Ten Percent Happier with Dan Harris - Weighing The Extraordinary Benefits And Disturbing Risks Of The New Weight Loss Drugs | Johann Hari

Episode Date: June 19, 2024

On this show, we talk a lot about ways to stop the interpersonal and intrapersonal violence of obsessing about thinness. Today’s episode, though, is a bit of a departure… because this whole dynamic and debate has been deeply disrupted by the advent of Ozempic and other new weight loss drugs, which are technically called GLP1s. This is a controversial and touchy subject, to say the least. Journalist and best-selling author Johann Hari discusses his latest book Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs. He believes drugs like Ozempic are the equivalent of the invention of the iPhone – and will impact all of our lives, whether we like it or not, and whether we take them or not. And in Magic Pill, Hari – who somewhat ambivalently takes Ozempic himself – marinates in the complexity of all of this. This is Hari’s third time on the show. He has come on before to discuss his books on distraction and depression—entitled Stolen Focus and Lost Connections.This is the latest episode of our Get Fit Sanely series. This is the third time we’ve done Get Fit Sanely, and in this go-round, we’ll be covering longevity, exercise, and the Buddhist case for laziness. Related Episodes:Get Fit Sanely PlaylistWhy You Can't Pay Attention - And How to Think About It | Johann HariFighting Depression with Social Connection | Johann HariSign up for Dan’s weekly newsletter hereFollow Dan on social: Instagram, TikTokTen Percent Happier online bookstoreSubscribe to our YouTube ChannelOur favorite playlists on: Anxiety, Sleep, Relationships, Most Popular EpisodesHelp Dan out and take our audience survey — we’ll thank you with 10% off all merch at shop.danharris.com! The survey is available at tinyurl.com/tphpod. Full Shownotes: https://www.tenpercent.com/tph/podcast-episode/johann-hari-2024See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This is the 10% Happier Podcast. I'm Dan Harris. Hello everybody. Welcome to the show. As you may know, here on 10% Happier, we talk a lot about ways to stop the interpersonal and also intrapersonal violence of obsessing over thinness. I am personally very interested in how we can get healthy and fit without compulsively trying to achieve some sort of arbitrary aesthetic standard. Today's episode however is a bit of a departure because this whole dynamic and

debate has been deeply disrupted by the advent of Ozempic and other new weight loss drugs which are technically called GLP-1s. This is a very controversial and touchy subject to say the least which is why I'm bringing on somebody who has thought deeply about this. My guest today is Johann Hari. He's got a new book called Magic Pill, the extraordinary benefits and disturbing risks of the new weight loss drugs. Johann believes drugs such as Ozempic are the equivalent of the invention of the iPhone and will impact all of our lives whether we like it or not and whether we take them or not. And in his new book, Johann, who takes Ozempic himself somewhat ambivalently, marinates in

the complexity of this issue. A little background on Johann before we jump in. He's a journalist and bestselling author. This is his third time on the show. He's come on before to discuss his prior books on distraction and depression, entitled Stolen Focus and Lost Connections, respectively. Just to say before we dive in, this episode is part of a series we're running right now called Get Fit Sanely, where we explore everything from longevity to exercise

to the benefits of laziness. If you missed the other episodes, I highly recommend you go check them out. We'll get started with Johannan Hari right after this. But first a little BSP or blatant self-promotion. We are conducting an audience survey over the next couple of weeks. We want to learn more about you. And also we want to get some feedback from you on the 10% Happier Podcast and my work more broadly.

For example, what do you want more of, less of in the future, etc. I would be very grateful to you if you would do me a solid and take five to ten minutes to fill this thing out. You can go to tinyurl.com slash tphpod, tinyurl.com slash tphpod. I will drop the link in the show notes to any of our new episodes. So you can just go click it there. By the way, anybody who completes the survey will get 10% off our new merch. And on top of that, you'll be entered into a little raffle where five respondents will win $100 worth of merch.

Again, super grateful to anybody who can take a few minutes to fill this out. We've got some big decisions to make. We could use your help. The link is tinyurl.com slash tphpod or just go into the show notes of any of our new episodes and you can get the link right there. Also want to tell you about a course that we're highlighting over on the 10% Happier app. It's called Healthy Habits. It's taught by the Stanford psychologist Kelly McGonigal and the meditation teacher Alexis Santos. It's great stuff. To access

it, just download the 10% Happier app wherever you get your apps or by visiting 10% dot com. That's one word all spelled out. Listening on Audible helps your imagination soar. Whether you listen to stories, motivation, expert advice, any genre you love, you can be inspired to imagine new worlds, new possibilities, new ways of thinking. Listening can lead to positive change in your mood, your habits, and ultimately your overall well-being. Audible has the best selection of audiobooks without exception, along with popular podcasts and exclusive Audible originals,

all in one easy app. There's more to imagine when you listen. Sign up for a free 30-day Audible trial and your first audiobook is free. Visit audible.ca. inside the lives of our biggest celebrities. And just a warning, our latest season will feature a lot of accents. Can I just check what accents? Because... I can't tell this story without going all in. Okay, I'm scared to ask, but can you give us a clue?

Why I'm Ant? Oh, Ant-and-or-de? I'm afraid not, and it's not Alan Shearer either. I am talking about a young woman, plucked from obscurity, who rose to become the nation's sweetheart. A woman who's had a lot of surnames. And has ditched them all to become just Cheryl. Love it.

Girls Aloud fans, strap in. We're going to follow Cheryl from her Girl Band glory days, getting together with Ashley Cole, and the many scandals and humiliations that followed. Not to mention a near-death experience. Oh, she's been through a lot. And she has needed every ounce of her Northern grit to see her through.

I promise you it's gonna be an emotional rollercoaster. Follow Terribly Famous wherever you listen to podcasts or listen early and ad-free on Wondery Plus on Apple podcasts or the Wondery app. Johan Hari, welcome back to the show. Oh, I'm so happy to be with you, Dan. Likewise, likewise. Alright, so I want to get right into the story, your story.

How and why did you end up on Ozempic? And I believe it is Ozempic of the GLP-1s. Ozempic is the one that you're taking? Yeah, that's right. I remember really vividly the exact moment I learned about the existence of these drugs. It was the winter of 2022, and it was that weird moment when the world was finally opening up again and I got invited to a party. It was a party thrown by an Oscar-winning actor. I'm not saying that only to name drop. There's a reason why it's relevant.

And in the Uber on the way there, I was feeling kind of self-conscious because I'd gained a lot of weight during lockdown. I was quite fat when it started and I gained a lot of weight. And on the way there, I was thinking, oh, you know, this isn't good. But I also thought, huh, kind of everyone gained weight during lockdown, so it's going to be fascinating to see these Hollywood stars with a bit of extra like flesh on them, right? Those are going to be a fascinating experience. And I arrived there and I went in and it was the weirdest thing. It's not just that they hadn't gained weight. They were all gaunt and not just the actors,

their partners, their agents, the writers. Everyone looked like their own Snapchat filter, you know, like kind of sharper and clearer. And I was wondering around feeling even more self-conscious and I bumped into a friend of mine on the dance floor and I said to her, wow, looks like everyone really did take up Pilates during lockdown. And she laughed and I must have given her a strange look because I didn't know why she was laughing.

And she said, well, Johan, you know it's not Pilates, right? And I must have looked to her blankly and she pulled up on her phone a picture of an ozempic pen. And obviously the next few days I read a lot about it and I don't remember ever feeling so immediately conflicted about a subject as I did about this. So I could immediately see the case for it. I realized I was about to turn older than my grandfather ever got to be because he died at the age of 44 of a heart attack.

Loads of the men in my family have serious heart problems. My uncle died of them. My dad had terrible problems. And I knew that obesity makes heart disease much more likely. Sadly, I knew the evidence on that is really clear. I knew it's actually one of 200 diseases and complications that are made more likely by obesity. So I could see, wow, if we really do have a drug that reverses or hugely reduces obesity, that would have real health benefits. But I also immediately thought, come on now, I've seen this story before, right? About every 20 years, going right back to the first world war, a new diet drug is announced. We're told it's a miracle diet drug, it'll save us all.

