Weight Loss Drugs: Are They Really Magic?

Johann Hari is the author of the book Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs.

Motley Fool host Ricky Mulvey caught up with Hari for a conversation about:

• The medical magic that makes glucagon-like peptide-1 receptor agonists so effective.
• Whether online pharmacies can responsibly prescribe these drugs.
• Why there’s a much larger market for them in the U.S. than in other parts of the world.

To catch full episodes of all The Motley Fool’s free podcasts, check out our podcast center. To get started investing, check out our quick-start guide to investing in stocks. A full transcript follows the video.

This video was recorded on June 9, 2024.

Johann Hari: It’s really important for people to understand this is not a fad. This is not a new diet drug craze. I’ve heard it described that way. This is a profound medical breakthrough that will have remarkable effects. And whether it’ll be better or worse, it’s a really important question, and disturbingly, the answer is, I don’t know, despite all the research I did.

Mary Long: I’m Mary Long, and that’s Johann Hari, author of the new book Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs. My colleague, Ricky Mulvey, caught up with Hari for a conversation about how these drugs work, the problems they solve, and the problems they create.

Ricky Mulvey: The book is Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs. I’ll record at the top to all of our listeners. It’s part memoir, part explainer, part investigative journalism. I found it beautifully written, and it dramatically affected the way I view obesity, increased my empathy toward it, and then also gave me a greater understanding of these drugs. Johann, thanks for coming on the show, and thanks for the book.

Johann Hari: I’m really moved by what you just said, Ricky. Thanks.

Ricky Mulvey: You’ve described these weight loss drugs as an artificial solution to an artificial problem. Can you break down the artificial problem for people who are less familiar with it, maybe have healthy eating habits?

Johann Hari: I would just say to anyone listening to the podcast, stop for a moment, pause the podcast, and Google something for me. I was born in 1979. Just Google photographs of beaches in the United States in the year I was born, 1979. Just go away and do that, and then come back. If you’ve come back, you will notice something a bit strange when you look at those photos. The vast majority of people in them look to us to be skinny or jacked. You look at it and go, where was everyone else on the beach in Miami that day? Where was everyone else on the beach in Provincetown? Then you look at the figures. In the year I was born, obesity was very low all over the world. Between the year I was born and the year I turned 21, obesity doubled in the United States. Then in the next 20 years, severe obesity doubled again. There’s been a staggering explosion of obesity in my lifetime. You basically have 300,000 years where human beings exist in obesity was very rare. Then it ticks up a little bit during the 20th century, and then it goes supersonic in the 45 years I’ve been on Earth. Why? What happened? We know the answer broadly. Obesity explodes everywhere, every country that makes one specific change. It’s not where people suddenly become lazy, or greedy, or lack willpower. It’s where people move from mostly eating fresh, healthy foods that are prepared on the day, whole foods, to mostly eating processed and ultra-processed foods, which are constructed out of chemicals in factories in a process that isn’t even called cooking; it’s called manufacturing food.

Sixty-seven percent of the calories the average American child eats in a day now are from ultra-processed foods. It turns out this new kind of food affects our bodies really differently to the old kind of food that human beings ate for literally hundreds of thousands of years before us. There’s loads of ways that’s the case, but there’s an experiment I describe in the book that to me, just totally nailed my understanding of this. I’ve nicknamed it Cheesecake Park. It’s not the official name. It was carried out by Dr. Paul Kenny, who’s the Head of Neuroscience at Mount Sinai, New York, a brilliant scientist. He explained to me, he raised a load of rats in a cage, and all they had to eat was the healthy natural food that rats have ought to eat over thousands of years. When that’s all they had, the rats would eat when they were hungry, and then they would just stop when they were full. They never over-ate. They never became overweight or obese. When they had the natural food that evolved for it, it seemed they had some innate nutritional wisdom that just told them when they’d had enough. Then Professor Kenny introduced them to the American diet, the thing I’ve been eating all my life. He fried up some bacon, he bought a lot of Snickers bars, he bought a cheesecake, and he put it in the cage alongside the healthy food, and the rats went wild for the American diet.

