The new weight loss drugs: Magic solution or magical illusion? with Johann Hari

0:04 This is Crappita Happy and I am your host, Cass Dunn. I'm a clinical and coaching psychologist. I'm mindfulness meditation teacher and of course author of the Crappita Happy books. In this show, I bring you conversations with interesting, inspiring, intelligent people who are experts in their field and who have something of value to share that will help you feel less crappy and more happy. Johann Harry is an international best selling author. You will know him from his previous smash hits, Lost Connections and Stolen Focus. Had him on the Podge to talk about that one. Johann has recently turned his attention to the extraordinary benefits and disturbing risks of the new weight loss drugs. Johannes started taking ozembic in January twenty twenty three, and while he was thrilled to finally have a solution to his own long term battle with his weight, he was also wildly conflicted. There is just so much that we don't know about the downstream effects of these medications. So Johann spent twelve months traveling around the world talking to experts, and as a result, he has published his book Magic Pill in which he outlines all of the extraordinary benefits that are to be gained with these medications, also outlines twelve significant potential risks.

1:30 It is a complex topic. It's a big episode, so grab a cup of tea strap in. I think you will find this just as fascinating as I did. Here is my conversation with Johann Hari. Yohn. Welcome to the Craft A Happy podcast. I'm so happy to be back with you. And last time we spoke was the height of COVID when we were all kind of sheltering in place, and it seems so nice to actually see you in the three dimensions. I'm so happy. I know this is so weird for me to be sitting from you when I'm usually sitting like in front of a computer screen. Thank you for having me to your house, which nobody can see because camera. Thank you so much for coming. I'm well excited, So, Johan.

2:12 What I love about your work, but I think most of us appreciate about your work is that you take an issue or something that is really culturally relevant and then you like just explore it to within an each of us. Like you do. You take this issue and look at the layers of complexity that are involved in just what we consider to be like just one single issue. So at the moment, the thing that you have been researching which is really interested to hear was these new weight loss medications O, zenpic, etc. We go v there's lots of new ones coming out, which is really obviously very topical at the moment, and people are really divided on their opinions about these medications, and there's so many conflicting stances and ideas about whether they're good or bad, or who should be entitled to use them or who isn't so so interested to have this conversation. So can you just start by sharing? So when you first came across a zempic, for example, which you did as somebody who has acknowledged that you've had weight issues for your life, like, what was your first reaction to to that?

3:15 I remember exactly how I felt. It was the winter of twenty twenty, and it was that moment when it looked like the pandemic was finally ending. So for the first time in two years, I went to a party. I remember it's so Vivily, and it was a party thrown by a kind by a Hollywood star, and I remember on the way there, thinking this is going to be interesting, right, because I'd gained loads of weight during the pandemic, like lots of people. But I thought, huh, all these Hollywood stars, they're going to have gained weight, right, it's going to be And I didn't think they would have podged out as much as the rest of us, but I thought, hah, it's going to be interesting to see them in this different light. And I arrived and everyone looked like their own Snapchat filter. Wow. Everyone was kind of cleaner and clearer and sharper. And this wasn't just the affect of them being famous as people I'd known before, And it wasn't just the kind of actors.

4:01 The agents look like that, their wives, their husbands looked like that. It was really weird and walking around feeling a little bit kind of schlubby and embarrassed. And I bumped into a friend of mine at the edge of the dance floor and I said to her, Hey, it looks like he looks like everyone really did take up pilates during the pandemic, and she laughed and I kind of looked at her and she said, well, you know why they all look like this, And I just looked at her blankly. I had no idea what she was talking about, and she pulled up on her phone an image of an ozembic pen. And in the next few days I read a lot about these drugs. And I don't think I've ever felt so conflicted, so strongly conflicted about anything, as I was when I started learning this.

4:45 I remember, like you said, you know, I'm someone who's yoyoed in my life from being you know, slightly underweight to being obese many times. And I thought, well, you know, I could, I could make a case that I've been waiting for this all my life, right, you know. At one of the low points in my life was Christmas Eve two thousand and nine, when it was lunchtime and I went to my local brunch of KFC in East London. And I went in and I said my standard order, which was so disgusting I were even repeat it. And the guy behind the counter said, O yeah, and I'm really glad you're here. And I said all right, and he he said, wait a minute, and he went off behind where they fry all the chicken, and he came back with a massive Christmas card and everyone who was working that day, and they'd written it to our best customer.

5:25 And one of the reasons my heart sank is I thought, this isn't even the fried chicken shop. I come to the most, how can this be happening to me? Right? So I could make a case. Look, we've all been trying to diet for forty years, and every year we get fatter and fatter. What we've been trying doesn't work. There's clearly a biological component to this. If there's a drug you can take that reverses the health harms of obesity, that's great. But I also immediately thought, well, there's been a lot of diet drugs in the past. They've always led to catastrophes. And even more importantly, you know, we don't have an obesity crisis because some biological malfunction happened in all of us, also many of us, you know, massive and rising numbers of us. We've got an obesity crisis because the food industry screwed up the way we eat in really profound ways. Surely we need to solve the problems. So many of my books are about stop treating symptoms, deal with actual the actual causes of our problems.

6:21 So I felt incredibly conflicted then, and I spent a year taking these drugs. For reasons I'll explain, But I spent a year then traveling all over the world, intervening the leading experts from Iceland to Minneapolis to Tokyo, the biggest critics of the drugs, the biggest proponents of the drugs, And at the end of that year, I know a lot more. There's a lot of information that we can weigh, but the honest truth cast is I'm still really divided, right, And I think this is really complicated and difficult topic where we're going to have to think our way through it inch by inch, point by point, being very sensitive to the huge benefits of these drugs and the huge potential risks of these drugs. Right the point that you make that this is a drug that's been created to treat a problem that's been created by the food factory, what do you call it?

7:08 Like fake food? Even my daughter says to me when her friends come over, she's we don't have food in our fridge. Mum, we don't have food, and so there's so much Finnish. She goes, no, we don't have food, we have ingredients and isn't that just the reverse of what you talk about in the book about how food is food, food is ingredients. This generation has grown up like if you can't just take it out of a packet, and that's what we've all grown up with pretty much. You know, if you can't just take it off the shelf and out of a packet and it's easy and convenient and cheap, then what are you even doing? Totally right, And it's one of the things that shocked me is how rapidly this changes happens. If you think about obesity, right, I'm blanking on his name, the Australian Prime Minister who drowned in charasitydhole, every interesting thing. Go and look at the archive footage of the beach that day, the day that he drowned, and look at just the random sampling of Australians who are on that beach that day.

7:57 They're all by our standards thin, right. You look at it and it seems a little bit odd at us, like what was this like a fashion models convention that was happening on the beach that I ain't know if you look at the figures. So the year I was born nineteen seventy nine is basically the beginning of a massive transformation. The year I was born, six percent of British people were obese. It's now twenty seven percent and rising rapidly. It's similar figures for Australia. It's not quite as bad, but very similar. The average American today is twenty three pounds heavier than the average American in nineteen sixty. This is an enormously rapid transformation, unprecedented in human history. When my parents were kids, were teenagers, there were no overweight children at their schools. None, right, And now you know, I go to my nephews and niece's schools and my god children's schools, you know, a huge proportion of the children overweight obese. So it's a weird thing. This has happened slowly enough that we've sort of just gone with it, yeah, but quickly enough that when you just look back relatively recently, you start to see how shocking that is. And we know why that happened. There's a few reasons, but we know the key reason why that happened, which is that we now eat food that bears essentially no relationship to the food our grandparents or our great grandparents ate and weirdly again, that happened fast enough that there wasn't that much friction, except funny enough in my own family, right.

9:20 So my dad's from a little village in Switzerland called Candishegg, so he grew up in a wooden heart on the side of a mountain. His parents were farmers and in Kandershegg when he was a kid, as everywhere in Switzerland and has pretty much ever in the world up to then. You ate fresh food all the time, right, You ate food that had recently been grown or recently killed if it was meat, and you cooked it yourself with fresh ingredients and you ate it that day. That was what food was for all of human history until very recently. My mum grew up in a working class part of Scotland, which was ahead of the curve. Right. It is the country that invented deep fried mars bars. So they didn't do that, right, I mean, they did more fresh food than we do now, but they, you know, they ate fried, stodgy food that you stored up putic because they were working really hard. They were exhausted. You needed to do that, right.

