The Rich Roll Podcast - Ozempic: Weight Loss Miracle Drug or Something Darker? Johann Hari on The Benefits & Risks

Episode Date: May 23, 2024

This week, I’m joined by Johann Hari, New York Times bestselling author, journalist, and speaker, to explore his journey into the world of the new weight loss drug phenomenon: Ozempic. Johann shares his surprising firsthand experience injecting himself weekly with the drug for over a year, leading to dramatic weight loss but also complex side effects. We discuss the staggering potential of these “magic pills” to curb the global obesity epidemic, but also the alarming risks like thyroid cancer, pancreatitis, and muscle wasting. Johann provides a nuanced look at the bigger picture—examining the role of pharmaceutical profit, societal pressures around body image, and whether medicalizing thinness addresses root causes. His investigation stretches from the science labs of Iceland to the food culture of Japan. This discussion ultimately confronts sobering philosophical questions about the ethics of pharmaceutical shortcuts versus growth through struggle. Please enjoy! Show notes + MORE Watch on YouTube Newsletter Sign-Up Today’s Sponsors: InsideTracker: Use code RICHROLL at checkout and enjoy 10% OFF the InsideTracker Subscription and any plan 👉insidetracker.com/richroll Seed: Use code RICHROLL25 for 25% OFF your first order  👉seed.com/RichRoll  On: 10% OFF your first order of high-performance shoes and apparel w/ code RICHROLL10 👉on.com/richroll  Momentous: Save up to 36% OFF your first subscription order of Protein or Creatine, along with 20% OFF all of my favorite products 👉livemomentous.com/richroll Squarespace: Use the offer code RichRoll to save 10% off your first purchase of a website or domain 👉Squarespace.com/RichRoll  Peak Design: 20% OFF thoughtfully designed carry solutions 👉PeakDesign.com/RICHROLL SriMu: Get 22% OFF artisanally crafted plant-rich cheeses w/ code RRP 👉SriMu.com Check out all of the amazing discounts from our Sponsors 👉richroll.com/sponsors Find out more about Voicing Change Media at voicingchange.media and follow us @voicingchange

The second day I was taking Ozempic, I had woken up and I wasn't hungry. It's easy weight loss. Maybe it's called diet drug miracle weight loss drug. This is Ozempic. Ozempic. Ozempic could be a game changer. This is a scientific breakthrough. People are actually getting healthier.

If you want a comparison for what these drugs are going to do, you've got to compare it to the invention of the smartphone. This will change the world for better and for worse. Back for his third appearance on the podcast is Johan Hari. Johan is a journalist and he is the author behind a series of New York Times bestselling books that include Stolen Focus, Lost Connections, and Chasing the Scream. His latest book is entitled Magic Pill. It's an in-depth investigation into the benefits and also, of course, the risks of the new

weight loss drugs like Ozempic that are creating a worldwide sensation. There are extraordinary benefits. You've got to weigh the risks of these drugs and you've got to weigh that against the risks of continuing to be obese. Is Ozempic a miracle weight loss cure or is it something more dangerous to be avoided? The answer is, it turns out, complicated. It's lovely to see you again. It's been a couple of years.

And as much as I would like this podcast conversation to stand apart from the other media appearances that you've been doing around this new book, I can't escape the elephant in the room. Like we have to address it upfront. Like your appearance is so dramatically different. You look fantastic. Clearly you lost a ton of weight.

You've written this book, you tell the story and you look quite handsome, my friend. Oh, wow. Yeah. Thanks. Actually your appearance has also profoundly changed. I feel like I've been interviewed by Gandalf. You got skinnier and I got gray and old, basically.

No, this is very glam. This is, yeah, there's something inherently unfair about this. No, I don't think so. It's funny, isn't it? Even now you sort of slightly hesitate to talk about this, but yeah, so I'm taking a Zen pick, right? I started taking it for the book that I've written because as soon as I heard about these new weight

loss drugs, I felt a massive mixture of emotions. First thing I thought was, well, I'm older now than my grandfather ever got to be. He died when he was 44 of a massive heart attack. Loads of the men in my family get heart disease. My dad had terrible heart problems. My uncle died of a heart problem. If there really is a drug that can reverse obesity or hugely reduce it, and we know the average person who takes a Zempik or Wegovy loses 15% of your body weight, I thought, wow, that could mean a lot to me, right? We know that obesity causes over 200 known diseases and complications. A drug that can move you away from that, that could be a big deal.

But I also immediately thought, wait a minute, I've seen this story before. Pretty much every 20 years, going back to the first world war, a new miracle diet drug is now- It's the oldest story. It dates back to the beginning of humanity. You know, what's the latest snake oil weight loss cure?

We've seen it time and time again. There's no biological free pass. There's no way that this could be on its face as efficacious as one might be led to believe. But I think, and we're gonna talk about it, the more you dive into this subject matter, the more complicated and nuanced it becomes. And there are many positives, there's also many negatives,

and where you come out in the end, I think is very case dependent on who you are and your relationship to weight, right? I think that's exactly right. To try to get to the bottom of this, to resolve these contradictions, to figure out know can it be as good as it seems can you really have a you know a free lunch i guess with those then pick it'd be a smaller free lunch i went on this big journey all over the world from iceland to minneapolis to japan to interview the leading experts on this

the biggest critics of the drugs the biggest defenders and i think you're exactly right i think people should be very wary of anyone who's saying about these drugs, either just uncomplicatedly, yay, everyone should be on them, or boo, nobody should be on them. I think it's missing the much more important nuance and complex point, which is, you know, the subtitle of my book, Magic Pill, is the extraordinary benefits and disturbing risks of the new weight loss drugs. Because the truth is both halves of that are true. There are extraordinary benefits and there are 12 disturbing risks of the new weight loss drugs because the truth is both halves of that are true there are extraordinary benefits and there are 12 disturbing risks and there's no one size fits all for that and there's a lot we don't know but there's a lot we do know and i think what people really need to do is go down the list of the benefits and risks see which ones apply to them

which ones don't and also just be prepared for some of the psychological changes that happen when you take these drugs some of the big cultural changes that are going to happen now, you know, 47% of Americans want to take these drugs. This is blowing up all around us. Everyone who takes these drugs becomes a kind of walking advertisement for the drugs. This is huge. This is going to change so much. You know, Barclays Bank commissioned a very sober-minded financial analyst called Emily Field to go away, research these drugs to guide their future investment decisions. And she came back and said, if you want a comparison for what these drugs are going to do, you've got to compare it to the invention of the smartphone.

I think she's right. There does seem to be something qualitatively different about Ozempic and these GLP-1 agonists that distinguishes them from past versions of what we might think of as a magic pill. Like there really is something unique and different here. But let's like walk through it. Like tell the story of how you came to decide that you were gonna give this a try.

Yeah, I think, you know, I remember the exact moment I learned about it. It was the winter of 2022, was invited to a party. It was that moment when the world got reopened, right? I hadn't been to a party like everyone else in the world hadn't been to a party in 18 months, however long it had been. And I was in an Uber on my way to the party. And this was a party thrown by an Oscar winning actor. I'm not saying that just to name drop, it's relevant to what happened next. And I was sitting there- And you didn't call me to say, hey, Rich, you want to come along to this party? You would definitely be my date to the next one. And on the way there, I was feeling a little bit

kind of self-conscious because, you know, I've been quite fat at the start of the pandemic and I gained quite a lot of weight during the pandemic. And I was feeling a bit kind of schlubby and embarrassed. And then I suddenly remembered, oh, actually almost everyone I knew gained some weight during lockdown. I suddenly thought, oh, this party is going to be fascinating. I'm going to see some of these Hollywood stars with a bit of flab on them, right? And I arrived and it was the weirdest thing. It's not just that they hadn't gained weight. Everyone was like gone. Everyone looked like their own Snapchat filter, right? They were like clearer and cleaner and sharper. And not just the actors, but like the agents, everyone was like markedly thinner. And I was

wandering around and I bumped into a friend of mine on the dance floor. And I said, oh, you know, it looks like everyone really did take up Pilates during lockdown. And she just laughed at me and I didn't know why she was laughing. And that was when it was explained to me. And you're absolutely right that there's a qualitative difference. It's obviously then began to research these drugs. So these are new drugs that work in a completely new way on a totally new set of mechanisms, which really do guarantee very high amounts of weight loss. In fact, the next in these classes of drugs guarantee of more. Munjaro, the average person who uses it loses 21% of their body weight. And for GGG, which is the next which will probably

be available next year, the average person loses 24% of their body weight, which is only slightly below bariatric surgery. And we know some things about how these drugs work. So if you ate something nail-rich, doesn't matter what it is, after a little while your pancreas would produce a hormone surgery. And we know some things about how these drugs work. So if you ate something now, Rich, doesn't matter what it is, after a little while, your pancreas would produce a hormone called GLP-1. GLP-1 is just part of your body's natural signals going, hey, Rich, you've had enough, stop eating, right? But natural GLP-1 only stays around in your system for a couple of minutes, and then it's washed away. What these drugs do is they inject you with an artificial copy of GLP-1 that instead of sticking around for a couple of minutes,

sticks around for a whole week, which has this bizarre effect. I will never forget the second day I was taking Ozempic, I woke up and I was lying in bed and I thought, huh, I feel something really strange. What is it? And I couldn't locate in my body what it was that I was feeling so strange about. And then I realized I had woken up and I wasn't hungry. That had never happened to me before, right? It's been my whole life eating processed food, ultra processed food. I used to wake up with this kind of raging hunger. And really on autopilot that day, I went to this diner just up the street from where I live and I ordered what I used to order every day for breakfast, which I'm embarrassed to say

to someone as healthy as you, it was a huge chicken sandwich with loads of chicken and mayo in it. And I would eat that normally and I would still like want to have a bag of potato chips or something. And I ate it and I had like three or four mouthfuls and I just was full. I didn't want anymore. So what these drugs do is they boost your GLP-1 levels and some other gut hormones for the other drugs, which makes you feel very full, very fast. Now, initially it was thought that was an effect primarily in your gut. We now know actually GLP-1 goes to your brain.

We have GLP-1 receptors in your brain. So, and it changes your brain in complicated ways. So this is a completely new kind of drug and the findings on weight loss are very robust, right? Most people lose significant amounts of weight when they take these drugs. But when they go off them, it's something like a 70% reversal, right? They gain the weight back 70% of the time within a year. That's exactly right. So there's a big debate about, there seems to be anecdotally,

a minority of people who use these drugs to interrupt their habits, build new habits, then come off them and keep the weight off. But we don't have any studies of that yet. We know that most people who stop taking them just regain the weight quite quickly. Now we want to take that with a little bit of a pinch of salt because those studies were funded by the drug companies who obviously have a vested interest in wanting you to take it forever. But it does seem to be the case that these drugs are more like statins or blood pressure medication.

They work for as long as you take them. And then when you stop taking them, the effect goes away. It's not a cure. It's a treatment for an ongoing situation, which makes it a much bigger deal to take them, right? It's not a holiday romance. It's getting married and it's getting married if you're a Mormon, right? It's not a holiday romance, it's getting married and it's getting married if you're a Mormon, right? It's gonna last your whole life if you want it to work. Initially, when I started hearing about Ozempic and Ozempic face and you see these pictures of these people who are looking gaunt

with their eyes kind of sunken in their head, I thought like, there's just no way that this can be good. Like I was just absolutely against the idea of this having any kind of long-term real meaningful benefit. there's just no way that this can be good. Like I was just absolutely against the idea of this having any kind of long-term real meaningful benefit. But when you reflect upon the obesity epidemic and what's driving it,

which is our unhealthy food ecosystem, which you write about, and we're gonna talk a little bit more about, we're looking at incredible increases in the percentage of obese people in the Western developed world. I think it's something like 27.8% of the British population is obese,

much higher in the US, something like 42, 42.5 or something like that. And then you consider that obesity sits at the foundation of all these lifestyle illnesses that are debilitating and unnecessarily killing millions of people. If there's a way to get people less obese, if we can get people to lose weight, they can sidestep some of those illnesses.

