Johann Hari Cautions Ozempic Users Over Long-Term Health Risks

The Diary Of A CEO

GLP-1 weight-loss drugs effectively suppress appetite and addiction cravings, but users face severe physical risks and high weight-regain rates without systemic food industry reform.

AI-assisted summary of Johann Hari: They’re Lying To You About The Side Effects Of Ozempic! — original source. Check the original for full context.

Source published: 2024-04-29

Detailed notes

## Background This episode of The Diary Of A CEO was published on YouTube by Steven Bartlett on April 29, 2024. The page description introduces New York Times best-selling author Johann Hari and highlights his book, 'Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs', while framing a discussion on the hidden side effects, benefits, and societal impacts of Ozempic.

## TL;DR Author Johann Hari discusses the transformative impact and potential hidden risks of GLP-1 weight-loss drugs like Ozempic, drawing from his personal experience losing 42 pounds and extensive global research. The conversation explores how these medications suppress appetite by altering brain signals, their potential to treat addictions beyond food, and the significant risks of muscle loss, pancreatitis, and long-term unknown side effects. Hari and Bartlett debate whether GLP-1s serve as a necessary tool against an obesogenic food environment engineered by the food industry or a systemic shortcut masking deeper societal issues.

## Atmosphere & style The dialogue feels deeply intimate, candid, and intellectually curious, driven by Hari's expressive storytelling and Bartlett's probing, reflective host style. The conversation shifts fluidly from personal vulnerability regarding body image and cultural shame to rigorous scientific scrutiny and sobering historical warnings. Throughout the episode, there is an underlying sense of moral urgency and existential contemplation about health, human nature, and societal food systems.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=0s) GLP-1 receptor agonists like Ozempic, Wegovy, and Mounjaro deliver unprecedented weight loss results (averaging 15% to 24%), whereas traditional dieting long-term success rates hover around only 10%. - [00:00](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=0s) Discontinuing GLP-1 medications typically results in regaining approximately 70% of the lost body weight within a single year. - [06:51](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=411s) Synthetic GLP-1 agonists mimic natural gut hormones but linger in the body for a week rather than minutes, significantly suppressing appetite and altering brain reward centers. - [20:12](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1212s) The 'Cheesecake Park' experiment demonstrates how ultra-processed foods hijack mammalian biology, triggering compulsive overeating that overrides normal satiety and survival instincts. - [52:25](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3145s) Rising global obesity is largely driven by an 'obesogenic environment' engineered by ultra-processed food manufacturers, rather than a sudden collective failure of willpower. - [42:41](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2561s) Removing food as a primary emotional coping mechanism can unmask underlying psychological distress and trauma, leading to phenomenon like addiction transfer. - [01:07:43](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4063s) Taking GLP-1 drugs for five years reduces the risk of heart attacks and strokes by 20% in individuals with a BMI over 27. - [01:18:08](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4688s) Significant documented risks of GLP-1 drugs include rapid loss of lean muscle mass (sarcopenia), acute pancreatitis, gallstones, gastrointestinal distress, and elevated relative risks of thyroid cancer. - [02:05:37](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7537s) Emerging clinical and animal research suggests GLP-1 agonists boost overall self-control and substantially diminish cravings for alcohol, opioids, and nicotine. - [01:43:26](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6206s) Structural public health reforms—such as Japan's Metabo Law and strict food environment regulations—offer proven population-level solutions to obesity beyond individual medication.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=0s) Introduction and the Promise and Risks of Ozempic

The conversation opens with host Stephen Bartlett noting that guest Johann Hari looks remarkably different since they last spoke two years ago. Hari reveals that he lost three stone (roughly 42 pounds) in a single year, introducing the central topic: the revolutionary and controversial weight loss drug Ozempic. As a bestselling author using his own body to test these new treatments, Hari highlights how Ozempic has quickly become "literally the hottest drug in the country right now," promising massive benefits while carrying profound, often unexamined risks.

Hari points out that after 40 years of relentlessly promoting diet and exercise—where only about 10% of people successfully achieve major, long-term weight loss—society has suddenly produced "the most effective tool for self-starvation human beings have ever come up with." However, he cautions that these medications act directly on key areas of the brain and bring at least 12 significant risks that have not been adequately explained to the public.

* On average, users of Ozempic and Wegovy lose 15% of their body weight in a year, while next-generation GLP-1 drugs approach a 24% weight loss, rivaling bariatric surgery. * Users who discontinue the drug regain roughly 70% of their lost weight within a year. * Potential side effects and risks include severe muscular loss, acute pancreatitis, gallstones, gastrointestinal issues, and concerns regarding suicidal ideation.

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[01:58](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=118s) The Hollywood Party Realization

Hari shares the origins of his personal experience with Ozempic, tracing it back to the winter of 2020 as post-pandemic gathering restrictions began to lift. Having gained significant weight during lockdown like many others, Hari attended a party hosted by a famous Hollywood actor. He anticipated that the celebrity attendees would have also put on weight, but instead arrived to a striking scene: guests appeared gaunt, clean-cut, and unusually sharp, looking "like their own Snapchat filter" with high cheekbones and lean frames.

Confused, Hari joked to a friend on the dance floor that everyone must have been practicing intensive Pilates during lockdown. She laughed and pulled out her phone to show him an image of an Ozempic pen, explaining that everyone from A-list stars to their agents, spouses, and kids was taking it. This revelation plunged Hari into deep internal conflict. Knowing his family history—his grandfather and uncle died young from heart attacks, and obesity is linked to over 200 health conditions—he recognized the immense medical appeal, yet remained deeply suspicious of yet another "miracle" diet drug and concerned about its impact on eating disorders and body positivity.

* Hari traveled globally for over a year—visiting experts in Reykjavík, Minneapolis, and Tokyo—to investigate the drug for his book *Magic Pill*. * Over 200 medical complications and diseases are directly linked to obesity. * Historical diet medications frequently promised dramatic short-term results before being pulled due to dangerous side effects.

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[06:37](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=397s) Using the Pen, Costs, and How Ozempic Suppresses Appetite

Demonstrating an empty injection pen that resembles a large Sharpie, Hari explains the mechanics of administering the drug once a week via a tiny attachable needle. Recalling his very first dose, Hari describes waking up two days later with a mild background nausea and a strange realization: for the first time in his memory, he was not waking up ravenously hungry. Visiting his local cafe, he took just three bites of his usual chicken and mayo roll before feeling completely full, leaving the cafe worker asking if he was ill. A similar pattern played out at lunch, with Hari feeling "literally 80% less hungry than I normally am."

Hari clarifies that GLP-1 is a naturally occurring gut hormone released when eating to tell the brain "you've had enough stop eating," but natural GLP-1 clears out within minutes. Ozempic injects a synthetic version designed to remain active in the body for an entire week. While it slows gastric emptying in the gut, leading neuroscientists now emphasize that its main mechanism is acting directly on the brain to change appetite and food desires entirely.

* Each pen typically contains four doses, administered once per week. * In the UK, private prescriptions cost around £250 per month, whereas in the US, prices range between $800 and $1,200 per month depending on supply shortages. * Diabetics have used GLP-1 receptor agonists safely under medical licensing for roughly 18 years, though widespread use for obesity is far more recent. * Hari reduced his daily intake from approximately 3,200 calories to 1,800 calories after starting the medication.

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[13:27](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=807s) Pleasure, Psychological Ties to Food, and the "Stuffing" Instinct

Addressing a major criticism of weight loss drugs, Bartlett asks whether losing the desire to eat robs people of day-to-day happiness. Hari acknowledges that for many, losing food pleasure is a massive drawback. He cites Danish scientist Jens Juul Holst—one of the key developers of GLP-1 drugs—who noted that a life without food pleasure is unbearable for many, leading them to quit the drug after a couple of years. Renowned UK food critic Jay Rayner similarly described visiting top Paris restaurants on the medication and finding the experience completely drained of enjoyment.

Hari notes, however, that his own psychological response was different. Taking the drug forced him to confront his underlying emotional relationship with food. Growing up in a turbulent environment, Hari had learned early in life to use heavy eating to self-soothe through "stuffing"—deliberately eating far past fullness until feeling physical pressure on the esophagus and stomach. Because attempting to stuff oneself on Ozempic causes violent nausea or vomiting, the drug forcibly broke that emotional coping mechanism, ultimately allowing him to eat slower and appreciate the taste of food more.

Here is a detailed, faithful walkthrough covering the provided section of the interview.

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[15:43](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=943s) Social Eating Dynamics and the Three Theories of Brain Impact

Johann Hari describes how his friends noticed a marked shift in his eating behavior a few months after he started taking Ozempic. They pointed out that while eating with him used to feel stressful because he wolfed down his food without seemingly enjoying it, he now appeared to genuinely savor his meals. However, Hari stresses that he is atypical in this regard, noting that far more people experience the loss of food pleasure akin to food critic Jay Rayner.

Transitioning into how Ozempic affects the brain, Hari notes that while GLP-1 is produced in the gut to promote satiety, scientific research reveals it also interacts deeply with the brain. Discovered in the 1990s at Hammersmith Hospital in London, GLP-1 receptors exist throughout the human brain (and GLP-1 can even be produced in the brain and thyroid). Tagging the drug with dye in animal experiments demonstrates that it diffuses everywhere across the brain, meaning its primary impact is neurological. Hari shares a personal anecdote illustrating this shift: taking his godsons to McDonald's a week after starting the drug, he found himself completely unmotivated to order anything, prompting his godson to ask, "Who are you and what have you done with Johann?" He reflects on a rock-bottom moment on Christmas Eve 2009 at a local KFC where the staff presented him with a massive, signed Christmas card thanking their "best customer"—a horrifying realization given that it wasn't even the branch he frequented most.

According to neuroscientists Hari interviewed, there are three main competing theories regarding how GLP-1 receptor agonists impact the brain:

* **Dampening the Reward System:** The drug dampens the brain's reward centers (which govern pleasure from sex, food, and socializing). While this stops cravings for junk food, it raises serious concerns about whether it also dulls pleasure for passions like reading or writing, potentially triggering depression or suicidal ideation—prompting warnings required by the US FDA. * **Resetting Preferences:** Researchers like Dr. Carel le Roux and Dr. Adalia G. suggest the drug does not cause generalized depression or dullness, but rather resets taste preferences back to "factory settings," automatically steering individuals toward healthier foods. * **Boosting the Satiety System:** Professor Paul Kenny argues the brain possesses a dedicated satiety system alongside the reward system. Instead of turning down the reward system, GLP-1 drugs dial up the satiety system—the signal that tells a person they have had enough.

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[20:12](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1212s) The "Cheesecake Park" Experiment and Food Addiction

Host Stephen Bartlett interjects with a personal observation, noting how sugar acts addictively in his own life—consuming a cookie one day creates a "sugar spiral" that drives intense cravings the next. He asks whether the reduced desire for junk food is simply a result of breaking the physical cycle of sugar consumption. Hari responds by referencing a pivotal animal study conducted by Professor Paul Kenny, Head of Neuroscience at Mount Sinai in New York, which Hari dubs the "Cheesecake Park" experiment.

Raised in Dublin, Kenny noticed upon moving to San Diego in his twenties that Americans ate drastically more sugar and fat than Irish people, causing him to gain 23 pounds (a stone and a half) within a year. To test whether processed foods fundamentally alter brain chemistry to compel overeating, Kenny designed an experiment with laboratory rats:

* **Baseline Diet:** When rats were provided an unlimited supply of their natural, evolutionarily adapted food pellets, they ate only until their hunger was satisfied and maintained stable weights with inherent "nutritional wisdom." * **Introduction of Processed Foods:** When introduced to an American diet featuring fried bacon, Snickers bars, and cheesecake, the rats abandoned their standard food entirely. They obsessively gorged on cheesecake, hurling themselves into it and emerging covered in it. Within days, their health indicators plummeted, and they became severely obese. * **Withdrawal and Starvation:** When Kenny removed the junk food and returned exclusively to the natural pellets, the rats refused to eat the natural food altogether—behaving as if it were no longer edible. They starved themselves until extreme hunger eventually forced them to consume it.

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[26:17](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1577s) Compulsive Overeating and the "House on Fire" Analogy

Bartlett highlights a further stage of Kenny's experiment detailed in Chapter 2 of Hari's book: researchers conditioned the rats to associate a yellow light with an electric shock. When the light flashed while rats ate standard pellets, they ran away. However, when the yellow light flashed while they were eating cheesecake, the rats ignored the shock and continued eating. This proved that prolonged exposure to hyper-palatable foods creates a drive so intense that individuals will ignore severe negative consequences to consume it—a reality Hari recognized in his own past KFC addiction.

Hari explains that modern ultra-processed diets break the human body's natural satiety signals. Weight loss drugs like Ozempic or Mounjaro function by restoring these missing GLP-1 satiety hormones, offering what Professor Michael Lowe at Drexel University terms "an artificial solution to an artificial problem."

Addressing the ethical dilemma of using a drug rather than fixing the broken food system, Hari shares a conversation with his close friend ("Judy"), a single mother and breast cancer survivor:

> "When I had cancer, we know there is something in the environment that is triggering breast cancer in women... But you didn't say to me when I got breast cancer, 'Well, fuck me, all this environmental problem has caused this breast cancer and now you want to inject yourself with another poison, chemotherapy, in order to deal with it?' No, you said, 'Okay, we've got an environmental problem, obviously that environmental problem needs to be dealt with, but you've got to stay alive or you can't deal with it.'"

Judy offered a vivid analogy: if your house is on fire, you should certainly support building future homes out of non-flammable materials and mandating sprinklers, but your immediate priority must be to put out the fire in your own house. Hari connects this to real-world patients, citing Jeff Parker, a 66-year-old lighting designer in San Francisco weighing 16 stone, who turned to Mounjaro to save his life amidst severe heart, liver, and kidney complications.

* Global obesity rates have trebled in Hari's lifetime (since 1979). * In 1979, 6% of British people were obese, compared to 26% today. * Currently, 47% of Americans express a desire to take weight-loss medication. * Breast cancer affects 1 in 7 women in Britain and the US, compared to only 1 in 38 women in Japan, pointing to environmental triggers.

[30:43](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1843s) Environmental Causes vs. Individual Survival

Johann Hari begins by reflecting on a conversation with a friend named Jeff who lost a significant amount of weight on GLP-1 medication. Jeff's health problems completely reversed, and he went from suffering to walking his dog across the Golden Gate Bridge every day in a happy retirement. When Hari asked Jeff if society shouldn't instead focus on fixing the root environmental causes of obesity, Jeff agreed in principle but offered a pragmatic counter argument: while he supported systemic campaigns, he would be dead long before society fixed the food environment, and he wanted to live now. Hari admits finding that logic difficult to dispute.

When challenged with the common societal critique—"Why not just make better choices at the coffee shop and choose a salad?"—Hari confesses that this was the exact self-critical voice inside his own head. He recalls another dinner conversation with a friend where Hari was weighing the risks of obesity against the risks of GLP-1 medications.

- When Hari mentioned the 12 significant health risks associated with the new weight-loss drugs, his friend cut him off, arguing there was a third option: going on a diet and exercising, something Hari had successfully done in the past. - This internal and external pressure made Hari feel like taking a weight-loss drug was "cheating" rather than taking personal responsibility.

