The therapy for Black Girls podcast is your space to explore mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, doctor Joy Hardin Bradford, a licensed psychologist in Atlanta, Georgia. And I can't wait for you to join the conversation. Every Wednesday, listen to the therapy for Black Girls podcast on the iHeartRadio app, Apple Podcast, or wherever you get your podcast. Take good care, and we'll see you there.

Get emotional with me, Radhi Devlukia, in my new podcast, a really good cry. We're gonna be talking with some of my best friends.

I didn't know we were gonna go there on this.

People that I admire, when we say, listen to your body, really tune into what's going on. Authors of books that have changed my life.

Now you're talking about sympathy, which is different than empathy, right?

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I'll never forget the second day I took Ozempic. I woke up. Oh, I feel something really weird. What is it? I'd woken up, and I wasn't hungry. I don't remember that ever happening before. One of the west's most prolific authors, and he has a brand new book.

Magic Pill, award winning journalist Johann Haring.

47% of Americans want to take these drugs. They are going to change all our lives, for better and for worse. And this is something I think people are not being warned about.

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And wellness podcast, Jay Shetty Jay Shetty.

The one, the only Jay Shetty hey everyone. Welcome back to on Purpose, the place you come to become a happier, healthier and more healed. You know that my goal here is to sit down with incredible thinkers, thought leaders, people who are crafting the way our mind works and defining culture to have conversations that truly, truly matter. Today I get to interview one of my favorite authors. I've been wanting him to be on the show for such a long time and I can't believe he's finally, finally here. And this new book is one of the ones that I really hope that you take the time to read because I promise you, you, your friend, a family member, is having to deal with the challenges that come with this theme and concept in their daily, weekly and monthly life. Today's guest is none other than Johann Hari. His new book is called the Magic Pill, the extraordinary benefits and disturbing risks of the new weight loss drugs and I can't wait to dive into it with him. If you don't have a copy of the book already, make sure you go and grab one. We'll put the link in the comments and caption below.

Please welcome to on Purpose, Johann Hari Johanna, thank you for being here.

Oh, I'm ridiculously happy to be here. Thank you so much.

Honestly, I mean it. I was saying this to you offline, but I'd like to repeat it for my audience. You're one of the most gripping and captivating authors that I've read in a long time in the nonfiction space. I enjoy your work so deeply. I feel completely enthralled when I'm reading your work. I love the way you tell stories and you, effortlessly, with so much grace and kindness, bring people into a universe that they can understand very complex things and make sense of how to apply them in their life, which is so hard, hard to do. So thank you so much for all the work that you do and the experiments you do on yourself.

Oh, cheers.

Thanks, Joey. And the fact that we're from very.

Similar places, we're basically neighbors. We're both as neighbors. We might go a little bit too british. In this podcast, I'm going to try and remember we are talking to mostly american audience. I was saying to you, I want I was once in a diner, in fact in an IHOP in a place called cactus, Arizona, and I was trying to order pancakes. I kept saying, can I have some pancakes, please? And she kept going, what? What? And after a while, she said to me, do you speak English? I was like, my people invented it. What do you mean? Right. So I'm very conscious that, you know, we sound like weird refugees from Downton Abbey. I'm going to try and americanize slightly.

Well, it's funny, because every time I'm in. When I'm in, I live in the United States, but everyone in the United States always tells me that they find the british accent quite authoritative, and they see it as a sign of education and knowledge. And for me, when I hear a TED talk in the american accent from a professor or a researcher, that's when I find that it's authoritative. Do you feel that way?

Or.

What's your take?

Oh, that's so interesting. I think because I spend. I live here half the year, I think I'm kind of torn between the value of our accents, but I'm conscious that we get given, like, we basically go in with the assumption of ten added iq points in any situation. Right? So, yeah.

And I'm like, if you knew me, I'm not from a posh part of England. Like, I'm not posh.

Anyway, we sound, like, hilariously, like, I was richly raised by my grandmother whose job was to clean toilets, but we sound basically like the queen.

The queen, yeah. Which we're not, but, yeah. And so I want to dive straight into this, and I want to start off by saying, what are some of the biggest misconceptions you've heard about ozempic almost things that people may even be thinking as they're tuning into this or watching this right now? What are some of the things people already think they know but you actually believe in misconceptions?

I think the biggest misconception is that we should either be, yay, these drugs are amazing, or boo, these drugs are evil. The biggest misconception is that we can be certain or confident about these drugs at the moment. I never forget. From the moment I learned about these drugs existence, I felt so conflicted. It's why I wrote the book. Right. I remember the moment so vividly. It was the winter of 2022, and it was that moment when the world was opening up again. And I got invited to a party for the first time in God knows how long, and I decided to go. And I was in an Uber on the way there, and the party was thrown by an Oscar winning actor, I think someone, you know, actually, and I'm not saying that, just a name. Drop it's. Relevant to what I had next. And on the way there, I was feeling kind of gained quite a lot of weight during lockdown. I was feeling kind of schlubby. I was quite fat at the start lockdown. I was fatter then, and I. And I was thinking, oh, this is going to be awkward. And then I suddenly realized that kind of everyone I knew had gained some weight during lockdown.

And I thought, oh, this is going to be fascinating to see all these Hollywood stars with a bit of chubb on them, right? And I arrived, and I started walking around, and it wasn't just that no one had gained weight. Everyone was gone, right? Everyone looked like their own Snapchat filter. They were, like, clearer and cleaner and sharper. And I was kind of wandering around, a bit of a daze. And I bumped into a friend of mine on the dance floor, and I said to her, whoa, looks like everyone really did take up Pilates during lockdown. And she laughed like you just said, no. I must have looked puzzled. And she said, well, you know, it's not Pilates, right? And I had no idea what she was talking about. And she pulled up on her phone and a zempic pen. And that was when I learned, I guess, in the next couple of days, that we now have a new form of weight loss drug that works in a completely new way that causes the average person who uses it to lose 15% of their body weight. In fact, with Munjaro, the next in this class of drugs, you lose 21% of your body weight.

And for the next, which will be available next year, triple g, you lose 24% of your body weight on average. And I remember as soon as I heard that, just feeling this tremendous division in my own mind between, on the one hand, I could obviously see the benefits. I'm older now than my grandfather ever got to be. He died when he was 44 of a heart attack. Loads of the men in my family get heart problems. My dad had terrible heart problems. My uncle died of a heart attack. My other uncle had a heart attack, but survived it. And I knew that, sadly, the scientific evidence is very clear that obesity makes it much more likely you'll have heart problems, along with many other medical problems. So I thought, okay, if there's a drug that can reverse or really reduce obesity, that could have really big health benefits. But I also thought, wait a minute, wait a minute. I've seen this story before, right? Every 20 years or so, a new miracle weight loss drug is announced. We're told it's gonna save us all loads of people take it. They always discover it has some horrendous side effect that, you know, means it has to be pulled from the market, leaving a wave of terribly damaged people in its wake.

So I thought, are we going to see that again? I also thought, what about the progress we've made with body positivity? What about people with eating disorders? There was just so many doubts that came into my mind. So to really get to the bottom of this, I ended up going on this big journey all over the world, from Iceland to Minneapolis to Okinawa in the south of Japan, to interview the leading experts in the world on it, the biggest defenders of the drugs, the people who made the breakthroughs that made them possible, the biggest critics of the drugs. And I learned a huge amount about the extraordinary benefits of these drugs, the disturbing risks of these drugs. There's twelve quite disturbing risks. How it's going to transform the culture in all sorts of ways, that even people who don't want to take these drugs, it's going to change the world around you in really fascinating ways. But at the end of all that, it's a slightly weird feeling. I still feel quite conflicted about it. So I guess the misconception is that we should be so sure, right? This is complicated, and we have to think through the complexity.

So this idea that we have of, or this misconception that you just mentioned that we have of this idea of that it's all good or all bad. I wondered through your research kind of how you felt about that type of thinking. I feel like as humans, we have this very binary thinking about anything and everything, right? That's a good person. They're a mean person, they're a healthy person, they're an unhealthy person when it comes to drugs. Oh, this one's perfect. This one's going to ruin your life. What did you discover about people's binary types of thinking through the research of this drug?

I guess because if you think about this drug, and the book is called magic pilka, there's three ways we could think about this is magic, and the first two are the kind of binary ways. Right. The first way is these drugs could be magic in the sense that they could just solve the problem of obesity. And I've got to tell you, there are days it feels like that my whole life I've hugely overeaten because I was screwed up by the food industry and various other things. And now to do the book, I've been taking Ozempic for a year. There's been lots of ups and downs. But now that problem has largely gone away. I've lost an enormous amount of weight, 42 pounds. But also I've lost a lot of these destructive habits. So it could be magic in the sense of just like, whoa, the problem solved. The second way. It could be magic. And I think this is a real possibility, is it could be like a magic trick. It could be like the conjurer who shows you a card trick while secretly picking your pocket. It could be that in addition to giving you these benefits, the risks, and there are really significant risks here, are so substantial that they undo the good.

I don't rule that out. In fact, I think it's a significant possibility. But the third way is actually the most likely, and I think it's the one that gets us out of that kind of binary thinking. And it's that think about the stories of magic that we grew up with as kids, right? Think about, I don't know, Aladdin, right? You find the lamp, you rub it, the genie appears, and it grants your wishes, and your wish comes true, but never quite in the way you expected, right? You get what you wanted, but always at some weird right angle that you never anticipated. And we're already seeing that with these drugs, you've got to get out the binary, good or bad, to think about that. But, you know, Barclays bank commissioned a really interesting, sober minded financial analyst called Emily Field to just look at these drugs to figure out, okay, what's this going to mean for our investment decisions going forward? What should be investing in, what should be not investing in? And she came back and said, if you want a comparison for the effect of these drugs, you've got to look at the invention of the smartphone, right?

So if you and me had been speaking in whatever it was, 2007, when Steve Jobs unveiled the iPhone, we would not have been able to game out, you know, Doordash and TikTok and all these things that have transformed our lives, that flowed from that. I think we're already beginning to see outside that kind of narrow binary, such an array of things that are happening as a result of these drugs. 47% of Americans want to take these drugs. They are going to change all our lives, for better and for worse, in a way that I think we need to take a moment as this extraordinary transformation happens all around us to really think through the benefits, the risks, and what it's going to mean for all of us and what we should do about it now.

Yeah, let's talk about how we got here. You mentioned there that the food industry has screwed us up. Screwed you up. You mentioned just there. Let's talk about how we got here, how we even needed to turn towards these drugs, starting with some of the issues that you think the food industry has caused and how we've been trained to almost eat more, eat worse, eat unhealthier for ourselves.

For a long time, I thought when I was researching the book that I was looking at two separate topics, because I thought at first. So I was looking at, why did obesity explode in our lifetimes, massively explode, and how do the drugs work? But actually, I discovered these are not separate topics. The same thing explains both at its core. So I would just urge everyone watching, listening to just stop for a moment and Google photographs of beaches in the United States or Britain in the year I was born, 1979. Just take a look at them, right? If you look at them, they seem really weird to us, because almost everyone is what we would call skinny or jacked, right? And you look at it and you think, that's really weird. Where's everyone else? Was it like a skinny person convention in Atlantic City that day? And then you look at the population figures. No, that's what people look like. In the year I was born, we basically, humans have a bit more than 300,000 years in which obesity is extremely rare, and then, essentially, in your lifetime, and mine absolutely blows up. Between the year I was born and the year I turned 21, obesity doubled in the United States.

