We've not spoken for two years, but I have to say, you look remarkably different.

So I lost three stone in a year. And there's a secret to that.

Stephen Johan Hari, the best selling author who's using his own body to unearth.

The extraordinary benefits and disturbing risks of the new weight loss drugs.

Ozempic. It is literally the hottest drug in the country right now.

I really worry about the risk of these drugs. You're nine times more likely to get this particular condition, which is excruciatingly painful. And these drugs are working very, very hard on key parts of your brain. In fact, there are twelve 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 the 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 is when I go through the twelve 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.

Congratulations, Dara Vasio 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, 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. Johan, we've not spoken for two years, but I have to say, you look remarkably different.

There's a secret to that, Stephen, really, we can dig into. Yeah.

What is the secret?

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 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 going to be kind of funny because all these Hollywood people are going to put on weight as well, right? They're going to have gained weight. What are they going to 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, 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, well, it looks like.

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 the image and she showed me an ozempic pen, and I didn't know what it was. And I said, what are you talking about? I said, everyone here is on this drug, right? Not just the stars, like their wives, their agents, their agents kids, everyone, right? And I've been really thrown. And then over the next few days, I read a lot about 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 aware that was. That was the tension. So the benefits are kind of obvious, right? You know, I'm older than my grandfather ever got to be because 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. There's a lot of evidence that obesity, unfortunately does cause a whole range of health problems, over 200 diseases and complications. There's a lot of evidence these drugs really do massively reduce or reverse obesity. The average person who uses them, ozempic wigovi, 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 have 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 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 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 and accepting a kind of broader range of weights? So I was really deeply conflicted. So to really get to the bottom of this film, I book magic pill. 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 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 going to do to the culture.

And it will be massive. But I'm still really conflicted.

So if we start there, then you're at the party, someone mentions this Zenpek thing to you. Have you got the Zempek pen on you?

I have it as a prop.

You've got it here.

Okay, so it's very simple. It's just a little pen. It's like an epi pen. So you take that, you put on the little lid. I won't take it out because I need this one later, but although this one's empty. So you put a little. 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, when you wake up and you're not quite with it and you think, what am I feeling? And I was struggling to articulate it and I was lying. I thought I felt mildly nauseous, which everyone gets when they start taking it. But that wasn't the thing that was puzzling me. 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 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 cafe 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 a 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. Remember leaving? I remember Tatiana, the woman who works in the cafe, 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 physically and psychologically strange experience.

So on the pen itself, because I just want to make sure I fully understand this is that little pen you have in your hand for people that aren't watching on video. There's a pen. It kind of looks like a big sharpie.

Yeah, exactly.

And is that one dose?

Yeah, there's loads of doses in there. So you twist the base, and.

Each.

Time you twist it, it would release with this pen, 1 mg.

Okay.

Yeah.

And how many twists you get out of one pen?

I think each one contains four doses. Yeah.

And how much does that cost?

So it varies massively, because, as you know, I live half in the US, half in Britain a lot of the time. So in Britain, this cost you, at the moment, about 250 pounds a month. In the US, it's way more like $800 a month.

So 250 pounds a month. How many sort of doses do I get for that? 250 pounds.

That would cover your whole month. So each month you'd have to pay 250 pounds. You get four doses in each one.

And you said in the US, it's.

Way more, way more.

How much more?

So it's about $800 between 801,200. Bearing in mind there've been lots of shortages, which I'm sure we'll talk about. So the price has kind of been a bit sensitive to how much is actually available at any given time.

Okay, interesting. And are these drugs new?

Relatively so I interviewed the scientists who played the key role in the breakthroughs that led to the development of the drugs and then 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, it doesn't matter what it is. After a while, a hormone would start to be produced in your body called GLP one. And it's one of many gut hormones that would start to be created. And it's basically, GLP one is a natural signal saying, stephen, you've had enough. Stop eating. Right. Just stop now. Right. But GLP one, natural GLP one, 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. So what these drugs do is they simulate GLP one. They inject into you an artificial copy of GLP one. But instead of that GLP one 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 cafe and I eat the thing I'd normally eat, my system is filled with signals that say, you're already full, Johan, you don't need anymore. 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. GLP one is a hormone that's made in the gut. 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 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 brings with it a huge parallel set of both benefits and risks.

Interesting. So it's once a week and you basically feel fuller for a whole week from one injection.

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, the best way I can describe it is imagine you just had Christmas dinner.

Yeah.

And I came up to you. So you're completely bloated, you're lying on the sofa. And I came up to you and said, hey, Stephen, 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 3200 calories a day, roughly. I now eat about 1800. There's a huge drop. The benefits are kind of obvious of that, but there are really big costs. I discovered there's in fact twelve really big risks and there's all sorts of. Because at first when you hear all this, you're like, well, this is just keqing win win. Right? Who wouldn't want this? But there's a lot of risks and downsides as well.

So I want to get onto all those risks and downsides. But one of the, I think rebuttals that some people would have when they hear this 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 role that you used to have for breakfast in the morning? Hasn't that taken something from you?

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. You're absolutely right. Even Jens Jules 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. 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 had almost the opposite experience. But I want to 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. 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, Ian, you do it at Christmas dinner, so 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.

You can't stuff yourself. I would literally throw up if I tried to 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 want to overstate it. I'm not foodie. I'm never going to be that person. But I remember going for dinner with one of my friends, I 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, because 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.

I really want to go into why people, you know, people's relationship with food more generally. But I wanted to close off on that, what you were saying about a Zempex impact on the brain. You talked about GLP one in the gut and the impact that 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.

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 want to 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 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, it was actually discovered in the nineties 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 one can be made in the brain, right? Which is fascinating. It could also be made in your thyroid, which is very significant, I'm sure. We'll come back to. So when you take these drugs, 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? It doesn't just feel like a physical sensation of I'm full, it feels. I remember taking my godsons to McDonald's maybe a week after I started taking it, and I didn't want a McDonald's. And one of my godsons saying to me, who are you and what have you done with Johan? Right. Cause it was so contrary to my preferences. And my. 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 in 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, johan, I'm really glad you're here.

Wait a minute. I was like, all right. 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 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? How can this be happening to me? So, when you speak to 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, this is a quite crude way of putting it. 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 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, because 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 required by the FDA, the Finn drug agency in the United States. That's one concern. But there are other scientists who say that that's not correct, that the suicide risk is not accurate, and that they don't work by dampening a reward system. Some people, like Orelli Ogali, who's at the University of 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.

Can I just say on that? Sorry to interrupt, but I was thinking constantly as you were talking about your trip to McDonald's and not wanting the McDonald's anymore. I've come to see in my life that if I have something unhealthy, if I have sugar or a cookie today, I feel like I'm much more compelled to have another one tomorrow. I feel like 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 not just a 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?

Yeah. There's an experiment that proves you're right, but in a complicated way. Can I just finish off one thing about the brain and then come back to that? Because. Super important 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, 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 anymore. We get that with food, sex, all sorts of things, right? You're just sated. He argues that in your brain, 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 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, because obviously I was trying to figure out, well, how did we get to this point? Because 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, 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 twenties 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, like, a year of being there, he'd gained, I think, a stone and a half or something. So he gained, 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, which I've nicknamed Cheesecake park.

That's not its official name, right? You get a load of rats and you raise them in a cage, and they've just got the kind of food that rats evolved 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 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. And as he put it to me, within a couple of days, they were different animals. All their health indicators were worse. They were obsessively eating. Within a few weeks, their health was really bad. They became extremely obese. And then he varied the experiment even more. In a way, it seemed to me, as a former junk food addict, a little bit cruel. He took all the american diet away, and they just have 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 so many people, 47% of Americans, want to take a drug that will make them stop.

I was reading about this thing you call the cheesecake park in your book in chapter two. 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 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 the natural food, when he shone the yellow light in their eyes, they would run away. But even if he 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're exposed 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, 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 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. 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 restore a sense of satiety. Carell Leroux, another one of the key scientists who developed these drugs, said to me, 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 Lowe, brilliant professor at Drexel University in Philly. He 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 got to deal with the feed system, right? And that is absolutely true and correct. And I remember going to one of my closest friends. I call her Judy in the book, it's not her real name, who you know, she'd had cancer seven years before. So I'd been with her all through that kind of really grueling process. And it was an absolute nightmare because she's a single mom. And you can imagine how grim that was. 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, Johan, 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 got to do is put out the fire in your house. Right? And then after that conversation, it was just after it, 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 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 Munjaro, 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 going to enjoy my retirement. And I said to him, but, geoff, 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 going to be dead. We're not going to get there in the next few years, and I want to live.

And I found that I found it hard to dispute.

What if people say, well, you know, you could just not choose the role at the coffee shop in the morning. You could have just gone for, I don't know, a salad or something. It's a choice you're making, Johan, to make better choices.

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'd been learning, and I was talking about, you know, what you got away 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 is 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 twelve 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.

And I thought, well, why don't I do? Why am I not doing that? Right? And I really began to get an insight into this when I went to interview an amazing person called Professor Tracy Mann, who's in Minneapolis, where I met her, 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 Isles Bun, which is a cinnamon bun shop, famous cinnamon bun shop in Minneapolis. When I arrived, the guy on 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, 2000 calorie, massive cinnamon bun that sat there the whole time 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? 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's looking at all these studies. It's 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 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, 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 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 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 way that you can sustain? So in the sixties and seventies, there was this theory about weight that was 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 will make us sweat, it will make us really uncomfortable. And again, if you're. And also if your temperature goes below the temperature we're currently at, your body will start to shiver again. It will 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 seventies, early eighties, 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, because if it was true, then you couldn't possibly have this. But then Professor Lowe at Drexel and other places and other people discovered 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, which seems really weird at first. Why would that be? So let's say you gained three stone, right? And then you tried to lose weight. We'd have to give a hypothetical Robert De Niro for the movie raging bull gained three or four stone, right? And then tried to cut back. But what you'd find was your metabolism would massively slow down, so you would have to burn far more to get the same number of calories as you do now. You would crave far more sweet and salty foods, you would have lower energy, so you would find it harder to exercise.

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 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, hyper abundant 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 going to be the last man standing, right? Timothy Chalamet will die in week one of a famine, and John Candy will still be alive at the end of it.

