How Ozempic Changes Our Bodies, Minds, and Economy — With Johann Hari

Channel: Alex Kantrowitz

Published at: 2024-09-04

YouTube video id: DEfjbtfHCN0

Source: https://www.youtube.com/watch?v=DEfjbtfHCN0

after spending a year plus on OIC and
interviewing its inventors and critics
Our Guest today shares how the drug
might reshape our relationship to food
and our economy all that and more is
coming up right after this welcome to
Big technology podcast a show for
cool-headed nuance conversation of the
tech world and Beyond Today we're diving
into Health specifically about OIC and
the other range of weight loss pills
weight loss medicine is starting to make
its way into our society and do it fast
and
um change really change our relationship
with food and change our economy
effectively we're going to talk about
how that's going to happen and then also
the pro the pros and cons of this uh of
these drugs we're joined today by yoan
hary he's a New York time bestselling
author and his new book magic pill the
extraordinary benefits and disturbing
risks of the new weight loss drugs is
out in any bookstore you could H for and
I've read it it's a terrific book yoan
welcome to the show oh I'm really
excited to be with you thanks so much it
is great to have you here we're going to
talk a little bit about the effects of
the economy but I I really want people
to understand sort of what this drug
does and what it's up against and the
way that I think we should do that is
talking about the cheesecake park or the
cheesecake rats um it it's an example
that you have in your book about
basically the way that the food industry
addicts us to food that's not really
good for us and there's uh there's this
story about the rats that basically find
find themselves gorging themselves on
cheesecake and can't stop that you know
my wife and I have now started to take
and we we've started to when when we're
eating dessert non-stop we just look at
each other and we're like oh no
cheesecake rat so what is the cheesecake
rat in the cheesecake Park well we're in
this incredible position 47% of
Americans want to take these new weight
loss drugs because they produce an
incredible amount of weight loss that
I'm sure we're going to
unpack and in a way when you first hear
that it seems like a kind of
mind-blowing moment the first time in
human history that almost half of us
would want to take a drug in order to
stop ourselves from eating right so you
think well how did we get here what
happened to us and actually
understanding how we got here is very
important to understanding the later
question of how these drugs work um and
I guess the way I would get into
explaining the experiment you're
alluding to is I would say to everyone
just stop for a moment pause this
podcast and Google something for me
Google photograph of beaches in the
United States in the year I was born
1979 and just look at them for a minute
and then come back so you will have
noticed about those
beaches something that seems really
strange to us everyone in those pictures
pretty much looks to us like what we
would call skinny right or jacked and
you look at it and go well huh where was
everyone else on the beach that day in
1979 but it turns out that's just what
Americans look like in 1979 right and
obesity was extremely low in the year I
was born and it has exploded in my
lifetime between the year I was born in
the year I turned 21 obesity doubled in
the United States and then in the next
20 years severe obesity doubled again so
we're in this bizarre situation you have
human beings exist for about 300,000
years and obesity is very rare and then
from looking at you I'm guessing you're
pretty similar age to me um in our
lifetimes obesity exploded why why what
happened we know the answer the most
important part of the answer obesity
explodes everywhere that makes one
change it's not where people suddenly
lack willpower or become
lazy it's where people move from Mostly
eating a diet based on whole fresh foods
that they prepare on the day they eat
them to mostly eating a diet of
processed and ultr processed foods which
are constructed out of chemicals in
factories in a process that isn't even
known as cooking it's called
manufacturing food and it turns out this
new kind of food that's built out of
chemicals affects us in a completely
different way to the whole fresh foods
that human beings ate for 300,000 years
before that and and one of the ways it
affects us when the most important ways
is processed and ultr processed food
undermines our ability to ever feel full
our ability to ever feel we've had
enough and then want to stop eating and
I go through loads of evidence for this
in my book and the many different ways
in which processed food has this effect
on us but you allude to an experiment
that to me just totally nailed the
effect I nicknamed it cheesecake park
that's not the official title this is an
experiment that was done by a brilliant
scientist named Dr Paul Kenny who's the
head of neuroscience at Mount siai in
New York and um Dr Kenny grew up in
Dublin in Ireland and he moved to the
United States in the 90s to San Diego to
continue his scientific research do his
PhD in fact and he quickly noticed huh
Americans don't eat like Irish people
did at the time right um they ate
Americans at the time ate much more and
now obviously ate much more processed
and Ultra processed foods and like many
good immigrant Dr Kenny assimilated and
quite quickly became you know gained a
huge amount of weight I think gained 30
pounds in a year or two and he started
to feel like this food he was eating
wasn't just affecting his gut it was
affecting his brain it was affecting how
he felt and what he wanted so he
designed this experiment to test it he a
load of rats in a cage and all they had
to eat was the kind of natural Whole
Foods that rats evolved to eat over
thousands of years and when that's and
when that's all they had the rats would
eat when they were hungry and then they
would stop when they were full they had
some kind of natural nutritional wisdom
that said hey guys you've had enough now
they never became overweight they never
became obese then Professor Kenny
introduced them to the American diet the
stuff I've been eating all my life too
he fried up some bacon he bought some
Snickers bars crucially he bought a load
