Because you do have these food companies processing food, manufacturing food in a way that make people not feel full and eat as much as possible. So that's one big industry. And then you have the pharmaceutical industry on the other side with their answer and something that can effectively deliver to their shareholders. And that is Ozempic. And not just Ozempic, but a full family of new drugs that is going to help people feel a little bit more full. So you're on it for a year and five months today. I'll say one thing about that because you're not doing this, but I just want to be clear. Sometimes that link that you're presenting is presented as an intentional link, right?

You've got, you know, the food companies making us fat and then the pharmaceutical companies stepping into profit as if they're kind of acting in concert or in collaboration. I want to be clear that is not the case, right? That's not how competing forces work in a capitalist economy. It's just a misunderstanding of what's going on, right? But you're absolutely right. As Professor Michael Lowe put it to me, who's a brilliant expert on hunger at Drexel University in Philly, have been researching this for 40 years.

He said, these new weight loss drugs are an artificial solution to an artificial problem, right? These processed and ultra-processed foods created this extraordinary hole of hunger inside most of us. 67% of the calories the average American child consumes in a day come from processed and ultra-processed foods. Staggering figure, right?

And what these drugs do, and I'm sure we're going to get into how, is they artificially boost your sense of satiety, your sense of fullness. To a degree that is bizarre to me, like, I realize now I had never felt full until I took Ozempic. Not really. I'd felt stuffed, but that was different to feeling full, right? I'd never really felt sated, or perhaps that's an overstatement, I had rarely felt sated until I took a Zen pic in a way that I now feel sated every day, right? So, yeah, this has been a really profound effect yeah and so i'm curious to hear you know we hear a lot about the studies but you like have

looked at the scientific literature and also have taken the pill or the sorry the drugs it's an injection right it's so some people but yeah mostly injections at the moment right so talk a little bit about how ozempic counters this insatiable hunger that we end up being left with from processed foods and what's your experience like been like in the year and five months that you've used ozemps Well, so if you ate something now, it doesn't matter what it is. After a little while, your pancreas will produce a hormone called GLP1, along with some other hormones. And GLP1 is basically your body's natural signals going, hey, buddy, you had enough. Stop eating, right? It's the brakes. But natural GLP1 only stays around in your system for a couple of minutes and

then it's washed away. What these drugs do is they inject you with an artificial copy of GLP1 that instead of sticking around for a few minutes, sticks around. running your system for a whole week, which has this incredible effect. I'll never forget. Second day I took Ozenpick, I was lying in bed, just behind where my laptop is now, if I turn my laptop around, you'd see it. And I woke up, and I thought, huh, I feel something strange, what is it? And I couldn't locate what it was, what I was feeling. And it took me about five minutes to realize I had woken up and I wasn't hungry. That had never happened to me before. And I went to this diner just up the street that I used to go to every morning. I'm slightly

embarrassed to say I ordered the thing I used to get every day, which was a huge chicken mayo sandwich with loads of chicken and mayonnaise in it. And normally I would eat that really quickly and I would still want some potato chips. And I had like three, maybe four mouthfuls of this sandwich and I was full. I just didn't want it. anymore. And that's how it was from then on. I just felt very full, very fast. So what these drugs do is they hugely boost your sense of satiety. And it's really important people to understand. This isn't a gimmick. This isn't a fad. This isn't some new fad diet drug. This is a profound scientific breakthrough. As one of the scientists who played a key role in developing

these drugs said to me, we've cracked the code of what regulates appetite and it's simulating and manipulating gut hormones, right? There are all sorts of gut hormones that are created when you eat. If you inject people with artificial copies of those gut hormones, you massively reduce the amount they eat. It's why I went from eating 3,200 calories a day to about 1,800. It's why I lost 42 pounds in the first year. It's a very, it's a dramatic effect. The average person who takes Ozympic Wagovi, they're the same thing with different labels, loses 15% of their body weight in a year. With Mungaro, so Ozempic and Wagovi work on one gut hormone, GLP 1. Mungaro works on two gut hormones. It's GLP 1 and GIP. The average person who takes

that loses 21% of their body weight in a year. And for Triple G, which will be coming online probably next year, which acts on three gut hormones, the average person loses 24% of their body weight, which is only slightly below bariatric surgery. And there are now more than 200 of these drugs in development, because we know there's over 40 gut hormones that affect appetite. So this is a staggering breakthrough, which will have staggering effects on human health, how we move, how we look, on the economy. You mentioned this at the start, but, you know, Barclays Bank commissioned a very sober-minded financial analyst, Emily Field, to go away and look at these drugs to guide their future investment decisions.