And this seems to be a very effective way to do that. If you are a chronically obese person who's tried everything and been on every diet and has never been able to make it stick, there seems to be a bit of opportunity here, right? And so I think it would be helpful and informative for you to share your own history with food. I mean, you tell these stories about, the chicken shops and the KFC

and your friend who passed away. And this is something you've kind of contended with your entire adult life, your relationship with food. Yeah, I had many low points in my relationship with the junk food, but perhaps the worst, I can tell you exactly when it happened. It was Christmas Eve, 2009 at 1 p.m i went to my local branch of kfc where i lived at the time in east london and the guy behind the counter said oh johan i'm really glad you're here

i was like oh okay and he went he said wait a minute and he went off behind where they fry the chicken and everything and he came back with every member of staff who was working that day and a massive Christmas card in which they'd written to our best customer and everyone had written like little personal messages. And one of the reasons my heart sank is I thought this isn't even the fried chicken shop I come to the most. This is not a good side, right? So I spend, you know, my diet was predominantly shit basically most of my life. Um, you know, I grew up in a working class family. Um, we, we ate what, I mean, we're a little bit ahead of the curve. We ate a little bit worse than British people did at the time, but now people in Britain

have basically caught up with where we were. Uh, my diet was mostly processed and ultra processed foods. And so I wasn't actually a fat kid, but I became kind of, well, I became obese when I was in my early twenties. I had periods where I would lose weight, but I would always kind of go back. And in your question, you've gone to the heart of this dilemma, right? If you can lose weight through diet and exercise and a significant number of people can, it seems to be 10 to 15 percent of people can do it that way and keep it off in the long term in this environment everyone should try that first there's very few risks to that there's much less risk than there are for these drugs

if that didn't work for you as it didn't work for me and we can explore why and there's some scientific evidence about why it doesn't work for a lot of people. I think you've really got to weigh two sets of risks. You've got to weigh the risks of these drugs, 12 big risks. Some of them are really worrying. And you've got to weigh that against the risks of continuing to be obese. And this will sound weird. And I think it will sound dumb to you because you know so much more about health than I do. I think it'll sound dumb to you because you know so much more about health than I do.

The thing that most shocked me in the research for my book is actually the thing I thought I'd known since I was a little boy. It's just how bad for your health obesity is, right? And this is a very painful thing to think about. And I understand why a lot of people wanna avert their gaze from it. But even let's think about one of the most simple things. I guess

I've known since I was seven years old that if you're obese, you're much more likely to get diabetes, right? But I think I thought until I did the research for my book, okay, diabetes is not a good thing. Obviously, I'm talking about type two diabetes. Diabetes is not a good thing. But as long as you've got health insurance you know you get insulin you're basically like everyone else i thought a diabetic plus regular insulin is like you or me that's not true at all diabetes knocks 15 years off your life on average and if you're obese when you're 18 you have a 70 chance of becoming diabetic in your life and diabetes causes horrendous problems it's one of the biggest preventable causes of blindness in the

Western world. More people here in the US have to have a limb or an extremity amputated because of diabetes than because they got shot. And you will have noticed a lot of us get shot. In fact, the harms of diabetes are so severe. A doctor I interviewed in Britain who treats diabetics, Dr. Max Pemberton, said something to me that at first sounds very shocking, but when you look at the evidence, you can see why he says it. He said, if you gave me a choice between becoming diabetic and becoming HIV positive, I would choose to become HIV positive because if you become HIV positive and you get treatment, you live as long as everyone else. That is not true of type 2 diabetes. And that's just one of 200 diseases and complications that are made more likely.

of 200 diseases and complications that are made more likely. All the things we fear are made much more likely by obesity, dementia, heart disease, stroke. I mean, knee and hip problems because right that physical pain, back pain, just go right down the board. I was taken aback by how bad that is. So you've got to weigh the risk of incurring that. Realistically, I would have continued to be obese, right? I would have had periods where I wasn't, periods where I dieted and exercised, but realistically that had been most of my adult life. There's no reason to think that would have changed no matter how much I tried.

And I really did try several times. We can talk about why it didn't work for me, but so you've got to weigh that against the risks of the drugs, right? And that is not a simple calculation. There's a lot we don't know. And there's a lot we know about obesity. Some significant stuff we don't know about these drugs.

So I think you're totally right. We've got to weigh those different things. It's hard to even talk about this without using words like weigh, right? What was your heaviest weight? I'm so bad at using the- 220 or something like that. Pounds to stone, stone to pound,

kind of you barbaric colonials. How many pounds is a stone? Like 14 pounds or something? I think it's 14 pounds, but double check this. So I think my fattest was, I was like 15 and a half stone. Let's figure out what that is. If any of you have a calculator, we can do that. Sorry.

I can't believe you guys still use stone. I know, it's madness. It's like, what are we, like in the middle ages? Exactly. We weren't believe you guys still use stone. I know, it's madness. It's like, what are we, like in the middle ages? Exactly. Stone. We were using it. But you lost like three stone, right? So what is that? I lost 42 pounds.

40 pounds, yeah, 42 pounds. On Ozempic, yeah, in a year. And are you still on Ozempic? Yes, I decided to continue taking it. Although I think there's lots of people who would look at the same evidence as me and come to the opposite conclusion. And the reason I did was pretty simple. People have only been taking these drugs for weight loss for a couple of years, right? And I think if you want to

understand the effects of these drugs, I think it actually helps to look at another medical intervention that's been going on for much longer, which is bariatric surgery, right? Things like stomach stapling, gastric sleeves, and so on. There's lots of different forms of bariatric surgery. So bariatric surgery, what do we know about it? It's rough. One in a thousand people die in the operation. It's grim. It's no joke. But the reason people put themselves through that is because afterwards, the benefits to their health from hugely reducing their obesity are staggering, right? If you have bariatric surgery in the seven years that follow, you are 56% less likely to die of a heart attack. You're 60% less likely to die of cancer. You're 92% less likely to die of diabetes-related causes. In fact, it's so good

for your health. In those seven years, you're 40% less likely to die at all, right? And we know now these drugs are moving us in a similar direction, right? That's why the first part of the subtitle is the extraordinary benefits of the new weight loss drugs. So for example, if you take these drugs and you have a BMI higher than 27, which I certainly did at the start, your risk of a heart attack or stroke goes down by 20% in the two years that follow. That's extraordinary. So for me, given the heart disease risk in my family, that outweighed my very real concerns about some of the other stuff that's going on here. But like I say, a lot of people will not have that heart attack risk in

their family. And for them, there'll be a different calculation. So there's all, you've really, I think, got to, I hope the book is a kind of guide to people who are thinking a much more personalized way about this. What are the risks that might be playing out for me in both areas, in the obesity and in the drugs? I have this incredible aversion to the idea that the solution to our poisonous food system that proliferates in ultra processed foods that people become addicted to, that's driving obesity,

that the solution to that poison is this other poison. And it plays into the kind of vertical integration of big food and big pharma and the control that these gigantic conglomerates have over the trajectory of our lives. Like I just hate that narrative so much. And I'm so resistant to the idea that a drug could be a viable solution, even in the short term to this problem. And that's informed also because of my own story and my own struggles with weight and this solution that I found

and eating a whole food plant-based diet and restoring my health and this exploration into diet, nutrition, and fitness that I've been on for many years. But I also have to recognize exactly what you just said. And I have a good friend who's a bariatric surgeon. His name's Garth Davis. He's in Houston.

He's been a guest on this podcast and he's a lifestyle medicine doctor who is on himself a whole food plant-based diet and talks about it constantly and has been kind of proselytizing this way of living, not only for himself, but with his patients. But he's, through his own experience, understands better than most how difficult it is

to get people to change their lifestyle habits. And he has said, if there was a war between Ozempic and lifestyle medicine, like Ozempic is going to win, you know, because people really struggle with changing their lifestyle habits. And in his own practice, his surgical schedule is not what it was, you know, two years ago,

like because so many people are on these drugs and they're not undergoing surgery. And I would agree that taking Ozempic from a risk analysis point of view is perhaps safer than undergoing the knife, right? A surgical procedure. But to my mind, and we're gonna get into the more pros and more cons with more detail, but in my mind,

it seems like the best case scenario is when you have a very obese person who has struggled for a very long time and has never been able to figure this out and is on the precipice of all these downstream health implications that you just kind of spoke to. Having that person go on one of these GLP-1 drugs, agonists as they're called,

but pairing that with lifestyle medicine to use that period of time when their appetite is suppressed or they're having that experience of feeling full. So like you said, you can't eat that much to teach them how to cook, to teach them about nutrition, to break those bad habits, form new ones, and do that repetitively enough,

like use this as an educational period, essentially, such that after however many days, 90 days, which I think is an adequate amount of time to break a habit and form a new one, they can go off that drug and they have like those neural pathways, those grooves have been, you know, kind of created so that they can then begin to adopt these new lifestyle

habits and make them kind of rote in their life. Like they've cleared out their cupboard, they've gotten rid of the shit food, they have learned to cook, they've, you know, have all these skills and these tools that they didn't have before that would then set them on a trajectory, a healthy trajectory, and also kind of get out of the risk

of whatever these drugs are gonna be doing to us long-term that we still don't quite understand. There's so many things that you said there that are so important and that I so agree with. Could I just go back to the very first bit, which was one of my two or three biggest doubts about the drug which was saying look this is a problem that is caused by the environment treating it with a drug is not the answer right and i i think this this was there's a thing that almost made me stop taking the drug quite early on so for a long time

i was researching why did obesity blow up, right? It's really important to understand because I think it's been kind of forgotten. Obesity has exploded in our lifetimes. You basically have, I would just urge anyone to just pause this podcast for a second and just Google for a moment, photographs of public beaches in the United States in the 1970s. So when you and me were born, right? Just look at them for a moment, photographs of public beaches in the United States in the 1970s. So when you and me were born, right? Just look at them for a minute. To us, they seem really weird because almost everyone on those beaches looks to us what we would now call skinny or jacked, right? And you look at it and you go, well, where was everyone else that day? Right? Was it like a

skinny person convention at the beach? And then you realize, no, that's what Americans looked like when we were born, right? You basically have around 300,000 years where you have humans and obesity is very rare. It existed. We know it's there in the historical record, but it's always remarked upon because it's so unusual, right? And then essentially in our lifetimes, this staggering explosion. So between the year I was born, 1979, and the year I turned 21, obesity doubled here in the United States. And then in the next 20 years, severe obesity doubled again, right? And you look at that and think, well, what happened? What's going on there? Because it goes to the heart of this point you were making where you're absolutely right. We know why this happened. This change, this explosion in obesity happens in every country that makes one change.

It's not where people suddenly have a collapse in willpower. It's not where people suddenly become lazy. It's where people move from mostly eating a diet that consists of whole foods that they prepare on the day to eating a diet that mostly consists of processed and ultra processed foods which are constructed out of chemicals in factories in a process that isn't even called cooking it's called manufacturing food and it turns out this new kind of food which never existed in the past right which is a totally new thing affects our bodies in a completely different way to the way the old whole foods used to affect us and there's loads of evidence for this i go

through seven ways in magic pill that these processed foods affect us so differently that they lead us to gain weight. But there's an experiment that to me just totally nailed it, right? So there's a brilliant scientist called Professor Paul Kenny, who I interviewed. He's the head of neuroscience at Mount Sinai in New York. And he grew up in Dublin in Ireland. And in the 90s, he moved to San Diego, I think to finish his PhD. And he quickly realized at the time, whoa, Americans don't eat like Irish people did back then, right? It was much more processed and ultra processed food, sugary food, salty food. And like many a good immigrant, he quickly assimilated. Within a year, he gained like 30

pounds. And he was like, whoa. And he started to feel like this food he was eating wasn't just affecting his gut, it was affecting his brain. It was making him want things differently. So he designed an experiment to test this, which I have nicknamed Cheesecake Park, right? It's a very simple experiment. He got a load of rats and he raised them in a cage. And all they had to eat was the kind of healthy food that rats ate over thousands of years, what they evolved to have. And it turned out when they only had that food, the rats would eat when they were hungry and then they would just stop, right? They had some natural nutritional wisdom that said, hey guys, enough now, right? They never became overweight or obese. Then Professor Kenny introduced them to the American diet, right? He fried up some bacon, he bought a load of Snickers bars. Crucially, he got loads of cheesecake and he put it in the cage alongside the healthy food. And the rats went apeshit for the American

diet. I don't know if rats can go apeshit, but you know what I mean? They went wild for it. They would dive into the cheesecake and literally eat their way out and just be slicked with cheesecake. And they ate and ate and ate and ate. The way Professor Kenny put it to me is within a few days, they were different animals, right? And they all became very overweight. Then Professor Kenny tweaked the experiment again in a way that to me as a former KFC addict feels a little bit cruel. He took away all the American food and left them with the healthy food again. And what he thought would happen, he was pretty confident he knew what would happen, that they would eat more of the healthy food than they had