And then the next 20 years, severe obesity doubled again. And it seems really weird what's going on. What could possibly explain this unprecedented transformation in our bodies, where we got to the point where now 42% of Americans are obese, right? Seems really weird. What happened? We know what happened. This change takes place everywhere where one thing happens, it's not where people become weak willed or lack willpower, or become lazy, or all the other cruel, stigmatizing things we say about overweight people. It always happens where people move from mostly eating fresh, whole foods that they prepared on the day, to mostly eating processed and ultra processed foods, which are constructed in factories out of chemicals, in a process that actually isn't even called cooking, it's called manufacturing food. And it turns out this new kind of food, which never existed before in human history, affects our bodies in a completely different way to the old kind of food that all humans before us ate. And there's loads of ways that's true. I go through seven reasons in the book, but there's an experiment that was actually done here in New York that, to me, just totally distills what happened to us, right?

So it's done by a brilliant irish scientist called Professor Paul Kenney, just up the road from where we are. So he's the head of neuroscience at Mount Sinai here in New York, and he grew up in Dublin in Ireland. And when he was in his twenties, he moved to San Diego in California to continue his scientific research. And he quickly clocked, whoa, Americans don't eat like irish people did at the time. Much more processed and ultra processed food. Much more sugary, salty food, right? And like many a good immigrant, he quickly assimilated. Within a year, he'd gained, like, 30 pounds, and he was like, wow, what's going on? And he felt like this new kind of food he was eating wasn't just affecting his gut, it was affecting his brain. It was changing what he wanted. So he designed this experiment to test it, which I have nicknamed Cheesecake park. It's not the official name of it. It's very simple. He got a load of rats, and he raised them in a cage, and they had nothing to eat but the kind of healthy food that rats evolved to eat over thousands of years, right in pellet form.

So when the rats have got the kind of natural food they're used to, they would eat when they were hungry, and they would stop when they were full. And they never became overweight or obese. Given their kind of natural food, they had a kind of innate nutritional wisdom that meant they would go, oh, no, I've had enough now. Then Professor Kenny introduced them to the american diet. He fried up some bacon, he bought a load of snickers bars. Crucially, he bought a load of cheesecake, and he put it in the cage alongside the option of the healthy food. And the rats went crazy for the american diet. They would literally hurl themselves into the cheesecake and eat their way out, just completely slicked with cheesecake, right? And they ate and ate and ate and ate. And all that nutritional wisdom they'd had before disappeared. They just rapidly became obese. In fact, the way Professor Kenny put it to me was within a couple of days, they were different animals. And so this nutritional wisdom that they'd had before with their natural food just disappeared. The brakes were off. Right then, Professor Kenny tweaked the experiment again in a way that, to a lifelong junk food addict, seems to me a bit cruel.

He took away the american diet and left them with nothing but the healthy food they'd grown up with. And he was pretty sure he knew what would happen, that they would eat more of the healthy food than they had before. And this would prove that 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 anything at all. It was like they no longer recognized the healthy food as food. It was only when they were really starving that they finally went back and ate it. Now, what this tells us, and there's loads of evidence in humans, is the diet we're eating is profoundly undermining our ability to ever feel full. And, in fact, the key word here, both in explaining the rise of obesity and how these drugs work, is satiety. It's not a word we use that often in everyday English, but it's the feeling of being sated, the feeling of having had enough and not wanting anymore. And this kind of food we eat profoundly steals our satiety.

Right. And what these drugs do is they give you back your sense of satiety. They give you back your sense of being full, but with a potential cost. Right.

Yeah. And that's. It's so fascinating to hear how so much of it has become stigmatized. You don't have enough self control. You don't have enough willpower. You're not disciplined enough. And that's why it's leading to these things. And as you're saying, I mean, I've also read different work that talks about how our portion sizes have increased. And I remember the first time I came to the United States. I think I was nine years old with my family. We were coming to Orlando to go to Disney World.

Orlando, yeah.

Yeah. I was gonna get you to sing the ozempic song in a second. But we come to Orlando, and I remember, like, getting one of those, you could get, like, this jumbo size coke, like, which was refillable at the gas station. And then if you wanted, you could get the double jumbo size coke, which is refillable every gas station. And I couldn't believe it. And that's all I wanted as a kid. Right. I was like, that's the coolest thing ever. My parents got it for me, and then I was drinking refillable cokes the whole time.

That's when you got diabetes the first time, right? Yeah.

And I'm predisposed to diabetes because of my genetics. So it's so interesting. And similarly for me, I grew up as a chocolate addict. So I ate a chocolate bar, a chocolate yogurt, a chocolate biscuit, and a chocolate ice cream. Every day growing up, and I was very overweight growing up, I lost a lot of weight.

Were you really?

Yeah.

You don't look like you've ever been overweight.

This morning up until age 1415. And then at 15, I started playing a lot of sports. I soon after became vegetarian, and I lost a ton of weight. And for me, what happened, though, was I still had bad habits. So I got through university having a sprite and a chocolate bar every single day. And it wouldn't show up as fat physically, but it would show up, as you know. Now I see it as glucose spikes now I see it as an increase in the chances of having diabetes and heading in that direction. And my wife has been the one to coach me more on the side of self control and discipline and finding alternatives. And I've seen a huge shift in my life ever since I've stopped refined sugars, ever since I've switch my diet to whole foods, less processed foods, and I've done it in a very self controlled way. I know how hard that is. I know how prone I still am to having cravings sometimes, and at the same time, I've lost taste for certain things. Anyway, I'm saying all of that to ask you the question of portion sizes have increased.

We're eating fake foods that are making us want them more. We don't feel satiated when we're consuming. How does the drug actually make you feel satiated? Because I think it's important for people to understand that what is happening in order for you to feel satiated.

It's the weirdest thing. I'll tell you how it feels as an individual, and then the science of it. I'll never forget the second day I took Ozempic. I woke up and I was lying in bed, and I thought, oh, I feel something really weird. What is it? And I couldn't locate in my body what it was, and it took me about five minutes, and I suddenly realized I'd woken up and I wasn't hungry. I don't remember that ever happening before. Right from when I was very young, you know, grew up in a working class family. We ate constant, processing junk food, and I was in a bit of a daze. And I went to, there's a cafe just around the corner from where I live, and I went in and I ordered what I used to order every morning for breakfast when I'm in London. It was a big brown roll with loads of chicken and loads of mayo in it, and I had, like, three or four mouthfuls, and I just didn't want anymore. I was full. I was full in a way that I never normally felt full. I thought, that's really weird.

And I went for lunch that day. I went to this turkish cafe next to my office and I went in and I ordered what I used to order every day when I went there, which was a mediterranean lambda, and again, I had three or four mouthfuls and I was just full. It was. It was so strange. It was like kind of shutters had come down on my appetite. I can't think of another way to describe it. Or it was more like when I ate. So imagine you had just had Thanksgiving dinner or Christmas dinner and you were stuffed. And then I came along and said, hey, jay, great news. I've got you a kfc bucket, right? You'd just be like, oh, no. But you get to that level really, really quickly. So, obviously, I interviewed the people who made the breakthroughs for these drug scientists who'd worked on key stages of developing the drug. One of the weird things about this drug is we don't actually know how it works. But there's some things we know for sure. There's a big amount of indeterminacy, but there's some things we know for sure. If you ate something now, it doesn't matter what it is.

Something healthy, unhealthy. After a little while, your pancreas will produce a hormone called GLP one. GLP one, we now know is just part of the natural signaling in your body, saying, hey, jay, you had enough, stop. It's like the brakes. But that natural GLP one only stays around in your system for a couple of minutes and then it's just washed away. So what these drugs do is they inject you with an artificial copy of GLP one that, instead of being washed away in a few minutes, stays around in your system for a whole week. It's why when I go to the cafe, I only want three or four mouthfuls because I'm already so close to full. My glp one or this artificial boosting of glp one, makes me feel full so quickly. So initially it was thought when they were developing these drugs, that because this hormone is made in the gut, it has an effect primarily on the gut. This must be a drug that's changing your gut in some way, and it clearly is. And there's all sorts of ways we know that. But from interviewing the cutting edge scientists working on this particular neuroscientist, it's increasingly clear that, in fact, these drugs work primarily on your brain.

You don't just have glp one receptors in your gut. You've got them in your thyroid, which is important for something else. And your brain and these drugs are profoundly changing your brain. We know that if you give these drugs to rats and then you kill them and cut their brains open, which obviously, you're not allowed to do with humans for very good reasons. What you see is the drug goes everywhere in the rat's brain. Everywhere. Right? So I remember when I learned that, and I learned it quite a while into, you know, a few months into taking the drug. So it's a disconcerting thing to learn. You realize, how would I put it? It's a much more intimate transformation. Right. Something that changes your gut. You sort of feel like, oh, okay, that's fine. Something that's changing your brain and profoundly changing your brain partly explains why the effect is so powerful, why these are so much more effective than all previous diet drugs. It also potentially raises some other benefits in terms of benefits for addiction. It also raises some other risks around whether it may cause depression, because there's a debate about what it's actually doing in your brain.

But for me, it just sort of made me realize, oh, this is a, like I say, a much more intimate change than a lot of people realize, I think, when they start taking it.

Yeah. Was it, who was it? Was it your nephew who said, where is Johann Hari and what have you done with him? Was he a nephew?

A little godson.

Your little godson?

Yeah, I took him to McDonald's. So I have a long. My relationship with junk food is probably best typified by one of the low points in my life. I was, I can tell you exactly when it happened. It was 01:00 p.m. on Christmas Eve 2009, and I went to my local branch of KFC in east London, and I went in, I said my standard order, which is so disgusting, I'm not going to repeat it in front of me. Healthy glow, please, please. It was literally a bucket of fried chicken. And the guy, trust me, I love.

A bucket of fried chicken.

You are such a healthy clothing. You look like you've never eaten a chicken drumstick.

I'm plant based now, but back in the day, like, popcorn chicken would have been my jam. Yeah.

The guy behind the counter said to me, oh, Johan, I'm really glad you're here. I was like, all right. And he went off behind where they fry the chicken and everything. And he came back with a massive Christmas card in which they'd written to our best customer. And everyone had written like personal messages to me. 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, it was the second lowest moment in my. My life as an overweight person. The worst was the time that I was fat, shamed by the Dalai Lama. But no, there was this moment where it's not even a joke, by the way.

Yes, you need to tell us.

I was trying to tell you the horror of the Dalai Lama all the time, but I'd had this very intimate relationship with this food all my life, and to have it, there were many good things that flowed from Takeo's empty for me, and there are many benefits to it, as well as some significant risks. But the weirdest moment for me, actually, was another moment that happened in KFC. In fact, one of my nephews said to me, a lot of the key moments in your life seem to happen in branches of KFC. I heard. I was like, that's a good point. But I had a real epiphany about this, because what these drugs do is they profoundly interrupt your underlying eating patterns, right? You can't eat the way you did before. And this is something I think people are not being warned about. And I try to take people through. And a lot of detail in the book is, you need to be prepared that because of that, a lot of the underlying emotional issues that drive your eating may well come to the surface. So I had this moment for me. I was in Vegas.

I was, as you know, I'm writing a book about a series of crimes that have been happening in Vegas that I've been researching for a long time. And I was researching the murder of someone that I knew and loved. And it was obviously very painful. As you can imagine. He was an incredible person. I was working on this, and I just, you know, felt bad. And I went to this branch of KFC on West Sahara, which is one of the grimmest kfcs in the world. And believe me, I could write a book about all of them. And I went in, and really on autopilot, this was like seven, eight months into taking the drugs. I went in and I ordered what I would have ordered a year before, right? I ordered a bucket of fried chicken, and I had a chicken, and I wasn't even really thinking about the eating or anything. And I had a chicken drumstick. And I looked at this bucket, and I thought, I can't eat this, right? I would throw up if I tried to eat this. And I remember Colonel Sanders was on the wall and it was like he was looking at me going, hey, what happened to my best customer?

