The Diary of a CEOJohann Hari: They’re Lying To You About The Side Effects Of Ozempic!
EVERY SPOKEN WORD
155 min read · 31,001 words- 0:00 – 1:46
Intro
- SBSteven Bartlett
We've not spoken for two years, but I have to say, you look remarkably different.
- JHJohann Hari
So, I lost three stone in a year, and there's a secret to that, Stephen.
- SBSteven Bartlett
Johann Hari, the best-selling author who's using his own body...
- JHJohann Hari
To unearth the extraordinary benefits and disturbing risks of the new weight-loss drugs.
- SBSteven Bartlett
Ozempic, it is literally the hottest drug in the country right now.
- JHJohann Hari
I really worry about the risks of these drugs. You're nine times more likely to get this particular condition, which is excruciatingly painful. And these drugs are working very hard on key parts of your brain. In fact, there are 12 significant risks, and we'll get into that. But it seems extraordinary that we've reached the point where we would inject ourselves with a potentially risky drug to stop us from eating. And we've had 40 years of relentlessly promoting diet and exercise as the only solutions. And only 10% of people really do lose huge amounts of weight on diets and keep it off. But now, we have the most effective tool for self-starvation human beings have ever come up with. When I started taking Ozempic, I was literally 80% less hungry than I normally am. These drugs really do massively reduce or reverse obesity. And a few years from now, we'll have 50% of the population taking it. It's the new miracle drug. Now, this when I go through the 12 big risks, some of which have not really been explained to the public. So, within a year of stopping, you regain 70% of the weight you've lost. Muscle mass loss is a real problem. There's concern that it may be causing suicidal feelings. And then there's one of the really big risks, and it's absolutely grim beyond belief, and that is...
- SBSteven Bartlett
Congratulations, Diary of a CEO gang. We've made some progress. 63% of you that listen to this podcast regularly don't subscribe, which is down from 69%. Our goal is 50%. So if you've ever liked any of the videos we've posted,
- 1:46 – 6:37
How Did You Find Out About Ozempic
- SBSteven Bartlett
if you like this channel, can you do me a quick favor and hit the subscribe button? It helps this channel more than you know. And the bigger the channel gets, as you've seen, the bigger the guests get. Thank you, and enjoy this episode. Johann, we've not spoken for two years, but I have to say, you look remarkably different.
- JHJohann Hari
(laughs) There's a secret to that, Stephen...
- SBSteven Bartlett
Really?
- JHJohann Hari
... (laughs) we can dig into. Yeah.
- SBSteven Bartlett
What is the secret?
- JHJohann Hari
So for me, it started... It's a kind of weird story. It started in the winter of 2020, so it was that weird period when kind of the world was opening up again after the pandemic. And I'd gained a lot of weight in lockdown, like loads of people. And because of that kind of weird moment of reopening, I went to a party for the first time in, like, I don't know, a year and a half, two years. And it was a party thrown by a kind of famous Hollywood actor. And on the way there, I remember thinking, "Oh, this is gonna be kind of funny, because all these Hollywood people are gonna put on weight as well, right? They're gonna have gained weight. What are they gonna look like?" So, I remember getting there, looking around, and having this really weird feeling. Because it's not just that they hadn't gained weight. Everyone was gaunt, right? Like, everyone looked like their own Snapchat filter. Like, they had...
- SBSteven Bartlett
(laughs)
- JHJohann Hari
... like, higher cheekbones. They looked cleaner and clearer and sharper. And I was kind of wandering around, feeling a bit like, "Oh, shit." And I bumped into a friend of mine on the dance floor, and I said to her, "Wow, it looks like, um, looks like everyone really did do Pilates during lockdown." And she laughed, and then she looked at me, and I sort of looked at her, and she said, "Well, you know it wasn't Pilates, right?" And I sort of looked at her blankly. And she pulled out her phone, and she showed, she Googled an image, and she showed me an Ozempic pen. And I didn't know what it was. And I said, "Well, what are you talking about?" And she went, "Well, this drug. Everyone here is on this drug, right? Not just the stars. Like, their wives, their agents, their agents' kids, everyone, right?" And I remember being really thrown. And then over the next few days, uh, I read a lot about these, these new weight-loss drugs. And I've never... I don't remember ever coming across a topic where I felt so deeply conflicted from the very beginning, and that conflict remained all the way through, right? The subtitle to my book is The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs. And that's... Even right from the start, I was, I was aware that was, that was the, the tension. So the benefits are kind of obvious, right? You know, I'm older than my grandfather ever got to be, 'cause he died of a heart attack. Loads of the men in my family get really fat and die of heart attacks. My uncle died of a heart attack. My dad had a lot of heart problems. Um, there's a lot of evidence that obesity unfortunately does cause a whole range of health problems, over 200 diseases and complications. Uh, there's a lot of evidence these drugs really do massively reduce or reverse obesity. The average person who uses them, Ozempic, Wegovy, loses 15% of their body weight in a year. With the new generation of drugs, the next ones that are coming down the line, the average person loses 24% of their body weight. It's staggering. It's just below bariatric surgery. So I could see the obvious health benefit, and I could see that the alternatives that most of us have been pursuing, diets, have not worked well for most people. But at the same time, I thought, I mean, just, I had so many doubts straight away. I thought, "Well, we've seen this story before. There've been lots of miracle diet drugs that have been announced. They cause dramatic weight loss at first, and we always discover some horrendous side effect that causes, you know, catastrophic outcomes that mean the whole thing has to be pulled." I thought that. I thought, "Well, we know what causes obesity, right? The reason obesity has massively increased is because of a complete change in the food supply. We eat completely different food to what our grandparents ate. We need to deal with that, not kind of drug everyone." I also thought, "Well, what will happen to people with eating disorders when they get hold of this? What will this do to the kind of positive changes that were happening in accepting a kind of broader range of weights?" So I was really...... deeply conflicted. So, to really get to the bottom of this for my book, Magic Pill, I- I spent a year taking the drugs and going on this big journey all over the world, from Reykjavik in Iceland to Minneapolis to Tokyo, to interview the leading experts in the world on these drugs, the biggest supporters, the biggest critics, all sorts of a- uh, kind of alleys and avenues that follow from them. And at the end of it, it's really weird. I know far more than I did before. I know far more about the benefits and risks. I know far more about what this is gonna do to the culture, and it will be massive. But I'm still really conflicted.
- SBSteven Bartlett
So if we,
- 6:37 – 9:51
What Is Ozempic & How Much Is It?
- SBSteven Bartlett
if we start there, then. You're at the party. Someone mentions this Ozempic thing to you. Can y- Have you got the, uh, Ozempic, um, pen on you?
- JHJohann Hari
I have it as a, a prop.
- SBSteven Bartlett
You've got it here?
- JHJohann Hari
Yeah.
- SBSteven Bartlett
Okay.
- JHJohann Hari
So, it's very simple. Um, you... It's just a little pen. It's like, um, an EpiPen. So you take that. You, uh, put on the little lid. I won't take it out 'cause I need this one later, but the, um... Well, though, this one's empty. So you put a little, uh, you twist a little needle onto there, and you inject yourself with it, and you inject yourself once a week. And it's really strange, the effect it has. I remember the first day I took the injection. A couple of days later, I remember waking up, and I was lying in bed, and I had this weird feeling. You know that feeling when you wake up and you're not quite with it?
- SBSteven Bartlett
Mm-hmm.
- JHJohann Hari
And you think, "Well, what am I feeling?" And I was struggling to articulate it, and I, I was lying there, and I thought... I felt mildly nauseous, which everyone gets when they start taking it, but that wasn't the thing that was puzzling me. Uh, and then I realized I'd woken up and I wasn't hungry. I don't remember that ever happening to me before. I mean, I don't mean that as an exaggeration. I, I used to be woken up every day, like, really hungry. Often, I would be woken up by hunger, by my stomach rumbling. And I went on my kind of typical routine for the day. I went to this café just around the corner from where I live, and I ordered the same thing I would always order, which was a kind of big, kind of, uh, brown roll with lots of chicken and mayo in it. And I had, like, three mouthfuls, and I was full. I just didn't want to eat anymore. And I remember leaving. I remember Tatiana, the woman who works in the café, kind of shouting after me to see if I was ill or something. And then for lunch, I went to the same place I always go, or went at the time. Next to my office, there's a Turkish kind of restaurant. I went there. I ordered a Mediterranean lamb. Again, I had, like, three or four mouthfuls. I wasn't hungry. It was like the kind of shutters had come down on my appetite. I was literally 80% less hungry than I normally am. And it basically stayed that way from then on. It was a very, uh, physically and psychologically strange experience.
- SBSteven Bartlett
So on the, on the, on the pen itself-
- JHJohann Hari
Yeah.
- SBSteven Bartlett
... 'cause I just wanna make sure I fully understand this-
- JHJohann Hari
Yes.