in the past. And this would prove that junk food expands the number of calories you eat in a day. That is not what happened, Rich. What happened is much weirder. Once they'd had the American diet and it was taken away from them, they refused to eat the healthy food at all. It was like they no longer recognized it as food, right? It was only when they were starving that they went back to it. Now, I would argue we all live in Cheesecake Park now, right? We live in an environment where it is very easy to be overweight or obese. 70% of Americans are overweight or obese. It's the norm and very hard to be a healthy weight. And that is because there's lots of things going on, but by far the biggest factor is processed and ultra processed food. 67% of the calories the

average American child eats in a day come from ultra processed foods, right? That's staggering. So it's very clear to me looking at this research, this is a crisis caused by the environment, caused by the food industry. Has it happened in Japan? There's almost no obesity in Japan. I went to Japan to see why, and it's because they did not allow that transition to happen. So it was very clear to me, that's what created the kind of hole that these drugs fill, right? The food we eat profoundly undermines our satiety, our ability to ever feel full, to feel like we've had enough. And what these drugs do is they give you back your sense of satiety. I had never felt full until I took these drugs. I don't think that's an exaggeration. I'd felt stuffed, but I'd never felt full. And when I learned all that, you know, a brilliant professor in Philly

at Drexel University, Professor Michael Lowe said to me, you've got to understand these drugs are an artificial solution to an artificial problem. And when I learned that, I thought this is just fucking hypocrisy for me to take these drugs. I write all these books about how we shouldn't just deal with the symptoms of our problems. We should deal with the underlying causes. Clearly the solution is to deal with the underlying problems with the food supply. I've got to stop taking these. And I went one day to see one of my closest friends and I said that to her. And this friend is, um, eight years ago, she got very bad breast cancer and she nearly died. And she's a single mother. It was, um, horrific. And I was there with her all through the double mastectomy, the hysterectomy, the

chemo. And she said to me, Johan, when I got breast cancer, you could very easily have said to me, there's something in the environment that's causing breast cancer. One in seven British women get breast cancer. One in eight American women get breast cancer. It's one in 38 in Japan, right? It's blown up. And it wasn't like this in the recent past. Something in the way we're living, obesity is a big factor, but there's other things going on and things that we don't know about, I'm sure, is driving up breast cancer. She said to me, you could have said, well, fuck me. The environment gave you breast cancer and now you're going to fill yourself with another poison. That's crazy. She said, you did not say that to me. You said, we've got to

deal with the environmental factors, but first we need to make sure you live to fight another day, right? And she gave me this analogy that really helped me. She said, if your house is on fire, you can say, it's a really good idea to change the building code. So we build houses out of less flammable material. Good idea. I'll support you. But if your house is on fire, that's no fucking use to you. You've got to call the fire brigade and douse the fire with water. Right. And I sort of realized actually there's no contradiction between dealing with the environmental causes or I put it more subtly, if we do this right, that we could get to a situation where there isn't a contradiction between fixing the environment

and people taking these drugs to deal with the crisis we are currently in. In the best case scenario, I hope the drugs wake us up, right? To go, how did we get to the point where 47% of us are willing to take a risky drug because the alternative is an even more risky medical condition? What the fuck happened to us? Why did we let this be done to our kids? Why isn't it happening in Japan? I hope it leads to an awakening now. Of course, if the house is on fire,

you gotta put the fire out first. But at some point, personal responsibility has to enter the equation. And the solution can't be to put a Band-Aid on a Band-Aid or to treat a poison with a poison. And I think, and I believe that there is a way forward with an intelligent use of this drug in the short term for the people that need it most to put out that fire.

But back to the Cheesecake Park rat study, I suspect that in that third phase where they reintroduced whole foods and the rats resisted it, if you allowed that phase of the study to persist for 90 days, at some point, they're gonna return to a baseline and they'll start eating that food again.

And that's because not only, that's gonna be driven not only by need because it's the only caloric source available to them, but also because there's changes in the microbiome and cravings adjust over time. You know this as somebody who's looked at addiction and the like, when you take an interval of time, a break in between the thing that you crave,

you will slowly, like the the craving subside, right? And there will be physiological changes and you will reach some kind of, you know, equanimity with the whole thing. So to the lifestyle medicine piece, using this period of time to, you know, get people trained up on healthy foods, like there is something about eating the correct foods

that will provide your body with the GLP-1 signaling that it needs. Like if you're eating tons of cruciferous vegetables and a high fiber diet, you're gonna feel full with less calories because you're eating the foods that your body craves. And when you're eating cheesecake, you're eating tons of calories, but you're not providing your body with any nutrients.

And there has to be something to the idea that your appetite is not sated because you're actually not nourishing yourself. All you're doing is putting pounds on the waistline along the way. And so I think with respect to your journey, I almost feel like the book is missing a final chapter, which is what happens when you go off it.

And are you going to be able to be in a better place to master your cravings and your habits and adopt new ones, healthier ones with staying power? Like that's the chapter that I want you to write next. And I know you're still on it, but at some point, my suggestion to you is to like, as a journalist, if for no other reason, to like, have that experience and share what happens. That's so interesting, because I'm interested about the first bit of what you said as well about personal responsibility, because you're

totally right. There are people who deny that willpower is real or that personal responsibility plays a role here. They're definitely wrong in my view. Everyone has experienced at some point in their life exercising willpower over something, right? And let me just interject one point, sorry. Sure, of course. Sorry to step on you. But I do wanna say that when we talk about willpower

and personal responsibility, the caveat, the important caveat I wanna make is, I don't know how intense your cravings are. Like I can't assume that whatever I went through in terms of my emotional attachments and the cravings that I experienced are on the same level as yours or anybody else's. It's not out of the realm of possibility

that whatever you experienced not too long ago was 10X what I experienced. And I think we make an assumption that those experiences are universal across the board and I'm certain they're not. I think that's a really good point. I think there's another sort of additional insight about willpower that's so important for people

to bear in mind. So we live in an environment that is making it hard to be a healthy weight and easy to be overweight or obese for all sorts of reasons we talked about and going to more we can go into more so the way i think about willpower in this environment is it's like an umbrella in a bad storm right for some people that umbrella is going to be enough to get them across the street and they'll stay dry but for most people the storm is so bad it's going to be enough to get them across the street and they'll stay dry. But for most people, the storm is so bad, it's going to break the umbrella, right? And that's why most diets fail, right? There's very strong evidence on this. The vast majority of people

who go on a diet are not able to keep that weight off over time. Now, some of that is willpower, but a lot of that is psychological factors which undermine self-control, which we can go into some of which really came up for me when I was taking these drugs. But mostly I think it's environmental factors. Environmental, socioeconomic, there's a variety of factors, of course. Huge. And more three-year-old children in this country know what the McDonald's M means than know their own last name, right? From the moment we're born, you are inculcated with messages to eat shit all the time, right? Try taking a kid for a walk around where we are, right?

In LA and then not being bombarded all the time with messages for this stuff, right? That's what we live in. And of course, then there's the effect of the food itself on you. And you're totally right when you were talking about nutrition. If you think about, for example, there's a really fascinating guy you should have him on called professor david raubenheimer in sydney in australia who's done this really interesting research so he kind of hypothesized in addition to having a general hunger for calories we also have obviously a physical need for protein so you have not just calorie hunger but protein hunger right your body will make you seek out enough

protein to be healthy but processed food ultra processed food has much less protein in it than healthy whole foods so to get the same amount of protein you have to eat a lot more processed food it's one of the things this underlying protein hunger in an environment filled with processed and ultra processed foods is likely leading us to overeat it's one of the things that this underlying protein hunger in an environment filled with processed and ultra processed foods is likely leading us to overeat. It's one of the seven factors that I write about in Magic Pill in the processed food environment that are driving us to become obese and overweight. I would suggest, and this is just like theory,

complete theory that it extends beyond protein. Like if you're not eating any phytonutrients or micronutrients, or you're not eating any phytonutrients or micronutrients, or you're not getting the adequate minerals and vitamins and what you're eating every day, which is what's gonna happen if you're just eating, French fries and takeout,

that your body on some level is going to be yearning, and that's gonna translate into some kind of signaling that's gonna make you eat some kind of signaling that's going to make you eat more. I think that's absolutely true. And I think one of the things that's happened in this environment is as Professor Gerald Mand at Harvard, who's the guy who designed the food label, it's on all foods sold in this country, said to me, we've separated flavor from food, right? So if you think about all our instincts evolved, let's say 3,000 years ago, if a human being found something that was sweet and soft, that meant it was very likely fruit, it was very

good for you, you should eat it, right? So those are our instincts. We evolved with really quite strong instincts around what's good for us, what's bad for us, what we should eat and what we shouldn't eat. But now that system is like a GPS that used to tell you how to drive home safely, but now tells you to drive off a cliff. The instincts that used to make you crave fruit now make you crave fruit loops, right? Now if you find something that's soft and sweet, it's as likely to be a banana milkshake as to be a banana, right? So our instincts are completely thrown off by this new food environment. And actually it's worse than being thrown off. They lead us astray, right? So one of the things we have to do is adapt the And actually it's worse than being thrown off. They lead us astray, right?

So one of the things we have to do is adapt the environment so it's more compatible with our instincts. Sure. I mean, it doesn't take a rocket scientist to understand that everywhere you look, it's fast food. And this is our great American export across the world, no matter where you go now. I've traveled through the Middle East

and seen strange American fast food chains and small corners of the world where you would never expect it to be. Like this is, we're metastasizing this problem all across the world. And if you go into any grocery store, these massive grocery stores that we have in the United States,

only one aisle on the far end is fresh produce. And everything in between those two kind of far end aisles is basically probably 90% processed foods. So we're in a food environment that is conducive to the unhealthy choice. And short of a systemic change in which the healthy choice becomes the most convenient available and cost-effective choice, it's on the individual to take responsibility to seek out the healthier choices and find a way to make it work economically.

And that's overly burdensome for too many people. So to kind of put a cap on the positive aspects of this before kind of digging deeper into the negatives. There's millions of chronically obese people who've tried everything and can't seem to figure out a way to sustain any kind of weight loss. Obesity is driving so many of these devastating illnesses.

There's a billion people worldwide who are obese. Obesity is the leading cause of death. And not for nothing, obesity is also driving insane costs in our healthcare system. So to the extent that there is something that can ameliorate this problem from an economic perspective, even, we're going to like save money

and that's helpful for the economy. Garth Davis, my bariatric surgeon friend said something I never thought I would hear him say, which is it's easier for me to teach my patients healthy eating when they're not starving than it is when they're starving. That's so interesting. Can I just pick on one thing you've said a few times where I just want to possibly push back on it? So a few times you've

framed it as the problem is chronically obese people. And you're definitely right. The problem is much worse for chronically obese people than for anyone else. But one of the, so you're framing it like maybe these drugs are right for chronically obese people one of the things that um really surprised me is we picture health problems kicking in at very high levels of obesity actually the evidence suggests the health problems kick in just at being slightly overweight right actually you know if people are listening and thinking well i'm not like you know 400 pounds i don't need to worry about this. I was kind of taken aback by how, and I think the reason you're framing it that way, and I think that your instinct is right,

which is, well, if you're closer to the borderline, try the other stuff before the drugs, because of the risks of the drugs, correct me if I'm wrong. Yeah, I see where you're headed is very triggering to me. Tell me why. Because it gets into the personal responsibility piece. Like if you're somewhat overweight and not chronically obese,

you're not 300 pounds or what have you, to me, like I can't help but think, come on man, like get it together. That's so interesting because there's definitely a bit of me that thinks that. And frankly, I thought about myself, right? So I'm not in any way critical of anyone who has that voice because I directed that voice to myself.

It's like, come on, you're not that fat. Why can't you just get it together, right? And I definitely think your instinct is right that people should definitely try the alternatives first. But it was interesting to me as a woman- Interesting that you frame it as the alternative when it should be like, this is what we're meant to do. This shouldn't be considered an alternative.