Do they have any implications for our future investments? And she came back and said, if you want a comparison for what these drugs are going to do, you've got to look at the invention of the smartphone. And I think she's absolutely... It's the iPhone in some ways, but sorry, go ahead. Explain how. In some ways, I think it's bigger.

I mean, this is the biggest cause of death in the United States. Obesity. Obesity. Professor Gerald Mann at Harvard calculates that obesity and food-caused illnesses caused 680,000 deaths every year in the United States. We don't usually think of it that way, right? Maybe your aunt died of cancer.

You don't think she was killed by obesity, but obesity massively increases the risk of cancer. Maybe your uncle died of a heart attack. You think, oh, he had a heart attack, but you don't realize obesity, or we know it, but we don't quite put it together as often. Obesity massively increases the risk of heart disease. But obesity increases over 200 known diseases and complications.

either causes or increases, basically everything we fear from stroke to dementia. This is an opportunity to radically reverse that thing that is the biggest killer in our society. By far, I mean, almost 10 times more people are being killed by obesity than by gun violence, for example. And rightly, we talk about gun violence a lot. You know, compare that to how little we talk about obesity. Gun violence is such a good comparison, because there's a lot of gun violence in the U.S. worldwide, I guess no one does it like we do here, unfortunately. Only the Brazilians are matching you, yeah.

Yes. But there's a very strong lobby that says, yeah, you know, a lot of people get killed, but this is important for our businesses. And in the U.S., at least, and I think worldwide, business really holds sway. And I was speaking with someone as an entrepreneur in the pharma industry right before we got on. And there's what this person said, told me 60% of the U.S. GDP is consumption. So what happens when, and by the way, these are the stats he gave me, you have 40% of people in the U.S. that are obese. Two-thirds of people are overweight.

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

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

I mean, think about you mentioned the food companies. The head of Nestle, Mark Schneider, has been making very nervous noises about their confectionery dunking donuts, you know, sorry, crispy cream donuts, rather. Forbes magazine interviewed a load of experts who said that their stock was being downgraded and then their stocks did. I mean, yeah, because OZEPA goes right after their target market. Exactly. Exactly. I mean, literally, I was their target market, at least two of my chins I do to Dunkin' Down at the Supreme. And now I don't need it anymore, right? The loss of my customer loan must have caused some of that plunging stock value. Yeah. And just think about the unpredictable cascading effects. Jeffrey's Financial just did a big report about a year ago to the American airline saying you're going to have to spend a lot less money on jet fuel pretty soon because it takes so much less jet fuel to fly a radically thinner population. And bear in mind, this is the case now when these drugs are extraordinarily expensive in the United States. But eight years from now, a Zempik goes out of patent. At that point, it will be a daily pill. It would be a dollar a day. If the 12 big risks that I warn about in relation to these drugs don't bear out or are not super

bad, then my prediction is that more than half of the population I'll be taking them when it's a daily pill that's a dollar a day. The effects on the economy and the society at that point are enormous. You know, my book is called Magic Pilker. There's three ways these drugs can be magic, right? The first is the most obvious. It could just solve the problem, right? And there are days when it feels like that. I've got to be honest with you. My whole life I've overeaten. Now, once a week, I inject myself in the leg. I don't ever eat anymore. It feels like magic. The second way it could be magic is more disturbing. It could be like a magic trick. It could be like a conjurer who shows you a card trick while picking your pocket, it could be that over time the 12 big risks

associated with these drugs that I describe in the book outweigh the benefits. I do not rule that out. That is perfectly conceivable. But the third way it could be magic is to me actually the most likely. If you think about the classic stories of magic that we grew up with as kids like Aladdin, say, how do they go? You find the lamp, you rub it, the genie appears, your wish is granted and your wish comes true, but never quite in the way you expected. There's all sorts of unpredictable effects. And I think we're going to see that. Some of them will be enormous, some of the anticipated and indeed proven positive effects

are enormous. You know, think about effects on heart disease, reduces your risk of heart disease, heart attack or stroke by 20%, right? That could well save my life. I'm older than my grandfather ever got to be. He died when he was 44 of a heart attack. Loads of the men in my family have heart problems. My dad had terrible heart problems.

