Just a few years ago no one had even heard the word Ozempic. Almost overnight, the drug previously used to treat type 2 diabetes became a household name. By the end of the decade, 30 million people are predicted to be on it. For comparison, that means that Ozempic is on track to do as well as birth control pills and Prozac—a blockbuster medication.
A little over a year ago we had a fiery debate on Honestly about these revolutionary weight-loss drugs and our cultural understanding of obesity. On one side of the debate, people saw Ozempic as the golden answer we’ve been searching for. After all, obesity is the second biggest cause of cancer.
On the other hand was another argument: Why are we putting millions of people on a powerful new drug when we don’t know the risks? Plus, doesn’t this solution ignore why we gained so much weight in the first place?
A year later, all of those questions are still up for debate. Our latest guest on Honestly, journalist Johann Hari, has spent the last year trying to find answers, traveling the world investigating weight-loss drugs and. . . taking them himself.
In his latest book, Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs, Johann investigates what we know and what we don’t know about how these drugs work, their risks and benefits, how our food system sets us up to fail, and how movements like “fat pride” and “healthy at any size” have completely altered the conversation. (He also discloses how the Dalai Lama fat-shamed him after he asked the religious leader about homophobic statements he had made.)
I asked Johann: How do these new drugs impact our brains, our guts, and our mood? What are the hidden risks? Are they really a permanent solution to the obesity crisis?
To listen to our conversation, click below—or scroll down for an edited transcript.
On discovering Ozempic:
Bari Weiss: When we last saw each other, we were both fatter. I was at a very wealthy home in L.A. when the wife of the couple said “I love your podcast, you should really do it on video,” and I said something self-deprecating like “I gained 20 to 25 pounds and I hate seeing myself on camera.” She looked me dead in the eye, took me up to a mini fridge in her home, and pulled out the pen and said, “Can I give you some?” I took it there on the spot. The craziest thing happened to me: the next week it was if I was full from a cup of water. I had never experienced the feeling of being so satiated with nothing. I was no longer interested in food. I shed 15 to 20 pounds of my Covid weight.
How did you first find out about Ozempic?
Johann Hari: It was the winter of 2022, when the world was opening up again. I got invited to a party for the first time in years, thrown by an Oscar-winning actor. In the Uber on the way there, I was thinking, Oh God, I’ve gained so much weight, and I was dreading it. Then I remembered that everyone had gained weight. And I thought, I’m going to see these Hollywood stars with a bit of pudge on them. It’s going to be fascinating.
I arrived at the party and it’s not just that they hadn’t gained weight. . . everyone was gaunt. Everyone was like their own Snapchat filter: tighter and clearer. I said to a friend of mine, “Wow, it looks like everyone really did take up Pilates during lockdown.” And I must have had a confused look because she said, “Johann, you know it’s not Pilates, don’t you?” I had no idea what she was talking about.
So she pulled up an image of an Ozempic pen. And I learned about the existence of these drugs.
On why these drugs are “magic”:
BW: You make the argument that this new set of drugs might be seen or come to be seen as profoundly transformative to our culture as the invention of the Pill and the smartphone. Make that case.
JH: There are three ways in which these drugs could be magic. The first is the most obvious. They could just solve the problem.
The second way in which it could be magic is more disturbing: 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 it’s giving us this benefit, but at the same time it’s screwing us over.
The third way I actually think is the one that’s most likely: if you think about all the classic stories about magic that we grew up with, like Aladdin, you find the lamp, the genie appears, you make your wish, and your wish comes true. But never quite in the way you imagined. Think about Fantasia: you unleash the magic and the magic runs away from you and has all these unpredictable effects.
On how we got here and the food industry:
BW: Let’s talk about how we got here in the first place—how we got to a place where millions of people are shooting themselves with a drug whose consequences we don’t fully know. How did we get to a place where in the richest, freest country in the history of the world, 40 percent of people are obese?
JH: It literally happens everywhere people move from eating a diet mostly based on whole foods that are fresh and prepared on the day they eat them to mostly eating foods built in factories out of chemicals in a process that isn’t actually called cooking—it’s called manufacturing.
There’s an experiment that really drove this home to me: there’s a brilliant scientist called Professor Paul Kenny. He’s the head of neuroscience at Mount Sinai and he grew up in Dublin in Ireland. When he was in his 20s, he moved to San Diego and he quickly clocked, Whoa, Americans don’t eat like Irish people did at the time. There was way more processed food, way more sugary, fatty food. And he started to feel like this different kind of food wasn’t just affecting his gut; it was changing his brain and what he wanted. So he designed an experiment to test this.
He got a load of rats and he put them in a cage. And he raised them with nothing to eat but the kind of fresh, whole foods that rats evolved to eat throughout their lives. And when they had this food, they would eat when they were hungry, and then they would stop.
Then Professor Kenny introduced them to the American diet. And he put it in the cage alongside the healthy food. And the rats went crazy for the American diet. As Professor Kenny put it to me, within a couple of days, they were different animals. And they very rapidly all became obese.