- SBSteven Bartlett
... is that, that little pen you have in your hand, for people that can't, aren't watching on video. There's a pe- It kind of looks like a big Sharpie.
- JHJohann Hari
Yeah, exactly.
- SBSteven Bartlett
And is that one dose?
- JHJohann Hari
Yeah. Well, there's loads-
- SBSteven Bartlett
Or is that multiple?
- JHJohann Hari
... of doses in there.
- SBSteven Bartlett
Oh, okay.
- JHJohann Hari
So you twist the base-
- SBSteven Bartlett
Yeah.
- JHJohann Hari
... and, um, the, e- each time you twist it, it would release, with this pen, one milligram.
- SBSteven Bartlett
Okay.
- JHJohann Hari
Yeah.
- SBSteven Bartlett
And how many twists do you get out of one pen?
- JHJohann Hari
Uh, I think each one contains four doses. Yeah.
- SBSteven Bartlett
And how much does that cost?
- JHJohann Hari
So, it varies massively, 'cause as you know, I live half in the US, half in Britain a lot of the time. Um, so in Britain, this would cost you at the moment about 250 pounds a month. In the US, it's way more like $800 a month.
- SBSteven Bartlett
So 250 pounds a month. How many sort of doses do I get for that 250 pounds?
- JHJohann Hari
You... That would cover your whole month.
- 9:51 – 16:03
How Does Ozempic Work
- SBSteven Bartlett
- JHJohann Hari
Relatively. So, I interviewed the scientists who played the key role in the breakthroughs that led to the development of the drugs, and then the scientists who worked on it at every stage. So in one sense, they're not that new. Diabetics have been using them on license now for 18 years. So for obesity, they're relatively new. For diabetes, they've been around for nearly 20 years. And it was fascinating talking to the scientists involved, because one of the things that's really weird about this is there's a huge debate about how they even work. So there's certain things that we know for sure. So if you now ate something, right? You... It don't matter what it is. After a while, a hormone would start to be produced i- in your body called GLP-1, and that is one of many gut hormones that would start to be created. And it's basically, GLP-1 is a natural signal saying, "Steven, you've had enough. Stop eating." Right? "Just stop now." Right? But GLP-1, natural GLP-1, only remains in your system for a couple of minutes, and then it's washed away. So if you sort of push through it, you can carry on eating, right? Most people do stop when they get the signal. Um, so what these drugs do is they simulate GLP-1. They inject into you an artificial copy of GLP-1. But instead of that GLP-1 remaining in your system for a few minutes and then disappearing, it stays in your system for a whole week. So when I go to that café, and I eat the thing I'd normally eat, my system is filled with signals that say, "You're already full, Johann. You don't need any more." Right? So, that was initially... That is definitely a key part of how it works, and it was initially thought that these drugs worked on your gut, right? This GLP-1 is a hormone that's made in the gut. Um, it's thought that the effect was it slows down your gut, it slows down gastric emptying. That is definitely happening, but the cutting-edge science and the kind of leading neuroscientists that I interviewed now believe actually it primarily has an effect on your brain. It changes what you want and how you want it, which ha- brings with it a huge parallel set of both benefits and risks.
- SBSteven Bartlett
Interesting. So it's once a week, and you basically feel fuller for a whole week from one injection.
- JHJohann Hari
Yeah. Not everyone gets to that state immediately. Some people, it takes longer. Some people, the side effects are just intolerable, and they can't take it at all, or they can't continue to take it, and I interviewed plenty of people who were in that position. But for most people, you-The best way I can describe it is, imagine you'd just had Christmas dinner-
- SBSteven Bartlett
Yeah.
- JHJohann Hari
... and I came up to you, and you're, so you're completely bloated. You're lying on the sofa. And I came up to you and said, "Hey, Steven, I got you a Big Mac. Here it is." And you'd be like... I mean, you could physically force yourself to eat that Big Mac. You might throw up, but you probably could eat it. But you just don't want to. You feel full. So it creates a very rapid sense of fullness in response to far... So, I used to eat 3,200 calories a day roughly. I now eat about 1,800. There's a huge drop. And the benefits are kind of obvious of that, but there are really big costs. And I discovered there's, in fact, 12 really big risks, and there's all sorts of... 'Cause at first when you hear all this, you're like, "Well, this is just ka-ching, win-win, right? Who wouldn't want this?" But there's a lot of risks and downsides as well.
- SBSteven Bartlett
So I want to get into all those risks and downsides, but one of the, I think, rebuttals that some people would have when they hear this, um, is kind of contrary to the reaction that I think you expect, which is, "Johann, I really love eating food. I really, really enjoy the process of eating food. Aren't you losing happiness?" Because food gives a lot of people happiness in various ways. "So aren't you a little bit annoyed now that you've lost your desire to have, you know, that roll that you used to have for breakfast in the morning? Hasn't that taken something from you?"
- JHJohann Hari
This is a big drawback for lots of people. I think I'm quite unusual, so I'll explain how most people feel about this, then I'll explain how I feel about it. Um, you're absolutely right. Even Jens Juul Holst, who was one of the scientists who developed Ozempic, said, "Look, for most people, it's just a life without pleasure in food is just unbearable. And after a couple of years, they just give up, because they want to enjoy life, right?" And one of the key things that gives us pleasure throughout the day is eating. Uh, and a lot of people feel that way. If you look at, for example, Jay Rayner, a brilliant food critic here in Britain, you know, he just described how he started taking it. He would go to the best restaurants in Paris, places he loves, and he just couldn't get any pleasure out of it. So for him, it was just awful. It's a very common complaint, that it drains pleasure from food. Honestly, I, I had almost the opposite experience, but I wanna stress, I do think I'm quite unusual. So I realized when I started taking these drugs, one of the fascinating things about these drugs is they will bring to the surface whatever psychological issues you had with food, right? Because it so radically interrupts your eating patterns, um, and that can be very challenging for a lot of people. I'm sure we'll get into that. But for me, I realized how much of my eating from when I was very young, the pleasure I got from food was not primarily from, like, tasting it and savoring it. The pleasure I got from food was mostly from kind of a feeling of stuffing myself. So, stuffing is like... You know, you do it at Christmas dinners. We all do it sometimes. Stuffing is when you sort of eat deliberately beyond the point at which you're full. And you feel it as a physical sensation. You can feel it sort of pushing up on your esophagus and out on your stomach. And I think from when I was very young, I grew up in a very violent and crazy environment. I think one of the ways I learned to cope with that, there are many productive and positive ways I learned to cope with that, but one of the kind of downsides is I learned to really eat to soothe myself, and I would stuff. And when I started taking Ozempic, I actually couldn't eat like that anymore, right? You, you can't stuff yourself. I would literally throw up if I, you know, tried to-
- SBSteven Bartlett
Mmm.
- JHJohann Hari
... stuff myself. So actually, for me, it massively slowed down my eating, and I actually enjoy food a fair bit more now. I don't wanna overstate it. I'm not a foodie. I'm never gonna be that person. But like, I remember going to dinner with one of my friends, um, I don't know, maybe three or four months after I started taking it. And her saying to me, "You know, it's always been a bit stressful to eat with you, 'cause you eat so quickly, but you don't seem to really enjoy it. And now, you do actually look like you're enjoying your food." But I stress again, I don't think I'm typical in that respect. There are far more people like Jay Rayner than there are like me.
- 16:03 – 26:17
The Impact of Ozempic on the Brain
- JHJohann Hari
- SBSteven Bartlett
I really wanna go into why people, you know, people's relationship with food more generally. Um, but I wanted to close off on that, what you were saying about Ozempic's impact on the brain. You talked about GLP-1 in the gut, and the im- you know, the impact it has on making you feel satiated. But you also alluded to there's now research that suggests it's doing something to the brain as well?