And I remember thinking, oh, you're just going to have to feel your feelings, right? Essentially, if you look at the scientific evidence, there's scientific evidence for five reasons why we eat. One of them is the obvious one, to sustain our bodies. And I would have told you before I started taking this drug, that was why I ate, right? But here I am. Then I ate maybe 3200 calories a day. Now I eat around 1800. So all that other eating was doing something else, right? And I go through the four psychological reasons why we eat. They don't, obviously, applies differently to different people. And those things kind of get surfaced. And I remember going to one of my closest friends when I got back from Vegas and saying to her, I've got to stop taking this. I can't take it. This is too upsetting. And she said to me, johann, stop taking it. If you want to, that's fine, but you need to know these drugs are not causing this issue. This issue was there all along. In this case, what they're doing is giving you an opportunity to deal with those issues in a better way than drowning your feelings in saturated fats.

Right. And that's been a bumpy transition, although I'm glad I stuck with it. Although lots of people, I respect the fact they don't.

Walk me through why people don't. What was their reasoning? What were they struggling with so much?

I think there's a lot of things people struggle with the drugs, but in relation to that, I'm sure we'll get into lots of them. But if we think about this specific one, if you want to think about the benefits and risks of these drugs when it comes to obesity, I actually think it's quite helpful to look at a parallel area of science. We've only been giving these drugs to people for obesity for a couple of years, but there's a parallel area of science that can help us to think about the benefits. And I think some of the answer to your question, and it's bariatric surgery. Up to now, it's been very hard without some kind of external intervention to lose huge amounts of weight and keep it off. Clearly, you did it. There are lots of people who do it, but it's actually a surprisingly small percentage of the people who try it succeed. I go through why in the book, and that reasons are really important. So actually, the most effective way up to now has been bariatric surgery. Things like stomach stapling, gastric sleeves. Bariatric surgery is a horrific operation. It's really grueling.

One in 1000 people die during operation. It's no joke. Right. But the reason people put themselves through that is because of the extraordinary benefits to their health afterwards. If you have now, bear in mind, they were severely obese at the start, otherwise you wouldn't qualify for the surgery. But if you have this 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 you're 40% less likely to die at all in that seven year period. Right. And we know similarly that these drugs are moving us in a similar direction. So if you take these drugs and your bmi is higher than 27 at the start, you are 20% less likely to have a heart attack or stroke. Right. In the years that follow, I was gonna say it's close to my heart. It is literally close to my heart. Right. But you also, when you look at bariatric surgery, begin to see some of the drawbacks. And I think the key to what you're asking might be there.

So one of the things that I think is really shocking is if you have bariatric surgery, your suicide rate quadruples in the years that follow. Right. It's still quite a low risk. Most people have bariatric surgery, glad they did it. But quadrupling, that's a big effect. Right. Just think, why would that be? What's going on? I think there's lots of things going on there. Some of it is actually, the after effects of the surgery are pretty onerous. Some of it is you can't comfort it anymore, so that pain comes to the surface. Some of it is. A lot of people who are overweight kind of think, well, if only I was thin, my life would be really great.

It's that magic pill.

Yeah, exactly. And they lose the weight and, you know, your husband's still an asshole and you still hate your job. And I think there's also some, I'll give an example of a really deep psychological issue that I think is surfaced in some cases by these drugs in bariatric surgery. Something I learned about from a wonderful man who you should have on, actually called Doctor Vincent Felitti. It was really hard for me to learn about this. So Doctor Felitti was a doctor in San Diego in the early 1980s, and he was approached by Kaiser Permanente, the big not for profit medical provider in California. And they said, look, we've got a problem. We don't know what to do. Please help us. A problem they had was that obesity was hugely rising. In fact, it was very low by our standards, but it was rising. And they said, look, nothing we do works. We give people diet plans, we give them personal trainers. It's not working. Can we give you a load of money and just do blue skies research, figure out what the hell we should do? So Doctor Felitti took the money and was like, oh, what can I do?

So he started working with 200 severely obese people, people who weighed more than 300 pounds and had for a long time. And he said, what could I do? And he had an idea that sounds, and in fact is kind of dumb. He said, what would happen if really obese people literally stopped eating? And we gave them like, you know, vitamin C shots so they didn't get scurvy or whatever. Would they just burn through the fat supplies in their body and get down to a healthy weight? So with a ton of medical supervision, they did it. And incredibly, at first it worked. There was a woman, of course, Susan, not her real name, who went down from being more than 400 pounds to 138 pounds. Staggering transformation. And, you know, her family are calling the doctor and saying, you saved her life. She's thrilled. And then one day she cracked. She went to KFC, or actually, I think that's projection. She went somewhere and, you know, started hugely overeating again and quite quickly got back to a dangerous way. And Doctor Felitti called her in. He said, susan, what happened? What happened? And she looked down, she was really ashamed.

She said, I don't know. I don't know. He said, well, tell me about the day you cracked. Did anything in particular happen that day that didn't happen? Some other day. It turned out something had happened that day that had never happened to Susan. She was in a bar and a man hit on her. Not in a nasty way, in a nice way. And she felt completely freaked out and went and started eating. That's when Doctor Felitti asked her something he'd never thought to ask her before. He said, susan, when did you gain your weight? In her case, it was when she was eleven. He said, well, did anything happen when you were eleven that didn't happen when you were nine or when you were 14? Anything in particular happened that year? And she looked down and she said, well, that's when my grandfather started raping me. Doctor Felitti interviewed everyone in the program, he discovered that 60% of the women had made their extreme weight gain in the aftermath of being sexually abused or assaulted. And at first, he was like, what's going on? It doesn't make any sense. And Susan explained it to him really well.

She said, overweight is overlooked, and that's what I need to be, right? Clearly, obesity for women has a protective sexual function. You are somewhat. It can still happen, of course, but you are less likely to be sexually assaulted if you gain a lot of weight. And so, for Susan, losing a huge amount of weight made her really frightened and feel really vulnerable and brought her back to that terrified place of abuse. Now, there's lots of psychological things that go on that's only one of many, but I think. And, of course, it can give you an opportunity to deal with those feelings. Right? But again, it gives you a sense of, like, the incredible psychological complexity of what's really going on here can kind of come to the surface in complicated ways.

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Yeah. And what's interesting about that is no matter what the psychological reason may be, you're almost dealing with that feeling for the first time in three or four decades. So it almost feels like a new feeling. Would that be fair enough to say, it almost feels like. What I mean by that is there are certain feelings and thoughts that we've had since we were young and we found ways to cope with them. But if this is something that you've been able to kind of put aside for 10, 20, 30 years, and all of a sudden, now that this is blocking something which is giving rise to that, it almost feels like, wow, I haven't learned how to deal with this for a long time.

I think that's really right. I think you're right. It's even worse than a new feeling. It's a buried feeling. Right. And obesity is so laden with shame and the cruelty in this culture towards, you know, which I've experienced to some degree. But women get it much, much worse. If you have a bmi higher than 35 and you're a woman, 42% of those women get insulted literally every day. Right. And I really wanted to think this through because I was very conscious that we've made so much progress in this culture. I mean, we were nowhere near where we need to be, but we've made some progress. I think about this, and one of the things I really worry about in relation to these drugs, I think it's really distilled in a moment, probably the worst moment in the whole writing of the book for me. So I've got a niece called Erin who's 19 now, but in my head, she's fixed as a six year old, like she's the baby of my family. She's the only girl. She's the youngest of my brothers and sisters children. But one day I was facetiming with her after taking the drug for a while, and she was sort of praising me in a teasing way.

She was like, oh, I never knew you had a jaw. I don't know. I knew you had a neck. And I was kind of preening. And then she looked down and she said, will you buy me some ozempic? And I laughed because I thought she was kidding. And I realized she wasn't. And she's like a perfectly healthy weight. She always has been. And I thought, I've undone all the messages I've ever tried to give her, right, about valuing yourself about. And I thought, you know, she's grown up seeing a broader range of body types in female celebrities than we ever grew up with.

Of course, you.

And now all of those women pretty much are bone thin, right? And I really wanted to think this through because I think there's two categories here which are quite different. There's overweight and obese people who are taking these drugs to get down to a healthy weight. Right now, they're still incurring the twelve big risks that I write about in magic pill. There's still a lot to discuss there, but I think there's a lot to defend there. Then you've got people who are already healthy weight, or indeed skinny, who are taking them to be super skinny. Now, I don't judge those people. We live in a culture that makes women feel shit about their bodies, whatever they do, and there are tremendous pressures on them. And I don't judge where those women are coming from at all. But they're incurring all the twelve risks for none of the benefits, right? I mean, rather for esthetic benefits, but not health benefits. And in fact, they're endangering their own health in all sorts of complicated ways. To give an obvious example, as you age, you naturally lose muscle mass. Muscle mass is the total amount of soft tissue in your body that you need to, like, get out of a chair, walk up the stairs, whatever it might be.

So, as you age, you naturally lose muscle mass from the age of 30. Depressingly so if you're going into the aging process already with quite low muscle mass, which people who've taken the drugs to be super skinny likely will be, it could cause you real problems when you're older. You'll be much less mobile. You'll find it harder to walk up the stairs. You're at risk of a condition called sarcopenia, which means poverty of the flesh. It's where, basically, you just can't do much because you're quite physically weak. So I think we've got to distinguish between those two things and then we've got to think about also what this means for body positivity and how we think about it in relationship. There's a particular person who helped me to think about that. I could tell you a bit about her, if you like.

Yeah, please.

So this woman, you probably remember her, Jay, because we're from the same place. So when we were kids, you only ever saw fat people on television as the butt of a joke, right? Particularly overweight women, right? It was vicious. And the first person I ever saw challenge that I remember, it blew my mind. It was on Kilroy, which people don't know. It's like a. If you imagine a kind of dollar store version of Ricky Lake, right? The first person I ever saw challenge it was this woman called Shelley Bovey, who basically introduced body positivity to Britain. She was the first person to ever talk about this and write about it in Britain on a big public stage. So I went and tracked her down because I really want to think this through with her. She's 76 now, and her story, I think, really helps us to think through the complexity of this. So she grew up in a kind of big working class town in Britain called Port Talbot. I guess the equivalent in the US would be like Scranton. She was, as she would put it, the only fat girl at her school. This was the 1960s.

And one day after class, her teacher said to her, bovee, stay behind, I need to talk to you. So she's sort of sitting there thinking, hey, what did I do? And she goes up to the teacher and the teacher said, you're much too fat. It's disgusting. Go see the school nurse. She'll sort you out. So completely thrown. She goes to see the school nurse and the nurse says, why are you here? She said, well, the teacher says, I'm too fat. And the nurse said, take off your clothes. I'm going to look at you. And the nurse looked to her and said, oh, disgusting. You're too fat. And just berated her. Said, you're greedy. You're a pig. Eat less. And Shelley completely thrown kind of leaves. She was soaking up this kind of abuse the whole time, right? Girls were constantly saying to her, thank God I don't look like you. And really, her whole life, she soaking up this abuse. When she got pregnant, she went to the doctor. First thing the doctor said was, shouldn't be pregnant when you're as fat as you are. When she gave birth, she had a very painful birth, difficult birthday.

She's lying there covered in blood, and the midwife said to her, you know, you really need to lose some weight. When her baby wouldn't attach, he wasn't feeding properly. She went to the doctor, the doctor said, what are you trying to do? Make the baby as fat as you are? Overweight and obese people are soaking this up all the time, and most of them just internalize it. Shelly told me she had never looked to her body naked. Even in the shower, she would sort of wash herself, but not look, because she felt such hatred for her own body. And one day, she learned in the US, there was this movement which at the time called itself fat pride. There's still some people who use that term now. We would probably call it more body positivity, who just said, why are we taking it? This is just cruelty. This is like racism or homophobia or sexism. Just, no, we're not going to be treated like this. You're not going to get to talk to us like that. And so she wrote the first ever book advocating for body positivity. Still stands up now. Brilliant book called the Forbidden Body, in which she argued against this stigma.