of cheesecake and he put it down
alongside the healthy food and the Rats
went ape [ __ ] for the American di I
don't know ifat Gango AP [ __ ] that's the
rats went crazy for the American
diet they would dive into the cheesecake
and eat their way out and emerge just
completely slicked with cheesecake they
ate and ate and ate and ate the way Dr
Kenny put it to me was within a couple
of days they were different animals that
kind of natural nutritional wisdom that
they'd had when they had the kind of
food they evolved for vanished and they
all became severely obese then Professor
Kenny tweeted the experiment
again he um he took away all the
American food in a way that feels to me
pretty cruel as a former KFC addict and
he left them with nothing but the
healthy food they'd evolved to eat that
they'd had when they were growing up and
he was pretty sure he knew what would
happen he thought they would eat more of
the um healthy food than they had before
for and this would prove that exposure
to junk food expands the number of
calories you eat in a day that is not
what happened something much weirder
happened once they'd had the American
diet and it was taken away they refused
to eat the healthy food at all it was
like they no longer recognized it as
food they would rather starve than eat
that food it was only when they were
literally wasting away that they finally
went back to eat it now I would argue we
are all living in a version of
Cheesecake park now we are living in an
environment from when we're very young
where we fed foods that physically
change us and undermine our ability to
ever feel full and know when to stop
eating and it's not the only thing going
on but it's the key reason why we have
this huge obesity crisis and why there
is such enormous demand for these new
weight loss drugs yes I feel like
whenever I'm just like I don't know
about to finish a pack of cookies in one
sitting I'm just like oh yeah here I am
cheesecake rat and I'm curious how
they've been able to engineer the food I
mean obviously we're going to talk about
OIC as an answer to this but before we
get into that how have they been able to
engineer the food to make make us never
feel full um is it intentional or is it
just a byproduct of the type of food
that exists when it's manufactured as
you mentioned versus Whole Foods I think
the honest answer to the question is a
bit complicated what's definitely not
happening is they're not like James Bond
villains going bah how can we make
everyone as obese as possible that's
that's not happening right that would be
a stupid way of thinking about it it's
in some ways much more simple if you're
the head of a KFC craft any of the food
companies you have a fiduciary
responsibility to your shareholders to
maximize profit so how do you maximize
profit as a food company you sell as
much food as possible right so they are
constantly figuring out ways to maximize
the amount we eat right so if there's
two food stuffs one that makes us feel
full and we stop eating after having
half of it and one that makes us want to
eat five packs of it they're going to go
for the one that has five packs of it
and I don't blame those individual
companies I mean they do things that are
unethical like employ lobbyists to rig
the rules or advertise to Children there
are certainly lots of things I would
condemn about them but actually it's the
job of the rest of the society to
regulate those companies right those
companies are doing what those companies
are meant to do the democracy needs to
do what it's meant to do and regulate
them to prevent them from harming our
children and screwing up our bodies and
harming our health there's lots of ways
in which processed food undermines our
sense of fullness some of which are not
by Design so for example processed food
has a very low amount of protein in it
uh much on average of course there's
some processed foods that have high
protein but on average as a class
processed foods have quite low levels of
protein it's a brilliant scientist at
the University of Sydney called
Professor David raubenheimer has done a
lot of research on this he's shown we
all know we have hunger for calories
obviously we all know that but your body
also has a hunger specifically for
protein because your body knows you need
protein to do things like build your
bones so if you think about if you have
a diet that's dominated by processed
foods as mine has been almost all my
life to get your body needs a certain
amount of protein if you're eating
processed foods which are low in protein
you have to eat a lot more of those
processed foods to get the amount of
protein your body needs he's done lots
of experim that show this if you give
people low protein food they will eat a
lot more of it to meet their body's
underlying hunger for protein itself
there's loads of factors like that going
on here with process and ultr processed
food I go through them in the book which
explain why it leads us to so massively
overeat and why it so profoundly
undermines our sense of satiety our
sense of being sated of having had
enough and not wanting more right and
it's interesting how you talk about this
is what the companies are meant to do
and it's the job of societies to
regulate them and that's why I think
this is almost uh as much of an economic
story as a health story because you do
have these food companies processing
food manufacturing food in a way that
make people not feel full and eat as
much as possible so that's one big
industry and then you have the
pharmaceutical industry on the other
side with their answer and something
that can you know effectively deliver to
their sh shareholders and that is OIC
and not just OIC but a full family of
new drugs that is going to help people
feel a little bit more full so you're on
it for a year and five months to date
can I just say one thing about that
because you're not doing this but I just
want to be um clear sometimes that link
that you're presenting is presented as
an intentional link right you've got um
you know the food companies making us
fat and then the pharmaceutical
companies stepping into profit as if as
if they're kind of acting in concert or
in collaboration I want to be clear that
is not the case right that's not how
competing forces work in a capitalist
