Motley Fool Money - Ozempic’s Unknowns

Episode Date: June 9, 2024

Nearly half of Americans say they’re willing to pay for weight-loss drugs. But what are the downsides to these so-called “miracle drugs”? Johann Hari is the author of the book, “Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs.” Ricky Mulvey caught up with Hari for a conversation about: The medical magic that makes GLPs so effective Whether online pharmacies can responsibly prescribe these drugs Why there’s a much larger market for these in the US than in other parts of the world To see where you can get a copy of “Magic Pill,” head to: www.magicpillbook.com Host: Ricky Mulvey Guest: Johann Hari Producer: Mary Long Engineer: Tim Sparks Companies discussed: NVO, LLY, ZM Learn more about your ad choices. Visit megaphone.fm/adchoices

Hi everyone, I'm Charlie Cox. Join us on Disney Plus as we talk with the cast and crew of Marvel Television's Daredevil Born Again. What haven't you gotten to do as Daredevil? Being the Avengers. Charlie and Vincent came to play. I get emotional when I think about it. One of the great finale of any episode we've ever done. We are going to play Truth or Daredevil.

What? Oh, boy. Fantastic. You guys go hard, man. Daredevil Born Again, official podcast Tuesdays, and stream season two of Marvel Television's Daredevil Born Again on Disney Plus. It's really important for people to understand this is not a fad, this is not a new diet drug craze. I've heard it described that way.

This is a profound medical breakthrough that will have remarkable effects and whether it'll be better or worse. It's a really important question and disturbingly, the answer is I don't know, despite all the research I did. I'm Mary Long and that's Johann Hari, author of the new book, Magic Pill, the extraordinary benefits and disturbing risks of the new weight loss drugs. My colleague, Ricky Mulvey, caught up with Hari for a conversation about how these drugs work, the problems they solve, and the problems they create. All right, the book is Magic Pill, the extraordinary benefits and disturbing risks of the new weight loss drugs. I'll wreck it at the top to all of our listeners. It's part memoir, part explainer, part investigative journalism. I found it beautifully written and it dramatically affected the way I view obesity, increased my empathy toward it, and then also gave me a great.

understanding of these drugs. So, Johan, thanks for coming on the show and thanks for the book. Oh, I'm really moved by what you just said, Ricky. Thanks. So you've described these weight loss drugs as an artificial solution to an artificial problem. Can you break down the artificial problem for people who are less familiar with it? Maybe have healthy eating habits.

Yeah, I would just say to anyone listening to the podcast, stop for a moment, pause the podcast and Google something for me. I was born in 1979. Just Google photographs of beaches in the United States in the year I was born, 1979. Just go away and do that and then come back. So if you've come back, you will have noticed something a bit strange when you look at those photos. The vast majority of people in them look to us to be skinny or jacked, right? And you look at it and go, where was everyone else on the beach in Miami that day?

Where was everyone else on the beach in Provincetown, right? And then you look at the figures. So in the year I was born, obesity was very, very. low all over the world. Between the year I was born and the year I turned 21, obesity doubled in the United States, then in the next 20 years, severe obesity doubled again. So there's been a staggering explosion of obesity in my lifetime. So you basically have 300,000 years where human beings exist and obesity was very rare, then it ticks up a little bit during the 20th century and then it goes supersonic in the 45 years I've been on earth, right? Why? What happened? We know the

answer, broadly. Obesity explodes everywhere, every country that makes one specific change. It's not where people suddenly become lazy or greedy or lack willpower. It's where people move from mostly eating fresh, healthy foods that are prepared on the day, whole foods, to mostly eating processed and ultra-processed foods, which are constructed out of chemicals in factories and a process that isn't even called cooking. It's called manufacturing food. 67% of the calories the average American child eats in a day now are from ultra-processed foods.