- JHJohann Hari
This is totally fascinating. It opens up a whole new set of potential benefits for these drugs in relation to addiction, and a whole set of potential risks for these drugs in relation to depression. So, I wanna stress, there is very big scientific disagreement about what is happening in the brain in relation to these drugs. And it's a bit like, when you interview people, it's like, it's like looking at a picture that's just coming into shape. So, a year from now, we'll know much more than we do now. But what was discovered, this was actually discovered in the '90s, um, here in London at Hammersmith Hospital, was that, in fact, we don't only have GLP receptors in our guts. We have GLP receptors in our brains. In fact, GLP-1 can be made in the brain, right, which is fascinating. It can also be made in your thyroid, which is very significant, and I'm sure we'll come back to. Um, so when you take these drugs, um, as John Wilding, one of the key figures in the development of these drugs, said to me, "You can tag the drug, which means that you can sort of dye it, and you can give it to animals and then cut open their brains." Obviously, you can't do that with humans. And when you do that, when you just give them the drug, and you cut open their brain afterwards, what you find is this drug goes everywhere in the brain. It's going all over the brain. It is primarily having a brain effect, right? And it definitely also, much more anecdotally, feels that way. When you take it, it feels like you want different things, right? This doesn't just feel like a physical sensation of, "Oh, I'm full." It feels... I remember taking my godsons to McDonald's maybe, I don't know, a week after I started taking it. And I didn't want a McDonald's. And then one of my godsons saying to me, "Who are you and what have you done with Johann?" Right? 'Cause it was-
- SBSteven Bartlett
(laughs)
- JHJohann Hari
... so contrary to my preferences and my... In fact, um, one of my low points in life was Christmas Eve 2009. I went to my local branch of KFC, just around the corner from where we are now, 'cause I used to live near here.And I said to the guy behind the counter my standard order, which is so gross I won't repeat it. And the guy behind the counter said, "Oh, Johann, I'm really glad you're here. Wait a minute." And I was like, "What?" And he went off behind where they fry the chicken and everything, and he came back with a massive Christmas card and everyone who was working that day, and they'd written, "To our best customer," and they all clapped for me. And one of the things that was so terrible is I thought, "This isn't even the fried chicken shop I come to the most," right? (laughs) How can this be happening to me? But, so when you speak to the, the cutting-edge neuroscientists, and I interviewed them in great depth, there's basically three theories about what these drugs are doing to your brain, right? Very broadly. I mean, they... they... this is a quite crude way of putting it. Um, so one is, you have in your brain something called the reward system. The reward system is what motivates you to do anything, so you know, you have sex, you eat, you meet up with a friend. Your reward centers hum, right? It's what makes you feel good when you do something pleasurable. And one theory about these drugs is they dampen your reward system. So the reason I don't want a Big Mac is that a Big Mac is not as rewarding to me as it would have been before I took these drugs, right? That obviously brings with it a set of risks, 'cause then you go, "Okay, if it's dampening my reward system for Big Macs, is it dampening my reward system for the things I love? Writing? Reading?" There's a big debate about this. There's concern that in some people, it may be causing suicidal feelings, and in some people, it may be causing depression. There is a warning on the drug to that effect, eh, required by the FDA, the, the Fin- Drug Agency in the United States. That's one concern. But there are other scientists who say that we don't... that that's not correct, that, um, that the suicide risk is not accurate and that, eh, they don't work by dampening your reward system. Some people, like Aurelio Galli, who's at the University of, um, Alabama in Birmingham, said to me what he thinks that it does is it resets your preferences. It's almost like taking your phone back to the factory settings. It resets key elements of the kind of food you want to a healthier level.
- SBSteven Bartlett
Can I just say on that? Sorry to interrupt, but, um, I was thinking constantly as you were talking about your trip to McDonald's and not wanting the McDonald's anymore.
- JHJohann Hari
Mm-hmm.
- SBSteven Bartlett
I- I've come to see in my life that if I have something unhealthy, if I have sugar or a cookie today, I'm... I feel like I'm much more compelled to have another one tomorrow. I feel like I... I... I... um, I look back on certain periods of my life where I almost get into a bit of a sugar spiral, and it could be because of stress or some other factor, but it made me think that the sugar itself is somewhat addicting. So when you were talking I was thinking, is it, is it not just the case that you're consuming less sugar and, you know, some of these addictive food substances so you want it less the next day, if you know what I'm saying?
- JHJohann Hari
Yeah. There's an experiment that proves you're right i- but in a complicated way. Um, can I just finish one thing about the brain-
- SBSteven Bartlett
Yeah, please. Yeah. Yeah.
- JHJohann Hari
... and then, you know, come back to that?
- SBSteven Bartlett
Yeah.
- JHJohann Hari
Because what you raised is super important and, and truthful point. The third theory about how it could be working in the brain, and this comes from a scientist called Professor Paul Kenny who actually did the experiment that, that you... that relates to what you just said. He argues that in your brain, you don't just have a reward system, you have something called the satiety system, and this is a crucial concept for people who want to understand these drugs and what's gone wrong with our diets more generally to understand. Satiety is just the feeling of having had enough, right? We've all had the feeling of being sated. You're like, "Okay, I'm done. I don't want any more." We get that with food, sex, all sorts of things, right? You're just sated. Um, he argues that in your brain there's, there's... basically alongside the reward system, there's also a satiety system, a system that just says, "Stephen, you've had enough. Stop now." And he argues that what these drugs do is they dial up your satiety system. They don't dial down your reward system, right? There's a huge and ongoing debate about that. What we do know is they're having some really significant effect on the brain, and that has all sorts of implications that we need to think about. When I was learning about this, I remember thinking, "This is a much more intimate and risky transformation than when you first hear, 'Oh, I'm taking something that affects my stomach,'" right? So there's a lot there about the brain and implications for addiction as well, which we can talk about. But to come to the thing you asked about, which is so important, of all the things I learned, there was an experiment that kind of freaked me out about this, um, 'cause obviously I was trying to figure out, well, how did we get to this point? 'Cause at first glance, I can see how it seems crazy. In a way it did to me. You know, we gained an enormous amount of weight in the last 40 years. So I was born in 1979. The year I was born, 6% of British people were obese. It's now 26%, right? Staggering increase, unprecedented in human history. And it seems extraordinary that we've reached the point where we would inject ourselves with a potentially risky drug to stop us from eating. It seems so unnatural and so wrong. And I was trying to think, well, how did we get here, right? What happened? Which is why satiety is so important. So it's this experiment that I think helps to understand that thing you were saying about sugar. It's done by this guy, Professor Paul Kenny, who's the head of neuroscience at Mount Sinai in New York, and a brilliant neuroscientist. So Paul grew up in Dublin and he moved to the US when he was in his 20s to do his PhD, I think. And he moved to San Diego first and he quickly clocked Americans do not eat like Irish people, right? They eat much more sugar, much more fat. They eat just much more, right? And within being... within like a year of being there, he'd gained, I think, a stone and a half or something. Uh, so he gained, uh... I think it was 23 pounds. So he gained a lot of weight. And he started to wonder, sort of like the question you were asking, does this food, when you consume it, change your brain in ways that compel you to consume it more? What's going on? So he designed an experiment that sort of investigated this, uh, which I've nicknamed Cheesecake Park. That's not its official name, right? Um, you get a load of rats and you raise them in a cage, and they've just got the kind of food that rats evolve to eat over thousands of years. It's pellets based on their natural diet. And if you do that, even though they've got far more pellets than they could actually eat, they will eat enough to deal with their hunger and then they just naturally stop, right? So when they've got the kind of food they evolved to have, they never become overweight or obese. They just stabilize their weight. They've got a kind of natural nutritional wisdom.Then Professor Kenny introduced the American diet to them. He fried up some bacon, he bought some Snickers bars, and crucially, he gives them a load of cheesecake. And they come along, and they nibble the cheesecake and the other stuff. And quite quickly, they just go wild for it. They shun the food they evolved to have, and they just start obsessively eating the cheesecake, the fried ba- the fried bacon, the Snickers bars. He described to me how they would like... He would put the cheesecake in, and they would just hurl themselves into the cheesecake, and then like eat their way out and emerge like completely slicked with the cheesecake. So given this kind of food, all their nutritional wisdom disappeared, just went away. And they became obsessed with this new kind of food. Um, and as he put it to me, within a couple of days, they were different animals. Their... All their health indicators were worse. They were obsessively eating within a few weeks. They were... Their health was really bad. They became extremely obese. And then he varied the experiment even more, in a way that seemed to me, as a former junk food addict, a little bit cruel. He took all the American diet away, and they just had the food they evolved to have, the food they used to eat, right? And he was quite sure he knew what would happen, that they would eat a lot more of the kind of natural food than they had before, and this would prove that junk food expands your appetites. That isn't what happened. What happened was much worse. They completely shunned the natural food. It was like they no longer recognized it as food at all. They just refused to eat it. They starved. And it was only when they were really starving that they went back to eating the natural food. There's lots of human examples of this, but there's something... As Professor Gerald Mann, who's a nutritionist at Harvard, said to me, there's something about the food we're eating, which I think you're getting at in that question, which is undermining our ability to know when to stop, which is how we got to the point where we... so many people, 47% of Americans want to take a drug that will make them stop.
- 26:17 – 31:16
The Cheesecake Park Experiment
- SBSteven Bartlett
I was reading about this, um, thing you call the Cheesecake Park-
- JHJohann Hari
Yeah. (laughs)
- SBSteven Bartlett
... in your book, in chapter two. And the other sort of step he took the experiment to was the whole idea of electrocuting the animals when they ate certain foods. And you say in the book that he then, um, would electrocute the animals while shining a yellow light in their eyes so that they would eventually become scared of this yellow light. And in the case of, um, the natural food, when he shone the yellow light in their eyes, they would run away. But even if you shone the yellow light in their eyes while they were eating the junk food, they would stay and continue to eat the cheesecake, which kind of the conclusion in chapter two of your book, as I've written it here, is... And I think this came from the researcher, "If you are exposed, um, to this food for a while," Paul concluded, "the desire for it is so great that you will ignore all sorts of negative consequences to eat it."