10:09 You didn't have time to come home and cook because you were so dog tired from all the work you had to do. And my parents they met here in London. They met in a nightclub in Carnby Street, and my dad only spoke ten words of English, and my mother always says, he seems so nice when I couldn't understand what he was fucking seeing. And they had what my mother caused, a series of one night stands, which I tried to explain, is not a concept that makes sense. If there's more than one of them, it's not a one nightstand. And they she got pregnant, they thought they had to get married, and then he learned English and it all went wrong. But throughout my childhood one of the things they really thought over was food and what I ate, because between the time I was born and the time I was ten, basically the entire diet of the Western world shifted from looking a lot like the diet my dad grew up eating to one that was a lot like the diet my mother grew up eating, so from fresh food that people prepare on the day to pre process, prepackaged food. And it turns out that shift has profoundly altered our bodies, how we move, the kind of diseases we get, and I can talk more about the conflict within my own family. But there was an experiment that I learned about in writing my book Magic Pilm that I think perfectly distills what that shift has done to us. There's a brilliant neuroscientist called Professor Paul Kenny who's the head of neuroscience at Mount Sinai in New York. And when he was in his twenties, he moved to do his PhD from Dublin, where he's from, to San Diego in California, and quite quickly he clocked Americans do not eat like Irish people, right. They seem to eat different kinds of food. They seem to eat

11:40 much more. And he leaned into it and quite quickly he gained like thirty pounds. I think it was within the two years, again thirty pounds. And he noticed that this American food seemed to make him feel very different. He was eating much more of it and it seemed to affect him differently. Who started to wonder, what does this food do to your brain? Does it change you? So we did an experiment which I've nicknamed Cheesecake part that's not his name, where we he did He's got a group. It's a pretty simple experiment. He got a group of rats, and he gave them an infinite supply or a huge supply of the kind of food that they evolved to eat. Right, just you know, pellets, that's kind of whole foods, right, the equivalent of what my dad grew up eating. And he noticed, you can give them a huge amount of that, but when you give them the food they grew up with, the food they evolved for, the eat enough of it that they're not hungry, and then they'll stop. Right, So they never made themselves the beast. They could have carried on eating and eating and eating, and there was a huge amount of it, but they didn't. They had a kind of nutritional wisdom when they were given the kind of food that they evolved to eat, and then they would stop when they were seated, when they'd had enough.

12:40 Then he did an experiment. Then he tweaks the experiment. He introduced the American diet. He gives them Snickers bars, he gives them fried bacon, and he gives them cheesecake, and suddenly they act very differently. Their nutritional wisdom disappears. With these foods, they would eat and eat and eat, and they were hugely obese. And he said, literally within a couple of days, they were different animals. They were in their brains different, they were physically different. They started to show signs of all sorts of physical problems, and they seemed to be unable to stop eating this food or to regulate their eating around this food. Then he tweaked the experiment again. He took away all the junk food and put them back with a diet that was nothing but the food they bolt eating, the kind of healthy pellets, and he thought, he knew what would happen.

13:28 He thought, what would happen? So now they're going to eat more of those pellets, and that will prove that this kind of junk food makes you expands your diet and makes you want more. That is not what happened. Something much worse happened. Once they'd lost the junk food, once they only had the pellets, they refused to eat anything at all. It's like they had ceased to recognize the healthy food as food. They literally starved. Eventually, when they were literally starving to death, then they went back to eating the pellets, but they really resisted it. And I think that's what really happened to me, right, Oh, never forget Paul, Professor car said that. I said, you know, ever since he did that experiment, he has never been able to eat cheesecake again. He partly has his mental picture of the rats would like hurl themselves into the cheesecake and eat their way out, and they would come out just completely slicked with cheesecake all over their faces and their whiskers, and he's like, no, anyone offers of any cheesecake. So that I know, thanks, right, And I think something very similar happened to me when I was a child. Something very similar has happened to huge numbers of people across our society. Seventy eight percent of the calories that the average American child gets now comes from ultra processed food, so food that is nothing like the food that our grandparents and great grandparents ate. And as Gerald Mann, who's one of the leading nutritionists at Harvard, he's the guy who invented the food label that's on all food in the United States, said to me, there's something about the food we're eating that is profoundly undermining our ability to know when to stop.

14:51 There will be people who argue, we know what we need to do. We need to go back to eating real food again, and that's a matter of willpower. So why can't people stop eating junk food start eating the healthy food. But let's start with like, what is the effect of the weight loss medication? How is it proposed to reverse this if we've all been messed up and hunger signals have all been messed up by the food we're eating. So the way it works, if you ate, now, if you had a kit cat or anything, you would get your in your gut, you would get the release of a hormone called GLP one, and gopo on GLP one is basically a natural signal in your body saying stop eating now, cass, You've had enough, Right, But natural GLP one only stays in your system for about for less than ten minutes and then it's washed away. Right, But it's usually enough that you kind of go, oh, I want to stop now. Right. What these drugs do A zenpic would go the monjano and others. There's additional mechanism and some of the other drugs, but the core thing they do is they inject into your body a copy, a replica of that GLP one hormone, but instead of it being washed away in a few minutes, it stays in your system for a whole week, which means that when you start to eat, you very rapidly get the feeling that you're full and you don't want anymore, so it hugely dials down your hungers. I remember the second day I took I'm taking a zmpic. I remember the second day I took it, waking up and having this really weird sensation and lyne there thinking what am I feeling?

16:16 And I could feel like mild nausea, which are very common sighted of it, but that's not what I was trying to lookay, And I suddenly realized, Oh, I'm not hungry, like I don't ever remember a day before that when I didn't wake up hungry right when I wake up, I would usually wake up rabbitus anger off and be woken up by my stomach grumbling. Right, I thought, oh, I'm not hungry, and I went to the caf just around the corner from here, run by a lovely Brazilian woman called Tasiana, and I ordered the thing that I always have for breakfast at the time and had for years, which was a big chicken mayo bread roll. Right. She brought it over to me and I had like four mouthfuls and I just couldn't see anymore. I was full.

16:59 Whereas normally I would that whole thing and I would still be a little bit hungry, but I would get through to lunchtime right, probably with a snack in between that and lunch. I thought, that's really weird, and then I went for lunch. I went to the Turkish restaurant well sort of the road where I have my normal breakfast lunch, which was a Mediterranean lamb, and again few mouthfuls, I was full. That night, I went to Camden Market not far from here, and I can hear anything, and I thought, this is like the shutters had come down on my appetite. It was very strange. Now we know, and this is a very important thing to think about for all sorts of reasons. It was initially thought that that injecting that copy of GLP one into your body primarily has an effect on your gut, that it must slow down your gut or something like that, and it does indeed have significant effects on the gut. But we now know actually it primarily works by having an effect on your brain. There are GLP one receptors in your brain in addition to in your gut, and these drugs actually primarily work by changing your preferences in your brain, not your gut, which opens up a whole other set of potentially alarming and potentially liberating effects. But yeah, that's the kind of that's how it begins when you're taking it for most people, not.

18:08 Everyone, So it reduces your appetite and amazing, so you're eating less and therefore people lose weight, and they do lose weight very quickly. And then the argument is that you have to be on the medication. Most people will need to be on it long term in order to maintain that effect. So is it not the case that when you've been taking it for a period of time and you've eaten less. I'm just thinking of the old way of thinking of your stomach shrinks and you get used to eating less, So then you can come off it and then you'll continue to eat less or do people typically revert back to being very hungry again? And is this why people tend to need to stay on it. Yeah, So to start with the first bit of what you said, which is about losing weight, Yes, so it's really important to uncertn how significant the weight loss is.

18:55 So the average person taking ozm pic will go V, they're the same drug with different names marketed for different purposes, loses fifteen percent of their body weight within a year. For Monjano, which adds another gut hormone. So as M people, go V works on GLP one, Monjarano works on GLP one and another gut hormone called GOP. The average weight loss is twenty one percent within a year. Wow. And the next drug coming down the line, triple G, which is not available yet, the average weight loss is twenty four percent, which is only a few points lower than barotric surgery. Right. That is a staggering level of weight loss. And we're going to talk. I'm sure about lots of the risks and reasons why I'm very worried about some aspects of these drugs, but I do think it's important to talk about the overwhelming benefit of that.