That's such an interesting point. This is like how we're meant to do. This shouldn't be considered an alternative. That's such an interesting point. This is like how we're wired to live, right? This should be the primary. Yeah, no, that's a very wise point. And you're right to pick me up on that. I think in terms of that feeling of kind of, come on, man, which we all have, I think, or almost all of us,

there was somebody who really helped me to think about this, a woman called Professor Tracy Mann, a brilliant professor at the University of Minnesota in Minneapolis, who I went to interview. It's funny, I went to interview her. She suggested we meet at a bakery called Isles Bun, which is kind of an institution in Minneapolis. And I went in, the guy behind the counter said, have you been here before? I said, no. He said, oh, we'll give you a free iced bun then. And they give you this thing, it must've been like 3000 calories that just sat there. And I thought, wow, this is the perfect thing to just sit on the table while we're discussing obesity, right? And Professor Mann has done really fascinating work on this. So when she began researching diet in the early 2000s, actually the evidence was very clear on this. work almost all the studies looked at people over

three months and a few looked at six months and if you look at it it's very clear if you stick at it you lose weight right but then she noticed the studies stop at three months or six months with the implication being and then you live happily ever after right she was like well it doesn't seem to be the case so she looked at all the studies there wasn't that much research at the time but there are i think 26 studies that had looked at diets over two years and over two years the outcome is very different now there are definitely people like you who succeed and have nothing but admiration for but the average weight loss over two years was two pounds so it's pretty low right um not nothing it's not even outside statistical significance i think but it was low right

surprisingly low from my point of view it would definitely be my experience with dieting and regaining weight and there's a big debate about this as question about why and there's a an explanation that has persuaded a lot of scientists not all which i think also might help us to think about some of the effects these drugs are having on the brain, although that's more controversial. So if you go back to the seventies, it was thought then that when you were born, you're basically, you're born with an innate, what's called a biological set point that just fixes your body fat percentage roughly, right? So think about your temperature. Your body temperature is fixed, right? By your brain. And if you go outside that range, if you get too hot, your body works really hard to make you sweat, bring it back.

If you get too cold, your body works really hard to make you shiver, bring it back up. So we have a fixed temperature set point, and your body works unbelievably hard to keep you at that temperature. And if you get outside that, your body, you know, really works hard. It was thought at the time that basically you had something similar with weight. So you could vary a bit, just like you and me could go to the Sahara, or we could go to the Arctic. You can vary it a bit, but you couldn't vary it that much. But then the obesity crisis happened and blew up, right? And suddenly they thought, that can't be right. You know, how could that be? If it's set fixed at birth,

how could it explain this staggering rise but that's led to um a professor like people like professor michael low have written about this it's led to an adjustment in biological set point theory which has also been used by some of the people talking about these drugs so what they argue and there's some good evidence for this is that as you gain weight your brain fights to keep you at that higher weight. So let's say you gained, you know, a hundred pounds now, like, please don't, it'd be a tragedy to women and gays everywhere. But you think about that weight gain as Dr. Giles Yeo, who's one of the leading obesity specialists at Cambridge university said, your brain hates it when you lose weight,

it would fight to keep you at that higher weight. So when you try to lose weight, all sorts of changes would start to kick in that would make it harder. Not impossible, but harder. Your metabolism would slow down. We've got a lot of evidence for that. So you would burn calories more slowly. You would crave more sugary and salty foods. You would actually pay attention more to sugary and fatty foods. And I remember when I first saw all these scientists explaining it and reading it frankly i thought i do not believe this because why would evolution endowers with something that was so maladaptive if being obese is so bad for your health why would evolution make us hold excess weight it made no sense to me but actually several scientists explained it to me they said

like professor low you've got to picture the circumstances where human beings evolved. In the circumstances where we evolved, the situation we now live in, where you're surrounded all the time by massive excess calories that will last your whole life, that never happened to human beings before us, right? It was impossible. You might have a short period where you have lots of excess abundant calories, but the risk that was really omnipresent for a lot of human existence was completely the opposite risk. It was famine, right?

There was a risk that you were gonna run out of food supply. So in that situation- So when you have access to the calories, you double down, you get as much as you can, and your body's gonna do whatever it needs to do to hold on to that. Exactly, because in a famine, the fattest guy at the start

is gonna be the last man standing. In, you know, if there's a famine tomorrow, Timothee Chalamet will die in week one and me at my fattest will cry over his body and still be alive a month later, right? Poor Timothee. So you can see, I know, I know, no disrespect to Timothee Chalamet.

So you can see why our bodies are preparing us for a famine that will now never come right so if this is right it is contested there are other theories about what's going on there's a big debate about what's going on in your brain when you take these drugs right and the the candid answer is we simply don't know we know it is massively changing your brain we know if you give the active component of these drugs semaglutide to rats and then you cut their brains open, which obviously we can't do with humans, the drug goes everywhere in their brain, right? It's affecting every part of the brain. Slightly alarming.

Extremely alarming. I remember saying to Dr. Clemence Bleu, a brilliant obesity researcher at Cambridge, so which parts of the brain are affected by these drugs? And she listed them. And I said, what else do these parts of the brain do? And the exact quote is in the book, I might be misremembering it slightly, but she said things like, oh, processing of memory, control of your gut. I was like, oh, okay, just the trivial stuff then, right? So, but one theory about what's happening in the brain is that it's effective, and this is contested and highly speculative, I want to stress that. But one theory is that it's basically lowering that effect on your set point, right?

It's lowering the increase in your set point that happened when you gain weight. It's almost like resetting your iPhone to the factory settings, right? Or when it comes to weight. So that's one thing that could be happening here. Again, the long-term implications of that, we don't know. And the fact that, you know,

it's lighting up the brain in all these ways and how little we actually know about how the brain functions is deeply concerning to me. You're totally right. Of the 12 big risks that I write about in Magic Pill that relate to these drugs, the one that most worries me for myself, there's some that worry me more for other people, but the one that most worries me for myself, there's some that worry me more for other people, but the one that most worries for myself is exactly what you're alluding to there. Have you experienced any changes in your cognition or memory or any other kind of brain-related neurological kind of things? I mean, you've been taking this for two years, right? No, no, about a year and four months now. Well, again, it comes back to that thing.

You gotta weigh the alternatives. We know that obesity unfortunately has effects on cognition. It's one of the reasons why you're significantly more likely to get dementia when you're obese, unfortunately. So you gotta weigh the- But the symptomology of that doesn't occur until much later, even if it's underway.

You're right. So if we think about the long-term risks, right? For me, like I said, the biggest thing that worries me is people have been taking these drugs for diabetes for 18 years. So we have some long-term data, but 18 years is not so long, right? So there's a comparison that was raised to me by Dr. Greg Stanwood, who's a professor at Florida State University working on these drugs. I want to stress, he said this was speculative. He broadly believes these drugs are safe, but he raised a potential parallel that he thinks we should think about.

If you go back to the, what is it, the late 50s, early 60s, doctors start to give people antipsychotics because they judge that the benefits outweigh the risks. And some people take those drugs for a very long period of time. It was only 40, 50 years down the line that they discovered if you take antipsychotics for a long time you're much more likely to get dementia alzheimer's in fact every form of dementia i think now he's not suggesting these drugs will give people dementia there's no reason to think that but he's just saying when something's long term we literally don't know right and this particularly worries me when it comes to children with ozempic and this is for me the one that is the most charged

and the most difficult of the whole debate. Partly because it's so obviously an environmental problem with children. You're talking about children who are taking Ozempic? Yeah. So Novo Nordisk is currently running a trial on giving Ozempic to children as young as six years old. There are loads of kids who have been given these drugs. And I empathize with the parents in this.

There's a wonderful woman called Deborah Tyler, who I interviewed. She's a nurse in Connecticut. A good person. You would really like her. And her daughter was very severely overweight. She tried all sorts of solutions. And she was told that her daughter was starting to have,

I forget if it was liver or kidney problems, when she was like eight or nine. Exact details are in the book. I don't want to get them wrong. And Deborah was agonized. She did not want to give her child these drugs. But equally, you know, as Dr. Giles Yeo put it to me,

you know, if you're obese when you're young, it is extremely hard to become unobese, right? She started to give her daughter a Zempik. Her daughter has got a lot, her kidney or liver problems have gone away, but she is really agonized about this. Partly because you think about those long-term risks, right? I don't wanna speak to Deborah now,

I'm speaking about for myself, but you think about those long-term risks, because they only work as long as you take them, her daughter presumably is gonna be taking them for 80 years, right? And has begun taking them while the brain is very much in development. Exactly, so all those worries I had for myself

are much more acutely the case when it comes to the dilemmas faced by parents and the question about children. But there's loads of, I mean, I experienced quite a few of the negative effects myself. Well, you talk about feeling nauseous the first time you took it. I mean, what are some of the other experiences over the last year and four months? Yeah, so there's the kind of common side effects.

So almost everyone feels nauseous at first. And for the vast majority of people, it goes away. For me, it wasn't horrendous. Like if I had randomly felt nauseous like that one day, you know, two years ago, I wouldn't have like not gone about my day and gone to bed i would have just felt a little bit nauseous right it wasn't some people it's much worse you know i interviewed someone called sunny newton in vermont who like was like horrifically nauseous for months on end she said it felt like an alien was inside her body right that's unusual but not unheard of. So there's lots of common side effects that I go

through in the book. Actually, weirdly for me, the kind of minority, but not uncommon side effect that was weirdest was that for some people, it increases the rate of your heartbeat, not like massively, but somewhat. And for me, it was hard. It's hard to have your heart racing and not interpret that as anxiety and just be like, oh, what's going on, right? So it took me a little bit of time to adjust to that. But actually, in terms of the 12 risks, the one that most played out for me, and I want to stress this is contentious and some scientists dispute that this is happening. Some scientists are concerned that it may be causing depression or even suicidal thoughts in a small minority of people using the drugs. I want to stress most people who take the drugs

are happy they take them. But there have been doctors who've raised a safety signal on this, both in Europe and the United States. And I had this weird thing. I had a real epiphany about it. So for the first six months I was taking the drugs, my friend Danielle was pregnant. And every time I bumped into her, I was like, oh, it's like we're going in opposite directions, right? She was swelling and I was shrinking. But I remember saying to her one day about six months in, this is really weird, right? I'm getting what I want. I've lost a shitload of weight, but I didn't actually feel better. I think I felt better in my body, but actually in my mood, I felt slightly muted. I don't want to say I wasn't depressed or anything, certainly wasn't

suicidal, but I felt a little bit down and muted, a little bit dulled. And I was like, what's going on here? And I had an epiphany about it. Not long afterwards, I was in Vegas, as you know, I spent a lot of time in Vegas because I'm writing a book about a series of crimes that have been happening there. And I was researching the murder of someone that I knew and really loved. And it was very, very hard and difficult thing to do. And I felt like, as you would expect someone to feel when they're doing that. And I went to the KFC on West Sahara and I ordered what I would have ordered before I was on a Zen pic, right? I ordered like a bucket of fried chicken and I had a chicken drumstick and I realized, I remember looking at the food and thinking, oh shit, I can't eat this. I can't eat it, right? If on an example,

if you tried to deliberately overeat, you would, I think, throw up. I've never tested that, but you, it would be very hard. It'd be like, imagine you just had a whole Thanksgiving dinner and I showed up. I mean, I know for you this wouldn't apply because you're a plant-based diet, but, and I showed up and said, hey, Rich, great news. I've got you a KFC bucket, right? You'd just be like, oh, can't do it. And I remember looking at this chicken and thinking very consciously, oh, I'm just going to have to feel bad, right? I realized in that moment, and there's evidence for this, I realized i realized so what these drugs do this is something i really don't think people are being prepared for what these drugs do is they radically interrupt your eating patterns obviously and what that can do for some people is it can bring to the surface

the deep underlying drivers of your eating all along that were in your emotions. I go through five reasons why we eat in my book, Magic Pill. Only one of them is like feeding your body, right? Sustaining your body. The rest are psychological. They're factors. And for me, I realized, you know, I've talked about this before, Rich, but I grew up in a family, there was a lot of addiction, a lot of craziness. And I realized, I think I was sort of aware of this before, but I didn't feel it as acutely until then, how much I had learned when I was very young to manage my emotions by stuffing myself. It's a very particular way of eating. Stuffing is where you eat,

deliberately eat beyond the point of being full. Cause you get a kind of- You're managing your emotional state through food. You're muting those uncomfortable emotions through feeding yourself and all the blood goes to your stomach. You feel differently. It's not that different from taking a drug or gambling

or any of these other kind of addiction outlets. But the thing that's interesting to me about the story you just told is that you're on Ozempic and then you still go to KFC, whether you eat there or not, like you're on this drug, you're losing all this weight, but you're actually not addressing your habits around food, right? You're still finding yourself at a fast food outlet.