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[32:28](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1948s) The Science of Dieting and Set Point Theory

To investigate whether traditional dieting is a viable long-term solution for most people, Hari interviewed Professor Traci Mann at the University of Minnesota in a Minneapolis cinnamon bun shop called Isles Bun & Coffee. Highlighting the ubiquitous nature of our obesogenic environment, the shop gave Hari a free 2,000-calorie cinnamon bun that sat on the table throughout their interview about dieting research.

When Professor Mann began evaluating diet studies in the year 2000, prevailing scientific consensus claimed diets were highly effective. However, her systematic meta-analysis of nearly 24,000 studies revealed a fundamental flaw: the overwhelming majority of studies only tracked dieters for three months. Participants exercised willpower, lost weight, and the studies ended, leaving the implicit assumption that the weight loss was permanent.

When Mann searched for long-term data, she found only 24 studies that tracked dieters over two years, and a handful that followed them for five years. The long-term picture was vastly different: - **Average Long-Term Weight Loss:** After two years, the average person on a traditional diet had retained a weight loss of only two pounds. - **Success Rate:** Only about 10% of people successfully lose significant amounts of weight on diets and keep it off long-term. - **The Paradox of Thermodynamics:** While the law of thermodynamics dictates that burning more calories than consumed leads to weight loss, human biological mechanisms actively fight this process over time.

To explain this paradox, researchers point to **Set Point Theory**. In the 1960s and 1970s, scientists hypothesized that the body regulates weight much like body temperature—using involuntary biological responses like shivering or sweating to keep internal conditions in a tight, fixed range. Though the sudden spike in global obesity in the late 1970s initially appeared to disprove the idea of a fixed weight set point, researchers like Dr. Michael Lowe at Drexel University discovered that **a person's set point rises as they gain weight**.

When a person gains significant weight, their body adopts that higher level as its new baseline and aggressively defends it. If they try to lose weight, their body responds defensively: - **Metabolic Slowing:** Metabolism slows dramatically to conserve energy. - **Increased Cravings:** Cravings for sweet and salty foods intensify. - **Decreased Energy:** Physical energy drops to disincentivize calorie expenditure.

From an evolutionary standpoint, this mechanism protected early humans against famine. In an environment where food scarcity was a constant threat, the body evolved to hold onto stored fat at all costs ("Timothy Chalamet dies in week one of a famine, while John Candy is the last man standing"). Because human evolution never prepared us for a world of hyper-abundant, low-cost calories, dieters are fighting an uphill battle against their own biology. Hari notes that GLP-1 drugs may work primarily by lowering this biological set point, preventing the body's defensive starving responses from kicking in.

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[40:01](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2401s) Emotional Numbness and Eating for Comfort

Shifting to the psychological impacts of GLP-1 medications, Hari describes his own personal experience on the drug. Having lost three stone (42 lbs) over the course of a year in a steady downward trajectory, he noticed a strange emotional dissonance. While watching his pregnant friend Danielle expand as he shrank, he realized that despite getting the physical outcome he wanted, he felt emotionally dulled and flat rather than overjoyed.

Hari explains that science identifies five distinct reasons why human beings eat. While he previously assumed sustenance was the primary driver, his drastically reduced appetite made him examine the other roles food plays in daily life:

1. **Sustenance:** Fueling basic physiological needs. 2. **Pleasure:** Enjoying taste and culinary experiences. 3. **Comfort and Emotional Regulation:** Soothing stress, grief, or anxiety through food.

To illustrate how deeply embedded comfort eating is in human behavior, Hari highlights data showing massive spikes in junk food orders following stressful societal events—such as pizza and fried chicken orders soaring after 9/11, or taco orders spiking on food delivery apps in blue states on the night of the 2016 U.S. presidential election. On an individual level, losing a job drastically increases a person's risk of gaining weight due to emotional eating.

GLP-1 drugs abruptly strip away the ability to comfort eat, leaving individuals without their primary coping mechanism.

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[42:41](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2561s) Lessons from Bariatric Surgery and Addiction Transfer

To understand the long-term psychological implications of suppressing appetite biologically, Hari points to bariatric (gastric band or stomach stapling) surgery as the closest historical equivalent. The physical health benefits of reversing severe obesity through surgery are massive:

- **Heart Attack Mortality:** 56% reduction over seven years. - **Cancer Mortality:** 60% reduction over seven years. - **Diabetes-Related Mortality:** 92% reduction over seven years. - **All-Cause Mortality:** 40% overall reduction over seven years.

However, the psychological fallout of abruptly eliminating food as a coping mechanism can be severe. - **Psychiatric Care:** 17% of bariatric surgery patients require inpatient psychiatric treatment post-surgery due to severe depression or distress. - **Suicide Risk:** The rate of suicide nearly quadruples following bariatric surgery. - **Addiction Transfer:** Roughly 1 in 10 bariatric surgery patients develop a new substitute addiction—such as alcoholism, gambling, compulsive shopping, or drug abuse—to replace the psychological comfort once provided by food.

Hari shares the story of a woman named Robyn Moore, who weighed 303 pounds before turning to bariatric surgery after feeling like a "slave" to food. Her experience highlighted how deeply psychological eating is, demonstrating that when a person's primary method of self-soothing is removed without addressing the underlying emotional driver, the psychological distress often transfers into new behaviors.

[45:36](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2736s) Trauma and the Unmasking of Appetite Suppression

When the underlying psychological triggers that drive overeating are suddenly dismantled by GLP-1 medications, the emotional reality underneath can surface with jarring intensity. In a profound example, a woman who had been sexually abused as a child deliberately carried extreme weight as a psychological shield to protect herself from men. After shedding the weight, she experienced a rapid, severe shift into alcoholism, losing her job near the Toronto airport due to drinking on duty. While this kind of extreme substitute addiction won't happen to the majority of patients, these drugs fundamentally disrupt emotional defense mechanisms.

Author Johann Hari shares a deeply personal anecdote from his time in Las Vegas while writing a true-crime book. After a particularly grim day of investigating, he instinctively went on autopilot to a local KFC on West Sahara—jokingly described as "the grimmest KFC in the whole world"—and ordered his usual mountain of fried chicken. Sitting beneath a poster of Colonel Sanders, he realized with a shock that he literally could not eat it. Being suddenly stripped of comfort eating is a difficult psychological reality. As a friend of his who navigated cancer astutely observed: "It's not that the drug is causing this problem; the drug is making this problem visible to you, and now you can deal with that in other ways." The sheer complexity of these physical and psychological trade-offs is why anyone framing weight loss drugs purely as a flawless miracle or an absolute evil isn't leveling with the public.

- **Vegas Anecdote Location:** The KFC on West Sahara Avenue, Las Vegas. - **The Core Paradox:** The drugs don't invent psychological distress; they remove the food-based coping mechanism used to suppress it.

[48:33](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2913s) The Kaiser Permanente Obesity Study and the Susan Case

The link between childhood trauma and compulsive comfort eating is backed by stark clinical data. In the early 1980s, a physician named Dr. Vincent Felitti was approached by the major non-profit medical provider Kaiser Permanente in San Diego. Confronted by an unprecedented rise in obesity rates that resisted traditional diet and exercise plans, they handed Dr. Felitti a large sum of money for "blue skies research" to find a root cause. Dr. Felitti began working with 200 severely obese patients and designed a radical, highly medically supervised program where participants practically stopped eating entirely, receiving vitamin shots to prevent deficiencies like scurvy so their bodies would burn through existing fat stores.

At first, the results were staggering. A patient given the pseudonym Susan dropped from over 400 pounds down to 138 pounds, prompting her family to call the doctor to thank him for saving her life. However, the experiment took an unexpected turn when Susan suddenly cracked, binged obsessively, and rapidly regained the weight. When Dr. Felitti investigated what happened on the exact day she broke her fast, Susan admitted she had been at a bar where a man hit on her in a perfectly polite manner, which completely panicked her. When asked about the year she first began gaining weight at age ten, she revealed it was the exact year her grandfather began raping her. Dr. Felitti subsequently interviewed every participant in the program and discovered a staggering 60% of the women had experienced extreme weight gain in the direct aftermath of sexual abuse or assault, using weight as a subconscious defense mechanism because, as Susan put it, "overweight is overlooked."

- **Principal Researcher:** Dr. Vincent Felitti in San Diego (early 1980s). - **Sponsor:** Kaiser Permanente. - **Susan's Weight Loss:** From over 400 lbs down to 138 lbs before regaining it. - **Key Statistic:** 60% of the women in the study developed severe obesity following sexual abuse or assault.

[52:25](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3145s) Surviving the Obesogenic Environment

Modern society functions as an "obesogenic environment"—a landscape systematically designed to prime human beings for weight gain while making a healthy lifestyle expensive, rare, and deeply difficult to maintain. As Professor Michael L. noted to Hari, humanity has engineered an environment as perfectly optimized for obesity as possible. Ultra-processed foods undermine a person's natural satiety cues through seven distinct mechanisms detailed in Hari's book *Magic Pill*, causing individuals to consume an average of 500 extra calories every single day.

While confronting the massive corporate and political forces behind processed food can spark deep pessimism, public health history proves that rapid societal transformations are entirely possible. A prime historical parallel is the dramatic decline of tobacco use. In 1987, over half the British population smoked regularly, lit cigarettes were ubiquitous on planes, subways, and game shows, and doctors even smoked during medical examinations. Hari recalls being with his mother on the anniversary of the tragic 1987 King's Cross station fire in London—which killed over 50 people after a discarded cigarette ignited a wooden escalator. When his mother called it the worst day of her life, it wasn't because she knew a victim, but because it was the day they banned smoking on the Underground. Today, British smoking rates have plummeted to roughly 12% and continue to fall. This proof of change shows that public health landscapes can be radically reshaped, despite pushback from incredibly powerful industries.

- **Caloric Surplus:** Eating processed foods causes people to consume an average of 500 more calories per day. - **Historical Comparison:** In 1987, over 50% of the UK population smoked; today, it is down to roughly 12%. - **King's Cross Fire:** Occurred in 1987, claiming over 50 lives and prompting the subway smoking ban. - **Political Reality:** As author Rebecca Solnit noted, "politicians are weather vanes, and it's our job to be the weather."

[58:06](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3486s) The Japanese Anomaly: Getting Rich Without Getting Fat