19:39 And the overwhelming benefit is very simple. I wish this wasn't the case, but the scientific evidence is very clear that obesity enormously harms your health. There are over two hundred known diseases and complications that I'm either caused or made significantly more likely by obesity, and even the ones that we kind of think of quite casually are horrendous. I mean, I'm embarrassed. Say, until I started doing research on diabetes, for example, I thought, Okay, diabetes is bad if you don't get treatment. But if you're diabetic and you're getting insulin, then you're basically like everyone else, right, that it's not that bad as long as you get treatment. That is really wrong. If you get diabetes when you're young, it knocks on average, fifteen years off your lifespan. Right.

20:21 It's the single biggest course of black preventable blindness in our society. More people have to have a limb amputated in the United States every year because of diabetes than because of being shot. I mean, it is a huge and devastating health condition, which you know, fourteen percent of Americans already have and nearly a third are pre diabetic. So we're talking about and that's just one of the many many It makes you much more likely to develop cancer, dementia, heart attack, stroke, have knee problems, hit problems. I mean that the list is devastating. And what we know is when you reverse obesity, you massively reverse these risks. Reversing obesity has been extremely hard up to now. The best comparison point we have is bariatric surgery. Right, So obviously, in it's important to stress people who get bariatric surgery obviously severely obese. So bear that in mind when you think about these figures. But if you look at the improvement in people's health, and they are big drawbacks to bariatric surgery, but if you look at the improvement in people's health after bariatric surgery, it's kind of staggering. In the seven years after you have bariatric surgery, you're fifty six percent less likely to have a heart attack, you are sixty percent less likely to develop cancer, and you're forty percent less lightly to dive any cause at all. Right, So what these drugs are doing is giving that benefit to you without the horrors of barractric surgery, which are very invasive and very unpleasant. People might know about that.

21:44 So there's a huge I mean, I can feel how much healthier I am now I have reversed my obesity. You know, my BMI went from over thirty to I think it's twenty three at the moment. So I've lost a lot, I've lost three stone, right, But also if my body weight decline has been incredible. My my body weight was I think thirty two percent, which is quite shocking. I mean a whale, it's thirty five percent, right, and it's gone down to twenty two percent, So it's a huge for I've lost basically I've lost nothing but fat. Wow. So yeah, there are obvious, really significant benefits to that that we need to weigh alongside the significant risks. Thing about weight is there are so many reasons. So we talked about the food industry and the manufactured food and the impact that that has. There are so many other reasons why people gain weight and struggle with their weight.

22:30 People eat for all sorts of reasons besides nutrition, clearly, and you cover this in the book as well, like people eat for emotional reasons. But there is this persistent way of thinking in our society, Like the argument is valid, obesity is a health crisis. It's a really significant health crisis, and this medication to reverse that is that's amazing. Is this persistent view in society that it's an individual issue, it's a will power issue. So why do you need to take this medication. This isn't me talking this, Yes, this is what's out there. This is what you see people saying on the internet. You know, well, why don't you Why can't you just get some willpower about you? Like, why can't you just make different decisions? What's your answer to those people?

23:13 Those people aren't wrong, but they're only seeing a small part of the picture. Right. Willpower is real, and will power can need to weight loss. But the way I started to understand it, you know, that was the dialogue I had in my own head, right, so I really understand where it comes from. Whenever I gained away, I'd just go to myself, are you fat, prick? Just eat less? What's wrong with you? And I would have periods where I exerted my willpower and I ate significantly less and I lost weight, right, and then it would always break. And I only really began to understand this when I went to interview one of the leading experts on diet in the world, an amazing woman called Professor Tracy Mann at the University of Minnesota. Interviewed her in Minneapolis in a interviewed her in a bakery where they literally when I came in, they said, have you been here before?

23:54 I said no. They said, oh, we'll give you a free cinnamon mum. Then there's this massive eye cinembon the must I like a thousand glories and it at least and Professor Mann has been researching this for a long time. When she started researching the effects of diets in the year two thousand, she noticed this slightly weird thing. So there is no dispute that if you run a calorie deficit, if you burn more calories than you eat, you will lose weight. Right, No one could dispute that unless they're disputing the laws of physics. Right. And she would look at the studies success in diets and the scientific evidence of the time. She showed diets really work. If you look at diets, you follow people for three or six months, lots of people, not everyone, but lots of people lose lots of weight. But she also knew lots of people who'd been on diets and it had not worked. And she was kind of puzzled because she kind of go, well, these studies they seem to act like so you lose weight for three months or six months, and then the story ends and you stay at that lower level forever. Right, That doesn't seem to match the experience of most people I know. So she looked at at that time, there was only a very small number of studies I think it was twenty four that had looked at the effects of diets, not three months out or six months out, but two years out or in a handful of cases, five years out. What she found is, over the longer term, the diets almost always failed, not invariably, but it was a very small number who succeeded. The average person two years after starting a diet weighs two pounds less than they did at the start. So it's not nothing, but that's a really, really small effect, and it was a small minority. For him, there was a bigger effect, but it was it was tiny, right. I think, well, why

25:25 would this be? And I spoke to a lot of experts about this and the way they explained it to me, and the science for this is really solid. If you go back to the sixties and the seventies, scientists thought they understood what determined any individual's wait. They thought that when you were born, you had something called a biological set point, a kind of amount of body fact that your body wanted you to carry, and you know, you could go a little bit above or below it depending on circumstances. But basically your weight was kind of fixed from when you were born. Right way of thinking about it by analogies with temperature. Right, so your body, everyone listening, your body wants you to be a particular temperature, whatever it is, thirty nine degree centigrade, whatever it is, right, and if you go above that, your body will work really hard to bring you down. It will sweat you know it, it will make you really really want shade.

26:12 And that's completely involuntary, right, Your body does that without your conscious mind having to do it. Or if you get below that temperature, if you're really cold, it will make you shiver, which warms your body up, so your body really has will fight very hard to keep your temperature set point. And then the obesity crisis comes along and the idea of an obesity a kind of body weight set point just kind of falls apart because they were like, well, it doesn't make any sense anymore if if so many people are getting so much more overweight, it can't be there's a set point. But then they realize what was actually happening. According to many scientists. Not all of them agree, but it's there's a broad agreement on this. Is that actually your body has an expanding set point. So let's say that you now gained three stone, right, your body set point would rise. It would try to keep you at that hi higher weight. Right, It would try to hold you. It would try to keep you at three stone heavier than you are now. And if you tried to come below that, and you could exert your willpower and you would have some effect, your body would fight really hard to bring you back up. It would slow down your metabolism, it would make you crave sweet, fatty foods, it would change your hormonal balance, it would make you more tired when you contemplated exercise. So as you become obese, a series of biological changes kick in where your body tries to resist you going below that level.

27:34 As Dr Giles Yohe, who's one of the leading obesity researchers at Cambridge University put it to me, your brain hates it when you lose weight, and it will fight really hard against it. And remember when I was told that, thinking well, how could that be? Why would that be? That's such as that would be such a bizarre biological malalapdation, because obesity harms health. But they kept explaining to me, you have to understand it in the context in which human beings evolved, in the context where human beings evolved. In fact, in every human context until four years ago, fifty years ago, there was never a situation where the danger was that you would, for your whole life, have far more calories to consume than was good for you. Right, That would never happen. Right. There might be small pockets where you'd have a surplus, but they would go away quite quickly. Right. The risk in the circumstances where we evolved and where we existed for three hundred thousand years was very different. The risk was famine. Right. The risk was you've got weight now, but tomorrow the food supply could go away and you could starve. And in a famine, the fattest guy at the start is going to be the last man standing at the end. Right, Kate Moss is going to die in week one of the famine, and you know, a very overweight person is going to still be alive. So our biology prepared us to survive a famine that is no longer coming, and all our biologies meant we've got this maladaptation. So when people say just go on a diet, right, dieting can make a difference.