And this goes to the bandaid on the bandaid thing. Like, okay, you've written extensively about addiction. You have a lot of self-awareness around your behavioral patterns and who installed these buttons and how they get pushed and how you self-medicate. And this is your opportunity while you have this reprieve from the appetite that's led you astray

for your entire adult life to basically turn the iPhone off and reboot it, like install the new operating system and not go back to KFC, but leverage this period of time to change those habits. And that's not only with respect to your food choices, but also like these psychological drivers, like, can you be more curious about that? What can you learn about yourself?

How can you untangle that knot so that you're not, kind of reactively turning to food to change your emotional state. You're definitely right. And I know you know this as well as I do. It's one thing to know that intellectually and another thing to do it, right? Sure, yeah, I know.

And I had this insight about it. I realized I was interviewing a guy called Professor Robert Kushner, who was involved in key parts of the research on these drugs, brilliant scientist. And I said to him, so I've made a lot of progress, but basically I'm eating smaller portions of the same old shit, right?

And that's better than eating huge portions of the same old shit to be sure. And he said, yeah, you've got to understand, even separate from the question of obesity, you need nutrients, right? I mean, if you're not hungry, at least when you're eating, eat the healthy foods. So I've made a progress on this. I realized, I'm very embarrassed to say this.

I realized I was 44 at the time and I realized I didn't have the most elementary skills, right? I didn't know how to cook. I'd never cooked anything, right? So I got my friend Rosie to teach me how to cook. Definitely going to Japan was a really transformative experience

around their relationship with food and the way they eat food that is delicious, but makes you feel full. So I built a lot of Japanese food into my diet. Obviously, I'm a very privileged person. I can get to do that. But I've been surprised by how hard that's been. So there was one time when it was easy.

So after I finished the book, I went to jamaica for three months went to an amazing fishing village in saint elizabeth in jamaica um partly to do some research and partly to kind of um decompress i said this before the podcast but you really know how to vacation like three months in jamaica and then your other book you were how many how long were you out in fire island like province town yeah yeah. The only more debauched gay place in the world than Fire Island. Yeah, I was there for three months.

I believe in, you know, I'm freakishly lucky that I get to do this, but yeah, I believe in that. And especially Jamaica, what a great country Jamaica is. Jamaicans know how to live. And I was in this fishing village, I barely left it for three months. It blew my mind in lots of ways, was in this fishing village. I barely left it for three months. Um, it blew my mind in lots of ways, but in, in this fishing village, basically you can't eat anything about

healthy, fresh food, right? There is nothing else, right? I mean, Jamaicans have quite a limited diet, but it's fresh, healthy food. Um, so like every day I was eating fish. So I did have these three months and I would love to tell you a neat redemptive parable that I learned better habits and I came back, but I've got to tell you this morning before I came here, my breakfast was a pack of peanut M&Ms, right? Come on. I know. I want to level with people. Have you learned nothing? You write these, obviously you write, you know, we write books to like, it's because we need to learn something, right? Yeah. I deliberately don't write my books, I don't know you know this, but I don't write it as, dear reader,

I am the living example of all that is right. I have done the right thing. And now you must follow me on my great example, because I'm a much more flawed. I'm very wary of anyone who says that in any context, but I'm a much more flawed and broken person than that, right? So I think these psychological things run so deep. The habits you learn when you're very young, they're not insurmountable. You're absolutely right to push me on it. I'm grateful to you for pushing me on it. There's the psychological elements.

There's the environmental elements. You know, try staying in West Hollywood and, you know, having a healthy breakfast, right? It ain't easy, right? Well, you got, having a healthy breakfast, right? It's not, it ain't easy, right? Well, you got Air One and Whole Foods. It's true. Actually, West Hollywood is a lot easier than Tri-Vegas, right? Not a place known for its great healthy eating, but of course you can eat healthily in those places. And I don't want to make excuses for myself in that. You're right to push me on it it but i do want to be level with people about how resilient these patterns are and how it's not that easy to undo this although we should all be

aspiring to maybe not easy but i would suggest doable this is the challenge that i'm putting to you at some point you're gonna have to go off this drug maybe i'm not sure i will i genuinely don't know i think um i don't think if i was so for example one of my best friends takes statins because he's got he's uh i think maybe a year older than me. I don't think you'd say, Tim, you've got to come off statins at some point. You would definitely say make all the lifestyle changes. People like Dr. Dean Ornish who I've interviewed, you know, argue for to improve cardiovascular health. Maybe if you make very dramatic lifestyle changes, you can come off them. But I don't think we would be uncomfortable with someone taking statins for the rest of their life,

to reduce their cholesterol levels some scientists and i feel the doubt you feel but i just want to also feel another side which is there are lots of scientists who are saying if the obesity comes back if that is the reality for most people we will have better studies on this soon if those studies find that you can use the drugs to radically change your habits stop taking them and continue without them and i very much hope that's the case and i your hunch is that's the case i i feel a bit more agnostic i genuinely don't know but i desperately hope that's true obviously the best case scenario is that's true in which case you and i agree happy days if that's not the case you and I agree, happy days. If that's not the case, if those studies suggest that most people do regain the weight, which I suspect might be the case, but who knows? We'll know soon enough.

The early studies suggest that will be the case. We're in a harder set of decisions. And I can imagine a scenario, if that is the case, I would continue to take them for the rest of my life. Now, I have this unique vulnerability, not but i have a um a vulnerability around heart disease in my family that a lot of people don't have obviously so that hugely skews the calculation for me in terms of weighing that against these big risks lots of which we haven't touched when i go through in the book but i'm not as confident as you are that i'll have to stop taking them now look there's a perfectly plausible scenario that this turns out to be like them. Now look, there's a perfectly plausible scenario that this turns out to be like fen-phen in the 90s.

So people who don't remember, and for some people will remember it in their nightmares. So in the early 1990s, a new weight loss drug was launched onto the market called fen-phen. It was a combination of two drugs, flexfluramine, which is an appetite suppressant that makes you very drowsy so it was never very popular and they combined it with an amphetamine called fentramine which counteracted the drowsiness and also you know makes you more manic and um as anyone who's ever tried amphetamines

knows uh also has a weight loss effect and it was talked about in exactly the way that ozempic is talked about now in, the front page of Time Magazine was the new miracle weight loss drug, question mark. And it was released. Huge numbers of people took it. There were 18 million fen-phen prescriptions in this country in 1995. And then it was discovered, it was in fact spotted just by a group of ordinary doctors in Fargo in North Dakota, noticed, huh, a lot of our patients taking these drugs seem to be having trouble breathing. So they raised a safety signal. It was then investigated.

It was discovered this drug both caused heart defects and caused a horrific condition called primary pulmonary hypertension, where the blood vessels in your lungs radically contract and you can't breathe properly. There's no cure for it. If you get it, you're on oxygen the rest of your life. It can kill you. I go through some really devastating stories in the book about that. We also discovered the drug companies knew about this from the start.

It came out in the civil litigation. I remember all this, yeah. I mean, there's one, I don't think it would have been an email then, whatever, it would have been an internal memo, where they said, one of the people joked, am I going to have to spend my retirement writing a bunch of checks to a bunch of stupid fat women who can't breathe?

Ha ha ha ha ha. I mean, now I want to stress, there's some reason to believe that Fen-Phen is very different to these new weight loss drugs. Fen-Phen was launched based on one study by a company that were frankly shysters, right? These drugs, these new drugs have had a huge number of studies carried out on them they've been taken by day by diabetics for 18

years it's not exactly the same to take it for diabetes as to take it for obesity but you know that that does tell us something about the safety profile both good things and a few risks um i don't think it's likely this will be like fem fem but equal i don't think you can rule it out right so we may well i might be coming back on this show in five years time and I go shit I should have listened to you rich right I have had to stop taking it I do not rule that out we've got to be level with people about the risks here well I thought it was interesting when you shared the story of running into your your pregnant friend uh and you said that you actually didn't feel great. Like normally if somebody loses that amount of weight,

they have a boost in their vitality and their energy. And they just have like an energized relationship with their body that often leads them into more physical fitness and the like. But for you to share kind of a different perspective, which was not feeling really better and maybe even a little bit worse than you did when you were very overweight, I think is interesting.

I do feel that benefit now. I definitely do. It took a while. I think I had to go through a quite bumpy process where I had to become more aware of the underlying emotional drivers of my eating. And once they come to the surface, of course there's a better solution to those problems

than Colonel Sanders, right, obviously. Have you started exercising? What is your relationship with fitness? Yeah, I mean, I walk for about three and a half hours a day. That's the exercise I can tolerate, but I walk very fast because I can listen to audio books. It's like some kind of David Sedaris. Exactly, I love David Sedaris.

I wanna dig down. We haven't even really kind of taken inventory of all of the kind of negatives or potential negatives here. And there are plenty, right? We referenced a few, but there's also a risk of bowel obstruction. I think Mark Hyman said there's like a 450% increase

in risk of that. Pancreatitis risk increase, thyroid cancer risk increase. This idea that it kind of violates this law of nature that is there's no biological free lunch for every benefit, there's some kind of downside and we're not sure we truly appreciate or understand what that downside is. And then also, and you talk about this in the book,

the shedding of lean muscle mass, right? Like you're not just losing fat, you're also in equal measure losing muscle mass and also perhaps bone density along the way, right? So when you're obese, you gotta put the fire out, right? That's the most important thing. But I think there's a lot of people who are mildly overweight

or people who just wanna get ready for the summer and lose that, you know, resistant 10 pounds around the midsection. And they don't give a shit about the long-term implications or the risks because vanity is such a powerful motivation. It overrides our better judgment in many cases. So even knowing the risks, most people, they wanna look good when they look in the mirror,

they wanna feel good about themselves and they'll just say, fuck it, I'm gonna go on this thing. It's just the easiest, fastest route to the body that I've always aspired to have. And I actually don't really have to take responsibility or work for it or change my habits in any regard, like this is going to do it

for me i think there's a few things in what you just said that are really important um vanity is definitely a factor in this it definitely was for me like one of my closest friends i remember challenged me on this she was kind of you know as you know because you know me rich like i explore things through discussing them with people right it's how my brain works i read a lot but i i have to process it through talking it out and the whole time we were talking the i know we must have had this argument about eight months in she was the one of my friends who was kind of pissy whenever i would bring up this topic and it's kind of weird because she's normally so interested in what i'm working on she's not herself overweight so it wasn't like a personal sensitivity and one day we had dinner

and i was talking about oh weighing the risks and the benefits and she said i can't listen to this fucking shit for a minute longer right you keep about, oh, weighing the risks and the benefits. And she said, I can't listen to this fucking shit for a minute longer, right? You keep telling me you're weighing the risks and benefits. It's all about health. Fucking be honest with yourself, right? Yeah, here we go. You know, a month into taking these drugs, your neighbor's hot gardener hit on you and that's why you're fucking taking it, right? Don't give me this shit about health. And she said, you're taking all these risks because you know not because you want to avoid heart disease but because you want to have fucking cheekbones right although sadly that's never happened uh tina fey once said um her cheekbones had to be uncovered by a team of

gay excavators i think that's true of me as well but she was going too far but there's a truth in what she was saying right no one can deny it a big motivation is to look better as it's defined by the culture right and i think that can make us excuse your judgment you want to overplay the benefits and underplay the risks i think that was a factor for me i think i've got to be candid about that um and you think about some of the risks you were talking about this particularly plays out so think about muscle mass right so i'm sure your listeners know but um muscle mass is the total amount of soft tissue in your body it's really important for like movement right um and naturally as you age you shed muscle mass every decade depressingly from the age of 30 which are statistic i don't like um so just whoever you are you're going to lose some muscle mass as you age

the risk with these drugs is as with any other form of radical weight loss you don't just lose fat mass you lose muscle mass. So the danger is that you go into the aging process with a diminished amount of muscle mass. Now, this is particularly true for a category of people we haven't talked about, who I think are really important to think about, which is not people who are overweight or obese

who are taking these drugs to get down to a healthy weight, but people who are, in fact, skinny, who are taking them to be super skinny. Think about that party I went to, right? Right at the start of our conversation. Or the joke at the Oscars, like nobody who's getting on stage at the Oscars needed to go on Ozempic.

Very, very few, exactly. Very, I mean, I can think of one or two, but there's a rarity, right? So they in particular are potentially setting up a big risk for themselves. It won't show up now, but if you're going into the aging process with very diminished muscle mass, you're going to lose more and more and more.