economy it's just a misunderstanding of
what's going on right um but you're
absolutely right as Professor Michael
low put it to me who's a brilliant
expert on Hunger at Drexel University in
Philly been researching this for 40
years he said these new weight loss
drugs are an artificial solution to an
artificial problem right these processed
and ultr processed foods created this
extraordinary hole of hunger inside most
of us 67% of the calories the average
American child consumes in a Day come
from processing Ultra processed foods
staggering figure right um and what
these drugs do and I'm sure we're going
to get into how is they artificially
boost your sense of
satiety your sense of
fullness to to degree that is bizarre to
me like I realized now I had never felt
full until until I took OIC not really
I'd felt stuffed but that's different to
feeling full right I'd never really felt
sated or perhaps that's an over
statement had rarely felt sated until I
took OIC in a way that I now feel sated
every day right so yeah this has been a
really profound profound effect yeah and
so I'm curious to hear you know we hear
a lot about the studies but you like
have looked at the scientific literature
and also have taken the pill or sorry
the drugs it's an injection right so
pills for some people but yeah most most
injections at the moment right so talk a
little bit about how OIC counters this
insatable hunger that we end up being
left with from processed foods and
what's your experience like been like in
the year and five months that you've
used OIC well so if you ate something
now doesn't matter what it is after a
little while your pancreas will produce
a hormone called glp1 along with some
other hormones and gp1 is basically your
body's natural signals going hey buddy
you had enough stop eating right it's
the breakes but natural glp1 only stays
around in your system for a couple of
minutes and then it's washed away what
these drugs do
is they inject you with an artificial
copy of glp1 that instead of sticking
around for a few minutes sticks around
in your system for a whole week which
has this incredible effect I'll never
forget second day I took o zenic I was
lying in bed just behind where my laptop
is now if I turn my laptop around you'd
see it
um and I woke
up and I
thought huh I feel something strange
what is
it and I couldn't look what it was what
I was feeling and it took me about 5
minutes to realize I had woken up and I
wasn't
hungry that had never happened to me
before and I went to this Diner just up
the street that I used to go to every
morning and I'm slightly embarrassed to
say I ordered the thing I used to get
every day which was a huge chicken mayo
sandwich with loads of chicken and
mayonnaise in it and normally I would
eat that really quickly and I would
still want some potato
chips and I had
like three maybe four mouthfuls of this
sandwich and I and I was full I just
didn't want
anymore and that's how it was from then
on I just felt very full very fast um so
what this what these drugs do is they
hugely boost your sense of satiety and
it's really important people to
understand this isn't a gimmick this
isn't a fad this isn't some new fad diet
drug this is a profound scientific
breakthrough as one of the scientists
who was played a key role in developing
these drugs said to me
we've cracked the code of what regulates
appetite and it's it's simulating and
manipulating gut hormones right there
are all sorts of gut hormones that are
created when you eat if you inject
people with artificial copies of those
gut
hormones you massively reduce the amount
they eat it's why I went from eating
3,200 calories a day to about 1,800 it's
why I lost 42 pounds in the first year
it's that's incredible very yeah it's a
dramatic effect the average person who
takes a zenic we're they're the same
thing with different labels um loses 15%
of their body weight in a year um with
munaro so asmic and movi work on one gut
hormone gp1 minaro works on two gut
hormones it's gp1 and Gip the average
person who takes that loses 21% of their
body weight in a year and for Triple G
which will be coming online probably
next year which acts on three gut
hormones the average person loses 24% of
their body weight which is only slightly
below bariatric surgery and there are
now more than 200 of these drugs in
development because we know there's over
40 G hormones that affect appetite so
this is a
staggering um
breakthrough which will have staggering
effects on human health how we move how
we look on the economy you mentioned
this at the start but you know Barkley's
Bank commissioned a very sober-minded
financial analyst Emily fileld to go
away and look at these drugs to guide
their future investment decisions do
they have any implications for our
future Investments and she came back and
said if you want a comparison for what
these drugs are going to do you got to
look at the invention of the
smartphone right and I think that's what
it's the iPhone in some ways but sorry
go ahead explain how in some ways it's
in some ways I think it's bigger I mean
this is the biggest cause of death in
the United States Professor Gerald M at
Harvard yeah obesity Professor Gerald M
at Harvard calculates that obesity and
food caused illnesses cause 680,000
deaths every year in the United States
we don't usually think of it that way
right maybe your aunt died of cancer you
don't think she was killed by obesity
but obesity massively increases the risk
of cancer maybe your uncle died of a
heart attack you think oh he had a heart
attack but you don't realize obesity or
we we we know it but we don't quite put
it together as often obesity massively
increases the risk of heart disease but
obesity increases over 200 known
diseases and complications either causes
or increases um basically everything we
fear from stroke to dementia um this is
an opportunity to radically reverse that
thing that is the biggest killer in our
society by far I mean almost 10 times
more people are being killed by obesity
than by gun violence for example and
rightly we talk about gun violence a lot
you know compare that to how little we
talk about obesity gun violence is such
a good comparison because there's a lot
of gun violence in the US worldwide but
I guess no one does it like we do here
unfortunately only the Brazilians yeah