And when I tracked Shelley down, she stressed to me, she's really proud of everything she said about stigma. And I think she's 100% right to be stigma. A is just a form of bullying, and b makes the problem much worse. Lindy west, who's a brilliant body positivity advocate, said, people don't take good care of a thing they hate. If you make people hate their bodies, it doesn't make them take better care of them. But something happened to Shelley. Next. I think if we're going to be truthful and compassionate, we have to talk about. Shelley was very overweight. She was not yet 50, and she was losing the ability to walk, and so she had to be in a wheelchair. And she went to a doctor, and her doctor said, well, because of your weight, because of the strain that's putting, you've got problems with your heart. And Shelley felt this profound dilemma because she was so proud of everything she said about stigma. But first she thought, well, I want to talk about these health challenges, but is this contradictory? There was, at the time, a newsletter in Britain called Fat News, which was like a body positivity newsletter, and she wanted to write about this.

And they said, no, no, that's not what we want. We're here to tell the positive news. And she said, but if we love ourselves, don't we want to tell the whole truth? And she felt really conflicted about this. And for a long time, she felt like it was either or. Either you're against stigma or you're in favor of reducing obesity where you can. But she then, and she's the first to acknowledge, this is extremely hard to do. But she lost a lot of weight through dieting. She went from being unable to walk to being able to run. Her health massively improved. Her heart problems went away, which tends to happen when you reverse obesity. Like when we talked about with the bariatric surgery. And Shelley, I thought, put it to me in a really wise way. She said, it's not either or, it's both. And if you love someone who's obese, as everyone watching will, I'm pretty sure you want to protect them from two things. You want to protect them from cruelty and bullying, and you want to protect them, if you possibly can, from the more than 200 diseases and health complications that are made much more likely by being overweight or obese.

And I was kind of shocked when I. You know, I looked at the science of this with an open mind. I'm very happy to challenge scientific consensus. I've done it before in my previous books. But when you look at the scientific evidence, and I was trained to assess scientific evidence at Cambridge University, I was kind of taken aback by how bad obesity is for your health, on average. Of course, there are exceptions. My mother smokes 70 cigarettes a day. She's alive and well at the age of 78, but she's an outlier. I mean, even think about something as simple as diabetes. Right? I'm really embarrassed to say this, but I thought if you'd asked me a couple of years ago, I knew that obesity makes diabetes much more likely. If you're obese when you're 18, you have a 70% chance of becoming diabetic in your life. But I thought, okay, that's not good. But as long as you've got good health insurance and you get insulin, you're basically like everyone else. A diabetic with insulin is like me or you. That's not true at all. When I interviewed the leading doctors who are leading people who treat diabetics, when you look at the scientific evidence, diabetes knocks 15 years off your life on average.

It's the biggest preventable cause of blindness in this country. More people have to have a limb or extremity amputated because of diabetes in the US than because they got shot. And you will have noticed a lot of us get shot, right. But the effects are so bad that one of the leading doctors in Britain who treats diabetics, Doctor Max Pemberton, said to me, if you gave me a choice between becoming diabetic or becoming HIV positive, I would choose to become HIV positive. Because if you're HIV positive and you get treatment, you live as long as everyone else. That is not true of diabetics type two diabetics. You have a shorter life and you're much more likely to have a terrible last few years where you're blind or you horribly, you know, your body is mutilated. And I found that so frightening to take on. And I'm conscious that loads of people hearing that will experience that. And it's very painful. It is extremely painful to hear, and it's an extremely painful truth. And we have to communicate it with great compassion and love, and not as concern trolling or. And I hate even saying it because you can see how it gives ammunition to the bullies in a way, because they use that.

It's like, oh, babe, I'm just worried about your health. I get that. But Shelley really taught me. Yeah. She put it, we have to live in reality, and we have to be as compassionate as we can within that reality. We have to do both. Right. And I'm conscious this is a long answer, but I'll just give an example of one other person who helped me to think about this. There's a brilliant guy interviewed called Jeff Parque. He's a 67 year old retired lighting engineer in San Francisco. And Jeff, a couple of years ago, was very severely overweight. He was finding it painful to walk. He had gout, he had liver problems, kidney problems, he was taking fistfuls of pills every day. And he started to take Manjaro, which is one of the new weight loss drugs, and he lost a lot of weight. All his health problems went into remission. The doctor almost took him off the pills. Now he walks his dog over the Golden Gate bridge every day. He said, you know, I feel like I'm gonna enjoy my retirement now. I don't think we can say to someone like Jeff that that improvement is not meaningful.

Right. There are many. Maybe the risks to the drugs will outweigh that benefit to him and for others. That's a real possibility. It's why I put a lot of weight on the twelve risks of these drugs in the book. But I do think we have to acknowledge that a lot of people who do successfully reverse their obesity, which is much easier to do now than it's been before, do experience a massive improvement in the quality of their life. I do think we're not being honest with people if we don't explain that as well.

Thank you for going into that, actually, it was a very thoughtful answer. And those stories give us an entryway into the psychology and the mind of so many of us and what we're all struggling with. Which Shelley, I'm intrigued. How is she now perceived by her community that she was the face for having now dieted, lost weight, it sounds like, and may appear different visually. How is she now perceived, and how does she feel about reconnecting with that community and talking about it with them?

So, as she would say, there's a. And she speaks to herself much better than I can, so I don't want to too much ventriloquize her. But she's a very articulate person. I think it's really complicated, and I understand why it's complicated. Some people saw her as a sellout. And I think Shelley's attitude was, what kind of body positivity would it be that would shame me for keeping my body alive. And there's a big division going on now among body positivity advocates, where they have many good arguments, and it's worth stressing. So if we think about the history of diet drugs, think about the seventies, right? One of the things that. One of the first things the fat pride movement did was point out. So there were diet drugs in the seventies that were amphetamines, right? They were hugely popular. There were staggering figures, like more than 10 million amphetamine prescriptions were written in 1970 in this country for weight loss, right? And it turns out, taking loads of speed to lose weight, not a good idea. Who knew? And they had to be taken off the market because it screws you up, partly because you develop tolerance to these drugs.

You have to take higher and higher doses to get the same effect. And if you're taking really high doses of speed, as anyone who knows, any recreational drug users will know, don't end so well for you. Skinny, but psychotic is not a great trade off. Definitely not. Maybe for some people it is, but not for me. And so a lot of the fat pride movement very presciently warned at the time, you know, this is really going to screw people up. Don't do it.

Right.

And they've been entirely vindicated by that. And it may be. And I. I think there's a significant chance of this. I don't think it's the most likely option, but I do think it's a significant chance that they'll be vindicated on these drugs as well, going, look, this is a big risk, right. For me, especially with the history of my own family, what I felt I had to do was way too risks. And I think that's what most people watching and listening will. This will be the position they're in. Realistically, I was going to remain obese. I tried dieting many times. I always ended up fatter than I was at the start. I tried insane and intense diets. I'd gone to diet camps in Austria where they give you tea for a week. I'd done it. All right. Realistically, I was going to carry on being obese to some level. So for me, the choice was, what are the risks of continuing to be obese versus what are the risks of these drugs? That is not an easy calculation. There's a lot we don't know. We're learning more and more. There's a lot of detail in the book that I think people don't know about.

It's a hard calculation and I don't know if I've made the right choice for myself. So it may well be there's a significant chance that they will. That their caution about this will be vindicated. And they're right. That they're also right to say it's clearly not the case that we're only taking this to deal with health problems. Right. And that's true of me as well. There's a significant amount of just relief from the stigma of being fat. Vanity. I like being thinner. Right. Because of the culture we live in. Some of that's the health benefits and the risks, to my heart, of course, but some of that isn't. A big part of it isn't. We've got a level with people about that, so it's possible that they'll be vindicated. And even if they aren't, we've really got to understand where it comes from. If you are soaking up abuse your whole life, that cruelty, that bullying, I totally get. You know, there's an analogy I always think of, which is, I'm gay. The height of the AIDS crisis, when doctors explain to gay men, look, because of the nature of anal sex, and because gay men tend to have a lot more sexual partners than other sexual combinations, this is going to affect gay men much worse than other communities.

So they wanted to, you know, shut down the bathhouses in San Francisco. Really warm. People say, while we don't know, you shouldn't have sex, right? And a lot of gay men were like, our whole lives we've been told our sexuality is disgusting, we're diseased, we're evil. And now you come along and tell us this as well. We're going to carry on going to the bathhouses, we're going to carry on. And I get where they're coming from. I might well have been like that myself at the time. But now we realize, looking back, well, you have to separate the stigma from the scientific advice, right? I'm sure there were lots of homophobes picking up those arguments and bullying gay people. Exactly. But equally, there was the scientific reality, which is it was much more likely to affect gay people. And lots of those people who refused that advice, tragically, are not here now because they refused it. So I think, and that doesn't mean that I stand over those people and go, what fools. I totally get it. But I do think we have to, as Shelley says, we have to separate out two things. We have to separate out the stigmatizing, cruel things that are said from things that are just physical.

Think about cancer, right? The leading cancer group in Europe, Cancer Research UK, explained, if you carry excess weight in your body, it doesn't just sit there, it's not inert, it's active, right? It sends signals through your body, and one of those signals is for your cells to divide more rapidly, which can cause cancer. This is why obesity is one of the biggest causes of cancer in the developed world. Right? That's true. Even if we got rid of all the stigma in the world, which we passionately should fight to do, it's still going to make you more likely to get cancer, right? That's not something we can undo with an argument, and therefore we do need to think about this also, though I'm very conscious, the most important thing we've got to do. So people like me are in a shitty trap. Right? You got to choose risky medical condition, risky drug, but that is not inevitable. And we should not tolerate that being the choice for our children. Right. Japan, for example. Right. I can explain how they did it, but the key thing to understand is the way one expert put it. For me, a brilliant man named Professor Michael Lowe at Drexel University in Philly is processed, and ultra processed foods dug this hole.

They stole our satiety and the drugs fill it in. The way he put it was. So you got to see that these drugs are an artificial solution to an artificial problem. Right. So we've got to pull back. In addition to the dilemma about the drugs, for people like me, we've got to pull back and go, how did we get here? And how do we make sure the next generation of kids are not in that position? Absolutely. This is the dilemma a lot of us face, but it doesn't have to be the dilemma for our children and grandchildren. And I went to places that have solved this dilemma that show us the way out. So that's the kind of broader argument which I think is so important to stress as well.

Yeah, absolutely. Before we get to Japan and before we get to those. So the Barclays bank produced a report to guide investors, and it told them to get out of investing in fast food and ice cream, because those markets are going to tank. Financial advisors are also expecting a decline in the demand for knee and hip replacement. But when you look at investment, I found that fascinating. I'm like, do I believe that fast food is growing or is shrinking? And while I see the rise of organic vegetables, while I see. But still expensive, while I see the rise in people proposing a largely plant based diet, if not not full, but a larger plant based diet, again, more expensive, harder to access, maybe difficult to know what to do. I don't see fast food shrinking as an industry. Did you see that? Are you seeing that through your research? Were you seeing investment shift and redirect, or is that a myth as well?

Krispy Kreme stock is down. The head of Nestle, Mark Schneider, has been making very nervous noises about their ice cream and confectionery market. So we've got to look at the longer term trend. 47% of Americans say they want to take these drugs. And there's a big access question at the moment. But eight years from now, Ozempic goes out of patent. At that point, it will be a daily pill and it will cost about a dollar a day. I would anticipate 47% is an underestimate for how many people will take. It provided some of the twelve big risks that I wrote about in the book don't blow up, which is a real problem. Think about Jeff Parker, the guy I just talked about in San Francisco. Everyone like Jeff becomes a walking advertisement for the drug. Everyone goes, what happened to Jeff? He looks completely different. My God, he's so much healthier. So you can see how it creates a huge growth effect. So you're right. At the moment, we've got two trends. We've got the ongoing explosion of fast food, which is blowing up and blowing up and is implanted in us from the moment we're born.