- JHJohann Hari
As we know, as I know in my own life, right? My KFC obsession had obvious negative consequences in my life, and the reason this is so important in relation to these drugs... So for a long time, I was looking at two things, right? I was looking at why did we, so many of us gain so much weight so rapidly? Obesity has trebled globally in my lifetime, right? Completely unprecedented in human history. Why did that happen, and how do these drugs work? And at first, I thought they were like parallel lines, right? But actually, I realized they were like kind of braided plaits. The answer is completely densely interconnected. What we know is the kind of food we eat profoundly undermines our sense of satiety. It completely disrupts, just like it did with the rats. It... We don't get that signal, "You're full, you've had enough, stop," from the kind of food we're eating. And what these drugs do is they res- restore a sense of satiety. Carell Larue, another one of the key scientists who developed these drugs, said to me, "What these, what these drugs give you is satiety hormones." They give you back a sense of being full. And in a way, at first, I thought, "Well, that makes the whole thing seem crazy, right?" Because there's a guy called Michael Lohe, brilliant professor, um, at Drexel University in Philly, who said to me, "Look, you got to understand, these drugs are an artificial solution to an artificial problem." We've artificially created this problem through a catastrophic food system that is screwing us up from childhood, and then along come these drugs as the artificial solution to that. And the first thing you think is, right, we've got to deal with the food system, right? And that is absolutely true and correct. And I remember going to one of my closest friends, um, I call her Judy in the book, it's not her real name, who, you know, she'd had cancer seven years before, and so I'd been with her all through that kind of really grueling process, and it was a, an absolute nightmare, 'cause she's a single mom, and you can imagine how, how grim that was. Um, and I said to her, "I feel like a complete fraud taking these drugs, right? I'm always talking about how we need to deal with the causes of social problems. I can see very clearly the cause of this problem, and this is just sort of dealing with the symptom." And she said to me, "Look, Johann, you can stop taking this drug. That's fine. Do it if you want to. But when I had cancer, we know there is something in the environment that is triggering breast cancer in women, right?" One in seven women in Britain now get breast cancer. That didn't happen in the past, it's not happening in Japan, where it's only one in 38 women. Something is really wrong in Britain and the US in the way we're living that is triggering breast cancer, right? But she said to me, "You didn't say to me when I got breast cancer, 'Well, fuck me.' All this environmental problem has caused this breast cancer, and now you want to inject yourself with another poison, chemotherapy, in order to deal with it. No, you said, 'Okay, we've got an environmental problem. Obviously, that environmental problem needs to be dealt with, but you've got to stay alive or you can't deal with it,' right?" The analogy she gave me that really helped me was she said, "If your house is on fire, right, you could say, 'Well, look, we need to build houses that aren't made of flammable materials, and we should make it the law that you've got to have sprinklers.'" And of course, I agree. But the first thing you've got to do is put out the fire in your house, right? And it... And then after that conversation, it was just after it, I- I met a guy called Jeff Parker. He's in San Francisco.He's a 66-year-old lighting designer who was about 16 stone when I- whe- when, when he first started taking weight loss drugs. And he was in real trouble. He had heart problems, liver problems, kidney problems. It was very painful for him to walk. And he got Mounjaro, which is the next generation up of these weight loss drugs. And he lost loads of weight, and all his health problems reversed. And now he walks his dog over the Golden Gate Bridge every day and is really happy. And said, "Look, I feel like now I'm gonna enjoy my retirement." And I said to him, "But Geoff, um, uh, don't you feel like we should be dealing with the environmental causes?" And he said, "Absolutely. I totally agree with you. You start that campaign, sign me up. But I've got to tell you, by the time we achieve that, I'm gonna be dead, right? We're not gonna get there in the next few years, and I wanna live." And I found that h- I found that hard to dispute.
- 31:16 – 44:53
Obesity Is a Choice
- JHJohann Hari
- SBSteven Bartlett
Wh- what if people say, "Well, you know, you could, um, you could just not choose the roll at the coffee shop in the morning. You could have just gone for, I don't know, a salad or something."
- JHJohann Hari
Yeah.
- SBSteven Bartlett
It's a choice you're making, Johann.
- JHJohann Hari
Yeah, so-
- SBSteven Bartlett
Just make better choices.
- JHJohann Hari
... so this was completely the voice in my head. I remember another one of my friends, when I was at dinner and I was doing this, I was talking through everything I've been learning. And I was talking about, you know, the ri- what you've got to weigh here, I thought, was the risks of obesity, which are really disturbing when you learn about them. I was actually surprised. We all know obesity's not good for your health, but I was actually stunned when you look at the evidence about how bad obesity is for you in relation to not just diabetes, but cancer, dementia, across the board. We can come back to that. So, I was like, well, you've got to weigh these risks of obesity against the risks of these drugs. And I learned that there are 12 significant risks associated with these drugs. And he said, "What are you talking about? You haven't got to weigh those risks at all. There's a third option. Go on a diet. Exercise," right? And he said, "I've seen you do it. You've done it plenty of times, right? Do that." And of course I had this voice in my head. I thought I was cheating, um, and I thought, "Well, why don't I do, wh- why am I not doing that," right? Um, and I really began to get an insight into this when I, I went to interview an amazing person called Professor Tracy Mann who's in Minneapolis where I met her, um, who's done some of the most important research on diet ever. I remember actually I met her, I interviewed her in a place called Al's Bun, which is a cinnamon bun shop, famous cinnamon bun shop in Minneapolis. And when I arrived, the guy at the door said, "Have you ever been here before?" And I said no. And he said, "Oh, we'll give you a free cinnamon bun then." He gave me this like 2,000 calorie massive cinnamon bun that sat there the whole time (laughs) we were talking about diets. And Professor Mann, she began to research this in the year 2000. And she wanted to figure out how much do diets work, right? Are they effective? And at that time, the science was very clear, diets are really effective. If you go on a diet, you will lose weight, right? But she looking, she's looking at all these studies, it was almost 24,000 studies, and she noticed as part of this big, it's called a meta-analysis, and she discovered something a bit weird. Which is most of these studies, the overwhelming majority, would follow people who were on a diet for three months. So, you, you exercise your willpower, you go on a diet for three months, you lose a load of weight, and then they just stopped. And the implication was you stay at that lower rate forever. She'd be like, "Well, I know quite a lot of people who are not in that position. That doesn't happen to them." So, she looked in more detail and discovered there were 24 studies that had followed dieters, not just over this short period, but for two years, and in a handful of cases, five years. And when you look at the longer picture, the picture is really different. After two years, the average person on a diet has lost two pounds in weight, right? So it's not nothing, but it's pretty close to nothing, right? It's- it's extraordinarily low. So what we know from the research on dieting is there's a very small number of people, around 10% of people, who really do lose huge amounts of weight on diets and keep it off. We all know people like that. I've got someone in my family like that, right? But for the vast majority of people, it doesn't work. And I remember saying to Professor Mann and loads of other scientists who've looked at this, "Well, how can that be?" Because we know, you only have to know the laws of physics to know if you consume fewer calories than you burn, obviously you will lose weight. To dispute that, you have to dispute the laws of physics, right? So, how can it be that these people are dieting but they're not losing weight? And Professor Mann and other people explained to me, um, something that's sort of missing in this picture that I think really helps us to understand it and is actually important for understanding these drugs, I think. So, a lot of the scientists explained that there are biological changes that happen as you gain weight which make it harder for you to find your way back in a, in a way that you can sustain. So, in the '60s and '70s, there was this theory about weight that was b- almost universally accepted. It's called set-point theory. It sounds a bit complex, but it's pretty simple. If you think about your temperature, your body temperature, right, your body wants you to be at the temperature you and me are at right now, right? And if our temperature goes higher than that, if we get a fever or if we go to the Sahara Desert, our body will work really hard involuntarily to bring us down. It'll make us sweat. It will make us really uncomfortable. And again, if your, and also if your temperature goes below the temperature we're currently at, your body will start to shiver. Again, it'll make you really crave heat, right? So your body has a set level at which it keeps your temperature, and it works extremely hard to keep you in that zone for your whole life. And it was thought for a long time that your weight was a bit like that. That when you're born or possibly even in the womb, you have a biological set point for your weight that remains the same throughout your life. And you can go a bit higher or a bit lower, but basically you're fixed there. But then the obesity crisis happened starting in the late '70s, early '80s. There's a huge weight rise in such a large part of the population. And it looked like, oh, set-point theory is just wrong, right? That