Then Professor Kenny tweaked the experiment again: he took away all the American food and left them with nothing but the healthy food again. What happened is they refused to eat anything. When the American food was taken away, it was like they no longer recognized the healthy food as healthy food at all. It was only when they were literally starving that they went back and ate it.
On being fat-shamed by the Dalai Lama:
BW: How did we get to a place where we are knowingly and happily eating petrochemicals and sawdust?
JH: You’re reminding me of one of the real low points of my life. It was Christmas Eve 2009 at 1 p.m. I went to my local branch of KFC and I said my standard order, which is so revolting I won’t repeat it on a podcast, and the guy behind the counter said, “Johann, I’m really glad you’re here,” and he said, “Wait a minute,” and he went behind where they fried all the chicken and came back with a massive Christmas card in which everyone who worked there had written, “To our favorite and best customer.” And one of the reasons my heart sank is I thought, This isn’t the fried chicken shop I come to the most. It was genuinely chilling. It was one of the two lowest moments in my fat life, along with the time the Dalai Lama fat-shamed me, but that’s another story I can tell you later if you want. He’s a horrible bitch, but. . .
BW: Wait, I’m sorry, we need to hear the Dalai Lama fat-shaming story.
JH: It was actually genuinely quite upsetting. So I was a baby journalist, I must have been, I don’t know, 25, and I got sent to interview the Dalai Lama. And I believe, even when you really agree with a powerful person, and I actually agree with the Dalai Lama on resisting communist tyranny for example, you should challenge them. So I looked up: Has the Dalai Lama ever done anything wrong? Turns out, he thinks disabled people are being punished for what they did in a previous life. That seems quite bad to me. He’s quite anti-gay. “You shouldn’t use the other holes” is an actual quote from the Dalai Lama.
So I go to interview him, and the first 20 minutes I’m asking about all the stuff we agree on, the brave resistance to communist tyranny. And then I started asking him about this stuff, and he started pretending that he didn’t speak English. And I said, “Your Holiness, I know you speak English. You just gave a speech in English. I know you can understand me.” And his goons—I assume that’s not their official title—were giving me really dirty looks, and I thought they were going to throw me out, and I was meant to have an hour. So I thought, I’ll bring it back to something where we agree. So I said, “You know, Your Holiness, you’ve always been very critical of income inequality in Western countries.” And he said, “Yeah, I don’t see why people need so much money. We each only have one stomach.” And then he said, “Except you, you clearly have at least three.” I was like, Wait, isn’t the Dalai Lama meant to love blades of grass and rocks? Is he calling me fat? Is that what’s happening here?
And it wasn’t my finest moment as a journalist, but I said, “Well, you’re quite fat as well.” And when I later wrote about this, I got the world’s first ever Buddhist death threat, which I was thrilled about. I wrote back and said, “You’re going to have at least three lives as a wood louse now.” So yeah, it wasn’t ideal. Where are you now, Dalai Lama? Let’s send him an Ozempic pen.
On the risks of these weight-loss drugs:
BW: Talk about the side effects of taking the drug.
JH: There’s a brilliant scientist I interviewed called Professor Jean-Luc Faillie, who’s at the University Hospital in Montpellier in France. He looked at loads of the diabetics who’d taken these drugs between 2006 and 2012, and he compared them to an almost identical group of diabetics who had not taken these drugs. And what he found, if he’s right, is really alarming. He found that they increase your risk of thyroid cancer by between 50–75 percent.
It’s important to not misunderstand that. That doesn’t mean that if you take these drugs you have a 50–75 percent percent chance of getting thyroid cancer. If that was the case, there’d be bonfires of Ozempic all over the world. What it means is, whatever your thyroid cancer risk was at the start, it will go up—if he’s right, and this is highly disputed—by 50–75 percent.
BW: Is there any research into Ozempic muting people’s ability to experience pleasure, happiness, even ambition?
JH: This was fascinating to me. I asked all these leading scientists, What’s it doing to my brain? And they all gave me a variant of “Come back to me in a few years, maybe we’ll know.”
One theory about how these drugs could be working, and I stress it is a speculative theory, is that in your brain you have something called your reward center, which basically motivates you to do anything pleasurable: eat, have sex, see your friends, etc. And one theory about these drugs is that they are dampening the reward centers in your brain. You and I are eating fewer Big Macs because we don’t want it as much because we don’t get as much of a reward from it, because our reward centers have been dampened. Now if that’s right, that obviously raises a question: If it’s dampening my desire for an In-N-Out burger, is it dampening my desire to write my next book or to have sex?
On how culture contributes to the obesity crisis:
BW: The New York Times recently profiled this woman who identifies as a “fat activist,” named Virginia Sol Smith. And here’s what the Times writes about Smith: “Sol Smith says that parents need not be concerned about how many Oreos their children eat. . . . If parents put restrictions on food, then children will never figure out how to eat according to their own bodies’ own needs, she explained.” I’d love for you to respond to that logic.
JH: The idea that you’ll learn your body’s needs from Oreos is a profound misunderstanding. The kind of food we’re eating is so different from the food that we evolved for that we do not have nutritional wisdom when it comes to this food. There isn’t an innate nutritional wisdom that your child will discover about an Oreo. No human before us encountered an Oreo.
