Should I Delete That? - Ozempic: miracle or myth? ... with Dr Giles Yeo

Episode Date: February 20, 2025

It’s time to address the elephant in the room - Ozempic. We know that Ozempic will change - and is already changing - the body image landscape. There is so much noise online, in the media and in our personal lives about the so called ‘miracle’ drug - so we decided to call in the help of an expert, to clear up the myths from the facts. Dr Giles Yeo is a professor at the University of Cambridge, whose research focuses on food intake, genetics and obesity. We got him in the studio to answer all the questions we had about Ozempic - to help us understand the science behind the drug that everyone is talking about. You can buy Giles’ latest book Why Calories Don’t Count hereFollow @gilesyeo on Instagram  If you would like to get in touch - you can email us on [e-mail] us on Instagram:@shouldideletethat@em_clarkson@alexlight_ldnShould I Delete That is produced by Faye LawrenceMusic: Dex RoyStudio Manager: Dex RoyTrailers: Sophie RichardsonVideo Editor: Celia GomezSocial Media Manager: Emma-Kirsty Fraser Hosted on Acast. See acast.com/privacy for more information.

Welcome back to Should I Delete That? This week, we've been exploring the drug that is changing the body image landscape as we know it, OZMPIC. There is so much noise around OZNPIC and it's GLP1 counterparts. So as part of this series, we thought it was really important to sit down with an expert to clear up the myths from the facts. So we spoke to Dr. Giles Yo, who's a professor at the University of Cambridge, whose research focuses on food intake, genetics and body weight. He's a leading voice in OZNPIC research. You heard from him in Monday's episode, but this is an extended version of our conversation.

We really hope you enjoy it. Here's Giles. Hi, guys. My name is Giles Yo, and I'm based at the University of Cambridge, where I study the genetics of body weight on one end of the spectrum just happens as in obesity. Can you tell us what is OZMPIC?

So OZMPIC is actually the brand name. of a drug called samaglutide. And Ozympic is the version of the drug that's actually meant to treat type 2 diabetes. Now, it is a, what's the best way to call it? It is a modified, a weaponized gut hormone. So when we eat stuff and stuff flows through our guts, hormones are released.

And the hormones do a number of different things. And one of these hormones is called GLP1. And it does two things. So it's a native natural hormone that comes from your gut. So it does two things. It goes to your pancreas and enhances the secretion of insulin so that for every given gram of sugar that you eat, more insulin goes up. JLP 1 signals to the pancreas for that. The second thing it does, because it's a gut hormone, and we know of over 20 gut hormones, and the vast majority of gut hormones make you feel full. And so it circulates to the blood, signals to the brain, the back of the brain in particular, making you feel full and letting you know how much and what you've just eaten. So that's what the native hormone does. The magic power of semi-glutide is the fact that the drug companies have taken it and have put chemical decorations of it so they stick around the blood for longer. Typically, it gets chopped up in two minutes.

JLP1 goes up, it goes to be very volatile, so it gets chopped up very, very quickly. But now the decoration on this means that semaglutide, Ozempic, the brand, is able to stick around the blood for more than a week, which means that you can do once-weekly injection. And so hence, Ozempic is for treating. type 2 diabetes because it enhances insulin secretion. Wegovi, which is the exactly the same drug but slightly different dosing regime, is the obesity version of the drug because it sticks around for longer, it makes you feel fuller,

you feel full, you eat less, you eat less, you lose weight. So ultimately, that's what OZMPIC slash Wigovi is. So it was originally created for type 2 diabetes. Correct, yeah, but the weight loss was the side effect. Okay. So it was out and then so it's been used for type 2 diabetes. longer than it has been for obesity. How did the FDA go to approve it as a treatment for weight loss?

In what sense, how? Is that an ethical or normal practice for something like this? For a drug that was sort of designed for one thing, would it be, is this a normal situation where the side effect would be something that the FDA would approve? Yeah. Yeah. So for example, I mean, Viagra is one of the most famous ones. Vigres, not even new weight loss, but it was released as something for blood pressure. Okay. But because the side effect was, and so now it was then, therefore, the moment you then,

you have to retrial it. You can't just do it. And then suddenly they go, oh, look, this is the side effect, we're going to approve it. So in order for them to approve it, you need to reset up the whole trial again. You don't have to do the safety because you know it's safe because you've done that bit. But now you've got to say, I am now the company. the company is now testing it for X. And so it was type to diabetes before.

Now he put that aside. And now you can say, well, now we're recruiting people with increased body weight or what have you. Then that's why it's ethical, because you have to reset up the trial and test specifically the question we want, which is body weight. Do you think that celebrities had a hand in making a Zemphics so well known and so commonplace? I think so. I think so. It's an interesting question because very, very, very. Very rarely, do people know the name of drugs?

In fact, I can't think of hardly any other examples. And for whatever reason, for whatever genie in a bottle that was suddenly let loose, I don't know. I mean, it came up. I think there was a TikTok thing. I think it was coupled with the fact that it was famous people, weight loss, which obviously people love to talk about. Plus, I think it was COVID and all of us were sat on our backsides at home, having nothing to do but look at our phones.

So I think there was probably a combination of all these effects that suddenly it lit the fire. I went boom. Because these drugs, this class of drugs, have actually been around for 20 years. So the magic about this is it went from a once daily injection, which has been used for obesity and diabetes as once daily injections for 20 years. And it was only because it suddenly went to once weekly and then this increased effect size, so 15, 20%, that suddenly it took off. So the class of drugs is not new. It's the fact that it's once weekly and the effect size, that's new. do you think and this is probably a hard question to answer do you think that increases its marketability it would have been a hard thing to sell for weight loss as a as a daily drug but as a weekly one it's kind of easier to market and therefore that was kind of taken advantage of oh undoubtedly and if you

look coming down the line as well other drugs that are coming down the line no not yet approved but in trials they're now going to ones monthly so so now suddenly yeah you're right because no one wants to inject. Okay, diabetics inject themselves daily for different reasons. But if you can get to once weekly, if suddenly you can get to once monthly, wouldn't you prefer that rather than have to inject yourself every single day? For sure. But, I mean, you know firsthand how desperate people are to lose weight. Do you really think that would be a barrier to stopping people wanting to take the drug? No, I don't think it would be a huge, a barrier.

because you remember, I don't know if you guys remember this thing called the Skinny Jab, people were talking about it. And the Skinny Jab was the one's daily injection. So it did take off a little bit. It was never as good as the ones weekly. So the skinny jabs, this was Lera glutide rather than semi-glutide. It's almost like one generation behind.