can't be correct 'cause if it was true, then you couldn't possibly have this. But then Professor Lowe at Drexel and other places, and other people, um, discovered what, what is really happening in my view. I think they produced very compelling evidence for this.As you gain weight, your body's set point rises, right? So let's say my body wanted me to be 18% body fat. As I get to 30% body fat, my body will then fight very hard to keep me at that higher level, right? Which seems really weird at first. Why would that be? So if you, if you, let's say you gained three stone, right, and then you tried to lose weight. Or we don't think of a hypothetical, Robert De Niro for the movie Raging Bull gained, you know, three or four stone, right, and then tried to cut back. But what you'd find was your metabolism would massively slow down, so it would, you'd have to burn far more to get the same number of calories as you do now. Uh, you would crave far more sweet and salty foods. You would have lower energy, so you would find it harder to exercise. Uh, so your set point has risen, and it's trying to keep you there. And I remember saying to loads of scientists, "Well, that just seems bizarre. Why would evolution endow us with that? That's such a maladaptation, right? Why would, why would, um, why would it be?" And they explained to me, "Well, you have to think about the circumstances where we evolved." In the circumstances where humans evolved, and in fact, every human circumstance pretty much until, like, 100 years ago, there was never a situation where you would have completely abundant calories, in fact, hyperabundant calories for your whole life. You'd have far more calories around you than you could ever possibly eat. That never happened, so your body didn't, evolution didn't prepare us with good instincts for that. What you did have, what was a big risk was famine, right? There was a big risk that at some point in your life, food would run out, and you would be in real trouble. And in a famine, the fattest person at the start is gonna be the last man standing, right? Timothée Chalamet will die in week one of a famine, and you know, John Candy will still be alive at the end of it,
- SBSteven Bartlett
(laughs)
- JHJohann Hari
Although it's not a great example 'cause John Candy has died, but you get the point, right? Um, so actually, that's why, uh, evolution prepared us that, "Oh, if you gain weight, fight to hold it, 'cause sooner or later you're gonna have to lose it in a famine anyway." So we evolve with this instinct that when we gain weight, we experience these biological changes that make it harder to go back. It's not impossible. Willpower is a real thing. Some people can do it. But when you try, you are fighting against your own biology. You're also fighting against your psychology and your environment for different reasons we can explore. So it's not that dieting doesn't work, but we've got to be honest. At any given time, 17% of people are on a diet. We've really tried that route, right? We've had f- you know, 40 years of relentlessly promoting dieting as the o- or diet and exercise as the only solutions, and we've gotten fatter and fatter and fatter. So there's something missing in that picture. I think it's partly set point theory. It's also important for the drugs 'cause some people argue, like the guy I mentioned before in relation to the brain, Professor Aurelio Galle, some of them argue that what the drug may be doing is actually resetting your biological set point, lowering the kind of temperature at which your body tries to keep your weight. It's bringing your set point down so that you don't get those effects like the metabolism slowing and all the other things that kick in when you try to lose weight.
- SBSteven Bartlett
I think on average, and this might not be accurate, but I think on average we live more stressful lives than we once did as well. And I wonder the relationship that our more stressful, more frantic, more busy, notification-filled, social media-driven screen time lives are having on our relationship with food, and if there's a relationship there at all, you know, more-
- JHJohann Hari
100%.
- SBSteven Bartlett
... more kids have ADHD now than ever, you know. Cortisol levels seems to be skyrocketing, and it seems there's a relationship between stress and appetite, which is acting as a gravitational force against our willpower.
- JHJohann Hari
No, you're totally right, and this is, when I go through the 12 risks of the, the drugs in the book, this is one that I really worried about and one that played out for me. So I noticed I had this weird thing. About six months into taking the drug, I had this realization. So I was losing a lot of weight, right? I lost a huge amount of weight. I lost three stone.
- SBSteven Bartlett
Three stone in what period of time?
- JHJohann Hari
From, from now to when I started, so just over a year.
- SBSteven Bartlett
And how quick, how quick was that weight loss, just out of interest, before we move on?
- JHJohann Hari
Pretty, pretty straight linear line downwards from, from the start. But I had this strange sensation. I had a, a... My friend Danielle was pregnant at the time. I kept bumping into her, and it was like we had, we were on opposite trajectories. Like, she was swelling and I was shrinking. Um, I remember walking away from her once and thinking, "This is really weird. I'm getting what I want. Why don't I feel better about this?" Right? I, I didn't actually feel that much better for quite a long time, for about six months. Thinking, "Why is that?" And I'm not-
- SBSteven Bartlett
So what do you mean by better?
- JHJohann Hari
I felt quite muted in my emotions. I felt... I felt, uh, I wouldn't say, I definitely wasn't depressed, but I felt a little bit dulled. I thought this is strange. I thought maybe it's just other things going on in my life. You never know when it's just an individual, but lots of people are reporting this. Most people are very happy when they take drugs, but there's a significant minority. And so I started looking at exactly this question, the psychology of eating, and it turns out there's kind of five, there's scientific evidence for five reasons why we eat. Um, and obviously the first and most important one is sustenance, right? I would have thought if you'd asked me a year ago, "Why do you eat?" I would have said, "Well, the main reason is to sustain my body." But here I am eating so much less than my body has sustained, so all those other calories I was consuming were doing something else, right? And one of the things, one of the reasons we eat, I mean, another one is pleasure, which we've talked about, but another reason why people eat is comfort, right? People get a tremendous amount of comfort out of food, particularly overeating can be very comforting. We know this partly because whenever there's a stressful event, uh, junk food orders massively go up. After 9/11, there was a huge increase in ordering, people ordering pizzas and fried chicken. The night Trump won the election, in blue states on Uber Eats and the other kind of delivery apps, there was a massive increase in people ordering tacos, you know, um, shitty food, right? Um, if you, if you're, you're a man and you lose your job, your chances of gaining weight massively increase, partly 'cause it's so upsetting and you eat to comfort yourself. Um, and one of the things that happens when you take these drugs is your ability to comfort eat is taken away from you.... you can't comfort eat. And we've got a good analogy, I think, or a good precedent for helping us think about how that affects you. So the best comparison for these drugs, if we're trying to figure out their effects, I think is bariatric surgery, right? So up to now, it was very hard to sustainably lose, like, more than 20% of your body weight. The only way it was possible to do it very quickly was bariatric surgeries. I think we have to look at the outcomes, that's stomach stapling, there's four different kinds of it. But it's basically what we think of as stomach stapling. Stomach operations-
- SBSteven Bartlett
Gastric band.
- JHJohann Hari
Exactly.
- SBSteven Bartlett
Okay.
- JHJohann Hari
That's one form of it, right?
- SBSteven Bartlett
Okay.
- JHJohann Hari
And so I think you have to look at the evidence from gastric surgery. And in some ways, it's very encouraging. So we know that gastric band surgery and other forms of gastric surgery massively boost your health. If you have one of these operations, over the next seven years, you are 56% less likely to die of a heart attack, 60% less likely to die of cancer, and 92% less likely to die of diabetes-related causes. In fact, it's so good for your health that ev- you are 40% less likely to die of any cause over the next seven years, right? So we know reversing obesity massively boosts physical health in most cases, right? Sometimes very dramatically. But we also know from bariatric surgery, there's plenty of downsides to bariatric surgery, it's a horrendous operation, and one in a thousand people die during the operation, it's grim. But we also know, and I think it's really important to the thing you're asking about, is that it has an effect on your psychology. So a lot of people are much happier, most people who have that surgery are glad. But 17% of people who have that surgery have to have inpatient psychiatric treatment afterwards 'cause they're so depressed or distressed. Your chances of committing suicide almost quadruple after you've had bariatric surgery. And I think there's lots of reasons why. Some of it must be the grimness of the operation and the aftermath. But I think a lot of it is, you know, you take away comfort eating from people, right? If you go through life, especially people who've had gastric band surgery or the other surgeries, you know, those are people who were very severely obese, so they will have had this effect very powerfully in their lives, most of them. If you take away something that is a key way of soothing people, when that goes well, you can rebuild your life, you can find other ways to get that soothing, and that's really valuable and important. But a lot of people just experience it as profoundly painful and distressing. And there needs to be a lot of people like
- 44:53 – 52:25
Addiction Transfer
- JHJohann Hari
that.
- SBSteven Bartlett
When people have those surgeries, I read in your book in chapter eight, that one in ten people then pick up a different type of addiction, to alcohol or gambling or shopping or drugs, uh, or something else. So that's pretty clear evidence that there's, the psychological soothing is just moving somewhere else.