My uncle died of a heart attack. For people like us, it could be transformative. At the other end of the spectrum, for people with eating disorders, I really fear it will be lethal. I can go into more detail on that if you want, but I think we did an opioid-like death toll of young girls who use these drugs to starve themselves. It's one of the reasons we need to tighten the regulation around these drugs urgently.

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

out of office this country this the world doesn't tolerate negative growth but we're looking negative growth in the face and i try to not be like i mean i'm definitely trying not to be conspiratorial but like how is society like there it just seems like there are powerful forces that are going to really come in opposition to this stuff and we can't say right now you've got the food industry and you've got farmer so yeah that they'll they'll definitely be friction between those two forces going forward. Let me talk a little bit about how we might happen, how it might happen in the short term. I mean, you mentioned that 2030 is when the patent comes off of OZMPIC, but actually in China, that patents off now. And there are compounding

pharmacies that are effectively putting OZMPIC together on their own, sort of off label. Maybe they add B12 in to say, okay, it's actually something different. And that's where lots of people are getting this drug from. And the only reason that they're able to get it from these compounding pharmacies is because Ozempic right now is on some sort of shortage list, which means that they're able to get it from these supply chains or from these supply chains. And there's a chance within the next couple years that it's going to be removed from those shortage lists. And I'm sure the food industry and all the concern, you know, anyone who's concerned about GDP would want it removed, even though like it's not going to be good for global health.

So what do you think is going to happen on that front? And how impactful do you think it might be if you have, let's say, millions of people taking the effectively the same drug as Ozmpic and then all of a sudden it goes from an affordable drug to what it is now if you want to get it like name brand, which is $1,300 a week? It's $1,300 a month. So $1,300 a month, yeah. Yeah, just to, I would just pull back for a moment. I think it's a really important question.

I would just pull back for a moment and say, I guess a few things. The first is a question of drug prices. As you can tell from my weird downtown abbey accent, I'm in fact British, and I spend a lot of my time in the US, a lot of my time in Britain. And I've got to tell you, it constantly stuns me the degree to which Americans are ripped off when it comes to drug prices. So I buy my ozempic here in Britain. it's the equivalent of $250 a month. When I've had to get it in Vegas a few times,

it's like $1,000 a month, right? It doesn't magically transform as it crosses the Atlantic. This happens for a reason. In the United States, Big Pharma employs armies of lobbyists to rig drug regulation in the United States, right? All drugs, almost without... You don't have to go so far away as Britain

just cross the Canadian border. All drugs are... radically more expensive in the United States than they are in Canada or Mexico, right? Not because the drugs are different. It's because the American political system doesn't work. It's not properly democratic, and it allows the ripping off of American citizens at every stage. By the way, both parties take massive amounts of money from Big Pharma. So that's the first thing you have to say.

Now, there's an issue around these drugs. There's the issue of the benefits of these drugs and the risks of these drugs. I'm sure we're going to dig more into that. and I don't believe everyone who's a wet or obese should be taking these drugs to some people who shouldn't be and I hope my book is a kind of guide to so people can think this through in a very personalized way that's a very good job with that

oh thank you thanks but but but but what I'd say is we're in this nightmare situation where the people who do at the moment only a very small elite of people can access these drugs so we have a situation where the real housewives of New Jersey get to be bone thin while the real school children of New Jersey get diabetic at the age of 12, right?

And the number I heard is that only 2% of obese people or if the obese market is on these GLP drugs, right? These ozympic style of drugs where if you're severely overweight, 20% are doing this bariatric surgery to shrink the stomach. Much riskier, much much riskier. Yeah, I mean, I think there's just a huge issue around that. you raise compounding.

So for people who don't know, yeah, when a drug is, when you can demonstrate a medical need for a drug, but there is a shortage of that drug as there is at the moment. And it's worth explaining why there's a shortage. Every person who takes a Zempeg Wagovi and Manjaro becomes a walking advertisement for that drug, right?