The global conversation often treats widespread obesity as an inescapable consequence of national wealth—an inevitability that will supposedly force 40% to 50% of Western populations onto weight loss drugs within a few years. However, Japan stands as a powerful counterexample, proving a nation can become wealthy without becoming fat. Only 4.5% of Japanese citizens are obese, compared to 26% in Great Britain and a staggering 42.5% in the United States. When combining the statistics for those who are either overweight or obese, the numbers show that carrying excess weight has become the absolute norm in the West, whereas it remains rare in Japan.

``` +---------------+-------------------+ | Country | Obesity Rate (%) | +---------------+-------------------+ | Japan | 4.5% | | Great Britain | 26.0% | | United States | 42.5% | +---------------+-------------------+ ```

This health disparity is entirely environmental rather than genetic. When Japanese populations migrated to Hawaii in the late 19th century and settled for generations, they adopted local dietary habits and experienced a five-fold increase in obesity rates compared to their counterparts in Japan, matching the baseline of other Hawaiians. Historically, Japan's food culture was consciously overhauled by the government. As Cambridge University Professor of East Asian History Barack Kushner points out, in the 1920s the average Japanese citizen had a terribly deficient diet, eating fish or protein only once a week. The government intentionally revolutionized the national food culture to build a healthier, stronger population. To observe the modern legacy of this systemic design, Hari visited the Kōchi School—an institution for children aged 5 to 18—where the day begins with all the children walking to school entirely on their own.

- **Migration Data Point:** Japanese-Americans in Hawaii are five times more likely to be obese than citizens living in Japan. - **Historical Context:** In the 1920s, the Japanese government deliberately transformed food culture away from a historically poor, low-protein diet to improve conscript health. - **Fieldwork Site:** The Kōchi School in Japan, serving students from ages 5 to 18.

[01:00:47](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3647s) Cultivating a Culture of Food in Japan

Johann Hari details his visit to a Japanese school of 1,000 children, where he was struck by the complete absence of childhood obesity. Starting at age five, Japanese children walk to and from school independently, building physical activity into their daily routine. Upon entering the school, Hari met Harumi Tate, a professional nutritionist. By law, every Japanese school employs a dedicated nutritionist who undergoes three years of specialized study on top of standard teacher training. Processed foods and packed lunches are strictly prohibited; every single meal is prepared fresh from scratch daily while doubling as a practical educational tool about healthy eating.

Children are taught fundamental cultural and nutritional principles, such as *hara hachi bu*—eating until one is only 80% full, allowing time for satiety signals to reach the brain. Meals typically consist of five small portions—such as white fish, miso soup, and sashimi—which promotes gut health through variety and naturally slows down the pace of eating. To demonstrate nutritional balance, the nutritionist holds up color-coded ropes to the class: a red rope representing calcium for strong bones, another for carbohydrates that supply energy, and then ties them together to visually represent a complete, balanced meal.

Hari shares a humorous moment from his tour when he asked students about their favorite foods. Expecting typical kids' answers, he was shocked when they answered "broccoli," "seaweed," and "white rice." Suspecting they were trolling him, he asked his translator, who looked genuinely puzzled and explained that Japanese children are simply raised to like healthy foods. When Hari showed the students photographs of typical British school lunches on his phone, they reacted with horror—as if viewing an "ISIS beheading video"—gasping in disbelief and asking, "Where's the salad?"

- In Japan, children walk to and from school on their own starting from age five. - Every school nutritionist completes 3 years of post-teacher training to design scratch-cooked, non-processed meals. - Japanese meals feature 5 small, varied portions consumed sequentially to slow down digestion and support gut health. - Cultural norm: *Hara hachi bu* (eating until 80% full).

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[01:04:55](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3895s) Purchasing Ozempic, Novo Nordisk, and Eating Disorder Risks

Transitioning back to the Western landscape, Hari examines the massive craze surrounding Ozempic pens, manufactured by the Danish pharmaceutical giant Novo Nordisk. Driven by the viral demand for these weight-loss medications, Novo Nordisk has rapidly transformed into the most valuable company in Europe, fueling a significant portion of Denmark's recent economic growth. Alongside Eli Lilly, the market for GLP-1 drugs is projected to reach $200 billion by the end of the decade.

However, Hari raises grave concerns regarding how easily accessible these medications have become, particularly through online telehealth platforms. Although official guidelines require a minimum Body Mass Index (BMI) of 27 derived from fat mass rather than muscle mass, individuals can easily bypass these checks. On a video call, patients can simply lie about their measurements and receive the medication by mail two days later, or turn to illicit online channels for counterfeit versions.

This lack of strict physical oversight creates a severe danger for vulnerable populations, especially young women struggling with eating disorders. Describing Ozempic as "the most effective tool for self-starvation human beings have ever come up with," Hari relays warnings from eating disorder experts like Dr. Kimberly Dennis. She advocates that GLP-1 medications should strictly require in-person physician visits with doctors specifically trained to screen for eating disorders before issuing a prescription.

- **Novo Nordisk**: Danish pharmaceutical company behind Ozempic, now the most valuable company in Europe. - **Market Projection**: Estimated $200 billion global market for GLP-1 drugs by 2030. - **Prescription Criteria**: Officially intended for patients with a BMI of 27 or higher (based on fat mass). - **Online Telehealth Loophole**: Patients can lie about weight on Zoom calls to get pens delivered within 48 hours.

---

[01:07:43](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4063s) The Origins of GLP-1s and Cardiovascular Benefits

The underlying mechanism of Ozempic traces back to 1984, when researcher Dr. Daniel Drucker made a scientific breakthrough at Massachusetts General Hospital while studying the glucagon gene in the pancreas. By isolating GLP-1 from the end of the gene chain, Drucker discovered in laboratory dish tests that combining GLP-1 with insulin significantly boosted overall insulin production. Subsequent animal testing—conducted on rats by Professor Svetlana Mojsov and on pig pancreases by a research team in Copenhagen—confirmed these properties, laying the foundation for GLP-1 diabetes treatments. The appetite-suppressing effects of GLP-1 were later discovered independently at Hammersmith Hospital in London when human subjects injected with the hormone experienced a marked decrease in hunger.

Hari emphasizes that beyond cosmetic weight loss, these medications offer dramatic, life-saving cardiovascular benefits. For individuals starting with a BMI over 27, taking GLP-1 drugs over a five-year period reduces the overall risk of suffering a heart attack or stroke by 20%. Given that polling reveals 47% of Americans express an active willingness to take these medications, the public health implications are immense.

- **1984 Breakthrough**: Dr. Daniel Drucker isolated GLP-1 from the glucagon gene at Massachusetts General Hospital. - **Key Researchers**: Professor Svetlana Mojsov (rat trials) and Copenhagen scientists (pig pancreas trials). - **Appetite Discovery**: Identified during GLP-1 trials at Hammersmith Hospital in London. - **Cardiovascular Effect**: 20% reduction in heart attack and stroke risk over 5 years for individuals with a BMI over 27. - **Public Interest**: Polling indicates 47% of American adults actively want to take GLP-1 weight-loss drugs.

---

[01:10:15](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4215s) Thyroid Cancer Risks and Long-Term Safety Debates

Despite the enthusiasm, Hari outlines serious potential health risks highlighted in his research. He highlights the work of Professor Jean-Luc Faillie from the University Hospital of Montpellier, who was commissioned by the French medicines agency to conduct a rigorous safety investigation. While advocates like Dr. Drucker point out that diabetics have safely used GLP-1 medications for 18 years without catastrophic global side effects, Faillie sought to analyze long-term health registry data to check for specific conditions, notably thyroid cancer—which had previously shown elevated rates in rat studies.

Analyzing health databases of French diabetic patients who took GLP-1 drugs for three years between 2006 and 2015 compared to a matched control group, Professor Faillie uncovered a "sobering" finding: patients taking GLP-1s experienced a 50% to 75% relative increase in their risk of developing thyroid cancer. Hari clarifies that this does not mean 50% of users will develop cancer, but rather that an individual's baseline relative risk rises. While the European Medicines Agency (EMA) currently remains unconvinced by this data and some scientists dispute the findings, it represents a notable area of concern when millions of people worldwide are taking the drug.

- **French Health Study**: Led by Professor Jean-Luc Faillie at University Hospital of Montpellier for the French medicines agency. - **Data Range**: Tracked diabetics on GLP-1 drugs for 3 years between 2006 and 2015. - **Thyroid Cancer Risk**: Showed a 50% to 75% relative increase in thyroid cancer incidence among users. - **Baseline Context**: Approximately 1.2% of people get thyroid cancer in their lifetime, with an 84% survival rate.

---

[01:13:56](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4436s) "Ozempic Face" and the Agony of Pancreatitis

Addressing popular concerns, the conversation turns to the phenomenon known as "Ozempic Face"—a sunken, gaunt facial appearance caused by rapid weight loss. Hari jokes lightheartedly that he personally does not worry about it because his face is naturally so round that "babies always smile at me I think because they think I'm their King... like a baby that inexplicably got to walk around." He notes that Ozempic Face is not a physical health danger, but rather a cosmetic issue related to rapid facial fat loss.

A far more severe and painful side effect is pancreatitis, an acute and dangerous inflammation of the pancreas. Hari shares the story of Michelle Stonc, a woman from Myrtle Beach, North Carolina. Before starting the medication, her doctor mentioned pancreatitis as a rare side effect, to which she jokingly replied, "With my luck, I'll probably get it." Six weeks into her treatment—delighted with her initial weight loss—she traveled to Pittsburgh to visit her daughter and woke up in excruciating agony.

Describing the incident, Hari notes she experienced a burning pain radiating from below her breast to her back, accompanied by severe vomiting and distress. Her son-in-law called an ambulance believing she was dying. Upon arrival at the emergency room, doctors immediately evaluated her pancreas and asked two telling initial questions: whether she was a heavy drinker, and whether she was taking Ozempic.

- **"Ozempic Face"**: A cosmetic outcome of rapid weight loss leading to facial volume loss and a gaunt appearance. - **Pancreatitis Risk**: A rare but severe side effect involving acute inflammation of the pancreas. - **Case Example**: Michelle Stonc suffered severe abdominal pain, vomiting, and hospitalization 6 weeks after starting Ozempic.

[01:15:11](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4511s) Pancreatitis, Pronunciation, and the Next Generation of GLP-1 Drugs

While pancreatitis remains a rare outcome, studies show semaglutide increases the risk of developing it by a factor of nine. The clinical severity of this risk became apparent in a conversation with a patient named Michelle, who described the excruciating agony of pancreatitis as vastly worse than childbirth, requiring fentanyl for pain relief. Beyond acute medical emergencies, everyday confusion surrounds the drug itself, starting with its basic pronunciation. Johann Hari clarifies that while many instinctively pronounce the generic compound "sem-a-GLOO-tide," scientists standardly pronounce it "se-MAG-lu-tide."

Semaglutide serves as the active ingredient behind both Ozempic (marketed for diabetes) and Wegovy (marketed for obesity), both manufactured in the exact same facility by Novo Nordisk. However, semaglutide represents only the early stages of a massive pharmacological wave. Newer compounds are rapidly advancing through clinical trials: * **Mounjaro (tirzepatide):** Developed by Eli Lilly, it targets both GLP-1 and a second gut hormone, GIP, driving an average body weight loss of 21% compared to semaglutide's 15%. * **"Triple G" (retatrutide):** Activates three distinct gut hormones, achieving an unprecedented 24.2% average weight loss in trials.

Leading obesity experts view this transition as a monumental watershed moment. South African psychiatrist Carell le Roux compares humanity's current progress to a baby suddenly standing up and walking after months of crawling. Epidemiologist Tim Spector likened the discovery to finding the "Holy Grail" of weight loss, while researcher Robert Kushner described it as cracking open a treasure chest to reveal gut hormones as the central controllers of human body weight.

* **Pancreatitis Risk:** 9x increase in baseline risk on semaglutide, causing severe abdominal pain that often requires hospital-administered opioids. * **Gut Hormone Targets:** Scientists estimate there are up to 37 distinct gut hormones involved in appetite regulation, opening the door for dozens of upcoming drug variations.

---

[01:18:08](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4688s) The Unspoken Side Effect: Muscle Loss and Sarcopenia

A major, under-discussed downside of rapid weight loss on GLP-1 receptor agonists is significant muscle mass loss. When a person loses massive amounts of weight rapidly through caloric restriction or medication, the body naturally sheds both fat and lean muscle tissue. In clinical data, some individuals lose up to 20% to 30% of their total lean muscle mass after starting semaglutide.

The long-term public health consequence of this side effect is a potential "time bomb" of frailty, particularly for people using the drug for aesthetic reasons who were not obese to begin with. Human muscle mass naturally declines every year past the age of 30. Accelerating that loss through GLP-1 drugs significantly heightens the risk of sarcopenia—derived from the Greek for "poverty of the flesh"—in later life. Sarcopenia leaves older adults unable to navigate stairs, severely increases fall risks, and drastically raises mortality rates following physical trauma.

* **Baseline Loss:** Individuals typically shed significant muscle mass along with fat during rapid weight loss unless mitigated by targeted resistance training and high protein intake. * **Personal Anecdote:** Hari notes that during his own time on the medication, his body fat percentage dropped from 33% to 22% without a noticeable drop in muscle mass, though he jokingly attributes this to having virtually no muscle to lose initially.

---

[01:20:36](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4836s) Mental Health, Suicidality, and Psychological Disillusionment

Reports linking GLP-1 medications to increased feelings of depression, anxiety, and suicidality have triggered widespread scientific debate. Disentangling whether the drug directly alters brain chemistry or triggers psychological crises remains complex, as baseline mental health struggles occur across all populations over time.

Scientists evaluating these psychological risks point to two primary drivers: 1. **Dampening of Reward Pathways:** By suppressing dopamine responses in the brain's reward centers, the drug can inadvertently strip away the emotional comfort and pleasure individuals historically derived from food or other soothing behaviors. 2. **The "Anomalous Expectation" Crisis:** As Dr. Carell le Roux points out, many individuals who spent decades struggling with obesity believe their weight is the sole barrier to their happiness. When the weight comes off but their underlying life stressors, unhappy marriages, or unsatisfying careers remain unchanged, the severe emotional anticlimax can induce a profound mental health crisis.

> "A lot of people who are overweight for a long time say... 'The reason my life is [terrible] is because I'm overweight. If I finally lose weight, my life will be good.' And then they lose weight and they've still got the same hassle husband, and they've still got the same job they don't like, and they suddenly go into this crisis." — **Carell le Roux**

---

[01:22:50](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4970s) The Horrific History of Diet Drugs: DNP, Amphetamines, and Jaw Wiring

To understand the current caution around GLP-1 medications, one must examine the dark, historical pattern of weight loss interventions where early enthusiasm eventually gave way to catastrophic safety failures. Modern anti-obesity pharmacology began with 2,4-Dinitrophenol (DNP) during World War I, after French munitions workers handling explosive powders experienced dramatic weight loss. Stanford researchers subsequently commercialized it in 1934 as "Alpha-Dinitrophenol" or "Redusols," attracting over 100,000 users. The drug hyper-accelerated metabolism, but high doses caused severe cataracts, blindness, and lethal hyperthermia—literally cooking users' bodies from the inside out before it was reclassified as a pesticide.

Following WWII, pharmaceutical companies turned to amphetamines after military radar operators given the stimulant to stay alert showed marked appetite suppression. By 1970, amphetamine prescriptions for weight loss accounted for an astonishing 8% of all prescriptions written in the United States. However, patients rapidly developed tolerance, requiring escalating doses that triggered severe sleep deprivation, psychological dependence, and full-blown psychosis.

As medical authorities pulled back on amphetamines, extreme surgical interventions emerged, such as jaw wiring. This invasive procedure physically prevented solid food intake, but carried a horrifying fatal risk: if a patient vomited while their jaw was wired shut, they faced immediate asphyxiation and death.

* **DNP (1930s):** Industrial explosive powder turned diet pill; caused fatal body overheating, blindness, and extreme cellular toxicity. * **Amphetamines (1950s–1970s):** Marketed heavily to women ("Mother's Little Helper"); caused severe addiction, psychiatric crises, and tolerance. * **Jaw Wiring:** Physical restriction mechanism abandoned due to the high risk of fatal choking during vomiting.

---

[01:25:28](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5128s) The Fen-Phen Scandal and the Threat of "Unknown Unknowns"

The most glaring modern cautionary tale prior to GLP-1s was Fen-Phen, a combination of fenfluramine (an appetite suppressant) and phentermine (an amphetamine derivative). Surging to popularity in the mid-1990s, the combination was lauded on the cover of *Time* magazine as a miracle cure, generating over 18 million prescriptions annually in the U.S. alone.

The phenomenon collapsed when primary care physicians in Fargo, North Dakota, identified severe heart and lung damage in patients taking the cocktail. Fen-Phen caused primary pulmonary hypertension—a fatal contraction of lung blood vessels—and ruined heart valves. A prominent case involved Mary Linnen, a 28-year-old woman in Massachusetts who took Fen-Phen to lose weight for her wedding, developed irreversible pulmonary hypertension within weeks, required continuous oxygen therapy, and died shortly thereafter. The resulting legal liability led to a landmark $12 billion settlement by American Home Products, the largest pharmaceutical payout in history at the time.

While GLP-1 drugs possess a far broader body of clinical evidence than Fen-Phen (which was initially brought to market based on a single study of just 120 people), top researchers emphasize that long-term safety profiles remain incomplete. Dr. Greg Stanwood of Florida State University highlights the danger of "unknown unknowns"—unforeseen side effects that only surface after millions of people use a drug over decades. As an analogy, antipsychotic medications introduced in the 1950s were considered safe for decades before researchers discovered late-life neurological side effects in patients reaching their 70s and 80s. Similar unknown long-term risks, including potential birth defect risks identified in animal exposure studies, make current widespread adoption an unprecedented real-world experiment.

* **Fen-Phen Peak:** 18 million prescriptions annually before being pulled from the market in 1997. * **Legal Settlement:** $12 billion paid out to victims suffering from valve disease and pulmonary hypertension. * **Clinical Trial Baseline:** Fen-Phen had been evaluated in only 120 patients prior to widespread commercial release, whereas GLP-1s have undergone vastly larger clinical trials.

[01:29:08](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5348s) The "Unknown Unknowns" and the Brutal Reality of Obesity

Johann Hari addresses the terrifying potential of hidden, long-term risks associated with new brain-acting medications. Drawing a parallel to early antipsychotic prescriptions—where patients only discovered decades later that the drugs significantly increased their risk of Alzheimer’s disease and dementia—he warns that GLP-1 receptor agonists also carry "unknown unknowns." Because these drugs act heavily on core brain regions involved in memory, taste processing, and gut motility, unknown side effects could eventually surface. However, Hari argues that these potential future risks must be weighed against the definitive, catastrophic harms of chronic obesity.

Quoting Dr. Shauna Levy of the Tulane University School of Medicine, Hari emphasizes: "We don't know the long-term risks of these drugs; we do know the long-term risks of obesity, and they are horrific." He candidly admits his own past ignorance regarding conditions like diabetes, which he once assumed was easily managed with routine insulin injections. In reality, contracting diabetes strips an average of 15 years off a person's life expectancy and remains the single largest cause of preventable blindness in Britain and lower-extremity amputations in the United States—causing more limb losses annually than gunshot wounds. Hari recounts a stark declaration from his friend Dr. Max Pemberton: "If you gave me a choice between getting diabetes or becoming HIV-positive, I would choose HIV every time," because modern HIV treatments allow a normal life expectancy, whereas diabetes triggers widespread, irreversible organ damage.

* **Family History & Personal Choice:** Hari highlights that individual health contexts matter immensely; those with a family history of thyroid cancer or severe muscle loss concerns should avoid these medications. For himself, given his family's history of men dying young from heart attacks, he chose the calculated risk of taking Ozempic over remaining obese. * **The Fen-Phen Parallel:** While he considers a major safety failure unlikely, Hari cautions that a modern "Fen-Phen scenario"—where a wildly popular diet drug is later pulled due to severe heart valve damage—cannot be completely ruled out.

---

[01:32:26](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5546s) The "No Free Lunch" Philosophy and Systemic Economic Shocks

Steven Bartlett challenges the framing of weight-loss drugs by offering his own perspective formed through interviewing hundreds of health, psychology, and medical experts. He expresses a deep-seated belief that "there's no such thing as a free lunch in life" and compares medical interventions to the laws of physics: energy cannot be destroyed, only moved. When a pharmaceutical promises a shortcut, Bartlett argues, it simply shifts the problem somewhere else—such as the psychological transfer of food addiction to other compulsive behaviors. He shares how he reacts with skepticism when friends praise "smart drugs" like Modafinil as flawless fixes: "History shows if you wait long enough, there's always a cost."

Hari acknowledges this philosophy, noting that while some drugs like statins offer clear, unambiguous net benefits despite lifelong dependence, weight-loss drugs represent a far more finely balanced dilemma. Reflecting on reactions to his book *Magic Pill*, Hari notes that readers formed wildly opposite conclusions—some felt inspired to start Ozempic immediately, while others believed taking it was pure madness. Beyond personal choices, Hari highlights how GLP-1 drugs are already triggering massive economic ripples across global markets, reshaping entire industries.

* **Rebound Weight Gain:** Research shows that within one year of discontinuing GLP-1 medications, patients typically regain roughly 70% of the weight they lost. * **Market Disruption:** Emily Field, an equity analyst at Barclays, compared the societal impact of Ozempic to the invention of the smartphone. * **Industry Fallout:** Krispy Kreme donut stock prices dropped; Nestlé CEO Mark Schneider voiced concern over declining ice cream sales; and Jefferies financial analysts projected US airlines will save millions in jet fuel costs due to lighter passenger loads. * **Healthcare Shifts:** Companies manufacturing hinges for hip and knee replacements have seen stock declines, as reducing obesity directly decreases joint degradation and joint replacement surgeries.

---

[01:38:21](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5901s) Sponsored Segment: WHOOP

Steven Bartlett takes a brief break to highlight Stress Awareness Month and share his personal strategies for stress management, primarily heavy gym workouts and tracking biometric data. He explains his use of the WHOOP wristband—a company in which he is both a sponsor partner and an investor—specifically calling out its real-time stress monitor feature. Built on neuroscientific research and structured breathing exercises, the feature helps users identify and actively mitigate physiological stress spikes. He directs listeners to `[join.whoop.com/CEO](https://join.whoop.com/CEO)` for a 30-day risk-free trial.

---

[01:39:21](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5961s) Will Everyone Be on a Weight-Loss Pill?

Returning to the conversation, Bartlett contemplates a future where sedentary lifestyles and ultra-processed food environments continue to drive rising obesity rates. He posits that once GLP-1 medications transition from costly weekly injections to affordable daily oral pills, the primary psychological and financial barriers will vanish. He envisions a dystopian divide: 50% of the population taking a cheap daily pill to stay lean, while the remaining 50% struggle helplessly against an obesogenic environment.

Hari responds by outlining two distinct dystopian futures alongside one cautious best-case scenario:

* **The Elite-Only Dystopia:** The current reality where wealthy individuals (like "The Real Housewives of New Jersey") access cutting-edge weight-loss treatments, while lower-income populations (like public school children) face skyrocketing rates of childhood diabetes. * **The Mass-Medication Dystopia:** Once key patents expire—such as semaglutide's patent in 2032—manufacturing costs drop to around $40 per month. Combined with pill formulations, vast portions of the global population could end up taking daily appetite suppressants indefinitely without fully understanding the multi-generational impacts. * **The Optimistic Awakening:** A scenario where the widespread adoption of weight-loss drugs acts as a societal wake-up call, prompting governments and public health bodies to aggressively reform food environments and emulate countries like Japan through strict institutional food regulation.

Bartlett points out that without heavy government interventions on school nutrition and food manufacturing, mass reliance on medication seems inevitable—especially given rising rates of body dysmorphia and anxiety among younger generations who feel overwhelmed by modern food environments.

[01:43:26](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6206s) The Food System vs. Regulation: Lessons from Japan and Beyond

Johann Hari dispels the common misconception that taking GLP-1 medications allows someone to keep eating fast food while staying slim. In reality, the drug suppresses the desire for food like fried chicken and burgers altogether. Reflecting on his own experience, Hari notes that even his taste for junk food waned over time. This leads into a deeper discussion about how society ended up relying on pharmaceutical interventions for weight loss in the first place.

Hari expresses anger over the realization that mass weight-loss medication—including its growing use in children—could have been avoided if governments had regulated the ultra-processed food industry. He highlights success stories from around the world showing that structural food reform is entirely possible:

* **Mexico:** Implemented a sugar tax that successfully reduced sugar consumption. * **Minneapolis, USA:** Introduced programs prescribing healthy food to low-income populations. * **Finland:** Undertook a comprehensive transformation of its national food supply. * **United Kingdom:** Professor Graham MacGregor successfully lobbied the UK government and food companies to reduce salt levels in bread. Done without public outcry, this reform prevented an estimated 6,000 to 9,000 strokes annually in the UK.

Hari compares these initiatives to Japan's cultural and policy interventions. In 2008, following a minor uptick in weight gains, Japan enacted the **Metabo Law** to combat metabolic syndrome. Under this law, companies are required to measure employee waistlines annually; if weight increases overall, the company risks government fines. Visiting the Japanese company Tanita, Hari observed extreme workplace health tracking, including mandatory step counts, meal photo uploads, and group workplace aerobics. While admitting such intrusive measures would face severe backlash in Western countries, Hari emphasizes that Japan’s broader health policies yield remarkable outcomes: Japan holds the world's highest life expectancy and exceptionally high healthy life expectancy.

During his research in Ogimi, Okinawa—known as the oldest village on Earth, where 190 out of 215 households include a resident over 90—Hari met 102-year-old Matsu Fukuchi. She shared her vibrant daily routine of caring for her son, watching volleyball, and dancing in a traditional red kimono. Hari reflects on the stark contrast between her youth (born before radio came to Japan) and his interviewing her on an iPhone. He argues that this level of health and joy in old age is what true systemic food reform offers—a stark contrast to the current reality where millions die prematurely from obesity-related complications.

- **Ogimi Village, Okinawa:** 190 of 215 households contain someone over the age of 90. - **UK Salt Reform Impact:** Reduced annual stroke events by 6,000 to 9,000 without consumers noticing a taste difference. - **Corporate Accountability in Japan:** Companies face financial penalties under the Metabo Law if their workforce's average weight increases.

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[01:50:46](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6646s) Long-Term Risks, Tolerance, and Metabolism

Turning to the long-term reality of taking GLP-1 drugs, Hari candidly acknowledges that stopping the medication usually leads to weight regain. Clinical trials show that approximately 70% of individuals regain lost weight within one year of discontinuation. Unless someone maintains a strict regimen indefinitely, long-term weight maintenance on the drug remains a challenge.

The discussion shifts to open medical questions regarding tolerance and metabolic changes:

* **Drug Tolerance:** Experts remain divided. Diabetics on GLP-1s generally do not seem to build tolerance (as their required dosage for blood sugar control remains steady), yet many pharmacologists anticipate that tolerance for weight loss could eventually occur. South African psychiatrist Dr. Carel le Roux compares GLP-1 drugs to bariatric surgery: patients lose significant weight, experience a slight plateau or minor regain, and eventually level off. * **Metabolic Slowdown:** All forms of rapid weight loss slow down baseline metabolic rate. Hari expresses concern that long-term use—or abrupt withdrawal due to unforeseen side effects—could leave users with a permanently slowed metabolism and higher baseline body fat than when they started.

---

[01:53:59](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6839s) Eating Disorders, Youth, and Hollywood's Secrets

The conversation turns to the societal risks surrounding GLP-1 adoption, particularly among young people and those vulnerable to eating disorders. Host Stephen Bartlett notes that since March 2020, eating disorder diagnoses (such as anorexia and bulimia) among teenage girls aged 13–16 surged by 42%, and by 32% among young women aged 17–19 (citing studies in *The Lancet* attributed largely to pandemic lockdown stress).

Hari warns that combining powerful appetite suppressants with eating disorder dynamics can lead to tragic consequences. He points to historical precedent: in the early 1990s, popular amphetamine-based diet drugs swept across America, triggering severe health crises among young women. Congressional hearings led by Ron Wyden (then an Ohio Congressman) documented tragic cases:

> "I'm hungry, I want to eat, but not yet, not yet." > — *Poem read during Congressional hearings by Tony Smith, whose daughter Noel died of a heart attack caused by extreme diet drug abuse.*

* **Jessica McDonald:** A ballet dancer in her early 20s who took amphetamine diet drugs until she passed out in order to maintain an extreme physical aesthetic. * **Noel Smith:** A young girl who became obsessed with fashion magazine standards, abused diet pills to starve herself, and ultimately died from a heart attack.

Hari shares a personal moment when his 18-year-old niece Erin complimented his weight loss over FaceTime, noting his defined jawline, before asking: *"Will you get me some Ozempic?"* Despite being at a completely healthy weight, she had internalized the cultural pressure. Hari realized that his own transformation sent an unintended message counter to everything he had tried to teach her about body image.

Finally, Hari and Bartlett address the sudden wave of rapid weight loss among public figures and celebrities. While many public figures attribute their dramatic transformations solely to new fitness regimes or diets, Hari strongly suggests that widespread off-label GLP-1 use is the driving factor, calling out the culture of secrecy surrounding celebrity weight loss.

Here is a detailed, faithful walkthrough covering the specified transcript segment.

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[01:58:16](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7096s) Social Stigma, Judgment, and Obesity as a Cultural "Sin"

Johann Hari and host Steven Bartlett explore why the societal judgment around weight loss drugs like Ozempic is so fiercely gendered and moralized. Hari notes that women face far harsher public criticism than men for using these medications. He shares an observation from one of his editors, who told him that "only a man could write this" book because a female author would be "crucified" or "monstered" for addressing the topic. They discuss how high-profile figures like Oprah Winfrey face severe backlash when speaking publicly about weight loss.

Hari reflects on his own internal conflict while taking Ozempic, admitting that for a long time he felt like he was "cheating" or "sinning." He traces this feeling back to deeply ingrained cultural narratives that date as far back as Pope Gregory I in the 6th century, who established the seven deadly sins—including gluttony, which historically featured grotesque, shaming depictions of fat individuals. In Western culture, admired forms of weight loss follow a traditional Catholic pattern of sin, suffering, penance, and redemption. Society demands that individuals starve themselves or undergo humiliating, grueling exercises—much like the TV show *The Biggest Loser*—before being granted societal forgiveness.