Huge numbers of people start taking it. And then they always discover there's some horrendous side effect that means it has to be yanked from the market leaving a huge trail of damaged people in its wake. So I thought can you really have such a thing as a free lunch? Can you get all these benefits without the drawbacks? I guess in the case of Ozempic it would be a smaller free lunch. I also worried about you know we'd made so much progress in body positivity. I was worried about people with eating disorders. I just felt really profoundly thrown and conflicted when I learned about it. I mean on that last part about body positivity and that's something we've talked about a

lot on this show. Sort of we talk about anti-fat bias, intuitive eating, basically this kind of interpersonal and intrapersonal violence we do by obsessing. About thinness or achieving some sort of arbitrary standard of how we should look and me shows right up in your origin story here of like i'm on my way to this hollywood party and i'm beating myself up because i gain too much weight and so to me that's where my mind goes with this whole debate and i understand it's complex but my mind goes right to wow our fundamental problem is that we are just Obsessed with this issue in ways that are really unconstructive So I think I think you're going to a really important point down and this is one of the things To really try to resolve my dilemmas about this. I went on a big journey all over the world I went from, you from Reykjavik

in Iceland to Minneapolis to Tokyo. I interviewed over 100 of the leading experts on the new weight loss drugs and these wider debates and people have been affected by them in all sorts of different ways. I took the drug myself for a year. And it's kind of weird because I haven't had this experience in my previous books. I know a huge amount more than I did at the start. I know a huge amount about the extraordinary benefits of these drugs and the disturbing risks associated with these drugs. I go through 12 in the book.

But weirdly, at the end of all this, I'm still pretty divided actually. I'm still very conflicted about the drugs. I'm not much more resolved in my mind than I was right at the start of the one certainly better informed and one of the reasons is because of the debate you're leading to. I think of all the moments i had in writing the book had some bad moments pretty bad moments of you i'm sure we'll get to them but the absolute worst was a moment i had. I had, must have been, I don't know, five months into taking those MPICs. I was FaceTiming with my niece and my niece Erin is the baby of my family, right? She's the youngest out of all of us. She's the only girl and no one makes me more protective than her, right? She's actually 19 now, but in my head she's fixed as a six-year-old.

So whenever she has a boyfriend, I'm always like, get away from her, you child molester. And then I have to remember, oh no, wait, she's actually an adult woman. And one day we were FaceTiming, she was in a pub. And she was saying, wow, you've lost so much weight. I had indeed, over the whole year, I lost an enormous amount of weight. And she said, I didn't know, kind of she was joking around me,

I didn't know you had a neck, I didn't know you had a jaw, you know, we were laughing. And then she looked down at herself and she said, will you get me some ozempic? And I thought she was kidding. So I laughed and then my heart kind of sank. She's always been a healthy way. And I thought, oh, all her life I've been trying to give her this message. You shouldn't be valued for being thin. You're valued for your talents, your ability, your character. And I thought, have I undone all this message I was doing? So I really wanted to explore this, this element of the debate about body positivity and how we need to think about it and there was one person in particular who massively help me to find my way through this debate an amazing woman named shelly bovey.

When i was a kid. When you were a kid down with pretty close in age. It was just taken for granted on TV that fat people were the butt of the joke, right? We can all think about classic sitcoms where they literally are just laughed at for being overweight. And the first person I ever heard challenge that was a woman called Shelley Bovy. So as you can tell, as you know from my weird Downton Abbey accent, I am in fact British. And Shelley Bovy was the first person to ever articulate body positivity or fat pride as it was called then in Britain. I remember really vividly, I was 10 years old and I saw her on the television telling her story.

And she was really the first person in Britain, she was obviously inspired by the American movement, to challenge just the grotesque stigma that is directed at overweight people. I remember being quite taken by it. And obviously when I wanted to think about these issues, I decided to track her down. So I went to the village where she lives here in England. And she had such a fascinating story. So Shelly grew up in a working class part of Wales.

It was one of the biggest kind of working class steelworks in the whole world at the time. And she was the only fat girl in her class, that's the phrase she would use. She was the only fat girl in her class. That's the phrase she would use. She was the only fat girl in her school, in fact. And one day she was sitting in class and her teacher said to her, Bovy, stay behind after class. I need to talk to you. So she stayed behind thinking, what have I done wrong? And the teacher said to her, you're much too fat. It's disgusting. Go to the school nurse. She'll sort you out. So in this kind

of state of shock, she goes to the school nurse. The school nurse said, why have you been sent here? She said, well, the teacher says I'm too fat. She said, okay, take off your clothes. I'm going to look at you. So she took off her clothes and the school nurse said, you're too fat. It's disgusting. And just berated her and told her to stop being greedy in the language she used. And of course, Shelley just left in this state of extreme distress. And she got this kind of abuse all the time. She was constantly being told by the other girls in the school, you're disgusting, thank God I don't look like you.

She was really smart. Shelley, she was told to apply to Cambridge, which was a huge deal for working class girl at the time. And indeed now, and she's like, I just can't do it. I'll be humiliated. They'll be cruel to me. I'm not doing it. She stayed in Port Talbot and all throughout her life, she was just soaking up this abuse.

You know, when she got pregnant and she went to the doctor, the doctor said, well, you shouldn't be pregnant at your weight. When she had a very difficult birth and she's lying there covered in blood and the midwife looked to her and said, you know, you really need to lose weight. When her baby couldn't feed properly, she took the baby to the doctor because he wasn't attaching and the doctor said what are you trying to do make the baby as fat as you are? And Shelly had this awakening where she just all her life she had internalized this. She thought it's saying wrong with me, I'm a bad person, I'm greedy. She told

me she'd never even looked at her own body naked because she couldn't bear to. And she decided to challenge this. And she wrote a wonderful book called The Forbidden Body that was the first book in Britain to really challenge this hateful bigotry towards overweight people. And she became a really important voice. And I went to talk to her about this and the new drugs in light of it. But Shelley was very proud of the work she did opposing stigma, but something happened to her after that book came out that she realized she needed to reflect deeply on. So she was very severely overweight at the time.

One day she took her kids to a theme park in Britain and she just couldn't walk anywhere. So her husband got a wheelchair but he couldn't push her and she went to the doctor. She was actually having heart problems. She was only 50 and she was losing the ability to walk. She was getting really physically unwell. And she felt this real dilemma because she was very proud of the work she did opposing stigma and she remains very proud of it, but she could also see that separately to that the excess weight she was carrying was making her

unwell and she looked at the science around this and the science is absolutely overwhelming. Obesity causes all sorts of various serious health problems from diabetes to cancer to dementia. dementia makes them all much more likely and she felt really conflicted because she was lying you know the time there was a kind of body positivity newsletter in Britain called fat news and she wanted to write about this dilemma and they wouldn't let her because they said no we're here to tell the good news about it we're here to change stigma I said well but what kind of body positivity is it if it doesn't keep my body alive?

There's some dilemma here and Shelley argued I think very persuasively and many people in the body positivity movement are doing this but clearly not all That we need to separate two things We need to look at the harm that is caused by stigma Which is horrific and very real, you know If you have a BMI higher than 35, 45% of women in that position are insulted every single day. There's the harm caused by stigma, and then there's the harm caused by the physical reality of obesity. And Shelley argued that actually love is opposing both of those things where possible, right? Of course it should

be done in a compassionate and loving way, but both those things were harming her, the stigma and the physical effects of the obesity. In Shelley's case, she was able to lose a lot of weight through calorie restriction, which is, she's unusual. She's the first to point that out. 90% of people who try that, it doesn't work. But she argued to me, the key here, when we're talking about opposing stigma

and opposing the harms caused by obesity, she said it is not either or, it's both and. We need to where we can reduce the effects of both and know that it's not your fault that you became obese and we can go into the wider reasons why I became obese, why other people became obese, which is absolutely not greed and all the disgusting stigmatizing things that are said. And I think Shelley made a really powerful point and lots of other people have been through that experience are talking about it in a really powerful and brave way I think.