I think a lot about a guy, an interview called Jeff Parker, lovely guy, 67-year-old retired lighting engineer in San Francisco, who was very severely obese. He was in quite a lot of physical pain as a result. it was difficult for him to walk. He had gout. He had liver and kidney problems. He was taking fistfuls of pills every morning. He started to take Manjaro. Actually, he was getting a compounded

version from China, like you say. Lost an enormous amount of weight, came off all his pills, all his medical conditions went into reverse. Now he walks his dog over the Golden Gate Bridge every day and said to me, I feel like I'm going to enjoy my retirement. Now, everyone who knows Jeff looks at him and goes, whoa, what happened to Jeff? He looks completely different. So one of the reasons there's these shortages is that everyone then becomes a walking ad. And so demand, produces demand, produces demand, produces demand, produces demand,

in this cascading effect. So although they have been, Nouveau Nordiscan, Eli Lilly, the companies that make these drugs have been massively, to be fair to them, expanding production. Of course, they want to, they want to make the money. They're racing to get to a finishing line

that's just getting further and further away because the more they race, the more people want it, right? so lots of companies are producing compounded copies of these drugs there's inherently risks in that they're not made in fda labs in austria recently there was a big problem where people bought what they thought was compounded somagletides the active component of these drugs they weren't they went into comas they were horribly injured there's an inherent risk in compounded versions for obvious reasons um but i understand why people are doing it right so yeah there's a um a a tremendous complexity. And I think you're right that big pharma will be pressuring to close those

loopholes pretty soon. I mean, they're already sending out lawyers letters to health spars. And if that happens, I mean, you could abruptly have people thrown off the medicine, whereas they can afford the compounded drug. They cannot afford $1,300 a month. So what happens if you get abruptly tossed off the drug? Well, it's a really important question. So I want to explain what the drug company say, and I want to explain why they're probably right, but we need to take it with a small pinch of salt. What the drug companies say is these drugs are like statins or blood pressure meds. They work for as long as you take them and when you stop taking them they stop working. So you regain the weight pretty rapidly and they have funded studies that a study that seems

to demonstrate. The vast majority of people regain the vast majority of their weight within a year. There's a small pinch of salt in that and of course they have a vested interest in telling us that we have to take them forever because they make money forever. They do seem anecdotally to be some people who take them for a shorter period, use them to radically change their habits, and then seem to stay at a lower weight, although I suspect they're a minority. There'll be more research on this soon.

But, yeah, if you're thrown off, you'll almost certainly regain the weight. Right, and that could be a very big issue. As we see, again, these opposing forces sort of try to jockey for position here. As this drug takes off. It could be worse than that. We don't know. and there's a lot of things we don't know about these drugs. One is, so we know if you gained a load of weight now

and then went on a diet and lost weight, and just through calorie restriction and exercise, so not using these drugs, we know that slows down your metabolism over time. It makes it harder to keep weight off, right? If you yo-yo diet, if you gain weight, lose weight, gain weight, lose weight, it can really wreck your metabolism, so you actually burn calories very slowly.

We don't know if taking these drugs and then coming off them slows down your metabolism probably does most other forms of weight loss do in fact all other forms of weight loss do so um that's another concern as well could you actually end up fatter than you were if you hadn't taken the drug we don't know but it's a concern and one of the things that i found so interesting in your book was just this concept of a set point that your body basically figures out the weight that you are the weight that you should be and if you try to move too far off of it at least you know in terms of the negative it will try to bring you back up to that set point of weight. Well, this is really interesting because, so there's the way people used to

think about this in the 60s and 70s and the way we understand it now. So in the 60s and 70s, scientists thought that your weight was basically set from birth or even in utero, that basically from when you're born, you have a certain fat percentage that's kind of innate to you, right? So think about your temperature set point as an analogy. We have a natural set, body temperature If you go higher than that, your body works very hard to bring it down. It makes you sweat. It makes you really want to get into the shade. If you go lower than that, your body works really hard to bring it up.