``` Classic Pattern of Moralized Weight Loss: Sin (Obesity/Gluttony) ➔ Suffering & Penance (Extreme Starvation/Humiliation) ➔ Redemption ➔ Public Forgiveness ```

Hari points out the double standard by comparing GLP-1 agonists to cholesterol-lowering statins: no one taking statins for a heart condition feels as though they are "cheating." He explains that people who endure immense deprivation to stay thin often view GLP-1 users the way clean cyclists viewed Lance Armstrong. However, Hari argues that the true villain is not individuals seeking health solutions, but rather the ultra-processed food industry that engineered the obesogenic environment in the first place. Comparing modern society to a 1975 British beach—where almost everyone was naturally lean—highlights how rapidly the environment changed, forcing people to process overwhelming amounts of shame and public hostility.

- **Gender Disparity in Criticism:** Women bear a disproportionate burden of body judgment and public insults regarding weight and pharmaceutical interventions. - **Extreme Public Stigma:** According to data cited by Hari, 45% of women with a BMI over 35 face direct public insults every single day. - **Parasocial Relationships and Public Reactions:** Sudden transformations in public figures—such as Adele or Rebel Wilson—often trigger feelings of anger or betrayal from fans who relied on them as relatable icons, reflecting deep-seated emotional pain and societal shame surrounding body image.

> "There is a sin and there are people who are cheating, but it's not Oprah... it's the food industry that fucked all of us, that's why we're in that race."

---

[02:05:37](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7537s) Ozempic as an "Addiction Killer" and Animal Research

The discussion shifts to one of the most surprising and controversial discoveries regarding GLP-1 receptor agonists: their potential to suppress addictions beyond food cravings. Hari outlines pioneering research conducted on animals that indicates GLP-1 drugs directly impact the brain’s reward systems.

In Sweden, Professor Elisabeth Jerlhag at the University of Gothenburg conducted experiments with rats accustomed to heavy alcohol consumption. After administering semaglutide, researchers observed that the rats voluntarily reduced their alcohol intake by approximately 60%, with the heaviest drinkers experiencing the most drastic reduction. To test whether this was purely driven by caloric suppression, subsequent experiments evaluated non-caloric substances:

* **Heroin & Fentanyl:** Professor Patricia "Sue" Grigson at Penn State University tested rats addicted to opioids and recorded a **50% reduction** in self-administration following GLP-1 treatments. * **Cocaine:** Professor Gregg Stanwood at Florida State University observed a **50% reduction** in cocaine consumption in mice.

``` [ GLP-1 Agonist Administration ] │ ┌───────────────────┼───────────────────┐ ▼ ▼ ▼ Alcohol Intake Opioid Usage Cocaine Usage Reduced ~60% Reduced ~50% Reduced ~50% (Jerlhag Lab) (Grigson Lab) (Stanwood Lab) ```

Scientists refer to this phenomenon as **selective activity**—the drug appears to downgrade cravings for harmful, highly compulsive behaviors while leaving healthy functions intact. While full human clinical trials are ongoing, early anecdotal reports (such as a Canadian nurse named Tracy, whose compulsive shopping, skin-picking, and binge eating stopped after taking Ozempic) and preliminary small-scale human trials suggest promising results, particularly when combining GLP-1s with other treatments like nicotine patches for smoking cessation.

> "What we found is a drug that boosts self-control across the board... the animal research is mind-blowing and really is highly, highly exciting."

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[02:10:25](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7825s) Personal Results, Dose Escalation, and Oprah's Journey

Hari shares his personal experience taking semaglutide, detailing his physical transformation over a single year. Starting with a body fat percentage of 33%—which his trainer Josh noted with a wince—Hari reduced his body fat down to 22%, losing three stone (42 lbs) in total.

He explains the standard dose escalation protocol, which begins at 0.25 mg specifically to help patients acclimate to side effects. Nausea is by far the most common reaction; while Hari's nausea eventually subsided completely, others experience severe distress. He quotes obesity researcher Carel le Roux, who bluntly states that in pharmacology, "there are two kinds of drugs: there are drugs that have side effects, and there are drugs that don't work."

The conversation concludes with a discussion of Oprah Winfrey's public journey with weight loss drugs. Having endured decades of extreme dieting—famously wheeling out a wagon containing 67 pounds of animal fat on her talk show after a liquid diet—Oprah spoke openly in interviews with *People* magazine and an ABC television special about how GLP-1 medications provided relief from a lifetime of relentless food noise and constant struggle.

- **Weight Loss Data:** Hari dropped 3 stone (42 lbs) over 12 months, reducing body fat from 33% to 22%. - **Dose Protocol:** Standard initiation begins at 0.25 mg to manage gastrointestinal side effects. - **Oprah Winfrey's Public Legacy:** Celebrated as a major turning point in reframing obesity as a chronic biological condition rather than a personal moral failure.

> "When it comes to nausea, you've got to level with people: there are two kinds of drugs—there are drugs that have side effects and there are drugs that don't work."

[02:12:51](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7971s) Complex Truths: The Oprah Example and the Three Forms of Magic

Johann Hari highlights that evaluating obesity treatments like Ozempic requires navigating profound personal and medical complexities. Mentioning high-profile cases like Oprah Winfrey—who openly disclosed her knee surgery and serious health concerns—Hari explains how transformational weight loss has yielded life-changing health benefits for many individuals. Despite the legitimate concerns and potential side effects associated with GLP-1 receptor agonists, Hari finds it impossible to argue against the choices of people who have experienced a dramatic improvement in their health and quality of life.

To capture the nuances of these treatments, Hari explains why he titled his book *Magic Pill*. He breaks down the concept of "magic" into three distinct interpretations: * **A Miracle Solution:** The drug appears to solve a massive, deeply entrenched problem so swiftly and effectively that it feels like a genuine miracle. * **An Illusion:** Like a magician's sleight of hand, it provides the appearance of fixing a problem without addressing the underlying root causes, potentially setting up future complications. * **A Cautionary Tale:** Akin to classic folklore or *Fantasia*, where a wish granted by a genie comes with unforeseen consequences, leaving humanity to deal with a solution that spirals in unpredictable directions.

- Oprah Winfrey chose to take GLP-1 medications following knee surgery and pressing health worries. - Jeff Parker in San Francisco is cited as another individual who experienced life-changing benefits from weight loss drugs.

---

[02:15:03](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8103s) Will Ozempic Lead to a Decline in Physical Exercise?

Stephen Bartlett shares a candid moment of internal debate: while staring at the Ozempic pen, he pondered whether using such a drug to eliminate belly fat might tempt him—and society at large—to skip the gym altogether. While an injection might yield aesthetic results, it forfeits the crucial mental health benefits, brain-derived neurotrophic boosts, and cardiovascular rewards gained through active exercise. Hari agrees wholeheartedly, warning that widespread adoption of these medications will likely lead to reduced physical activity, worsening existing sedentary lifestyle trends.

``` Exercise Benefits vs. Weight Loss ┌─────────────────────────────────────────────────────────┐ │ Exercise (270 hrs/yr) ──► +3 Years Longevity │ │ (Mental Health & Anti-Aging) │ ├─────────────────────────────────────────────────────────┤ │ Weight Loss Injections ──► Rapid Fat Reduction │ │ (No Cardiovascular/Brain Up)│ └─────────────────────────────────────────────────────────┘ ```

Hari outlines clear guidance regarding who should and should not consider these medications: * **BMI Under 25 (Non-Overweight/Obese):** "If you are not overweight or obese, you definitely shouldn't take these drugs." Taking them solely for aesthetic thinness incurs all the physical risks with none of the health benefits. * **BMI Over 35:** For individuals with a BMI over 35 (and no family history of medullary thyroid cancer or plans for immediate pregnancy), the risk-benefit balance heavily favors taking the medication if traditional dieting has failed. * **BMI Between 27 and 35:** This threshold requires a carefully weighed personal risk-benefit assessment, where reasonable individuals will arrive at different conclusions.

- Exercising for approximately 270 hours a year adds an average of three years to a person's lifespan, completely independent of weight loss. - Elise Loehnen, former Chief Content Officer at Goop, noted that social dining culture in Los Angeles has shifted dramatically due to widespread appetite suppression, remarking that "dieting is out, elimination is in." - A lighthearted social observation: if a celebrity loses significant weight through grueling gym sessions and diet changes today, public skepticism is so high that virtually no one will believe they did it without Ozempic.

---

[02:18:58](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8338s) Shortages and the Ethical Dilemma for Diabetics

The explosive demand for Ozempic among non-diabetics seeking weight loss has caused severe global supply shortages, leaving Type 2 diabetics unable to access critical medication. Hari shares the story of Zami Jalil, a 41-year-old musician who could not obtain the Ozempic necessary to manage his Type 2 diabetes due to market scarcity. Forcing diabetics off GLP-1 medications and back onto early insulin therapy carries grave long-term health risks.

Hari expresses personal remorse for taking the drug given his family history of heart disease, acknowledging that his own access contributed to the broader systemic shortage. He argues that governments should have managed distribution similarly to the COVID-19 vaccine rollout by establishing a strict triaged rationing system:

1. **Top Priority:** Diabetics and severely obese individuals with critical medical needs. 2. **Moderate Priority:** Individuals with moderate obesity or elevated genetic risks (e.g., family history of heart disease). 3. **Lowest Priority:** Mildly overweight individuals seeking modest weight reduction.

---

[02:20:42](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8442s) Reflection on Authorship and Storytelling

Stephen Bartlett takes a moment to express deep gratitude to Johann Hari, recalling their early history when Hari agreed to appear on *The Diary Of A CEO* back when Bartlett recorded in his London flat with a tiny audience and poor audio quality. Bartlett praises Hari's ability to tackle controversial subjects with exceptional nuance, avoiding dogmatism while framing complex trade-offs so readers can make informed personal choices. He cites Hari's narrative style in *Magic Pill* as a profound influence on his own writing.

- Johann Hari's book *Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs* was scheduled for publication on May 2, 2024.

---

[02:23:10](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8590s) The Last Guest Question: Why Should Humanity Exist?

Following the podcast's tradition, Hari answers a closing question left by the previous guest: *"Why should humanity continue to exist?"* To answer, Hari draws on his 13 years of research into a series of events in Las Vegas, focusing on two men—Rob Banghart (known in the tunnels as "Hobo Santa") and Paul Veen-O—who lived in the extensive storm drainage tunnels beneath the city before turning their lives around.

Hari recounts a harrowing incident from 2017 when Rob was attacked by rival dealers who split his skull open with an axe and left him on railway tracks to be run over by a train. Miraculously surviving, Rob turned his life around and joined *Shine a Light*, a non-profit run by Paul to deliver aid, flashlights, and practical support to people still living in the underground tunnels.

A few years later, while visiting the tunnels after a mutual friend named Picket died of an overdose, Rob insisted on delivering food supplies to a group of men that other residents warned him to avoid. When Hari later asked why Rob helped them, Rob revealed that those very men were the ones who had struck him with the axe and tried to kill him. "Because they're human beings and they're suffering and they need help," Rob explained. For Hari, this radical capacity for forgiveness and empathy demonstrates the ultimate value of human existence.

> "Why did you go and help them?" > "Because they're human beings and they're suffering and they need help."

[02:26:47](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8807s) Why Human Beings Should Continue to Exist

Johann Hari reflects on extraordinary individuals like Rob and Paul, who dedicate their lives every single day to helping those left behind by society. They earn no money from this work and live lives without material luxury, yet when asked why they make such personal sacrifices, their response is disarmingly simple: "because it's the right thing to do." For Hari, this unpretentious, selfless commitment captures the absolute best of human nature.

When considering the fundamental question of why humanity deserves to continue existing, Hari observes that while one could point to abstract answers like philosophy or art, the true answer is found in real-world compassion. Meeting people like Rob and Paul offers direct proof of human worth and moral goodness. The interview concludes on this quiet, emotional note as Hari thanks Steven Bartlett and wraps up their conversation.

## Notable quotes > [00:00](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=0s) the most effective tool for self-starvation human beings have ever come up with. — Johann Hari

> [15:43](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=943s) Who are you and what have you done with Johann? — Johann Hari's godson

> [26:17](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1577s) When I had cancer, we know there is something in the environment that is triggering breast cancer in women... But you didn't say to me when I got breast cancer, 'Well, fuck me, all this environmental problem has caused this breast cancer and now you want to inject yourself with another poison, chemotherapy, in order to deal with it?' No, you said, 'Okay, we've got an environmental problem, obviously that environmental problem needs to be dealt with, but you've got to stay alive or you can't deal with it.' — Judy

> [45:36](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2736s) It's not that the drug is causing this problem; the drug is making this problem visible to you, and now you can deal with that in other ways. — Johann Hari's friend

> [52:25](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3145s) politicians are weather vanes, and it's our job to be the weather. — Rebecca Solnit

> [01:20:36](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4836s) A lot of people who are overweight for a long time say... 'The reason my life is [terrible] is because I'm overweight. If I finally lose weight, my life will be good.' And then they lose weight and they've still got the same hassle husband, and they've still got the same job they don't like, and they suddenly go into this crisis. — Carell le Roux

> [01:29:08](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5348s) We don't know the long-term risks of these drugs; we do know the long-term risks of obesity, and they are horrific. — Shauna Levy

> [01:29:08](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5348s) If you gave me a choice between getting diabetes or becoming HIV-positive, I would choose HIV every time — Max Pemberton

> [01:53:59](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6839s) Will you get me some Ozempic? — Erin

> [01:58:16](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7096s) There is a sin and there are people who are cheating, but it's not Oprah... it's the food industry that fucked all of us, that's why we're in that race. — Johann Hari

> [02:05:37](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7537s) What we found is a drug that boosts self-control across the board... the animal research is mind-blowing and really is highly, highly exciting. — Johann Hari

> [02:10:25](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7825s) When it comes to nausea, you've got to level with people: there are two kinds of drugs—there are drugs that have side effects and there are drugs that don't work. — Carel le Roux

> [02:15:03](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8103s) If you are not overweight or obese, you definitely shouldn't take these drugs. — Johann Hari

> [02:15:03](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8103s) dieting is out, elimination is in. — Elise Loehnen

> [02:23:10](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8590s) Because they're human beings and they're suffering and they need help. — Rob Banghart

## Mentioned Johann Hari, Steven Bartlett, The Diary Of A CEO, Ozempic, Wegovy, Mounjaro, retatrutide, tirzepatide, Jens Juul Holst, Jay Rayner, Dr. Carel le Roux, Dr. Adalia G., Professor Paul Kenny, Professor Michael Lowe, Jeff Parker, Professor Traci Mann, Isles Bun & Coffee, Robyn Moore, Dr. Vincent Felitti, Kaiser Permanente, Rebecca Solnit, Barack Kushner, Kōchi School, Novo Nordisk, Eli Lilly, Dr. Kimberly Dennis, Dr. Daniel Drucker, Professor Svetlana Mojsov, Hammersmith Hospital, Professor Jean-Luc Faillie, University Hospital of Montpellier, European Medicines Agency (EMA), Michelle Stonc, Tim Spector, Robert Kushner, Dr. Greg Stanwood, Mary Linnen, American Home Products, Dr. Shauna Levy, Dr. Max Pemberton, Barclays, Emily Field, Krispy Kreme, Nestlé, Mark Schneider, Jefferies, WHOOP, The Real Housewives of New Jersey, Professor Graham MacGregor, Tanita, Matsu Fukuchi, Ron Wyden, Jessica McDonald, Noel Smith, Tony Smith, Erin, Oprah Winfrey, Pope Gregory I, Adele, Rebel Wilson, Lance Armstrong, Elisabeth Jerlhag, University of Gothenburg, Patricia 'Sue' Grigson, Penn State University, Gregg Stanwood, Florida State University, Tracy, Josh, People magazine, ABC, Goop, Elise Loehnen, Zami Jalil, Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs, Rob Banghart, Paul Veen-O, Hobo Santa, Picket, Shine a Light, The Lancet, The Biggest Loser

[Source](https://www.youtube.com/watch?v=0YMnHNIuK3M)

中文简报

Johann Hari警示Ozempic使用者注意长期健康风险 GLP-1类减肥药能有效抑制食欲和成瘾渴求，但在缺乏食品工业系统性改革的情况下，使用者仍面临严重的身体风险与高复胖率。作家Johann Hari结合自身减重42磅的经历及在全球范围内的广泛调研，探讨了以Ozempic为代表的GLP-1类减肥药所带来的变革性影响与潜在隐患。对话探讨了此类药物如何通过改变大脑信号来抑制食欲、其治疗食物以外其他成瘾行为的潜力，以及肌肉流失、胰腺炎和长期未知副作用等显著风险。Hari与Bartlett还辩论了GLP-1药物究竟是对抗食品工业制造的致肥环境所必需的工具，还是一种掩盖了更深层社会问题的系统性捷径。像 Ozempic 和 Wegovy 这样的 GLP-1 受体激动剂可带来平均 15% 至 24% 的显著体重降幅，但患者停药后约 70% 的减重会在一年内反弹。 (0:00) “芝士蛋糕公园”实验显示，超加工食品会彻底打乱哺乳动物的自然饱腹信号，促成强迫性过度进食，证明全球肥胖激增主因是人为制造的致肥环境，而非个人意志力的突然失效。 (20:12) 长期研究发现传统节食成功率仅约 10%，因为人体具有“体重设定点”机制，一旦体重增加，身体便会通过降低代谢和加剧食欲来主动对抗减重努力。 (32:28) 药物剥离以食物为核心的情绪宣泄机制后，可能暴露潜在的心理创伤，并带来成瘾转移风险——类似减重手术后约 10% 的患者会转向酗酒或过度消费等新成瘾行为。 (42:41)