- JHJohann Hari
It's fascinating, and, and, and distressing. And obviously, I spoke to people who've been through those, what's called an addiction transfer. Um, I spoke to this amazing woman called Robin Moore, who, uh, had been 303 pounds. She'd had, um, bariatric surgery 'cause just nothing else had worked, and she felt she was really a slave to food. That was how she put it. And it had this incredible effect. She, she knew why she had gained her, gained weight so much. In her case it was she, when she was a child, she had been sexually abused. She'd been raped, and she'd never told anyone. And she quite deliberately gained weight in order to keep men away from her. She thought, "Well if I'm, if I'm really fat, I'm less likely to be attacked." Um, which is surprisingly common. And she lost all this weight, and she felt great. She felt physically much better. People were treating her much better. But she had this shift where she, she'd never been much of a drinker. She had periods when she was at college where she drank a fair bit, but you know, she'd never been a heavy drinker. And she just quite rapidly became a very full-blown alcoholic. She used to work out by the airport in Toronto, and she would, you know, drink on the way there, drink on the way back. And she got fired 'cause she was drunk at work eventually. And, um, for her, she, she kind of realized, you know, and I think there's interesting ways of thinking about this in relation to these drugs. And I want to stress this is not going to be everyone. I don't think this is even going to be a majority of people, by any means. But when you take these drugs, the underlying psychological reasons that drove your eating are profoundly disrupted, and in many cases, come to the surface. And for me, that was help, painful at first, but helpful. I remember having a day in Vegas. As you know, I'd 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 had a day where I was investigating something really grim, and I f- I felt really bad, and it was relating to someone... It's a long story, but something terrible. And I went to the KFC on West Sahara. It's the grimmest KFC in the whole world. I have a secret love for it. And I, on a kind of autopilot, I ordered what I would always have ordered, you know, like a loaded fried chicken. And I sat there, and I remember thinking, "Oh, shit. I can't eat this." I remember Colonel Sanders was on the wall, looking down on me. It was like he was going to me, "What happened to my best customer," right? So being deprived of comfort eating is, is, quite apart from the being deprived of pleasure, which I think is sort of related but a bit different, is, is, is very difficult. And again, my friend who I'd spoken to had had cancer, I went to her and said, "This is really hard, right?" And she said, "Look, it's not that the drug is causing this problem. The drug is making this problem visible to you. And now you can deal with that in other ways," right? And that's what I've been trying to do. I write about how in the book. But yeah, so one of the things that fascinated me about all the research for, for my book, Magic Pill, was how incredibly complex this is. Every time you look at one effect, it seems to have another effect. This is a really complicated, difficult topic, and anyone who's coming in telling you either, "Ra ra, these drugs are great and they're gonna save us all." Or, "These drugs are devils, it's terrible," um, I don't think it's leveling with people. I think it's complicated, I think there's risks at every turn, and I think we need to think through the complexity together in a way that's honest and, and, and honors the complexity.
- SBSteven Bartlett
You talk there about the impact that early childhood trauma has on our relationship with food and eating. Um, I remember reading a little bit about that in your previous book, Lost Connections, as well. But what is, wha- what is the sort of data and the stats that, that prove that trauma can cause us to have this kind of excessive comfort-seeking relationship with food? Is there any particular studies that stand out for you?
- JHJohann Hari
Oh, yeah. I mean, a guy that I got to know quite well when I worked on Lost Connections, and I thought about this research in a different light when I worked on this book. So there's a guy called Dr. Vincent Felitti, and in the early 1980s, he was a doctor in San Diego. And he was contacted by Kaiser Permanente, who are a big not-for-profit medical provider in the state. And they said to him, "Look, we got a problem. We don't know what to do." Obesity was massively rising. Actually, it was very low by our standards, but it was hugely rising. And they were trying, giving people diet plans and exercise plans, and nothing was working. And they said, "Look, we don't know what to do. Can we give you a load of money to just do blue skies research, go away, figure out what we can do?" And he said okay. So he took a load of money, and then he's like, "What can I do?" And he started working with 200 very, very obese people, people who were severely obese, who had tried all sorts of ways to cut back, and it hadn't worked. And he's sitting there working with them, and he's thinking, "What can I do?" And he had an idea that sounds and actually is quite stupid. He said, "Well, what would happen if really obese people literally stopped eating? And we medically supervised it, and we gave them vitamin shots so they didn't get, like, scurvy or whatever. Would they, would they burn through the fat stores in their body and get back to a healthy weight?" So with a shitload of medical supervision, they did it. And incredibly, at first, it worked. There's a woman who I'll call Susan, that's not her real name, who went from being more than 400 pounds to 138 pounds. It was incredible, right? And, you know, her family are ringing the doctor and saying, "You saved Susan's life." She's really thrilled. And then one day, something happened that no one expected. She cracked. She went to KFC or wherever it was, she starts obsessively eating, and after a while, she's back where she was. Not exactly where she'd been, but similar. And Dr. Felitti called her in. He said, "Susan, what happened?" And she looked down, she was obviously really ashamed. She goes, "I don't know. I don't know." And he said, "Well, tell me about that day, right? The day you cracked. Did anything happen that day that didn't happen any other day?" It turns out something happened that day that had never happened to Susan before. Um, she was in a bar, and a man hit on her. Not in a nasty way, in quite a nice way. But she just felt completely freaked out, and she went and started eating. And that's when Dr. Felitti said to her, "Well, Susan, when did you start gaining weight?" In her case, I think it was when she was 10. He said, "Well, did anything happen when you were 10 that didn't happen when you were 9 or 11, or anything happen that year?" And she looked down and said, "Well, that's, that's when my grandfather started raping me." Dr. Felitti interviewed everyone in the program. He discovered that 60% of them had made their extreme weight gain in the aftermath of being sexually abused or assaulted, which is a staggering figure, right? Uh, 60% of the women. Um, and he was like, "Well, how could this be?" He was really puzzled. And Susan explained it to him really well. She said, "Overweight is overlooked, and that's what I need to be," right? If you're severely overweight, you're much less likely to, to be sexually attacked, right? It obviously can happen, but it's, it's rarer. Um, and when you understand that, you begin to see again in relation to these drugs, um, why some people get really freaked out when they take these drugs. 'Cause some of them experience it as suddenly, oh, my God, I'm really vulnerable to this traumatic event being reenacted again and again. Now, that's one example. There's lots of, if we go down the, the list of reasons why people eat, like I do in the book, there's lots of other ones that get triggered and activated as, and disrupted as well.
- 52:25 – 1:04:55
Obesogenic Environment
- JHJohann Hari
- SBSteven Bartlett
You talk in the book about this, this word I've never really come across before, which is, um, it's a phrase, I guess. You say, "The environment is obesogenic." I, I've only ever heard of that term carcinogenic.
- JHJohann Hari
Carcinogenic, yeah.
- SBSteven Bartlett
Carcinogenic, yeah.
- JHJohann Hari
Yeah.
- SBSteven Bartlett
Which basically means something can give you cancer. But you're saying that the environment we live in is... Uh, I mean, the way that I read it was like that it, that it's almost contagious. Like, it's gonna give me obesity just by being alive in the modern world. Um, one of the stats that really stood out to me when you're talking about processed food is that on average when we eat processed food, we, we end up eating 500 more calories every single day. And, um, that, again, is startling. You know, I've had a few guests on this podcast that have talked about processed food and the rise of it, and I do wonder to myself if there's ever gonna be a change in society. If we, if there's any indication that at some point, I don't know, government will step in and ban it or tax it more or something will happen. What's your, what's your view on, uh, th- if we talk about the optimism of the obesogenic environment changing? Do you think it can change? Do you think it will?
- JHJohann Hari
So crucially, I went to a country that had completely transformed its diet, and as a result, has very low obesity. Japan, we can talk about that. And I went to loads of countries that are making the changes you're talking about, so prompt me to come back to that. But I would start by saying, well, A, you're totally right. We live in an obesogenic environment. An obesogenic environment is an environment that primes you to be obese and where it is hard to be a healthy weight, right? It's hard to get healthy food. Healthy food is expensive and rare, whereas shitty food that makes you obese is cheap, abundant, and constantly promoted to you, right? So that's an obesogenic environment, and there's loads of evidence that, well, as Professor Michael Lowe put it to me, we live in as obesogenic an environment as human beings could possibly design, right? Um, and there's seven ways in which processed food undermines your ability to stop eating that I go through in the book. So if you're feeling pessimistic, and I'm clearly... You're right to feel pessimistic. Someone as charismatic and brilliant as Michelle Obama could not even get us to join a campaign to physically move, so I get it. There's big obstacles here. But when you feel pessimistic about it-The first thing I would say is, think about smoking. Right? My mother smokes 70 cigarettes a day. There's a photograph of me and her where I'm, um, she's breastfeeding me, about six months old. She's smoking and resting the ashtray on my stomach. (laughs) And when I showed her this photo, I thought she'd feel guilty. She said, "You were a fucking difficult baby. I needed that cigarette." Um, but you think about that, that was normal, right? When... I mean, in Scotland, that was normal when I was a kid, right? Um, so you think about smoking. When I was seven years old, um, more than half of the population of Britain smoked, right? And people smoked everywhere. People smoked on the Tube. People smoked on planes. People smoked on game shows. The doctor would smoke while he was examining you. I'm not joking. I remember that happening, right? So if I could take you back to the Britain of 1987, and you could walk around, you would just... y- you would feel sick because the smell of smoke was everywhere, right?
