Johann Hari on extraordinary benefits, disturbing risks of new weight loss drugs

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That's Shopify.com slash system. With me right now though in studio back with us for a different reason, Johan Hari, New York Times bestselling author. Remember Stolen Focus? Well, now he's got a brand new book out. It's something that I know you if you're not using it personally, you've talked about it.

It's called Magic Pill, the extraordinary benefits and disturbing risks of the new weight loss drugs. Johan, welcome. Hey Brian, great to be back.

First off, I had a notice from you. You have lost weight. Is that what prompted the writing of this book? Did you use Ozempic? Yeah, it was a mixture of things really. The first time I learned about Ozempic, I remember just feeling so kind of torn because part of me thought, wow, this is going to be huge and there's going to be great health benefits to this, right? I'm older now than my grandfather ever got to be because he died of a heart attack when he was 44. He wasn't in good shape?

No. And we know that obesity makes a huge array of problems, much more likely. It's actually 200 diseases and complications are made more likely by being obese. And I learned that these drugs cause you to lose on average 15% of your body weight in a year. In fact, for the next in this group of drugs, which will be available soon, you lose 24% of your body weight in a year on average. And I knew, okay, so if there's a drug that really can hugely reduce or reverse obesity, that's going to have some obvious benefits. But I also thought, wait a minute, wait a minute. I've seen this story before, right? You'll remember that every 20 years, we're always told, you know, there's a new miracle diet drug that's been discovered. Exotrim. Exactly.

We could list them right from our lifetimes. It's going to save us all. They always discover it has some horrendous side effect.

They have to pull it from the market, leaving a trail of broken people in its wake. So I wanted to understand, okay, what's going on here? What are these drugs?

What would they mean for all of us? So I started taking them and I went on this big journey all over the world. Were you doing it because you want to write the book? Are you doing it for Johan to be healthier? Both. Okay.

Yeah. And I went on this big journey all over the world, from Iceland to Minneapolis to Japan to interview the leading experts, the biggest critics of the drugs, the biggest defenders of the drugs. And what I learned is kind of, it's complicated. There are really big benefits to these drugs for your health and there are 12 really quite big risks associated with these drugs. And I think everyone out there, and also there's a lot people need to be prepared for, for what will happen to you if you take these drugs that I go through my magic pill. So I think we really need to take a beat to think carefully about the benefits, the risks and the changes that are coming. So let's, in the time we have, let's go through some of your extensive research. Number one, it's not just Ozempic, there are other drugs.

Exactly, Munjaro, yeah. How many are there? So there's lots of them. How many did you look at?

I looked at all the ones that are currently available. So Munjaro is big. Exactly. Munjaro gives you 21% body weight loss. And it's fascinating to look at how these drugs work. So if you ate something now, Brian, they'll work on a similar mechanism. If you ate something now, your pancreas would produce a hormone called GLP-1. And it's basically we know that's just your body's natural signal going, hey, Brian, you've had enough, stop eating, right? But natural GLP-1 only stays in your system for a few minutes and then it's washed away.

What these drugs do is they inject you with an artificial copy of GLP-1 that instead of being washed away in a few minutes, stay in your system for a whole week. So it has this really weird experience. I'll never forget the second day I was taking Ozempic. I woke up, I was lying in bed and I thought, oh, I feel something really weird here.

What's going on? And I couldn't locate what it was in my body. And then I realized I'd woken up and I wasn't hungry. I don't remember that ever happening to me before. I used to wake up and be so hungry. And I went to this diner that I used to go to every morning and I ordered what I used to order, which was every day for breakfast, I'm slightly embarrassed to say, which was a huge brown roll with loads of chicken and loads of mayo in it. And I had like three, four mouthfuls and I was just full. You feel very full, very fast because they boost your GLP-1 levels so that you're basically starting at almost full. That's why I lost 42 pounds in a year. Because that's what people describe when they get their stomach tied.