Not a great example, because John Candy has died. But you get the point, right? So, actually, that's why our 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 evolved 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, you know, 40 years of relentlessly promoting dieting as the. 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 because some people argue, like the guy I mentioned before, in relation to the brain, Professor Aurelio Galli.

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.

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, 100% more kids have adhd now than ever. You know, cortisol level 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.

No, you're totally right. And this is when I go through the twelve risks of the drugs in the book. This is one that I really worried about, 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.

Three stone. In what period of time?

From now to when I started. So just over a year.

And how quick was that weight loss? Just out of interest, before we move.

On, pretty straight, linear line, downwards from the start. But I had this strange sensation I had. My friend Danielle was pregnant at the time. I kept bumping into her, and it was like we were on opposite trajectories, like she was swelling and I was shrinking. 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? I didn't actually feel that much better for quite a long time. For about six months, thinking, why is that so?

What do you mean by better?

I felt quite muted in my emotions. I felt. 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, 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, and my body is 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, and another one is pleasure, which we've talked about, but another reason why people eat, is comfortable, 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, junk food orders massively go up. After 911, 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, shitty food. Right. If you're a man and you lose your job, your chances of gaining weight massively increase, partly because it's so upsetting. And you eat to comfort yourself. 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 surgery. So 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 operation.

Exactly. That's one form of it. Right. 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 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 is grim. But we also know where 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 in 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 would 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 I need to feed a lot of people like that 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 or something else. So that's pretty clear evidence that there's. The psychological soothing is just moving somewhere else.

It's fascinating and distressing. And obviously, I spoke to people who'd been through those, what's called an addiction transfer. I spoke to this amazing woman called Robin Moore, who had been 303 pounds. She'd had bariatric surgery because 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 knew why she had gained weight so much. In her case, 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 really fat, I'm less likely to be attacked, 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'd never been much of a drinker. She had her periods when she was at college where she drank a fair bit, but 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 drink on the way there, drink on the way back, and she got fired because she was drunk at work eventually, for her, she kind of realized, you know, and I think it's interesting ways of thinking about this in relation to these drugs.

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 painful at first, but helpful. I remember having a day in Vegas, as you know, I'd spend a lot of time in Vegas writing a book about a series of crimes that have been happening there. I had a day where I was investigating something really grim, and 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 load of fried chicken. And I sat there and I'm thinking, oh, shit, I can't eat this. I remember Colonel Sanders was on the wall looking down, and it was like he was going to be what happened to my best customer, right?

So being deprived of comfort eating is quite apart from being deprived of pleasure, which I think is sort of related, but a bit different is very difficult. And again, my friend who I'd spoken to had cancer 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 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, rah, rah, these drugs are great, and they're gonna save us all, or all these drugs are devils. It's terrible. I don't think he'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 honors the complexity.

You talked there about the impact that early childhood trauma has on our relationship with food and eating. I remember reading a little bit about that in your previous book, lost connections as well. But what is the sort of data in 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?

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, there's a guy called Doctor Vincent Felitti. And in the early 1980s, he was a doctor in San Diego, and he was contacted by Kaiser Permanente, who were a big not for profit medical provider in the state. And they said to him, look, we've 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 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 was 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 Doctor Felitti called her in. He said, susan, what happened? She looked down. She was obviously really ashamed, said, I don't know.

I don't know. 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. 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 Doctor Felitti said to her, well, Susan, when did you start gaining weight? In her case, I think it was when she was ten. He said, well, did anything happen when you were ten that didn't happen when you were nine or eleven or anything happened that year? She looked down and said, well, that's. That's when my grandfather started raping me. Doctor 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, 60% of the women. 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 be sexually attacked. Right. It obviously can happen, but it's rarer. And when you understand that, you begin to see again, in relation to these drugs, why some people get really freaked out when they take these drugs, because 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. We go down the list of reasons why people eat like I do in the book. There's lots of other ones that get triggered and activated and disrupted as well.

You talk in the book about this word I've never really come across before, which is. It's a phrase, I guess you say the environment is obesogenic. I've only ever heard of that term, carcinogenic.

Carcinogenic.

Carcinogenic, yeah. Which basically means something can give you cancer. But you're saying that the environment we live in is. I mean, the way that I read it was like, it's almost contagious. Like it's gonna give me obesity just by being alive in the modern world. 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 end up eating 500 more calories every single day. And that, again, is startling. You know, I've had a few guests on this podcast that I've talked about processed food and the rise of it. And I do wonder to myself if there's ever going to be a change in society, 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 view on if we talk about the optimism of the obesogenic environment changing? Do you think it can change? Do you think it will?

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 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's 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? 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. She's breastfeeding me. I'm about six months old, she's smoking and resting the ashtray on my stomach. 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. But you think about that. That was normal, right? I mean, in Scotland, that was normal when I was a kid, right? So you think about smoking. When I was seven years old, 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. You would feel sick because the smell of smoke was everywhere, right? 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 so it was a terrible disaster. There was a fire. Someone had put out a cigarette near an escalator and it killed more than 50 people. It was awful. 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. Anyway, so if I could take you back. And I said to you, right, however many years we are on from that now, 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, there'll be almost no cigarette smoking among young people, and they're going to progressively ban it by age. That would have seemed ludicrous, right? You would have said, well, tobacco industry is one of the most powerful industries in the whole world.

You've got a very motivated. Half the population are addicted. It's never going to happen. These things can change. That's a huge public health 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 twelve big risks associated with these drugs.

What are they waiting for? Because the government knows this. The government knows that processed foods and the sugar quantities that the average person's eating is bad. So they could presumably get something done this year, but they won't.

There's a brilliant writer called Rebecca Solnit who says politicians are weather veins, and it's our job to be the weather. 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? 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 do, I saw in Japan, we can go down the list of all the things we need to do that could transform health, particularly for our children, you'd get some praise, but you get a lot of shit, right? You get a lot of shit for it. And for many years of my life, I would have been one of the people who gave them that shit, right? So 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. Please. Japan is really important, I think, for thinking about how we get out of this trap, because at the moment, 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 going to have loads of obesity, and inevitably, we're just going to 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 42%. 42%. 42.5% are obese, 70% are obese or overweight. Right.

Jesus.

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 expecting the average American to look like a bald eagle or something, right? Suo 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 it must just be genetic, right? They just. They 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. 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. 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 Barack Kushner, who's a professor of east asian history 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 want to see how do they do that now. Right? What's going on? So I went to a school called Koenji school, which takes kids from five to 18, and it was totally fascinating. So when I arrived there, I went with my translator. 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. There's no processed food in any japanese schools ever. Every meal has to be prepared from scratch at the start of the day, 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. 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 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. And 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 us, but they're pretty small, right? So you might have some fish, some miso soup, a whole range of things, which is important for your gut health, because there's a bigger variety of ingredients, which makes your gut much healthier, but also you eat it differently. So if you gave us 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 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 it slows your eating down massively if you eat that way. They're also taught. I remember her standing there. So the meals in all the schools are designed to be nutritionally balanced through these five components. She stands in front of the class and teaches the kids, okay, this is a red rope. This represents calcium. What does calcium do? Kids go, ah, 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. And then she ties the rope together. She goes, you see, now it's all tied together. Now it's a balanced meal. So they use this healthy food to educate the children about how to eat healthily. It's a very beautifully designed system, and it was fascinating looking at them. I mean, I got taste, even. It was really weird. This is a school of 1000 children. I walked through that school all day. There was not one fat child. 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, 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 chie, my translator, are these kids trolling me? Right? 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 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? Did you eat this every day? I was like, yes. They're saying, where's the salad? I said, there is no salad. They're 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 was the kind of first. That was the first pillar of it that I saw.

And then over here, we're in this sort of craze of injecting ourselves with this thing called a zenpan. Can I see the pen? Actually, I've never actually seen one before. I won't open it or anything.

Oh, sure. Of course.

I won't contaminate it.

Me pen or zoo pen.

I've just been so intrigued to see what these things are like. Once weekly.

Nova Nordisk. Novo Nordisk, now the most valuable company in the whole of Europe. What are they?

Give me some context on Nova Nordisk.

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 there. You know what I mean? So Novo Nordisk 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. The market for these drugs is predicted to be $200 billion by the end of this decade. And the other one is Eli Lilly.

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 online or something?

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. 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, 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. 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 think we're going to 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 going to have a huge wave of young women who get hold of these drugs and do a lot of harm to themselves. Now, there is something we can immediately do to massively limit that harm. Lots of the eating disorders experts I interviewed, like Doctor 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.

So these were initially created for people that had diabetes.

They have a dual effect. So glp one, the hormone glp one, and this kind of replica of it stimulates the creation of insulin, which is obviously what diabetics are lacking, either type one or type two diabetics. So 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. So your whole body is made out of cells, right? And in the seventies, it was discovered there were new ways of looking inside cells that human beings had never had before. So by the eighties, 1984, was when he made a brain 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 pancreas. And they were trying to figure out. So the glucon gene is a long chain, and at the end of it is GLP one. 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. Doctor 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, Professor Svetlana Mosjoy, gave it to rats, put it in rats, and discovered 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 train what later became giving it to diabetics. So that's the most. Obviously the greatest benefit of these drugs that was initially discovered, is they hugely helped diabetics. Then the effects around appetite were discovered separately, initially here in London, in the Hammersmith hospital. That was when they discovered, oh, if you inject people with GLP one, this is before they had copies of it. If you inject people with GLP one, 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 the effects on diabetics, obvious.

But if you look at the health effects that are emerging around these drugs, and this is very close to my heart, literally, because of the heart problems in my family, 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, like, 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.

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?

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.

Oh, they want to. So about 50% of the audience will be actively wanting to take it as we sit here now.

Yeah.

And now tell me why they shouldn't.

Well, there's a huge array of risks, 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 Faille, 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 that in their rollout for obesity, is people have said, like Daniel Drucker, for example, who I mentioned, who discovered GLP, one, 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, 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 Fai did. So 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 the 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've taken the drugs had a 50% to 75% increase in their risk of thyroid cancer. Now, when I first said that, I was like, what the fuck? 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 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 is being further investigated. There are some scientists who dispute it. The European 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. You know, a big increase in people getting thyroid cancer when you're talking about millions of people across the world, taking it is very alarming.

What about this thing called a zenpak face?