They would literally dive their way into the cheesecake, and eat their way out, and just emerge completely slicked with the cheesecake. They ate and ate and ate and ate. The way Dr. Kenny put it to me is within a few days they were different animals. All that nutritional wisdom they’d had before disappeared, and they quite rapidly all became severely obese. Then Professor Kenny tweaked the experiment again in a way that feels a bit cruel to me as a former KFC addict. He took away all the American food and left them with nothing but the healthy food they evolved to have. He was sure he knew what would happen. They would eat more of the healthy food than they had before, and that would prove that this food expands the number of calories we eat in a day. That is not what happened, Ricky. What happened was much weirder. Once they had had the American diet and it was taken away, they refused to eat the healthy food at all. It was like they no longer recognized it as food. It was only when they were literally starving that they finally went back and ate it. Now, I would argue, we are all living in a version of Cheesecake Park now. This food is profoundly undermining our ability to ever feel full, to ever feel we’ve had enough. I go through the seven reasons why that food affects us in this way, and that’s left us with this tremendous crisis because we feel unfull, unsated, and hungry much more than human beings did before us, and it leads us to massively overeat. What these drugs do, the new weight loss drugs, is they give you back your sense of fullness, but at a cost, which is why Professor Michael Lowe at Drexel University in Philly described these drugs to me as an artificial solution to an artificial problem.

Ricky Mulvey: Essentially, the new processed food, it hijacks our evolution. They make the food softer, or they have these tremendous spikes in sugar that gives you a ton of energy for a moment, and then you crash back down and you feel less full. The thing that’s surprising to me about these drugs, given your previous work on addiction, for example, if you give smokers a nicotine patch, it only helps a minority of them come off cigarettes. The conclusion from that may be if it’s a chemical, it’s not just a chemical problem. But with food, this seems to be not completely solved but significantly solved across the board with these new weight loss drugs. Why do you think that is?

Johann Hari: It’s a really smart and interesting question, and I think the answer is that some of the things are solved and not others. I’ll just pull back for a second and say, for people who don’t know, I’m guessing pretty much upon those now, but there has been a staggering medical breakthrough. As one of the scientists involved put it to me, we now know what controls appetite. It’s gut hormones. If you take Ozempic and Wegovy, they’re basically the same drug marketed under different names. You lose on average, 15% of your body weight within a year. If you take Mounjaro, which is the next in this class of drugs, you lose 21% of your body weight within a year. For the next that will be available next year, known as triple G at the moment, you lose on average 24% of your body weight, which is only slightly below bariatric surgery. We know how it works. If you ate something now, Ricky, it doesn’t matter what it is. After a little while of eating, your pancreas will produce a hormone called GLP-1. GLP-1 is part of your body’s natural system, going, hey, Ricky, you’ve had enough; stop eating. It’s the brakes in your gut, basically.

But natural GLP-1 only stays in your system for a few minutes, and then it disappears. What these drugs do is they inject you with an artificial copy of GLP-1 that instead of sticking around for a few minutes, sticks around for a whole week, which has these bizarre effects. Obviously, to research these drugs, the extraordinary benefits and disturbing risks, I took the drugs myself. I’ve been taking them for a year and five months and a few days, and I went on this big journey all over the world, from Iceland to Minneapolis to Okinawa to investigate them. But it has this bizarre effect. You just feel very full, very fast. You eat a small amount, and you feel very full and don’t want to eat anymore. So you’re absolutely right. For the vast majority of people who take these drugs, they lose really remarkable amounts of weight. I lost 42 pounds in a year, for example. You’ve gone to a really interesting area in your question, though, which is, so let’s think about an analogy. Let’s think about people who are addicted to heroin, and fentanyl, and other forms of opioids. You can give them something called an opioid blocker which blocks the effect of those drugs. You think, well, because we believe the issue with heroin addiction is heroin, your body’s tremendous physical desire for heroin, giving an opioid blocker when they were first invented caused a huge wave of optimism. They’re like, oh, we’re just going to people, give them the opioid blocker or stop using heroin.