It makes you shiver. It makes you seek warmth. And it was thought that, so it's very hard to stay out. Basically, you can't stay outside your safe temperature level, your temperature set point for very long, right? Your body really works to keep you there. And if you do stay out of it for long, you get very unwell. So it was thought that there was something similar with your weight That you had an innate set point

That just sort of regulated You could go a little bit above or a little bit below But it was basically set and regulated And then the obesity crisis happened Mainly starting in the early 1980s The late 70s, early 80s when I was born I'm not blaming myself I'm not like Damien in the Omen

Couldn't cause it But And that seemed to blow set point theory up Right Well what's going on if it's set, if it's innate and biological, how come it changed so much so quickly? But what scientists realized, this is contested, but I think it's quite persuasive, is actually what happens is you do have an innate set point,

but as you gain weight, your set point rises. This is really important for understanding why the alternative to these drugs, diet and exercise, does not produce sustained weight loss for about 85% of people who try it. So let's say that you now gained 40 pounds. and you try to lose that 40 pounds through calorie restriction and exercise. Because your innate set point has risen, your brain is trying to hold you at that higher weight.

All sorts of physical and biological changes will happen in your brain and your body to try to stop you going down. It will slow your metabolism down so you burn calories more slowly. It will make you crave more sugary, salty foods. All sorts of changes happen. And there's lots of evidence for that,

overwhelming evidence about metabolic slowdown for example. And I remember when I first learned that, thinking, well, that can't be true. Because obesity is really bad for your health. Why would evolution endowers with the desire to hold onto a biological mechanisms to hold onto obesity, given that obesity is so bad for us, it's so maladaptive, it doesn't make sense to me. And it was explained to me by Professor Michael Lowe, who I mentioned before at Drexel, the best way of thinking about this, I think, is you've got to think about the circumstances where human beings evolved. In the circumstances where human beings evolved,

the situation we live in now essentially never happened or vanishingly rarely, which is where you have infinite abundant calories all around you, far more than you could consume, and they last your whole life, right? That just never happened. So evolution did not prepare us for that scenario. The scenario that did happen quite frequently that evolution did prepare us for is the exact opposite famine. Famine was very common, right,

in the circumstances where human beings evolved, that it was quite likely there would be a famine in your lifetime. If you think about it in that context, it makes perfect sense that if you gain weight, your body fights to hold on to the weight, right? If there's a famine, the fattest man at the start is the last man standing, right? There was a famine.

The version of me from three years ago, he's going to still be alive at the end, whereas Timothy Shalamee will die in week one, right? And I'll cry over his body, but he'll bury him and we'll have to move on, right? Exactly. Yes. Right.

Exactly. So you can, so you see set point, this innate set point is preparing us for a famine that now is never going to come, right? So that explains why diets don't work. It also explains one theory of this is significantly more contentious. There's a huge debate about what these drugs, so we now know these drugs are primarily working not on your gut but on your brain. You have GLP1 receptors, not just in your gut, but in your gut.

your brain. They're profoundly changing our brains from interviewing the cutting-edge neuroscientists as I did in my book. This is very clear. And it's so disconcerting to interview the leading neuroscientists and you say to them, well, what is it doing to my brain? And they kind of go, yeah, come back and ask us in a few years. We don't really know. But one theory about what it may be doing to the brain is it may be lowering your biological set point. The equivalent of, this is a very crude analogy, I suspect the scientists I interviewed would think it was overly crude, but it's a bit like taking your set point, you know, to the resetting your iPhone to the factory settings, right? It lowers your set point for the duration that you take the drugs. So again, you see the debate

about what causes obesity is intimately related to the debate about how these drugs work in all sorts of fascinating ways. Yep, and you mentioned brain chemistry. That's something that I definitely want to talk about, I also want to talk about whether kids should be taking these drugs. I think the kids, the U.S., at least, has approved kids as young as 12, taking these drugs. And we're going to do that on the other side of this break, back right after this. Hey, everyone, let me tell you about The Hustle Daily Show, a podcast filled with business, tech news, and original stories to keep you in the loop on what's trending. More than two million professionals read the Hustle's daily email for its irreverent and informative takes on business and tech news. Now, they have a daily

podcast called The Hustle Daily Show, where their team of writers break down the biggest business headlines in 15 minutes or less and explain why you should care about them. So, search for the Hustle Daily show and your favorite podcast app, like the one you're using right now. And we're back here on Big Technology Podcast with Johan Hari. He's a New York Time bestselling author. You can grab the new book, Magic Pill, the Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs and a bookstore near you. A great book. I've finished it. I think it's terrific. Let me ask you, this, Johann. You know, one of the things that I think you was really fascinating that you tackle in the book, of course you talk about the risk. Like there's a slight uptick in your risk