And it turns out this new kind of food affects our bodies really differently to the old kind of food that human beings ate for literally hundreds of thousands of years before us. And there's loads of ways that's the case, but there's an experiment I describe in the book that to me just totally nailed my understanding of this. I've nicknamed it Cheesecake Park. It's not the official name. It was carried out by Dr. Paul Kenny, who's the head of neuroscience at Mount Sinai, New York, a brilliant scientist. He explained to me, he raised a load of rats in a cage, and all they had to eat was the kind of healthy natural food 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 just stop when they were full. They never overate. They never became overweight or obese. When they had the natural food they evolved for, it seemed they had some kind of innate nutritional wisdom that just told them when they'd had enough. Then Professor Kenny introduced them to the American diet, the kind of thing I've been eating all my life. He fried up some bacon, he bought a load of Snickers bars, he bought a cheesecake, and he put it in the cage alongside the healthy food. And the rats went wild for the American diet. They would literally dive their way into the cheesecake and eat their way out and just emerge completely slicked with the cheesecake. And they ate,

and ate and eight and eight. The way Dr. Kenny put it to me is within a few days there were different animals. All that nutritional wisdom they'd had before disappeared, and they quite rapidly all became severely obese. Then Professor Kenny tweaked the experiment again in a way that feels a bit cruel to me as a former KFC addict. He took away all the American food and left them with nothing but the healthy food they'd evolved to have.

And he was sure he knew what would happen. They would eat more of the healthy food than they had before, and that would prove that this kind of food expands the number of calories you eat in a day. That is not what happened, Ricky. What happened was much weirder. Once they'd had the American diet and it was taken away, they refused to eat the healthy food at all. It was like they no longer recognized it as food. It was only when they were literally starving that they finally went back and ate it. Now, I would argue we are all living in a version of Cheesecake Park now. This food is profoundly undermining our ability to ever feel full, to ever feel we've had enough. I go through the

seven reasons why that food affects us in this way. And that's left us with this tremendous crisis because we feel unfull, unsated and hungry much more than human beings did before us. And it leads us to massively overeat. What these drugs do, the new weight loss drugs, is they give you back your sense of fullness, but at a cost, which is why Professor Michael Lowe at Drexel University in Philly describe these drugs to me as an artificial solution to an artificial problem. Yeah, essentially the new processed food, it kind of hijacks our evolution, right? Like, they make the food softer or they have these tremendous spikes in sugar that gives you a ton of energy for a moment and then you crash back down and you feel less full.

The thing that's surprising to me about these drugs, given your previous work on addiction, so for example, if you give smokers a nicotine patch, it only helps a minority of them come off cigarettes. And the conclusion from that may be if you give a, if it's a chemical, it's not just a chemical problem, right? But with food, this seems to be not completely solved, but significantly solved across the board with these new weight loss drugs. Why do you think that is? It's really interesting. It's a really smart and interesting question. And I think the answer is that some of the things are solved and not others. So I just pull back for a second and say, for people who don't know, I'm guessing pretty much everyone knows now, but there has been a

staggering medical breakthrough. As one of the scientists involved, put it to me, we now know what controls appetite, it's gut hormones. So if you take a Zempec and Wagovi, they're basically the same drug, and Markets into different names, you lose on average 15% of your body weight within a year. If you take Munjaro, which is the next in this class of drugs, you lose 21% of your body weight within a year. And for the next, that'll be available next year, known as triple G at the moment, you lose on average 24% of your body weight, which is only slightly below bariatric surgery. And we know how it works. If you ate something now, Ricky, it doesn't matter what it is. After a little while of eating, your pancreas will produce a hormone called GLP1. And GLP1

is part of your body's natural systems going, hey, Ricky, you've had enough. Stop eating. It's the brakes in your gut, basically. But natural GLP1 only stays in your system for a few minutes and then it disappears. What these drugs do is they inject you with an artificial copy of GLP1 that instead of sticking around for a few minutes, it sticks around for a whole week, which has this bizarre effects, obviously, to research these drugs that extraordinary benefits and disturbing risks. I took the drugs myself. I've been taking them for a year and five months in a few days, and I went on this big journey all over the world, from Iceland to Minneapolis to Okinawa to investigate them. But it has this bizarre effect. You just feel very full, very fast.