But actually, we discovered it’s more complex. What we know about addiction is that, while there is certainly a biological contribution, there are changes that happen in your brain as you become addicted that do make it harder to go back. We know that the core of it are in a different book about this called Chasing the Scream. The core of addiction is about not wanting to be present in your life because your life is too painful a place to be. The addictive behavior is a way of numbing pain and distress and not being present, and that’s true whether it’s heroin, alcohol, gambling, pornography, whatever it might be. We know is if you give people addicted heroin opioid blockers, they will generally reduce their heroin use, but that profound underlying distress will generally emerge in other ways. Often, people can actually become suicidal. There’s an interesting analogy with these weight loss drugs, and I don’t want to overstate it. I want to stress I’m talking about a minority phenomenon, but in the book, I go through the five reasons why we eat. Only one of them is to sustain our bodies. I was eating 3,200 calories a day before Ozempic, and now I eat 1,800, and here I am; my body is alive and well. It’s in fact healthier. So all those other calories, something else was going on. The other four reasons why we eat are primarily entirely psychological. We eat for complex reasons: to manage our emotions, to numb ourselves, to comfort ourselves, and so on.

One of the really interesting things happened, so obviously I talk about the extraordinary benefits of these drugs in the book. I’m sure we’re going to get to them. But I also talk about 12 significant risks, and one of the risks, the one that played out for me a bit, I want to stress this is contested, but some doctors are concerned that a minority of people taking these drugs may become depressed or even suicidal, and I don’t want to overstate it. I didn’t become depressed or suicidal, but the first six months I was taking the drugs, it was weird. I was getting what I wanted. I was losing weight, but I actually didn’t feel better. If anything, I felt slightly worse emotionally. I had a real epiphany about this in Vegas.

I was in Vegas researching something for a different book. I was actually researching the murder of someone that I knew well and loved. This was a very painful thing to do, and so I felt bad, and obviously, on autopilot really, I went to the branch of KFC on West Sahara, and I ordered what I would have ordered before Ozempic. I ordered 1,000 times in that branch of KFC. I ordered a bucket of fried chicken. I had one of the chicken drumsticks, and I suddenly realized, oh, I can’t eat this. You can’t overeat when you’re on Ozempic. Imagine if I came to you at the end of a massive Thanksgiving dinner and said, great news, Ricky, I bought your bucket of KFC. You just couldn’t eat it. You feel like that. I realized one of the things these drugs do is they interrupt your underlying eating patterns. Now, that’s obviously a really good thing. It’s why you lose weight. But what that can do and does do for many people is bring to the surface some of the deep underlying psychological reasons why they ate, just like opioid blockers surface the emotions that you are trying to suppress with heroin use and quite likely were suppressing with heroin use to some degree. These drugs take away the possibility of doing that and therefore bring this to the surface. That can be a good thing. There are better ways for me to deal with my sadness than Colonel Sanders, clearly, but that can be a difficult and bumpy process as it is for people who are trying to come off heroin or any form of addictive behavior.

Ricky Mulvey: You mentioned you’ve been on Ozempic, and normally, we don’t ask guests about their prescription drug use, but we can make an exception for you.

Johann Hari: I’m not judging you.

Ricky Mulvey: You’ve been on it for a comparatively long time, and I’ve heard that essentially, there’s plateaus and that it changes the more you take it; maybe you build up a tolerance to it. What’s your experience been, especially now that you’ve been on it for more than a year?

Johann Hari: Tolerance is one of the big questions about these drugs. One of the things that was disconcerting in the research, it’s going around interviewing the leading experts and asking them quite basic questions like, these drugs primarily work on the brain, we now know that. You have GLP-1 receptors, not just in your gut but in your brain. And it’s increasingly clear from interviewing the cutting-edge scientists it’s affecting your brain. You say to them, what is it doing to my brain? They say a very polite version of, we don’t know.