in getting thyroid cancer from this, but not a massive. It's not like you're sure to get thyroid cancer if you take this. It's a little bit more of an increase in your risk there. But the thing that really struck me as the risk was you talk about how it could potentially dull people's emotionally a little bit to pleasure and like physical. rewards. For instance, like people start to drink less, but there's concern that it might just make everything in life less pleasurable. Can you talk a little bit about why that might be? So I want to stress this is all the scientists who've expressed this concern, expressed that it's speculative, and we can't be sure. So some scientists have argued that these drugs seem to be

causing depression or even suicidal thoughts in a minority of people who use them. That in itself is contested. It did not persuade the European Medicines Agency, although the FDA in the United States does have a warning about potential suicidal ideation from these drugs. And there's a huge debate about why that might be. Some of it relates to the question about

the brain effects. So a different theory about how these drugs may work in the brain and on the brain is that in your brain you have something called your reward systems. Your reward systems are what motivate you to do anything that propagates life, right?

We eat because we get rewards from it. We have sex because we get rewards from it. We engage in social behaviours because we get rewards from them. They all make the reward centres of the brain hum. One theory about how these drugs work is they may be dampening your reward systems. So it may be that I no longer feel the urge to eat a Big Mac over a salad because I get less reward from the Big Mac than I did before. There does seem to be some evidence that there's lots of people report losing their pleasure in eating.

after taking these drugs, although not everyone, and I actually increased my pleasure in food, but I'm unusual, I can talk about why if you like, but you don't have to think about that problem for long to realize, okay, if it's dampening your reward system for food, is it dampening your reward system more generally? Is it dampening your reward system for, in my case, reading or writing of things I love, right? Would it be doing that? So that's a huge debate. We don't know, is the honest answer. I actually think, though, there's something much more basic

and more easily grasped, actually, that is going on for lots of people. And I felt it happened to me. So for the first six months I was taking the drugs, I mean, it was in this slightly weird position where I was getting what I wanted. I was losing loads of weight.

And all sorts of good things happened. But I actually didn't feel better emotionally. Actually, I felt slightly worse. And it's hard to generalize from any individual. Maybe it's just other stuff that was going on in my life. But I had a real epiphany about this in Vegas where I spend a lot of my time. I was in Vegas. It was seven months into writing the book and I was there.

I was researching the murder of someone that I knew and loved for a different book that I'm writing in. As you can imagine, that was a very painful and difficult thing to do. And so one day I did what I've done a thousand times on auto. pilot, I went to the KFC on West Sahara, and I ordered a bucket of fried chicken, as I would have done before I was taking O'SMPIC. And I had one of the chicken drumsticks, and I suddenly looked at the bucket of chicken, and I thought, oh shit, I can't eat this. And I remember Colonel Sanders was on the wall. It was like he was looking down at me going, hey, what happened to my best customer? I thought we were friends. Exactly. I thought best friends. Talk about a share price

declined. And I had an epiphany in that moment where I realized, so what these drugs do is they interrupt your eating patterns radically. Obviously that's key to how you lose weight and is obviously a good thing in many ways. But there's scientific evidence for five reasons why we eat that I go through in the book. Only one of them is, you know, to sustain our bodies that all the rest are psychological, right? In my case, I realized from when I was very young, how much of my eating was driven by desire to comfort myself, to numb myself, to manage my emotions. And I couldn't eat that way on a Zen pic, right? If you try to overeat on a Zen pic, you will literally vomit.

You can't do it. It would be awful. And so these feelings kind of came to the surface. It was very conscious in my mind. I remember you thinking, oh, you're just going to have to feel like shit today then, right? Right. Now, that can be a good thing. bringing those emotions to the surface can help you find a better way to deal with them

clearly there are better ways to deal with sadness and grief than colonel sanders but some people find worse ways right like they they when they stop having that food addiction they go to alcohol or other things that harm them even more yeah exactly so I think and we know this with other forms of um I often think the best way of understanding the effects of these drugs is actually to compare them to bariatric surgery. People have only been taking these drugs for obesity for a couple of years now, but when it comes to radical weight loss, the most reliable method up to now has been bariatric surgery. Things like stomach stapling, gastric sleeves, gastric bands and so on. So when we look at bariatric surgery, what do we see? I mean,