You put yourself at the risk when you're older of a condition called sarcopenia, horrible condition. It means poverty of the flesh. It's basically where you just really struggle to do basic things like climb the stairs, get out of a chair, you know? So the danger is particularly people who are skinny, who are taking them to be super skinny,

we're setting in place a kind of time bomb of much more frail, older people further down the line. It's why the firmest piece of advice I would give on this, there's lots of things where I give advice with lots of caveats and uncertainties. But the one thing, pretty much all the experts I spoke to agreed on,

is if you have a BMI lower than 27, don't take these drugs. You're incurring all the risks for only aesthetic benefits, right? Now, don't diss those aesthetic benefits, particularly for women. Women are made to feel shit about their bodies no matter what they do in this culture. There's a huge amount of pressure on them. I'm not judging those people. I understand where they're coming from. I'm not so different to them, right? I'm not standing above them. But I would say for yourself, you are potentially setting in train a risk that you don't need to take.

I can imagine a lot of people hearing what you just said and just disregarding it, especially if you're somebody who has a disordered relationship with eating or a full-blown eating disorder. This just sounds like your greatest dream come true. So what do we know and what do we not know with respect to how this is impacting people

with eating disorders? Because I can just imagine somebody with anorexia, it's like, I'm going on this immediately until I just absolutely wither all the way down to the bone. Of all the things that I'm worried about, this is by far the thing I'm most worried about. And I don't think we need to speculate. I think it's already begun. So Dr. Kimberly Dennis, who's one of the leading eating disorders specialists, she runs SunCloud Health in Chicago, she said that these drugs are rocket fuel for eating disorders, right? Now, this is me speaking

now, not her, but I'm sure you've known people with eating disorders i'm sure everyone watching has you know that there's a conflict going on within them there's the psychological part of them that wants to starve themselves for all sorts of complicated reasons and there's the biological part of them that wants to live and what these drugs do is they massively empower the psychological if you take a high dose they can just amputate your appetite right so my biggest fear about these drugs is in addition to all the benefits that we should we've rightly stressed in the worst case scenario we could have an opioid like death toll of young girls and unfortunately eating disorders is mostly young girls there's some boys but not many just a huge

number of young girls who will be able to starve themselves to death using these drugs in a way they would not have been able to do had these drugs not been invented. We don't have to speculate about this. Think back to the early 90s. There was a actually much less powerful amphetamine-based weight loss drug that loads of young women were using, girls and young women.

And there was a congressional hearing on it called by by the um i think it was the ohio congressman rob wyden pretty chilling when you read it now you know there was a young ballet dancer called jessica mcdonald who testified who talked about how she would take these drugs until she passed out because she desperately wanted to be thin there was a really heartbreaking testimony for a guy called tony smith who was from state center in i. His daughter, Noelle, from when she was a little girl, had just been obsessed with the idea that she was too fat. She would go to the supermarket, she would rush to the fashion magazine and say, Daddy, why do I look like this? Why am I so fat? And she started to take these amphetamine-based

weight loss drugs. And when she was 21, she died of a heart attack because she was severely anorexic. And he read out this heartbreaking poem that she'd written saying she wanted to eat. She wanted to eat, but not yet, not yet. And there's a lot we can do right now to forestall some of that happening. So as Dr. Dennis says, at the moment, right? So think about you, your entire crew, everyone here, you are not eligible for these drugs, right? None of your crew are eligible for these drugs.

You all clearly have a BMI lower than 27, but I guarantee you every single one of you this afternoon could go on Zoom and get it, right? From a legit doctor. It's that easy to get it? What you do is you go on- I mean, how are these doctors prescribing it to people who are not suited for it?

They've been prescribed on Zoom and the doctor is meant to check your BMI on Zoom, but good luck with that also i mean frankly so i get it sometimes because i divide my time between britain and the u.s sometimes i get these drugs in britain and sometimes i get them in vegas right so i initially got them in britain and when i got them in britain you know i met the criteria right i was obese they tested me i went in they saw me by the time i came to Vegas, I was actually below the BMI you should get it for because I'd lost so much weight. Now, that's a legitimate use of it because I was taking

it to maintain that lower weight, but they didn't check that I'd already been overweight. I could have been anyone, right? I could have been someone with a healthy BMI who was taking it to be much thinner, right? So what we need to do is really tighten the regulations around this. Firstly, no more Zoom prescriptions, right? You should have to physically see a doctor who physically checks your BMI. If you are lower than 27, they should deny it to you. And those doctors should be trained in detecting eating disorders so that you can be diverted. Now, that's not a perfect, that's a leaky sieve, right? There's all sorts of issues with that, but that will prevent some people who shouldn't be getting it, getting it, right? We can't disinvent this any more than we can disinvent,

I don't know, nuclear weapons or Jell-O, but we can do the best we can to reduce the harm around it. And that is one of the things, I don't know why I just compared it to nuclear weapons and Jell-O and what's happening in my head there. It's a weird thought, but you know what I mean? You're missing your metaphors.

Exactly. But the reality- I don't know which has been worse for humanity, nuclear weapons or Jell-O. Definitely give me a lot more chins is Jell-O. Novo metaphors. Exactly. But the reality. I don't know which has been worse, the humanity, nuclear weapons or Jell-O. Definitely give me a lot more chins is Jell-O. Novo Nordisk, the manufacturer of Ozempic, made $13.9 billion on this drug alone last year, right? Huge, powerful company with a gigantic upside

invested interest in making sure that this drug has staying power and getting as many people on board with it as possible. And I suspect as a very powerful lobbying group in Washington that is going to fight tooth and nail against any kind of regulatory oversight that would impede the flow of this drug into as many hands as possible, including Zoom prescriptions and the like.

So I'm not exactly sanguine about, you know, our kind of regulatory bodies and government entities being able to police this responsibly. And I'm just imagining, like you mentioned this young girl who would look at the magazine and feel fat, but now we're on steroids with that. And I'm just imagining, like you mentioned this young girl who would look at the magazine and feel fat, but now we're on steroids with that.

Like every young person is scrolling on Instagram and TikTok and seeing idealized versions of, you know, what they think, you know, their body should look like. And it's fueling this, you know, massive mental health epidemic. I just had Jonathan Haidt in here talking about the anxious generation. And this is, it's like epidemic stacked upon epidemic,

stacked upon epidemic, the obesity epidemic, the mental health epidemic, kind of taking all of these things and pressing them together creates this toxic stew that's gonna drive people to make irresponsible decisions around drugs like Ozempic. And I think we're running a massive experiment without adequate data to know where this is going to lead. And the idea that adolescents and young people

could get access to this drug because they wanna be a little bit skinnier is only going to in turn fuel more disordered eating, more anorexia, more mental health issues, more dysfunction physically, mentally, emotionally, spiritually. Like the whole thing is kind of bankrupt, honestly, when I think about it.

And yet I have to reconcile that with the fact that we are in the midst of an obesity epidemic and there is a house on fire and there are people who can and are benefiting from this. I think you've put that so well. And if I think about the dilemma, I thought about two people as you were saying that. So I interviewed a guy called Jeff Parker, who's a retired lighting engineer in San Francisco.

He's 67 when I interviewed him. He must be 68 now. Super nice guy. And he was severely overweight. He was finding it painful to walk. He had gout. He had, I think, liver and kidney problems. He was taking fistfuls of pills every day. And his friend Mel gave him Munjaro, right? Because he tried all the apps, he tried dieting all his life. And he started taking Munjaro, which is one of these new weight loss drugs. And he lost a huge amount of weight. He felt much better. His doctor took him off most of his pills. Now he walks his dog over the Golden Gate Bridge every day. He said to me, I feel like now I'm going to finally enjoy my retirement. And I said to Jeff, but don't you think we should deal with the underlying environmental drivers of why you and me got into this state? And he said, I couldn't agree with you more. Sign me up for

that fight. But I got to tell you, Johan, by the time we win that, I'll be dead and I want to live. And I found that hard. So I think it's very hard to argue against people like Jeff. There's much more borderline cases where you and I might come down on different sides. But I think it's very hard to say to Jeff, given the risk he was in with the weight he was, it would be better for you if Novo Nordisk could never develop these drugs, right? So for all the concerns I have about Novo Nordisk, and I do have concerns about their lobbying for exactly the reasons you said, I want to also be fair to them, and I'm very happy to criticize pharmaceutical companies. I was very critical of them in a whole different area in my book about depression, lost connections. I want to be fair to Novo Nordisk. These drugs wouldn't exist without

Novo Nordisk, and Jeff Parker would have died much sooner, right? So I want to be fair to them in addition to criticizing them. But the other person I thought of it's actually the worst moment I had in all the research for the book I've got a niece called Erin she's 19 now but in my head so she's the only girl in my family and she's the baby of she's the youngest of my nephews and my niece so no one makes me more protective than her and like in my head she's six years old right um and one day after we'd taken the drugs for a while we were facetiming she was in a pub and she was kind of complimenting me in her jokey way she was like hey i never knew you had a neck before i never knew you had a jaw and um and i was kind of preening and she looked down and she said will you buy me some ozempic and she's a perfectly healthy

weight and i thought she was kidding i laughed and then I realized she wasn't kidding. And I thought, fuck, what am I doing here? Right? Yeah, if you don't think that that isn't a conversation that's happening constantly with millions of young people right now, you're deluded. You're right. The way I think about this, the book is called Magic Pill because there's three ways these drugs could be magic.

The first way is the most obvious, right? They could just solve the problem. They could solve the problem of obesity. There are days it feels like that, Rich, right? My whole life I've overeaten. Now I jab myself once a week in the leg. I don't overeat anymore. Yeah, it's called magic pill,

but it's actually, you have to inject yourself. Yeah, they're increasingly gonna be pills. By the time the paperback comes out, it'll be pills. But the second way it could be magic is much more disturbing. It could be like a magic trick. It could be like the conjurer who shows you a card trick while he picks your pocket. It could be the 12 big risks that I go through in the book outweigh the benefits over time. I do not rule that out.

That's a significant risk. But I think the third way they could be magic is the one you're alluding to, which to me is the most likely. Think about all the stories of magic that we grew up with when we were kids, right? Think about, what would be a good example aladdin you find the lamp rub it the genie appears he grants your wish and your wish comes true but never quite in the way you expected right so here i am i've rubbed my lamp and i get my wish i'm much thinner i'm almost certainly getting the health benefits for my heart but here's my niece who's a perfectly healthy weight going shit i need this here's her seeing every woman in the public eye who was slightly larger has dramatically shrunk and says it's just because she's taken up pilates i don't criticize women in public i get shit so i understand why

they're doing that but unless there's been an outbreak of dysentery in malibu we know it's not you know we know what's going on there. Yeah, there's loads of unpredictable effects. This will change the world for better and for worse. The analogy that that Barclays Bank analyst came up with, the smartphone, is right. If we were to wind back to whatever it was, I think it was April 2007, when Steve Jobs unveiled the iPhone, right? We wouldn't have been able to game out TikTok and DoorDash and a million things, right? That made our lives better, made them worse.

How could being more connected turn out to be a bad thing? It was unimaginable at the time. I mean, this is more ambiguous from the start. I think you're right that we would have actually been more naively optimistic at the time of the invention of the iPhone. I think you're right that we're more alert to many of the potential risks now. I don't think you could have foreseen social media algorithms would promote political extremism that would undermine democracy all over the world, right?