Or think about tolerance. Here’s what we know. The graph for the vast majority of people is pretty similar. You start to take the drug, you gradually increase your dose, and your weight massively falls. Then it hits a plateau at a lower level, which is exactly what you would want, by the way. We wouldn’t want a drug that made you endlessly lose weight; that would kill you. Then you plateau, and you plateau for about 60 months. Then, in the only long-term study we’ve got, weight seemed to very slightly tick up at the end, but it ticked up to a level that was still vastly lower than where you started. Of course, I ask the scientists involved. Well, so some drugs you never develop tolerance to; your body never gets used to them. Antihistamines, for example, you don’t seem to develop tolerance to them. Some other drugs, think about amphetamines, which used to be used as a diet drug in the ’60s and ’70s still are incredibly by some people. With amphetamines, anyone who’s used amphetamines recreationally you’ll be nodding along here, you need higher and higher doses to get the same effect.

It’s why they were a really bad diet drug because, in the end, you had to take such high doses that you became psychotic, and skinny, but psychotic is not a great deal. Is it like antihistamines or is it like amphetamines? We don’t know. People haven’t been taking them for obesity for that long. We do know, of course, type 2 diabetics have been taking them for nearly 19 years now. They don’t seem to develop tolerance. They don’t need higher and higher doses to control their blood sugar. That’s encouraging. If you asked me to guess if we develop tolerance for it, I think the most informed guess I got was from Professor Carel Le Roux, who made lots of breakthroughs that were really important for developing these drugs and also works on bariatric surgery and with patients who have bariatric surgery. He said his best guess, he stressed it was a guess, is that it’ll probably be like bariatric surgery. The general pattern with bariatric surgery is you lose an enormous amount of weight after the surgery. You plateau, you remain at a lower weight, and then after a couple of years, you tick up a little bit more. For most people, nowhere near back where they were. He thinks it’ll probably be that pattern, but we don’t know.

Ricky Mulvey: With bariatric surgery, it’s the surgical removal of fat. [Editor’s note: Speaker means a surgical treatment resulting in weight loss, not liposuction.] This is a drug solution. There’s benefits and costs to either. Do you think when we look back five, 10 years from now, the benefits of weight loss drugs like Ozempic and Wegovy will be seen as a much better solution?

Johann Hari: Then bariatric surgery, yeah. I think that’s very likely. Bariatric surgery is a horrendous operation. It is extraordinarily physically grueling. One in a thousand people die during the surgery. The reason people put themselves through it is for the benefit that you also get with these drugs, which is staggering. The evidence is overwhelming. If you reverse obesity, you dramatically improve health.

Bear in mind people having bariatric surgery by definition are really quite obese. But if you have bariatric surgery and you make it through the operation, 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. We really underestimate how much cancer is driven by obesity. You are 92% less likely to die of diabetes-related causes. In fact, it’s so good for your health, in those seven years, you’re less likely to die, period, of any cause by 40%, which is remarkable. Clearly, if you can get triple G, the one that will probably be available next year. Just to explain, Ozempic and Wegovy work on simulating one gut hormone, GLP-1. Mounjaro simulates two gut hormones, GLP-1 and GIP, which is why you get a much bigger effect, 15% with Ozempic and Wegovy, 21% with Mounjaro, and triple G works on three gut hormones. We now know there’s lots of gut hormones that affect appetite. That’s why there’s over 200 of these drugs now in development, and they will have different side effect profiles. But the way one scientist put it to me, I think it was Professor Robert Kushner, we’ve cracked the code, we’ve found the treasure chest, we’ve figured out what regulates appetite, it’s gut hormones. It’s really important for people to understand, this is not a fad. This is not a new diet drug craze. I’ve heard it described that way. This is a profound medical breakthrough that will have remarkable effects. Whether it’ll be better or worse, it’s a really important question, and disturbingly, the answer is, I don’t know, despite all the research I did. The book is called Magic Pill because there’s three ways these drugs could be magic.