first thing we know is that it's a fucking horrible operation, right? One in a thousand people die in the operation. It's no joke. It's grim. But why do people go through that? Well, they go through it because they get extraordinary benefits. So bear in mind that they obviously had to be really quite obese to get the surgery in the first place. But if you have bariatric 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. In fact, it's so good for your health that in those seven years, you're 40% less likely to die of at all, of any cause. So we know it has extraordinary benefits. But also we know,

interestingly, after bariatric surgery, your suicide risk almost quadruples. Which is crazy. Which is, I mean, I want to stress it remains low. Suicide is a more risk anyway. But that's a huge increase, right? And you think, well, why would that be? Some of that is possibly the actual physical effects of dealing with the surgery, which, as I say, is grueling. But I think it's much more this kind of thing, right? You can't comfort eat. As Professor Correll-La Rue, who's done a lot of work

on both on biorectuary and on these drugs, said to me, part of it, I think, is a lot of people who are obese tell themselves, if only I was thinner, my life would be great, right? And then you lose all this weight

and your husband's still an asshole and your boss is still a prick. And here you are, right? So I think there's all sort of go through a lot more in the book, but there's all sorts of complicated psychological phenomena that are going on. A lot of women who've been sexually abused, consciously or unconsciously gain a huge amount of weight in the aftermath to make themselves safer.

You're less likely to be sexually assaulted if you're obese, or that it can still happen. It's more rare. And they experience losing weight as actually becoming severely and suddenly vulnerable. There's all sorts of complicated things going on. Right. Yeah. So we have about one minute left.

So I just want to ask you this question quickly and we'd be eager to hear your thoughts on it. And then we can sign off. So here's my question about kids. The US just approved, I think kids, 12 years old can start taking these medicines. Is this a good idea? The debate about children is the thing I find most difficult.

And it takes the core debate about these drugs and dials it up to 20. as far as I'm concerned, because what you have to weigh is two competing risks. The risks of obesity, which are enormous. If you're obese when you're 18 years old, you have a 70% chance of developing diabetes in your life, and diabetes, type 2 diabetes, knocks 15 years off your life on average. And that's one of the effects of being obese. There's more than 200 of them, and they are horrendous. You've got to weigh those risks against the risks of these drugs, which are significant, and particularly with children, the most worrying risk about these drugs,

which is that we don't know the long-term effects of these drugs. No one's been taking them that long. And if you're a six-year-old and you're giving these drugs, and Novo Nordisk is currently doing a trial on giving them to six-year-olds, if you're a six-year-old and you take these drugs, we're presumably saying you're going to take these drugs for 80 years. We have no idea about the long-term effects. So I interviewed parents who have given their children as Empic. I have a lot of feeling for them. It is a horrendous dilemma. What it makes most clear is we should not tolerate our children having to choose between a risky medical condition and a risky drug. We don't have to accept that choice. I went to Japan where there is

no childhood obesity. That's not an overstatement. There is statistically no childhood obesity. I've got to tell you, it's a really weird thing to walk around schools with 1,000 children and realize there is not one fat child in that school. Why is that? It's because they didn't allow processed food to fuck their kids up, right? And I talk in the book about how Japan achieved. That Japan was not a healthy country, 100. 100 years ago, I had one of the worst diets in the world, right? This was done by absolutely concerted government policy. We can do that too. Obviously, we need to do that. But at the moment, we're in a trap, right? And these drugs are a risky, rusty trapdoor. I don't blame any parent who makes any decision on that. We've got to deal with

the wider forces that have got us into this shitty situation. in the first place. And then parents have to make that agonizing choice. I hope my book will help them make a more informed choice, but I really empathize with them because that is the hardest of the hard questions that are brought up in my book, Magic Pill. The book is Magic Pill, the extraordinary benefits and disturbing risks of the new weight loss drugs. You heard a little bit about it here. I really suggest you go and pick it up, whether you're thinking about taking it or whether you're just interested in what the broader effects are going to be. It's a great book. Yohan Hari, thank you so much for joining us. Oh, thank you so much. I meant to say as well,

or my publisher tames me, you can get an audio book as well, which is read by me. If you go to magicvillebook.com, better pretty much anywhere, you can get the book, the physical book, the e-book. I meant to say you can get it from all good bookstores, but you can get it from a lousy bookstores, as well. We don't have a podcast. I've really enjoyed this. What great questions. Thank you. Thank you so much. We'll see you next time on Big Technology Podcast.