More three year old children in this country know what the McDonald's m means than know their own last name. More people in the world recognize the McDonald's m as a symbol of McDonald's than recognize the cross as a symbol of Christmas Christianity. Right? So this is really deep in our consciousness. So you've got that huge explosion in fast food, which is growing and growing and growing, and you've got huge numbers of people who want to take these drugs. Now, one of those trends is going to win, right? So as more and more people take the drugs, we're already seeing the effects. And I think in a way, the best, some of the best predictors are the financial markets. Jeffrey's financial. Just a big report for the us airlines saying you're going to have to spend a lot less money on jet fuel pretty soon because a lighter population takes less jet fuel to fly. There's even just like crazy little things. There's been a huge run on jewelers in Los Angeles because people's fingers have shrunk so much that they need their wedding bands refitted. Or think about, you mentioned the hip and knee replacements companies that manufacture knee and hip replacements.

The joints for them, their stock is going down because the main driver of knee and hip replacements is obesity. And if there's a lot less obesity, there's going to be a lot fewer knee and hip replacement operations. So I do think we're. You're right. The trend you're seeing, which is the growth of fast food, which earning more and more. I mean, thank God when I was a child, you couldn't just push a button on a device and they'd bring McDonald's to you. Right? You had to actually leave your house. At least imagine how overweight I would have become if that had been the case. That trend is driving the other trend as well. Right? So they're densely interconnected.

Tune in to the new podcast stories from the village of nothing much like easy listening, but for fiction. If you've overdosed on bad news. We invite you into a world where the glimmers of goodness in everyday life are all around you. I'm Katherine Nikolai, and you might know me from the bedtime Story podcast. Nothing much happens. I'm an architect of cozy, and I invite you to come spend some time where everyone is welcome and kindness is the default. When you tune in, you'll hear stories and about bakeries and walks in the woods, a favorite booth at the diner on a blustery autumn day, cats and dogs and rescued goats and donkeys, old houses, bookshops, beaches where kites fly and pretty stones are found. I have so many stories to tell you, and they are all designed to help you feel good and feel connected to what is good in the world. Listen, relax. Enjoy. Listen to stories from the village of nothing much on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

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That's where the bright side comes in. A new daily podcast from hello, sunshine that's bringing you a daily dose of joy. I'm Danielle Robet.

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Imagine you asked two people the same exact set of seven questions. I'm Minnie Driver, and this was the idea I set out to explore in my podcast, mini questions. This year, we bring a whole new group of guests to answer the same seven questions, including actress and star of a mega hit sitcom, Courtney Cox.

You can't go around it, so you.

Just go through it. This is a roadblock.

It's gonna catch you down the road.

Go through it.

Deal with it.

Comedian, writer, and star of the serious catastrophe, Rob Delaney. I shouldn't feel guilty about my son's death. He died of a brain tumor. It's part of what happens when your kid dies. Intellectually, you'll understand that it's not your fault, but you'll still feel guilty. Alt rock icon Liz phair. That personal disaster, wrote Guyville.

So everything comes out of a dead end.

And many, many more. Join me on season three of mini questions on the iHeartRadio app, Apple Podcasts, or wherever you get your favorite podcasts. Seven questions, limitless answers.

It's also a big question. Comes out as. And like you kept saying, like you keep saying, we don't know enough. And I want to talk about the risks now, because we've talked about somewhat of how we've got here, challenges that we're facing mentally, psychologically, societally into why we're in this situation in the first place. But what's fascinating to me is, are a lot of the twelve big twelve, which I want to dive into. The big twelve risks and the issues with the drugs are a lot of them more long term than short term. And based on your own personal experience, are the short term ones tolerable and the long term ones the ones that we would consider intolerable and complicated.

So I would distinguish between the well known side effects and these twelve big risks. So things like nausea. Almost everyone who takes these drugs feels nauseous at first throughout the day. No, different people have different experiences. So some people have horrible experiences. I interviewed someone called Sunny Newton in Vermont, who, you know, she had, like she said, it was like there was an alien living inside her, and it was like, thrashing about, and she just wanted to vomit the whole time. That's rare, but not unheard of. I mean, in the clinical trials, about 5% of people did just stop because the nausea was so bad. For me, it was like. It was mild. It was like when I would get on the bus or something, I would get a little bit of exaggerated travel sickness. But if I'd got that feeling just randomly on a normal day, it wouldn't have stopped me going about my day. It just would have been a bit unpleasant. And after a few months, generally, you get it worse the day you take it or the day after, and then you're okay for the rest of the week. And then again, you inject yourself, and it gets.

And the regularity of injecting yourself, is it the same for everyone, or can you accelerate the dose? Is there a slower version?

What does that mean? I should just say, because a lot of people get horrified by injection, and I am a complete worse. I'm the kind of person who, when you give me a blood test, I.

Like, I don't want to look at it.

I literally look away and sing Katy Perry songs to pretend it's not happening. But. And my singing is not pleasant, but this, it's an EpiPen. It's the tiny. And I wish someone had told me at the start, I didn't know this at first. You can inject yourself in the leg or the stomach, and for some reason, the idea of injecting in your stomach seems to me so horrifying. For the first month I was injected in my stomach, it was like, ah. And actually the leg is just the same. No, I mean, it's literally like the tiniest scratch. It's like a mosquito bite.

But are there different doses? In terms.

Everyone starts at 0.25 milligrams is to get you used to the nausea, and the effect is quite mild. And most people go up and up and up, so generally you go up to 1 mg, you can go as high as 2.4 milligrams. It would depend on your level of obesity. I think a lot of people are on too high a dose.

And who's advising you on that dose?

I mean, the official guidance from Novo Nordisk and Eli Lilly, the companies who own it, is, you know, build up to 1, then you can go higher if you need greater effects.

But because you're self medicating, you're not self medicating.

I mean, part of the problem is people are buying it online, you're not actually getting it from a doctor. And that's a really big problem. And that particularly relates to probably my single biggest worry about these drugs. There's a lot. But the thing I'm most concerned about, not for myself, but for the society, is eating disorders. We went into the pandemic with an unprecedentedly high level of eating disorders, probably because of social media and what it's doing to young girls. You'll interview my friend Jonathan Haidt. He can tell you much more about that, and everyone should read his brilliant, amazing work. Then, during the pandemic, eating disorders went up even further, which is mind blowing. And what these drugs do is they give you an unprecedented tool to amputate your appetite. Right. And anyone who knows, anyone who's got eating disorders, imagine. I'm sure you do. Pretty much everyone does. They're in a conflict. There's the psychological part of them that wants to starve themselves for complex reasons created by the sick culture we have, mostly. And then there's the biological part of them that wants to live and wants to eat. And what these drugs do is they, you know, if you take them and you're in that position, they massively empower the part of you that wants to starve yourself.

So I am. And people like Doctor Kimberly Dennis, who's one of the leading eating disorders experts in Britain, another person who should interview a very wise and brilliant person, are really worried about this. Right. My biggest fear is that we could have an opioid like death toll of huge numbers of young girls. And unfortunately, these disorders do mostly affect young girls, or there are, of course, some young men and boys. I mean, I'm really, really worried about that now. There are things we could do right now, as Doctor Dennis says, we need to. I got them on Zoom. You know, when I got them in Britain, initially in Vegas, I had to go in person. They're meant to check your BMI on Zoom. I mean, good luck with that. Basically, you are very visibly not eligible for these drugs. Right? You clearly have a BMI lower than 27, and yet I have no doubt you could go on Zoom. Literally, your lovely team here could arrange, in half an hour, we get a Zoom call and you would get it delivered in the, you know, biked over to you today. Right. We need to stop that.

As doctor Dennis says, we should only have in person prescription, and the in person prescription should be done by doctors who are given clear guidance about how to spot eating disorders and how to prevent the prescription of these things to eating disorders. It's not perfect. People might still buy it online, but it would put at least some barrier between these drugs and people who should not be getting them. At the moment, there is basically no barrier.

Is that one of the big risks?

Yeah, massive. I mean, if you said to me, what are the risks that most. That's the risk that most worries me for the society. The one that most worries me for myself is quite different. So how would I put it? It's weird. I feel a wave of anxiety as I say it. We don't know the long term effects of these drugs at all. No one knows. We know they're chronically activating key parts of your brain. So a brilliant expert called Doctor Greg Stanwood, who works on these drugs at Florida State University, said to me, now, he stressed to me, he's broadly in favor of these drugs, he's considering taking them himself, but as a responsible scientist, he has to warn people. So he gave an analogy. I want to be clear, he's not suggesting these drugs will have this effect, but it's an analogy that helps us to think about it. If you look at antipsychotic drugs, if you go back to when they were first given to people in the late 1950s, at the time, doctors judged that the benefits outweighed the risk. It's always been controversial, but they judged that. So loads of people were given antipsychotics for really long periods of time.

And it was only, what, 40, 50 years later that they discovered if you take these drugs for decade after decade, you are much more likely to get dementia, Alzheimer's. In fact, all forms of dementia are much more likely. It's not that the doctors were being negligent in the 1950s. You couldn't know that, right? You had to have people taking it for a really long time to know that. What could these drugs do over the long term? We don't know right now against that, doctor Sean Olivia, brilliant obesity specialist at Tulane University School of Medicine in New Orleans, said to me, well, look, we don't know the long term effects of these drugs. We do know the long term effects of obesity, and they are very serious. But, you know, I'm 45, right? If you stop taking the drugs for almost everyone, they stop. You just go back to where you were before. And there's a big debate about that. But for most people, that seems to be happening. So I'm assuming I'm going to be taking these drugs for 40 years. That's anxiety provoking. I asked doctor Clemence Blouet, who's one of the leading obesity specialists at Cambridge University, so what brain areas do these drugs activate?

And she talked me through it, the hind brain and so on. I said, well, what else do those areas of the brain do? She said, oh, are they memory processing, taste processing, gut motility? Like, not. This is me speaking now, but not trivial things. Right? So for me, that was of the twelve. That was the one where I thought shit. So I tried to go more eloquent way to say shit. But that was.

Yeah, yeah. What's the debate you were saying there about the idea of if you stop taking these drugs, you go back to the same way you were. What's the debate?

So we don't have that much research on it. What the drug companies say is these drugs are like statins. You take statins, it lowers your cholesterol. And if you stop taking statins, your cholesterol goes back to what it was. The drugs are not a cure, they're a treatment, an ongoing treatment. Right? So they say these drugs are like that. Now. They have a vested interest in saying that they want you to carry on buying the drugs forever. It would not be good news for them if they discovered that actually you can take the drugs for a short time, stop and then you'd stay at the lower weight. Some people, this is anecdotal because we don't have any research on it yet. Other people are studying it, as we'll know in a while. Like, I'll give you an example. Someone I know took Manjaro, lost loads of weight, interrupted their relationship with junk food, started exercising a lot in a way they felt too embarrassed to do when they were obese, and has now stopped and seems to be maintaining that lower weight. So how many people will there be like that? We don't know. I mean, the early studies we have, we're just looking at if you take it and then stop.

But what about motivated people who change, use it as a tool to promote change? We just don't know.

How long does it take to measure for us to realize? How long do you need to be on it for to have those long term implications? Like, how long will we have to study research and measure?

I mean, when you talk about the medium term effects, again, it's important to be balanced about this because it's a complicated truth. So a lot of people, a lot of the experts will say, and these are really good scientists, and it's a good point, actually, we know loads about the medium term effects of these drugs because diabetics have been taking them for 18, nearly 19 years. Right. So for people who don't know, these drugs, in addition to having this effect on your appetite, also stimulate the creation of insulin, which is what diabetics both type one and type two diabetics are lacking. It's why it's a diabetes treatment. And so, actually, we've got 18 years of data on diabetics. So they're, I mean, I'm putting it more crudely than they would, but if the drugs made you grow horns, the diabetics would have grown horns by now. Right. And that's a good and important point, and it should give people some degree of security. But some other people say, some other leading experts say, well, hang on, if we're going to base a lot of our confidence on these drugs on the diabetics, let's dig a bit deeper into the diabetics.