Yeah, I'm not worried about that, purely for a selfish reason. So a zempic face is where I'm worried about it. For other people, a zempic face is where you lose so much weight that your face looks really gaunt and you look kind of hollow and a bit. My face is so naturally round, like, babies always smile at me, I think, because they think I'm their king. I'm just like a baby that inexplicably got to walk around. I could lose so much weight in my face and not look gaunt that I'm not worried about that myself. Health problem with ozempic face, it's just.

You know, it's a vanity thing.

Well, vanity is too negative a word. It's, you know, people don't want to look gorn and ill. That's fair enough.

Pancreatitis.

Pancreatitis is a rare side effect, but it's very, very unpleasant. So pancreatitis is basically where your pancreas just goes haywire as a result of taking these drugs. I interviewed a woman called Michelle Stesniak, who's in Myrtle beach in North Carolina. She started taking these drugs, and her doctor said to her, you know, there's a few side effects. One of them is pancreatitis. And she said, no, my luck. I'll probably get it. She starts taking it, was really happy with the weight loss. Six weeks later, she went to Pittsburgh to visit her daughter, and she woke up in the worst agony she's ever been in. She had this excruciating pain running all from below her breast, around her back. She was vomiting, she was shitting herself, she was screaming in pain. And her son in law phoned for an ambulance. He thought she was about to die. She was in such a state of distress. She arrives at the hospital, and they discovered something gone really wrong with her pancreas. They said, are you a heavy drinker? She said, no. Then they said, are you taking Ozempic? And it's kind of revealing. That was the second question they asked.

So we know that if you take Ozempic, there's a study by the University of British Columbia that found it increases your risk of pancreatitis by a factor of nine. So you're nine times more likely to get it. It's still rare. You're very unlikely to get pancreatitis. Even when you time use it by nine, it's still a very rare outcome. But, you know, doctors often compare it to the pain of being stabbed. Michelle said to me it was much worse than the pain of childbirth. Right. They had to give her fentanyl to take the pain away. So if you get medical care, you recover. But so it's worth people knowing that is a significant risk of just an excruciatingly painful condition.

One of my friends has started taking a sempek you know, there's this word on the side of this pen in front of me, semaglutide.

Semaglutide, yeah.

What did I say? You said it the way that it's intuitive.

The way the scientists say it, I think, is semaglutide.

It says it looks like semaglutide.

Exactly. That's how I said it, until all the scientists kept correcting me in a slightly patronizing way. But, yeah.

What's the actual word?

Semaglutide.

And is that the chemical? And is Zempex the brand?

Yeah, exactly. So semaglutide. So there's several brands. So there's semaglutide, which is the drug which has this glp one agonist effect. Ozempic is the one for diabetes. Wigovi is the one for obesity. They're exactly the same drug. They're made in the same factory, they're identical. It's just that Wigovi is marketed for obesity, and you can, in the US, not here yet, prescribe wigovi for higher doses than you would for diabetics. And then there's other drugs that are coming along the line. So there's Minjaro, which is made by Eli Lilly. So ozempic, or wagovi, produces an average of 15% loss of body weight over a year. Munjaro causes a loss of 21% on average. And the next one that will come down the line is probably gonna come out next year. Triple G causes 24.2%. The reason Munjaro works differently. So this only works on glP. One Munjaro adds another gut hormone, Gip. So it works on two gut hormones, not just one. And triple G works on three gut hormones. And there's going to be more and more drugs. I mean, there's 37 gut hormones that can affect appetite, they think. So there's going to be lots of variants of these drugs with different side effect profiles, different risks, different benefits.

So, yeah, this is, you know, one of the south african psychiatrists called Corell Larue, who's been at the absolute forefront of the developments in this, said to me, you know, when a baby starts to walk, it's been crawling for ages, and then it just stands up and it walks. And we are at that point. And it was striking how much the scientists kept describing it as a game changer. One of them, Tim Spector, who I think you might have had on, described as, it's like they found the holy grail. They found the thing that causes weight loss. Right. Robert Kushner said that to me, who's another one of the scientists been at the heart of it, said, we cracked open the treasure chest, we found the thing that controls weight. It's your gut hormones. I worry about the parallels with previous diet drugs, and we can talk about that. These are new drugs working in a new way. And the overwhelming feeling in the science is, no, this really is different.

My friend is a biotech billionaire, and when I saw him say he's at the very forefront of all of these things, he takes so many different things to optimize his life. One of them he started taking is a Zen peck. And last time I saw him, we were in the gym together and he was significantly weaker. He was significantly skinnier. But I noticed when we did our exercises, he was significantly weaker as well. And that strikes me as a bit of an unspoken about side effect is muscle loss.

It's one of the twelve big risks that I write about in the book. So muscle mass loss is a real problem. People who don't know muscle mass is the total amount of soft tissue that you have in your body, and it's essential for doing anything that requires movement and strength, basically. And any form of weight loss causes a reduction in muscle mass. So if someone's very overweight and they lose a huge amount of weight on a diet, they lose a lot of muscle mass. Hopefully you lose more fat mass than muscle mass, but you lose a lot of muscle mass.

You can't control that, right.

You just, there's no way to lose a lot of weight that doesn't involve some muscle mass loss unless you're very, very lucky. Right? So obviously this triggers a huge amount of muscle mass loss and there's real worries with that. Right. If you lose muscle mass, you naturally lose muscle mass from when you're 30 onwards anyway. You lose quite a lot every year. It's incredibly depressing when you look at the figures. You lose muscle mass naturally every year anyway. But if you lose too much muscle mass, you'll be a bit weaker now. But the real risks are when you're older. So if you have really low muscle mass when you're older, you're at risk of a condition called sarcopenia, which is greek for poverty of the flesh. Basically just means you'll really struggle to climb the stairs, do any kind of physical activity, you're more likely to fall. If you do fall, you're more likely to die. It's quite a serious thing. And this, I think, is particularly going to be an issue for people who are already skinny, like the people at that party we were talking about right at the start. None of them were fat at the start, right?

People who were already skinny, who are taking it to be super skinny, they're going to see, they're going to have real issues with their muscle mass, likely when they're older. So this is a very serious problem. We could be building up a time bomb of more frail, older people further down the line.

You lose up to 20% to 30% of your lean muscle mass when you start taking a zenpic. It says in your book, as one of the risk profiles.

That's for some people, yeah, not everyone, actually, weirdly, I was 33% fat mass when I started, and I went down to 22%, I think it is now. So I lost nothing but fat mass. But I suspect that might be for the slightly humiliating reason that I had no muscle to start with, but I'm not sure.

And then on the psychology, the mental health side of things, suicidality, there's some cases where suicidality, things like feelings of anxiety and depression, increase. Is that because of the underlying reasons why we're eating the self soothing stuff, or is that a separate side effect?

So it's hugely debated. There isn't even agreement that the drugs cause that effect on a minority of people. You've got to bear in mind, at any given time, some of the population becomes suicidal, some of them will be taking these drugs. So it's very hard to disentangle that, especially early on. So some scientists would say there isn't even any evidence they cause suicidality. Among the scientists who fear that it may cause suicidality, there's a big debate. Some of it will be, you're deprived of comfort food or pleasure. Some of it will be, as Carell Larue put it to me, a lot of people who are overweight for a long time say, you know, the reason my life is shit is because I'm overweight. If I finally lose weight, my life will be good. And then they lose weight and they've still got the same asshole husband and they've still got the same job they don't like, and they suddenly go into this crisis where they're like, oh, it wasn't the weight that was blocking me. It was everything else. Right?

They say, don't they, that the difference between, like, happiness is your expectations and reality. So you can imagine if you have that expectation that losing this weight's gonna make me happy, and you fall short of the expectation because it doesn't. The anticlimax can cause so much psychological discomfort.

Yeah. And I spoke to people who'd been through that, and I think that can be a really, a really big issue. There's also a suicidality. So some other people would say, well, okay, the psychological effects are probably real, but it might come back to what we were saying about dampening the reward system in the brain. Right. There were people like Professor Patricia Grigson, who's done some of the really cutting edge research on effects with addiction in this, who said to me, that's a real concern. Now, she stressed, we don't know yet. No one definitively said, yes, it is causing these problems. We know how it was weird. It was like a. Like I said before, you're seeing this picture form. It was fascinating that you're. There's so much we don't know, which makes it kind of disconcerting. It's like, oh, so this is an experiment on millions of people and I'm one of the guinea pigs. Great, right. So it's disconcerting how much we don't know. But, yeah, that is a big worry.

And we've been here before with diet drugs, as you were alluding to, where we kind of rush into the party and then everyone rushes out of the party because we realize that the history.

Of diet drugs, Stephen, is absolutely grim beyond belief. So the first kind of modern diet drug was something called dynetrophenol. So there were a load of people in France who were working in ammunition factories during the first World War, and people noticed that they lost loads of weight, right? Not that they didn't have weight problems at the start, but they lost a huge amount of weight. And it turned out they were ingesting this explosive powder through their skin and breathing it in. So after the war, a lot of scientists at Stanford were like, oh, maybe this can be a weight loss treatment. So they made it into a pill called reduce ols, which were very popular. There was 100,000 people taking them in 1934, which, when you consider there was very low obesity back then, that's a huge number of people. And then they discovered just. I mean, it's almost unbelievably terrible what happened. So loads of the people taking them went blind, and then they went into this horrific fever where their bodies were burning up. So it's an explosive, right? So it was discovered that the way it works is it massively speeds up your metabolism, but when you take a high dose, it gives you cataracts, makes you go blind, and then your body goes into a fatal fever.

And the way one person put it is you become cooked from the inside. So they stopped marketing that one. It continued to be used as a pesticide for, like, years and years because it is so good at killing anything it comes across. So then there was a craze for amphetamines. So during, again, during the war, during the second world war, radar people had to watch radars. Soldiers who had to watch radars were extremely bored. So they gave them amphetamines to sort of keep them on the job, keep them active, mentally alert. And it was discovered they lost loads of weight as well. So after the war, they started marketing amphetamines as a weight loss drug. Right? And they became hugely popular. They were described as mother's little helper. By the time you get to 1970, 8% of all the prescriptions in the United States were for amphetamines, for weight loss. But it was discovered that when you take amphetamines, you develop tolerance to them. Your body gets used to them. So you need higher and higher doses to get the same effect. But if you take really high doses of amphetamines, you just lose it.