28:53 And there's a small minority for whom it works, and there's an interesting debate about why there's this small minority when it fails for most people. But we've just got to be honest, we've really tried that as a culture and as a society is the primary response to the problems caused by this totally new kind of food that we're all consuming, and it has failed catastrophically for most people. Right, the best argument for these drugs, and there's lots of arguments against them that I'm sure we're going to get to, but the best argument for these drugs, in addition to the health benefits of reversing obesity, is we are stuck in a trap. Yeah, and this is a trap door right now, it's not the only trap door, and the other ones that I looked at that we can get to it, which are not just the simplicity of an individual going on a diet. But yet, if the answer was go on a diet, we wouldn't be in this crisis.

29:37 Because I doubt there's a single overweight or obese person who hasn't been on a diet. And the way I began to think about willpower is will power is definitely real, right. Willpower is like an umbrella in a really bad storm right now. For some people, that umbrella is going to get them dry across the street, you know. But for most of us, the storm is so powerful it's going to break that umbrella. And is it for that reason that they're quite clear that they consider this to be a lifetime medication. Oh yeah, so you asked about that's really important. So there's a question about what happens when you stop taking these drugs, and this is much debated. Actually, it's been even more debated since I've finished the book, relatively recently. So what the initial studies show is if you stop taking the drug, seventy percent of people regain the weight they lost within a year. So it's very rapid reversion to what you were like before. Their evidence is becoming a little bit more ambiguous since then. I mean, seventy percent still means there's thirty percent who who don't go back to the weight they were before. All those within that many of them will have regained some weight. So the way the drug companies are talking about this, and of course take this with a pinch of salt because they have a vested interest in saying this for obvious reasons is you have to take this for your whole life or the effect goes away. So in that sense, it's not like if I get malaria, there's drugs I can take the treat malaria. The malaria goes away. Right, This is not like that. This is more like statins for a heart condition. You get a benefit from taking status and if you stop taking the statins, you lose the benefit. So, yeah, the the whatever the benefits these drugs are giving for most people, it seems the benefits

31:10 last as long as you take the drug and then stop. Yeah. Right. What I find really interesting when I see this coming up online, like Oprah at the moment is really plugging get it over the weight shame, you know, there's people shouldn't be shamed for using these medications when they've been struggling their whole life with obesity. I'm seeing a lot more of that come out. The argument up until this point from people has been there's been two Number one has been all of these overweight OBEs people are taking the drugs away from the people who really need them because it's a diabetic medication, and there's obviously there has been a shortage. I'm sure there's going to be less of a shortage as more manufacturers keep producing more versions of it, et cetera. But you know there has been a shortage over the past couple of years. Number One, you're taking these like really necessary, important medications away from the people who really need them, who are the diabetics.

31:57 And the second one is nobody knows what they're going to do to you. It's going to be all sorts of horrible health consequences down the line, Like you said, those weight loss medications in the past that have turned out to be catastrophic. I always read those two arguments and ask myself, why is nobody concerned about the awful, horrible, negative health consequences for the diabetics who apparently supposedly need these mirac called drugs, Like it's so contradictory. So I think people just generally, to be honest, I think people just generally don't like the idea that there's an easy, you know, a magic pill, a simple solution for all of these people who who should just have more willpower, you know, So I think they just come up with whatever argument that they can. But you make the point in the book, which I thought was just to get back on to my point. You make the point in the book that obesity is as much of a health issue as diabetes is, and in fact, diabetes is also a lifestyle disease. So why do we make the distinction.

32:51 Why do people make the distinction between diabetics who are the real sick people who need it versus just the fat people who just need to use some willpower. Yeah, We've raised so many important things there, I just don't know when to go through. And I'm very glad you mentioned Oprah. The highlight of my entire life is that I am now friends with Oprah, which is like such a bizarre. Every now and then she texts me and my friend and I'm like, she love everyone needs us. Oh no, I'm now friends with Oroby Association friend. I've been to her house, which, oh my god, I know, it's like it was literally like a bizarre. I know this would be a big deal for anyone, but I was like obsessed with Oprah from when I was like eleven to when I was twenty one. I watched me and my grandmother watched the Oprah Show every day, So to me, being friends with Oprah is infinitely surreal, right the Yeah, it was madness, but setting aside my Oprah excitement, and so you've raised a few things there that I think are really important, and those criticisms are not illegitimate.

33:44 I think it's worth thinking them through. The argument about diabetes, Some people who don't know a zen pic in addition to producing weight loss, also GLP one, the gut hormone. GLP one stimulates the creation of incident. So if you take it, and obviously type two diabetics or indeed any diabetic, if you take them, it stimulates the creation of incident, which obviously the regulation your blood sugar levels, and it is incredibly important for diabetics and massively improves their health. And the huge demand for this from people who want to lose weight has led to a global shortage across the board. And so for the book, I interviewed at a wonderful guy called Zami Jaliel who is type two diabetic couldn't get the medication, and I felt really ashamed of speaking to him because I had some in my fridge, right, and there is. So I would start for the position that we should have done what we did with the COVID vaccine. We should have centrally controlled the supply, and it should have been distributed with the people are the greatest need at the front. And at the front there would certainly have been mostly type two diabetics. There would also have been some people who were civillely obese, because obesity is terrible for your health, and the more severe obesity, the worse it is for your health. I mean, I'm now older than my grandfather ever got to be because he had a heart attack, and my dad had heart problems.

35:08 My uncle died of a heart attack. So somewhere in that mix of weighing the medical need would also have been people like me. Now clearly at the bottom of the medical need. There would have been people who were already thin who wanted to be even thinner. Some of the people who were that you know, the Hollywood party that I was talking about right now, Clearly them taking these drugs away from someone like Zami is not right, is terrible, right, But I think you're right that there's a charged nature to that kind of accusation, which I think is partly about the thing that it appears to be about about diabetics, but I think there's a deeper thing going on which is not for everyone. I don't want to overstate it, but I think there are these and I know this because I can actually affect it how I felt about myself taking these drugs. I think there are these much deeper tectonic ways of thinking about fatness and obesity that are really leeching out when we talk about these drugs. So one of them is I really felt like I was cheating when I was taking these drugs, right, Like that, I felt like I was the equivalent of Lance arms Strong, right, And I think that's really that's a really odd way to think about myself.

36:13 Like I'm taking this drug because yeah, I want to look better. I'm not ashamed to say that. But I also, you know, I have family history of heart disease and it's really not and I particularly had the kind of obesity which is added post obesity, which is where you're kind of got skinny arms and legs but a big gut that is particularly bad for increasing your heart disease risk. Why am I sort of feeling like I'm doing something immoral. And if you look at the kind of people, the kind of weight loss weird mind. I think it goes to this even deeper way of thinking about it, which is obesity as a sin. Right, if you look at the seven deadly sins that were first formulated by Pope Gregory the First in the sixth century, you know gluttony is one of them. It's always depicted with a fat person sort of stuffing their face, right, And we've been taught to think of obesity as a sin, as an offence against everyone else and indeed against God and against the individual. Right. And if you look at the kinds of weight loss we admire, they follow the pattern of sin, punishment redemption. Right. You sin, you've got to suffer and then we'll say that you're redeemed. So who do we admire your Your former podcast host was on The Biggest Loser, Right, People who don't know, a horrifying game show where you know, very overweight people compete to lose weight in incredibly macabre ways where they suffer and wail on camera. Okay, if you go through that, we'll like you. Right, if you pay, you suffer in the stream exactly, then it's Okay, you paid the price for your sin, right, But you know this isn't a sin. I think there is a sinner here.

37:39 It's the processed food industry. But this is not a sin that I ate the food that was advertised to me from the moment I was born, Right, I don't believe that's a sin if I think about it rationally. Do I think about my friends who my friend who died who was obeast, Do I think she was a sinner who deserved to be punished? No? Do I think my grandmother who was very overweight, do I think she deserves to be No? Of course I don't. But it's these ideas are just beneath the surface, and I think we need to sort of bring them out so we can think about them in a kind of calmer way, because I think in a way with these drugs, we have to weigh the benefits and risks very carefully, and different individuals will reach different conclusions, and it's very complicated and it's very difficult, and I'm not sure I've made the right decision for myself even But if our ability to weigh those risks is polluted by these the ideas of a sixth century pope and or these kind of other stigmatizing, angry ideas. I don't think that I'll get as we want, which is not to say that the people who are critical don't have lots of good points.