Probably got weight loss just south of 10%. So it was like high single digits. And it was daily injections. So it was there. people sort of understood it and used it and people were marketing it, but just, I think it was the leap of 15 to 20% with ones weekly. It's a big, it's a big deal, big job. That's, that's, no, I think if you were desperate enough to lose weight, you would probably go down this skinny jab route. Thinking back to the celebrity's involvement in the sort of popularity or the, the, the,

rise in awareness, what do you think about Oprah and her admission of taking Ozempic? after having fronted Weight Watchers for such a long time. That's an interesting question. I think Oprah, on balance, I think, did good, so to speak, in terms of talking about it because she was acknowledging that obesity, carrying too much fat, was therefore a disease. And I do think that obesity is a disease, okay? And as a result, sort of tackle the stigma of it being a lifestyle disease. I hate the term lifestyle, a bandword lifestyle, behavioral disease.

And so she tackled it on. Now, I think the Weight Watchers thing is a slightly different scenario, because obviously, you know, that's a group therapy session, almost. That's how it works, really. You know, everyone, group support and everyone goes together. That's how it works. I don't see a conflict there, no. And I think on balance, I think she did a lot of good because she's so famous

and she has such a huge platform that she was therefore able to. So take it on. It says, look, you know, I thought I had a problem. There is a drug available. I'm finding it useful. I'm taking it. So from that perspective, I think that she did good with it. Can I jump in with a question, not a Zen pick?

Just on your language, why do you challenge lifestyle and call it behavioural? Ah, because when you say something as a lifestyle, what is a lifestyle? Lifestyle's a choice. A lifestyle. I like to wear blue jeans versus black jeans. I like to wear trainers versus not. It's a choice. whereas if you actually take diseases which are called lifestyle diseases, type to diabetes, obesity,

that assumes, therefore, that immediately puts on the fact, wait a minute, you're larger because it's your choice, because you have chosen to do it. That's the reason why. It's semantics in very many ways. A lot of people still use the term lifestyle, but I like to sort of just highlight it when the opportunity arises. Because it's not a choice. It's not, I don't think it is a choice, no. I think that's important. It's important. And I think that's why Oprah's admission was jarring for a lot of people because she'd been the spokesperson for weight watchers for so long and she owns a huge stake or did own a huge stake in Weight Watchers. And obviously Weight Watchers and those kind of diet companies,

they're founded on the premise that weight, body size, is the individual's responsibility. It's a personal responsibility. And obviously, OZMPIC kind of negates that personal responsibility somewhat. It takes away the idea that we have to, you know, the idea of Weight Watchers is essentially that it's self-control and willpower. That's what's going to get you to lose weight. And then Ozempic comes and takes that away. So I think I do see a slight, a conflict there with, do you see what I mean?

So I think, I mean, if we get down to brass tax and say, well, how do we then treat obesity? I think there is a spectrum. So obviously there are people who are. a few pounds overweight, that people who are 20 to 30 or 40 pounds away, and there are people who are 150 pounds overweight. Okay, I think at the most severe, severe end, I still think that something like surgery probably still is the answer, the most severe end, because you lose the weight the quickest, and it's permanent, because you replumb your guts. You're not going to roll that out to the entire population, for obvious reasons, it's a major surgery. Then there are

people like, you know, my wife figures I could probably lose a stone or so, which is probably true. No one's going to give me a Zepic. Okay? So I would fit under the behavioral category, where me, it would probably be weight watches or more exercise or whatever. You can imagine going on keto, whatever, okay? Something behavioral in which I would try and do. It's in between that range where I need to lose a stone versus to I need to lose 10 stone. And there are a lot of people that sit there that therefore the drugs make it easier, gives them a leg up in order to try and get that weight off, where actually behavior, diets was just never, ever going to work, certainly not sustainably.

So it depends, I think is the answer. Weight watchers still is very effective for people who need to lose a stone or so. And it should exist and it should still be there. Whereas what the drugs do is sort of segment the population down to how severe the overweight and obesity is. But do we not have the science that says that weight watchers and other, you know, other, well, diets just aren't effective. And they don't create sustained long-term weight loss. Well, ah, so like with any drug, because the same is going to be true for a drug. The drug only works when you're taking it. OZepic only works when you're taking it. The only

thing permanent is surgery, because you've gone and then replumb the guts. Yeah. So Ozempic only works when you're on it, because if you stop it, the weight comes back on. The same thing is true for any intervention. Okay. So people say that 95% of diets don't work. Weight watchers don't work. If they work, people, they would be out of business. This is what people say. 95% of diets we can't stick to. That's the problem. The way to keep it sustainable is you change your lifestyle, your behavior, so that you

end up actually eating something completely different, then you'll keep the weights off. The problem is that is nearly impossible for most people over a lifetime. So it is effective when you're on it. It's just when you stop, the weight will come back on. Yeah. It feels like the diet is the one that's at fault, right? It's not as for not sticking to the diet. I guess it's the diet that fails us.

I mean, there's some diets that are more sustainable than others in terms of for, not environmentally, just in terms of us keeping it, obviously. And by its very definition, if you therefore have to keep going with it in order for your weight to stay off, then anything extreme is not going to work because it's extreme. And you can go on a water fast diet. You'll definitely lose weight, but then you'll also die. So I think ultimately you have to find something that is sustainable for you,

in order to keep the weight to keep the weight off. Can I go back to something you said before about the sort of division of people into different categories? You said no one would give you Ozempic because you'd only have a stone, right? See, the people at the lesser end

who only had like a little bit of weight to lose wouldn't get prescribed it. We are seeing people with less and less weight to lose being prescribed ozempic. They're taking it privately. Okay. So the vast majority of the... So, let's just, in the UK, rather than the United States, which is the Wild West in terms of that.