So give an example. There's a brilliant scientist called Professor Jean Luc Failly, who's at the university hospital in Montpellier in France, and he was commissioned by the french medicines agency to look at the safety of these drugs for the french market. He started looking at what's called the preclinical research, which is on animals. And something really took him aback, which is, if you give these drugs to rats, they're much more likely to get thyroid cancer. And he said, huh, okay, let's do some digging. So what he did is they have very, very good medical databases in France. He compared a large number of diabetics who'd been taking these drugs between, I think, 2006 and 2012 with a large number of diabetics who were similar in every other way but hadn't taken these drugs. And what he calculated with his colleagues was, if he's right, and it's highly contested, these drugs increase your thyroid cancer risk by between 50% to 75%. And he said to me, we've got to understand what it doesn't mean. It doesn't mean if you take the drugs, you have a 50% to 75% chance of getting thyroid cancer. If that was the case, we'd be having bonfires of ozempic all over the world.

What it means is, if he's right, whatever your thyroid cancer risk was at the start, these drugs increase it by 50% to 75%. Now, thyroid cancer is an overall low risk. 1.2% of people get it in their lives. 82% of them survive. So it's a relatively. But it's a big increase in a small risk. Right. And I'm very conscious, a that you've got to weigh that against just the cancer risk of continuing to be obese. But also, one of the things that really worries me about that is you think about the history of diet drugs. Very often they began to unravel based on small warnings. So if you think about. There was a diet drug in the nineties called fenfen, the most popular diet drug ever before, a zempic. So if you look at how it was a combination of two drugs, it was an appetite suppressant called flexfluramine and an amphetamine called phentrimine. And it really worked. People who took it got the same level of weight loss as people get on a zempic. And people talked about it in a very similar way. Front page of Time magazine was the new miracle weight loss drug, right?

Very similar. In 1995, there were 18 million fenfen prescriptions in this country. It was huge. And then it was discovered. A small group of doctors in a practice in Fargo in North Dakota noticed. Huh, a lot of people using this drug in our practice seem to be having trouble breathing, and so they raised what's called a safety signal. It was then investigated. It turned out these drugs caused in a lot of people something called primary pulmonary hypertension, a horrific condition where the blood vessels in your lungs contract and you can't breathe, it kills you or it can kill you. If not, you're on oxygen the rest of your life. It's horrendous. So it obviously got withdrawn from the market, led to the biggest payout in the history of the pharmaceutical industry. $12 billion actually emerged. The drug companies had known about this risk all along. You look at the stuff, the drug companies. One of the documents that was presented at the civil case was just someone saying. One of the people at the drug company saying, oh, am I going to have to spend my retirement writing compensation checks for silly fat women with lung who can't breathe?

Horrendous. Right now, I want to stress Eli Lilly and Novo Nordisk. I'm very happy to criticize drug companies. I do it a lot. But they are not shysters like those people were. They are reputable drug companies. There's no reason to believe that they're like that. But I'm conscious that small things could lead to the whole thing unraveling. We need to be vigilant. I'm alert to that. It's why if you have thyroid cancer in your family, I mean, I was gonna say, I recommend it. Don't really matter what I recommend. The FDA recommends don't take the drugs. It's not a good idea.

Are there any others in that line?

Oh, loads. I mean, yeah, I mean, I would. There's all sorts of things, all sorts of categories of people, I would say, shouldn't take it. If your bmi is lower than 27, don't take it. You're incurring all the risks for none of the benefits. If you have thyroid cancer in your family, if you have a history of eating disorders. Yeah, there's a whole array of people who should not be taking it, who currently are taking it. Another big one, which obviously doesn't apply to me, is if you think you might get pregnant. So one of the things that really worries me is we have really no data on what it does to people who are pregnant. Obviously, you're told to not take it if you think you might get pregnant, but people get pregnant in all sorts of ways that you don't expect. So we know rats, when they're given semaglutide, the active component, are much more likely to have children with birth deformities, fetuses with birth deformities. Doctor Stanford, who I mentioned before at Florida State, said to me, again, stressed, he's broadly confident, but has to alert people to potential concerns because he's a very responsible scientist.

He said to think about this, you might want to look at the long term research on mothers who are exposed to contaminants when they're pregnant. So think about, for example, mothers who are exposed to lead. This happens scandalously, frequently in this country because a lot of poor people still live in housing that still has lead in it and still get water from. We know about Flint, Michigan, but actually, in lots of places get water from pipes that are made of lead. It's insane that in the richest country in the world, we allow that, the poisoning of children. Anyway, if you look at mothers who are pregnant and get exposed to lead during pregnancy, actually their babies look like all the other babies. It seems like there's no difference. But when those kids get to be 1213, we know that they have less impulse control, they're more likely to have attention problems. So it seems to have affected their developmental trajectory, even though that wasn't immediately obvious at first. Could that happen with these drugs? Yes. I mean, it might not. It might affect their trajectory in a positive way. We don't know. Maybe they'll be less likely to become obese.

It could have a protective effect on that. But it's just disturbing when you look. It's a really weird feeling to go all around the world, interviewing these leading experts, sit with them and to realize, oh, this is an experiment on millions of people and I'm one of the guinea pigs. Shit. Right. It's a weird feeling, right?

Yeah, it's.

And it makes me angry that we've been put in the position where we have to make these choices. Like I say, there are countries that don't have to make these choices because they didn't allow their population to be up with processed and ultra processed food in the first place. And that piss me off.

Yeah.

Yeah.

What has been the most horrific ozempic story so far?

Most horrific ozempic story, but I interviewed people who've gone through rough experiences. There's a. I want to stress, this is very rare, but there's a condition called pancreatitis, which is excruciatingly painful. It's basically where your pancreas doesn't work properly. Doctors compare the pain of pancreatitis to being stabbed, and it makes you nine times more likely to get pancreatitis when you take these drugs. So pancreatitis is very rare, but it's obviously a huge increase in this very rare thing. I interviewed a woman called Michelle Steziak, who lives in Myrtle beach in South Carolina, which is a place I only thought existed in country songs until I interviewed her. And Michelle said to me, you know, she went for a Zen pick for weight loss. The doctor said, oh, these rare side effects. One of those pancreatitis. She said, no, my luck. I'll probably get it. And she started taking it. Lost loads of weight. Six weeks later, she went to visit a daughter in Pittsburgh, and she woke up, she said, in the most excruciating agony she'd ever been in. She felt like she. Like she was being stabbed all over her body. And she was rushed to hospital, and they identified pancreatitis.

And the first thing they said was, are you an alcoholic? She said, no. Then they said, are you taking her zenpic? She was like, yes. So that was probably the. Michelle said to me, you know, I've had children. It was much worse than the pain of childbirth, right? So, which, thank God, you and I will never have to go through, but unless you got something you want to announce, Jay. But the. There's some real horror stories, and most people are not having these horror stories. Most people are having. I want to be responsible. Most people's experience is more like Jeff Parker or Oprah than it is like, you know, Michelle. Yeah, but that's now 20 years from now, 30 years from now, 40 years from now, we don't know what the picture will be, which. Which puts us in this difficult position.

So we've got some questions from the team that I want to refer to.

Hello, team.

This is the team. So what is your view on when ozempic should be used for kids, if at all?

For me, the debate about Ozempic for kids threw open the whole thing for me, because. For so many reasons. Because it's when you look at kids that you realize how this is a crisis created by the fast food industry, right. And by process food industry, and by the fact that we as a society have allowed that industry to poison our kids. Right. Think about where we are in Brooklyn. Try walking around Brooklyn with a kid and them not seeing ads the whole time saying, you don't feel good. Hey, stuff your face with asset. Right. The first thing I want to say is, this is a crisis created by them, and we need to stop them doing that. And we can do that. And I went to places that have done it. But given that's where we are, I think people are in a really tough position because there's. So I'm very sympathetic to both sides of that debate. So, for example, I interviewed a really lovely woman called Deborah Tyler, who's a nurse in Connecticut. Her daughter was very severely obese from when she was very young. And she took her daughter to the doctor when I think she was eight.

And the doctor said she had liver problems. And she's like, can you imagine when you've been told your child has liver problems at the age of eight? And she faced this agonizing decision about whether to put her daughter on Ozempic, and in the end, she decided to do it and her daughter's liver problems have gone away. So I have a. And she's still very agonized about it. All the problems are accentuated when it comes to children. I mean, there are benefits. Doctor Giles Yeoh, who's one of the leading experts at Cambridge University on obesity, explained to me, if you are obese when you're a child, it is very hard to become Unobee's. I mean, you're unusual, right? It happens. Your proof of that? There are other people proof of it, but most people don't. Right. It's really partly because as you become obese, all sorts of changes happen in your brain that make it very hard to go back that I go through in the book. So there's a case for dealing with it early. Right. And we know childhood obesity has really devastating impacts on your health throughout your life and radically shortens your life on average.

There are other people I have a lot of sympathy for, like Professor Dan Cooper, who's at UC Irvine, who say, well, a, and I can't believe anyone would disagree with this. We need to deal with the underlying causes, but the environmental factors. But b, children are not miniature adults, right. This could affect children in different ways. For example, one of the things children use calories for is bone mineralization. And if you don't have enough calories, maybe your bones don't form properly. Maybe they'll get. Become osteoporotic as they get older. So it's really complicated. Novo Nordisk is currently doing a trial on giving these drugs to children as young as six years old. It turns my stomach. It's a sign of a sick society that we've reached this point. We need to fix the society. But if you're trapped in the choice that Deborah Tyler is trapped in, honestly, I think I would probably do what she's done and I would feel as anguished as she does about it.

So this came up with what you just mentioned now, like, what is your view on Oprah's ozempic special, and what were the benefits and some of the challenges that came from it on people's perspectives?

So I can't think dispassionately about Oprah, right? Like, I know everyone loves Oprah and kind of, oh, we love Oprah. Oprah is one of the two or three humans alive who has most influenced me. Like, when I was a kid, you remember this when we were kids? Remember it so vividly. The Oprah show would be on at 05:00 p.m. on channel four, right? And no one in Britain when we were kids spoke like Oprah, right? No one spoke about their, no one spoke about their emotions. No one spoke about in this extraordinary and profound way that Oprah does. And I really think one of the reasons I get on well with Oprah, I think, is because I've, I've so internalized her voice that I sort of, I mean, clearly, as a british person, you can't talk like Oprah, but, like, well, and clearly no one can talk like Oprah, but you know what I mean? Like, so I can't think dispassionately about it because I love her so much and I'm weirdly friends with her, which is, like, still to me, the most surreal. Whenever she emails me or texts me and my friend, I was like, shut up, everyone.

Oprah needs us.

Be quiet.

But I thought her special was incredible. I cried a lot. For the minute it started, I cried. And my friend said, thank God Oprah has not brought her show back, because if you had this emotional reaction every day, you'd be in a psychiatric hospital. Because just seeing Oprah in front of an audience made me emotional. But I thought it was amazing. And I think part of it made me really sad because you think about how much Oprah has given us, right? How much she's given to the culture. People forget, you know, I mean, even just think about the incredible work she did on breaking the taboos around sexual abuse, right, where what she's done is incredible. And I could list, like, 15 things like that that Oprah's done that have transformed the culture. And you think all that time she was doing that and rising, she was being bullied in the most hateful ways. I really recommend people watch. And this is someone else who I admire and was a damaged person. So I don't want to say this in a spirit of judgment, but you can watch it on YouTube. There's an interview between Oprah and Joan Rivers from, I think, 1985.