yes so but there's a very strong Lobby
that says yeah you know a lot of people
get killed but this is important for our
businesses and in the US at least and I
think worldwide business really holds
Sway and I was speaking with someone an
entrepreneur in the Pharma industry
right before we uh got on and here's
what this person said told me uh 60% of
the US GDP is consumption so what
happens when um and by the way is these
are the stats he gave me uh you have 40%
of people in the US that are obese
2third of people are overweight what
happens when these people start
consuming less than half in the food
alone right food because it might extend
beyond food what happens when these
people are uh consuming less than half
of the food that they were eating before
and even Walmart uh this is person told
me uh has in their board meeting
discussed the effects and their concerns
so you have concern with food concern
with retail
I guess like are we being set up for and
you know I kind of said we have you know
food versus Pharma but really you know
are we being set up for like a pretty
big fight that between let's say you
know this in this effectively an economy
that relies on consumptions and
consumption and the pills that might
stop consumption are we being set up for
an NRA NRA style battle here where like
you're going to have you know folks for
like the food rights or whatever it is
against people for a safer future yeah
well The Washington Post has reported
that the big food industry is already
funding body positivity push backs
against against some of this um I mean
covertly just like the cigarette
companies covertly funded uh denial
about lung cancer and just like the oil
companies covertly for many decades
funded global warming denial yeah and I
think we are and there's going to be a
huge tension there um and just the
economic consequences are just already
we're see we're seeing so many of these
kind of unpredictable effects I mean
think about you mentioned the food
companies the head of nestle Mark
Schneider has been making very nervous
noises about their confectionary Dunkin
Donuts you know um sorry crispy K Cream
Donuts rather um foras magazine uh
interview load of experts who said that
their stock was being downgraded and
then their stock didn't because goes
right after their target market so
exactly exactly I mean literally I was
their target market at least two of my
chins are due to
dunky and now I don't it anymore right I
think the loss of my customer loan must
have caused some of that plunging stock
value um yeah
and just think about the unpredictable
cascading effects um Jeff Financial just
did a big report um about a year ago to
the American Airlines saying you're
going to have to spend a lot less money
on jet fuel pretty soon because it takes
so much less jet fuel to fly a radically
thinner population and bear in mind this
is the case now when these drugs are
extraordinarily expensive in the United
States but 8 years from now asmic goes
out a patent at that point it will be a
daily pill it would be a dollar a day if
the 12 big risks that I warn about in
relation to these drugs don't bear out
or are not as are not super bad then my
prediction is that more than half of the
population will be taking them when it's
a daily pill that's a dollar a day the
effects on the economy and the society
at that point are enormous you know my
book is called Magic pill because
there's three way these drugs could be
magic right the first is the most
obvious it could just solve the problem
right and there are days when it feels
like that I've got to be honest with you
my whole life I've overeaten now once a
week I inject myself in the leg I don't
even overeat anymore it feels like magic
the second way it could be magic is more
disturbing it could be like a magic
trick it could be like a condra who
shows you a card trick while picking
your pocket it could be that over time
the 12 big risks associated with these
drugs that I describe in the book out
way the benefits I do not rule that out
that is perfectly conceivable but the
third way it could be magic is to me
actually the most likely if you think
about the classic stories of magic that
we grew up with as kids like uh Aladdin
say how do they go you find the lamp you
rub it the genie appears your wish is
granted and your wish comes true but
never quite in the way you expected
there's all sorts of unpredictable
effects right and I think we're gonna
see that some of them will be enormous
some of the anticipated um and indeed
proven positive effects are enormous you
know think about effects on heart
disease reduces your risk of heart
disease heart attack or stroke by 20%
right that could well save my life I'm
older than my grandfather ever got to be
he died when he was 44 of a heart attack
loads of the men in my family have heart
problems my dad had terrible heart
problems my uncle died of a heart attack
for people like us it could be
transformative at the other end of the
spectrum for people with eating
disorders I really fear it will be
lethal I can go into more detail on that
if you want but I think we get
opioidlike death toll of young girls who
use these drugs to starve themselves
it's one of the reasons we need to
tighten the regulation around these
drugs urgently
so you know we came up with the
smartphone comparison or rather the
Barley's analyst did if we've been
talking in 2007 I think it was April
2007 when Steve Jobs first unveiled the
iPhone we would not have been able to
predict Tik Tok and meoo and you know
door Dash and all these things that have
transformed our lives right but here we
are they've changed our societies
profoundly um and I think these drugs
are going
to is not hyperbole to talk about these
drugs in the same breath yeah and I
think it Bears repeating I mean 60% of
an economy consumption and yeah we don't
we have a president that if you know if
not we have a president if there's a
president that allows GDP to be flat
they get thrown out of office this
country this the world doesn't tolerate
negative growth but we're looking
negative growth in the face and I try to
not be like I mean I'm definitely trying
not to be conspiratorial but like how is
societ like there it just seems like
there are powerful forces that are going
to really come in opposition to this