38:38 They absolutely do think about you know, you mentioned there are loads of unknown risks, right, I mean probably alyout half of my book is about analyzing what we know about those risks, and many people will reach the conclusion. It's been so interesting for me when I went to meet the marketing department of my British and American publishers in London and New York and they they'd read the book. They were the first people other than me and my fact checkers and some of my friends whove read the book. And some of that came up to me and said, I loved your book. It made me absolutely convinced to take ozen pic and that it's a great thing. And some other people come up to me and said, I loved your book. It made me convince you'd be absolutely insane to take these drugs. And it was a bit like what was that dress, you know, or a gold right.

39:19 It was a bit like that, and I thought, that's a sign I've done my job, right, Yeah, because you should be able to see the evidence and make your own judgment on this, but you can't see the evidence if you're not aware of the unconscious forces that are sort of polluting our judgment. Which is not to say they do have a legitimate point about diabetics. They absolutely do. It is outrageous that diabetics who needed that drug didn't get it because some people who were rich, who had much less medical need got it. But to me, the answer to that is not to be angry at the individual person who bought it, to be angry that we didn't build a system like the COVID vaccine that would have made sure that people who need it get it. Yeah. Yeah, So on that though, on that sort of stigmatization of weight and being overweight, which you know people have experienced for the longest time, and there's there's a thirty billion dollar I don't know the figure, but the diet culture, diet, the diet industry, industry, industry is an enormous industry, and it's been playing to this four years and you know, there's been this big pushback against it and to encourage people to be okay, you know, they don't need to be a certain achieve a certain ideal weight, and they don't need to be flogging themselves at the gym, and everybody should be okay and accepting themselves as they are.

40:30 The whole body positive movement has been great, and then these weight logs drugs come along and it's like, what is the how much is that going to send back that movement? You know, like, I think that's what goes through my mind as well, because you push back against this. You know, you're not a good person if you're not working out and walking all the rest of the messages that we're fed we should just all accept ourselves as we are. But then, oh, when this thing is offered that could potentially be the solution, and maybe I I don't have to just learn to live with myself in this bigger body. It feels almost like wrong to want to take it. I don't know if you experienced something like that. You know, right, we've all been encouraged to just accept ourselves. We don't have to be waf thin.

41:14 But oh, but that would be nice. But should I want that? One of the worst moments in the writing of the book, I think actually the worst moment for me was about six months into taking these drugs, I facetimed with my niece, Erin, and Erin is the youngest member of my family and she's the only girl. I've got lots of nephews and lots of godsons, but she's the only girl. And no one makes me more protective in the whole world than Erin. Right, And in my head, she's always six years old. Whenever she gets a boyfriend, I was like, who are these pedophiles? Get away? But actually she is like eighteen at that university and we're facetiming and we're having this lovely chat. She's like, oh, look, you've lost so much weight. You look great, and we were talking about it and I was sort of preening a little bit, and then she said she looked down at herself and she said, well, you get me somemo zen pic And she's a completely held the way, And for a moment I thought she was joking, and I realized she was actually asking me to get her, and I thought, what the fuck am I doing. I've spent eighteen years working so hard to give her the message you don't have to be super thin, you know, embrace who you are and have I just completely undercut all of that, and I want to explore this in a lot of details. There's a lot about this in the book, and I spent a lot of time talking to people with different in different aspects of the debate about this. And one of the people who most helped me to understand this is a woman called Shelley Bovy, a wonderful person. So when I was a kid, like when you were a kid, I think we're the same age. It was just completely taken for granted that fat people were like a joke on television, right, They were like the what of a punchline? Right? And the first person I ever saw challenge that was this woman,

42:46 Shelly Bovy. So I remember I was ten, and she went on the British equivalent of Oprah, not that there can ever be a British equivalent vote but obviously just in case she's listening, but the my podcast, and she went on this program. And so Shelley had grown up. She's from a town called Port Talbot, which was a working class town in Wales, had the biggest steel works in Europe at the time when she was growing up, and she was the only fat girl in her school and One day when she was twelve, her teacher said to her, at the end of a lesson, stay behind bovy. And she was sitting there the younger what have I've done wrong? And the teacher said to her, you are far too fat. Go to the school nurse. She'll sort you out. So Shelley goes to the school nurse and the school nurse looks and says, take off your clothes, and she takes up a clothes and she looks. The nurse looks and says, you're much too fat, and just gives her this kind of angry lecture about how disgusting it was that she was fat, and says, pull yourself together or you'll die young. And Shelley left feeling absolutely wretched about herself, and throughout her entire school career, she's constantly being told just so fat, you so disgusting, you make me sick. Thank God, I'm not you. She had one teacher, I Meselves like a story from a Roll Dahl's novel or something, but who was watching her eat a lunchtime and said, you're a pig. I'm going to make you eat all of these desserts that made it eat all these deserts in front of everyone until she vomited.

44:08 So this kind of humiliation which she completely internalized. She would never look at her own body naked because she was so disgusted and so internalized this this hatred of her own body. And she actually she's really clever and she was Her teachers wanted her to apply for Cambridge, which was a huge deal for a working class girl at the time. What I mean would be now, and she wouldn't do it because she's just like, they'll be so cruel to me, they'll humiliate me. She didn't go to university. She end up working in her parents pub when she had kids. You know. The first thing happened when she was pregnant and went to the doctor was the doctor said, well, you shouldn't even be pregnant when you're as fat as you are. After she gave birth, she had a very difficult birth. I just gave birth. She's lying there sort of covered in blood, and one of the first things the midwife said to her is, yeah, you're so fat, you should lose weight or this constant her baby actually had difficulty eating, feeding, breastfeeding, and when she took into the doctor, the doctor said to the baby as fat as you are. So it's just constant humiliation, which she just took us her due, right, She's like, well, it's my fault. I'm fat, I'm greedy, all the horrible things that we say about overweight people. And then she learned that there had been this movement in the United States, she's sometimes called fat Pride, which had argued against these forms of stigma. Actually one of the reasons they one of their early campaigns was against an early diet drag and fetamines, which really screwed people up and can indeed call psychosis. And just hey, kids, it's not a good idea to take her fetterments all the time, right, And Shelley wrote the first book ever in Britain, a wonderful book called The Forbidden Body, arguing against this form of prejudice.

45:39 And I remember seeing her and she was treated as like a joke, right, the daily mail around this arsca about how big she was, as kind of mad fat woman saying this glorifying obesity. And Shelley became this incredibly articulate and thoughtful opponent of stigma and the leading thing, the most well known figure in Britain in this fight and she really fought against this shaming and was very good at it. And then something happened to Shelley that it was difficult for her to think about. So by the time she was fifty, she weighed nineteen and a half stone, and she was losing the ability to walk. As she went to Center Parks at a theme park with her family, and she just she couldn't walk anywhere. She had to be pushing in a wheelchair, and even though her daughter was a personal trainer, she couldn't get up. It was very humiliating, and she was having heart problems and a young woman to be losing the ability to walk and have heart problems, and she had to think about this very difficult question, which was I'm passionately opposed to the stigma that is directed towards obese people. But there's another thing going on here, which is the physical effects of obesity. Now, stigma makes those problems worse. The body positivity people absolute right about that and go into more detail about why. But there are one hundred percent right about that. Firstly, stigma is just to form a cruelty and meanness and bullying, but secondly actually makes the problem worse. If you insult and terrorize overweight people. They eat more to comfort themselves. You know, forty five percent of women with a BMI higher than thirty five get insulted every single day. Like Shelley was right. But Shelley had to explore irrespective the debate about stigma, even if we got rid of all the stigma in the world,

47:12 it would still make me much more likely to become diabetic, to develop cancer, to develop dementia. And she really struggled with this, and within the body positivity movement at the time, there was a newsletter that they had called fat News, and she and other people wanted to write about the struggles are living with diabetes and the fat newsletters. Right, No, this is about celebrating and challenging stigma. That's deepening stigma. And even then Shelley was like, but surely we can. We have to do two things. We have to challenge the stigma that harms our minds and our souls, and we have to challenge if we possibly can, and it was very hard to do at the time, challenge the obesity that harms our bodies. They're both forms of self love.