You talked about the reasons why we have these issues with obesity in our culture and why you struggle with it personally. I think it might be interesting to dive into that. I do want to get back to your experience with those. I don't want to lose the thread of that, but since you brought it up, let's talk a little bit about the underlying conditions. I was born in 1979. Between the year I was born and the year I turned 21, obesity more than doubled in the United States and then severe obesity doubled again over the next

20 years. This is unprecedented in human history. This has never happened before. Nothing like it has ever happened before. If you look at a picture of a beach, just Google the words, photo of Atlantic City, 1975, say for example, Miami Beach, whatever. It's really weird when you look at it through our eyes, because everyone is what we think of as skinny, right? You think, well, where was is everyone else that day and you look at the population figures. That's what people look like in nineteen seventy five so there's been this enormous transformation in an extremely short period of time. I want to know why it happened the science is really clear on this. This change happens not where people become greedy or lazy or all the stigmatizing things we say it happens cuz one thing.

people become greedy or lazy or all the stigmatizing things we say, it happens because of one thing. It happens when the food supply system changes. When you go from a food system that is predominantly built around preparing whole fresh foods that you eat that day to a food system that is built out of chemicals artificially in factories to produce processed and ultra processed foods. 78% of the calories the average American child eats every day now is ultra processed food, which means it is literally assembled in a factory. The process of creating it is not even called cooking, it's called manufacturing. And we know that that food affects us really differently to the kind of food that human beings evolve to eat. And I learned this for lots of reasons and I go through the seven ways this is the case

in my book, but there's an experiment that's in me totally distilled it. There's a brilliant neuroscientist called Professor Paul Kenny. He's the head of neuroscience at Mount Sinai in New York. And he grew up in Dublin, in Ireland, and he moved when he was in his 20s to San Diego to continue his medical research. And he quickly noticed that Americans don't eat like Irish people. There was a lot more processed and ultra processed food, a lot more sugary, fatty food. And like a good immigrant, he assimilated and within a year he gained 30 pounds. And he began to feel like this

food he was eating was changing his brain, was changing his appetites, was changing the way he felt. So he designed an experiment to test this. I have nicknamed this experiment Cheesecake Park. That's not the official name of it. So what he did is he got a lot of rats and he raised them in a cage and all they had to eat was the kind of food that rats evolved to eat, the equivalent of whole foods, right? They were in pellet form, but it was the natural food they used to. And they had far more of it than they could eat but something fascinating happened when they just had

the kind of foods they evolved to eat they would eat when they were hungry and then they would stop they would get the kind of natural signal to stop so given the kind of food they evolved to have these rats never became overweight or obese then professor Kenny introduced them to the American diet. He got some cheesecake, he fried up some bacon, he bought a load of Snickers bars and put them in and the rats still had the healthy food but they went crazy for this new food right. They would hurl themselves into the cheesecake and eat their way out and just emerge completely covered like slicked with with cheesecake.

Something weird happened. That natural signal that they knew when to stop eating that they'd had with the other food just completely disappeared. They ate and ate and ate and the way Professor Kenny put it to me is within a couple of days they were different animals and they rapidly became very obese. Then Professor Kenny tweaked the experiment again in a way that feels pretty cruel to me as a former junk food addict. He took away all that American food and left them with nothing but the healthy food

they'd gotten used to, they'd had when they were kids. And he thought he knew what would happen. He thought, well, it's obvious, they'll eat more of the healthy food than they did before and this would prove that junk food expands the amount of calories you eat. That's not what happened. Something much weirder happened. When the junk food was taken away, they refused to eat anything at all. It was like they no

longer recognized the healthy food as food. It was only when they were literally starving that they went back and ate it. Now this fits with a much wider body of evidence. As Gerald Mande, a professor at Harvard who designed the label that's on all food in the United States said to me, there's something about the food we're eating that is profoundly undermining our ability to know when to stop. And this is intimately related to why 47% of Americans want to use these drugs because what the food we eat is doing to us is undermining our satiety, it's undermining our ability to feel we've had enough and stop. And what these drugs do in ways that are risky and that we'll explore is they give you back your sense of satiety. In fact, one of the scientists who designed them said to me, you know, what they give you is satiety hormones.

So when you see it in that context, suddenly you see, right, it's not our fault. We got fat, right? It's not the stigma is dumb and misunderstanding, in addition to being cruel, but also the, well, the way Professor Michael Lowe is at Drexel University put it to me is these drugs are an artificial solution to an artificial problem. Ultra processed food undermined our satiety and that left us with this situation where we desperately want these drugs to give us back our sense of satiety. Yeah, that's my struggle with it. And again, I have, I don't know even know how much standing

I have to comment on any of this because I'm not a candidate for Ozempic or other GLP ones. So with the concern I have as a bystander, as a concerned bystander is we have this one big industry, food, Inc. that created or part of creating this huge issue with our health. Now we're looking to another huge industry, pharma, to, I guess, solve it. And so that just, there's something in there that worries me a little bit.

Yeah, this was one of my really big worries, just to say, by the way, you may think you're a bystander, but Barclays bank commissioned a very sober minded analyst called Emily Field to investigate these drugs, looking at it for, you know, what will, to guide their investment decisions. And she came back and said, you want a comparison for the creation of these drugs? It's the invention of the smartphone, right? You're not a candidate for taking these drugs,

but this is going to transform the society around you in all sorts of complicated ways. If we'd been having a conversation in 2007, the day Steve Jobs unveils the iPhone, we would not have been able to game out TikTok and Uber Eats and everything else. This is going to affect your life, whether you use these drugs or not, because it's going to profoundly transform the society around you. But I think you're absolutely right. This was a really big concern for me. I remember learning all this evidence about what caused this crisis that then makes us

want these drugs. I remember I went to one of my best friends and I said, I've got to stop taking these drugs. This is completely hypocritical. I'm always writing books about how we need to deal with the underlying social causes of our crises, not just deal with the symptoms. It feels completely fraudulent to do this. She said something to me that really impacted me.

So seven years before this, she had got very bad breast cancer. She's a single mom, it was terrible. She nearly died and I was there with her all through the chemo and the double mastectomy and the hysterectomy. It was a very painful time. She said to me, look Johan, something is really wrong in our environment that's causing breast cancer. One in seven British women get breast cancer, one in eight American women get breast cancer. That wasn't true in the recent past, it's not true in a lot of other countries. In Japan it's one in 38 women. Something in the environment is causing breast cancer. But when I got cancer you didn't say to me, well geez, the environment's caused this problem and now you're injecting

yourself with another poison to get rid of it. She said no, you made sure that I lived to fight another day. She said to me, if your house is on fire, it's a very good argument to say, you know, we should build houses with less flammable materials and we should change the building code so buildings have to have sprinklers. But when your house is on fire, that's no use to you. Call the fire brigade and douse the house with water, right? In the same way, she said, you're absolutely right, there's environmental causes to this. We need to deal with those environmental causes, but you're the equivalent of the house on fire, right? And I later discussed that with a guy

called Jeff Parker. Jeff's a 66 year old lighting engineer, super nice guy who lives in San Francisco, and he was very severely overweight. And one of his friends gave him some Moonjaro, which is one of these GLP-1 agonist drugs. And he started to take it because he was really worried about his health. He was losing his ability to walk. It was painful to walk. He had gout, problems with his kidneys, his liver. He was taking fistfuls of pills every morning. And he took Moonjaro and he lost a huge amount of weight. And he's coming off the pills, all his health indicators improved and now he walks his dog over the Golden Gate Bridge every day. And he said to me, I feel like I'm going to enjoy my retirement now.