stuff I know we can't say right now
powerful forces here haven't you you've
got the food industry you've got farmer
yeah I
mean so yeah that there will definitely
be friction between those two forces
going forward let me talk a little bit
about how how we might happen how it
might happen in the short term I mean
you mentioned that 2030 is when the
patent comes off of OIC but actually in
China that patents off now and there are
compounding pharmacies that are
effectively putting OIC together on
their own sort of off label maybe they
add B12 in to say okay it's actually
something different and that's where
lots of people are getting this drug
from and the only reason that they're
able to get it from these compounding
pharmacies is because OIC right now is
on some sort of shortage list which
means that they're able to get it uh
from these Supply chains or from these
Supply chains and there's a chance
within the next couple years that it's
going to be removed from those shortage
lists and I'm sure the food industry and
all the conern you know anyone who's
concerned about GDP would want it
removed even though like it's not uh
going to be good for for Global health
so what do you think is going to happen
on that front and how how impactful do
you think it might be if you have let's
say millions of people taking the
effectively the same drug as OIC and
then all of a sudden it goes from an
affordable uh drug to what it what it is
now if you want to get it like name
brand which is 1,300 a
week it's 1300 a month but yeah the 00 a
month yeah yeah Ju Just to to uh I would
just pull back for a moment uh I think
it's a really important question I would
just pull back for a moment and
say um if I guess a few things um the
first is the question of drug prices as
you can tell from my weird downtabby
accent I'm in fact British and I spend a
lot of my time in the US a lot of my in
Britain and I've got to tell you it
constantly stuns me the degree to which
Americans are ripped off when it comes
to drug prices um so I buy my asmic here
in Britain it's the equivalent of $250 a
month when I I've had to get it in Vegas
a few times it's like $1,000 a month
right um it doesn't magically transform
as it crosses the
Atlantic this happens for a reason in um
in the United States big farmer employs
armies of lobbyists to rig drug
regulation in the United States right
all drugs almost without you don't have
to go as far away as Britain just cross
the Canadian border all drugs are
radically more expensive in the United
States than they are in Canada or Mexico
right not because the drugs are
different it's because the American
political system doesn't work it's not
properly Democratic and it allows the
ripping off of American citizens at
every stage by the way both parties take
massive amounts of money from Big farmer
um so
that's the first thing you have to say
now there's an issue around these drugs
there's the issue of the benefits of
these drugs and the risks of these drugs
and I'm sure we're going to dig more
into that um and I don't believe
everyone who's oo or obese should be
taking these drugs there some people who
shouldn't be and I hope my book is a
kind of guide to so we can think this
through in a very personalized way
that's a very good job with that yeah oh
thank you thanks but
um but but um but what I'd say is we're
in this nightmare situation where the
people who do at the moment only a very
small Elite of people can access these
drugs so we have a situation where the
new the The Real Housewives of New
Jersey get to be bone thin while the
real school children of New Jersey get
diabetic at the age of 12 right and the
number I heard is that only 2% of obese
people uh of the obese Market is on
these glp drugs right these OIC style
drugs where uh if you're severely
overweight 20% are doing this bariatric
surgery to shink the stomach much
riskier much much riskier um yeah uh I
mean I think there's just a huge
um huge issue around that and so you
raise compounding so for people who
don't know um yeah when a drug is when a
when you can demonstrate a medical need
for a drug but there is a shortage of
that drug as there is at the moment and
and it's worth explaining why there's a
shortage every person who takes a zenic
wovi Manjaro becomes a walking
advertisement for that drug right I
think a lot about guy interview called
Jeff Parker lovely guy 67y old retired
lighting engine in San Francisco he was
very severely
obese he was in quite a lot of physical
pain as a result it was difficult for
him to walk he had gout he had liver and
kidney problems he was taking fistfuls
of pills every morning he started to
take mararo actually he was getting a
compounded version from China like you
say um lost an enormous amount of weight
came off all his pills all his medical
conditions went into reverse now he
walks his dog over the Golden Gate
Bridge every day and said to me I feel
like I'm going to enjoy my retirement
now everyone who knows Jeff looks at him
goes whoa what happened to Jeff right he
looks completely different so one of the
reasons there's these shortages is that
everyone then becomes a walking ad and
so demand produces demand produces
demand produces demand in this cascading
effect so although they have been Novo
nordis and Eli the companies that make
these drugs have been massively to be
fair to them expanding production of
course they want to they want to make
the money um they're racing to get to a
a Finishing Line that's just getting
further and further away because the
more they race the more people want it
right um so lots of companies are
producing compounded copies of these
drugs there's inherently risks in that
they're not made in FDA labs in Austria
recently there was a big problem where
people bought what they thought was
compounded some aglo tiddes the active
component of these drugs they weren't
they went into Comas they were horribly
injured there's an inherent risk in
compounded versions for obvious reasons
U
um but I understand why people are doing
it right so yeah there's um a tremendous
complexity and I think you're right that
big farmer will be pressuring to close
those Loop Pooles pretty soon I mean
they're already sending out lawyers
letters to right he that happens I mean
you could abrupt you could abruptly have