And I'll preface this by saying a Joan Rivers was the funniest comedian I've ever seen. And baby, Joan Rivers was someone who hated her own body and was at war with her own body. So she's externalizing something that's an internal, horrifying battle, but it's viscerally shocking when you watch it. Now, she says to Oprah something like, I haven't watched it in a long time, so I'm going to get the exact wording wrong. But she says something like, you can't be this fat. You need to lose weight. And it's not said as a joke. It's not framed as, like, I mean, it wouldn't be acceptable as a joke, but it's not even framed as a joke. And you can see Oprah just looks really thrown and makes some joke about herself because what else could she do? But you think, God, that's the Tonight show. They're on the Tonight show, right? That's because Joan was the guest host. How many people watch that? 25 million people. That's being brutally shamed in front of 25 million people. You think Oprah's carrying that the whole time she's torturing herself? You know, that famous, the famous image of her with the, you know, the thing that represents as much fat as she's lost, and you think, God, I feel so sad.

If you, even if you're Oprah, you get tortured about it, right? You just realize. So to see her overcome that and see her looking so well and to see her given a space beyond that stigma, I found incredibly moving. But that's tied up for me with so many other feelings about Oprah that I can't really know for sure.

And do you feel like some of that stigma is now going the other way, too? Right? Oh, you lost weight because of ozempic. So then that stigma creeping in. Have you.

I think what's happening is a complicated thing, just like the drugs interrupt the way we eat and bring to the surface these emotional feelings we didn't know were there. I think culturally, Ozempic is leeching out some deep, underlying ideas about obesity. So, for example, I'm a feeling experience to myself. When I was taking the drug, I kept thinking, I'm cheating, I'm doing something wrong. I think that's really weird. One of my best friends takes statins, right, to lower his cholesterol. I've never once thought cheating to get lower cholesterol than me. You'd think I was crazy if I said that, right? That's really weird, what's going on here? And I think it lies with, I looked a lot into the history of obesity and how we talk and think about it. So if you look back in the 6th century, the pope, Pope Gregory I was the first one to lay out the seven deadly sins, and one of them is gluttony. And it's always depicted with, like, some hugely fat person pigging out. It's very deep in our kind of psyches to think of obesity as a sin, right? And one of the ways, you know, that is, what are the forms of weight loss we admire?

There's basically only one form, and it follows the classic catholic pattern of, like, the sinner, you're a sinner, you've got to be tormented, you've got to go through hell and purgatory, and then we'll forgive you. So think about that game show. The world is called the biggest loser, repulsive and wicked show in my view, but it's where people haven't seen it. People are very unwell, very seriously overweight, are humiliated, made to take part in very extreme and in fact, dangerous forms of exercise and starve themselves. And whoever loses the most weight is the biggest loser and therefore wins. It's like, oh, yeah, if you torture yourself and go through agony, then we'll forgive you for your sin. Then we'll go, well done. Good job, Joe. Right? But I think one of the things that's weird with Ozempic is it's so easy, right? So it's like, I think a lot of people look at it and go, well, you haven't paid for your sin, right? You haven't suffered. If you suffer, we might forgive you. You suffer with bariatric surgery. I also think it underlies you. Think about cheating, right? In this culture, which makes it so easy to overeat and be obese and so hard to be healthy, lots of people are making daily sacrifices to not gain weight, particularly women.

They're starving themselves, they're denying themselves, they're going hungry. They're doing extreme forms of exercise. And I think to them, people like me must look a bit like Lance Armstrong looks to a cyclist. It's what you. You bastard. I work so hard for this, and you just inject yourself once in a leg a week and you get the same benefit as me. Screw you. I can see where that impulse comes from. And I think we have to re. I think we have to acknowledge those feelings are there. They were there in me, they're there in everyone. I think it's, you can't live in this culture and not absorb those ideas at some level. But then we have to say, okay, well, a, I don't think obese people are sinners. I think we're typical products of this environment. And I'd hope we can move beyond the ideas of a 6th century pope, but also in terms of being in a race and competing against each other. Well, we are competing, but it's not me against you. It's all of us against the forces driving up obesity, which are the processed food industry. If we reframe it that way, we can get out.

Look, we live in, as you know very well, a toxic age where, you know, every conversation turns toxic very quickly, partly because of social media algorithms, which prioritize negativity, all sorts of factors that are going on. If we want to have a non toxic conversation about obesity and about Ozempic, I think we've got to acknowledge that those ideas about sin and cheating are there, and then we've got to move beyond them.

Well said. Well said. Yeah. I wonder whether you saw, did you dive into any research on investors in fast foods and weight loss drugs? Did you find any patterns between.

I didn't, but I'd be surprised if there was some reporting in the Washington Post, which I only read briefly. So I don't want to get it wrong, but if I remember rightly, I suspect. I don't know this, but I suspect the fast food industry will soon be funding anti ozempic propaganda, just like the tobacco industry used to fund claims that smoking isn't bad for you did for years and years. Or like the oil industry still funds claims that global warming isn't happening or is actually a good thing, or, you know, I would be amazed if that isn't. I mean, they're going to lose a lot of money, and they are some of the most profitable companies in the whole world. So I'd be. I suspect they're already doing it, but I don't know.

Yeah, yeah. No, it's an interesting to think about because I feel like we, part of our, part of the environment we all live in is somewhat of an illusion and ignorance of not understanding who's behind the narrative storytelling. You know, when fast food first came around, how did everyone not go, wait a minute, this is going to ruin the world? Like, how did we not do that? Or when, as you said, we're trying to find artificial solutions to artificial problems, and now that we're living in an artificial world, it's like, well, where did we allow that to happen? And I want to talk about Japan in that vein, because that was a place where you found that at least tried to deal with this in a much healthier, smarter way.

This completely blew my mind. Have you been to Japan.

So that's number one on my list right now.

Okay? If there's one thing you take away from this conversation, just go to Japan. Go to Japan. I expected it to be great, and it massively exceeded by expectations. But it's completely amazing. I'll give you a list of things to do. But the. So Japan is really important because some people say about these drugs, look, if a country gets to be rich, people are going to have more food than they can eat. Obesity is just inevitable, right? And therefore these drugs become inevitable. But actually, Japan is the third richest country in the world, in the history of the world, and now is the third richest country in the world. And they have almost no obesity at all. 42.5% of Americans are obese. It is 4% of people in Japan, right? There's almost no childhood obesity in Japan. I went to a school in Tokyo. Typical middle class school. Went to several schools. It's the weirdest thing, walking around a school with a thousand children, and there being not one overweight child anywhere. It's weird if you're used to going to british and american schools. So I wanted to understand, how did Japan do it? Because I remember first I read about, you know, Ozempic has been approved in Japan, and there aren't any sales because there's no one to take it, right?

Almost nobody. It's a tiny, tiny market for it. And it's kind of weird that we expect japanese people to look like sumo wrestlers. It would be like expecting an american to look like a bald eagle. And at first I thought it must just be that japanese people won the genetic lottery, right? But that's not true. We know that because in the late 19th century, lots of japanese people moved to Hawaii. I was just there, and they've been there ever since. And japanese Hawaiians are almost as overweight as other Hawaiians, so. And it's not that their genes suddenly mutated in the 120 years since. So something else is going on, right? There's something in the environment that's. That's driving up obesity in our societies and hasn't in Japan. And there's so many fascinating things about this. I went to a. The most important to understand is Japan deliberately created an environment in which it is hard to get fat and hard to eat badly. If you go back to the 1920s, japanese people have one of the worst diets in the world. They only ate protein on average once a week. Right? They were quite unwell.

They had poor life expectancy. And the japanese government at the time deliberately transformed the society, not for a good reason. It's because they wanted to have an army to go and invade the rest of Asia. So we all got our motives for weight loss. Not the best one, but, you know, whatever, it worked, right? And they deliberately created this new diet and this new way of being, which is now continued in policy in Japan. So I went to a school, like I say in Tokyo, to see how does it begin. There's lots of layers at which they do this. And I was greeted at the door by a woman called Harumi Tatibe, who's the nutritionist at this school, Koenji school. Every school by law in Japan has to employ a professional nutritionist. It's a difficult qualification to get. It's three years on top of your teaching qualification. Your job is to design the food that the kids eat. By law, the kids can't bring packed lunches. They have to eat what's prepared there. And they can only that food has to be fresh prepared on the day and have no processed ingredients at all. And then they use this healthy food, which has to contain all the food groups every day to educate the kids about how to make their bodies healthy.

So they're eating this food. And japanese people love food. It's not a place where people deny themselves food. They love it, right? So I'm with this group of kids. They're eating the school lunch, which literally is more like something from nobu than like anything we ever ate at school, right? And they're eating it. And I said to these kids through my translator chie, I said to these kids, I never forget it. The class I think of in particular, there were 910 year olds. I said, what's your favorite food? The first kid said, broccoli. I love broccoli. I was like, okay, little freak. So to the next kid, what's your favorite food? She said, white fish. I said to the next kid, and she said, oh, boiled white rice. And I turned to Chia and I said, are these kids patrolling me? Right? Their favorite foods are broccoli. And what? Cheer. Like all japanese people could not understand why. I was puzzled and said, well, what do you mean? We teach our kids to eat healthy food. Don't you do that? Every food group, they have, they have a rope, a colored rope, so they like when they're eating the calcium.

She holds up the white rope, she goes, this is calcium. What does it do? And someone yells out, it makes your bones strong. And she goes, the red rope. This is carbs. What do they do? Give you energy. And she ties the ropes together in every lesson. And that surrounded meal that you should have in every meal, right? So they teach kids from a very young age how to nurture their bodies. And I was with these kids, and I couldn't help. I couldn't resist the temptation. I pulled up on my phone videos of british animals, american school meals, and these kids reacted like I had shown them an Isis beheading video. They, like, screamed. They were like, what did they say to me? Where are the vegetables? I said, there are no vegetables. They said, where's the salad? I said, there is no salad. They were just complete. And one. It was very touching. One little girl put her hand on my shoulder and said, I'm worried about you. It was completely adorable. Right? It begins there. And then all through the society, there are measures taken to make processed food. You can buy it if you want to, but it's very much a minority pursuit.

It exists, but it's a tiny part of the japanese diet. Overwhelmingly fish. Fresh food, vegetables. Most people eat fresh food that's prepared on the day. And I think probably the most moving conversation I had for the whole book was in Okinawa, which is an archipelago of islands in the south of Japan, where I really saw what you win, if you get this right. So Japan has the longest life expectancy in the world. Women live to be 88 men. I think it's 82. But not just that. They have the healthiest lifespan in the world. So the average british person is in poor health. I think it's 16 years before they die. In Japan, it's like a few years. So it's a very different relationship. And so I went to this place that sounds almost mythical. It's called Ogimi. It's the oldest village in the whole world. It has 215 houses and 192 have someone older than the age of 90 living there. And I went there, and I went to. They got this little community center. And the first person I met, the first woman who walked through the door, was a 10, two year old woman called Matsu Fukuchi, who walked there on her own from her home down the hill.

And she said, I can't stay long because I'm looking after my son, who fell off the roof fixing it. The other day. I was like, jesus, how old is your son? And we sat down and we talked, and she talked about how much she loved life. It was volleyball season. She's been watching her great grandchildren play volleyball. She actually loved volleyball. You could see how much joy she took in life talking to all these old women. And then someone put on some old Okinawa music, and she put on a kimono and she started dancing. And so I started dancing with this 10 two year old woman, and I thought, wow, you were born before they started doing radio broadcasts in Japan. And here I am dancing with you and recording it on my iPhone. That's what you get if you solve obesity. You don't get destroyed. Clearly, not everyone will live to be 102, but you don't get your knees destroyed and your heart destroyed. You get to live and you get more years of joy and more years of laughter and more years of dancing. That's what we get if we solve this. This crisis, and it is within our grasp to solve it.