And I said to him, but Jeff, don't you think we should be dealing with these environmental causes? And he said, I could not agree with you more. Sign me up for that campaign. I'll be with you every step of the way. But I've got to tell you, by the time we achieve that, I'll be dead. And I want to way, but I've got to tell you by the time we achieve that I'll be dead And I want to enjoy my retirement and I want to live and I found that a very hard argument to rip up Unless there are side effects that we're not aware of that are gonna shorten his life

Anyway, well what the side effects we are aware of so this is a you've gone to the the core dilemma of my book magic pill Which is what I was facing was Basically what I felt I was facing was a choice that I had to weigh. What are the risks of taking these drugs versus what are the risks of continuing to be obese with all the risks in my family associated with that? And that's really the core of what I started investigating and what I kind of weigh in the book. And there were some risks associated with these drugs that really alarmed me as well as some extraordinary benefits that come from them.

Well, I'm trying, I'm at a crossroads in my mind. I want to get a primer from you on what these drugs are, what they do to the body, but I also, you also just brought up the risks and benefits of it, so I want to hear about those. Want to just do it in that order? I defer to you on all audio matters. You're the king of this. Yeah, we could talk about some of the risks.

So there's a broad array of risks associated with these drugs. So there's the well-known side effects, things like nausea and so on, and I can talk about how that feels. Most of those side effects go away for most people, although they can be pretty unpleasant. And there's some people who think they don't go away and they have to stop taking the drugs. But there were some other risks that really concern me. So when you look at the safety of these drugs, what a lot of the defenders of the drugs say, very reputable scientists, serious, good people, they make a point that is a powerful point. They say actually we have pretty good evidence about them short to medium terms effects of

these drugs because actually people have been taking these drugs for 18 years now. For people who don't know, in addition to reducing your appetite, these drugs also stimulate the creation of insulin, which is what diabetics are lacking. So they've now been licensed and used to treat diabetics in many countries in the world for 18 years. So what a lot of the scientists say is if there was some horrendous side effect from these drugs, some disastrous consequence, we would know by now. That would have shown up in the diabetics.

And that is indeed a powerful argument, and it should give people some peace of mind. But some other scientists said, OK, And that is indeed a powerful argument and it should give people some peace of mind. But some other scientists said, okay, let's dig into the situation with the diabetics, let's look at them a bit more. I'll give you an example. There's a brilliant scientist called Professor Jean-Luc Faillit, who's a professor at the University Hospital in Montpellier in France.

And he was commissioned by the French Medicines Agency to investigate the safety profile of these drugs for the French market. So he looked at all the research and there was one thing that caught his eye. When you give these drugs to rats, they're much more likely to get thyroid cancer. So he started to look at the potential thyroid cancer risk. And he did a very good study, actually very hard to do the study in the US because of the HIPAA laws. But in France, it's very hard to opt out on medical databases, so they've got really good solid

data. So what he did was he looked at a load of diabetics who took these drugs between 2006 and 2016, and he compared them to a very similar group of diabetics who had not taken these drugs. And what he and his colleagues calculated is pretty startling. If you take these drugs, if he's right and it's disputed, they increase your thyroid cancer risk by between 50 and 75 percent. Which when I first heard it you're like what? Now it's important to understand what that doesn't mean. It doesn't mean if you take these drugs you have a 50 to 75 percent chance of getting thyroid cancer. If that was the case they'd yank them off the market immediately what it means is whatever your thyroid cancer risk was at the start.

If the scientists are right and other scientists disputed. That risk will increase by between fifty seventy five percent so it's a pretty big increase in a pretty small risk about one point two percent of people get thyroid cancer in their life and eighty four percent of them survive it. get thyroid cancer in their life, 84% of them survive it. But you know, I was kind of taken aback, especially given the terrible history of diet drugs in the past. This was one of the 12 kind of flashing lights that alarmed me, it's why the FDA advises that if you have thyroid cancer in your family, don't take these drugs. Now against that, and one of the things that's so interesting to me, was fascinating to me in all the research for magic pill, was whenever you think you found something that you could hold on to, you have to weigh it against

another complex part of the picture. Anyone whose reaction to these drugs is yay they're gonna save us all or boo they're the devil, I think is missing the much more complex and interesting picture in the middle. So when people warn about the thyroid cancer risk, some other scientists go well even if that's right, you've got to weigh that against the cancer risk associated with being obese. And this is, I have to say, I found this research really shocking. If you look at, for example, Cancer Research UK, who are the biggest cancer group in Britain,

explain if you carry excess weight, that fat doesn't just sit there. It's not inert. It's active. It sends signals throughout your body. And one of the signals it sends is for cells it can send, is for cells to divide more rapidly, which can cause cancer. It's why in fact it's one of the biggest causes of cancer in our societies. So again, every stage, if you only look at the risks of the drugs or you only look at the risks of obesity, both seem terrible. But what we've got to do is the much more complex, difficult and

interesting and individualized question of asking, okay, how do we weigh them against each other? It is so complex. I mean, I think that's one of the services you're doing in this book is really marinating in the complexity and the confusion and the dilemmas. And I appreciate that about your work on this subject. Oh thanks Dan and I think we really need to embrace that complexity and I you know I could feel it so often in myself that there were so many moments

when things came along that I didn't expect both in my experience of taking the drugs and how they made me feel. Yeah and I just want to signal to you and anybody listening even though my question is thus far and they will continue to be somewhat skeptical or concerned, I also you know I feel for everybody on all sides of this issue so I'm not doing any of this questioning with any judgment per se. No I think you absolutely have got the right level of skepticism. We need to be skeptical about everything at every stage of these, of this debate because probably why I think about the book is called Magic Pill because there's three ways in which these drugs could be magic, right?

The first way is the most obvious. They could just solve the problem really quickly, really easily in a way that feels like magic. And there are days I've got to tell you when when it feels like that. My whole life, I've eaten garbage. I've cried craving KFC. And what, once a week I do a little jab in my leg and it goes away. There are days it feels like magic. The second way in which it could be magic

is a much more disturbing way. It could be like a magician's illusion. It could be a trick. It could be like the magician who shows you a card trick while he's picking your pocket, right? It could be that it seems to be benefiting you, but is actually screwing you over because of these 12 big risks, some of which we've alluded to. The third way in which it could be magic is actually, I think, the most likely scenario. If you think about classic stories of magic, like Aladdin, for example, you find the lamp,

you get your magic wish, but it never plays out in quite the way you expected, right? You get your wish, but it's not the wish you thought you were going to get granted, right? Or think about Fantasia. You unleash the magic and then it runs away from you and starts having all these effects you couldn't anticipate. And I think we can begin now to glimpse that third scenario as well, that it's already

having these unpredictable and unanticipatable events that they did for me. Coming up, Johann Hari talks about some of the other risks and benefits of Ozempic, and he also speaks candidly about why he is still on Ozempic. Hello, I'm Matt Ford. on Ozempic. A next level bra that remoulds the cleavage. An uplifting story which gives you a real boost. I hate myself. She moved from business to politics and when Covid hit says she knows a great company to supply PPE. And the company, PPE Medpro, made millions of pounds of profit from the contract. Oh and a lot of the equipment was unusable. Oh a minor detail.

And having said that she had nothing to do with that profit repeatedly, she then goes on national television and says that Hona Children are actually in line to receive nearly £30 million as a result of it. To find out the full incredible story, follow British Scandal wherever you listen to podcasts or listen early and ad free on Wondery Plus. I'm Mike Bubbins. I'm Ellis James. And I'm Steph Guerrero.

And we're convinced that our podcast, The Socially Distanced Sports Bar, is going to be your new favourite comedy podcast with just a little bit of sport thrown in. You don't have to love sport, like sport or even know anything about sport to listen. Because nobody has conversations which stay on topic and it's the same on our podcast. We might start off talking about ice hockey but end up discussing, I don't know, 1980s British sitcom Alo Alo instead. Let's use the word nuance in your pitch for Alo Alo. He's not cheating on his wife, he's French. It's a different culture.