I mean, you can become psychotic. It has a really bad effect on you. You don't sleep. It's terrible. So then there was a real rolling back of amphetamines, and then there were some real horror shows, like jaw wiring, where they would wire up the jaws of obese people so they literally couldn't get any food into their mouths. But then it was discovered, if you it, while your drawer is wide, you can choke to death. I mean, just like nightmarish, horrifying, humiliating solutions. And then we get to the worst of them all, and also the most popular of them all, until these new drugs, which is called Fenfen. So this was in the 1990s, early 1990s, a group of scientists decided to combine two diet drugs that had existed until then. One was called flexfluramine. It's an appetite suppressant, but it was never very popular because it makes you very drowsy. So they combined it with phentramine, which is an amphetamine. So it had the kind of, it counteracted the drowsiness, and it had an additional weight loss effect. And it worked incredibly well. People taking it lost as much weight as they lose on ozempic.

And it's actually eerie when you go back and look at the coverage, front page of Time magazine. The new miracle drug was the headline. By the time you got to the mid nineties, there were 18 million prescriptions for Fenfen every year. In the US. And then a group of ordinary doctors in Fargo, in North Dakota, were like, a lot of our patients are getting really ill when they take this and raised a safety signal. Turned out the drug company had known about this risk all along. So it was discovered that when you take these drugs, they cause something called primary pulmonary hypertension. It's where the blood vessels in your lungs massively contract and you can't breathe properly. They also damage your heart. I mean, the stories were just horrendous. There was a young woman in Massachusetts called Mary Linen, who was about 28, wanted to lose weight for her wedding day. Starts taking Fen Fen a couple of weeks later. Is trying to climb a hill and just gets really breathless, and it's, like, so weird. Here goes home, is really breathless. Goes to the doctor. He takes her off the drug. But by then she had the problem.

She needed oxygen her whole life, she was told she could never have children. And then one day, she couldn't breathe, and she died. This happened to lots and lots of people. It led to the largest payout in the history of the pharmaceutical industry. Up to that point, they had to pay $12 billion to the people whose hearts and lungs were harmed. And that is not that long ago. Now, I want to stress again, that was given to people with a very poor. There was a single study of 120 people of fen phen at the point at which it was marketed to people, which is staggering. This has a much bigger body of evidence. So this is not going to be in the short term fen fen. But when I looked at the twelve big risks associated with these drugs, some of which have not really been explained to the public, one of the ones that was most disconcerting and was explained to me by a brilliant scientist called Greg Stanwood, who's at Florida State University and is researching these drugs, the biggest risk is what he called unknown unknown. So you remember that Donald Rumsfeld thing, right?

So when he was talking about the invasion of Afghanistan, but when he was the US secretary of defense. So, you know, when it comes to these things, there are things there are we called known knowns. There are things we know we know there are known unknowns. There are things we know we don't know. Where is Osama bin Laden? And there are unknown unknowns. Things we don't know we don't know that might hit us out of the blue. And with these drugs, there's a big worry about longer term unknown unknowns. So, for example, we know very little about what happens to pregnant women when they're taking these drugs, right. We know that in the animal studies, when animals or other non human animals are exposed to these drugs, they're much more likely to get birth defects. So one thing doctor Stanwood said that we should think about, and he stressed, this is speculative, we don't know was think about antipsychotics, right? In the 1950s, doctors started giving people antipsychotics. They were judged to be safe. Lots of people dispute that. But park that for a second. And people took them for many, many decades. And then it was discovered really late in the day that when you get into your seventies and eighties, if you've been taking antipsychotics, you are much more likely to get Alzheimer's disease and other forms of dementia.

Like, much more likely. Now, there's no way you could have known that at the start, it was an unknown. Unknown. You couldn't have known that. You had to have people taking it for a really long time before you could find that out. Now, one of the concerns about these drugs is that there will be unknown unknowns that we can't know about. These drugs are working on your brain. They are working very hard on key parts of your brain, parts that relate to memory processing, taste processing, gut motility, right? We don't know, but there's at least some risk there. Now, again, you have to weigh that against the risks of obesity. As doctor Sean Olivie, who's at Tlane School of Medicine, put it to me, we don't know the long term risks of these drugs. We do know the long term risks of obesity, and they are horrific. Really horrific, and much worse than I thought at the start. You know, for example, I'm actually quite embarrassed to say this. Diabetes, right? Okay. I knew that you were much more likely to become diabetic if you were obese. Figures on that are kind of shocking. If you're obese when you're a teenager, your chances of developing diabetes are 70% in your life.

Right? Shocking. But I thought, all right, diabetics, they get insulin, and then they're basically like the rest of us, right? As long as you've got healthcare, you're fine. Interviewing doctors, they were like, no, no, no. Lots of people think that if you get diabetes, it knocks, on average, 15 years off your life. There's a doctor here, Doctor Max Pemberton, a close friend of mine and a brilliant doctor, who says something to me. It seemed really shocking when he first said it, but then he went through the evidence. He said, if you gave me a choice between getting diabetes or becoming HIV positive, I would choose HIV every time. If you become hiv positive, as long as you get medical treatment, you live as long as everyone else. If you get diabetes, you know, not only does it knock 15 years off your life, your chances of all sorts of catastrophic complications in your life are really high. It's the biggest single cause of blindness in Britain. Preventable cause of blindness. It's a massive cause of leg amputation. More people get an extremity cut off in the US because of diabetes every year than because of being shot.

Right? I mean, it's. And you go down the list of all the harms associated with obesity. Diabetes isn't even number one, right? So every time I talk about the risks of these drugs, I really worry about the risks of these drugs. Right. There is a lot of them. People should go through it very carefully. If you have thyroid cancer in your family, for example, I would strongly recommend you don't take them. If you're already worried about your muscle mass, don't take them. There's a whole range of caveats and clauses, but we have got to be honest about the risks of obesity. And for me, if I'm being honest, I think the choice was ongoing obesity, all these drugs. And so for me personally, I have made the judgment call, after looking at all of this evidence, that I'd rather take the risks of Ozempic than the risks of ongoing obesity, especially given my family's history and how many men die young of heart attacks. But loads of people will look at the evidence that I present in magic pill and take totally the opposite point of view, and they may well turn out to be right, and I might well turn out to be wrong.

Right? I wouldn't debar that there's a fenfen like scenario down the road. Right? It's not likely, but you'd be a fool to dismiss it.

I am in a different camp, and I have to say, before I express my opinion, that I understand there's a lot of people out there where drugs like this will literally save their life. And if they don't take these drugs, then, you know, you've gone through some of the stats, but they. I mean, they will probably die from something. You know, some kind of form of, you know, we talk about all cause mortality a lot. Like, something will kill you in the next couple of years, whether it's a cardiovascular issue or something related to another ailment related to obesity. My thing and this has, I think, developed over time. We're doing this podcast and speaking to so many experts in health and fitness and wellness and psychology and psychiatry is. I just have this really deep, innate belief that there's no such thing as a free lunch in life. And I've just. The more I've done these interviews, the more I've come to learn that everything is a trade off. And I almost see life as, like, a scale. So if you put a weight on one end, there's going to be an equal and an opposite force somewhere else.

You know, like, what's the law of physics? Is it Einstein that said that, that you can't, like, destroy energy? You can just move it? And I think about the same with, like, drugs often and other things that seem like miracles or shortcuts. You're moving the set of issues somewhere else. You've talked about some of those movements today, like the psychological transfer of soothing behavior to an addiction, for example. That's always been my belief that whenever one of my friends says, steve, I'm taking this limitless pill, modafinil, and it's making me super productive, and it's fixed all my problems in life, and I'm killing the game now. I go, what's the cost? And my friend said to me, I remember when he started taking it, he was like, there's no cost, there's no side effects. And my brain goes, mmm. History shows if you wait long enough, there's always a cost. It's just being conscious of the cost. And when you balance up, as you've done in your life, the pros and cons, you say, okay, I'm willing to take the cost. Now, when I see things like a zenpak and people say to me, there is no downside, I get more scared because I can't run the numbers to see whether the cost is worth the upside for me.

So I don't know what the big obvious downsides of a zenpak and these magic drugs are, but I feel like, logically, there must be one.

We do know there are some medications where, pretty dependably, the benefits outweigh the risk. Think about statins, right? If you have a problem with your cholesterol, what statins do is they block part of your body that makes cholesterol, right? So it's the most commonly prescribed drug in the US. It's pretty close to it in Britain. Almost every doctor would agree there are some downsides to statins, but sometimes they're just like, you have to stay on.

Them for life, right?

Yeah, you have to stay on them, like with these drugs, right the minute you stop taking them. So within a year, of stopping, you regain 70% of the weight you've lost. Right. This is one of the big questions around these drugs. Now, that's not 100% of the people regain it, but it's. Most people seem to regain their weight. So I think there are some times when a drug, a medication. I'm not saying these drugs are that, definitely not, but there are some medications which do seem to be. Just not that there's no cost, but the benefits are really unambiguous and massively outweigh the costs. This is a much more finely judged thing. And it's interesting to me. It's been funny talking to people who've read the book, because. Remember talking to the marketing teams at both my publishers, because some people who were the first people to read the book, apart from my friends. So some of them came up to me and said, oh, johann, I loved your book. It made me really want to take Ozempic. Some monkey came up to me and said, johann, I loved your book. It made me think, convinced that you'd have to be completely insane to take Ozempic.

And it was a bit like, you know, the dress, some people saw it as gold, some people saw it as blue. And I felt like that meant I'd done my job, because unlike pretty much everything else I've ever written, I've ended this feeling as conflicted almost as I was at the start. Right. This is a huge thing. It's going to change. And we've talked a lot about the personal dilemmas. It's going to have a huge social effect. Barclays bank commissioned a very sober minded analyst named Emily Field to make predictions that could guide investment based on these drugs. And she said, if you want an analogy, you have to think of the invention of the smartphone, right? I mean, this is going to have so many unpredictable effects. Already. Krispy Kreme doughnut stocks have been tanking. The head of Nestle, Mark Schneider, has said they're worried about their ice cream and confectionery ranges. And Jeffrey's financial did a report for the airlines in the US saying they're going to have to spend much less on jet fuel pretty soon because it takes so much less jet fuel to fly a much thinner population. What I was fascinated by is companies that manufacture hinges for knee and hip replacements are seeing their stocks tank because people are going to need far fewer knee and hip replacements because overwhelmingly, that's driven by obesity, right?