people thrown off the medicine whereas
like they can afford the compounded drug
they cannot afford 1,300 a month so what
happens if you get abruptly tossed off
the the drug that's a really important
question so
uh I want to explain what the drug
companies say and I want to explain why
they're probably right but we need to
take it with a small pinch assault what
the drugs say what what the drug
companies say is these drugs are like
statins or blood pressure meds they work
for as long as you take them and when
you stop taking them they stop working
so you regain the weight pretty rapidly
and they have funded studies that a
study that seems to demonstrate the vast
majority of people regained the vast
majority of their weight within a year
um there's a small pinch of sort in that
in that of course they have a vested
interest in telling us that we have to
take them forever because they make
money forever they do seem anecdotally
to be some people who take them for a
shorter period use them to radically
change their habits and then seem to
stay at a lower weight although I
suspect they're a minority we there'll
be more research on this soon but yeah
if you're thrown off you'll almost
suddenly regain the way right and that
could be a very big issue as we see
again these opposing forces sort of try
to jocky for a position here as this
takes off it could be worse we don't
know and what there's a lot of things we
don't know about these drugs one is so
we know if you gained a load of weight
now and then went on a diet and lost
weight and it just through calorie
restriction and exercise so not using
these drugs we know that slows down your
metabolism over time it makes it harder
to keep weight off right if you yo-yo
diet if you gain weight lose weight gain
weight lose weight it can really wreck
your metabolism so you actually burn
calories very slowly we don't know if
taking these drugs and then coming off
them slows down your metabolism probably
does most other forms of weight loss do
in fact all other forms of weight loss
do so um that's another concern as well
could you actually end up fatter than
you were if you hadn't taken the drug we
don't know but it's a concern and one of
the things that I found so interesting
in your book was say this concept of a
set point that your body basically
figures out the weight that you are the
weight that you should be and if you try
to move too far off of it at least you
know in terms of the negative it will
try to bring you back up to that set
point of weight well this is really
interesting because um so there's
there's the way people used to think
about this in the 60s and 70s and
there's the way we understand it now so
in the ' 60s and 70s scientists thought
that your weight was basically set from
birth or even in utero that basically
from when you're born you have a certain
fat percentage that's kind of innate to
you right so think about your
temperature set point as an
analogy we have a natural set body
temperature if you go higher than that
your body works very hard to bring it
down it makes you sweat it makes you
really want to get into the shade if you
go lower than that your body works
really hard to bring it up it makes you
shiver it makes you seek warmth and it
was thought that so it's very hard to
stay out you basically you can't stay
outside your safe temperature level your
temperature set point for very long
right your body really works to keep you
there and if you do stay out of it for
long you get very unwell um so it was
thought there was something similar with
your weight that you had an innate set
point that just sort of regulated you
know you go a little bit above or a
little bit below but it was basically
set and
regulated and then the Obesity crisis
happened mainly in starting in the early
1980s late '70s early ' 80s when I was
born I'm not blaming myself I'm not like
Daman in The Omen go and cause it but
um and
that seemed to blow set point Theory up
right well what's going on if it's set
if it's innate and
biological how come it changed so much
so quickly but what scientists realized
this is contested but I think it's quite
persuasive is um actually what happens
is you do have an innate set point but
as you gain weight your set point Rises
this is really important for
understanding why the alternative to
these drugs diet and exercise does not
produce sustained weight loss for about
85 % of people who try it so let's say
that you now gained
40 and you tried to lose that 40b
through calorie restriction and
exercise because your innate set point
has risen your brain is trying to hold
you at that higher weight yeah all sorts
of physical and biological changes will
happen in your brain and your body to
try to stop you going down it will make
it will slow your metabolism down so you
burn calories more slowly or make you
crave more sugary salty foods all sorts
of changes happen
and there's lots of evidence for that
overwhelming evidence about metabolic
slowdown for example and I remember when
I first learned
that thinking well that can't be
true because why obesity is really bad
for your health why would Evolution
endows with the desire to hold on to or
biological mechanisms to hold on to
obesity given that obesity is so bad for
us it's so maladaptive it doesn't make
sense to me and it was explained to me
by Professor Michael low I mentioned
before it drank
um the best way of thinking about this I
think which is you got to think about
the circumstances where human beings
evolved in the circumstances where human
beings evolved the situation we live in
now essentially never happened or
vanishingly rarely which is where you
have infinite abundant calories all
around you far more than you could
consume and they last your whole life
right that just never happened so
Evolution did not prepare us for that
scenario the scenario that did happen
quite frequently that Evolution did
prepare us for is the exact opposite
famine famine was very common right uh
in the circumstances where human beings
involved it was quite likely there would
be a famine in your lifetime if you
think about it in that context it makes
perfect sense that if you gain weight
your body fights to hold on to the
weight right if there's a famine the
fattest man at the start is the last man