If you like me and Mammoth or you like Alison, fantasy football league, then you'll love our podcast. Follow the Socially Distant Sports Bar wherever you get your podcasts. The Socially Distant Sports Bar, it's not about asymmetrical overlords. James, podcasting from his study, and you have to say that's magnificent. Before we get back to the show, just a reminder about the Healthy Habits course over on the 10% Happier app taught by Kelly McGonigal and Alexis Santos. To access it, just download the 10% Happier app wherever you get your apps.

You invoked yourself and I do want to come back to your personal experience here, but you were talking about the risks and benefits and also how these drugs came into being. One other side effect that appears to be a concern is suicidality. Yeah. So this is highly contested as are so many things about these drugs. But I did not feel suicidal on these drugs or anything like it, but I had this moment that really threw me. So the first six months I was taking these drugs, my friend Danielle was pregnant and it was like we were going on opposite trajectories. Every time

I saw her, she was swelling and I was shrinking. And I physically felt much better and I was getting all sorts of like nice benefits. My neighbor's hot gardener hit on me. But I remember saying to her one day, this is really weird. I'm getting what I wanted and I don't feel better. Right? If anything, I felt slightly worse. I felt quite muted. I felt a little bit down.

So why is that? And there's a big debate going on about this. So there's some scientists, this is not convinced the FDA or the European Medicines Agency, agency but there some scientists who are concerned that this may be causing depression or suicide ality. I think there's a range of possible reasons why if that is happening we know these drugs predominantly work on the brain not on the car that changing your brain is possible to have a brain effect is causing this show will come back to that but i think for me it was something much more basic and that was the kind of moment of epiphany for me. So about seven months into taking the drugs, I was in Vegas. I'm writing a book about a series of crimes that have been happening in Vegas. And I spent that day and indeed that week researching the murder of someone that I knew and loved. So it was, you know, hard. And really on autopilot, I went to the, there's a KFC on West Sahara, the world's easiest KFC, and that's saying something. And I went

in and really almost literally on autopilot, I ordered what I would have ordered a year before. I ordered a bucket of fried chicken. And it tells you something that all the way through writing this book, I mistyped fried chicken as friend chicken. You don't need to be Freud to figure that one out, right? And I was sitting there and I had a chicken drumstick and I looked at it and I thought, oh, I can't eat this. You know, like when you're on Ozempic or Wagovi and the other new weight loss drugs, you can't come for eat in the way you used to.

Right. And it's funny, Colonel Sanders was on the wall and I felt like he was looking down at me going, Hey, what happened to my best customer? Right. And again, it's so something I think people really need to be aware of in relation to these drugs has been really under discussed is these drugs disrupt your eating patterns radically. And what that can do is it can bring to the surface some of the underlying psychological reasons

why you overate in the first place. I go through the evidence for five different reasons why we eat in the book, many of which will be surface for many people listening. Now, in some ways that can be a good thing. You can bring it to the surface in order to deal with it. But that's not an easy process and it's not to be taken on lightly, right? And there was certainly a disruptive period. I did get through it, but where it did not make me feel better, where being deprived of that comforting behavior that I'd literally had

since I, as long as I can remember, since I was a very young child, having that taken away from me was very, very hard. Getting back to the moment in KFC, when you looked at the chicken wing or chicken thigh, I can't remember what chicken part. It was all of the above, in that bucket, believe me. And you looked at the bucket and you said, and you thought, I can't eat this. Was that because you didn't have the appetite to eat it

or because you no longer liked it or both. It's funny how many of my key turning points in my life have happened in branches of KFC. So lots of people say when they take these drugs, the food noise in their brain is hugely turned down. They don't want food anymore or they don't want the kind of food they ate before. For me, it was kind of complicated. I was not someone who was massively driven by food noise and constantly thinking about food. I actually realize now I've never really enjoyed food very much, sadly. And if anything, these drugs have boosted my pleasure in food from a very low level, but I think

I'm very unusual in that respect. But I think it was more, it's actually more just a practical thing. When you're on these drugs, if you tried to overeat and stuff yourself, you would just vomit. You just can't do it. You physically can't do it. It would be physically very uncomfortable. You would feel indigestion very rapidly and then I think you would be, I haven't tested this to the point of vomiting, but I have had times when I've gone out and I've been at a friend's party or whatever and we've all gone out for dinner and I've eaten more

than the Ozempic makes me feel I should and I wasn't sick, but I was physically very uncomfortable in the way that you would be if you think about how you feel after Thanksgiving dinner if you've really crammed it all in. It's that feeling, but you get that feeling pretty quickly. So I couldn't eat it, I think, for a pretty physical reason. Now, obviously, the physical reason is debated as well. Yeah, but where does that physical impulse come from? It comes from your brain, right?

It comes from your brain not letting you do it. You're describing it accurately, yeah. And you said way back early on in the interview that you'd been on Ozempic for a year. Is that a year then you stopped or are you still on it now? No, it's a bit more than a year now, yeah. So I decided to carry on taking it and I decided to carry on taking it for one reason above everything else.

So the first part of the subtitle of my book is The Extraordinary Benefits of the New Weight Loss Drugs. And this particular study that I'll come to in a minute that really made up my mind, but it's interesting because diabetics have been taking these drugs for 18 years, but for obesity people have only been taking them for quite short period of time. Actually to get the best evidence about the effects of these drugs, we shouldn't only look at the limited number of studies we have on these drugs, I think we should look to something else entirely. So up to now it's been very hard to lose huge

amounts of weight and keep it off. By far the most reliable method has been bariatric surgery. So stomach stapling, all the other different forms of interventions that make up bariatric surgery. Bariatric surgery is a horrendous operation. One in a thousand people die during the surgery. It is grim. People do not take it lightly. But the reason why people do it is because of the extraordinary benefits that follow for people's health. So if you have bariatric surgery, and bear in mind, by definition, these are people who are very obese. If you have bariatric surgery, in the seven years that follow, you are 56% less likely

to die of a heart attack. You are 60% less likely to die of cancer. You are 92% less likely to die of diabetes-related causes. In fact, it's so good for your health that you're 40% less likely to die of diabetes-related causes. In fact, it's so good for your health that you're 40% less likely to die of any cause at all. And the evidence is increasingly clear that these drugs move us in the same direction. Now, of course, I was not severely obese. The effect is going to be less intense on me because I'm starting from a different place.

But we now know if you take Wigov to be an exam pick, for example, your chances of having a heart attack or stroke go down by 20%. If you started with a BMI higher than 27 over the next few years. Now to me, that was just when I saw that because I don't fall into the major categories of risks that I'm worried about. No one in my family had thyroid cancer. I'm not trying to get pregnant. Obviously we can go down the list. It was not making me depressed. I've never

had an eating disorder. For me, I just thought, well, given the heart disease profile in my family, given how many of the men in my family, in fact on both sides, develop terrible heart disease and die, I just thought this could literally be saving my life. And that's when I thought, okay, for me, that benefit outweighs the potential risks, which I'm nonetheless still worried about. And I'm worried about them partly for myself, but a lot for other people.

So different people will come to this with different appetite for risk and different, you know, actual measurements on these various risk scales. And I don't want to deny it as well or play this down. There's also an element of vanity in it. I like that my neighbor's hot gardener hit on me. I like looking the way I do now and I had a really interesting argument with one of my friends. As you know Dan, because we've talked before, I'm someone who processes ideas by talking to people right so I'm doing all this research I'm reading enormous numbers of scientific studies I'm someone who processes ideas by talking to people, right? So I'm doing all this research. I'm reading enormous numbers of scientific studies

I'm going all over the world learning this the evidence about these drugs and I would talk about it to my friends and I have one friend is one of my oldest and closest friends at a wonderful person Who was getting kind of pissed off with me? And it was kind of weird she's not herself overweight. So I knew it wasn't like a personal sensitivity I was like, huh? Well, I call her Lara in the book. I was like, well, why is Lara getting so annoyed with me? And one day she was in, we were both in London and we went out for dinner. And she just snapped.