But in the UK, the nice rules, the NHS, have given some pretty clear rules for these drugs. Ozzypic is not the only drug that's out there. There are a number of other drugs that are out there as well. But in this particular class of drugs, you need to have a BMI body mass index above 35 or a body mass index above 30 with what they call a co-mobility, which means that plus another illness. you'll be in my 30 with diabetes or high blood pressure or high cholesterol or something then you can actually then you can actually get it so it's a very very specific it however people can get it privately and I know a lot of people who do it it's really quite amazing in a country with an NHS the vast the vast majority of people

on these class of drugs in this country is on it privately and what do you think about that I think they are I think there are more or less scrupulous purveyors of these drugs. I'll give you an example. So I think the drug needs to be prescribed. And I think you need line of sight. The physician, the doctor, needs a line of sight to the individual before they get given the drug. And the reason why is these drugs are incredibly powerful.

And they're powerful in a sense where they will work whatever you're starting weight. They'll work whether or not you are 350 pound mass. needing to lose X stone, or a 16-year-old girl weighing, you know, 50 pounds. Okay, so maybe not that light, but a 16-year-old girl. So you will feel full and you will eat less. So they're so powerful, you need to make sure the doctor sees you, looks at you, why do you need the drug, and then give it to you, privately or not. And that's up to people to do.

I did an event for the fitness industry, elevate. You know, at the London Excel, big crowd. Everyone was wearing tight t-shirts and looking very buff. And the event was called Jim or Jab. It's Jim and Jab, by the way. So anyway, Jim or Jab. And I got a stage. And this couple came up, okay, to mean that the lady was a larger lady and her other half.

And they were both on some version of the Dragos. And I was talking to the lady. I was saying, how long have you been on it? Blah, blah, blah. And, you know, and then I turned to her. husband slash partner. Now he was just, he was just a buff guy. Okay. I was looking and I'm going, how long have you been on it? Thinking that, oh, you know, maybe he's been on it for half a year, blah, blah, blah, blah. You know, he says, I just lied about my weight. I'm taking it to lean up.

Like, so that it shouldn't chap. I don't think it should happen because because it is a powerful drug. It is an effective drug. But I think it should be treated as a drug, which means it needs to be prescribed to the people who need it to cure a disease rather than to lean up, rather than as a cosmetic tool. For this episode, we saw if we could try and get it, how easy it would be. Have you tried? It's incredibly easy. I know.

I'm nine months pregnant, and I could order it online. I know. It's nuts. I know. Yeah. So that feels a bit frightening. The only criteria that I came up against was a picture of my weight on the scales. So I went on TikTok and I found a woman stepping on the scales,

screenshotsed it, put that in. Shut up. I got approved. It's crazy. You can get it on these apps to your house. You can get it delivered to your house. Do you know, here's the problem that I really have with this. Look, I study how the drug works.

That's in terms of in Cambridge. That's one of the things which I do. I study how the drug works. We map where it signals to in the brain and things like that. So I understand how the drug works. It should, it's powerful. it should be used, it's going to help a lot of people. The problem is this kind of stuff, it's going to get someone killed.

And if someone gets killed, then suddenly a wonderful, and I'll use the word wonderful tool that can help a lot of people having a very tough time trying to lose weight. We'll suddenly get pulled off the shelf because it's suddenly, we need to really get a grip. It's a drug. It's a drug. It's not a freaking, you know, cosmetic tool. It's a drug and it should be treated as such. Can I ask about the marketing of it then?

Because it is, whether or not by the brand, the sort of public conversation around it has meant that in lots of ways it's felt cosmetic. It's felt like something that people are using as a cosmetic announcement. So that is a very interesting thing. So last years, or was it, as Oscars? Whatever. The last Oscars that actually happened. Yeah.

So the two main players at the moment in the space are Novo Nodisk. The Danish company, they make semaglutite, Ozampic slash Wegovi, and Eli Lilly. Now, Eli Lilly make Munjarro and Zepbound, and once again, they have the major competitors, and an American company. And what happened was clearly Lily were trying to needle Novo, because in the lead up to, like seriously, in the lead up to, to the Oscars being on, you know, they had a little advert, what have you, red carpet, whatever, and it says, you know, Eli Lilly, our drug is not meant for the red carpet. No names mentioned, no names mentioned, needle, needle, needle. So I think you're right.

I think whether or not by choice, and I don't think it's by choice, I think it's a situation where people have begun to use it as a cosmetic thing. I mean, that's where, certainly that's where the celebrity nature of it. actually comes from you know i don't think novenot is specifically in fact i know they don't they don't go out and say that this is a you know they wouldn't they wouldn't okay but but if you get sort of celebrities using it and putting it on ticot then ultimately you that's it that's the advertisement and that's what then people people listen to and that's what people hear well and that's what i wanted to ask whether you you worry that ozempic will get into the wrong hand i mean it's undoubtedly

already in the wrong hands, you know, people, vulnerable people with eating disorders. And where you see this going from here, because it feels like it's not slowing down the craze. It feels like if anything, it's gaining more and more momentum. And we're starting to say it with people in our own private circles, you know, it's not just celebrities anymore. It's like the average people in our lives and, you know, people that aren't, that wouldn't fit, you know, the obese critic criteria. Do you worry about where it's, going where the landscape is what do you how do you foresee it i think we need to have a balance i think we need to have balance because like as i said i think that it this drug is going to save a lot of

lives okay these drugs these drugs or the entire class are going to save a lot of lives they're going to really give people the necessary tools i've been in this business for nearly 30 years We have not ever had this many tools in order to be able to reduce the burden of obesity in a long, long time. So we have to understand that. But that doesn't mean that we don't, that doesn't mean that we take off the guardrails. I think if we play a mind game, some fantasy mind game, will we ever get to, like, for example, for example, paracetamol. Okay. Now, we know that if we take too many paracetamoles, you're going to take, right?