47:52 She said, it's not either or, it's both, and Now, there are very cruel ways of encouraging overweight people. There's something called concern trolling, where you to be worried about their health, but you're actually using it as another excuse to bully and terrorize people. And there's a lot of that. But Shelley says there's concern trolling and then there's actual concern. Right. And Shelley was one of the minority of people who was able to lose a huge amount of weight by a dieting right, a small minority. She always stressed that she was in a small minority, but she lost seven stone by dieting. Wow, and kept it off. She had that sort of dilemma in the more than twenty years ago, and she's kept it off. I went to I spent a lot of time with her and became friends with her.

48:32 But I think Shelley is right that where we can, we should do both. We should challenge stigma and if we can, we should help people reverse the health harms that are caused to them by obesity. Now, there are some people in the body positivity movement who have a lot of sympathy for and I understand where it comes from, and it comes from a lifetime of soaking up the most vile abuse who argue that presenting the evidence the overwhelming medical consensus around the harms caused by obesity, which is as overwhelming as the evidence that greenhouse gas emissions cause climate change or that vaccines work, they argue that putting forward that evidence is itself a form of stigma, and they have tried to dispute some of the science around that. And I did look into that with an open mind and a lot of detail, like Shelley did, and I'm afraid the sciences just couldn't be more clear about this. Right, of course, there are some overweight people who remain healthy, just like my mother smokes seventy cigarettes a day and she is She's alive and well at seventy eight. But the odds are rigged against you. Yeah, right.

49:31 So I want to communicate that as delicately as I can, and with a huge amount of love and sympathy, and with a desire to protect people, and an awareness that that would be really upsetting and painful and challenging to hear. And I know it is because it is for a lot of my relatives, and it was difficult for me to hear. But I think we can have It's very hard to do in a social media age where everything gets simplified into screaming abuse at each other, yeap and tribalism. But I have to believe that we can have that complex conversation with each other, and we can have it in a spirit that's not angry, but that's loving and compassionate. Yeah, you mentioned before, Johan about people who are already thin accessing the drugs and how that's really wrong when diabetics potentially couldn't get a hold of it. The other people that can potentially get a hold of these drugs, just talking about the kind of the supply chain and the accessibility. Who who can get them and who can't?

50:21 You know, I know that you can jump online and order these things and they will ask you what's your uh, you know, put in your details, what are your wait like, nobody's checking. You can type in any information that you want and qualify to have these medications delivered straight to your front door. So you know, the other group of people, not just the thin people who want to be thinner, but what about the people who at the other end of that extreme, who potentially eating disordered people and are exit people potentially having access to these medications, and you know, what are your thoughts about that and what we need to do to be controlling who who's prescribing and who monitoring. Now, this isn't a potential problem. This is happening. So in the book, I go through these these twelve risks that are associated with these drugs, and this is one of the two that most worries me. We've got a lot of evidence around this, so there's a significant as everyone knows, there's some people in the population who want to starve themselves for a complex range of reasons, and that was hugely has actually massively exploded during the pandemic, and it was already very high because of all sorts of pressures. Particularly is overwhelmingly teenage girls, although there are some boys as well. And you know, people like Kimberly Dennis, doctor Kimberly Dennis, who's in Chicago, who's one of the leading people treating eating disorders. We're talking to me about how they're seeing people in their clinics who are you know, they're very worried about in relation to these drugs. So these drugs give you a tool to amputate your appetite, which obviously, if you're trying to starve yourself, is catastrophic.

51:54 And we don't have to speculate about this. We've been here before. So in the early nineteen nineties, there was a popular diet drug and there was a huge explosion in teenage girls getting hold of it and starving themselves. There were congressional hearings in the early nineties called by Rob Widen, who at the time was a congressman for Oregon, and I mean, it's chilling when you read it now, so that it's a string of people testifying. There was a young woman who testified called Jennifer, who you know, she'd wanted to get into ballet. She'd taken these diet drugs. She'd absolutely I mean she took something dark drugs that she would just pass out from extreme hunger. There was a really heartbreaking testimony by a guy called Tony Smith who his daughter Noel, from when she was very young, became obsessed with the idea that she was fat, obsessed with fashion magazines, and when she was in her early teen started buying loads of these diet drugs but also diuretics.

52:50 And he was from a place called State Center in Iowa, and she died in her early twenties of a heart attack because she'd starved herself death right, and he read this heartbreaking poem that she'd written about you know, I want to eat, but not yet, not yet. And so this is a huge problem, and you're absolutely right. This is going to get into the hands of people who eat disorders, is already and it's going to cause a lot of deaths, and in the worst case scenarios, it having a death toll like the opioid crisis. I mean, it could be really catastrophic. There's something we should do immediately to limit that. It won't eliminate that risk, but it will limit that risk, which is these drugs should only be prescribed in person, never on zoom, and they should only be prescribed by doctors who have an expertise in spotting eating disorders and can refer you for treatment for eating disorders. Now, there's a whole other debate about whether they will or a parallel debate, but whether it will cause eating disorders. We don't know much about that yet.

53:46 I suspect it will in some people. But absolutely we should be doing that to protect the most vulnerable people because We've already got staggeringly high deaths from anorexia and bolimia and rising even before these drugs came along. So yeah, we should be absolutely urgently doing that. You said that was one of your biggest concerns. What's the second biggest one? I mean, because there's twelve, This is just purely like on a personal level, what I fear the most. Actually, all twelve of them are pretty serious, but the one that most sobered me was the risk around thyroid cancer. So we know that when you give these drugs to rats, you massively increase the risk of thyroid cancer. So when people, when scientists have looked at what are the risks surrounding these drugs, what the proponents of the drugs say, and there's a lot of truth in this is what we can be pretty confident about the safety of these drugs because diabetics have been taking them for what is it, sixteen years now, and so if it caused some horrendous short or medium term effect, we would know by now right that it would show up. And there's a lot of truth in that. Now, though scientists will almost always say we have to caveat that by saying it could affect people who are taking it for obesity differently to how it affects diabetics. But in the main that's actually quite a long period. Most drugs are not to for that long, right, So that's a reason that should give people some reassurance. But there are a series of problems which scientists are investigating may be emerging among that population.

55:10 So interview guy called Professor Jean Luc Fay, who's professor of pharmacology at the University Hospital in Montpellier in France, and he was asked by the French Medicines Agency. He was tasked with the it's called Pharmacovigilance program. He was tasked with looking at the risk of these weight loss drugs for French people. And France is in the best position in the world to investigate this because they have really good medical databases. It's almost impossible to opt out of their databases, so they can really check this out. So what Professor Fai did with his colleagues is saying, it's kind of in a way very simple. They look at all the people who were taking all the diabetics who were taking these drugs. Sorry, it was a representative sample.

55:51 I think it was ony five hundred diabetics who were taking these drugs between I think it was two thousand and six and twenty twelve, so all of them, and they compared them to a very similar group of diabetics who are not taking these drugs to see is there any difference in their thyroid cancer outcome, And it's pretty striking. The group that had taken the drug, it seemed to have caused a fifty to seventy percent increase in the risk of their thyroid cancer. That's really important to understand what that doesn't mean. That doesn't mean you had a fifty to seventy percent risk of gaining thyroid cancer. That would be obviously they would immediately take the drug off the market if that was the case, that would be horrifying. Beyond words, what it means is whatever your thyroid cancer risk was going in, it was increased by fifty to seventy percent. Right, I am saying to press a fight that that doesn't sound like a small effect to me. Now, what the scientists say rightly is you have a very small risk of your in thyroid cancer. So even though that's a big increase in the risk, the overall risk remains very small. Nonetheless, Professor fy You said to me, you're right, it's not a small increase, right, Fifty to seventy five percent is a big increase in the risk.