And she said to me, I just can't listen to this anymore. You're constantly telling me you're weighing these risks, the risks of obesity and the risks of the drugs, you're kidding yourself. You're doing this out of vanity, right? You're doing this because you've never been happy with the way you look. All the time I've known you, I've thought you look great. You've never thought you did. This is about your psychological issues about how you look. And I was like, I was really thrown because she knows me very well. There's moments when you really doubt yourself. And she said to me, if these drugs had all these benefits for your health, but they gave you boils on your face, would you take them?

And the honest answer is no, I wouldn't. And although I think she was underplaying, you know, my dilemma is sincere. There are real health problems that she, you know, in her less angry moments does acknowledge. There was a truth there as well. This is, it's complicated for me like it's complicated for everyone else. Yeah, but vanity, we evolved to have this capacity of vanity and being sensitive to how other people see us. And we can do our best to deal with the stigmas that are there in society and to fight them, but they're there and we might not agree with the beauty standards, but they are there and they're in our molecules in deep ways and they show up in how others treat us. And so it's hard for me to get overly condemnatory of you for having vanity, especially as a recovering anchorman myself.

It's funny whenever I speak to you, we were talking about this offline, but whenever I speak to you, it actually triggers my envy and vanity because, presumably this is because Dan does have the best hair of anyone I know, so I'm filled with rage, my hair never looks as good as your hair, no matter, even when I go to the hairdresser and walk out it doesn't look as perfect like the effect that yours does so. My vanity is currently activated in a negative way but yeah, no I think you're right that we all exist in these complex webs of emotion and feeling and these, this topic in particular, I don't think there's any topic in our culture that activates more shame and anger. And I felt it bubbling up in myself

when I, both when I was overweight and when I started taking these drugs. And I felt it bubbling up in myself when I, both when I was overweight and when I started taking these drugs. And I remember having this feeling. I had all the rational intellectual doubts that we're talking about and lots of other ones that we might allude to, but I also had this feeling, a much more primal feeling, like I was cheating. It was a word that kept coming into my head, I'm cheating. This isn't right. This is too easy. And I think that's really odd because like if one of my friends starts taking

statins, I don't go, hey, you asshole, you're cheating. Why are you bringing down your cholesterol compared to me, right? Thought wouldn't even cross my mind. What is it about this topic and about obesity that makes us feel that way. And I think it goes to some really deep things in the culture that are sort of bubbling to the surface in loosely articulated ways in relation to these drugs. One of them is just, so think about the idea of obesity as a sin. If you go back to the sixth century, Pope Gregory the first is the first pope to articulate the seven deadly sins. And one of them is gluttony and it's always depicted with the images of obese people looking monstrous, kind of pigging out. People remember

the pin-hair consciousness, right? If you think about the forms of weight loss that we admire, they follow very much the old Catholic idea of like, you go to purgatory and then you get to redemption. So think about that show The World's Biggest Loser, absolute repulsive show in my view, but it's where they get very severely overweight people and they get them to compete in horrifically degrading forms of exercise and starvation to be the biggest loser, to lose the most weight. It's like, oh, if you torture yourself, if you go through hell, then we'll forgive you. You've paid the price for your sin. But I think to some people, and this is a voice in my own head, me just getting this

jab, it feels like the Catholic Church in the Middle Ages, some parts of the Catholic Church would sell indulgences. You would get to commit a sin, and then you go and you make a donation and they go, God has forgiven you, right? And it's a bit like what you get out of the sin for nothing. You did all this sin and you don't even have to suffer, right? I think that's somewhere in our minds. I also think the idea about cheating, right? I felt like I was Lance Armstrong, right? And everyone else was looking at, with the other cyclists

looking at Lance Armstrong. I think this is really weird what's going on there. And I realized, so we are surrounded, and this is much worse for women than for us men, but we are surrounded by people who are constantly making sacrifices to be thin. They are going hungry, they're doing grueling forms of exercise, they are experiencing pain to be slim. And I can well understand those people looking at me

and going, what? I go through all this suffering and you just inject yourself in the leg once a week and you get all the benefits I get. Screw you, right? I can see where that comes from. But I think we need to acknowledge those feelings that are there and reframe them. Firstly, I think we can move beyond the idea of sin.

We're not sixth century popes anymore. But I'll say, if there is a contest, and I think there actually is, the contest is not me versus the person is starving themselves. The contest is all of us against the forces that cause the obesity crisis against the food industry. You know, more three year old children know what the McDonald's M means than know their own last name. Right?

You didn't choose that. I didn't choose that. We didn't choose this environment that's making us obese. We are in a contest against those forces. and I went to places that have overcome those forces like Japan. That to me seems a much healthier way. We could just tear each other down if we want. I can shout at you, you can shout at me, we can all shout at the next celebrity who loses

weight and we can all go into their Instagram comments and go, I'm Zempik, you're cheat, I'm Zempik, you're cheat if we want. But where does that get us, right? We live in an age of shame and anger where it's all supercharged by social media. So this is against the spirit of the times, but shame and anger is not going to get us out of this crisis, right? Compassion, understanding and dealing with the deep structural underlying reasons

and just being compassionate for while we deal with those structural underlying reasons or until we do, we're in a trap, right? We're all in this trap. And if people choose a trap door that is imperfect and risky, well, we should understand the issue is the person who put us in the trap, not the person choosing the trap door. As you're speaking, I'm thinking about another issue here, which is that we don't all have equal access to this trap door. I mean, these drugs are expensive and not everybody can afford them.

A hundred percent. And there are really five scenarios for how this could all play out now. If we think about the next 20, 30 years of these drugs. And it's a bit weird for me to have done all this research, to interview all the leading experts, to have gone on this huge journey to all these different places. And I still don't know which of these five scenarios are going to happen. And they're really different. So I'll start with the most pessimistic and I'll build up to the most optimistic because I think it addresses your question.

So the most pessimistic scenario is this is like a drug called FenFen. So in the 1990s there was a weight loss drug called FenFen that was marketed exactly like Lozenpick is now. In fact, the front page of Time Magazine was the new Miracle Weight Loss drug. So it was a combination of two drugs. It was an appetite suppressant called Flexfluramine, which made people drowsy. So it was never that popular. So they combined it with an amphetamine called Fentramine.

And obviously the amphetamine counteracted the drowsiness, so it was never that popular. So they combined it with an amphetamine called Fentramine, and obviously the amphetamine counteracted the drowsiness, but also had an extra effect of suppressing your appetite. It was huge. In 1995, there were 18 million Fentfen prescriptions. And then it was discovered that it caused a horrific lung problem, something called primary pulmonary hypertension,

where the blood vessels in your lungs radically contract and you can't breathe. You have to be on oxygen for the rest of your life. If it doesn't kill you, it was a catastrophe. It had to be pulled from the market. Huge numbers of people died. It led to the biggest payout in the history of the pharmaceutical industry up to that point, $12 billion.