These drugs are one tool. They are a difficult and controversial tool, and I'm not sure I've made the right decision to carry on taking them. It was the Heart benefits that did it for me. But we absolutely can deal with this wider crisis. They've done it in JApan. Think about smoking, right? When we were kids, people smoked everywhere. People smoked on the subway, people smoked on the bus. People smoked on the plane. Doctors used to smoke while they examined you. I remember it happening. There's a photo of me and my Mother where she's breastfeeding me when I'm a baby, obviously smoking and resting the ashtray on my stomach. And when I found this photo a few years ago, I thought she'd feel guilty. I showed it to her. She said, you were a difficult baby. I needed that cigarette. Right. But you think about how normal that was then, right? Now, if you saw that, you'd call the police. Right? We've gone from, you know, more than 50% of people were smokers when we were kids. It's now 12%. You very rarely see a young person smoking cigarettes now. Okay? We've got an issue with vaping, but, you know, that's an enormous transformation that's happened in our lifetimes through concerted action.

Right? We can do the same with food. We can free future generations from this shitty choice. Japan showed me. You can do it with joy. Right? Japanese people aren't sitting there being miserable. They love food. Their food is great. I've never eaten better than in the two and a half weeks I was in Japan, right. Literally never. Right. It's not about depriving yourself. It's about making better choices and empowering everyone to be in an environment where we can make better choices.

Do they still have a stigma around body shape, size, weight, and all of that as well?

Yeah. This is one of the complexities. So I don't want to shy away from it. Japanese people are horrifically stigmatizing towards overweight people, and that informs some of their policies, which are just so strange to us that they sound like a kind of just bizarre parallel universe. I'll give you an example. So 2008, their obesity level went up by, like, 0.4%, and they had a massive, like, national freak out. And it was like this huge debate in Japan. And what was it? I was from, like, you know, I can't remember. It's literally for something like 3% to 3.4% or something like saying that, like, we wouldn't even notice in the US if that happened, right? And then this huge debate, and they introduced something that I, frankly, just, when I read about it, thought, this can't be true. It's so called the mutabo law. It's named after metabolic syndrome, which is a kind of combination of problems you can get when you're obese. This has very bad health effect. So they introduced this rule. I actually can't even say it without, like, it decided. Insane. In Japan, every single employee, once a year, has to be weighed by their employer.

If your weight has gone up, you have to, by law, drop a plan with your employer to bring your weight down. And a company overall has to report its weight levels to the government. And if your overall workforce got fatter, you can be fined by the government. Right? So it's like, how can this work? So I went to this company that does it. I mean, every company does it, but this is a company that agreed to show me, partly because they manufacture products to keep you healthy, so they can't want people to know about it. Super nice people, but it was freaky. So you arrive. The first thing you see when you arrive at work is a face recognition thing. It says, hi, Jay, you walked 1300 steps yesterday or whatever, because you have to wear a Fitbit equivalent of a Fitbit. And then it says, you were number 121 in the company. By the way, Susie, who sits two desks away from you, hasn't weighed herself this week. Tell her to weigh herself. You're like, so every. You're encouraged. It's not required, but you're encouraged to take a photograph of every meal you take and post it.

So you can literally go, oh, I wonder what Bob, who sits next to me, ate yesterday. And you can look at it all, it's just bizarre. And I was interviewing people there, so I interviewed the boss, who's this 58 year old man, I have to say, incredibly hot boss. And he was like, talking about, yeah, this is, you know, it's great. It's really good for everyone. And I was interviewing the employees and they would go, yeah, this really helps me be healthy. And I would kind of go, right, so if you did this in the US or Britain, we would burn the office building down. And they genuinely didn't understand what I'm saying. They would kind of go, but why? They just. It was. It really was a moment. I felt like a profound cultural chasm. Right. I thought, this is. You're not like us and we're not like.

As in we can't. Yeah, yeah. Just as they can't understand us, we can't understand. Understand that.

Exactly. So there are lots of things about the japanese model I definitely would not. I mean, we couldn't integrate that even if we wanted to, but if we could, I wouldn't want to. So there's lots of things about the japanese model we can't integrate, including just shame. Right. It's a. Very. Particularly to women who are overweight, it's really brutal, the shaming there. So, yeah, there's lots of things we wouldn't want to integrate and lots of things we would.

Yeah, yeah. It's one thing that has stayed with me as we've been on this beautiful journey together today for, like, we've. You know, I've learned so much from you. I learned so much from the book. I really want people to read the book, to dive into it. We've kind of nicely kind of visited different chapters and different sections inside of the book. But there's one thing that stayed with me and it's this idea of, even after being on ozempic, if people are unable to change their eating habits, even though they're satiated quicker, does that not necessarily double up on the health problems, too?

So it inevitably changes your eating patterns in one key way, that you eat much less. Right, right. But an issue, and this was definitely true of me for the first six months, is, to put it crudely, I was eating smaller portions of the same old chicken.

That's what I mean. Yeah, yeah.

So I was going to McDonald's, but instead of getting, like, a large, big Mac meal and nine nuggets, I was getting a hamburger.

Right.

And that's a move in the right direction, but still very imperfect, as Robert Kushner, one of the scientists who was involved in the studies about these drugs, explained to me. Look, there's an issue about nutrition, just separate to weight. If you're eating food that doesn't give your body what it needs, even if you're not obese, that's still really bad for you. Right? So for me, it made me realize I had to do. I'm super embarrassed to say it, but I didn't know how to cook. I didn't know how to do really basic things. I learned that partly because I realized I had to make that change. But you could. I could have just carried on eating smaller portions. And frankly, I'm on the road at the moment. I am eating smaller portions to sandwich. This morning, I had travel is impossible.

Travel is really tough.

Or even try living in Las Vegas. Not ideal, but you're worried about portion size in this country, generally, you want to try Vegas, but, yeah. So, yeah, the issue you're pointing to is real. I mean, you're still moving in a positive direction, but it can leave you far from the ideal position. Yeah.

Yeah. Absolutely. Yeah. And it's been such a joy talking to you today. Oh, joy.

What pleasure.

Deeply insightful. I appreciate the honesty of just what a challenging, nuanced, layered subject matter this is. And I feel your analysis, research and thought through it is actually so, so, so helpful in that if people are confused in their decision making for themselves, their family, I think you've at least given them every angle possible to think about, which is, I think, somewhat. Sometimes what's missing, right. Sometimes we are just presented a binary angle, which is where we started. And now we're ending today feeling like we can look at this from twelve different angles and twelve different points of view. We end every episode of on purpose with a fast five or a final five. These have to be answered in one word to one sentence, maximum.

Okay. This is very hard for me. As you can tell. I'm gonna do my brutal right. Okay.

These are your final five.

Should have someone to tell. Your colleagues. Should taser me if I go beyond the sentence right.

We should. We should wire you up.

Exactly.

First question is, what is the best health advice you've ever heard or received?

It's what Lindy west said that I quoted before. You can't. It's hard to treat well an object you hate. You've got to learn to love your body.

That's great advice. I love that. 1 second question. What is the worst health advice you've ever heard or received?

I went to an austrian diet clinic in Clara where they made me eat nothing but tea for like, days and days and days. Yeah. Not good advice.

Yeah, just tea. How did that end up? Tell us. I want to know.

Well, I was surrounded by people. I would go like, so there were people there who'd. Who'd been there for, like, three weeks, and they were on the tea diet. And I said, how do you feel? And they said, terrible. I was like, yeah, you're gonna die. Get out of here. I felt like Jack Nicholson, who flew over the cookers nestling outfit. He's gotta buy a breakfast up the road.

Question number three. What's something that surprised you about this journey that you went on with the magic pearl?

How hard it is, how complicated? It's not. I'm not normally such an even handed person. It's really complicated.

And that surprised you? You thought it'd be a lot more clear cut.

I thought every other book I've ever written, I've come to a more firm conclusion at the end than this. You know, with this, it's sort of like you've really got to go down the list of the risks and benefits for yourself, and it will really help you to know all these risks and benefits. But I can't tell you at the end. And now, dear reader, do it or don't do it or do these things. You know, I'm completely failing at these. One sentence.

That's great. I'm asking you.

Be too permissive, Jay.

Exactly.

Angry face when I go to be on one sentence.

Question number four. If you had to ask people to reflect on three things while they're making their decision, there are many things in the book that they need to read and study, but three things while they're reading in the book that you'd like them to reflect on as they're making their own decision, what would they be that are not related to BMI or some of those more tactical elements? Not tactical. Those tangible elements you shared with us earlier.

Think about what your relationship with food was in your family when you were a child, because all sorts of issues around that will come to the surface, which we haven't touched on but is really important. Number two is think about how important pleasure in food is for you, because a lot of people experience a huge reduction in it, although I didn't, a lot of people do. Number three is these drugs might be significantly reducing addiction. This is hugely contested, but there are serious scientists who think they are, and that's a whole dimension we need to think about, not just food addiction, but actually, like, cocaine addiction, fentanyl addiction, across the board. Those would, I guess, be the three things that we haven't covered. That would be the things. I mean, there's about 100 things from the book we haven't covered.

Yeah, exactly. Yeah. Okay, great. Fifth and final question. If you could create one law that everyone in the world had to follow, what would it be?

Oh, one law. Can I get rid of a law?

Can you be the first person to do it? I love it.

The law I would get rid of would be the criminalization of addiction. You know, a lot of addiction in my family. Punishing people who've got addiction problems makes the problem worse. Most of the money we spend on drug policy in this country is shaming, humiliating, and literally caging people with addiction problems. In Portugal, when they took all that money they spent on putting people in prison, shaming them and humiliating them, and spent it instead on, like, helping them, addiction massively fell. Overdose deaths massively fell. We could do the same and we'd get the same results. So it would be, I guess, take the current law on criminalizing addiction and drug use more generally and transfer all that money to helping people instead.

Brilliant. You're the first person ever to get rid of.

Get rid of a law. Great. Happy days. I'm not normally so libertarian, but there we go.

Ever on. The book is called the magic, the extraordinary benefits and disturbing risks of the new weight loss drugs. Johann, Hari, thank you so much. Make sure you go and grab and order a copy right now. I really, really want this. Make this the book of your book clubs, the book that you're reading with your friends, your family. I think it will. As Johann said, there's so many parts of it that we didn't even get to cover. I hope you'll come back and we'll dissect it a second time. But I really believe that this book is so significantly important at this time, especially, and especially for the younger generations to follow. So highly, highly recommend. Magic pill.

Thank you so much, Joe.

I really mean it.

I feel quite emotional hearing you say that.

Thank you so much. I really mean it. I think there's so many things, like you said, that we still haven't covered, and I hope you'll come back to do those anytime because, yeah, I think this is, it's the biggest thing right now and especially with the way you've dived into it when you're talking about just the amount of stigma there is from day one. And it seems to never go, like you said, even with Oprah. Right? Like, it's like whether you're here or you're here, it's like that experience of that stigma doesn't disappear. And so if you're living with that for your whole life and it was created by a system that needs to be addressed, and I think you're addressing in a really deep and profound way. So thank you.

I think I meant to say my lovely publicist is in the corner, so she'll taser me if I don't say this. Anyone who wants to know anything more about the book can go to magicpillbook.com, then get the audiobook, which I read, the ebook, the physical book. Um, and I think I meant to say you can get it from good bookshops or good bookshops, but you can also get it from shitty bookshops as well. Any bookshop at all.

Yeah, I've never understood that.

I know. It's like a weird. It's weirdly like distance, like a quality test. So let's go order some KFC on Uber eats.

We got some for you to end.

By bringing home buckets of KFC.

I hope that served you and amazing.

I hope you felt, of course, it was amazing.

Glad to share with you.

Oh, thanks, everyone.

If you love this episode, you will enjoy my conversation with Megan Trainor on breaking generational trauma and how to be confident from the inside out.

My therapist told me, stand in the mirror naked for five minutes. It was already tough for me to love my body, but after the C section scarf with all the stretch marks, now I'm looking at myself like I've been hacked. But day three, when I did it, I was like, you know what her thighs are? Hi, friends, I'm Danielle Robet.

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