The first is the most obvious. They could just solve the problem. There are days when it feels like that, Ricky. My whole life I’ve overeaten. Now I inject myself once a week in the leg. I don’t even barely even feel it, and I eat dramatically less, and I’m no longer obese. It’s staggering. Feels like magic. The second way it could be magic is much more disturbing. I talked in the book, and I’m sure we’re going to go into some of the 12 significant risks associated with these drugs. The second way it could be magic is that it could be like a magic trick. It could be like the conjurer who shows you a card trick while picking your pocket. It could be that over time, the 12 risks outweigh the benefits. There’s a significant chance of that. The third way it could be magic is I actually think the most likely, think about the stories of magic that we grew up with as kids. Think about Aladdin. You find the lamp, you rub it, the genie grants your wish and your wish comes true, but never quite in the way you expected. We’re already seeing all sort of unpredictable effects, many of which we can go into. I actually think the third one is the most likely, but I think the most honest answer to your question, will this do more harm than good or more good than harm? The way I think about these drugs is they’re a tool like fire. This is slightly hyperbolic, but not crazily so. If you said to me, does fire do more good than harm, I’d be like, well, fire is a great thing if I use it to warm my house. It’s a terrible thing if I use it to burn your house down. These drugs are going to be staggeringly powerful for people like me. I’m older than my grandfather ever got to be. He died of a heart attack when he was 44. Loads of the men in my family get heart disease. My dad had terrible heart problems. My uncle died of a heart attack, just like my grandfather did.

These drugs are probably saving my life. If you take these drugs and you had a BMI higher than 27, it lowers your risk of a heart attack by 20%, staggering. And that’s just one of the many health benefits of reducing or reversing obesity. Equally, there are people with eating disorders who will be killed by these drugs. I’m really worried if we don’t regulate these drugs, I can explain how, we will have an opioid-like death toll of young girls, is overwhelming in young girls, and some young boys, and some older people, but mostly young girls. Anyone who’s known people with eating disorders knows, there’s a conflict going on within them. There’s the psychological part of them that wants to starve themselves for all sorts of complicated reasons. Then there’s the physical part of them that wants to live and therefore wants to eat. What these drugs do is they just amputate your appetite if you take a high dose. I’m saying this hypothetically, is in fact happening. There are lots of young girls, and people like Dr. Kimberly Dennis who is one of the leading experts on eating disorders in the United States, warned me about this. 

There are young girls who are getting hold of these drugs and my worry is that they will be able to kill themselves with these drugs in a way they would not have been had they not got the drugs. Which is why I really urge everyone to contact their electoral representatives to make a very simple change. I can see you, Ricky. We’re talking on Riverside or whatever it is, Lancaster. I can see you are not eligible for these drugs. You clearly have a BMI lower than 27. You should not be given these drugs. Doctors are not meant to give it to you. I guarantee you, if you go online this afternoon, you can get an appointment on Zoom. Doctors are meant to check your weight. Well how are they doing that on Zoom? It’s ludicrous. You can’t. I guarantee that you could get these drugs delivered to you tomorrow if you had the money. What Dr. Dennis and other experts are saying is, we need to change that so you can only get these drugs after an in-patient appointment with a doctor who weighs you, checks that you’re overweight and is trained in detecting eating disorders and can divert you for help if that’s your problem.

Ricky Mulvey: Yesterday, I did that. I went on an online pharmacy as a test to see what it would take for me to get weight loss drugs prescribed to me. Basically, I don’t want to reveal what it was because I lied about it, but it was for an experiment. I tried to essentially say, I’m just trying to lose 10 pounds to see if they would prescribe me Ozempic or Wegovy? They wouldn’t. It was another type of medicine that they were still prescribing me, but I realized just how easily I could lie about the information in this because I was filling out my own chart. We’ve talked about on the show about companies that are online pharmacies that are prescribing these weight loss drugs. There’s been a tremendous amount of investor excitement around these companies, especially on the prescribing side, but do you think it’s even possible for an online pharmacy? Is there any way that they could prescribe these weight loss drugs in a responsible way?