You eat a small amount and you feel very full and don't want to eat anymore. So you're absolutely right. For the vast majority of people who take these drugs, they lose huge amounts of weight, right? Really remarkable amounts of weight. So I lost 42 pounds in a year, for example. You've gone to a really interesting area in your question, though, which is, so let's think about an analogy. Let's think about people who are addicted to heroin and fentanyl and other forms of opioids.

you can give them something called an opioid blocker, which blocks the effect of those drugs, right? And you think, well, because we believe the issue with addiction is, you know, the issue with heroin addiction is heroin. Your body's tremendous physical desire for heroin. Giving an opioid blocker when they were first demented seemed caused a huge wave of optimism. They're like, oh, well, we're just going to, people, given the opioid blocker, we'll stop using heroin, right? But actually, we discovered it's more complex. What we know about addiction is that while there is certainly a biological contribution, there are changes. that happen in your brain as you become addicted that do make it harder to go back.

We know that the core of it, another different book about this called Chasing the Scream, the core of addiction is about not wanting to be present in your life because your life is too painful a place to be, that the addictive behaviour is a way of numbing pain and distress and not being present, and that's true, whether it's heroin, alcohol, gambling, pornography, whatever it might be. So what we know is if you give heroin people addicted to heroin opio blockers, they will generally reduce their heroin use, but that profound underlying distress will generally emerge in other ways. Often people can actually become suicidal. There's an interesting analogy with these weight loss drugs, and I don't want to overstate it. I want to stress on talking about a minority phenomenon,

but in the book I go through the five reasons why we eat. Only one of them is to sustain our bodies, right? I was eating 3,200 calories a day before I Zemphic and now ate 1,800. And here I am. My body is alive and well. It's in fact healthier. So all those other calories, is something else was going on. The other four reasons why we eat are primarily entirely psychological, right? We eat for complex reasons to manage our emotions, to numb ourselves, to comfort ourselves, and so on. And one of the really interesting things that happened, so obviously I talk about the extraordinary benefits of these drugs in the book, I'm sure we're going to get to them. But I also talk about 12 significant risks. And one of the risks, the one that played out for me a bit,

is, so some, I want to stress this is contested, but some doctors are concerned that a minority of people taking these drugs may become depressed or even suicidal. I don't want to overstate it. I didn't become depressed or suicidal, but the first six months I was taking the drugs, it was kind of weird. I was getting what I wanted. I was losing weight, but I actually didn't feel better. If anything, I felt slightly worse emotionally.

And I had a real epiphany about this in Vegas. I was in Vegas researching something for a different book. I was actually researching the murder of someone that I knew well and loved. So it's obviously a very painful thing to do. And so I felt bad. And obviously on autopilot, really, I went to the branch of KFC on West Sahara. And I ordered what I would have ordered before a Zempec. I'd ordered it a thousand times in that branch of KFC.

I ordered a bucket of fried chicken. And I had one of the chicken drumsticks, and I suddenly realized, oh, I can't eat this, right? you can overeat when you're on a Zempeak. I mean, imagine if I came to you at the end of a massive Thanksgiving dinner and said, great news, Ricky, I bought you a bucket of KFC. You just couldn't eat it, right? You feel like that. And I realized one of the things these drugs do is they interrupt your underlying eating patterns.

Now, that's obviously a really good thing. It's why you lose weight. But what that can do and does do for many people is bring to the surface some of the deep underlying psychological reasons why they ate, just like opioid blockers surface the emotions that you were trying to suppress with heroin use. and quite likely were suppressing with heroin use to some degree, these drugs take away the possibility of doing that and therefore bring this to the surface. That can be a good thing.

There are better ways for me to deal with my sadness than Colonel Sanders, clearly, but that can be a difficult and bumpy process as it is for people who are trying to come off heroin or any form of addictive behavior. Yeah, you mentioned you've been on a Zempic and normally we don't ask guests about their prescription drug use for a major exception for you. I'm not judging you. You've been on it for a comparatively long time. And I've heard that essentially there's plateaus and that it changes the more you take it.