- SBSteven Bartlett
(laughs)
- JHJohann Hari
And there were just ashtrays everywhere. Funny enough, I was with my mother when it was the anniversary of... There was a terrible catastrophic fire at King's Cross Station here in London in 1987, I think. And I was with my mother when it was the anniversary a few years ago, and, uh, so it was a terrible disaster. There was a fire. Someone had put out a cigarette, uh, near an escalator, and it killed, uh, more than 50 people. It was awful. Uh, and my mother said, "Oh, that was the worst day of my life." And I said, "Oh, were you there? Did you know someone who died?" She said, "No. That's the day they banned smoking on the Tube." (laughs)
- SBSteven Bartlett
(laughs)
- JHJohann Hari
So anyway, the... So if I could take you back and I said to you, "Right, however many years we are on from that now, um, only 12% of British people will be- will smoke. It will be falling, and the British government will be about to progressively ban smoking. You won't be allowed to smoke indoors anywhere except your own home. The rates will have tanked. Young people will ha- there'll be almost no cigarette smoking among young people, and they're gonna progressively ban it by age." That would have seemed ludicrous, right? You c- would have said, "Well, tobacco industry is one of the most powerful industries in the whole world. Uh, you've got a very motivated, half the population are addicted. It's never gonna happen." These things can change. That's a huge public health, uh, transformation in a very short period of time. These things can change, and I've seen how it can change with food, so that we're not in this situation where we have to choose, as we are at the moment, between, for many of us, not all, between the risk of obesity and the 12 big risks associated with these drugs.
- SBSteven Bartlett
What are they waiting for? 'Cause the government knows this. The government knows that ph- processed foods and the f- you know, the sugar quantities that the average person is eating is bad. So they could presumably get something done this year.
- JHJohann Hari
So-
- SBSteven Bartlett
But they won't.
- JHJohann Hari
There's a brilliant writer called Rebecca Solnit who says, "Politicians are weathervanes, and it's our job to be the weather."
- SBSteven Bartlett
Okay.
- JHJohann Hari
If you're a politician, you're constantly making a calculation, right? "If I do this thing, how much praise will I get and how much shit will I get for it?" Right? Constantly. And, you know, some of them are good people. Many of them are good people. But you're constantly making that calculation in a democracy. And right now, if you do the right thing on food, and there are loads of things we can do. I saw in Japan, we can go down the list of all the things we need to do, um, that has- could transform health, particularly for our children. You'd get some praise, but you'd get a lot of shit, right? You'd get a lot of shit for it. And m- for many years of my life, I wanted to be one of the people who gave them that shit, right? So I- I- I understand it. We have to change that calculation by helping people understand and make better choices in ways that I saw happen. So I can explain how they did it if you want.
- SBSteven Bartlett
Please.
- JHJohann Hari
Japan is really important, I think, for thinking about how we get out of this trap, because at the moment, um, the way it's often presented is, look, we're just screwed, right? There's just this huge obese population that's the product of being rich. If you're a rich country, you've got lots of calories around you. Inevitably, we're gonna have loads of obesity, and inevitably, we're just gonna need to give loads and loads of people these drugs forever. And you know, a few years from now, as many people predicted to me, we'll have 40%, 50% of the population taking these weight loss drugs, right? And what Japan showed us is we don't have to choose that fate, right? So if you look at Japan, Japan is the only country that got rich without getting fat. 4.5% of Japanese people are obese compared to 26% in Britain and 42.5% in the United States. And it's actually-
- SBSteven Bartlett
42%?
- JHJohann Hari
42%. 4.5% are obese. 70% are obese or overweight, right?
- SBSteven Bartlett
Jesus.
- JHJohann Hari
So it's- the norm is to be obese or overweight, right? Whereas in Japan, it's completely the opposite. It's kind of weird that when we picture Japan, we often picture sumo wrestlers. It's a bit like-
- SBSteven Bartlett
Mm-hmm.
- JHJohann Hari
... expecting the average American to look like a bald eagle or something, right?
- SBSteven Bartlett
(laughs)
- JHJohann Hari
Sumo wrestlers are completely atypical. And I learned a huge amount about what's happening there. So the first thing you think when you hear that is that it must just be genetic, right? They're just... they've won the genetic lottery. That must be what's going on. But we know that's not true, because in the late 19th century, loads of Japanese people went to live in Hawaii, where I just was. Um, and there's now this settled Japanese population in Hawaii who've been there for four or five generations, and they're almost as fat as other Hawaiians, right? So they're five times fatter than- th- they're five times more likely to be obese than Japanese people in Japan. So actually, when the environment changes, Japanese people become obese like everyone else. So there's something else going on. So I wanted to understand how did Japan do it, and one of the really interesting things is it was very consciously done. There's a guy called Professor Barak Kushner, who's a professor of East Asian History in, um, in Cambridge University, who's talked about how, actually, if you go back to the 1920s, Japanese people had one of the worst diets in the world. They only ate protein once a week. They almost never ate fish, right? They only ate fish once a week. They had a terrible diet. And the Japanese government at the time wanted a healthy population so they could form armies that would go and invade the rest of Asia, so they deliberately transformed the food culture in Japan very consciously. So I wanted to see how do they do that now, right? What's going on? So I went to a school called Koenji School, um, which takes kids from 5 to 18, and it was totally fascinating. So when I arrived there...I went with my translator. Uh, the first, you arrive and all the kids walk to school on their own. From the age of five, all Japanese children just leave the house and walk to school on their own. So they get a lot of exercise in the morning, and they walk home on their own as well. And we were greeted at the entrance by a woman called Harumi Tatibe, who's the nutritionist at the school. By law, every Japanese school has to employ a professional nutritionist. It's a difficult qualification to get. It's three years of study on top of learning to be a teacher. And your job is to design and oversee the creation of the food in the school. All processed food is banned. No one is allowed to have pro- there's no processed food in any Japanese schools ever. Every meal has to be prepared from scratch at the start of the day, um, and no one is allowed to bring in a packed lunch. So every kid has to eat the food that's prepared in the school. Uh, her job is also to use those meals to educate the children about how to eat healthily. So they teach them all sorts of key principles. One of them is, in Japan, this is a very deep cultural norm, you should only eat until you're 80% full. So it, it takes a while for your body to realize you're full. So if you get the signal that you're full while you're still eating, they're like, "You've eaten too much," right? So you should eat until you're 80% full and then stop. Um, there's all sorts of norms that are very different to ours. So if you look at a typical Japanese meal, it will have five portions, significantly more than ours, but they're pretty small, right? So you might have some fish, some miso, miso soup, a whole range of things. Um, and you, which is important for your gut health because there's a bigger variety of ingredients, which makes your gut much healthier. But also, you, you eat it differently. So if you gave us, you know, a meal with three bits, generally you'd eat all of one, then all of another, then all of another. You'd have all the lasagna, then you'd have the carrots or whatever. In Japan, that's regarded as, like, a crazy way to eat. You have a mouthful of the miso soup, then you have a mouthful of the white fish, then you have a mouthful of the sashimi, and you, you have a mou- it slows your eating down massively if you eat that way. Um, they're also taught, I remember her standing there. So the n- the meals in all the schools are designed to be nutritionally balanced through these five components. And so she stands in front of the class and teaches the kids, you know, "Okay, this is a red rope. This represents calcium. What does calcium do?" And the kids go, "Oh, it makes your bones stronger." She's like, "Yes, that's this on your plate. This represents carbohydrates. What do they do? They give you energy." And the kids yell out. So they, and then she ties the rope together and she goes, "You see, now it's all tied together now and it's a balanced meal." So they use this healthy food to educate the children about how to eat healthily. It's a very, um, beautifully designed system. And it was fascinating looking at them. I mean, I've got to tell you, Steven, it was really weird. This is a school of 1,000 children. I walked through that school all day. There was not one fat child. It, it, it was r- i- it's odd. Like, it's jarring when you go, right? That they have, you know, they have extraordinarily low childhood obesity. And I remember with these kids, I was asking them their favorite foods. The first kid I asked said, "Oh, my favorite food is broccoli." I was like, "Right." The second kid said, "My favorite food is seaweed." And the third one was like, "I like white rice." And I said to Chiae, my translator, "Are these kids trolling me, right?" (laughs) Like, what, their favorite foods are broccoli and, like, white rice? And she just looked kind of puzzled. And every Japanese person I asked said, "Well, we teach our children to like healthy food. Don't your children like healthy food?" And I was so taken aback by these kids. I, I brought up on my phone some pictures of, like, typical British school dinners and showed it to them. And they literally reacted like I had shown them an ISIS beheading video. They, like, screamed. They were like, "What is this?" And one said, "Did you eat this every day?" I was like, "Yes." They're saying, "Where's the salad?" I said, "There is no salad," right? (laughs) They were just completely baffled. So they partly start with this very strong culture, creating a very deliberate culture of how to eat differently that begins at a very, very young age. There are some other steps that are a bit more dodgy that we can come to, I'm sure. But that, that was the kind of, um, first, um, that was the first pillar of it that I saw.