Exactly. I think you've gone to a really important thing, which is actually if you want to understand the effects of these drugs, both the good and the bad, it helps to look at bariatric surgery. Because up to now, it's been extremely hard to lose loads of weight and keep it off for the long term. Some people can do it just through willpower.

If you can, do it that way because then you don't get all these risks. But most people fail at that method I had. So up to now, actually the most reliable method has been bariatric surgery, things like stomach stapling. And if you look at bariatric surgery, we know a few things.

Firstly, it's a horrible operation, right? But if you get through it, if you have this operation and these drugs are having a similar effect, we know that 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, you're 40% less likely to die at all in those seven years. So we know sadly, obesity is catastrophic for your health. It's not the fault of people.

We shouldn't stigmatize them. But it is catastrophic for your health. And if you can reverse it, it's a really good idea to do it. And these drugs do hugely reduce or reverse it, which is why when you take these drugs, you're 20% less likely to have a heart attack or stroke. But you can also begin to see some of the drawbacks when you look at the evidence from bariatric surgery that we know are also playing out with these drugs.

I'll give you an example. It seems kind of shocking and weird at first. After you have bariatric surgery, even though your health gets so much better, you're four times more likely to commit suicide and actually a lot more likely to become depressed. I was thinking, huh, that's really weird. What's going on there? And I noticed when I took the drugs, for the first six months, I was in this kind of weird thing. I was getting what I wanted. I was losing loads of weight. Actually, I didn't feel better. If anything, I felt a little bit kind of muted. This is weird.

What's going on here? And I think I began to understand it as a debate. This seems to be happening to lots of people. It's a debate about why.

Some people think it's because the drugs primarily affect your brain. There's something going on in your brain. There probably is. But for me, I actually and the bariatric surgery people, I think it was something much more basic. I had a real kind of realization about this. I was in Las Vegas.

And I'm spending a lot of time there because I'm writing a book about some crimes that have been happening there. And I was researching the murder of someone I knew and loved. So it was really, you can imagine, rough. And I felt bad. And I went to this branch of KFC I've been to 1000 times.

And I ordered what I would have ordered a year before, right? A big bucket of fried chicken. And I had one of the drumsticks and I suddenly thought, oh, I can't eat this, right? Like you can't comfort eat when you're on these drugs. You can't overeat. You would vomit if you tried to.

And I remember thinking, oh, I'm just going to have to feel bad, right? One of the things that's going on with these drugs, along with many positive things, is they interrupt your eating patterns, right? You can't eat the way you did before. Obviously brings lots of benefits. But also, what that can do is bring to the surface a lot of the kind of underlying psychological reasons why you eat. Because people get satisfaction from eating. They look for something to look forward to. They enjoy eating.

Maybe they don't love the fact that they're overweight, but that's something they enjoy doing. And now that's gone. I think there's a few things.

You're exactly right. One of them is just pleasure. Food is one of the great pleasures in life for most people, right?

And for example, there's a brilliant British food critic called Jay Rayner who talked about, he started taking a Zen pic. He would go to the best restaurants and it would be like, he just got nothing out of the food, right? That didn't actually happen to me, but a lot of people lose their pleasure in food.

To me, I think it was something different. I realized ever since I was a kid, one of the ways I would calm myself down and kind of soothe my feelings was actually by overeating, by stuffing myself. And I couldn't do that anymore. So that's one of the 12 risks of the drugs that seem to be playing out that I write about in my book Magic Pill that I think we all need to be prepared for. Because this is blowing up. 47% of Americans want to take these drugs.

We really need to be aware. There's a very strong case for the drugs. If you have a BMI higher than 35, I would recommend them. I think the benefits outweigh the risks at that point. Because really what you've got to be constantly comparing is two things. The risk of continuing to be obese, which is really significant. Okay, that's a big one. And the risk of the drugs.

And there's no magic calculator. So what are the downsides? Number one, I hear it's hard to get muscle tone back. Number two, you constantly feel a little sick, right? You feel a little nauseous. Is that true?