Oh, you have to take no more than six and 24 hours, whatever rules are, and we all read the back. And we know that if I take a whole, I can injure myself if I take a whole tub of it. But yet I can go to a, you know, a drugstore and actually get it. We give it to our kids, okay, as scalphole or what have you. So we've got to the stage now that we're comfortable that there is this drug where if I took the whole bottle, I would need to go get my stomach pumped at the hospital. But yet I don't. And I can go to boots or whatever.

and take it. So will we ever get to that stage with this drug? Let's imagine that we can. Okay, I'm not saying we are, please. I'm not saying we are. If we get to that stage, is this a bad thing? I think just as a middle game, right? I don't think it is if we get to that stage. I'm not saying we, I'm not saying we will. So back to your original question. I think we need to still consider it a drug. We need to really get a handle on this. try and make sure that it only gets to the right hands. That's what I think it should do. And maybe it requires legislation. I don't know. Is it the company's job? Is it the government's job? It depends which country I guess you're in. But I think it's just make sure we stay

just on the right side of the line when it comes to these drugs, because otherwise it could get out of hand. Speaking specifically about the UK, is there, with private medicine, is there a governing body that regulates private medicine and enforces like the criteria for his MPEC has to be BMI of 35. Is there a governing body or is it just a free? Is it just the Wild West? The NHS restrictions with regards to 30, a BMI 30 and a comorbidacy 35 is so that you prescribe and get it on a NHS, which means that someone pays for it, okay, for you. If it's private, then as long then the then the then it's up to the doctor it's their discretion okay it's at their discretion in order to prescribe what they think to you this is this is this is how why it's

going at the moment that feels scary and it is just very very unusual in a in the UK for this to happen because typically the vast the vast majority of us go to the NHS to get our drugs okay right the vast majority of us do heart transplants, cancer drugs, we go to the NHS and get them. This is a very unusual situation where the vast majority of people taking these drugs are doing it privately. We know that it's incredibly expensive. It's not that expensive.

Long term for the average person, it would probably come at a cost that they wouldn't normally, like you say, take on privately. It does feel big in terms of that. It's a commitment. like you say, you've got to stay on it if you want to see the effects of it. So people are making a big financial commitment when they do this. That a lot of people don't, you know, it's a sacrifice. They're sacrificing one thing perhaps to afford this.

It is unusual, as you say. Why do you think there is this boom? Because it's body weight. Yeah. Because it's body weight. Because it's how you look. I mean, be that a reflection of society that we're actually in at the moment, it's because it's body weight.

And, like, what does it mean to have obesity? I think it's an interesting question to actually ask, okay? And if it's purely body weight, in other words, then it's just a number on a scale, right? So in other words, if BMI above 30 means that you have obesity, and that tends to be the clinical description, then all it is is a number on scale. And I think that's not the right answer. I think that obesity is carrying too much fat that it begins to influence your health, which, by definition means as a disease because it's influencing your health. The question to ask is how much fat is too much fat? Aha. Now here's the complexity because as it turns out, each of us can

store different amounts of fat safely. So for example, East Asian people, people that look like me, South Asian people, Indians, Pakistanis, Bangladeshis, we can't get as large as compared to white people compared to Polynesians, for example, before increasing a risk for type to diabetes. So I don't have to get anywhere close to BMI 30 to increase my risk for diabetes, okay, because I can store less fat safely than some other people, which means that what we should be doing is understanding and the individual in front of us. I said, well, how close are you to your safe fat-carrying capacity? And therefore, we shouldn't be treating people just on BMI, but we should be treating people who are ill, or at least we can predict are going to get ill if we don't

actually prevent that from happening, which would mean that there are going to be some people who are BMI 32, but actually metabolically, healthy as an ox. And so maybe shouldn't get a Zepic because then it would be a cosmetic reason, right? Whereas if your goal is to say, well, I want to stop my diabetes, I want to stop, reduce my high blood pressure or cholesterol or this or that or the other, well then yes, I think you should be given the drug because therefore that's treating the disease underlying your heavierness, if you see what I'm saying. Heavierness, I don't think that's a word, but anyway. It's interesting to hear you say that.

It's good to hear, it's good to hear an expert saying that, saying that we can't, you know, it's not a blanket rule of your BMI is this much, therefore you are unhealthy, because that's what are, that's what, that's the premise on which our medical system is predicated. So it's, it's, at the population level, on average, it's true. On average, the heavier you are, the higher BMI, the more likely you are to be unhealthy at the population level. But as an individual, you know, famously, you know, if you're a rugby player or something, you know, if you're very muscular, well, then you're going to have an obese BMI. And, and whereas if you are, you are, you are, You can be skinny, but have no muscle mass on you at all, and you can be ill.

That's one element of it. But then there's also the safe fat carrying capacity, which goes beyond just being muscular. It has to do with your internal biology and how you store fat. Can I ask a personal question? Please. Have you ever tried Ozemic? No. No.

Okay. Why? Why, have you? No, no, no. I've just wondered if you're in your capacity as, you know, it's through the research, if you'd ever tried it and then you could talk from personal experience. I don't know.

I think if I was you and I'd been working so closely with it, I'd be like, I need to know. This is why you can't work in medicine. I'm so tempted. I'd just try, I'd be trying everything. You've been a worst doctor. Self-experimentation. One for you, one for me.

I don't know, I know. People have, literally, people have been super open about the effects. side effects of ozempic. Can you explain what the most common ones are? Okay. So the most common side effects of this whole class of drugs is not only ozempic. Okay, I just want to be clear. Have to do with the biology of the system. Okay. So what do gut hormones do? Remember, it's a gut hormones. So gut hormones, broadly speaking, regulate the speed at which food moves through your food to poop tube, your gastroattestinal tract. Okay. So clearly you need to make sure that

food is shuffling through at the right rate so that you're digesting and removing the stuff that you need to do and then stuff comes out the other side. Okay, that's important. Equally, it's also important that you get rid of any toxins that are suddenly in you. So, number one side effect, feeling puky. And the reason is because if you've got food poisoning, and we've had food poisoning before, you've got to eat in a bad prawn, okay, and suddenly you run to the loo explosively, both directions. The reason that happens is because your gut hormones suddenly spike, including GLP 1, all right? And so this is the biology. So it'll spike so you go there. Now, imagine, we know people who are slightly, I know you're pregnant, so this is a different scenario,

but there are people who are slightly puky than others, just just feeling a little bit ill, probably because they're more sensitive to these gut hormones. So imagine if you're just slightly more sensitive, then you're taking a drug, so suddenly you feel a bit puky. Side effect number one. Side effect number two, because it has to do with the speed of food going through the tube, then the other side effect is either too fast or too slow. Okay, so diarrhea or constipation, that's side effect number two. And those are going to be the most common ones. They're not, most of the people who take the trials, finish the trials.