standing right there was a famine the
version of me from three years ago is
going to still be alive at the end
whereas Timothy shalomay will die in
week one right and I'll cry over his
body but he'll bury him and we'll have
to move on right ex rest in peace to be
the J exactly so you can so you
see set point this innate set point is
preparing us for a famine that now is
never going to come right right so that
explains why diets don't work it also
explains one Theory or this this is
significantly more contentious there's a
huge debate about what these drugs so we
now know these drugs are primarily
working not on your gut but on your
brain you have glp1 receptors not just
in your gut but in your brain they're
profoundly changing our brains from
interviewing The Cutting Edge
neuroscientist as I did in my book this
is very
clear and it's s disconcerting to
interview the leading neuroscientists
you say to them what is it doing to my
brain and they kind of go yeah come back
and ask us in a few years we don't
really know um but one theory about what
it may be doing to the brain is they may
it may be lowering your biological set
point H the equivalent of this is a very
crude ology I suspect the scientist I
interviewed would think it was overly
crude but it's a bit like taking your
set point you know to the resetting your
iPhone to the factory settings right it
lowers your set point for the duration
that you take the drugs so again you
see the debate about what causes obesity
is intimately related to the debate
about how these drugs work in all sorts
of fascinating ways one of the things
that I think you was really fascinating
that you tackled in the book of course
you talk about the risk like there's a
slight update your risk in getting
thyroid cancer from this but not a
massive it's not like it you're sure to
get thyroid cancer if you take this it's
a little bit more of an increase and
your risk there but the thing that
really struck me as the risk was um you
talk about how it could potentially dull
people's emotionally a little bit to
pleasure and reward and like physical
rewards uh for instance like people
start to drink less um but there's a
concern that it might just make
everything in life less pleasurable uh
could you talk a little bit about about
why that might
be so I want to stress this is all the
scientists who've expressed this concern
expressed that it's speculative and we
can't be sure but so some scientists
have
argued that these drugs seem to be
causing depression or even Suicidal
Thoughts in a minority of people who use
them that in itself is contested it did
not persuade the European medicines
agency although the FDA and the United
states does have a warning about
potential suicidal idation from these
drugs and there's a huge debate about
why that might
be some of it relates to the question
about the brain effects so a different
theory about how these drugs may work in
the brain and on the brain is that in
your brain you have something called
your reward systems your reward systems
are
what motivate you to do anything that
propagates life right we eat because we
get reward from it we have sex because
we get rewards from it we engage in
social behaviors because we get rewards
from them they all make the reward
centers of the brain
harm one theory about how these drugs
work is they may be dampening your
reward
systems so it may be that I no
longer feel the urge to eat a Big Mac
over a salad because I get less reward
from the Big Mac than I did before there
does seem to be some evidence in this
lots of people report losing their
pleasure in eating
after taking these
drugs now although not everyone and I
actually it actually increased my
pleasure in food but I can I'm unusual I
can talk about why if you like but
um
so you don't have to think about that
problem for long to realize okay if it's
dampening your reward system for
food is it dampening your reward system
more generally is it dampening your
reward system for in my case reading
writing things I love right would it be
doing that um so that's a huge debate
it's we don't know is the honest answer
I actually think
though there's something much more basic
and more easily grasped actually that is
going on for lots of
people and I felt it happen to me so for
the first six months I was taking the
drugs I was was in a slightly weird
position where I was getting what I
wanted I was losing loads of
weight and all sorts of good things
happened
but I actually didn't feel better
emotionally actually I felt slightly
worse and it's hard to generalize from
any individual maybe it's just other
stuff that was going on in my life
but I had a real Epiphany about this in
Vegas um where I spend a lot of my time
I I I was um I was in Vegas it was seven
months into writing the book and I was
there um I was researching the murder of
someone that I knew and loved for um a
different book that I'm writing in as
you can imagine that was was a very
painful and difficult thing to
do and so one day I did what I've done a
thousand times on autopilot I went to
the KFC on West Sahara and I ordered a
bucket of fried
chicken as I would have done before I
was taking asmic and I had one of the
chicken
drumsticks and I suddenly looked at the
chick the bucket of chicken and I
thought oh [ __ ] I can't eat
this and I remember Colonel Sanders was
on the wall it was like he was looking
down at me going hey what happened to my
best customer we were friends exactly
best friends um talking about a share
price decline um and and I had had
Epiphany in that moment where I realized
so what these drugs do is they interrupt
your eating patterns radically obviously
that's key to how you lose weight and is
obviously a good thing in many ways but
there's scientific evidence for five
reasons why we eat that I go through in
the book only one of them is you know to
sustain our bodies that all the rest are
psychological right in my case I
realized from when I was very
young how much of my
eating was driven by desire to comfort
myself to numb myself to manage my
emotions and I couldn't eat that way on
asmic right if you try to overeat on
asmic you will literally vomit you you
can't do it it would be
awful and so these feelings kind of came
to the surface it was very conscious in
my mind I think oh you're just going to