The first one is definitely right. For the second one, for nausea. So almost everyone feels nauseous at first. For me, it wasn't so bad. If I just randomly one day felt that nauseous, I wouldn't have gone to bed or not gone to work. But it's unpleasant. But for most people, that goes away pretty quickly. There are some people it doesn't and they have to stop taking the drug.

But the vast majority of people, like I've been on it a year and four months now, and I don't get nauseous at all. But there's some risks that I'm much more worried about. I mean, there's a lot that I'm worried about. There's some serious scientists who are concerned that it significantly increases your risk of thyroid cancer.

The risk remains rare, but that does seem to be happening. Pregnant women, I'm really worried about this. We know that if you give these drugs to rats, they're much more likely to have fetuses with birth deformities. There are currently no studies on giving this to women.

Is it true they overcome, Mozambique overcomes the pill, the birth control pill? I've not heard any research on that, but there's some that we also should be worried about in terms of, think about eating disorders, right? So we already have a huge number of young girls, it is overwhelmingly young girls, who have terrible eating disorders who are trying to starve themselves. I am really worried about those girls getting hold of these drugs because you can just amputate your appetite, right?

So in the worst case scenario, we could have a kind of opioid-like death toll of young girls who shouldn't be getting these drugs, right? Obviously, this is not what they're for. They're for overweight or obese people to come down to a healthy weight, not for people who are already thin to come down to sleep. And you're just assuming people that this is a prescription, isn't it? So it's meant to be a prescription.

This is one of the big problems. But you can overcome the prescription by going to another country. In practice, you don't have to go to another country. In practice, you are not eligible for these drugs. I can see looking at you, you should not be given them. But I guarantee you, your producer could line up now on Zoom, an appointment for a doctor with you in half an hour, and a doctor is meant to check your BMI on Zoom.

But how much are they doing that? When I got these drugs in Vegas, I had already been using them in Britain. My BMI was too low to be given it. They didn't check. They didn't ask me. It's basically been given out to anyone. So we've got to tighten the rules around who gets it. But it's interesting because the book is called Magic Pill. But could you go back? You said I'm right about muscle tone.

Yeah. So what if you're working out at the same time? You're just not going to get the same response when you take the pill? So when you lose weight in any way, through dieting or these drugs or anything else, you lose a lot of muscle mass, which is the total amount of soft tissue in your body. It's really important because muscle mass is what makes it possible for you to move. And as you age, depressingly from the age of 30 onwards, you lose muscle mass every year, right? The danger here, particularly for people who are using these drugs who were not fat at the start, who were already thin, is that you're going to go into the aging process with already low levels of muscle mass.

You're not going to have much to lose. The problem with that is that won't show up now, five years, ten years down the line. But when you're old, you're much more at risk of having a condition called sarcopenia, which is a terrible condition where basically you can't really get out of a chair, on your own, you can't walk up the stairs. So we could be setting up. This would mostly not be the case for overweight people, but for people who are taking it who are not overweight, there's a real risk we're setting in place, a time bomb.

And there's a few different time bombs we could be putting in place. Let me just hold that thought so we have some more. I won't take up too much.

I have one huge segment and one small. We'll have more with Johan Har. He's got a brand new book out called Magic Pill. Certainly be a bestseller. He is a multiple bestseller.

The extraordinary benefits and disturbing risks of the new weight loss drugs. Don't move. This episode is brought to you by Shopify. Do you have a point of sale system you can trust or is it a real POS? You need Shopify for retail. From accepting payments to managing inventory, Shopify POS has everything you need to sell in person. Go to Shopify.com slash system, all lowercase, to take your retail business to the next level today.

That's Shopify.com slash system. The name of the book is Magic Pill. Johan Hari in studio guests. We have a few more minutes. The extraordinary benefits and disturbing risks of the new weight loss drugs. You said you took Ozempic. You take an Ozempic? You take a shoot every day? No, it's once a week.