Maybe we would have been total geniuses in 2007, but I doubt it. So there will definitely be, and if you think about like small things that are playing out from these from these drugs jeffrey's financial did a report for the u.s airlines saying they're going to have to spend a lot less money on jet fuel pretty soon because it takes so much less jet fuel to fly a thinner population here in la there's been a big run on jewelers because people's fingers are shrinking so much. Their wedding rings don't fit anymore. Right. So there's all sorts of like weird, unpredictable effects. And that's just,

we're just at the beginning. You know, one of the scientists who worked on them, I think it was Professor Karel Leroux, but it might've been someone else. The quotes in the book said to me, you know, we've cracked the code of what regulates weight. It's gut hormones. We've cracked the code of what regulates weight. It's gut hormones. There are more than 70 gut hormones that affect weight. So a Zempik works on one, GLP-1 or simulates one. Munjaro works on two, GLP-1 and GIP. Triple G works on three. But now there's 70 of these damn things, right? There's going to be all sorts of combinations. And increasingly it's going to be pills. Eight years, we've got big issues around cost at the moment but eight years from now as then pit goes out of patent it doesn't cost much to make this as a pill eight years from now unless we're in a fen fen situation which i

don't rule out and if someone's watching this in the future on youtube and go ah right okay um but eight years from now it'll be a daily pill it'll cost a dollar a day barring a catastrophe i would anticipate 47 of the population using it as a low estimate actually wow wouldn't you wow given that 70 are overweight or obese and a dollar a day ain't much right and i would be worried about that and the biggest thing i hope is it wakes us up to go how like i said before how the fuck did we get here and why are the japanese not there right how come in japan when i went to japan it's the weirdest sensation to walk around a school of a thousand children just a normal school and realize there were no overweight children in

that school right because japanese people protect their children from processed and ultra processed foods. And there's very few obese adults, right? 4% of Japanese people are obese compared to 42.5% here in the US. So the hope is that it wakes us up. Now, as I say that, there's a little bit of me that goes, bullshit, it'll send us to sleep. If you've got a little technical fix, why would you bother fixing the environmental problem? It blinds you to getting at the root cause of what's driving the problem in the first place. So it moves us further away from the actual solution. This is not my settled opinion. I don't think most of me thinks this, but it's my most bleak thought about what you just said. So I would say to people, I think I said to jeff parker that guy was talking about in san francisco but don't you think this will undermine the movement to deal with the causes and someone said to me what fucking movement you can't imagine a more charismatic

and persuasive person than michelle obama right a person more beloved by the american people even michelle obama couldn't get a movement going saying people should physically move their bodies, right? So should we resist these drugs because it might undermine a movement that didn't even exist in the first place? Now, I don't think that, and the analogy I would use,

the reason, okay, I've just had a very dark thought. I want to just lighten it because I actually do think this. As soon as I say that, another thought kicks in, which is think about smoking, right? I think the thing that would most shock your kids if we could take them back in time, like to say the world we grew up in, is people smoked everywhere, right? People smoked on the subway, on planes, in restaurants. I remember the doctor used to smoke while he was examining you.

I think I might have said this to you on a previous occasion, but there's a photo of me and my mother where she's breastfeeding me when I'm a baby, smoking and resting the ashtray on my stomach. And when I discovered this photo a few years ago, I showed it to her. I thought she'd feel guilty. She said, you were a fucking difficult baby. I needed that cigarette, right?

So that has been completely transformed, right? Okay, we've got issues with vaping. I'm not dismissing that. But we've gone from, I think the figure in 1987 was something like more than half of Americans and British people have been smokers. And now it's something like 12%. Britain has actually just begun outlawing smoking for each, basically no one born after the, I think, 2006 will ever be legally allowed to buy cigarettes. Whatever you think of that, after they think 2006 will ever be legally allowed to buy cigarettes. Whatever you think of that,

we've had a massive transformation in smoking in a very short period of time. I don't think we would have realistically thought that was possible in 2007. Sure, but if there was a drug that you could take that curbed your craving to smoke just a little bit, so you only smoked one pack of cigarettes a day instead of two,

how would that have impacted this whole movement? That's a really interesting thing to think through. And when you laid out like the three most likely outcomes for this drug, the third one being the genie who grants you your wish, but the wish doesn't pan out in the way you imagined, the genie's out of the bottle, right? So come what may, then, you know,

what's the drug that we then have to take to treat the side effects of this drug? You know, there's no end to this. It's like the old woman who swallowed the spider just swallowed the fly. It becomes a fun house, you know, mirror situation all the way down the line. And I think that is, you know, somewhat concerning.

And I would imagine, you know, you said, we're just learning about, we're learning every day more and more about the gut brain access and the incredible impact of our microbiome on all our metabolic and physiological functionality. And I feel like we're just at the starting line of beginning to understand those complex systems

and how the immune system and our hormonal system, like so much is regulated in our gut, right? And it's not a leap to imagine identifying an analog to this GLP-1 agonist that would do for addiction what Ozempic is doing for obesity? In other words, is there some kind of hormonal system or particular hormone that if modulated could reduce the cravings for drugs and alcohol? Well, there are lots of scientists who say we don't need to hypothesize that drug. This is drug now i want to say this is highly contested of all the things i write about in the

book this is the chapter where the scientists most disagree or where the picture is most still to come into view but there's a few things we know um we know that lots of people taking ozempic are anecdotally reporting that it seems to have reduced or eliminated their other addictions. So for example, I interviewed a mental health nurse in Canada called Tracy, who she'd had a bad breakup and she'd just become obsessed with online shopping in a really unhealthy way. She was buying huge amounts of clothes she'd never wear, books she'd never read. She started taking a Zempik and that impulse went away. Lots of people are describing reductions in smoking and actually drug addiction, right? So we know that anecdotally. We know in animal studies, there are staggering effects on

this. So for example, I interviewed a woman called Professor Elisabeth Jarlhaug, who's at the University of Gothenburg in Sweden. So what they do, what she did, her and her team, they get rats and they get them to drink a lot of alcohol. It turns out rats really like getting fucked up on booze. They wobble around in the cage. You give it to them for week after week after week until it basically, the rat cage starts to look like a dive bar in North Vegas. And then you inject them with a GLP-1 agonist, a semaglutide, and they drink much less. And interestingly, the heaviest drinkers are the ones who cut back the most. But then they thought, some scientists said, well, that could be that alcohol has a caloric component. So maybe it's just that they want the calories less. So other teams have been

researching, who I also interviewed, people like Professor Patricia Grigson at Penn State University. She then experimented with getting rats to heavily use heroin and fentanyl. And again, you give them a semaglutide, they have a really significant fall in their use of that. Professor Greg Stanwood, who I mentioned before, did the same thing with giving mice cocaine. I don't know why I find the idea of mice on coke really funny, but I do. But you get mice to use cocaine a lot, give them smaglutide, big reduction in their use, 50% reduction. So the most-

Casual cocaine use with these mice. Exactly, I always picture like Al Pacino in Scarface, but as a mouse. So what this, the most optimistic scenario, and I wanna stress this is speculative, is that actually this is not a drug that is about weight loss it's a drug that boosts self-regulation across the board that's the dream scenario right now what we know about the human trials on addiction are much

smaller and they're a bit of a mixed bag we know they do reduce smoking but only if you combine them with a nicotine patch we know they do reduce alcohol use but only if you had them with a nicotine patch. We know they do reduce alcohol use, but only if you had an alcohol problem. There's a load of studies now going on. We'll know much more in the next few years, but there are optimistic scenarios around these drugs that we should talk about cautiously, but we should talk about, which is that these drugs do significantly reduce addiction. Now, again, they're not dealing with the underlying drivers of addiction. We've done a whole podcast on that. You and me, Rich, people can look at about my previous book, Chasing the Scream, which was all about addiction and the addiction in my family and addiction policies all over the world. And you could say, we don't need a drug for that.

We know what reduces addiction. Portugal decriminalized all drugs and took all the money they used to spend on fucking people up,ing them shaming them punishing them and spent it all on turning their lives around housing job creation therapy love and support lo and behold their addiction massively fell right so you could say we don't need a drug we've got a social solution we can deal with these underlying factors it's maddening to me in my work in vegas i'm seeing quite a lot of the time, because the case I'm working on is, I'm writing about, relates partly to homelessness. I'm seeing a lot of people who are dying, who would live if they were in Portugal, right? So we don't need to wait for a miracle drug. We got addiction policies that work. We could choose them in this country if we wanted to. We could deal with the massive fentanyl

crisis that we're facing, which is killing so many people who should get to live. Nonetheless, that shouldn't preclude us being excited about this drug potentially, although with a lot of caution. Sorry, I got a bit ranty there. Yeah. I want to turn to a finer point of addiction. And you referenced, you've written extensively on this. We've talked about it in the past and you're no stranger to the idea that the substance or the behavior really isn't the problem.

That's the solution to the problem. The underlying driver of addiction, the emotional dis-ease left untreated will persist and find creative ways to express itself. So I want you to imagine a perfect world, Johan, in which Ozempic is completely safe. You're able to regulate your food intake and all the heroin addicts in the world can take it.

And suddenly they have zero craving for drugs and alcohol. It solves addiction, it solves alcoholism. Everybody is able to suddenly and miraculously self-regulate without any downside, right? Is this not just another way of putting blinders on that is a vehicle for continuing to separate ourselves from ourselves. Like I'm someone who subscribes to the idea that we're here to grow and we're here to evolve and the obstacles that are thrown in our path are meant to be faced with curiosity and as an opportunity

to like learn something about yourself and evolve, right? So if you're dealing with food issues, if you're dealing with substance issues or other behavioral issues, or you have a childhood trauma, like when you behave in a certain way that is not in your best interest, that is your moment to kind of dive in and try to understand what's triggering that behavior.

And that is the opportunity to grow and evolve. And if we just have pharma to throw up a shade to tell you everything's fine, we never take advantage of that opportunity to look inward and evolve and grow. And we will live out the rest of our lives with these unresolved emotional dilemmas or triggers or stories we tell ourselves about who we are

that are going to impulse our behavior and our decision-making and our thoughts and every interaction that we have. And they will persist in being unaddressed because we've muted the most deleterious kind of indicia of those, right? They'll find other ways to manifest, I'm sure. But from a macro, like 10,000 foot view,

like, is this what humanity actually needs? Or is it separating us from our inherent divinity so i think there's a huge amount of wisdom in your question i want to just think through some of the things you said so with the caveat that i don't think that scenario will happen but just so it understands me that it was as miraculous as you described but let's imagine for a thought experiment that it was right so the reason why i i suspect you're right but i want to just give a bit of friction so let's imagine the scenario for example that it just solved the problem of addiction right that you could give it to people who are taking heroin or fentanyl and they would never take heroin or

fentanyl again there's a beat in your argument that i don't think would then happen so i do not think that if we could do that if we could just switch off the addictive behavior, they would then experience emotional muting. I think what would happen is the underlying problem that they were trying to deal with through heroin and fentanyl- Would be inescapable. Yeah, would then come to the surface.

Or you would find another way to medicate yourself. Exactly, so I don't think it would produce emotional muting. I think it would produce, in the best case scenario, it would bring the emotions to the surface where they could be dealt with. In the worst case scenario,

it would find other outlets. So I don't think it produces, I think there's a beat in your argument that's totally right. And there's a beat in your argument, which I don't, I suspect, and I'm spitballing here,

so I could be wrong, is not quite right. So the implication is that it's almost like the drug Soma in Brave New World, the Aldous Huxley novel from the 1920s, which is basically, it just sort of tranquilizes everyone. I don't think taking away our dysfunctional behaviors tranquilizes us. I think it surfaces the problem.

Now that can be a disaster. Think about bariatric surgery. We were talking about the benefits of bariatric surgery. If you have bariatric surgery, your suicide rate quadruples afterwards, almost quadruples, right? It seems really weird. Why would that be? It's still quite a low risk. Most people are glad they had it. But I suspect what's happening is, and bear in mind if you have bariatric surgery, you were severely obese. You can't tranquilize yourself with food anymore probably um for some of them you've told yourself all your life if only i was thin my life would be great and then you're thinner and your

husband's still an asshole and you've still got a job you hate so all sorts of emotional things are surfaced there so i don't think it would switch i think the underlying premise of what you're saying is one that actually is at the and we've talked about this before and, and I know we agree on this, is at the absolute core of my book, Lost Connections, which was about depression, which is you need your pain. You need your nausea, right? Those are not malfunctions. They are signals. They are telling us something. We need to listen to and honor those signals because in fact, it is through listening to those signals, to your signals it is through listening to those signals that you understand yourself and grow.

And if we could somehow surgically amputate them, like with the drug Soma, that would leave you temporarily relieved, but ultimately diminished, right? Right, so perhaps you're suggesting that this might expedite that growth curve because you can no longer run and hide from those uncomfortable emotions

through your favorite distraction, right? That they're gonna percolate up and confront you in a more acute way that is either gonna break you or lead you on a path towards some version of wholeness. By articulating my underlying premise, you've made me doubt it. You articulated it very well

because I think that would happen with some people, right? I think there would be some people, look, we know loads of people in recovery, right? There are some people who stop, who grow in the most incredible ways. I think about two of the people I most admire in the whole world, who you should definitely have on your podcast,

Rob Banghart and Paul Vautrinot. So Rob and Paul used to live in the tunnels underneath Las Vegas. As people probably know, there's many homeless people who live there. And Rob was known as Hobo Santa. He used to steal things and give them out. And he was a kind of low-level dealer for many years. And one day, Rob was attacked by a rival group of drug dealers.

They thought he was sort of infringing on their their part of the tunnels they hit him in the head with an axe they broke his skull open they dragged him over to the train tracks and the train was meant to run him over but fortunately someone saw him just before and he was rescued he spent nine months in hospital he never went back to his addiction he went into recovery recovery. He now runs with Paul, another incredible human being, a charity called Shine a Light. I really urge people to donate to them.