Johann Hari: No. And I think we’re going to look back on it like the opioid crisis, where we now look back and see, although the opioid crisis had complex causes and is sometimes talked about in too simplistic way, the primary driver of the opioid crisis was in fact profound despair. This is why the leading experts on this Professors Anne Case and Angus Dayton call them deaths of despair. I hurt my thumb when I was in Vegas, I went to the doctor and they offered me Oxycontin. I’d only slightly hurt my thumb. Everyone knows that opioids were handed out in a crazily loose way for a long time in the United States with terrible effects. So, no, there isn’t a safe way. You cannot be prescribing these things safely over Zoom. The risk is too great to people with eating disorders and just people who aren’t overweight. People who are not overweight taking these drugs are incurring all of the 12 risks and piling other risks. I think about, for example, muscle mass. Muscle mass is the total amount of soft tissue that you have in your body. It’s essential for movement. Getting out the chair, climbing the stairs, whatever it might be. Naturally as you age, you lose muscle mass.

Depressingly from the age of 30, you lose muscle mass, I think it’s 8% per decade. Any form of weight loss, no matter what it is, also causes a loss of muscle mass. You don’t just lose fat mass when you lose weight, you lose muscle mass. But if you’re going into the aging process, artificially thin, you’re going in with a very low reserve of muscle mass. That won’t cause your a problem when you’re 30 or 40 or probably not even when you’re 50. But when you get to be 60 or 70, you’re really at risk of a condition called sarcopenia, which means poverty of the flesh, which basically where you have such low muscle mass that you really struggle to do anything, like get out of a chair, climb the stairs. I was on a TV show the other day with one of the real housewives of New Jersey saying they’re all on it, none of them were fat at the start. Indeed, they were skinny at the start. They’re taking it to be bone thin. I don’t judge anyone for that. We make women feel terrible about their bodies in this culture, whatever they do so I understand the pressure, and I understand where it comes from. I’m not morally judging them at all. But I’m very worried for their health because they’re going to go into the aging process with a very low level of muscle mass. We could be setting in place a time bomb of sarcopenia further down the line.

Ricky Mulvey: But for a lot of people, we’re decreasing the risk of heart disease, which is a tremendous killer.

Johann Hari: Yeah. Massive. I think about Professor Gerald Mann who designed the food label that’s on all food in the United States now at Harvard. His calculation, which is somewhat contested, but I think plausible is that obesity and food-related illnesses cause 680,000 deaths a year in the United States alone. We don’t think of it that way. You aunt gets cancer, and you don’t think obesity killed my aunt, your uncle has a stroke and you don’t think obesity killed my uncle, but it’s of course not the only cause of these issues, but it’s one of the really big ones. So yeah, you’re absolutely right. Obesity is staggeringly bad for your health on average and by reducing or reversing obesity, these drugs massively improve health.

Ricky Mulvey: I want to go to a more optimistic place. You mentioned your trip to Japan, and there are solutions there that some of which simply we couldn’t implement in the Western world. You go to a company where they broadcast, your coworkers tell you if you need to go weigh yourself for the week or they have these walking competitions. I’ll tell you, the one I’m not doing. I’m not doing five different techniques. It’s like they want to include five different cooking techniques in their meals. Johann, I don’t want to do that. But what do you think we can take from a country like Japan in the Western world, which has really combated obesity in an effective way without these drugs?