Once a week. So at which time you said your appetite was curtailed, but you also mentioned some of the good part is you lose the weight. You no longer, anyone who takes it is no longer obese.

You lost 42 pounds. So people listening right now, if they read Magic Pill, will they be more or less likely to do what you did? I think what they'd have to do is go down the list of the risks of obesity that I talk about in the book and the 12 big risks of the drugs and figure out which of these are likely to apply to me. So different people have different, I think there's no like blanket one side fits all policy. Generally, though, I would say if you have a BMI higher than 35, so you're severely obese, on balance, unless you have thyroid cancer in your family or you're trying to get pregnant, I would say you should probably take the drugs because the benefits will outweigh the risks.

If your BMI is lower than 27, I would say don't take them because you're taking all the risks for no benefit or only an aesthetic benefit. But I do think we need to think about these drugs in a complicated and truthful way. We also need to understand how we even got here, Brian. You and I were talking about this off air, but obesity has exploded in our lifetimes.

We're a similar age. Anyone who Googles a photo of a beach in this country in, say, 1979, it's kind of shocking, right? Everyone looks thin to us.

Where's everyone else? And we know why obesity blew up. It blows up everywhere where there's one change. It's where people move from mostly eating fresh whole foods they prepared on the day to mostly eating processed foods, which are built out of factories, built out of chemicals in factories. It turns out that food affects us in a completely different way, which is what set us up for these drugs. So these foods undermine our ability to ever feel full. And what the drugs do is they give you back your feeling of being full but at a risk, right?

And there's an experiment that really helped me to understand this done by a scientist here in New York called Professor Paul Kenning. He got a load of rats and he raised them in a cage. And all they had to eat was the kind of healthy whole foods that rats grew up with for thousands of years. And when that's all they had, they would eat when they were hungry and then they would just stop.

They seemed to know naturally, oh, I've had enough now. So they never became fat. Then he introduced them to the American diet, right? He got a load of Snickers bars and fried bacon and cheesecake and he put it alongside the healthy food. And the rats went crazy for the cheesecake and the other food, right?

They would literally dive into the cheesecake and eat their way out. And this kind of natural ability to know how to stop that they used to have disappeared. They all became really obese, right?

And this is happening to us, right? The food environment we live in, if you're sitting there, you know, when I was fat, I felt like such a failure. And there was definitely an element of willpower that is real. But I also realized now I was a totally typical product of our times. The food we eat is totally undermining our ability to ever feel full and to know when to stop. And what these drugs do is they give you back that feeling of being full. How long were you nauseous for and your digestive system, how long has it affected? So for me, I was nauseous. So you inject once a week and I was nauseous the next day for about three or four months. And it's quite unpleasant.

I don't want to undersell that. And for some people, it's like horrifying and they have to stop. I also got constipation.

Sorry, it's an unpleasant thing to mention on the radio. And I had that for maybe three or four months. But for most people, those common side effects go away. What did you do for your self-esteem? I felt much better.

I got to be honest. Right now, you feel better than a year ago? Much, much better. People treat you differently.

Now, it shouldn't be like that, but we've got to level with people. People treat you better. You feel better. Partly that's health, right? You feel healthier.

You don't get tired so much. But there's definitely a kind of self-esteem thing. Why did you say magic pill? Why magic? I think there's three ways these drugs could be magic.

The first is they could just solve the problem, right? And there are days it feels like that. My whole life, Brian, I've been addicted to junk food. Now, I inject myself once a week in the leg.

That's all gone away. It feels like magic. The second way is much more disturbing. It could be like a magic trick. It could be like a conjurer who shows you a card trick while picking your pocket.

It could be the risks outweigh the benefits. I don't rule that out. The third way it could be magic, I actually think is the most likely. Think about the stories of magic we grew up with, like Aladdin, right? You find the lamp, you get your wish, and the wish comes true, but never quite in the way you expected, right? I think it's most like that. Johan, thank you.