56:53 Now again, I know it's frustrating, but there's so much complexity in this that you have to keep weighing against that. Some of the scientists say, you have to also look at how much continuing to be obese increases your cancer risk, and it massively increases your canceerris. Look at what Cancer UK say. They don't say this in the context of these drugs, but they say the Cancer Research UK are the biggest cancer charity in Britain. And what they explain is when you carry excess weight, that weight doesn't just sit there, right, it's active. It sends signals to your body and one of the signals it often sends is for yourselves to divide more rapidly, which can cause cancer. Right. It's why Actually obesity is one of the biggest preventable factors contributing to cancer. So at every stage of this, you've got this, you're weighing these these tremendous complexities. So I can well imagine you know, there are many different scenarios for these drugs. Don't think it's likely, but there is one plausible scenario. I kind of end the book by talking about the five possible scenarios, but where I think we could go from here? And it's kind of daunting, having spent a year doing so much research on this to actually not know. I mean, I have some sense, But the first possible scenario is that where we were with fen fens so. Fenfen was a hugely popular diet drug in the nineties. In nineteen ninety six, there were eighteen million Fenfen prescriptions written in the United States. It was massively popular drug, and then it was discovered it had horrific physical effects. It caused something called primary pulmonary hypertension, which is where the blood vessels and your lungs contract

58:24 and you can't breathe very well. It also caused heart defects. Thirty six thousand women, most of the women were horrifically harmed by these drugs. That led to the biggest payout in the history of the pharmaceutical industry at the time. They had to pay out twelve billion dollars in compensation to women for the families of women who died, and also women who are catastrophically harmed. It's possible. I think it's pretty unlikely, but it's possible that that will play out again. Right that twenty years from now, we'll look back, people will find my book in some second book shop and they'd be like, Wow, the worst case scenario happened, that there's some effect from this drug that is horrendous. And you know, this is always a risk with new drugs.

59:04 Think about antipsychotics, for example. Yeah, so it's a huge debate about antipsychotics. Park that for a second, but let's just say one thing about it, which is that antipsychotics were judged by scientists. It was much disputed, but they were judged by scientists to be safe or for the benefits to outweigh the harms for years and years. And it was only after people have been taking these drugs for like forty fifty years that they discovered a very long term effect, which is they make you much more likely to develop dementia. Now, there was just no way to know that because people had to be taking them in evans, because people had to be taking them for forty to fifty years. So one of the risks is just the unknown right. These drugs are activating chronically activating parts of the brain, as even the advocates of the drugs said to me, Well, of course that could have all sorts of unknown effects, right, So there is a significant risk there just in that alone. Never mind the other risks.

59:57 There's lots of other issues that you've raised and researched in the book. But the conclusion that you have come to for you personally is that the benefits outweigh the risks and that you will continue to take the drug. Have you decided that that is something that you'll continue to stay on it, or have you thought that you'll come off and see what happens? Like, what's your personal for me? And this is very much a personal decision, And you know, different people with the exact health profile of me might look at these risks and way them differently. Diferent people are different appetites for risk and different budgets. Right, I'm in the very lucky position that my books have sold well, so I can afford this. Right, lots of people listening, I'll be like, well, screw you. There's all these benefits that I can't afford them, which is why I'm very strongly in favor of healthcare systems providing them to people who need them. The judgment I've made is given the history of heart disease in my family, given the research that was published relatively recently that showed that these drugs, if you start with a BMI higher than twenty seven, which I did, and you take these drugs, you reduce your risk of a heart attack or stroke by twenty percent over a couple of years.

1:00:59 For me, that benefit outweigh and I don't have a history of thyroid cancer in my family, and I'm obviously not trying to get pregnant, and I'm relatively young. I mean, I don't know if I can still camp as red to be young, but I'm read to be young in some senses, so I'm not worried about losing muscle mass if you're older. These drugs tend to make you lose muscle mass, as any formal weight loss does, and that can cause real problems as you get older. So if I was sixty five with the exact healthcare profile, it might be different. So given all of those factors, I have decided to continue taking them. But I hugely respect people who look at this evidence and go I'm not fucking touching this right, and I also respect people look at this evidence and go get me on them as soon as possible. It's very difficult. We'll know more a few years from now. We're I feel like we're a bit like I was about to say that if I can say this now, about to say it's like, look at Rolf Harris picture, you know, can you see what it is? Yet? It's like those pictures where it's just for me, but unfortunately that's somewhat tainted memory for us all now. But you're looking at a picture that's sort of slowly coming into focus. And even in the period I was researching the book, we knew much more at the end than we did at the start of that year.

1:02:01 So we're going to know more and more and more. There's an enormous a moment. The drugs are becoming better and better and better as well, they'll have fewer side effects and they'll be more effective, which again postes even more RICI if they get better and better at promoting weight loss, well then you have an even more stream effect on the people with eating to sort of it's super complicated, but I hope people who read Magic Pill you understand the really big and unpredictable effects of this. You know, Buckley's Bank commissioned a kind of very sober minded financial analysts called Emily Field, to just look into how is this going to affect the economy because they want it to guide investment decisions. And she said, if you want a comparison, you've got to look at the invention of the smartphone. Wow, it's like this is going to have all sorts of hugely unpredictable If we were sitting here talking in two thousand and seven when Steve Jobs first unveiled the iPhone, we would not have been able to game out TikTok trump all these kind of crazy effects of the iPhone. So there's going to be lots of things. I hope it helps people to understand the cultural context of the psychological content if you've not talked about and people have to look at in the book the physical consequences. There's so much going on here that we need to think about really urgently because this is coming out as whether we like it or not. Right, you might want to disinvent these drugs, but you're not going to be able to write. You might wish away the invention of the iPhone. But you're going to live in a world where the iPhone exists, whether you like it or not. So I really believe we have to get through. The book is called magic Pill. It's it's slightly ambiguous or ironic title because there's three ways in which this could be magic. Right. It could be magic in the sense something solves a problem so quickly and rapidly you're like, WHOA, it's magic. It could be magic

1:03:35 in the sense of a trick. It could be like a conjurer's trick. It could be screwing as over, or it could be magic in a third sense. I think of it as like the famous Disney cartoon Fantasia, where and this happens in most parables about magic, the magic works, but then starts to work in ways we didn't anticipate at the start, Right, it starts to spiral away from us in all sorts of weird and complex ways. So, in a way, what I'm really curious to see is what kind of magic is it. Is it the magic of a solution, Is it the magic of a trick, or is it the magic that begins to spiral away from you? You know, you make a wish with the genie and you get much more than you have a bargain for. Yeah, it's very clever. Actually, yeah, Han, what you said is true. Though they're coming, there's more, they're being improved.

1:04:22 They're going to get cheaper. Like you talk about the cost prohibitiveness of those drugs now, but they're only going to get cheaper and more accessible. So well, I think it's really important that only costs about forty dollars a month to make these drugs. I read that it's that Obviously, the rest of it is enormous amounts of profits going to Nervo, nordiskanty Li literally the companies who make it. And now what they argue, and I think there's some reason in this, but they take it too far, is Look, we spent an absolute fortune developing these drugs. They wouldn't exist without us, so we should profit from them. That's absolutely true. We want to incentivize companies to make drugs. I mean, do they need two hundred billion dollars? Do they need to be the most profitable company in the whole of Europe? Probably not.

1:05:02 So I think what we should be doing in terms of the price coming down, and the price will come down one way or another in the medium term, because in twenty thirty two the patent passes fort a zenpic so at the very least in twenty thirty two, which seems a long way away, but it's not that far. It's only eight years away, which it seems really weird to me because I can remember when it was nineteen eighty seven. But anyway, in twenty thirty two the patent passes. At that point you'll be able to manufacture cheap versions that are forty dollars and by then it will overwhelm only be a pill, so you'll be talking about buying a daily pill for forty dollars a month that can cut your weight by twenty percent. I think that's going to be a very appealing prospect a lot of people, and if we don't see these catastrophic effects that I'm worried about, it's partly that. But in the medium term, you know, we're talking in Britain, it's possible the British National Health Service could bulk buy. You could have similar situation with Australian medical providers. It's possible this will lead to some regulation in the United States around drug buying or it's possible that the drug companies will just decide to compete based on we want to reach the biggest possible audience for a lower prices, and they'll start because it's now more than one company that has these drugs or drugs with these effects, it's possible they'll start to compete on price and we'll see the price come down that way. So yeah, I think there's a range of options where the price is going to come down. At the moment is you know it's very expensive.