So, not entirely, but overwhelmingly so. Yet if we were talking in 2007, when the day Steve Jobs unveiled the iPhone, I don't think we could have gained out, you know, one 10th of what was about to hit us. And I kept having these moments, traveling all over the world, interviewing these experts. I remember one day I was in a cafe. I was interviewing one of the key neuroscientists at Cambridge University who's working on this. We were in a cafe, and there were loads of people walking past, and it's, you know, just random british people, a lot of whom are overweight or obese like I was. And I'm thinking, wow, you don't know what's about to hit us all. It was a slightly weird, unreal feeling. I mean, this is for better and for worse. And I think there will definitely be positive effects, and there will definitely be negative effects. And I think we can see early on what quite a lot of them are. This will change the lives of all of us in one way or another.

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I'm just thinking, as you were speaking there, about a bunch of statistics that I've read recently, humans are getting more and more sedentary, which means we're moving a lot less. Obviously, obesity is going up across the sort of western world, most obviously. And then you've got this rise in a zenpak, which allows us to stay skinny, basically, and suppress our appetite. I was just wondering. It feels like there's going to be two groups of people. When these drugs drop in cost and they become really accessible. And I've saw you say in the book that the next sort of iteration of these drugs is going to be a pill. A lot of people won't want to inject something. I'm one of the people that just. I'd get too squeamish about having to inject myself. So the minute something becomes a pill, it brings down one of the psychological barriers. It's cheap, it's a pill. A lot of people are doing it. If you're not doing it in the obeseogenic, or whatever that long word was, environment we live in, it's almost like you're going to be an inferior human to some degree. There's going to be two parts of society, the 50% that are down to take the pill, and they're going to be skinny and they're going to be whatever, and then the 50% that are struggling in this difficult food environment we live in with the ultra processed food.

I almost can't play out a scenario where most people aren't taking this magic pill.

So there's a few assumptions of what you've said. I think you're probably right, but there's a few assumptions. So, in a way, what you're saying, there's sort of a few different dystopias that could emerge. One is actually that we don't even get to where you are because it's restricted to a tiny number of rich people. Right, so let's start with the first, like, dystopian vision we could have. The first is that we never even get to that point. Let's imagine, basically, we have a situation at the moment where the Real Housewives of New Jersey get to be super, super skinny and the real school children of New Jersey get diabetes at the age of twelve. Right? So we could have a situation where these drugs exist and they work very well, but they are restricted to a tiny elite of rich people, which is kind of where we are.

It's not going to stay like that, though, is it?

In the longer term, it won't, and it's not that far off. So in 2032, the patent on ozempic passes. So then it's not actually that expensive to make these drugs. It's $40 a month to actually make them. It's. The rest is profits for Nova Nordisk, who argue understandably. Look, we took all the risks of developing this. We should cash in now. You can see that argument, although I don't think they need to cash in quite as much as they are. So one scenario is it will go out of patent in 2032. By then, it looks like the main way of taking semaglutide will be pills anyway. So you can well imagine a situation where you've got $40 a month to take a daily pill that will make you much thinner. I think in that scenario, you're right. Now, what I most hope is that, a, the drugs don't have a catastrophic side effect, obviously, b, the people who want them get them, and c, it wakes us up, and we go, how did we get to this point? How did we get to the point where we're looking at potentially drugging our children forever, not knowing the long term effects?

Who did this to us, and how can we be more like Japan and all the other countries that are making these changes? That's optimistic. That requires a lot of raising of consciousness between now and then, but that's the most optimistic scenario for me. But you're totally right. There could be a scenario. It's probably the most likely scenario if there isn't some big risk that emerges that we'll just have staggering amounts of the population taking these drugs.

Unless the government intervened. Feels like the most likely scenario unless the government introduced some laws that put restrictions on what children can eat at school and all those kinds of things in a more severe way. I can't see a scenario where, especially with this younger generation, you know, you hear all these stats around young girls on TikTok being more anxious than ever before, the suicidality going up. Men are struggling more than ever with body dysmorphia, which no one's talking about. I was reading some stats about that yesterday.

Yeah, it's shocking. The figures on the.

And the antidote appears to be. I mean, this.

It's not a good solution. Right.

And perfectly normal, healthy people who just have a little bit of belly fat and they hear this, you know, they hear about this stuff, they go, you know, going to the gym is hard. And I do love those burgers. And that KFC is really nice. It just tastes really good. So I could eat my KFC and I could stay skinny.

Well, if they think that last bit, then they're wrong. If you take it, you won't want to eat the KFC and the burgers. And believe me, I have been the king of KFC.

Just three bites. I got a couple of bites, though.

Well, but you don't get. You actually don't even want that particularly. Right. And huge numbers of people are seeing that. I mean, for most of the time, I have been eating smaller portions of similar shit. But actually, even your taste for that tends to kind of wane over time. Right, so the last bit's wrong. But I think, yeah, it's one of the things. It's funny, I didn't. It's one of the things that made me really angry. In Japan, I was thinking, all this agonizing I've done, all this worrying, and I worry even more about the fact we're almost certainly about to start a mass wave of drugging children. With Ozempic already begun in the US. I interviewed parents who are drugging their kids because their children are obese. And I thought this whole dilemma never had to happen. Right? This happened because the food industry screwed us over and we didn't regulate them and we didn't stop them, and we can start to do that. And I went to places that have done it. I went to Mexico, where they introduced a sugar tax, hugely reduced the amount of sugar that people consume. I went to Minneapolis, where they prescribe healthy food for poorer people who can't afford it.

Has a really positive effect. I went to Finland, where they had a huge transformation in the food supply. I went to Japan. Here in Britain, there was a really interesting experiment. Bread used to have far more salt in it. And a really heroic guy called Professor Graham McGregor, who I interviewed, persuaded the government. So just to get the food companies to sort of law them, I mean, they would have. They threatened regulation, which meant that the companies gave in before they did it, to just massively reduce the amount of salt in bread. No one even noticed. And it reduced strokes every year in Britain by between 6009 thousand. Right? And a stroke is one of the worst things that can ever happen to you. Now, we could do. It's called reformulation. There's loads of other things we can do like that. We could reformulate loads of foods in ways that aren't even painful to us. Right? There's so much we can do. There's so much we can do to be like Japan. I mean, it was a bit weird in Japan, though, because there were things they did that we can't do, right? So I'll give you an example.

This was one of the weirdest days of the research for the book. In 2008, obesity very slightly went up in Japan. It was still, like, laughably low, and they had a real panic. And they introduced this new law. It's called the Matabo law. It's named after metabolic syndrome, which is a really nasty combination of, like, diabetes, obesity and other problems you can get when you're very overweight. And the law is very simple. Every single company in Japan on a particular day every year, has to weigh every single person who works there. And if their weight has gone up, they have to drop a plan with their employer to bring their weight down. And as a company overall, if your weight goes up, you can be fined by the government. And I was like, how could this possibly work? So I went to a company that does it, Tonita. They all do it. But a company that let me go and see how it works, and it's really weird, right? At this workplace, you arrive, you show your face to a video screen. It says, hi, Stephen. You walked 14,000 steps yesterday. You're number 121 in the company in terms of steps taken, because everyone has to wear, like, a Fitbit, or the equivalent to a Fitbit.

Everyone uploads pictures of every meal they have to this system where you can see it. It was bizarre, right? And, yeah, explain to the japanese people who kept going, you know, every morning in this office, when we'd all be having doughnuts and coffee, they do aerobics together. It was bizarre. And I would sort of explain to these japanese people, right, if you tried to do this in Britain, we would burn the fucking office down, right? Like. And they would just go, well, why? Why? They couldn't understand why I was so affronted by it, and that, okay, that's a big cultural chasm, and we can't do that. And I wouldn't want us to do that. If you look at so many of the other changes in Japan, I started to see, like, what you win if you get this right. So Japan has the longest life expectancy in the whole world. And one of the best things I did for the book, one of the most moving things for me, is I went to the oldest village in the whole world. It's in Okinawa in the deep south of Japan. And there's a village called Ogimi, where there's 215 households, and 190 of them have someone who's over the age of 90 living there, right?

So it's the oldest place on earth. Japan has by far the longest life expectancy in the world. And not just that, you're far less likely to get sick as you age. So they have not just more life, but more healthy life. And I went to their little community center, and the first person I met was a 10, two year old woman called Matsu Fukuchi, who was this, like, almost like this kind of perfect crumple of wrinkles right? She was so cheerful chatting to her. She was like, I can't stay for long because I'm looking after my son, who fell off the roof the other day, fixing it. I was like, jesus, how old is your son? And she was like, oh, I love. You know, she was so full of joy. She's like, I love life. I spent all of yesterday watching volleyball with my grandchildren. It's so great. She was so happy. She'd walked there on her own. And then there was this moment where they put on some music. She put on this red kimono, and she started dancing. And all these old women, as old as a century start dancing, right? And I danced with her.

And I was thinking, God, this is. This woman was born before radio started broadcasting in Japan. And here I am recording an interview with her on my iPhone. This is what you get if you get this, right, if you sort out the obesity crisis, you get to have more years of health and joy and dancing, right? That's what we're fighting for here. I think about how many people I know who died young because of complications related to obesity. Everyone listening and watching will know someone who would be alive now if we had sorted out the obesity crisis but has died. Everyone, right? And it doesn't have to be this way now. Part of that solution in the short and medium term is going to be these drugs in the longer term, it doesn't have to even be that. Japan is a real country. It exists. They solved this problem. There are other countries in the world that are solving these problems. We don't have to tolerate this being done to our children. We don't have to accept us being made sick and our children being made sick. But it requires an awakening around what's really happening.

Who's doing this does at the moment. You know, whenever I. My weight goes up and down, right? It has gone up and down throughout my life. And whenever I was fatter, I would blame myself, right? I wasn't angry with the forces that have done this to us, right? More three year old children know what the McDonald's m means than know their own last name, right? I didn't choose that world. I didn't choose to live in a world where we were, you know, constantly promoted and fattened and physically changed such that it's hard to come back, right? I don't mean I had no responsibility in that. I did. But we don't have to continue like this.