That every day they go back into the tunnels. They help the people who live there. They give them supplies. They help them get out. One of the most moving, and they're very close friends of mine. And one of the most moving experiences in my whole life was someone who used to live in rob's tunnel with

him a guy called pickett died he od'd in the tunnel and me and rob went there all the pickett stuff was still there and um rob bumped into a woman he knew i'd never met her before and they she obviously loved pickett as well and they were talking about her and kind of commiserating and whenever rob goes into the tunnels he they help people get out if they want to go to rehab but he also just brings supplies like tampons and you know water and flashlights and so on and he said to this woman oh who's in the tunnel over there i've got some supplies and she said oh you don't want to go there and he said why and she named them and he said i'll go it's okay and she said no don't i don't and then he went and he came back. And

it was only much later, a few days later, when I listened to the audio, I said to Rob, why did she tell you not to go into that tunnel? Who was it? And he said, oh, those are the people who tried to kill me. And I said, Rob, why did you help them? And he said um because they're human beings they fucked up i fucked up plenty of times everyone needs help and um i think about rob and paul who set such a high moral bar and that growth you're absolutely right that growth that they have experienced to make literally the most admirable people i know came from this deep pain right you know that line that Rumi the great Persian poet said the wound is where the light enters you I'm sure that was somewhere in Leonard Cohen's heart when he wrote you know there's a crack in everything it's

how the light gets in so we absolutely do not want to take away people's pain that would be taking away their growth but I don't i think weirdly to extend this analogy probably much further than it can go i suspect that if there was this drug that could just switch off the addictive behavior for rob it would have been like being in hospital for nine months it would have surfaced all this stuff and give him an opportunity to grow rather than just been like oh i'll just carry on exactly as i. I don't see that he would have done that. I could be wrong and I'm going quite far out on a limb in imagining your hypothetical,

but I think it's a very fertile one to think about. Yeah, I think it's interesting. I mean, I think everything you said is accurate, but I layer on top of it this idea that anything of value has to be earned, right? And the idea that there's some kind of shortcut to whatever goal that you're trying to achieve robs you of the value of experience.

And it is the value of experience that basically girds your growth trajectory. And so if you're receiving things that are unearned, then you're not having the life experience that's required in order to kind of grow and evolve, right? So that man that you just shared about, like his pain drove a certain growth trajectory for him and he had to earn that for himself. And so to the extent that there are things out there that are kind of moving people away from the experiences that are required to earn,

you know, a certain level of wisdom or life experience that, you know, can be shared for the benefit of others and for oneself like that, I think you would agree would not be the best thing. I do agree with that. I'm just thinking about a few things as you say it, this is not what you're saying,

but there are some people who I think hear that and they think there's this old argument, like the worst things get the better they'll get, right? That in a way, I'll give you an example. I believe in gun control, partly because I've had someone I loved who was murdered with a gun. Reasonable people can disagree with me.

I have lots of friends who don't agree with me on that. But if someone was shot in front of me, I wouldn't say, well, don't call an ambulance, leave them to bleed, because that will prove the case for gun control. Their death will add. I don't believe that if things get worse, it necessarily makes things better further down the line. Sometimes things just get worse, right? So I think, I don't think, again, I know this is not what you're saying, but I don't think saying to say Jeff Parker, that guy in San Francisco, well, you should just die of your obesity and

not take this drug. And that will prove the terrible harms that obesity causes and processed food industry causes. And then we'll use that to fight for change, right? I don't think you can say to people, I think the fact that suffering can lead to growth. You need to face your suffering and- Exactly. I don't think we can say that to them.

Of course, I understand. I think there's such an important insight in what you're saying and I've said it to other people. I think it can be taken too far. And I don't think the boundary for saying it is easy, right? I think it's a very hard... But I also think there's another thing that might be playing out in how you're thinking about this, just because you live in this culture. I think it plays out for almost everyone. It's an implicit thing. And I think it would be less than you cause you're a very loving and nonjudgmental person

than it is in a lot of people. But I think it's worth thinking about. So when I was taking the drug at first, for quite a long time, I felt like I was doing something immoral. Yeah, this was exactly where my head was going. Our intuition is telling us like, if this is all it's cracked up to be, ozempic,

then why should we be embarrassed or guilty or ashamed and afraid to like tell our friends that this is what we're doing, right? Yeah, exactly. Like there's something about it and it's loaded culturally, obviously, because it is considered, oh, you're cheating, you're not doing it the right way.

In the same way, an athlete on performance enhancing drugs would be considered. Exactly, I really wanted to crack this, understand this for my book, Magic Pill, because I could feel it about myself, right? I could feel me criticizing myself on this ground. So I was thinking that's kind of weird because it's like I mentioned before, one of my best friends takes statins. I've never looked at

him and thought you're fucking cheap, getting ahead of me on cholesterol. It's not like that thought has never crossed my mind. I think you'd think I was kind of crazy if I thought that. And I think to understand these attitudes, it really helps to think about, I looked a lot at the history of how we think about obesity, right? So if you look at in the sixth century, the Pope, Pope Gregory I, formulated for the first time or put in writing for the first time, the seven deadly sins, right? And one of them is gluttony. And it's always depicted as, you know, a very fat person pigging out, right? It's very deep in our culture, the idea that obesity is a sin.

And one of the ways you can see that is what the only forms of weight loss we admire are ones that follow the classic pattern of, you've got to go to hell, you've got to earn your place back, and then we forgive you. Think about that game show, The World's Biggest Loser, right? This is a very cruel example of that, but people who haven't seen it, please don't watch it, it's fucking vile, but it's a game show where you get very severely obese people and get them to take part in actually what are very dangerous exercise regimes,

people of their weight, very extreme exercise regimes, really starve themselves, and then the biggest loser is the winner, right? We admire them. It's like you were a sinner. We watched you go through hell. We saw your suffering, you cried. Well, because gluttony is considered a moral failure or a character defect.

And you can see why that evolved over a long period of time. Almost all humans before us have lived in situations of food scarcity. If you were a glutton, you were fucking over everyone else in the group, right? So it's not hard to see why there, it'd make perfect sense to have a taboo around gluttony. I'm not saying, by the way, that obese people are gluttons, but you see the point I'm making. So I think we have these very deep ideas about

sin, but there's an even deeper one, which is about cheating, right? Why did I feel like I was cheating? In this environment, it's very hard to not be overweight or obese because for all the reasons we've talked about so even the people who are not overweight or obese are often making quite big sacrifices to not be obese they're going hungry they're you know doing lots of onerous things and i can well understand that they look at me and think, I must look to them like Lance Armstrong looks to a cyclist, right? Well, I put in all this effort to get this and you, you motherfucker, you just inject yourself once a week and you get it. So I can see where it comes from. But the way I began to think of it is, firstly, I don't think we're sinners. I think that's a

outdated way of thinking, although I understand where it comes from and we should acknowledge it exists in all of us pretty much. But it comes to cheating that comes from the belief that we're in a race and I actually think we are in a race but it's not me against you against your neighbor who's on munjara whatever the race is between the forces that are making all of us almost all of us heavier than we should be and us right now we can deal with those forces together right but if you reframe it that way look we can turn this you're not definitely not doing this and i really appreciate this whole conversation we can turn this into a toxic argument if we want to right every fucking argument we have in this culture turns toxic pretty quickly partly because it's happening through social media

which is you know driven by algorithms that reward people for being angry and hateful, like we talked about for my previous book, Stolen Focus. Well, this can be another argument that's toxic if we want. We can tear each other down. But I think if we remain stuck in these old stories about sin, about cheating, about anger, it blocks us from the much more sensible conversation, which is the one we've been having which is what are the benefits and risks here what does this mean for our society but we can't think clearly about any of those things if we're trapped in this bitter rage-filled conversation which not to say there aren't things to be angry about people who can't afford it people are angry about some of the risks they're not wrong um i i agree with them on many of the things they're angry about, but we've gotta have a better conversation than that.

And I actually think you've kind of been modeling that. Yeah, I mean, it's not a binary thing, obviously. And I have mixed feelings about the whole thing. Like, yes, we live in an environment where all the incentives and all of the, you know, all of the industrial structures are driving us towards these unhealthy choices. But I recoil from the idea that we have to be victims

of that, that we lack agency. And to the extent that the discourse around a drug like this is that we are powerless, like I don't like that aspect of it. We do have a responsibility to ourselves, to honor ourselves, to make better choices. If the house is on fire, I can understand the appropriateness of this,

but then it becomes incumbent upon the individual to shoulder responsibility for their own choices going forward. And that's my hope for you. Like I don't want you going to KFC occasionally because you can get away with it. I want you, like I said at the outset, to like really honor yourself in this moment

to learn better habits for yourself and to begin to master those yourself in this moment to learn better habits for yourself and to begin to master those. So you can be around for a long time, you know, and I think you are having this opportunity. And I would like to read the chapter where you go off it, even if you end up going back on it, to have that experience and to see what happens

and to see if you can adopt healthier habits and make them stick. Yeah, I'm gonna think about what you said. You gonna take up that challenge? I think I was, it's funny that you said that. The thought I had in my head was, what's the quote from the American Revolution? They'll have to take the fried chicken drumstick from my cold dead hands.

Right, so to the extent that you're gonna keep jabbing your legs so that you can go to KFC once in a while, this is what I meant by like the blinder, you know, that's preventing you from the growth that is within your grasp. I think that's, I think you're definitely right. And I think the, we don't want to make the perfect the enemy of the good.

If the choice is eating a KFC bucket every day and go to KFC once a week, take the once a week option. But you can do better. Yeah, no, you're right. You can do better for yourself. You'll be a good friend and you're urging me can do better for yourself. You're being a good friend and you're urging me to do the right thing.

You're definitely right. And I did do better in Jamaica and you- Because you were in an environment that was more conducive to healthy choices. So how can you be a better curator of the environments that you find yourself in? And that's one of the challenges. You're in West Hollywood right now.

There's an Air One right down the street. I know. You got cash in your pocket. You don't have to go to KFC. You're right, you're right. I'm gonna literally go to Air One for lunch today. You've inspired me. There you go.

You have an incredible knack for writing books that just are of the moment, like super zeitgeisty. And books take a long time, right? But you have this knack, this uncanny like acumen to like deliver a book that speaks to, you know, something that we're all thinking about or is, you know, just very kind of current with something that's happening in the culture.

And you've done it again with this book. I don't know how you figure that stuff out, like years in advance. I know this book that you're writing, this crime book in Las Vegas is taking you a minute. Maybe that's a different kind of book. But true crime is definitely a thing. I don't have to tell you that.

So hopefully we can expect that book soon, but congrats on the book. I think it's really, and I appreciate that you're not bringing a binary, you know, kind of perspective to this, that it is nuanced. And, you know, once again, you've put yourself in the narrative as a protagonist, but in this one more so than any other

and in a more vulnerable way. And I think it's cool. And I think this is a conversation that we need to be having and we need to continue to have as we learn more. Oh, I really enjoyed this Rich. Thank you so much. Thanks, man. So magic pill, pick it up everywhere.

Should we hold up the cover? Yeah, we can do it. Publishers tase me if we don't hold it up. Come on. You're shameless. I'm shameless. Shameless promoter. I know. Are you?

Well, you work like a motherfucker on a book. You want people to read it. I understand. I meant to say, you can such a shameless promoter. I know, I know. Are you? You work like a motherfucker on a book, you want people to read it. I understand. I meant to say, you can get the audio book, the ebook, physical book. They always tell me to say you can get it from all good bookstores,

but the truth is you can get it from shitty bookstores as well. We don't have like a quality test, but the website is- Get it from your favorite shitty bookstore. Exactly, seek out the worst fucking dive. The one next to the KFC in Las Vegas. Yeah, actually Vegas has one of the best bookstores

in the entire United States. It just up the street from Fremont Street. Why am I blanking on its name? It's yeah, it's called Writer's Block. A completely, yeah, one of the best bookstores in the US. Actually lots of nice little ones as well. So don't diss the Vegas bookstores. All right, there you go.

All right, we'll come back and share more about Las Vegas than when you finish this stupid book. When you finish this book and you have gone off Ozempic and just mastered your diet. I like these strict rules you're laying down. I like it. Cheers, Rich. Peace.

That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guest, including links and resources related to everything discussed today, visit the episode page at richroll.com where you can find the entire podcast archive, my books, Finding Ultra, Voicing Change

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Plants. Namaste. Thank you.