Maybe you build up a tolerance to it. What's your experience been, especially now that you've been on it for more than a year? Tolerance is one of the big questions about these drugs. One of the things that is disconcerting was disconcerting in the research is going around interviewing the leading experts and asking them quite basic questions like these drugs primarily work on the brain, we now know that. You have GLP1 receptors not just in your gut, but in your brain, and it's increasingly clear from being the cutting edge of neuroscientists is affecting your brain. So you say to them, what is it doing to my brain? And they say a very polite

version of, we don't know, or think about tolerance. So here's what we know. The graph for the vast majority of people is pretty similar. You start to take the drug, you gradually increase your dose, and your weight massively falls. And then it hits a plateau at a lower level. which is exactly what you would want, by the way. We wouldn't want a drug that made you endlessly lose weight. That would kill you. Then you plateau and you plateau for about 60 months. Then in the only long-term study we've got, weight seemed to very slightly tick up at the end.

But, I mean, it ticked up to a level that was still vastly lower than where you started. So, of course, I asked the scientists involved. Well, you know, we know that lots of drugs. So some drugs you never develop tolerance to, your body never gets used to them. Antihistamines, for example. You don't seem to develop tolerance to them. Some other drugs think about amphetamins, which used to be used as a diet drug in the 60s and 70s still are incredibly by some people. With amphetamines, anyone has used at amphetamines recreation.

He'll be nodding along here. You need higher and higher doses to get the same effect. It's why they were a really bad diet drug because in the end you had to take such high doses that you became psychotic and skinny, but psychotic is not a great deal. So is it like antihistamines or is it like amphetamines? We don't know. people haven't been taking them for obesity for that long. We do know, of course, diabetics, type 2 diabetics have been taking them for nearly 19 years now. They don't seem to develop tolerance.

They don't need higher and higher doses to control their blood sugar. That's encouraging. If you ask me to guess if we develop tolerance for it, I think the most informed guess I got was from Professor Karel Leroux, who made lots of breakthroughs that were really important for developing these drugs and also works on bariatric surgery and with patients who have bariatric surgery. He said his best guess, he stressed it was a guess, is that it'll probably be like bariatric surgery.

The general pattern with bariatric surgery is you lose an enormous amount of weight after the surgery. You plateau, you remain at a lower weight, and then after a couple of years you tick up a little bit more, but for most people, nowhere near back where they were. He thinks it'll probably be that pattern, but we don't know. So with bariatric surgery, it's the surgical removal of fat. This is a drug solution. There's benefits and costs to either.

Do you think when we look back, you know, five, ten years from now, this will be the benefits of weight loss drugs like Ozympic and Wagovi will be seen as a much better solution? Than bariatric surgery? Yeah, I think that's very likely. I mean, bariatric surgery is a horrendous operation. It's extraordinarily physically gruelling. One in a thousand people die during the surgery. The reason people put themselves through it is for the benefit that you also get with these

drugs, which is staggering. The evidence is overwhelming. If you reverse obesity, you dramatically. dramatically improve health. So if you have bariatric surgery, now bear in mind, people having bariatric surgery by definition are really quite obese. But if you have bariatric surgery and you make it through the operation, 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. We really underestimate how much cancer is driven by obesity. 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 less likely to die, period, of any cause by 40%, which is remarkable. So, yeah, clearly if you can get, I mean, Triple G, the one that will probably be available next year. So just to explain, a Zempik and Wagovi work on one, simulating one gut hormone, GLP1. Mungaro works on two gut hormones, GLP simulates two gut hormones, GLP1 and GIP, which is why you get a much bigger effect, 15% with those Zempik and Wagovi, 21% with Mungaro. G works on three gut hormones. So, you know, we now know there's lots of gut hormones that

affect appetite. That's why there's over 200 of these drugs now in development, and they'll have different side effect profiles. But, you know, the way one scientist put it to me, I think it was Professor Robert Kushner, we've cracked the code, we've found the treasure chest, we figured out what regulates appetite, it's gut hormones. It's really important for people to understand. This is not a fad, this is not a new diet drug craze. I've heard it described that way. This is a profound medical breakthrough that will have remarkable effects and whether it'll be better or worse. It's a really important question and disturbingly, the answer is I don't know, despite all the research I did. The book is called magic pill because there's three ways these drugs could be