So it can't be that bad, I guess it's the point. But it is relatively, it's rare but not, it's not super common, but it's not super rare. and those are the two main side effects. So faster, too fast or too slow through the south side and feeling puky, those that are those that are side effects. People are being quite open about having the side effects, but pushing through anyway. And they deem the weight loss worth it. Why do you think that?

Because it's weight. Because it's so difficult to, I think it has to depend on how bad it makes you feel. Okay. At some point, like, if you feel really sick, you can't push through that. No one can push through being really sick or most people can't because it's so deeply unpleasant. Okay. If, however, in fact, let me just change a different way of thinking about it. So imagine if you are the spectrum, okay, in which you're eating, and you obviously can be hungry, you can be not so hungry, you can be comfortably full, you can be really full. You can be really full. you can be oh my god I feel like puking full okay and there's a full spectrum a large part of that is the gut hormones and so can you imagine where actually you are able to take it to the uncomfortably full section which means that so that is a side effect already uncomfortably full and these drugs can sometimes make you feel uncomfortably full and what then happens is you end up backing off your food more and then you actually end up losing more weight so that kind of thing I can I can imagine

put through. If, however, you take it and suddenly you explosively puky, there's no way you'll stick to it. It just won't happen. I keep hearing sulphur burps. What are they? What? Sulfur burps. People, on Ozmpic, burping and it tastes and smells apparently like sulphur. Okay, from first, I have never heard of the term, but if we work on it from first principles because it has to do with regulating the speed of stuff that's actually coming through if your food is not moving through as quickly then maybe you have food that's slightly more digested closer to the top you know like when you puke it doesn't smell nice right and and so you can imagine a situation i've never heard of this before but you can imagine a situation

where therefore if you got food that is inappropriately digested at the wrong part how you can get weird smells that actually come through. There's another side effect. Have you heard of those Zempic babies? Babies. Or Zempic babies? No. So what happens is when you are on an oral contraceptive, which many women are on, it is absolutely crucial.

The way that it works is that the drug, the hormone, is delivered to the right part of the gut at the right time, released at the right concentration, so that it suppresses your reproductive system. If you suddenly change the rules of the game where things moving too fast or too slow, suddenly you're just a little bit off. And so women who have been on contraceptive has suddenly got pregnant because they're contraceptive and are suddenly on a Zempec. So they're not being delivered. So now I think people are beginning to understand that actually if you have any sort of gastrointestinal issues in addition to being like being on these drugs, then you should move away from oral contraceptives and go into an injectable con. Because you solve that problem

by injectable contraceptives because then you don't rely on the gut. But obviously, the easiest way to take a contraceptive is orally because then you don't have to inject yourself. So, ozepic babies? That seems like a big side effect. Thinking, again, we know long term, well, no, we don't know. I don't know. I imagine you know more about the long-term effects. So, I'll answer in two questions. So the class of drugs, so in other words, these weaponized modified gut hormones, because they've been in use for a good 20 years already, it is likely to be relatively safe, okay? Side effects notwithstanding what we're talking about.

The big difference is these are once weekly and they've really only been released a few years. So kinetically, which means that how the drug, the content, concentration of the drug behaves in your bloodstream does change. And so it is true that we do need to make sure we have a good look. We within the field, the people who are looking at the safety of the drugs, we do need to make sure that in the longer term, they're safe. I mean, it is a big reason why initially the NHS have only approved OSEPIC to be prescribed for two years. Now, this is on the NHS. Clearly, privately is a different story. And that's because the trials have only been for two years and we know that it's safe for two years. So as more and

more people are on the drug and we get a better idea, we will have a better idea about the long-term safety profile of this specific, of these specific type of once weekly injections. But the class of drugs do appear to be safe because they've been in use for 20 years. Okay. So the answer is we don't know. We don't know. We can kind of make it informed guess. It's likely, no, no, we don't know. So we do need to know. And that is another big reason why it should still stay on prescription. I mean, what about the, there's been reports that 18 deaths have now been linked to taking, in the UK, have now been linked to taking these injections. And we hear about potential, you know, side effects, like the side effects, right word? Yeah, like gastroporesis, pancreatitis,

I've even heard that it can increase your likelihood to get a Bezoa. You know, when you have a ball of undigested feet, stuck in your tummy. What about all of these? We've got the feeling sick and having diarrhea, but what about these more serious potential consequences? So there are going to be more serious potential concentration, more serious potential side effects, but are just incredibly rare.

And by definition, they're rare because, so the reason why we're seeing them now, it's because I don't know of millions yet, but certainly tens of millions will be on this drug pretty damn soon, okay? Which means that the rare side effects will suddenly begin to rear its head. Now, how much of it is because they're slightly, for lack of a better term, allergic to the drug, that's not, that's kind of me just, I'm putting it in quotes because I don't think it's that kind of allergy.

But you are going to have people who respond very badly to something, but that's going to be true to a lot for a lot of stuff as well. I think you need, and the drug companies have, their eyes, beady eyes opener, trust me. Like, like, I mean, there are rarest side effects that have appeared both positive and negative. I mean, there are, for example, let's go with a negative first. There's getting hints of rare cases of people with a little bit of suicidal ideation,

which is obviously not a good thing, okay, for that, very rare. But I think this is related as well, okay, where there people have found that actually if you want to quit smoking or quit drinking or quit drugs, being on Ozympic or equivalent makes it easier to stop. They're now trialling for this. Why? I don't know the answer why, but I can imagine. So now opinion, I'm just giving you an opinion about why rather than what I know. For many people, for most people, eating feels nice.