Reading summary

Johann Hari argues that while GLP-1 receptor agonists like Ozempic offer a potent biological intervention against chronic obesity, their rapid adoption obscures serious physical and psychological hazards. Rather than functioning as a benign cosmetic shortcut, these brain-altering medications represent an artificial stopgap for a broken food environment that demands strict medical triage and aggressive public regulation. The Obesogenic Environment and Why Diets Fail (32:28) Hari asserts that modern obesity is fueled by an engineered, hyper-palatable food supply rather than a collective loss of willpower. In animal models developed by neuroscientist Paul Kenny, rats exposed to an ultra-processed American diet disregarded severe electrical shocks to gorge on cheesecake, proving that industrial food formulations override evolutionary satiety signals. Modern ultra-processed products dismantle the body's natural GLP-1 signaling mechanisms, driving individuals to consume an average surplus of 500 calories daily. Traditional dieting interventions fail to reverse this environment long-term. Citing meta-analyses by Professor Traci Mann covering nearly 24,000 studies, Hari notes that while short-term calorie restriction produces weight loss, roughly 90% of dieters regain the weight, retaining an average loss of only two pounds after two years. Because natural GLP-1 hormones clear from the body within minutes, synthetic GLP-1 agonists that remain active for a week offer what researcher Michael Lowe terms an artificial solution to an artificial problem. Severe Physical Hazards and Historical Pharmacology Lessons (70:15) While GLP-1 medications reduce the five-year risk of stroke and heart attack by 20% in patients with a body mass index (BMI) over 27, Hari highlights evidence of severe physical complications. French health registry data analyzed by Professor Jean-Luc Faillie showed a 50% to 75% relative increase in thyroid cancer risk among diabetic patients taking GLP-1 drugs over three years. Users also risk acute, life-threatening pancreatitis and significant lean muscle loss—averaging 20% to 30% of total shed weight in clinical observations—which accelerates premature sarcopenia and physical frailty in older adults. Hari warns that weight-loss pharmacology has a history of catastrophic safety oversights, citing 1930s dinitrophenol (DNP), postwar amphetamines, and Fen-Phen, the 1990s combination withdrawn after causing fatal pulmonary hypertension and triggering a $12 billion legal settlement. Because GLP-1 receptors are distributed throughout the human brain, Hari emphasizes that widespread long-term usage involves critical 'unknown unknowns' that may take decades to manifest. Psychological Fallout and Disrupted Emotional Coping (42:41) Suppressing appetite biologically dismantles fundamental emotional regulation strategies. Drawing parallels to bariatric surgery—where 17% of patients require post-operative psychiatric hospitalizations and suicide rates nearly quadruple—Hari observes that abruptly eliminating comfort eating can unmask deep-seated psychological distress. Clinical research by Dr. Vincent Felitti revealed that severe obesity frequently functions as an unconscious defensive shield against childhood trauma; removing this coping mechanism without psychiatric care can lead to substitute compulsions such as severe alcoholism. Simultaneously, GLP-1 medications act directly on the brain's dopamine reward architecture. Animal experiments conducted by Elisabeth Jerlhag, Sue Grigson, and Gregg Stanwood demonstrated that semaglutide reduced voluntary alcohol intake by roughly 60% and curtailed self-administration of cocaine and opioids by 50%. While this dampening effect holds potential for addiction treatment, it frequently depresses everyday culinary and emotional pleasure, leaving many users experiencing an unexpected affective flatness. Systemic Countermeasures, Scarcity, and Ethical Misalignment (58:06) Hari rejects the notion that widespread obesity is an inevitable consequence of economic wealth, presenting Japan as a counterexample. With an adult obesity rate of just 4.5% compared to 26% in Great Britain and 42.5% in the United States, Japan maintains low obesity through structural policies, including mandatory school nutritionists, whole-food school meals, and the cultural practice of *hara hachi bu* (eating until 80% full). When Japanese populations historically migrated to Western food environments, their obesity rates rose five-fold, proving the issue is environmental rather than genetic. In Western markets, permissive online prescribing enables non-obese individuals to bypass clinical thresholds for cosmetic thinness, exacerbating eating disorder risks among adolescents and generating severe shortages for Type 2 diabetics. Because patients regain roughly 70% of lost weight within a year of stopping GLP-1 treatments, the drugs effectively lock users into lifetime reliance. Hari argues that public authorities must triage access based on medical risk while enacting structural food regulations—such as taxes and ingredient reform—to tackle the root drivers of metabolic disease. Hari concludes that GLP-1 medications represent a complex trade-off: an invaluable, life-extending option for individuals facing severe obesity (BMI over 35) or imminent cardiovascular events, but an unacceptably risky intervention for cosmetic weight loss. The central unresolved question is whether societies will use these drugs as an alarming signal to regulate ultra-processed food environments, or simply settle into indefinite, multi-generational pharmaceutical dependence.

精炼阅读摘要

作家Johann Hari在《CEO日记》中指出，以Ozempic为代表的GLP-1药物虽带来匹敌减重手术的降重与心血管获益，但公众严重低估了其潜在的生理危害、心理失衡，以及掩盖系统性致肥环境的深层社会代价。药理突破、减重实效与代谢反弹风险 (6:37) GLP-1是人体肠道天然分泌的饱腹激素，通常几分钟内被代谢，而人工合成的Ozempic可持续作用一周。神经科学证实，该药物不仅延缓胃排空，更广泛扩散至大脑，直接重塑食欲中枢。临床数据显示，Ozempic和Wegovy使用者一年内平均减重15%，新一代药物更达24%，且使BMI大于27者的心血管事件风险降低20%。Hari亲身试验在一年内减重42磅（约3英石），体脂率由33%降至22%。然而，这一生理奇迹伴随着终身依赖与代谢代价。临床数据显示约70%的患者在停药一年内会反弹减掉的体重。快速减重亦导致人体基础代谢率显著下降。专家对该药是否会产生代谢耐受性存在争议，患者面临长期依赖或停药后代谢受损、体脂比更高的双重困局。生理健康风险与历史减肥药的安全教训 (70:15) Hari指出GLP-1药物潜藏至少12项重要风险。法国学者Jean-Luc Faillie基于三年医保数据的对照研究显示，使用GLP-1药物的糖尿病患者甲状腺癌相对风险上升50%至75%（尽管欧洲药品管理局对此存疑）。此外，部分使用者突发剧烈坏死性胰腺炎；快速减重还伴随高达20%至30%的瘦体重流失，加速少肌症（sarcopenia）并抬高跌倒和创伤死亡风险。历史上的减肥药物屡屡以灾难收场：一战时用于炸药的DNP因引发高热致死被列为农药；战后安非他命一度占全美处方的8%，却导致大范围成瘾与精神异常；20世纪90年代红极一时的芬芬（Fen-Phen）因引发致命性肺动脉高压和心瓣膜损坏，最终导致120亿美元天价赔偿。专家警告，直接作用于大脑关键区域的GLP-1药物同样存在未知的长期隐患。情绪抚慰剥离、创伤反扑与成瘾转移 (40:01) 进食承载着生理供能、感官享受与情绪安抚三重属性。许多暴食者将肥胖作为抵御心理创伤的盾牌，如Kaiser Permanente研究中的患者Susan在极端节食后因遭遇搭讪恐慌而报复性复胖。Ozempic强行剥离了通过暴食自我抚慰的通道，过度进食即刻诱发剧烈恶心或呕吐，导致底层心理创伤无处遁形。参考减重手术的历史数据，术后患者中17%需住院接受精神治疗，自杀率攀升近四倍，约十分之一的患者出现酗酒或赌博等成瘾转移。该药抑制多巴胺奖赏回路导致部分人丧失进食愉悦感并引发情绪扁平。但这一机制在成瘾治疗上显现出独特前景：动物实验显示，使用司美格鲁肽使大鼠酒精摄入减少约60%，芬太尼等阿片类药物自给减少约50%，可卡因摄入减少约50%。这种对神经奖赏系统的深度干预兼具戒断潜能与心理致郁的双刃剑效应。致肥环境的系统缺陷与滥用伦理争议 (52:25) 传统节食被证明难以维系：明尼苏达大学Traci Mann教授的元分析显示，节食者两年后平均仅保住两磅减重，仅10%的人能长期维持。Mount Sinai大学Paul Kenny教授的“芝士蛋糕大鼠实验”证实，超加工食品会瓦解生物饱腹感并促使强迫进食。西方的高肥胖率（英国26%、美国42.5%）源于被资本重塑的致肥环境，而非个人道德缺陷；对比之下，日本推行校内专职营养师配餐、“腹八分目”文化与全食教育，肥胖率仅4.5%，证明系统性公共干预的可行性。当前以药物替代食品治理的模式催生了严峻的伦理危机：远程医疗缺乏监管，使得非肥胖者乃至厌食症患者轻易购药以追求极度消瘦；供不应求的局面又导致真正的糖尿病患者面临断药风险。西方文化中将肥胖视为“原罪”、将药物减重视为“作弊”的道德苛责，进一步加剧了患者尤其是女性的心理创伤。 Hari总结认为，Ozempic是一份伴随代价的“魔法契约”。对于BMI大于35、面临截肢与早亡威胁的重度肥胖者，其减重益处远超潜在风险；但对于BMI低于25的非肥胖人群，将其用作审美捷径是承担少肌症与未知长期风险的危险行为。社会不应盲目走向半数人口终身服药的异化未来，而应汲取控烟与日本饮食经验，从源头监管超加工食品工业。