magic. The first is the most obvious. They could just solve the problem, right? There are days when it feels like that, Ricky. My whole life I've overeaten. Now I inject myself once a week in the leg. I barely even feel it and I eat dramatically less. And I'm no longer, obese, it's staggering. It feels like magic. The second way it could be magic is much more disturbing. I talk in the book, and I'm sure we're going to go into some of the 12 significant risks associated with these drugs. So the second way it could be magic is that it could be like a magic trick. It could be like the conjurer who shows you a card trick while picking your pocket. It could be that over time, the 12 risks outweigh the benefits. There's a significant chance of

that. The third way it could be magic is I actually think the most likely. It could be think about the stories of magic that we grew up with as kids. Think about like Aladdin. You find the lamp, you rub it, the genie grants your wish, and your wish comes true, but never quite in the way you expected, right? We're already seeing all sorts of unpredictable effects, many of which we can go into. I actually think the third one is the most likely, but I think the most honest answer to your question, will this do more harm than good, or more good than harm?

is the way I think about these drugs is they're a tool-like fire. I mean, this is slightly hyperbolic, but not crazily so. If you said to me, does fire do more good than harm? I'd be like, well, fire's a great thing if I use it to warm my house. It's a terrible thing if I use it to burn your house down. These drugs are going to be staggeringly powerful people like me. I'm older than my grandfather ever got to be. He died of a heart attack when he was 44.

Loads of the men in my family get heart disease. My dad had terrible heart problems. My uncle died of a heart attack. like my grandfather did. These drugs are probably saving my life. If you take these drugs and you had a BMI higher than 27, it lowers your risk of a heart attack by 20% staggering. And that's just one of the many health benefits of reducing or reversing obesity. Equally, there are people with eating disorders who will be killed by these drugs, right? I'm really worried if we don't regulate these drugs, I can explain how we will have an opioid-like death toll of young girls

is overwhelmingly young girls, so some young boys and some older people, but mostly young girls. You know, anyone who's known people with eating disorders knows there's a conflict going on

within them. There's the psychological part of them that wants to starve themselves for all sorts of complicated reasons. And then there's the physical part of them that wants to live and therefore wants to eat. And what these drugs do

is they just amputate your appetite if you take a high dose. There will be lots of young girls who, well, I'm saying this hypothetically, it is in fact happening. There are lots of young girls and people like Dr. Kimberly Dennis, who's one of the leading experts on eating disorders in the United States, warned me about

this. There are young girls who are getting hold of these drugs. And my worry is that they will be able to kill themselves with these drugs in a way they would not have been had they not got the drugs, which is why we need to make, I really urge everyone to contact their electoral representatives to make a very simple change. So I can see you, Ricky, right? We're talking on Riverside or whatever it is, Lancaster. I can see you are not eligible for these drugs, right? You clearly have a BMI lower than 27. I guarantee you you could go, so you should not be given these drugs, right? Doctors are not meant to give it to you. I guarantee you, if you go online this afternoon, you can get an appointment on Zoom, doctors are meant to check your weight, well, how are they doing

that on Zoom? It's ludicrous, you can't. I guarantee that you could get these drugs delivered to you tomorrow if you had the money, right? So what Dr. Dennis and other experts are saying is, we need to have changed that so you can only get these drugs after an inpatient appointment with a doctor who weighs you, checks that you're overweight, and is trained in detecting eating disorders and can divert you for help if that's your problem. So yesterday, I did that. I went on an online pharmacy as a test to see what it would take for me to get weight-lossed drugs prescribed to me.