I don't think that's a very likely scenario here, given what we know about the diabetics, but you'd be a fool to rule it out, right, given that wasn't that long ago. So it's possible there will be some catastrophic effect that will be detected associated with these drugs. And there are some red lights that I go through in the book that are being investigated. That's one scenario. I don't think it's likely, but you have to acknowledge its possibility. The second scenario is that these drugs are like chemical antidepressants. So what we know about chemical antidepressants as someone who used to take them is they give you a huge boost when you start taking them, but for most people, unfortunately, over time

they do become depressed again. And not everyone and anyone listening, if you're taking chemical antidepressants and they're helping you, my advice is to carry on taking them. But unfortunately, most people, the effect does wear off. So it could be that these drugs work, but we develop tolerance to them, their effect reduces over time, and they wear off. There's some evidence suggesting that may be the case, but some evidence that it's not the case. We don't know yet. We'll have to wait and see. The third option relates very tightly to your question. So the third option is that they work, that the benefits outweigh the risks. They're essentially like statins. They don't solve the underlying problem,

but they massively reduce part of the problem. But that they're restricted to a small number of rich people who can pay for them, right? So the Real Housewives of New Jersey get to be super skinny and the Real Schoolchildren of New Jersey get to develop diabetes at the age of 12. That's the kind of dystopian way of framing it, right? It's not actually very expensive to make these drugs. It's only about $40 a month. All the rest is going to Novo Nordisk and Eli Lilly, the companies that develop these

drugs who argue, not totally unreasonably, that they spent a fortune developing them. Most drugs development doesn't lead to anything, so they deserve to rake in the profits. I mean, I would say there's some truth in that given the way we currently structure drug development, but they don't need this much profit, right? I mean, Nova Nordisk is now the most profitable company in the whole of Europe. The fourth scenario is that they're like statins, they work, the benefits outweigh the risks, and we give them to everyone who wants them, right? Now, there's different ways we could get to that route. One way could be that the companies could start to compete

based on price to bring the price down. There's more than 70 new weight loss drugs based on these mechanisms that are in development. There's going to be more and more and more of them. There's 37 gut hormones that we now know reduce appetite. So there's going to be lots of variants on these drugs. The companies might decide to undercut Novo Nordisk and do it cheaper. Or it could be, this would be my preferred option, that we regulate the drug companies. We do what the US fails to do on everything. We could talk about lobbying and everything we want, but we should regulate the drug companies to force them to lower the price, right? That's perfectly within

the power of the US government if we want to. And that would save a fortune further down the line, because we know if you deal with these problems early on, you're not only improving people's health, you're not only expanding their lifespan, you're saving a fortune further down the line. The fifth option is the one that I most hope for. And that's basically scenario four, the drugs work, the benefits outweigh the risks, we

give them to everyone who wants them. But at the same time, it wakes us up. We go, how the hell did we get here? How did we get to the point where almost half the population wants to inject themselves with drugs to sever their appetite? Do we really want to give this to our kids? Is this what we really want the future to be? Why don't we also deal with the underlying structural problems like they've done in Japan

so that the next generation doesn't have to face this lousy choice between the risky condition of obesity and the risky option of taking these drugs? That to me is what we should be doing. I think probably the most likely scenario is for the next few years is scenario three, where we are, right? And as your question implies, it's an unacceptable situation, right? It's not right that I can pay for these drugs. But actually, people with greater need than me, people who are much more overweight than I ever was, or people who are diabetic are not getting them, that is scandalous, right?

That's a product of this illegitimate system. I think that's probably the most likely scenario, but that scenario won't last forever. I mean, every day it lasts is a day too long, but Ozempic goes out a patent in 2032, so only eight years from now. At that point, it'll be a daily pill, almost certainly. It'll cost maybe 80 cents, a dollar a day. I mean, I anticipate just by that point, enormous numbers of people will be taking it. Coming up, Johan talks about the choices we as a society now face with the advent of Ozhempic.

His thoughts on the question, why don't you just diet and exercise instead? A very common question. And he responds to his own critics. Do you want some more positive news in your headlines? Well here's some. So the second-hand clothing market is on track to make up 10% of the global fashion industry by next year and the gender pay gap in the UK has shrunk to its lowest level in seven years. Well if you want a more balanced and uplifting view of the world, search for the Positive News podcast with me, Dr. Rhoda Maudgill and me, journalist and broadcaster Shay Rhodes.

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Toward the end of your book, you talk about the choices facing us now. Can you give us an overview of what you think those choices are for us as a society on the dealing with what could be this huge change. Well, lots of people listening, given that 70% of the American population is overweight or obese, I guess your audience is representative of that. There's 70% of people listening who'll be thinking, should I be taking these drugs myself? And everyone will love someone who's in a position who is making that decision, right? With everything else, every other book I've ever written at the end of the process

of course I still have doubts but I'm pretty sure why I would recommend to people right? With this, this is a science that's just coming into view there's so much of the picture that's sort of fuzzy at the moment where it's part of the balancing of risk we have to do. But if you were someone I loved and you came to me and you said, okay, look, Johan, I get all this. You've told me to go and see my doctor. You've told me there's a lot of uncertainty. What are you personally advising I should do?

I would say, if your BMI is lower than 27, definitely don't take the drugs. You're not overweight or obese, so you're incurring all the risks for't take the drugs. You're not overweight or obese so you're incurring all the risks with for none of the benefits. In fact you'll be imposing risks on yourself if you're taking them to be super skinny you're risking losing a lot of muscle mass which may actually leave you very disabled when you're older. Don't do it. If your BMI is higher than 35, if you were someone I

loved, in fact there are people I love in this situation, I would say my advice is to take them because the risks of obesity at that level are so great. I mean, if you think about diabetes, diabetes knocks, and that's only one of many effects, diabetes knocks 15 years off your life on average. It's a really serious condition. It's the biggest preventable cause of blindness. More people in the US have to have a limb or extremity amputated every year because of diabetes than because of being shot. And a lot of us get shot in the US, right?

So I would say in that situation, my advice with a heavy heart and a lot of doubt would be to take it. If you're provided you don't have thyroid cancer in your family, you're not trying to get pregnant If you're provided, you don't have thyroid cancer in your family. You're not trying to get pregnant. Um, and you don't have a history of eating. If you're BMIs between 27 and 35, I'd kind of throw up my hands and say, look, go through the risks in my book, go through the benefits in my book, go through the wider evidence. But really, I don't know what to recommend.

I don't know. It's the honest answer. This is a question I should have asked earlier, but one of the canards you take on, one of the sort of unhelpful counter arguments you take on early in your book is why don't you just do diet and exercise instead? Can you address that now? Belatedly?

One night taking the drugs, I had dinner with my friend Dave. I don't know why it's lodged in my head that he was eating chicken schnitzel while he said this. But I had to talk about the benefits and risks and all the things we've been talking about. And he said, what the hell are you talking about, Johan? There's a third option, right? I've seen you do it. Diet and exercise. When you do it, you lose weight. And of course, this has been running through my head throughout the research for the book.

So I did a lot of digging into this. And one of the people who really helped me to understand and decode it is a brilliant person called Professor Tracy Mann, who's at the University of Minnesota in Minneapolis. In fact, I went to interview her, we met in a cafe called Isle's Bun, a brilliant cafe in Minneapolis.

And the first thing that happens when you go in there is they say to you, have you been here before? And I said, no. And they said, well, we'll give you a free cinnamon bun. And they gave me this enormous sugary cinnamon bun. Then I must've been like 2000 calories that sat there on the table while we had this conversation about why people fail at diets. But so Professor Mann began researching this in the year 2000. And at that time, it was thought that the science around dieting was settled. And very clear, there were thousands of studies showing diets work.

If you go on a diet, you lose weight. Based on the very simple physical principle, which is no one disputes, which is that if you burn more calories than you have coming in, you'll lose weight. But Professor Mann looked at these studies and she noticed something which is that they were almost all three month long studies, some were six months long. So what they find is you've got a diet, you lose a lot of weight, it's a downward graph and then the study stops and the implication is you live happily ever after at this new lower weight. But Professor Mann thought well

that doesn't seem to fit with most of the people I know who've been on diets. Let's look into this more. So she looked to see if there were any studies that had followed people over a much longer time period. And it turns out there were 26 studies that have followed people over two years or a handful that have followed people over five years. And they showed a completely different picture.