1:06:20 Right, Yeah, it is. And I think that as the price comes down and it becomes more available to people, it's much more important for people to be across all of the issues that you've covered in your book, because you know, right now there's probably people who may not be aware of the possible downsides who if they could afford it, they would they'd go and they'd go and get it. And what we what we really want to avoid is a situation where you know, the real housewives of New Jersey are super thin because they can buy these expensive drugs, but the real school children of New Jersey get more and more obesis that passes because you know, it's about kids and getting the rug which are talking about the book. But you know, because they did to do they're denied, you know, the access to either a healthy food environment or drugs that can reverse some of the effects of the catastrophic food and rone. And one thing that makes me really angry is this shouldn't be the choice. Right Japan, We've got twenty six percent obesity in this country, twenty seven percent in the US, it's forty two percent. In Japan, it's just over three percent, and it's falling. Right, I went to Japan. I learned how they did it. Japan is not a science fiction country, right, that could feel like it sometimes it's a real country. We can become more like Japan. Right, It's a false choice to say we are trapped forever with a choice between the dangers of obesity and the dangers of these drugs. We can make big social changes that will mean that our kids and grandkids will not face these choices. That can sound a bit pie in the sky. But think about smoking. Right, It's photo me and my mother when I'm six months old.

1:07:42 She's breastfeeding me, smoking and resting the astray almost stomach. Right, this is something all Scottish posts made. My mother was the more hardcoured. When I discovered that photo a few years ago, I showed it to her. I thought she'd feel guilty. She said, you were a difficult fucking bb I needed that cigarette, right. But you think about that. When we were kids, people smoked everywhere. They smoked on the train, they smoked on the plane, they smoked on game shows. You would go to the doctor and the doctor would smoke while he was exabitting you. I remember this happening, right, Yeah, it's funny. I remember my mother. My mother's a chronic chainsmoker. We had a terrible catastrophe here in London where the underground station King's Cross. Someone put out a cigarette at the bottom of an escalator and it caused a fire. In about seventy people died.

1:08:28 And it happened to be with my mother when it was the anniversary a few years ago, and someone on the radio mentioned, you know, the King's crossfire, and she said that was the worst day of my life. And I said, oh, did we know someone who died? She said, no, that's the deer. They're bands smoking on the tube. But you think about the scale of that transformation, right, Okay, there's an issue about vaping, which is a separate thing. But yeah, almost none of my nephew's friends, my grand godchildren's friends, my niece's friends smoked cigarettes, right, almost none, in fact, in Britain were about to literally start legally phasing it out. I would not have conceived that that was possible in nineteen eighty seven, right, that's true. It would have seemed ludicrous. So big social changes that boost public health can happen. They can happen relatively quickly. We're not that old, right, So that should be irrespective of what you think about the drugs, we should all unite to fix the environment. And I go through how we can do that, and I went to loads of countries that have done it, from Mexico to the Netherlands to you know, the parts of some small parts of the United States. We absolutely can do that Finland, not that that's part of the United States. I said, that's it was.

1:09:32 We absolutely can deal with that, and then we get out of this terrible bind. Okay, that doesn't help us in the short to medium term, and the short to medium term, we've got a way these risks and make this choice. But we don't have to be trapped in this. I was just reading the Japan chapter in your book on the Way over Here actually, and I was really surprised to read that that that change in the way that they eat is so recent. Yeah, Like I thought what you thought, which is they're just I don't know genetically why differently, or they're just culturally they do things differently. But no, that was that was a change that came about what. Was it after World War Two? Yeah, I mean it was really fascinating. So we Japanese people eat very very differently to us. There's lots of reasons why I go. I spent a lot of time in Japan to research this and it blew my mind for all sorts of reasons.

1:10:13 But Japanese people eat very differently. And you think, okay, well that's just some ancient cultural thing. There's nothing we can how we we're not going to learn thousands of years of history. But actually, a guy called Professor Barak Kushner, who's professor of East Asian History at the University of Cambridge, this is a very recent invention. You just go back to the First World War. Time of the First World War, Japanese people ate appallingly. They only had protein once a week, they barely ate any fish. It was because the Japanese Imperial Army in the well, the imperial government in the nineteen twenties needed conscript soldiers to go and invade the rest of Asia, China and eventually attacking the US, that they had to very consciously make the population healthier. So this was a huge kind of top down project to change the japan His diet. And in a way, the wonderful food writer B. Wilson has written about this that should really encourage us. Right, yeah, Japan didn't have Japanese food, No, until relatively recently. We can change out. That's We're never going to be exactly like Japan. But but yeah, these changes they can happen, can happen, and it can happen relatively quickly, and once they happened, they seem like I was always like this, right, But it is possible we get to a situation where we look back on this forty year period, which is just by coincidence, the period of my life. You know, it really is nice to seventy nine, the year I'm born, as the year the IBST starts to really blow up. I don't think I don't blame myself. I feel like Damien from the Omen, like I can get bored. It's like, oh, and I think about that. You know, I felt like such a failure when I gained weight. I was an entirely typical product in my times. Yes, right, And there's something reassuring

1:11:45 about that. You know. Oprah's talking a lot of the moment about lifting shame, and part of it is to say, you know, you're not so strange. No, you're like everyone else. Yeah, exactly. The other thing that I saw to there, which I thought was very wise, was it was it was actually on TikTok, and it was I don't use ozembic, but I invest in. It right at the start, right. I thought, good, good point. I mean, if you if you look at Yeah, there's two things. I really I'm not a financial person at all. I'm like the worst, the worst. I know nothing about finances anyway, I'm terrible at it. But the before my book about attention problems came out. In my book, I talk a lot about this thing called a k which plastic safe you can lock your phone away. Their shares blew up after my book came out. It's like I should have invested. But the I did, maybe they'll give me a conflict of interest, but also with thoseembic right at the start for a good friend of mine, I started talking about it very just after that party, literally in the week after that party, is like, she's literally I'm going on, I'm going online and buying no own order stock. That seems a bit premature to me. Dev I don't know right what a fool I was. It's like octopled in value since she did that. So I'm like, I want, I want commission on this one.

1:12:59 Right. One of the comments on that TikTok was what I heard was if you're if you're seeing it on live, seeing that advice on line, you've already missed the book. Well, and also look at it the other way. This is one of the things that so fascinates me. If you want to game out the effects of these drugs, look at what's happening to shares the other way. Krispy Kreme Donuts that shares are massively down. And there's a company, a kind of market dominant company, I forget their name, who manufacture the hinges for hip and near replacements. Their stock is right down because a few people are going to need near and hip replacements relatively soon. Yeah, there's an accompanying Jeffrey's Financial who did a report that advised airlines your stock's going to gout because you're gonna have to spend much less money on jet fuel because it costs much less money to fly thinner people you think about, I'm fascinated about how this.

1:13:47 Is effect Yeah, it's fascinating. Fascinating, and we're going to see much more of that, even like jewelers. Jewelers have seen a huge in the US, in New York and LA in particular. This is the called o Zmpic finger. When you take a zem pit, your finger shrinks, so loads of people are having to have their wedding rings resize because their fingers are so much dinner, right, who to gain that one out? So we're going to see all sorts of weird, unpredictable things, good and bad. It's like Perspects Perspects Glass before COVID your hand. This has been a fascinating conversation. Always, thank you so much. It has been a pleasure. I love talking to Cassie sy Joy. And I meant to say on my publisher's tasing me that anyone who wants to know where to get the book, the ebook, the audiobook. You can basically get them anywhere, but if you go to my website, it's j O h A N N h A r I dot com and you can see where to get them and all my other books. Yeah, I'll put all ink to your hands website.

1:14:43 In the show notes, if you enjoyed the episode, please think about leaving as a five star rating and review. Hit me up on the DMS, on Instagram, cast on underscore XO tell me what you think. I'd be really interested to know. Obviously, if you enjoy the episode, if you think somebody else would enjoy it, feel free to pass along help so us to get more listeners. As always, appreciate you so much. Thank you for being here. I can't wait to catch you next week on another episode of Crabby to Habby