Basically, I don't want to reveal what it was because I lied about it. It was for an experiment. I tried to essentially say, I'm just trying to lose 10 pounds to see if they would prescribe me Ozempic or Wagovi. They wouldn't. It was another type of medicine that they were still prescribing me, but I realized just how easily I could lie about the information in this because I was sort of filling out my own chart. We've talked about companies that are on the show about companies that are online pharmacies that are prescribing these weight loss drugs. There's been a tremendous amount

of investor excitement around these companies, especially on the prescribing side. But do you think it's even possible for an online pharmacy? Is there any way that they could prescribe these weight loss drugs in a responsible way? No. And I think we're going to look back on it like the opioid crisis, where we now look back and see, although the opioid crisis had complex causes and is sometimes talked about in too simplistic a way. The primary driver of the opioid crisis was in fact profound despair. This is why the leading experts on this, Professor Anne Case and Angus Dayton and call them deaths of despair. But equally plainly, the wildly lacks over, I mean, you know, I hurt my thumb when

I was in Vegas. I went to the doctor and they offered me oxycontin. I'd only slightly hurt my thumb. You know, like everyone knows that opioids were handed out in a crazy, crazily loose way for a long time in the United States with, you know, terrible effects. So, no, there isn't a safe way. You cannot be prescribing these things safely over Zoom. The risk is too great to people with eating disorders and just people who aren't overweight, right?

People who are not overweight taking these drugs are incurring all of the 12 risks and piling other risks. So think about, for example, muscle mass. Muscle mass is the total amount of soft tissue that you have in your body. It's essential for movement, right? Getting out the chair, climbing the stairs, whatever it might be. And naturally as you age, you lose muscle mass. Depressingly from the age of 30, you lose muscle mass. I think it's 8% per decade.

And any form of weight loss, don't matter what it is, also causes a loss of muscle mass. You don't just lose fat mass. When you lose weight, you lose muscle mass. But if you're going into the aging process, artificially thin, you're going in with a very low reserve of muscle mass.

That one causes you a problem when you're 30 or 40, or probably not even when you're 50. But when you get to be 60 or 70, you're really at risk of a condition called sarcopenia, which means poverty of the flesh, which basically where you have such low muscle mass that you really struggle to do anything like get out of a chair, climb the stairs.

So the danger is that this rash of, it's just on a TV show the other day with one of the Real Housewives of New Jersey saying they're all on it. None of them were fat at the start. Indeed, they were skinny at the start. They're taking it to be bone thin. And I don't judge anyone for that.

We make women feel terrible about their bodies in this culture, whatever they do. So I understand the pressure and I understand what comes from. I'm not morally judging them at all. But I'm very worried for their health because they're going to go into the aging process with a very low level of muscle mass.

And we could be setting in place a time bomb of sarcopenia further down the line. But for a lot of people, we're decreasing the risk of heart disease, which is a tremendous killer. Yeah, massive. I mean, you've got to think about Professor Gerald Mande, who designed the food label that's on all food in the United States now at Harvard, his calculation, which is somewhat contested, but I think plausible is that obesity and food-related illnesses cause 680,000 deaths a year in the United States alone, right? We don't think of it that way, your aunt gets cancer and you don't think, oh, obesity killed my aunt.

Your uncle has a stroke, and you don't think obesity killed my uncle. But, you know, it's, of course, not the only cause of these issues, but it's one of the really big ones, right? So, yeah, you're absolutely right. This is, obesity is staggeringly bad for your health on average. And by reducing or reversing obesity, these drugs massively improve health. I want to go to a more optimistic place. You mentioned your trip to Japan. And there are solutions there that some of which we simply, I don't, like, we couldn't

implement in the Western world. I don't think you go to a company, you go to a company where they broadcast what is it? Your coworkers tell you if you need to go weigh yourself for the week or they have these walking competitions. It's so weird. I'll tell you, the one I'm not doing it. I'm not doing five different techniques. It's like they want to include five different cooking techniques in their meals. I don't want to. Johan, I don't want to do that. What do you think we can take from a company like Japan in the Western world, which is really combated obesity in an effective way without these drugs? Yeah, it's kind of weird that our mental picture of Japan is a sumo wrestler because it's basically like expecting an American to look like a bald eagle. There are very few. So, the United States has 42.5% of people who are obese in Japan.