Do you think you could stay at the weight you are now without this? Zenpak?

It's funny you holding this. I feel like we're in a weird dystopian version of QVC. Do I think honestly? Well, if I'm typical, we know from the clinical trials 70% of people regain the weight within a year. No, I don't think so. If I'm being really honest with myself, I don't think so. I think I have made lots of changes in my life that mean I don't think I would go back to quite where I was, but I think I would very rapidly regain a lot of weight.

So you have to take this for life now to stay it the way you're at, therefore.

Yeah, and there's a big debate about, we mentioned before with the amphetamine based diet drugs from the past that people develop tolerance. One of the big question marks around this is do people develop tolerance? Does it mean that over time it will have less of an effect? Right now, some scientists, the scientists asked about this just were wildly all over the place. Some said no. We do know diabetics don't seem to develop tolerance because if they did, they would need higher and higher doses to get the same level of control for their blood sugar. So that's a point against tolerance. But others said it would seem quite likely. We developed tolerance. We developed tolerance for most drugs. It would be surprising if we didn't. Probably. What's most likely again, Carroll Leroux, the south african psychiatrist, said to me, again, probably the best comparison is bariatric surgery. You have bariatric surgery, you lose an absolute shit ton of weight and then you regain a little bit of it over the next few years and then you sort of plateau at that higher point. But we don't know. The truth is no one knows.

I'm also concerned that if you. Is there a world where if you stopped taking this, your body had become reliant on your glp one coming from this, so your body makes less glp one itself.

I don't think that's the concern, but I think you've gone to a really important point. We know all forms of diet slow down your metabolism, right? That's a reality about diet, which is why often people end up fatter at the end than they were at the start. I'm worried about, and again I asked lots of scientists and people just said, we don't know. I'm worried about is my metabolism slowing down as I take this drug, lets say they discovered some terrible problem with it and it had to be withdrawn. Would I then have a slower metabolism and be fatter than I was at the start.

Yeah.

No one knows. Thats a significant risk.

And the other big risk here is youve talked about a few times, is this eating disorder epidemic. It seems, I think you talk about in your book that since March 2020, rates of anorexia and bulimia were 42% higher than they would be expected for teenage girls aged 13 to 16.

I think that's because of lockdown. To be fair. That's not a result of the drugs. That's because of the massive stress of lockdown. Yeah.

Some research in the Lancet journal and 32% higher for those aged 17 to 19. What I'm saying here is that we do have an issue with eating disorders in the western world especially. They skyrocketed after the pandemic. But when I think about eating disorders and bulimia and anorexia, and I think about this and what it might mean for those eating disorders, I feel somewhat concerned, especially when kids get their hands.

On them, go beyond concerned. And we don't have to speculate about this. We've been here before. So in the early nineties, there was a very popular amphetamine based diet drug that was marketed in the United States, and it was huge, and lots of teenage girls used it, and it led to a catastrophe. There was a guy called Rob Wyden, who was a congressman for Ohio at the time, who held congressional hearings on this. And they are really chilling to read because they show what happens when a popular diet drug combines with eating disordered young women. Right. So there was a woman called Jessica McDonald who testified at the hearing. She was in her early twenties at the time. So she was a ballet dancer. Obviously, we know about the horrendous pressures on body shape for ballet dancers. And she would take this drug, like this amphetamine based drug until she passed out to be thin. She would take it to starve herself because she wanted to be that ballet shape. There's a guy called Tony Smith from State center in Iowa who testified. So his daughter Noelle, from when she was very young, became obsessed with the idea that she was fat.

She would go and look at these fashion magazines and say, daddy, do you think I'm fat? Why don't I look like these women? And she got hold of these diet drugs, massively starved herself and died of a heart attack. And he read out this heartbreaking poem she describes, like, you know, I'm hungry. I want to eat. But not yet. Not yet. Right. So we know that when a diet drug combines with eating disorders, it leads to catastrophic outcomes. We don't have to speculate. So, yeah, that's one of my three or four biggest concerns. Now, like I say, we can introduce regulation now to mean you only get it from a doctor. The doctor has to see you. That will cut some of that. But I don't see how. And that's really important. And anyone we save is worth saving. But, yeah, very, very concerned about that. I'm also concerned about a more subtle effect in relation to that. So the worst moment I had in writing the book was not any of the physical side effects for me. Although there were some grim moments there early on. It was a moment when. So mine, I've got a niece called Erin, and she's 18 now, although she's 19, actually.

But in my head, she's sort of six years old all the time, like, because she's the baby of my family, she's the only girl, she was the youngest. So no one makes me more protective. And one day, a few months into taking these drugs, I was facetiming with her. She was in a pub in Liverpool, and she was like, oh, Johan, you've lost so much weight. And I was preening. She's like, oh, look, I can see your jaw. I never knew you had a jaw. And I was like, oh, yeah. I was thinking, you're happy. And then she looked down and she said, will you get me some ozempic? She's a perfectly healthy weight. She always has been. And I thought, what the fuck am I doing? All her life, I've been trying to give her this message, don't be judged by how you look. Don't worry about that. You know? And I thought, oh, I've counteracted everything I wanted to communicate, and we know. And she decided not to take it. And it all ended fine with her. But when I was a kid, there were no fat people on television, except as the butt of the joke.

And I think about my niece. She's grown up seeing actually quite a lot of women who have a broader range of body shapes, the public eye. And in the last two years, almost all of those women have massively shrunk. Now, they're not talking about ozempic, but unless there's been some kind of outbreak of dysentery in Malibu, I think we know what's happening, right? Some of them are talking about it, but most are not.

Can I just ask on that? Because we've seen a lot of very famous faces suddenly shrink over the last couple of years. And when you read their autobiographies, they talk about, like, going to the gym and getting their lifestyle right. Do you think they're lying?

I mean, obviously, yes, it does appear.

I wasn't sure if it was just me, but think about a lot of people that were a little bit bigger, and it seems that suddenly everybody's kind of cracked. Weight loss, and it's rapid and it's super fast. I don't want to name any particular names because it's not my place to talk about individuals like that. But it really does seem like Hollywood has found a great personal trainer. And I'm just like. I'm wondering if this is what it is.

Yes. Although I think I would say the people you and I are thinking about are almost all women. And I do think we should bear in mind. No, you would agree with this. I'm not making this as a point against you. Women get so much more shit than men for this sort of thing, right? Like, actually, it was interesting. One of my editors said to me, you know, I was saying, why has no one else written a book about Ozempic yet? Why am I the only one? And they said, because only a man could write this. Because a woman would be crucified for writing it, right? She would be monstered. And if you look whenever, even someone as unbelievably popular and amazing as Oprah, who slightly, surreally is my friend, gets savaged for it, right? And there's lots of deep, underlying reasons for that that came out for me as well, actually, that I projected towards myself. I remember for a long time taking the drug. I felt like. I mean, I mentioned this a little bit before, but I felt like I was cheating. I felt like I was sinning almost. And I started to look at the kind of deep ideas that.

So deep in our kind of collective unconscious. If you look at. So for example, in the 6th century, the pope, Pope Gregory I, draws up the seven deadly sins, right? And one of them is gluttony. And it's this image. It's always depicted with an image of some hugely fat person looking like a pig. And it's horrible. It's very deep in our culture, the idea that being obese is a sin, right? If you look at the forms of weight loss we admire, they follow the pattern of sin, right? The kind of classic catholic pattern of sin. You sin, then you have to suffer and redeem yourself, and then we forgive you, right? So if you look at the forms of weight loss we admire, they're ones where people are humiliated and suffer terribly. You starve yourself. You. You know, you think about that show the biggest loser, which I hate, you know, where severely obese people are made to sort of compete in grueling, horrific forms of exercise. Then we're like, okay, jabber, we forgive you now. Do you know what I mean? We use these kind of stigmatizing ways of thinking cheating is a bit more subtle because I kept thinking, I'm cheating as I do this.

And I was like, well, that's really weird. If I had a heart problem and I took statins, I would not think I was cheating, right? I said, why is that? And I think it's partly. So. People put in a huge amount of effort to be thin, right? Loads of women watching this. And it's disproportionately women will suffer some privation and deprivation in their life because they are really trying to be thin. And then they hear, oh, this fucker just injects himself once a week and he gets to be thin like me. It's like they feel the way I imagine cyclists do when they look at Lance Armstrong, right? And the only way out of those, that negative conversation where we turn on each other like rats in a sack is to realize, oh, there is a sin and there are people who are cheating, but it's not Oprah. It's not someone who Jeff Parker, that guy I mentioned, who, you know, didn't want to die young. It's the food industry that fucked all of us. That's why we're in that race, right? That's why you're starving yourself. That's why we feel we're sinners. Okay, well, we can collectively come together and challenge that shared opponent if we want, but if we're just gonna get into.

Look, it's very hard in this age of social media madness to not have every conversation turn into a toxic conversation. And it's not surprising that something has charged as a debate about a zempik and weight has become so toxic so quickly. But again, we don't have to do that. The toxicity isn't going to get us out of this, right? We're in a shared crisis. Everyone watching has someone they love who is on course to die young because of the problems associated with obesity, because obesity is so widespread in this society in a very recent amount of time. Look at a picture of a beach in Britain in 1975, not a million years ago. Everyone is thin by our standards, right? This happened in the blink of an eye in human terms. Right? Again, we don't have to tolerate that.

Part of it is also we don't like when people lose weight. Some of us, because it shines a light on us. And I think about someone like Adele who dropped a ton of weight very quickly. And the shocking thing when she dropped that photo, I think it was at, like, a birthday party, because she went from, like, being, you know, a certain weight to then dropping weight very quickly. So we, because we don't see Adele's private, like, life much. It was just this selfie she dropped. And if you look online at the reaction, people were betrayed. They felt betrayed by Adele's weight loss, not because they're assuming she used a Zen pick or anything. The fact she's now not the way she was in terms of her weight, people were almost angry about it. And the same happened with Rebel Wilson, when Rebel Wilson dropped a ton of weight, because in her book, she talks about she wanted to increase her chance of having a kid, so her doctor advised her to lose the weight, almost angry that they lost someone they could maybe relate to or that made them feel a certain way about themselves, which I find to be really interesting that we actually don't like it when someone loses weight.