Okay, that's, like sex feels nice, eating feels nice. Okay, there are things which tickle the part of your bread. Oh, delicious chocolate. But imagine if you suddenly take away the edge of that pleasure because you make yourself feel fuller. Because this is what these drugs do. They make you feel fuller. And you know that the moment you feel full, you enjoy the food less by its very definition. It's when you're really hungry that the food is really delicious. So if you suddenly make yourself feel fuller all the time chronically because you're on the drug, you no longer have that acute for lack of a better term.

high. Now, I know people who are slightly more depressive than others. I am a perennial optimist, so it's not me. But they're going to be people who are slightly depressive. Imagine if someone is a little bit on the spectrum of being slightly depressive and you take a bit of the edge of, then you can figure maybe that tilts someone into that area a bit quicker. On the other side, if you've taken away that little bit of a joy, then maybe you don't get the same joy from smoking. maybe you don't get the same joy from from having a you know drinking alcohol and you need to and you need to stop and so it's it's an interesting time the more and more millions of people go on it will be able to unpick this it's now being trialled for treatment of Alzheimer's how to freaking hell does that work okay but it looks very good the trial data looks very very good it's being trialed for for any number of different things so I think they're going to be and these are all side effects quote unquote like the weight loss was a side of effect, originally, these are all side effects. Some are going to be positive, some are going to be negative, and we really need to parse these. We need to really have a good, close look

and understand how this all works. But yes, they're going to be positives and negatives to this whole story. But you don't necessarily foresee it as a, I mean, and I guess all you can give is your opinion on this, but you remember like that diet drug, fen, fen. That's very different. That was very different. So that one, so that one was a situation where the side effects were because the drug were not reaching, were reaching other places that it wasn't meant to be reaching, okay? Because Fen is a small molecule drug that targets other receptors. So in other words, this is a modified version of a normal hormone. And what happens is the normal hormone, it just keeps in around your blood for longer. The normal hormone self-homes to the receptor. It automatically

goes to the normal place it's supposed to go to. It just sticks around the blood for longer. So it's not going to be that kind of fend, fan scenarios, because it's a different type of drug. You don't see it being taken off the market all of a sudden because of... No, no. Do I... Will I say never? No, I won't say never, right? So I do think we need to watch.

Things have been removed for under less weird situations, right? I don't think so from first principles because of trying to understand how the system, how the system works. It's not impossible, of course, depending on the situation. But no, I don't foresee it happening

based on first principles. You've said that OZMPIC or its counterparts are good for some people. They are objectively a good thing for some people. Many people. For many people. With that in mind, do you envisage their treatment, them using this as a treatment as something that they will need to do for the rest of their lives?

Is that kind of the expectation of professionals in this space when it comes to these drugs? I think it is the expectation that, the majority of people that start these drugs will be on it for a pretty long time. Can I ask about what happens if the drug is successful, if you need to, if we're speaking in very binary term for the BMI here, if you have a BMI of let's say 40 and you take it because you are obese, you need to lose weight, you then get into the healthy range over a long time and you end up with a BMI of like, I don't know, 24,

you're in a healthy range. You would no longer meet the criteria for being allowed OZMPIC on the NHS. What happens then? At the moment, the drug's taken off and you gain the way back. That seems terrible. Sorry.

No, no, no, but you're right. It is, right? Because let's take, you're absolutely right, but that's because we're trying to get our head around how we treat this. So just as an example, let's take something which many of us does it's not that foreign to many of us because we know people on it

or maybe you are on it high blood pressure medication okay I know lots of people on high blood pressure medication and the moment you start on high blood pressure medication you have to stay on it because the moment you stop it your blood pressure is no longer normal by its very definition that's how it drugs but high blood pressure is weird not weird high blood pressure doesn't accumulate right Your blood pressure doesn't increase to pop

And it doesn't decrease to you die Okay, it stays at the rate that it's supposed to stay Body weight is very different Because you can have a little bit more And you start gaining weight Because it accumulates on you If you have a little bit less than what you need Then you start losing weight

That's how it works, right? So it is going to be a balance Okay, of when you You either ratchet down the dose Because you remember, these drugs do not come as one dose most of them come in three or four different doses in which you go up and for some people they'll never reach the maximum dose

they'll just hover around the middle or maybe the stay at the lowest dose so there is room for maneuver but if you are going to be losing too much weight then you're going to be pulled off the drug you are you're going to be pulled off the drug and then you can start and stop I mean it's bad and it's good

it's bad in a sense where well I don't want to gain all the weight back again but it's good in a sense where you just stop because there's no permanent effect But the mental health ramifications, like we can't, we, we can, it's easy enough to speak about this in a very like, abstract fashion. Yeah. And also very scientific and just thinking about BMI. But the consequences of being overweight, of being obese, of, of yo-yo dieting, of your weight going up and down, of fluctuations, we know that that causes an effect on self-esteem, self-worth, on mental health in general. Is, is that not quite a risky thing that we're doing with? people? So I think it's a cost-benefit analysis. I do think that the drug should come with full wraparound care, which means that you shouldn't just give the drug to someone, which is

back to my point. It should be prescribed. But it should be prescribed, not an isolation, but come with a whole suite of other things, including dietary improvements, including probably exercise to maintain muscle mass. And just to understand the system. Okay, from a purely scientific perspective, your risk from being too heavy, from carrying too much fat, there's an area under the curve, which means that the more you spend at that too much fat range, the longer the problems you have with your health. And the more time you can spend at close to healthy range, the longer you add, you add time at the end of your life, health span at the end of your life. Okay. So ultimately, actually, it's probably, it's better to have been on the drug, even if it's only for a few years,

there never to be on the have happened on the drug at all. From a purely, from a purely scientific perspective, your mental health point is very well taken. And I do think that that's why it does need to be, your doctor needs to understand and says, okay, well, look, you're losing too much weight or you're in a healthy range. Why don't we either take down the dose

or why don't we stop for six months? And let's see what happens. Okay? If you feel you're getting too much weight, please come back to us, and then maybe we'll have to see something, do something about it, maybe restart it again.