It's 4%. So huge, huge difference. And they have almost no childhood obesity in Japan. And it's interesting. At first, you think, well, that must be genetic, but we know that's not true. So 120 years ago, loads of Japanese people moved to Hawaii, where I was recently. and they've obviously been there now for whatever it's five generations. And Japanese Hawaiians are almost as fat as other Hawaiians, right?

So it's not, and they obviously have genetically mutated in that time, right? The environment is driving it. Japanese Hawaiians are four times more likely to be obese than Japanese people in Japan. So what's going on? Interestingly, it's not just sort of innate to Japanese culture. 120 years ago, Professor Barak Kushner at Cambridge University has written and talked about this. Japan had one of the worst diets in the world. They were really unwell. And actually, the Japanese government decided to radically improve the health of the population. Not for a good reason. It's because they wanted an army to go and invade the attack, the rest of Asia. So not the best motivation for weight loss, but we've all got our reasons. And they really concertedly changed how Japanese people ate. And Japan has lots of policies to build in resistance to process and ultra-processed foods and to compel people to eat healthily. Right. And some of those measures are things, like you say, we would not do. So by law, if you're over the age of 14, this is just so crazy.

But to me, but your employer has to weigh you every year. And if your staff as a company, overall gain weight as a company, you can be fined. So you have to, if you is an individual gain weight, you have to draw up a plan with your employer to lose weight. It's just bizarre. It's so weird talking to Japanese employees about it. And I would say to them, you know, if you did this in the United States, we would burn the office down. And they would. just look puzzled. They'd be like, well, why? It's such a profound cultural gap on that question. But yeah, there's lots of things they do. Every Japanese school has to employ a nutritionist. It's a serious qualification that nutritionist prepares fresh food,

oversees the preparation of fresh food every day. Japanese children never eat processed or ultra-processed food in their schools. They only eat healthy fresh food, and then they use that healthy fresh food to educate the children to like healthy fresh food and to understand what it does for their bodies. we should do that. There is no more precious asset in a country than its children, right? If our children are sick as our children are becoming terribly sick with obesity, that is setting us up for, well, it's a tragedy for the individual child and it's setting themselves up for all sorts

of problems. So absolutely, it is not inevitable. The reason Japan is so important is some people just go, look, obesity is just a quirk of wealth. At the point of which you have enough money, your population will, a significant amount of your population will just overeat. Well, Japan is the third richest country in the world and it has the same level of obesity as Somalia, right? It is not true that obesity is inevitably a product of wealth at all. Japan shows us it's not. We can learn from Japan. It's not a fictional country. It can feel like it sometimes, but it really isn't. Yeah. After going to Japan and seeing how they essentially manage nutrition for kids, how did that affect your views on these weight loss drugs being prescribed to children in the

States. This was for me the most difficult of all the topics. Because adults or kids, when you're thinking about these drugs, you need to weigh two sets of risks. There's the risks of obesity, which are enormous, and then there's the risks of these drugs, some of which are significant and many of which are unknown, which makes them hard to quantify. That's bad enough if I'm making that decision for myself. But if you're making it for a child, then Novo-Nordisk, the company that make Ozambica and Wagovi are currently doing a trial on giving these drugs to children as young as And what's very painful when you see children that young who are obese is unless they have an exceptionally rare genetic condition like Prada Villis Syndrome, which some people do have. I mean, we're talking about, you know, vanishingly tiny numbers of people, unless they're in that category, that is driven by the environment, right?

And it's very painful to go to Japan and realize there's almost no obese children at all and then come back and go to my godson schools here in Britain or go to the schools that I can see in Vegas. and see, you know, in many of them, half the kids are overweight or obese. And you realize, oh, right, this isn't some inevitable thing. This is the product of a sick environment. The Bengali philosopher Krishna-Merti said it's no sign of good health to be well-adjusted to a sick society. So plainly, we should deal with the underlying cause. And that is much easier to do with children because they haven't had the damage that

comes from years and years of being obese. But that's very hard to do as an isolated individual. I interviewed a mind. mother in Connecticut called Deborah Tyler, faced a really wonderful, amorable woman, a nurse, had a terrible choice. Her daughter was obese. She was having liver and kidney problems when she was like eight.