On other solutions to obesity:
BW: Let’s talk about some solutions to the deeper problem. You traveled with your nephew, who has recently lost a hundred pounds, to Japan, which has a food culture so different from the food culture in America, and they have not experienced the same obesity crisis that we have here in America. Tell us a little bit about what you discovered on that trip and lessons that those of us who are concerned about this crisis might learn from it.
JH: So Japan has 4 percent obesity. Americans have 42.5 percent obesity. But Japan shows us that is not inevitable, right?
I went to a Japanese school, a normal middle-class school, with a thousand kids. It was bizarre walking around this school. There were no overweight children in this school. Every school in Japan has to employ a professional nutritionist. Her job is to design the meals. All processed food is banned.
So I go to the school and I’m watching these kids eating these unbelievably healthy meals. And I said to them, “So what’s your favorite food?” And one of them goes, “My favorite food is broccoli.” Another one goes, “My favorite food is white fish.” And another one goes, “I like boiled white rice.”
And I turned to my translator and I said, “Are these kids fucking trolling me? Their favorite food is broccoli?” She said, “We teach our children to love healthy food, don’t you?” No Japanese person understood why I was shocked.
One of the funniest experiences I ever had was trying to explain the concept of “fat pride” to Japanese people. They were just completely baffled.
They have a law; it was so bizarre witnessing. . . in 2008, in Japan, obesity went up by 0.4 percent, and there was a massive national freakout. And they introduced a law called the Metabo Law. And the law says every company in Japan has to weigh its entire staff on a particular day. And if your weight has gone up, you have to make a plan with your employer to bring it down. And if as a company overall your staff’s weight has gone up, you are fined by the government.
I went to this company in Tokyo. You arrive at the company; it scans your face and says, “Hi, Bari, you walked 13,000 steps yesterday. You are 112th in the company’s ranking.” It might also say, “By the way, Suzy, who works at the desk next to you, hasn’t weighed herself in the last two weeks. Could you remind her?”
For me, the most moving experience I had was when I went to a place called Ogimi. It sounds almost mythical. It’s the oldest village in the world. It’s in Okinawa. They’ve got 215 homes and 190 people are older than 90 years old. Japan has, by far, the longest life expectancy in the world, but more than that, people are healthy almost until they die.
So I go to their little community center. The first person who walked through the door was a 102-year-old woman called Matsu Fukuchi, who walked there on her own, from her house up the mountain. This is what you get if you solve the obesity crisis.
I went to countries that have begun to solve the obesity crisis. I went to Mexico, where they’ve got a sugar tax. I went to the Netherlands, where they give obese children personal trainers, and where they took sugary drinks out of schools. We can solve this crisis. We do not have to tolerate this being done to us. It shouldn’t be the case that half the population of the United States wants to inject itself with a risky drug to prevent an even riskier medical condition.
To support more vital conversation, become a Free Press subscriber today:
I have been overweight/obese most of my life. Most recently, I hit a BMI over 50 (and over 300 lbs) about almost two years ago. I was seeing my endocrinologist - who because of my continued gain, my expressed frustration with my inability to lose weight (despite trying to eat better and exercise) and the fact that I was pre-diabetic, offered to write me a script for Ozempic. I said yes. After six months, i had lost about 10 lbs, and she upped my dose. By my next six month visit I realized two things - it wasn’t working for me and i absolutely needed to come off it. In that six month period I had gone through an entire family sized bottle of antacid, and lost only another 5 lbs). So we agreed to stop the med, let my system purge it, and readdress writing for a different one in six months time.
Three months after that, I had gained the little weight I had lost back. Unhappy with that, I decided to go back to the one thing that ever had me losing weight. I downloaded an app, and started keeping track of what I ate (following macros). I told the app I wanted to lose 60 lbs. It gave me a target calorie count, and targets for protein, carbs, and fat. Since starting that, I am down nearly 40 lbs (my weight loss was slowed a little by foot surgery that has required me to be much more sedentary than usual and kept me from the gym for a month). But I focused on what I was eating - and I realized I was eating tons of empty calories, not nearly enough protein and mindless snacking was killing me. Now, 7 months in, I’ve changed the foods I eat significantly, but in a way that I can still do things like enjoy a glass of wine, eat dessert, go to a restaurant, etc.
I’m an anesthesiologist by trade. Ozempic and the like have significantly changed the way I practice. My anesthesia groups are full of anecdotal stories of patients who had been NPO for 2+ days coming in for endoscopy with a stomach full of food. Now, we are asking patients to skip a dose prior to surgery (and we aren’t sure if that is helping) and even if they do, we still treat them differently than a standard patient because of their aspiration risk. This is something I rarely see discussed.
Given all that, I’m overall not a fan of the drug.
“Why are we putting millions of people on a powerful new drug when we don’t know the risks?”
—————————————————-
I take my Ozempic to protect other people. But, sadly, if the MAGA extremists don’t take their Ozempic, mine doesn’t work.