And I think that for some people, that is going to be the case, where when you reach the maintenance weight, what do you do? Will there be some people who are able to shift to a purely behavioral approach? I think so, okay? I think so because it depends who you are, right? It depends how your new habits. You know how we're very habitual creatures. If we've been on the drug for two years and suddenly when I cook a meal and we follow a recipe, But because I've been eating less, I have reduced all of the component parts of this dish, whatever the dish I'm making.

And suddenly you get used to only cooking this amount of food. If you come off the drug, will you continue just, because you've now memorized the recipe for your chicken dish or something, you know, would you end up just cooking that smaller amount of meal? Some people probably will. Okay, I mean, we'll have to, we'll have to see. So this is going to be very, very personalized. For some people, this is not going to be a problem. for other people it is because their mental health

is going to come into play then we'll have to treat it as such would there be a worry then that again just thinking about the criteria thinking about the state of the NHS as it is and yes in an ideal world we do have wraparound care but we don't live in an ideal world

so if we get to the point where Azoenp has done a GLP one drug whatever it is has done its job it's been successful you've lost the way you're signed off by your doctor because you no longer fit the criteria, but then you start either putting the weight back on or feeling very, I don't know, body dysmorphia,

feeling very confused, feeling whatever, there may be long-term, because like you say, we don't know the long-term effects. The worry then surely is that these people are forced to go private to access the drug. So this is going to be true. I just want to add one more little element of consideration to this. These drugs have a limited patent life.

Okay. Okay, so semaglutide, Uzampic slash Vigo comes off patent in 232. What does that mean? While on patent, only the company who make the drug can make the drug while it's on patent,

and therefore they can charge what they want. Okay? They have to be in competition with somewhere else, and so market forces take a play. The moment it comes off patent, it means that anyone can make it. So paracetamol, why is paracetamore dirt cheap?

It's dirt cheap because it's not. not on patent. And so anybody can make paracetamol, and that's why I can go to boots and spend a pound 25 and get my paracetamol. That's not going to cost that little. It's a slightly different drug. But the moment it comes of patent, then any drug manufacturer that understands the recipe of how to actually make it, can make it. And the moment that happens, then the cost of that specific drug will plummet. It will plummet. And now, the rich people are always going to want the shinier new one. I want the ones monthly injection. I want the ones that

give me 30% weight loss. But semi-glutide, the one we're talking about today, Ozambic, will go off patent in seven years? 2025, 24. Yeah, it'll be seven years soon. Seven years. It's not that long away. I don't know how much would the price plummet. Tenfold.

Because the moment it goes generic, it means that anybody who is, you have to fulfill specific criteria can make it. The cost implications for this won't be that way, at least for the majority of people. For some people, they'll never be able to afford it because, but the cost implications are a time-limited issue. Okay. That's scary. It feels quite scary.

I know I'm selling, I know I'm talking about, I don't want to sound like I'm only selling this, you know, for all the positiveness of it. You have to remember that this treats the obesity. It doesn't prevent the obesity to begin with. Okay. Now, the prevention of obesity requires policy change. It requires education in kids. It requires improving our bloody diet. This drug will not improve your diet. The drug will make you eat less of your diet. If you're nice and middle-classy like us and live in leafy areas and we eat relatively healthy anyway, then that's fine. But if your diet was crap to begin with, okay, you ate whatever Oreos and chips only, all these, all this drug is going to be. do is make you eat less Oreos and chips. So yes, you'll lose weight because you're eating less of it. But you may very well go into malnutrition because suddenly now you're no longer eating enough crap to actually maintain what you're having. So it is an important point where it does not prevent the obesity. That's fine. I think it should be, we should use a hammer

for a nail and a screwdriver for a screw. Okay, use the tool for the job. The drug to treat the obesity and help save lives. But we still need to fix our food environment to prevent obesity from happening to begin with. Yeah, that's really, I'm glad you talked about that because I guess that taps into something else that I wanted to ask you about, which is, you know, people are talking about how it eliminates food noise, OZMPIC, gets rid of this food noise and we only, I mean, I know how plaguing food noise can be. It's horrible. It's constant. It doesn't stop. And the idea of that is so tempting to eliminate food noise. and I think it also

just by virtue of that puts a plaster over any kind of psychological issues around food and relationship with food and eating but that's all it's doing right all it's doing is putting a plaster over it because those things are going to come back and potentially with a vengeance no it depends on who you are

and what your mental space is so for some people with the food what is this food noise I guess we can let's talk about what this food noise I have the food noise, okay, and the food, because I love my food, which means that, oh, I, you know, I'm going to eat next week, for example, because I do the shopping, I do the thing, I'm going to, oh, I'm almost, and if I am traveling somewhere, I would have done research around the hotel I'm staying in, look at the restaurants, even looked at the menu, and that's food noise, okay? It doesn't mean that I'm hungry, because I'm not hungry now. I've really, I've had something before I should have to you, but yet I know if I'm going to be traveling for the next place, oh, I know this restaurant nearby and I'm going to go have it. That is food noise. I don't think I have food noise. We can talk about that another time. No, but that's interesting, right? So this is, this is one of me, it's food doesn't just mean I'm hungry. Everyone feels hungry and then you think about food because you are hungry. Food noise is thinking about food even when you are not hungry.

For some people, constantly. Constantly. Absolutely. Absolutely. And that does remove the noise. For some people, that's a blessing in disguise because now, oh my God, I can now think of something else. I can read my book. I can do my job. You're right for other people. You suddenly begin to obsess over it. I do think that because we're dealing with food and everyone needs to eat, okay? This is very different from trying to quit smoking or drinking or drugs or anything like that, right?