Detailed notes — zh

## Background 本期节目由知名播客频道《The Diary Of A CEO》（主持人斯蒂芬·巴特利特）于 2024 年 4 月 29 日发布在 YouTube 平台。页面简介围绕《纽约时报》畅销书作家约翰·哈里（Johann Hari）展开，重点探讨他为其新书《魔力药丸》（*Magic Pill*）所做的全球调查，揭示当前风靡全球的 Ozempic（司美格鲁肽）等新型减重药物背后被掩盖的惊人效益与严重副作用。 ## TL;DR 在节目中，亲自以身试药并减重 42 磅的约翰·哈里详述了司美格鲁肽如何直击大脑奖赏中枢以强效压制食欲，并指出在超加工食品彻底破坏饱腹感机制的现代环境中，单纯依赖意志力节食在长期来看有 90% 的失败率。与此同时，他深入剖析了此类药物带来的 12 项潜在严峻代价，包括停药后 70% 的体重反弹、肌肉流失加速衰老、急性胰腺炎与甲状腺癌隐患，以及剥离食物抚慰后浮出水面的成瘾转移与抑郁心理危机。哈里进一步结合日本从源头重塑食品环境与午餐文化的成功案例，强调人类绝不能将终生依赖人工注射视为解决系统性食品工业危机的唯一答案，呼吁建立兼顾知情权与社会伦理的平衡视角。 ## Atmosphere & style 整场对话兼具严谨的新闻调查质感与毫无保留的情感坦诚，叙事风格在风趣自嘲与严肃沉痛之间自如穿梭。两位嘉宾在演播室中面对一支看似小巧的注射笔，从好莱坞名流的伪善外表、肯德基暴食的至暗时刻，一路剖析到阶层极化与现代食品工业的原罪，碰撞出极强的思辨张力。访谈后半段由医学与社会议题升华至拉斯维加斯排洪渠中的人性宽恕，让整期节目在带给听众智识震撼的同时，更笼罩着一层深沉且温厚的人文关怀。 ## Bulletin - [00:00](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=0s) 以 Ozempic（司美格鲁肽）为代表的 GLP-1 药物重塑了大脑中枢饱腹感与奖赏系统，使用者平均一年可减重 15%，新一代多靶点药物减重幅度甚至可达 24.2%，直逼代谢手术。 - [31:16](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1876s) 研究表明传统意志力节食在 2 年后仅有约 10% 的人能维持大幅减重，因为人体存在向上单向滑动的“体重调定点”并会触发对抗机制，而减重药物在生理层面重置了该调定点。 - [01:14:08](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4448s) 药物伴随着 12 项潜在身心风险，包括停药一年内 70% 的体重强力反弹、瘦肌肉量显著流失、急性胰腺炎患病风险暴增至 9 倍，以及剥离情绪性进食后诱发的成瘾转移与心理崩塌。 - [01:42:47](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6167s) 随着 2032 年专利到期与口服片剂的研发，全球可能走向半数人口终身服药的新常态，但这也进一步加剧了挤占二型糖尿病患者救命药的伦理争议与现代食品工业治理困境。 ## Key takeaways - [09:39](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=579s) GLP-1 药物不仅通过延缓胃排空产生饱胀感，更直接渗透血脑屏障作用于大脑中枢受体，通过调高饱腹感信号或钝化奖赏回路来改写食欲冲动。 - [23:06](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1386s) “芝士蛋糕公园”等动物实验证明，现代超加工食品能够彻底击穿哺乳动物感知“何时该停下”的生物本能，导致大脑即使面临电击惩罚也无法停止过量暴食。 - [34:52](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2092s) 人体具备演化形成的“体重调定点”机制，一旦发胖，身体会将更高体重视为正常生理稳态并极力阻抗减重，这解释了为何纯靠意志力节食的长期成功率仅约 10%。 - [45:32](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2732s) 食物长期扮演着应对高压与心理创伤的情绪抚慰剂（Comfort Eating）；GLP-1 药物阻断暴食通路后，底层创伤易浮出水面，并可能像减重手术后一样诱发转向酗酒、赌博等“成瘾转移”。 - [48:38](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2918s) 文森特·费利蒂等医学研究指出，严重肥胖往往被受害者潜意识当作防御创伤的“心理盔甲”，迅速减重可能使部分人群产生失去安全感的恐慌反应。 - [54:48](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3288s) 肥胖流行本质上是“致肥胖环境”驱动的工业化危机；英国控烟历史与日本通过学校午餐立法、“腹八分分”文化维持极低肥胖率的实践，证明系统性环境干预完全可行。 - [01:05:51](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3951s) 门槛监管缺失导致减重药物在互联网上极易滥用，成为进食障碍（如厌食症）群体的极端自我饥饿凶器，极度营养不良存在诱发心脏骤停等致命危险。 - [01:14:08](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4448s) 生理层面潜藏明确隐患：大样本数据显示急性胰腺炎风险激增至 9 倍，甲状腺癌相对风险有所上升，且部分人群流失的体重中有 20% 至 30% 为瘦肌肉组织，埋下老龄肌少症隐患。 - [01:22:49](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4969s) 回顾历史上二硝基苯酚、安非他命以及 90 年代芬-芬（Fen-Phen）等减肥神药的惨痛悲剧，长期大范围暴露后可能浮现目前未知的远期神经系统或胚胎毒性风险。 - [01:31:24](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5484s) 临床决策本质是两害相权取其轻：尽管药物存在未知与已知副作用，但相较于二型糖尿病导致的高截肢率、失明及平均折寿 15 年的确定性危害，BMI>35 或高危重度肥胖患者用药利大于弊。 - [01:50:46](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6646s) 临床试验表明约 70% 的使用者在停药一年内体重会迅速反弹，迫使患者可能面临终身用药的困局，并在耐受性、机体基础代谢率受损方面存在长期不确定性。 - [01:57:21](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7041s) 好莱坞名流暴瘦引发的社会道德审判，源于公众潜意识中将减肥视为“原罪与肉体受难救赎”闭环，认为轻松注射是“作弊”，同时刺痛了弱势肥胖群体的拟社会认同。 - [02:05:37](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7537s) 动物实验与初步临床数据观察到 GLP-1 药物对酒精、阿片类与可卡因等成瘾冲动具有广泛削减作用，展现出从神经中枢调节强迫性渴望的广谱潜力。 - [02:15:03](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8103s) 仅靠药物变瘦无法替代规律运动带来的心血管保护、衰老延缓与多巴胺奖赏，盲目依赖捷径可能导致日常身体活动进一步匮乏。 - [02:18:58](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8338s) 美容减重潮引发了严重的药品供应挤兑，导致真正依赖 Ozempic 维持生命与器官健康的二型糖尿病患者陷入断药危机，亟需建立梯队式医疗配给机制。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=0s) 震惊的外貌变化与“奇迹减肥药”的登场时隔两年再次与主持人斯蒂芬·巴特利特（Steven Bartlett）对坐，畅销书作家约翰·哈里（Johann Hari）的外貌发生了翻天覆地的变化——他在短短一年内瘦了足足 3 英石（约合 42 磅 / 19 公斤）。面对主持人的惊叹，约翰直言这绝非什么传统努力的奇迹，而是一个公开的“秘密”：他亲自充当小白鼠，使用并深入调查了当前风靡全球的降糖减肥药 Ozempic（司美格鲁肽）。这种药物被形容为当今世界上最热门的药物，它以前所未有的强效方式作用于人类大脑的核心中枢，实质上成为了“人类有史以来发明的最强效自我饥饿工具”。使用后，人的食欲能直接锐减 80%。然而，这场体态革命的背后潜藏着极其不安的代价。约翰严肃警告，过去 40 年全社会不断灌输“节食与运动”是减重的唯一正途，但残酷的现实是只有大约 10% 的人能靠节食长期维持大幅减重；如今人们走向另一个极端，不惜通过注射可能带来巨大健康隐患的药物来强行阻止进食。随着数年后可能有多达 50% 的人口使用此类药物，公众却对其真实风险知之甚少。从停药一年内 70% 的体重强力反弹，到肌肉量的大幅流失、潜在的自杀念头，再到患上某种极度痛苦病症的几率暴增 9 倍，这些极度严峻且未被充分解释的 12 项重大风险，构成了这场减肥狂潮背后令人心惊的阴影。 - **减重成效对比**：传统节食仅有约 10% 的人能维持大幅减重，而使用 Ozempic / Wegovy 的人平均一年减重 15%，下一代研发中的药物平均减重幅度甚至可达 24%，效果直逼减重代谢手术（胃转流或缩胃手术）。 - **严重风险隐患**：停药一年内反弹 70% 减掉的体重；特定极度痛苦的并发症风险激增至 9 倍；肌肉严重流失；神经心理层面的抑郁与自杀倾向风险。 --- ### [01:58](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=118s) 好莱坞派对的震撼：从名流滤镜到一支注射笔约翰谈及自己接触 Ozempic 的荒诞起点。那是在 2020 年冬季，全球刚从新冠疫情的封控中缓慢重启，约翰与绝大多数普通人一样，在居家隔离期间体重飙升。当时他受邀参加一位好莱坞知名男演员举办的复工派对。赴宴途中，约翰心里还在暗自窃喜并打趣：“这下有好戏看了，那些好莱坞明星肯定也跟我一样吃胖了，看他们怎么见人。” 然而踏入派对现场的那一刻，眼前的景象让他彻底震惊：全场不仅没人发胖，反而一个个面容消瘦、颧骨高耸，整张脸仿佛自带锐化后的 Snapchat 滤镜，皮肤紧绷、轮廓清晰得不可思议。约翰困惑地在舞池边徘徊，甚至向一位女性朋友开玩笑搭讪：“看来隔离期间全好莱坞都在拼命练普拉提啊？”女伴听后笑了起来，严肃地看着他戳破真相：“你该不会真以为这是普拉提的效果吧？”随后，她掏出手机搜索并展示了一张照片——那是一支 Ozempic 注射笔。她告诉完全蒙在鼓里的约翰，现场根本没人靠运动，不仅是当红巨星，就连他们的配偶、经纪人乃至经纪人的孩子，全员都在注射这种药物。 ```mermaid flowchart TD accTitle: 好莱坞派对认知颠覆路径 accDescr: 展示约翰在派对上从以为群星发胖到发现 Ozempic 普及的认知颠覆过程。 subgraph S1["现实落差"] A["预期: 好莱坞名流疫情期间也会发胖"] --> B["现场: 全员消瘦、颧骨突出如自带滤镜"] end subgraph S2["真相揭示"] B --> C["搭话打趣: '大家都在练普拉提吧？'"] C --> D["好友亮出底牌: 手机展示 Ozempic 注射笔"] D --> E["圈层真相: 明星、配偶、经纪人乃至家属全员用药"] end ``` --- ### [03:51](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=231s) 极度矛盾的心态与跨国调查之旅派对归来后，约翰开始疯狂查阅关于新一代减重药物的文献。他发现自己陷入了一种前所未有的剧烈内心撕裂——这也成为了他新书《Magic Pill》（魔药）副标题的核心主题：“新减肥药的惊人效益与令人不安的风险”。一方面，药物带来的医学效益是实打实的：约翰有着沉重的家族病史，其祖父早早死于心脏病发作，叔叔同样死于心脏病，父亲也饱受心血管疾病折磨，家族中的男性大多难逃肥胖与心脏早亡的宿命。医学上肥胖与超过 200 种疾病并发症高度相关，而新药平均 15% 甚至下一代 24% 的减重幅度，对降低心血管死伤有着不可忽视的价值。但另一方面，约翰直觉中的警钟大作： 1. **历史惨痛教训**：医学史上出现过无数被冠以“奇迹”的减肥神药，每次都是起初疗效惊艳，随后便暴露出灾难性的严重副作用，最终被全面下架。 2. **治标不治本**：现代肥胖流行的根源在于整个食品供应体系的工业化剧变，人类摄入的食物结构与祖辈截然不同；给全民注射药物反而掩盖了应该针对劣质食物环境做出的系统性变革。 3. **社会心理冲击**：这种强效饥饿抑制剂一旦流入进食障碍（如厌食症、贪食症）人群手中会引发何种灾难？它是否会彻底粉碎过去几年社会艰难建立起来的“身材包容性”（Body Positivity）？为了寻找答案，约翰决定以身试药一年，并展开了一场跨越冰岛雷克雅未克、美国明尼阿波利斯到日本东京的全球调查，深入采访了世界上最顶尖的支持者与反对派学者。 --- ### [06:37](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=397s) 注射体验、食欲骤降与高昂的药价鸿沟在演播室现场，约翰拿出了一支随身携带的道具注射笔。它的外观非常像一支粗大的 Sharpie 记号笔，操作类似肾上腺素笔（EpiPen）：每次旋转底座设定剂量（例如 1 毫克），拧上一次性微型针头，每周自行皮下注射一次。一整支笔通常内含 4 剂，刚好满足一个月的用量。约翰生动地回忆了自己首次用药后的真实生理冲击。注射几天后的一个早晨，他在床上醒来，脑海中涌起一股前所未有的陌生感。起初他以为是多数初用者都会经历的轻度恶心，但很快他意识到最震撼的事实：**他竟然完全不饿**。在过去的人生里，他几乎每天早晨都是被腹中的饥饿感与肠胃轰鸣吵醒的。当天他来到常去的街角咖啡馆，照旧点了平时必吃的厚切鸡肉蛋黄酱全麦面包卷，结果仅仅咬了三口，就产生了彻底的饱腹感，再也吃不下一丝一毫。店员塔蒂亚娜（Tatiana）甚至紧张地追出店门，大声询问他是不是生病了。午餐在办公室旁的土耳其餐馆面对招牌地中海烤羊肉时，同样的一幕再次上演：仅仅咽下三四口，食欲就像被凭空拉下了一道铁闸。主持人随即询问该药物的经济成本。约翰指出英美两地存在极大的价格断层： - **英国售价**：由于国家医疗与定价体系，私自购买每月 4 剂的用量花费约为 **250 英镑**。 - **美国售价**：相同一个月份额的支出则急剧飙升，普遍在 **800 美元至 1200 美元** 之间，价格是英国的数倍之多。 ### [09:39](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=579s) GLP-1 药物的起源与作用机制在讨论药物供应短缺对价格造成的影响后，话题转向了这类药物究竟算不算“新技术”。Johann Hari 指出，在肥胖症治疗领域它们确实是新鲜事物，但作为糖尿病处方药，它们其实已经合法获批使用了将近 18 到 20 年。在采访该药物突破性研发的关键科学家以及各个阶段的研究人员时，Hari 发现医学界对于药物的运作机理曾经历过深刻的认知转变。从基础生理学来看，人体在进食后肠道会自然分泌一种名为 GLP-1（胰高血糖素样肽-1）的肠道激素。它向大脑传递天然的饱腹信号——宛如在大脑中对你说：“你吃够了，快停下来。”然而，天然 GLP-1 在体内的寿命极其短暂，短短几分钟内就会被代谢清除，因此人们往往能凭意志力“顶着信号”继续暴食。而像 Ozempic 这类药物本质上是人工合成的 GLP-1 受体激动剂。与人体几分钟就消退的天然激素不同，注射一剂人工合成的模拟物可以在体内持续作用整整一周。最初医学界普遍认为它的作用靶点仅限于肠胃系统，主要通过延缓胃排空来让人保持饱胀感。但前沿神经科学研究却揭示了一个颠覆性的事实：虽然减缓胃排空确实在起作用，但这类药物的核心靶向其实在于大脑，它从神经层面直接重构了人们对食物的“欲望”以及渴望食物的方式。 ```mermaid flowchart TD accTitle: 天然GLP-1与Ozempic在体内机制的对比 accDescr: 对比进食后天然GLP-1的快速代谢机制与Ozempic注射后在体内及大脑产生的持续饱腹与欲望抑制效果。 subgraph Natural["天然机制：进食与饱腹"] A["日常进食"] --> B["肠道分泌天然 GLP-1"] B --> C["发出短暂饱腹信号"] C --> D["数分钟内被酶代谢清除"] D --> E["饱腹感消退，容易继续进食"] end subgraph Synthetic["药物机制：Ozempic 注射"] F["每周单次皮下注射"] --> G["人工合成 GLP-1 持续循环 7 天"] G --> H["延缓胃部排空速率"] G --> I["直接结合大脑中枢受体"] H & I --> J["全天候强效饱腹，热量摄入减半"] end ``` - **糖尿病临床历史**：相关 GLP-1 靶点药物在糖尿病治疗领域已拥有近 20 年的应用历史。 - **体内留存时间**：天然 GLP-1 仅存活数分钟，而 Ozempic 注射剂可在循环系统中维持高浓度长达整整一周。 - **双重作用途径**：传统认为的“延缓胃排空”仅是表象，前沿神经学证明它深度参与了大脑中枢奖赏回路的调节。 --- ### [11:48](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=708s) 暴跌的热量摄入与失去“吃”的快乐每周只需打一针，就能让整整一周都处在饱胀状态中。Hari 形象地比喻这种感觉：试想你刚刚吃完丰盛无比的圣诞大餐，整个人瘫在沙发上撑得肚子发胀，这时有人端来一个巨无霸汉堡放在你面前对你说：“趁热吃吧！”虽然在生理极限上你或许还能硬塞下去，但你的大脑只会感到作呕并产生绝对的抗拒。这种强烈的饱腹信号让 Hari 的日常热量摄入发生了断崖式骤降——从过去的每天约 3,200 卡路里直降到现在的 1,800 卡路里左右。表面上看这是立竿见影的减肥奇迹，但在深入调查后，Hari 发现这背后潜藏着整整 12 项重大健康与心理风险。主持人提到了许多人对该药物的核心疑虑：美食是人生重要的快乐源泉，如果失去了对早餐可口面包的渴望，难道不是剥夺了生活中的极大幸福感吗？