have to feel like [ __ ] today then right
right
now that can be a good
thing bringing those emotions to the
surface can help you find a better way
to deal with them clearly there are
better ways to deal with sadness and
grief than Colonel Sanders um but some
people find worse ways right like they
they when they stop having that food
addiction they go to alcohol or other
things that harm them even
more
yeah
exactly
so I think and we know this with other
forms of um I often think the best way
of understanding the effects of these
drugs is actually to compare them to
bariatric surgery people have only been
taking these drugs for obesity for a
couple of years now but uh when it comes
to
um ex radical weight loss the most
reliable method up to now has been
bariatric surgery
um things like stomach stapling gastric
sleeves gastric bands and so
on so when we look at bariatric surgery
what do we see I mean first thing we
know is that it's a [ __ ] horrible
operation right one in a thousand people
die in the operation it's no joke it's
Grim but why do people go through that
well they go through it because they get
extraordinary benefits so bear in mind
that they obviously had to be really
quite obese to get the surgery in the
first place but if you have bariatric
surgery in the seven years that follow
you are 56% less likely to die of a
heart attack you are 60% less likely to
die of cancer you are 92% less likely to
die of diabetes related causes in fact
it's so good for your health that in
those 7 years you're 40% less likely to
die at all of any cause so we know it
has extraordinary benefits but also we
know
interestingly after bariatric surgery
your suicide risk almost
quadruples which is crazy which is I
mean I want to stress it remains low
suicide is RIS anyway but that's a huge
increase right and you think why would
that be some of that is possibly the
actual physical effects of dealing with
the surgery which as I say is
grueling but I think it's much more this
this kind of thing right you can't
comfor eat um as Professor Carell Laro
who's done a lot of work on both on
barric surgery and on these drugs said
to
me part of it I think
is a lot of people who are
obese tell themselves if only I was
thinner my life would be great right and
then you lose all this weight and your
husband's still an [ __ ] and your boss
is still a prick yeah and here you are
right um so I think there's all sort I
go through a lot more in the book but I
think there all sorts of complicated
psychological phenomena that are going
on a lot of women who've been sexually
abused consciously or unconsciously gain
a huge amount of weight in the aftermath
to make themselves safer you're less
likely to be sexually assaulted if
you're if you're obese although it can
still happen it's more rare um and they
experience losing weight as actually
becoming severely and suddenly
vulnerable there's all sorts of
complicated things going on the US just
approved I think kids at 12 years old
can start taking these medicines is this
a good
idea the debate about
children is the thing I find most
difficult and it takes the core debate
about these drugs and dials it up dials
it up to 12 as far as I'm concerned
because what you have to weigh is two
competing
risks the risks of obesity which are
enormous if you're obese when you're 18
years old you have a 70% chance of
developing diabetes in your life and
Diabetes Type 2 diabetes knocks 15 years
off your life on average and that's one
of the effects of being obese there's
more than 200 of them and they are
horrendous you got to weigh those risks
against the risks of these drugs which
are significant and particularly with
children the most uh worrying risk about
these drugs which is that we don't know
the long-term effects of these drugs no
one's been taking them that long and if
you're a 6-year-old and you're giv these
drugs and Novo nordis is currently doing
a trial on giving them to six-year-olds
if you're a six-year-old and you take
these drugs presumably saying you're
going to take these drugs for 80 years
we have no idea about the long-term
effects so I interviewed parents who
given their children a zic I have a lot
of feeling for them it is a horrendous
dilemma what it makes most clear is we
should we should not tolerate our
children having to choose between a
risky medical condition and a risky drug
we don't have to accept that choice I
went to Japan where there is no
childhood obesity that's not an
overstatement there is statistically no
childhood obesity I got to tell you it's
a really weird thing to walk around
schools with a thousand children and
realize there is not one fat child in
that school why is that is because they
didn't allow processed food to [ __ ]
their kids up right and I talk in the
book about how Japan achieved that Japan
was not a healthy country 100 100 years
ago it had one of the worst diets in the
world right this was done by absolutely
concerted government policy we can do
that too obviously we need to do that
but at the moment we're in a trap right
and these drug draw a risky risky Rusty
trapdoor um I don't blame any parent who
makes any decision on that we got to
deal with the wider forces that have got
us into this shitty situation in the
first place and then parents have to
make that agonizing choice I hope my
book will help them make a more informed
choice but I really empathize with them
because that is the hardest of the hard
questions that are brought up in my book
magic pill the book is Magic pill the
extraordinary benefits and disturbing
risks of the new weight loss drugs you
heard a little bit about it here I
really suggest you go pick it up whether
you're thinking about taking it or
whether you're just uh interested in
what the broader effects are going to be
it's a great book yoan hary thank you so
much for joining us oh thank you so much
I meant to say as well all my Publishers
tased me you can get an audio book as
well which is read by me if you go to
magic book.com but pretty much anywhere
you can get the book the physical book
The ebook I meant to say you can get it
from all good book stores but you can
get it from lousy book stores as well we
have a quality test I've really enjoyed
this what great questions thank you
thank you so much we'll see you next
time on big technology podcast