Johann Hari: It’s weird that our mental picture of Japan is a sumo wrestler because it’s basically like expecting an American to look like a bald eagle. There are very few. United States has 42.5% of people who are obese and Japan it’s 4%, so a huge difference. They have almost no childhood obesity in Japan and it’s interesting. At first, you think, well, that must be genetic, but we know that’s not true. One hundred and twenty years ago, loads of Japanese people moved to Hawaii where I was recently, and they’ve obviously been there now for whatever it is, five generations. Japanese Hawaiians are almost as fat as other Hawaiians so it’s not that they obviously have genetically mutated in that time. The environment is driving it. Japanese Hawaiians are 4 times more likely to be obese than Japanese people in Japan. So what’s going on? Interestingly, it’s not just innate to Japanese culture. One hundred and twenty years ago — Professor Barak Kushner at Cambridge University has written and talked about this — Japan had one of the worst diets in the world. They were really unwell. Actually, the Japanese government decided to radically improve the health of the population. Not for a good reason. It’s because they wanted an army to go and invade the attack the rest of Asia, so not the best motivation for weight loss, but we all got our reasons, and they really concertedly changed how Japanese people ate. Japan has lots of policies to build in resistance to processed and ultra-processed foods and to compel people to eat healthily. Some of those measures are things, like you say, we would not do. By law, if you’re over the age of 40, this is just so crazy to me, your employer has to weigh you every year and if your staff as a company overall gain weight as a company, you can be fined. So if you as an individual gained weight, you have to draw up a plan with your employer to lose weight. It’s so weird talking to Japanese employees about it.

I said to them, if you did this in the United States, we would burn the office down, and they would just look puzzled and be like, well, why? It’s such a profound cultural gap on that question. Yeah, there’s lots of things they do. Every Japanese school has to employ a nutritionist. It’s a serious qualification that nutritionist prepares fresh food, oversees the preparation of fresh food every day. Japanese children never eat processed or ultra-processed food in their schools. They only eat healthy fresh food, and then they use that healthy fresh food to educate the children to like healthy fresh food and to understand what it does for their bodies. We should do that. There is no more precious asset in a country than its children. As our children are becoming terribly sick with obesity, well, it’s a tragedy for the individual child and it’s setting themself up for all sorts of problems. Absolutely, it is not inevitable. The reason Japan is so important is some people just go, look, obesity is just a quirk of wealth. At the point at which you have enough money, a significant amount of your population will just overeat. Well, Japan is the third-richest country in the world, and it has the same level of obesity as Somalia. It is not true that obesity is inevitably a product of wealth at all. Japan shows us it’s not. We can learn from Japan. It’s not a fictional country. It can feel like it sometimes, but it really isn’t.

Ricky Mulvey: After going to Japan and seeing how they essentially manage nutrition for kids, how did that affect your views on these weight loss drugs being prescribed to children in the states?

Johann Hari: This was for me the most difficult of all the topics. Because adults or kids, when you’re thinking about these drugs, you need to weigh two sets of risks. There’s the risks of obesity, which are enormous, and then there’s the risks of these drugs, some of which are significant, and many of which are unknown, which makes them hard to quantify. That’s bad enough I’m making that decision for myself. But if you’re making it for a child, Novo Nordisk, the company that makes Ozempic and Wegovy, are currently doing a trial on giving these drugs to children as young as 6. What’s very painful when you see children that young who are obese is unless they have an exceptionally rare genetic condition like Prader-Willi syndrome, some people do have. We’re talking about vanishingly tiny numbers of people. Unless they’re in that category. That is driven by the environment. It’s very painful to go to Japan and realize there’s almost no obese children at all and then come back and go to my godson’s school here in Britain or go to the schools that I see in Vegas and see in many of them, half the kids are overweight or obese. You realize, right, this isn’t some inevitable thing. This is the product of a sick environment. The Bengali philosopher Krishnamurti said it’s no sign of good health to be well adjusted to a sick society.