- 1:04:55 – 1:07:43
Where Can You Buy Ozempic
- JHJohann Hari
- SBSteven Bartlett
And then over here, we're in, we're in this sort of craze of injecting ourselves with this thing called Ozempic. Can I see the pen, actually? I've never actually seen one before. I won't open it or anything.
- JHJohann Hari
Oh, sure. Of course.
- SBSteven Bartlett
I won't contaminate it, but-
- JHJohann Hari
Mi-Pen or Zu-Pen.
- SBSteven Bartlett
I've just been so intrigued to see what these things are like.
- JHJohann Hari
(laughs)
- SBSteven Bartlett
Once weekly. Novo Nordisk.
- JHJohann Hari
Novo Nordisk, now the most valuable company in the whole of Europe.
- SBSteven Bartlett
Wh- wh- what are they? Give me some context on Novo Nordisk.
- JHJohann Hari
They're a Danish pharmaceutical company. So there's two companies that are kind of pushing the main drugs in this. Pushing sounds too pejorative though, you know what I mean? So Novo Nordisk, who are a Danish company, the entire Danish economy has had a massive growth because of the popularity of these drugs. Since they came out, they've become the most valuable company in Europe. Um, the market for these drugs is predicted to be $200 billion by the end of this decade. Uh, and the other one is Eli Lilly.
- SBSteven Bartlett
And if I... How do I get this? Do I have to go to a doctor and get a prescription or can I just go buy this on- online or something?
- JHJohann Hari
So this is part of the problem, and this leads to one of the really big risks associated with the drugs, which is eating disorders. I am really, really worried about this. So there are lots of young girls in particular, some boys, but it's mostly girls, who want to starve themselves, right? We know that. It hugely rose during the pandemic. And this is the most effective tool for self-starvation human beings have ever come up with. So I interviewed a lot of eating disorders experts who are terrified about what's coming down the line. And the truth is, it is very easy to get hold of it. I went, you know, you could go online now. You clearly do not meet the criteria for getting these drugs, right? You've got to have a BMI of higher than 27, which is a BMI that comes from fat mass and not muscle mass. So you would not meet the criteria at all. If you went online, you could go and see a doctor on Zoom, lie about your BMI, and you would get it in the mail two days later, right? Um-They're meant to check your BMI, but on Zoom, that's very hard to do. If, in the unlikely event you were turned down by a doctor on Zoom, you can just order, effectively counterfeit ones online very, very easily. So I'm extremely worried. I, I think we're gonna have a... There are many downsides to these drugs. Possibly the worst, from my point of view, one of the two or three worst, is you're gonna have a huge wave of young women who get hold of these drugs and, and do a lot of harm to themselves. Now there is something we can immediately do to massively limit that harm. Uh, lots of the eating disorders experts I interviewed, like Dr. Kimberly Dennis, who's one of the leading experts in the US, said to me, "These drugs should only be given by prescription if you go to a physical doctor, and the doctor you physically go to to get them needs to be trained in detecting eating disorders, and referring people for help with eating disorders if that's what they think they've got."
- SBSteven Bartlett
So these were initially created for people that had diabetes?
- 1:07:43 – 1:10:15
The Origins of Ozempic
- JHJohann Hari
They have a dual effect. So GLP-1, the hormone GLP-1, and this kind of replica of it, uh, stimulates the creation of insulin, which is obviously what diabetics are lacking, either type 1 or type 2 diabetics. So it was, the whole thing was discovered by accident. I interviewed the guy who discovered it, a guy called Daniel Drucker, amazing man. So they discovered, he was just looking at, um... So your whole body is made out of cells, right? And in the '70s, it was discovered there were new ways of looking inside cells that human beings had never had before. So by the '80s, 1984 was when he made a breakthrough, they were just going through different cells in the human body trying to figure out what they do. And they got to the glucagon gene, which exists inside your, your pancreas. And they were trying to figure out, so the glucagon gene is a long chain, and at the end of it is GLP-1. And they were trying to figure out, well, can you break off that little bit of the chain, or if you break it off, does it just wither and die? And he discovered, Dr. Drucker discovered you can break it off, and then he was like, "Well, what does it do?" So he starts experimenting in lab dishes in Massachusetts General Hospital, and he discovered that if you combine it with insulin, it produces more insulin. So that's why it's so valuable for diabetics. And immediately, he was like, "Whoa, that's really significant." So then other people in the lab, um, Professor Svetlana Mosjoy, um, gave it to rats, put it in rats, and discovered it, it in fact produced insulin in rats. A team in Copenhagen put it into the pancreas of pigs, discovered it produced insulin there. And that set in, set in train what later became giving it to diabetics. So that's the most am- one, obviously greatest benefit of these drugs that was initially discovered, is they hugely help diabetics. Then, the effects around appetite were discovered separately initially here in, in London, in Ham- the Hammersmith Hospital. That was when they discovered, oh, if you inject people with GLP-1, this is before they had copies of it, if you inject people with GLP-1, it reduces their appetite. Oh, okay. You can see where their thinking went from there. So there's dual uses. And the dual uses are kind of incredible. If you look at, uh, well the effects on diabetics are obvious, but, um, if you look at the health effects we, that are emerging around these drugs, and this is very close to my heart, literally, because of the heart problems in my family, um, if you take these drugs, if you started with a BMI higher than 27, and you take these drugs, over the next five years you are 20% less likely to have a heart attack or stroke. So we're talking about, this isn't, some people are like, "Oh, this is vanity," and there's an element of vanity in me and in most people taking these drugs, I'm sure. But this is having massive health benefits for lots of people.
- 1:10:15 – 1:13:56
Why You Shouldn't Take It
- SBSteven Bartlett
How many people are willing to take it? Because as you, as we discuss this now, say that there's, I don't know, a million, 10 million people that listen. What percentage of those people on average would go, "Do you know what? That sounds like the thing I've been looking for"?
- JHJohann Hari
If they're Americans and the polling is right, 47% of Americans have said they would be willing to take, they want to take these drugs, actively want to.
- SBSteven Bartlett
Oh, they want to, so about 50%-
- JHJohann Hari
Yeah.
- SBSteven Bartlett
... of this aud- the audience will be actively wanting to take it as we sit here now?
- JHJohann Hari
Yeah.
- SBSteven Bartlett
And now tell me why they shouldn't.
- JHJohann Hari
Well, there's a huge array of risks, um, some of which are very, very serious. So I'll give you a few examples, I go through lots in the book. There's a professor in France called Professor Jean-Luc Fahy who works at the University Hospital in Montpellier, who was commissioned by the French Medicines Agency to investigate these drugs and the safety around these drugs. And one of the reasons lots of people have felt very happy about the safety of these drugs, and it's a good reason, is they, in their rollout for obesity, is people have said, like Daniel Drucker, for example, who I mentioned who discovered GLP-1, they say quite rightly, "Well look, diabetics have been taking these drugs for 18 years now. If there was some catastrophic effect, we would know. It would have emerged in diabetics, right?" Now he would also add, "Well, it could affect obese people a bit differently than diabetics, so there's some gaps in the knowledge." But he said, "Look, we, this drug has been used by enormous numbers of people all over the world without some huge safety concern emerging." But others have said, "Okay, let's really dig into those diabetics, then." So that's what Professor Fahy did. So they've got a, they've got very good health databases in France, the best in the world. So he decided to look at diabetics who'd taken these drugs for three years sometime between 2006 and, I think, 2015. So he looks at loads of diabetics who've taken them, and then he compared them to a group of other diabetics who were very similar in every other way but had not taken these drugs, to see are there differences in outcome. And he was particularly looking for one outcome. We know that when you give these drugs to rats, they are much more likely to develop thyroid cancer. So he's looking, "Okay, is there a difference in thyroid cancer risk in this population?" And what he discovered was very sobering. It was published. So the people who'd taken the drugs had a 50 to 75% increase in their risk of thyroid cancer. Now when I first heard that, I was like, "What the fuck?" But you have to understand what that doesn't mean. That doesn't mean 50 to 75% of people who take the drug get thyroid cancer. If, if it was that outcome, they would pull it immediately and no one would ever take it again. What it means is, whatever your thyroid cancer risk was at the start...... it will go up by between 50 to 75%, if this research is correct, right? This then ha- is being further investigated. There are some scientists who dispute it. The European Medines- Medicines Agency has not been persuaded by the evidence so far, but that's pretty sobering, right? That's, you know, 1.2% of people get thyroid cancer in their lifetime. 84% of them, I think, survive. But, you know, a big increase in people getting thyroid cancer, when you're talking about millions of people across the world taking it, is, is very alarming.
Episode duration: 2:27:47
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