So we are in a situation in which we all need to eat. And so it is all about tuning to make sure you eat the right amount and eat the right thing. And so for some people, that could. lead to obsessions, I'm not denying that. And so we need to be mindful and we need to treat the person that's actually there. But as a whole, I think the cost, the benefits of this far, far outweighs the negatives. That doesn't mean that we don't watch out and deal with the negatives as they appear. Yeah. No, it's an interesting discussion. I just, I guess as I'm seeing it as like, I'm imagining if I was a psychologist, and I'm not, I'm not an expert in anything. I'm imagining

if I was a psychologist and someone came to me with a really terrible relationship with food and eating and that had had an impact on their body weight, so they were a binge eater, you know, I'm not saying everyone who is at a higher weight has binge eating, but this person does, right? If they came to me and they wanted to fix their binge eating and, you know, they were going to take Ozempic, I would think, well, this is bad because you're going to take Ozempic and yes, it's probably, from what you're saying, it sounds likely that it's likely that it's going to stop your binge eating and it's, okay, you're saying different. I'm saying different.

So binge eating is very, very different, right? What Ozmpic and equivalent does is make you feel fuller. Binge eaters, it's a very different thing, override all of the natural, I feel full things because you're eating not out of pleasure, not out of hunger, but out of something else. Okay, there is a different pathology. And so therefore you binge eat beyond. Ozempic will never work for binge eaters, or at least the vast majority of binge eaters. Really? Yes. So it's because they've learned to ignore all the signals, which is why they can eat so much where you can almost, I had a PhD student one, no names mentioned, who had, who had any binge eating disorder? I could see it was just a completely different pathology. No, just from first principles, they ignore the I feel full signs. So taking the drug, which makes you feel full, is not going to make a difference. Oh, God, this is so interesting.

I presumed that it was being prescribed for people who struggled with So binge eating eating is very different from eating too much Very very different because you do it for very different reasons At some point Eating too much you do lose the pleasure That is true okay because because almost in a slightly addictive Way you do lose the pleasure from it But you still react to the sense of

I need to stop eating now because I am really stuffing my I'm really feel stuff that binge eating goes right through blasts right through all of those safeguards so it's a different pathology very interesting can then can i reframe the example then and maybe i'm barking at the wrong tree here but again i'm a psychologist someone comes to me terrible relationship with food and eating they use food as a coping mechanism they're not a binge eater but they rely on food a lot constantly, you know, they're inundated with food noise. They take OZempic and all I'm thinking is they're going to stop OZempic and they're

going to have the same psychological problems, if not worse, because it's like with, I mean, you know, when you stop a lot of diets, often the weight comes back and more so. And I'm wondering if that applies to psychological problems as well. They come back and stronger. So I'm not a psychologist either. I'm not a tradition to be fair. I get the feeling that if you've got a disordered relationship with food, rather than you being too heavy and love food too much,

I'm not sure how appropriate something like this drug is necessarily going to be. And I think this will show out in the fullness of time. I think this is designed to stop people thinking about food too much, rather than having a disordered relationship with food. I think I love food. I don't think it's disordered. I love food.

I eat, you know, I think about it a lot, you know, and I don't think it's disorder. And I think for most people it's not necessarily disordered. You just eat too much. And so what the drug does is to make you eat less, blah, okay? The issue is if you do have some disordered behavior with food, I just get the feeling that this, this class, of drugs is not going to be the answer.

Okay. Yeah. I'm really glad to hear you say that actually. Yeah. Two things actually. Yes. Yes. Really quickly.

Do you think that OZempic and how widespread it's becoming, do you think it's going to change the landscape of body diversity? Do you think everyone's going to end up thin or at least have the expectation that everyone has to just to be really thin? Do you think it's going to become that widespread? Not everyone responds to OZemper. but many, many people do. Most people do, actually. Will it have the ability

once it comes off pattern? In fact, let's get to the situation where we have actually minimized the financial cost of it being on it. I guess it's possible. Once again, we're just playing it in our head here. If everyone who wanted the drug had access to the drug,

would then suddenly obesity no longer be a problem. Certainly the symptoms of the obesity. I mean, from a mental game you play, that's possible that for a large percentage of people that would be the case. But I think that there is a significant number of people that won't respond to it, 5, 10%, won't respond. We don't know why. And a significant percentage of the people who do respond have side effects,

which means that they don't want to stick on. So call it another 10%. So I think ultimately there's still going to be 20% that are people who need to lose the weight, who need something else to lose the weight. That's a substantial proportion of people. But I still think that there are more genes, and more pathways and more mechanisms and more targets to be found. And this, I don't think, is the B-O-N-N-O to my view.

Looking more at like a sort of cultural shrinking, if you like. If we're not talking about people... Cultural shrinking. Well, if we're all... If we look, if you look at the red carpet this year versus 10 years, over the last 10 years, I will be more specific. If you look at the Kardashians... Okay.

Who we know are responsible. for a lot of trends, right? They do dictate a beauty ideal that is coveted by a lot of people. Watching their bodies change, they, for me, were my first, like, awareness of Ozenpic. It was Kim getting into Marilyn's dress for the Met Gallo a couple of years ago. If you're looking at people who are misusing this drug, people who are being prescribed it when they don't need it, people who have bypassed things like we were able to do just to get our hands on it because we just wanted to be a little bit thinner, looking at that, rather than treating it as

obesity, rather than looking at it as it's meant to be used, if we look at the misuse of it or the misdiagnosis, you know, the people who are accessing it who don't quote unquote need it, does that feel dangerous? That we have this tool, that we are used, not even that we have it, that we're using this to get to thinness, perhaps, that we don't need to be? I do think it's dangerous, yes, is the answer. I don't think there's no, we shouldn't shy away from calling it dangerous if people that don't need to get their hands on it. And at the moment, it's easy to do so. And so we do need to wake up. We, the entire field, do need to wake up and make sure that more safeguards are in place. I think the problem is the safeguard, like people

are scrambling for the safeguards. They didn't quite realize. Certainly in the UK, we're never thought. We have an NHS. Why would people pay for it? Wow. They're obviously misunderstanding underestimating the desire for actually having these drugs. So no, it's, it is dangerous if the wrong people get their hand on it, undoubtedly because they're so powerful. And so we need to make sure that they don't get in their hands on the wrong people. Thank you so much. Thank you. This was amazing. Thank you. This was amazing. Like how informative and I really loved that you've got a very nuanced and balanced take on it, which we really appreciate. So thank you so much, Charles. Thank you so much for having me. Thank you. Should I delete that as part of the ACAST

Creator Network?