After two years on a diet, your average weight loss is two pounds. Not nothing but pretty trivial right? There's a small subsection of people on diets who do keep the weight off. We all know people like that, I have someone in my family like that. But they are total outliers. The vast majority of people on diets regain the weight. And there's a big debate about why is that, right? Because calories in, calories out, that science is clear. And it seems to be, there's lots of disputes about this, but it seems to be that as you gain weight, so imagine if now, Dan, you gained like 60 pounds, your brain would then try to keep you at that higher weight. Dr. Giles Yeoh, one of the obesity

specialists at Cambridge University said to me, your brain hates it when you lose weight and it will fight to make you keep it. So once you gain that weight and you try to lose it, think about this happened to Robert De Niro when he gained a load of weight for the movie Raging Bull. You gain a load of weight and then you try to cut back. But what happens is your brain alters, physically biologically alters you. It slows your metabolism down so you burn calories much more slowly. It makes you crave far more sugary and fatty foods and all sorts of mechanisms kick in. It makes you more lethargic so you don't want to exercise.

And I remember thinking, so loads of scientists explained this to me, the science of it is really clear. And to be honest, I just didn't believe it. So it's like, well, why would evolution endow us with such a glitch, right? If being overweight is really bad for you, why would it make us hold on to being overweight? It makes no sense. But lots of scientists like Professor Michael Lowe explained to me, you've got to think about the circumstances in which human beings evolved.

In the circumstances where we evolved, we almost never experienced the circumstances we now have, which is there are way more calories than we can consume all around us all the time. An overabundance of calories that lasts over a whole lifetime, essentially never happened in human evolution. What did happen was a completely different scenario. There was a pretty permanent risk of famine, right? Famine was a risk that would come along pretty often in your life when we were evolving.

So in a situation where famine might come along, you can see why if you gain weight, your body makes you try and hold it. Think about famine. In a famine, the fattest guy at the the start is gonna be the last man standing right cuz you burn through the fat stores in your body as you stop. If i'm in timothy shalameh will die in week one of me at my father's will be standing there gloating over his body i'm gonna go to the show and i don't be sad but you get my point right and. So actually evolution. It prepared us to hold our weight because it thought that a famine was coming.

But now it's preparing us for a famine that ain't going to come. And this is more contentious, but there's a debate about whether what these drugs do to your brain is they basically reset that mechanism. It's like taking your iPhone to the back to its factory settings. They lower that mechanism that makes you try to hold the higher weight. Now that is contentious and disputed, but I do think we need to think about this deeper evidence. Look, if diets work, I don't know a single fat person who hasn't been on a load of diets,

right? 17% of Americans are on a diet at any given time. We know about dieting and it does work for some people, but the way I think about it, because it's so tied up with ideas of willpower. And the way I think about willpower is there's three kinds of cause of obesity. There's biological causes. Your genes can make you more vulnerable to it. There's brain changes like the ones we just talked about. There's psychological causes. We talked about comfort eating.

There's a lot of other ones. And there's social causes like we just talked about, the food industry. So the fancy term for it is the biopsychosocial model, biological, psychological, social causes. What willpower is, is it's one little sliver of the psychological response to it. So it's real. Willpower is a real thing. Everyone listening will have exercised willpower at some point in their life. But the way I think about willpower is it's almost like an umbrella in a really big storm.

Some people are going to be able to use the umbrella to run across the street and stay dry. All credit to those people. But for most people, the umbrella of willpower is just going to break because the storm around us is so great. And that's why diets aren't working. This is tough stuff. Well, let me ask you one last question. Speaking of tough stuff, are you worried personally about wading into this debate where it's so controversial, and you've already have your critics, you've had folks who've criticized your last book

for allegedly they didn't like the way you used the science, you've had some stuff in your distant past where you had to apologize for plagiarism, et cetera, et cetera. Are you worried that this is gonna bring all that back because you are wading into such an emotional issue? Oh yeah, there's a few things what you just just said. So 14 years ago I presented some quotes that have been said to other journalists as if they've been said directly to me, which is totally unacceptable.

Since then all the quotes from my books are just put on the website so people can hear them being said directly to me so people can be confident about that. In terms of my other book, you're referring to someone called Matthew Sweet, who made a series of claims that were investigated and proven to be false. So he claimed that I'd misrepresented some studies that was investigated in great detail. And what he said was untrue. I'll give you an example. I cited a study that collective attention really is shrinking. The book was about why we're having attention problems. And he claimed that the study said, if read the study it says there is no evidence that collective attention is shrunk as the scientist who wrote the study professor suna layman pointed out

that's a quote from the introduction where they're explaining the state of the science before they did the research he then goes on to provide the evidence so professor layman said that um matthew sweets criticisms were disingenuous full of errors and bullshit and everyone is that to the evidence around the show and that's not true and. In terms of waiting into this debate i'm not got of course i'm terrified and the main reason i'm terrified is not actually public criticism i'm strong i can take that. It's. It's not what it's up so anyone. Like i think I mentioned before, 45% of women with a BMI higher than 35 get insulted every single day.

And they are soaking up so much pain and humiliation that they do not deserve. And people are so wounded around this issue, and I include myself, right? We've been made to feel like failures all our lives for things that are not our fault. And these drugs and this debate, they bring with them great potential and great risks, but they also surface those feelings of pain and humiliation. And I'm aware that by writing about this, I'm going to bring some of that to the surface as well, including for some people that I love, right? People very close to me. And I only do that, I don't do that lightly. And I've done it because I believe that this is a topic we need to understand. And it needs to be approached in a spirit of love

and compassion and great care about the detail. But if we don't, these drugs exist, right? And these prejudices and stigmas exist and there's all the factors we're talking about that drive up obesity exist. We can hide from that if we want, but no one wants for the people they love to hide from the difficult things, right?

That's not how we go through life. I think what we have to do is very carefully and methodically go through all the complex questions in a spirit of love and compassion. I actually think if we do that, although it will activate feelings of shame in some people and indeed did in me, I think if you keep going through that, actually I think the truth sets you free and I do think that actually the truth is profoundly de-stigmatizing. We don't have anything to fear from the truth. The brilliant writer Maggie Nelson said, the antidote to shame is candor. If you're being candid, no one can shame you, right? If we're candid about the facts, if we're candid about

the truth and acknowledge that it's complex and live in the complexity I think we will ultimately get to a healthier place a physically healthier place and a psychologically healthier place I can't ultimately believe that hiding from the truth is good for us even though acknowledging these truths can be very difficult and painful but yes the short answer to your question is yes I'm very worried about it and I'm sure it will it will be painful for some people. And I hate that. I hate that. I hate to activate pain in people. That's the last thing.

The whole point of doing this is to get us to a better place, not a more painful place, but I'm aware that will happen and that it was painful for me. And I've tried to minimize that, but I can't totally mitigate it. And I wish I could. Johan, I always love talking to you about your work.

Before I let you go, can you just remind everybody of the name of the book and any other resources you've put out that you want to direct our attention to? It's called Magic Pill, the extraordinary benefits and disturbing risks of the new weight loss drugs. You can go to the website magicpillbook.com to see the audiobook, the ebook, the physical book. I meant to say my publishers give me this blurb where I say you can get it from all good bookstores, but the reality is you can also get it from shitty bookstores. We don't have like a quality test. You can see what lots of prominent people, including many

former guests on 10% happier have said about the book there. And if you want to know more of my other books, you can go to j-o-h-a-n-n-h-a-r-i.com I'm sure I meant to say something else but I can't what it is and I always love talking to you Dan what a pleasure what a joy and I'm still very jealous of your hair we're trying not to look at it all the way through but what a delight other than that it's been delightful. Likewise congratulations on the new book thank you for your time. Likewise, congratulations on the new book. Thank you for your time. Thanks again to Johan Hari.

Always great to have him on the show. If you're interested in the other episodes we're doing in our occasional series, Get Fit Sanely, we've put a link in the show notes to a playlist where we give you access to all the prior episodes. And don't forget to sign up for my new newsletter where I will list out for me the biggest takeaway from each of the episodes of the week. Before I go, I wanna thank everybody

who worked so hard to make this show. Our producers are Tara Anderson, Caroline Keenan, and Eleanor Vasili. With additional pre-production support from Wanbo Wu. Our recording and engineering is handled by the great folks over at Pod People. Lauren Smith is our production manager. Marissa Schneiderman is our senior producer.

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