I think I remember that correctly. The details are in the book. She had this agonizing choice. Do I give my daughter a Zempic or do I let her liver go wrong? Because she tried giving her diet and exercise programs, and it wasn't working. And she made the choice for a Zempic. I don't blame Deborah.

She's an admirable person. I suspect in her position I would have done the same. And she's very alert to the fact this is a an environmental problem. She's like, yeah, we need to fix this. It's very hard to fix it at the level of an isolated individual. So, yeah, the issue with kids, and also with kids, the other issue is with kids, it really draws out what the thing of the 12 risks that I write about in the book, the one I'm most worried about for myself. There are ones that I'm more worried about for other people, but for me, the biggest concern for me is we don't know the long-term risks

of these drugs, right? Type 2 diabetics have been taking them for nearly 19 years, but for obesity we've only been taking for a couple of years. And there's an analogy that may or may not apply, but I think is worth thinking about that was alerted to me by Dr. Greg Stanwood at Florida State University, who I want to stress believes these drugs are broadly safe and raise this speculatively, but nonetheless thinks we should think about it. If you go back to, what is it, the late 50s, early 60s, when antipsychotics were first given to people, doctors judge the benefits outweighed the risks, right?

It's always controversial, but that was their judgment at the time. 40, 50 years down the line they discovered, if you take these drugs for a really long time, you're much more likely to get dementia, all forms of dementia, in fact. Now, it's not that they were being negligent back in the 50s and 60s. You just couldn't have known that. You had to have people taking it for 40, 50 years before you could figure that out, right? Now, I'm not suggesting these drugs will cause dementia. There's no reason to think that.

What I'm saying is, it could have some long-term effect that we have no idea what it is, right? We just don't know. Now, that's worrying for me. I'm 45. I hope I live a long time. I'll presumably, I hope I'm halfway through my life, given that the effect of these drugs seems to wear off when you stop taking them for the vast majority of people. I'm guessing I'm going to be taking these drugs for 45 years.

Will I 45 years from now? Be bitterly regretting it. Will someone be digging up this podcast from the ashes of whatever world exists in the broken wreckage of the world in 1945 years from now? And saying, what a fool. He shouldn't have done it, possibly. But the way Dr. Shawna Levy, a leading obesity specialist put it to me, at Tulane University School of Medicine is we don't know the long-term risk of these drugs,

but we do know the long-term risks of obesity, and they are very serious. So I've chosen my set of risks, but lots of people read the benefits and risks that I go through in the book and come to a different conclusion for them, and I totally respect that. Anyone telling you there's a one-size-fits-all solution for this is not leveling with people. I hope my book is a guide so people can think through the risks of obesity, the risks of these drugs, which ones are like to apply to them, the psychological effects, the economic effects. A lot of the books about the economy, what it's going to do to our economy and society. But I have no doubt this is coming for you.

47% of Americans want to take these drugs already. And most of them don't yet know someone like Jeff Parker, who's lost a huge amount of weight. Eight years from now, a Zempe goes out of patent. At that point, it's going to be probably a daily pill. It'll probably be a dollar a day. I think it's an underestimate that half the population will be taking it. So, you know, this is coming for us. we've got to all think about this.

Anyone's interested in the economy. He's got to think about this. It's going to have a staggering transformation analyst for Barclays Bank. So the best comparison for the economic effects is the invention of the smartphone, and I think she's right. If you're interested in learning more about Magic Pill or want to find out where you can get yourself a copy of the audiobook, the e-book, or the physical book,

you can head to MagicPillbook.com. I'll also include a link in the show notes. It's also available at your local bookstore. As always, people in the program may have information. in the stocks they talk about. And The Motley Fool may have formal recommendations for or against, so don't buy or sell stocks based solely on what you hear. I'm Mary Long. Thanks for listening. We'll see you tomorrow.