Plainly, we should deal with the underlying cause, and that is much easier to do with children because they haven’t had the damage that comes from years and years of being obese. But that’s very hard to do as an isolated individual. I interviewed a mother in Connecticut called Deborah Tyler, a really wonderful, admirable woman, a nurse, had a terrible choice. Her daughter was obese. She was having liver and kidney problems when she was eight. I think I remember that correctly, the details in the book. I shared this agonizing choice. Do I give my daughter Ozempic or do I let her liver go on, she tried doing a diet and exercise programs, and it wasn’t working. She made the choice for Ozempic, I don’t blame Deborah. She’s an admirable person. I suspect in her position, I would have done the same and she’s very alert to the fact that this is an environmental problem. She’s like, yeah, we need to fix this. It’s very hard to fix it at the level of an isolated individual. Of the 12 risks that I write about in the book, the one I’m most worried about for myself — there are ones that I’m more worried about for other people — but for me, biggest concern for me is we don’t know the long-term risks of these drugs. Type 2 diabetics have been taking them for nearly 19 years, but for obesity only taking for a couple of years. There’s an analogy that may or may not apply, but I think it is worth thinking about. That was alerted to me by doctor Greg Stanwod, at Florida State University, who I want to stress believes these drugs are broadly safe and raised this speculatively, but nonetheless thinks we should think about it. If you go back to what is it, the late ’50s, early ’60s when antipsychotics were first given to people, doctors judged the benefits outweighed the risks. It’s always controversial, but that was their judgment at the time. Forty, 50 years down the line they discovered if you take these drugs for a really long time, you’re much more likely to get dementia, all forms of dementia, in fact. Now, it’s not that they were being negligent back in the ’50s and ’60s, you just couldn’t have known that you had to have people taking it for 40, 50 years before you could figure that out. Now not suggesting these drugs will cause dementia, there’s no reason to think that. What I’m saying is it could have some long-term effect that we have no idea what it is. We just don’t know. Now, that’s worrying for me, I’m 45.

I hope I live a long time. I’ll presumably hope I’m halfway through my life. Given that the effect of these drugs seems to wear off when you stop taking them for the vast majority of people, I’m guessing I’m going to be taking these drugs for 45 years. Will I, 45 years from now, be bitterly regretting it? Will someone be digging up this podcast from the ashes of whatever world exists in the broken wreckage of the world in 45 years from now, and saying what a fool, he shouldn’t have done it? Possibly. But the way Dr. Shauna Levy, a leading obesity specialist put it to me, at Tulane University School of Medicine is we don’t know the long-term risks of these drugs, but we do know the long-term risks of obesity, and they are very serious. I’ve chosen the risks but lots of people read the benefits and risks that I go through in the book, and come to a different conclusion for them and I totally respect that. Anyone telling you there’s a one-size-fits-all solution for this is, it’s not leveling with people. I hope my book is a guide to people who can think through the risk of obesity, the risks of these drugs, which ones are likely to apply to them. The psychological effects, the economic effects, a lot of the book is about the economy, what it’s going to do to our economy and society. But I have no doubt, this is coming for you. Forty-seven percent of Americans want to take these drugs already, and most of them don’t yet know someone like Jeff Parker who’s lost a huge amount of weight. Eight years from now, Ozempic goes out of patent. At that point, it’s going to be probably a daily pill. It’ll probably be $1 a day. I think it’s an underestimate that half the population will be taking it. This is coming for us. We’ve got to all think about this in — in the economy. We’ve got to think about it’s going to have a staggering transformation. An analyst for Barclays Bank said the best comparison for the economic effects is the invention of the smartphone, and I think she’s right.

Mary Long: If you’re interested in learning more about Magic Pill, or want to find out where you can get yourself a copy of the audio book, the e-book, or the physical book, you can head to magicpillbook.com. I’ll also include a link in the show notes. It’s also available at your local bookstore. As always, people in the program may have interests in the stocks they talk about, and The Motley Fool may have formal recommendations for or against, so don’t buy or sell stocks based solely on what you hear. I’m Mary Long. Thanks for listening. We’ll see you tomorrow.