We've got to understand where that's coming from. Obviously, I don't support anyone being cruel to people online. And it's good for both Adele and Rebel Wilson that they've improved their health. But I think where it comes from and a lot of these things that can seem a little bit odd, that are kind of sad, we've got to realize how much shame people are soaking up on this issue. You know, if you have a bmi higher than 35 and you're a woman, 45% of women in that position get insulted every single day in public. Every day, right? So you're walking through the world constantly being made to feel there's something wrong with you being treated like shit. And I can see how people in that position develop a sort of parasocial relationship with Rebel Wilson or Adele. They're like, oh, look, we can look to Adele and they feel trapped. They feel they can't lose weight. And then they see Adele and Rebel Wilson, and they're just like, oh, et two brute. Fuck you. I get it now. It's not the right response. I would want to talk to them more about, okay, we want to think deeper about this, but I can see where it comes from, and I can see why some people look at me and go, you fucker.

Right? I totally get it. I suspect I would have felt that anger were I not me looking at me, right? So I get where the anger and this comes from, from the moment we're born in this culture. We are primed to be overweight and we are primed to feel tremendous amounts of shame about being overweight. Right. And anything that comes along and brings up those stories and forces us to think to them, brings them to the surface. Like these new weight loss drugs just leeches out of all of us. So many negative and angry and hurt feelings. And I felt it myself. Right. I felt so much self doubt all the way through this. I still feel self doubt about it. I still have days where I wonder, am I doing completely the wrong thing? So I do think we have to understand where it's coming from and not just sort of, I know you're not doing this. You're always interested in understanding where people come from, but it's tempting to just condemn people and go, look at this bad behavior. And I'm always more interested when people are behaving badly. And it is cruel to say to Adele, you bitch, you betrayed us.

I mean, I would never say anything bad to Adele anyway, because I love Adele, but so do I. I saw her in Vegas. She's incredible. But I do think we always have to try to understand, and it comes from a place of profound pain, and that's not a pain that those people deserved. Right. And that's a pain they should never have been subjected to.

One of the really surprising things you talk about in your book is the relationship that Zempek has on addiction. And I couldn't quite figure out why there'd be any impact on addiction if we start taking a Zempek drug. So you talk about the. How it eases the food chatter in our brains and the sort of food cravings we have. But then there's a lot of research you go into that shows a zempec and these kinds of drugs can actually have an impact on our addiction to things like cocaine and alcohol.

So this is much disputed and there are serious scientists on both sides, but I found it mind blowing and totally fascinating. So, for example, a woman called Elizabeth Joelhag, who's a professor at the University of Gothenburg in Sweden, has done some of the pioneering work on this. I interviewed her a lot. They get a load of rats and they put them in a cage and they give them loads of alcohol. And rats will like alcohol, and they get hammered like the rest of us, and they wobble about and they love it, right? So they put them in this cage for a while, they've got plenty of alcohol. They get drunk over many weeks, and then once it starts to resemble like a dive bar in vegas, they do an intervention. They come along and they inject them with GLP. One agonist, the exact drug you've got in front of you, semaglutide. And then they watch. And what they discovered, what Professor Yul Hag and her colleagues discovered is afterwards, the rats drink about 60% less than they did before. And the rats who drank most heavily are the ones who cut back on their drinking the most.

Like, whoa, what's going on there? But then they thought, okay, maybe it's because alcohol's got a caloric content. It's like they want the calories less, right? So then there were experiments done with drugs that don't contain any calories. So Professor Patricia Grigson, who's at Penn State University, gets rats heavily using heroin and fentanyl, gives them a GLP agonist, again, finds the same thing, 50% reduction in the rats using the heroin, self administering the heroin and the fentanyl. Then Greg Stanwood, who I mentioned before, who's at Florida State University, does it with cocaine. It was mice, not rats for him. Again, 50% reduction in them using cocaine. We don't know why. Again, some of the theories come back to that question about the reward system. Could it be dampening the reward system? One of the things a lot of the scientists find fascinating is these drugs appear to have what they call selectivity. So selectivity is where the drug makes you want less of the Big Mac, but not less of a salad, right. So it seems to. It doesn't just generally dampen. You don't just not eat at all. Some people do with malnutrition as a risk, but most people don't.

Right. So given that some of them argue, again, it's highly speculative at this point. It seems to be activating, downgrading your desire for things that are bad for you but not things that are good for you. Right. I'm thinking, how can that be? That seems so weird. Let's imagine I'm Elton John, right? And I get my pleasure from playing music. How can it know to tell me to eat fewer jam sandwiches but not to engage in jamming? Right. How can it do that? And they kept saying, we don't know. There does seem to be a mechanism that does that. We're trying to explore it. So obviously, hugely encouraging results in animal studies with addiction. So now there's lots of experiments going on with giving these drugs to humans to see if they reduce addiction. There. There's been a huge amount of anecdotal evidence. I interviewed a nurse in Canada called Tracy, who had a bad relationship breakup and just became completely addicted to shopping. She would just obsessively buy books she'd never read, clothes she'd never wear. She was doing a lot of skin picking and obsessive eating. She goes on as MPIC and all these addictions, like, disappeared.

So there's now this debate. Okay, is it going to have this effect more widely? The early research is kind of mixed, so there's only very, very small studies on humans so far. It found that it does reduce smoking, but only if you pair it with a nicotine patch. They found that it does reduce alcohol consumption, but only if you were a heavy drinker at the start. So we're going to know a lot more. We're going to get a lot of results actually this year and definitely a lot next year, but it's a very promising. So some people argue. So the most extreme, I want to stress, this is speculative. The biggest cheerleaders for the drug would say, actually, we haven't found a drug that causes appetite regulation. What we found is a drug that boosts self control across the board. Right now, that's very contested. I'm always conscious, you know, of the overselling of drugs. Generally, we want to be careful about, but it's a possible scenario. And the animal research is mind blowing and really is highly, highly exciting. And you don't normally see this. Right. There's no other drug that I'm aware of.

Pretty sure there isn't. That just reduces addiction across the board in animal studies. Right. It's remarkable. I mean, there's a debate about whether you can even call it addiction in animals, but you know what I mean. Heavy compulsive use.

What impact has Zempek had on your weight loss journey? How much have you lost?

I mean, I just lost a huge amount of weight. So I lost three stone across a year. And actually, it was even more dramatic was the percentage of body fat that I lost. So at the start, I was 33% body fat. I remember the day Josh, my trainer, measured that and winced as he saw it. And I said, oh, God, if I was a sandwich, you wouldn't want to eat me. I later looked up. Whales are only 35% body fat, so it's slightly disconcerting. So I went from 33% body fat to 22% body fat. So it's a really dramatic fall.

And did you increase your dose?

Yeah. So everyone starts at 0.25 milligrams, partly because the most common side effect by far is nausea. Right. Almost everyone feels nauseous a bit when they start taking it. For some people, the nausea is unbearable. I interviewed someone called Sonny Newton in Vermont who said, you know, it felt like an alien had entered her body and was thrashing and trying to get out. Yeah. A significant minority experienced such extreme nausea. They just have to stop. For me, the nausea has now totally gone away. And Carell le Roux, one of the scientists who worked on this, said, look, when it comes to nausea, you've got a level with people. There are two kinds of drugs. There are drugs that have side effects and there are drugs that don't work right. And he's right about that. But, yeah, the nausea is pretty bad. But, but for me, it's all gone away now.

I really do admire Oprah. I've watched her. She's kind of like a role model of mine for how she's kind of conducted herself throughout her career. And as you say, she's a friend of yours and she's, I think, recently come out and admitted to using a zenpak. She's talked about how she struggled with weight for her life. And a zenpak has been a bit of a magic bullet, it seems, for her in her weight loss journey. You know her as a person. I've not been paying enough attention to her describing her decision to know why she decided to take a zenpak versus, I don't know, some other form of dieting. Has she explained that?

Yeah, she talks about it very movingly. She talked about in an interview with People magazine and in a brilliant special for ABC, I think, I mean, nobody has publicly tortured themselves with diets more than Oprah. There's this famous clip that you've probably seen where she comes on stage at, on her show and shes wheeling a huge bucket of fat. And thats the amount of fat shed lost on this diet. And she describes very movingly in the special, she says it much better than I can, how she had starved herself to get that right. And you think about, so she had tried all the extreme diet and exercise options that were available, and theyd always yo yo ed back for the reasons that we talked about before. And, you know, and she had to have a knee operation. I'm not giving away anything. She's disclosed this. She had to have a knee operation. And she was very worried about her health. And so for those reasons, she's made this choice. There are lots of reasons to be worried about these drugs. But I have found it very hard when you talk to people who've really struggled with this, like that guy, Jeff Parker, I mentioned before in San Francisco, like Oprah, people who've made the decision to do it and seen the benefits of the weight loss, staggering benefits, whatever the other arguments are, I don't want to argue against them.

Right? If you are taking these drugs and experiencing an enormous improvement in your health, as they both have and as lots of other people have, then that's been the right choice for you. Now that won't be right for everyone. I met people who really regretted taking the drugs for all sorts of reasons, including many of the terrible side effects and risks. But I think we have to be truthful to the complexity of these drugs, right? I mean, one of the reasons it's called magic pill, the book, is because there's three different ways you could think about this as magic. Loads of people who take the drug go, this is magic, right? So the first form of magic is obvious. It seems to solve a problem so quickly, so effectively, that you're like, whoa, it's like a miracle, right? That's one way. The second way is it could be magic, like a conjurer's illusion, right? It could be like a magic trick. It seems to solve the problem, but doesn't. Or sets up and trains something else. Or the third way is, think about almost every fable about magic is you get what you want, but then you get what you want in a way you didn't quite expect.

You make a wish with the genie and you get what you want, but the wish doesn't quite work out how you thought. Most famous story about magic is fantasia. You know, the magic can spiral away from you. So I think one of the things we're still trying to figure out is, what kind of magic is this? Is it a magic solution? Is it a magic trick? Or is it a magic solution that's going to spiral in all sorts of unpredictable directions? I have to say, you know, when you were holding that pen, looking at me, I got weird. Like you were doing slightly judgmental dragon's den eyes. And I was like, shit, how do I persuade him to invest in me, right?

I was just thinking. I was thinking I was having a conversation with myself, and I was staring at it, thinking, God, this would be easier than going. Because after you leave here, I haven't eaten yet today. So I'm gonna have my lunch, and then I'm gonna go to the gym for about an hour and a half. And much of the reason why I go to the gym is to try and stay in shape. You know, I wanna keep my I wanna keep my belly fat off, I wanna keep my muscles strong, I wanna be strong, I wanna look good. That's the reasons I go to the gym. Also, the positive consequence of me going to the gym later on after this conversation is it will make my brain feel really good.

Yeah.

Now, as I was looking down at the pen, I was thinking, I could take this and then the belly fat wouldn't be there, but then I would lose the positive upside of the exercise that I'm going to get from going to the gym as well. So I was wondering to myself, are people going to exercise less? And is there a consequence to us not exercising as much to our mental health and our feelings of happiness and all the things that exercise does for us?

Yeah. The answer to both your questions is yes, people will exercise less and it will have negative effects. So we know.

I want to add to that the point that I alluded to earlier on. People are getting more and more sedentary. We're living in, like, a vision pro headset, don't need to move world. You know what I mean? So we're going to be able to inject to keep the weight down, but we're still going to be moving less. And there's a lot of upsides to moving and exercise.

Yeah. So we know that there are enormous benefits to exercise, which exists quite separate to the question of weight loss. Right. If you exercise for 270 hours a year, you add three years onto your life, even if it doesn't cause weight loss. Right. So it benefits in terms of preventing disease, slowing down aging, mental health are just enormous from exercise. And I think you've gone to a really important drawback, which is, yeah, if you can get the benefit in the short to medium term, just from a jab. But that calculation you were thinking through as you were holding the pen in the slightly sinister dragonstone way, is a calculation lots of people are going to make. And there's a lot of things I'm not sure about in these drugs. But there's a few bits of advice which I am very sure about. If you are not overweight or obese, you definitely shouldn't take these drugs. You are incurring all the risks for none of the benefits that I'm certain of. And there are lots of people who are not overweight or obese who are taking the drugs to be super thin. My friend Elise Lonan, who used to be the chief content officer at Goop, said she won't even go out for dinner in LA with people we know now, because no one eats anything.

It's like, why did we come out for dinner? You're all starving, she says. You know, dieting is out. Elimination is in the way she put it. So I'm confident about that. I'm also fairly confident, although slightly less, but fairly confident, if your BMI is higher than 35 or your body fat percentage is very, very high and you're not someone with thyroid cancer in your family and you're not trying to get pregnant, I would recommend taking the drugs. I think for you, the balance of risk, and assuming you've tried diet and it didn't work, I think for you the balance of risk is more towards the benefits of taking the drug. I'm not as confident about that, but I'm pretty. The people I love who are bmi higher than 35, who are in that position, I have recommended the drug to them. For people with a bmi between 27 and 35, I think it's much more. You've got to just go down the list of the benefits and drawbacks and really think it through for yourself. And reasonable people will reach completely different conclusions.

It can be quite interesting to see that people who do decide to do exercise and they change their diet and they start running marathons when they lose weight, everybody is going to say, no, you didn't.

That's so funny.

Everyone's going to say, your Zempac. If some celebrity now drops, I don't know, three stone or four stone, and they did it, you know, in the gym and with a dietary change, no one is going to believe them. No one.

That's very funny. And I think certainly, I think you're right there. I hadn't thought of that.

You wouldn't believe them. Of course you wouldn't believe them.

No, you're right.

One of the big rebuttals that I see online is that because people are now taking these drugs, people like you are taking them to lose weight, diabetics can't get their hands on these drugs anymore. And I saw some articles that said the drugs had been in such high demand that diabetics who really, really need them to save their lives now can't get access to them.

I think those people have a really good point, and I interviewed some of them for the book and it was a very painful conversation. I think the solution is what we should have done right from the start, and what we should do now is what we did in Britain with the COVID vaccine. So we should ration the drug, and the people with the greatest need should be given it first. And everyone agrees severely obese people and diabetics together would be the people who most need the drug, and they should be given it first. People like me, who've got heart disease in my family but were not hugely obese would probably be around the middle. And, you know, people who don't have heart disease and are just sort of overweight would be at the bottom. We didn't have that system. What we had, unfortunately, because the government didn't set up that system, was a scramble, which meant that, you know, some diabetics didn't get the drug they needed, had to go on insulin earlier, which poses a real threat to their health. That's awful. And I feel a bit ashamed about it because, of course, if people like me hadn't all together bought it, that wouldn't have happened in practice.

For me personally, I was worried about my own heart risk. You know, I'm a year older than my granddad was when he died, but that's not much of an excuse. And when I met the diabetics in that position, like, for example, a guy called Zami Jalil, who was exactly in that position, he could, as a musician, 41, couldn't get the Ozempic he needed for his diabetes, for his type two diabetes, I felt ashamed. You know, clearly, his need was greater.

Johan, thank you. Thank you for a few things. I think it's worth saying that the first time you came on my podcast, I had basically no listeners.

You were like a tiny little baby podcaster. I remember it really clearly. You came to my flat.

I showed up at your flat in London. I'd read your book lost connections. I was so fascinated by it. So I reached out to you and asked if you'd come on, and you said yes. When I was. When no one was listening to the podcast, I wasn't even videoing it back then, and it was an incredible conversation. The audio was terrible. We had loads of issues and stuff like that. But you were one of the first people to really give me a chance. So it's so wonderful that we can still stay in touch and that I get to cover your work still to this day. So thank you for giving me a chance back in the day. I really appreciate it.

Oh, my pleasure.

And thank you for writing this book, because one of the most sort of popular things that our audience have been asked, seeking to understand is a zenpak. We've seen that in all the data and the way that you approach this, even though you are someone that's taking it, so it's easy to see how you would be biased in various ways to defend it or whatever. That's not the approach you take. And in the book magic pill, you're able to be incredibly nuanced in how you look at the pros and the cons in a way that I was not expecting from someone who was taking it themselves. And I think that's really important because you're right. You finished the book, and in a weird way, you have more information. But I can understand how the decision still remains with the individual. And I think that's really what any book on this subject should aim to achieve. It should not have a dog in the fight, but present you both sides of the trade off so that you can make a decision for yourself. And that's what you do so skillfully. And the real thing as an author that you've taught me over the years is you're just remarkably good at writing.

And it's really, your storytelling is phenomenal. It's influenced me profoundly as an author myself. And whenever I read a book now, I often wish that they'd written it like one of your books, because you take a concept that's difficult and widely discussed, and you take us on a journey, and that journey is so much more enjoyable than just reading, like, a science book. So I recommend everybody to go and get magic pill right now. It's obviously a huge point of conversation at the moment, these magic pills, and this is the book to read on it. Magic pill. The extraordinary benefits and disturbing risks of the new weight loss drugs. It's due to be released on the 2 May 2024. So we're a couple of days away from that now. And, yeah, I would just highly, highly recommend this book. Thank you so much, Johan.

Oh, I'm really touched by that, Steven. Thank you so much.

I almost forgot we have a tradition on this podcast.

Oh, yes, the question. Yes, what is the question? Who posed this question?

I'm not going to tell you who this is, okay? But the question that's been left for you is, it's a really interesting one. Why should humanity continue to exist?

So, as you know, I've been writing for God, twelve years now, 13 years, a book about a series of crimes that have been happening in Las Vegas I'm not allowed to talk about, but it will come out next year, and I promise we'll finally talk about it.

I think you're just saying this so you can hang out in Vegas. Every time I see you. So you're just in Vegas writing a book. I'm like, where's the book, Johan, there are people.

Many people in Vegas have said to me, yeah, your book's been a long time fucking coming your hand. But so I know two people called Rob Banghard and Paul Beautrino, who a lot of people won't know, but there's many thousands of homeless people who live in the drainage tunnels beneath Las Vegas. And Rob and Paul used to live in the tunnels, and Rob lived in a particular set of tunnels that I know very well and have spent a lot of time in. And in 2017. So Rob was known as Hobo Santa. He would steal things and give them to people. And he was also a kind of low level dealer. Very low level. And there was a group of rival cuban dealers who didn't like him. And one day in 2017, they hit him in the head with an ax, split his skull open, dragged him onto the railway tracks, and left him there for a train to run him over. But fortunately, someone spotted him, pulled him off the tracks, and he survived. And he. In the next six months, as he recovered, he turned his life around, and he began to volunteer for a group that my friend Paul runs called shine a light, which is a group of people, overwhelmingly people, who used to live in the tunnels, who managed to get out, turn their lives around, who now help the people who are still down there.

They give them loads of practical things, from tampons to flashlights, and they, most importantly, give them support when they want to leave and have got lots of people out at every month, get people out of the tunnels. And I've seen them do it with some people I really love who were down there. And one day, a few years ago, I was with Rob. And so one day, a few years ago, I was with Rob when he got word that a friend of his from the tunnels called Pickett had died. He'd od'd in the tunnel they used to live in. So we went straight down there, and Pickett's stuff was still there. They'd taken away his body. And we bumped into a woman who also lives down there. And whenever Rob goes to the tunnels, even in a situation like that, he always brings supplies, you know, food and stuff. And he said to her, who's in the tunnel over there? And she said, oh, you don't want to go there? And he said, why? And she named some people, and he said, no, I'll go there. I'll give them some stuff. And he went and gave them some stuff.

Anyway, I didn't really think about it very much. I was thinking about Pickett, and what happened? And a few days later, I said to Rob, what did she mean when she said, you don't want to go there? And he said, oh, it's just these guys. And I said, what guys? He said, oh, well, they're the guys who hit me in the head with an ax. They're the guys who tried to kill me. And I said, well, why did you go and help them? And he said, because they're human beings and they're suffering, and they need help. And I thought a lot about Rob. Every day, him and Paul go back into those tunnels. You know, they could do anything. They could leave and do a million things right. They're incredibly intelligent and talented people. Every day they go back and they help the people who got left behind, and they make no money doing it, and they don't have great lives doing it in any material sense. And I say to them, why do you do it? And they just. They say, because it's the right thing to do. And if you said to me, why should human beings continue to exist?

I could give you a load of abstract answers. I could talk to you about philosophy, and I could talk to you about art, and I'd just say, come and meet Rob and Paul. Thereby humans should continue to exist.

Thank you.

Cheers, Stephen.