Hari 承认这确实是 Ozempic 最受诟病的负面效应之一。就连参与研发该药的丹麦著名科学家 Jens Juul Holst 都曾坦言，对绝大多数人来说，“失去食物带来的快感是难以忍受的”，很多患者在注射一两年后索性选择停药放弃，因为他们无法接受一个毫无进食乐趣的人生。英国知名美食评论家 Jay Rayner 在亲身体验该药后就曾抱怨，当他置身于巴黎最顶级、最心仪的餐厅时，面对珍馐美馔却完全提不起兴致、感受不到丝毫愉悦，这种感官钝化对美食爱好者而言犹如一场噩梦。 --- ### [14:15](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=855s) “填塞式进食”背后的心理创伤与进食转变与大多数抱怨“丧失美食快感”的人截然不同，Hari 发现药物在自己身上产生了截然相反的心理投射。他指出，Ozempic 就像一面镜子，会毫不留情地将每个人隐藏在食物背后的深层心理症结彻底翻到台面上。Hari 回忆自己从小生活在一个充满混乱与暴力的家庭环境中，年幼的他为了寻求情绪寄托，逐渐发展出一种依靠食物安抚自我的防御机制。对他而言，进食的快感从来不是细细品味或享受美味，而是来自毫无节制的“填塞感”（stuffing）——故意将食物吃到远远超过胃容量的极限，感受食物压迫食道、把胃壁撑到极致的沉重物理压迫感。用药后，暴饮暴食的生理通路被硬生生切断。只要他敢尝试过度填塞，身体立刻会引发强烈的呕吐反应。这迫使他不得不彻底放慢吃饭的速度，不再狼吞虎咽地用食物麻痹神经。他甚至意外发现，自己反而比过去更加能够品尝食物本身的滋味了。一位朋友在 Hari 用药数月后与他共进晚餐时感慨道：“以前和你一起吃饭压力很大，因为你吃得飞快，却又看起来完全没有享受食物；但现在，你看起来是真的在品尝一顿饭。”然而 Hari 强调，自己这种从填塞到品尝的转变属于少数个案，现实中像 Jay Rayner 那样因丧失食欲乐趣而倍感空虚的人远比自己更多。 --- ### [16:05](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=965s) 大脑中的 GLP-1 受体与戏剧性改变的渴望讨论随之深入到药物在神经生物学层面的真正影响。Hari 强调，虽然医学界对该药在脑部的详细运作机制仍存在巨大争议，但早在 1990 年代，伦敦哈默史密斯医院（Hammersmith Hospital）的研究人员就已经证实：GLP-1 受体不仅存在于肠道中，更密集分布于人类大脑内，甚至大脑和甲状腺本身也可以自主合成 GLP-1。肥胖症专家 John Wilding 教授曾向 Hari 解释过动物示踪实验：科研人员为药物分子打上放射性示踪标记后注射进实验动物体内，脑切片分析明确显示，药物分子迅速渗透到了大脑的各个区域。这证明它主要是在神经中枢引发连锁反应，直接扭转了个体的冲动机制。 ```mermaid flowchart LR accTitle: GLP-1 药物在中枢神经系统的分布与行为影响 accDescr: 展示药物分子进入大脑后分布于各个神经区域，从源头改写食欲和成瘾冲动。 Drug["合成 GLP-1 分子 (Ozempic)"] --> Circulation["体循环与血脑屏障渗透"] Circulation --> Receptors["激活大脑广泛的 GLP-1 受体"] Receptors --> Reward["重构大脑奖赏系统"] Reward --> Effect1["消除强迫性进食欲望"] Reward --> Effect2["抑制对高脂高糖垃圾食品的依赖"] Reward --> Effect3["潜在影响成瘾与抑郁情绪"] ``` 用药后的个体体验深刻印证了这种神经层面的改变——它不仅仅是胃部撑胀的物理感觉，而是你大脑深处的渴望被彻底改写。Hari 幽默地分享了用药初期两件荒诞而真实的经历： - **麦当劳之行**：用药大约一周后，他带教子去麦当劳，面对以前无法抗拒的快餐，他内心竟然毫无波澜，甚至连一口汉堡都不想吃。惊愕不已的教子当场质问他：“你到底是谁？你把真正的 Johann 弄到哪里去了？” - **炸鸡店“最佳顾客”奖**：Hari 回忆起自己人生中的一段至暗尴尬时刻——2009 年的平安夜，他像往常一样走进住处附近的肯德基点了一大堆“恶心到难以启齿”的油炸食物。柜台员工见到他后热情地让他稍等，随后厨房员工全体走出来，递给他一张写满员工签名的巨大圣诞贺卡，上面写着“致我们的最佳顾客”，并集体为他鼓掌欢呼。令 Hari 既绝望又羞耻的是，他当时脑海中浮现的第一个念头竟然是：“老天，这甚至还不是我平时去得最多的那家炸鸡店！”而如今，这类一度令他深陷其中的强迫性食欲，在药物作用下彻底烟消云散。 ### [18:39](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1119s) 药物作用于大脑的三种核心理论与潜在风险在深入采访了多位前沿神经科学家后，约翰·哈里（Johann Hari）指出，关于诺和泰（Ozempic）等 GLP-1 药物到底如何影响人类大脑，科学界目前主要存在三种理论假说。第一种理论认为，这类药物抑制了大脑的“奖赏系统”（Reward System）。正常情况下，进食、性生活或与朋友聚会都会激活奖赏中枢，让人产生愉悦感。然而药物可能会调低这一系统的反应敏感度——“我之所以不再渴望巨无霸汉堡，是因为汉堡带给我的奖赏反馈大幅降低了”。但这也伴随着显著隐患：如果它能削弱对快餐的渴望，是否也会钝化人们对阅读、写作等热爱事物的热情？目前医学界对此争论激烈，部分使用者报告了抑郁情绪甚至自杀念头，美国食品药品监督管理局（FDA）也在相关药物上标注了此类风险警示。与之相对，第二种理论则由阿拉巴马大学伯明翰分校（UAB）的神经科学家阿雷利奥·加利（Aurelio Galli）等人提出。他们认为药物并非粗暴地压制奖赏系统，也没有普遍的致抑郁风险，而是像“将手机恢复出厂设置”一样，重新校准了大脑对食物的偏好系统，将食欲偏好重置到了更为健康的基准线。听闻此处，主持人史蒂芬·巴特利特（Steven Bartlett）打断并分享了自己的亲身经历：他发现自己一旦吃了饼干或高糖食品，第二天就会陷入更强烈的渴望，陷入一种由糖分引发的恶性循环（Sugar Spiral）。他提出疑问：哈里不再想吃麦当劳，会不会仅仅是因为停吃高糖上瘾物质后，身体自然摆脱了成瘾循环？哈里表示这确实切中了问题的核心，而后续的一项标志性动物实验完美证实了这一点。 ### [20:53](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1253s) 第三种理论：激活饱腹感系统与肥胖率的暴增在解答糖成瘾之前，哈里补充了神经科学界最具说服力的第三种假说。纽约西奈山伊坎医学院（Mount Sinai）神经科学系主任保罗·肯尼（Paul Kenny）教授提出，大脑中除了奖赏系统外，还独立存在着一套“饱腹感系统”（Satiety System）。饱腹感是人类与生俱来的停止信号，用来提醒个体“你已经吃饱了，该停下来了”。肯尼教授认为，GLP-1 药物的核心机制并非降低奖赏，而是直接“调高了饱腹感系统的运作音量”。 ```mermaid flowchart TD accTitle: GLP-1 药物对大脑作用的三大假说 accDescr: 展示科学界解释 GLP-1 药物影响食欲的三种核心机制路径 subgraph Hypotheses["GLP-1 作用于大脑的三大假说"] H1["假说一：抑制奖赏系统 钝化多巴胺反馈，但也可能带来抑郁/自杀风险"] H2["假说二：恢复出厂设置 重置食物偏好系统，回归健康基准"] H3["假说三：放大饱腹感系统 直接调高'叫停'信号，强化停止进食机制"] end H1 --> BrainImpact["深刻改变大脑神经认知"] H2 --> BrainImpact H3 --> BrainImpact ``` 哈里坦言，当他意识到这类药物正在以如此深刻且私密的方式重塑人类大脑回路时，感受到了巨大的震动——这绝非最初听说的“只是减缓胃排空速度”那么简单。人类社会之所以会走到今天这步田地，甚至需要依靠注射具有潜在风险的药物来强迫自己停止进食，背后有着惊人的历史转变： - 1979 年（哈里出生的年份），英国成年人的肥胖率仅为 6%； - 如今，英国肥胖率已飙升至 26%，全球肥胖人口在哈里有生之年整整翻了三倍； - 这种在人类演化史上前所未有的暴增，迫使科学家不得不去探寻现代饮食如何彻底摧毁了大脑的天然饱腹机制。 ### [23:06](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1386s) “芝士蛋糕公园”实验：超加工食品如何摧毁进食本能为了厘清垃圾食品对大脑控制力的侵蚀，保罗·肯尼教授设计了一项被哈里戏称为“芝士蛋糕公园”（Cheesecake Park）的经典神经学实验。肯尼早年在爱尔兰都柏林长大，二十多岁移居美国圣迭戈攻读博士，刚到美国一年体重就暴增了 23 磅（约 1.5 英石）。他敏锐地察觉到美国饮食中充斥着超常的高糖和高脂肪，进而开始探究：现代食物是否在生理层面永久改变了大脑，迫使生物不断过量进食？在实验第一阶段，实验大鼠被圈养在笼中，提供它们在漫长进化过程中适应的天然谷物颗粒饲料。即便食物无限量供应，大鼠依然表现出极高的“天然营养智慧”——饥饿时进食，一旦满足热量需求便自然停下，没有任何一只大鼠出现超重或肥胖。随后，肯尼教授为大鼠引入了典型的“美式饮食”，投喂煎培根、士力架巧克力，以及大量的芝士蛋糕。大鼠的本能彻底失控：它们完全抛弃了演化所需的天然食物，近乎疯狂地扑向芝士蛋糕，“整只钻进蛋糕堆里大嚼，钻出来时全身裹满了芝士奶油”。短短几天内，大鼠的健康指标全面恶化，陷入持续的强迫性暴食，数周后全部陷入极度肥胖。更残酷的转折发生在戒断阶段：研究人员撤走了所有美式垃圾食品，重新换回原本健康的天然颗粒。肯尼教授原本预期大鼠只是胃口被撑大、会吃下更多天然饲料，然而事实完全出乎意料——大鼠直接无视天然食物，仿佛彻底不再将谷物视为食物，宁愿在笼中绝食挨饿；直到濒临饿死的边缘，它们才极度勉强地重新去啃那些天然饲料。正如哈佛大学营养学学者所言，现代高度加工的食物系统正在系统性地摧毁人类“感知何时该停下”的生物本能，导致如今高达 47% 的美国人希望借助药物来强迫自己停嘴。 ### [26:17](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1577s) 电击都挡不住的暴食欲望：成瘾机制与负面后果巴特利特提到哈里在新书《奇迹药丸》（*Magic Pill*）第二章中记录的后续实验：肯尼教授进一步测试了大鼠面对负面惩罚时的行为抉择。研究人员对大鼠进行条件反射训练，在它们进食时用黄光照射眼睛并施加痛苦的电击，使大鼠建立起对黄光的恐惧。当大鼠进食天然健康饲料时，只要黄光亮起，它们就会吓得立刻逃跑。然而，当大鼠正在大口吞食芝士蛋糕等美式垃圾食品时，即便头顶亮起刺眼的黄光并伴随强烈的电击，它们依然硬生生忍受着电击带来的痛苦，赖在原地疯狂进食，绝不松口。肯尼教授得出了令人警醒的结论：一旦大脑长期暴露在此类超加工食品的刺激下，机体对它的渴求将超越理智，生物体甚至愿意完全无视任何严重的负面后果去获取它。哈里深有共鸣地反思道，这与他在生活中对 KFC 炸鸡的强迫性依赖如出一辙——明知健康和体态正在恶化，却无法自拔。这揭示了一个关键关联：现代肥胖率的爆炸性增长并非个体的道德意志薄弱，而是工业化食品彻底击穿了大脑的神经防线；而新型 GLP-1 药物的作用靶点，恰好直击这一套被现代食品工业彻底打乱的大脑控制系统。 ### [27:33](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1653s) 人工药物应对人工危机：给饥饿的身体找回饱腹感现代高度加工食品彻底破坏了人类的饱腹感机制。就像之前动物实验中的大鼠一样，人们在吃下这类食物时，大脑根本接收不到“你饱了，停下来”的生理信号。开发这类药物的关键科学家之一卡雷尔·勒鲁（Carel le Roux）指出，GLP-1 药物的本质是提供“饱腹感激素”，帮助身体找回吃饱的感觉。费城德雷塞尔大学（Drexel University）的迈克尔·洛教授（Professor Michael Lowe）则一针见血地评价道：“这些药物是用人工手段去解决一个人工制造出的问题。”我们当下经历的肥胖危机，并非自然演化的必然，而是灾难性的现代食品体系从童年起就将人体机能彻底打乱的结果。面对这种“治标不治本”的局面，哈里（Johann Hari）曾陷入严重的道德自我怀疑，觉得自己像个伪君子——平日里总呼吁要从社会与环境根源解决问题，如今却靠注射药物来压制症状。但一位曾罹患乳腺癌的挚友“朱迪”（Judy）用生动的切身经历点醒了他：现代环境问题导致英美女性乳腺癌发病率高达七分之一（而在日本仅为三十八分之一），但当病人确诊乳腺癌时，绝不可能因为“这是环境诱发的”就拒绝化疗这种“毒药”疗法。朱迪提出了一个无可辩驳的着火比喻： ```mermaid flowchart TD accTitle: 面对危机时的紧急应对与长期根治逻辑 accDescr: 对比解决房屋着火与应对肥胖危机的逻辑，强调必须先保命灭火，再谈制度与材料改造。 subgraph Fire["房屋着火的比喻"] A["房屋被大火吞噬"] --> B["当务之急：立刻灭火保命"] B --> C["长远规划：制定防火建材法规与安装喷淋系统"] end subgraph Health["肥胖与健康危机"] D["现代不良食品环境导致全身重病"] --> E["现实自救：使用减重药物降重脱险"] E --> F["制度变革：彻底改革致胖的食品工业体系"] end ``` 旧金山一位 66 岁的灯光设计师杰夫·帕克（Jeff Parker）的故事进一步印证了这一点。帕克体重曾高达 16 英石（约 101.6 公斤），伴有严重的心脏、肝脏和肾脏问题，甚至行走都会带来剧痛。在使用下一代减重药物替尔泊肽（Mounjaro）后，他的体重显著下降，各项器官指标逆转，如今每天都能轻松带着狗走过金门大桥。当被问及“难道我们不该去整治致胖的外部环境吗”时，帕克回答得无比坦诚：“如果你发起那场运动，我举双手赞成，但等你们真正改革成功那天，我早就进棺材了；我等不起，我现在就想活下去。” --- ### [31:16](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1876s) “纯靠意志力减肥”的伪命题与节食的真实数据社会舆论与个人内心的道德批判往往将肥胖归咎于“个人选择”：“早上去咖啡馆为什么选高热量面包而不吃沙拉？管住嘴迈开腿不就行了？”哈里曾就此与朋友争论：人们一面低估了肥胖带来的致命威胁——它不仅导致糖尿病，还与癌症、阿尔茨海默病（认知障碍症）全面挂钩；一面又不得不面对这类减重药物潜在的 12 项重大健康风险。而朋友却认为这根本不是一道二选一的难题，第三条路——“少吃多动、靠意志力节食”才是正道。为了查清“节食究竟有多大效果”，哈里前往明尼阿波利斯的一家著名肉桂卷店（Isles Bun & Coffee），采访了在节食心理与生理机制领域深耕二十余载的特雷西·曼教授（Professor Tracy Mann）。曼教授在 2000 年展开的一项涵盖近 2.4 万项研究的元分析（Meta-analysis）中发现，主流科学文献之所以得出“节食极度有效”的结论，存在一个巨大的学术盲区：绝大多数实验仅追踪受试者 3 个月。在短期内，靠意志力大幅减重确实屡见不鲜，但这种研究往往在受试者体重降到最低点时戛然而止，给人留下了“从此永远瘦下去”的假象。当曼教授筛选出仅有的 24 项长期追踪（2 年乃至极少数 5 年）的研究后，真相浮出水面： - **2 年后的平均成效**：节食者在 2 年后的平均减重仅剩 2 磅（约 0.9 公斤），几乎等于没有减。 - **能成功维持体重的人群比例**：人群中仅有约 10% 的人能够通过传统节食大幅减轻体重并在多年内不反弹，另外 90% 的人均以失败告终。 - **物理定律与生物本能的冲突**：虽然“摄入热量低于消耗热量必然变瘦”符合热力学物理定律，但人类肉身并非简单的熔炉，长期的卡路里亏空会触发强烈的反向生理代偿机制，使绝大部分人无法通过纯意志力与自身生理对抗。 --- ### [34:52](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2092s) 体重调定点理论：身体防线为何只能“单向调高” 为什么节食减重会如此艰难？多位科学家向哈里阐明了体重大幅增加后体内发生的深层生物学改变。在 20 世纪 60 和 70 年代，学术界曾普遍流行“调定点理论”（Set Point Theory）。该理论认为人体对体重存在自我调节中枢，原理酷似体温调节： - **体温机制的稳态对照**：人体会自动锁定正常体温。若外界过热（如发烧或身处撒哈拉沙漠），身体会不由自主地通过出汗、血管扩张来强行降温；若外界严寒，身体则会不受控制地颤抖产热并极度渴望热源。 - **传统观点的局限**：原先的理论认为人的体重调定点从出生甚至在子宫内起就已被基因锁死，一生基本恒定，上下波动幅度有限。但这一假说在 70 年代末至 80 年代初遭遇了严峻挑战——西方社会爆发了空前的肥胖浪潮，整个人群的体重中枢被集体推高，证明调定点并非绝对一成不变。德雷塞尔大学的迈克尔·洛教授等学者随后揭示了这一理论的关键修正：**调定点并非固定死板，但它具有可怕的“向上单向滑动”属性**。当不良饮食环境推动人体体重不断攀升、体脂率持续上涨时，下丘脑等生理控制中枢会重新校准，将更高的体重视为新的“正常生理稳态”。此时若强行靠节食把体重拉低，身体并不会庆祝减肥成功，反而会拉响遭遇饥荒的警报，动用一切激素和代谢手段逼迫体重反弹回那个已经被推高的调定点。 ### [36:38](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2198s) 体重调定点理论与演化机制 Johann 解释了为何人体减重如此艰难：当你长胖后（例如体脂达到 30%），身体会拼命将你维持在更高的体重水平。举个假想的例子，就像罗伯特·德尼罗（Robert De Niro）当年为了电影《愤怒的公牛》（*Raging Bull*）增重三到四英石（约 40~50 多磅），如果之后尝试减重，就会发现自己的新陈代谢大幅减慢；为了消耗掉同样的热量，必须付出多得多的努力；同时，身体还会强烈渴望高糖高盐的食物，精力严重下降导致更难坚持运动。这是因为人体的“生理调定点”（set point）被推高了，机体正在反抗减重。很多科学家向 Johann 解释，这种看似“适应不良”的机制实际上源于人类漫长的演化史。在过去上百万年乃至直到大约一百年前，人类社会从未出现过一生都处于热量极度过剩的环境；恰恰相反，致命的危险是饥荒。在饥荒来临时，最先储备了大量脂肪的人才能活到最后——就像幽默的比方：饥荒第一周蒂莫西·柴勒梅德（Timothée Chalamet）这类消瘦体型可能就撑不住了，而体格健硕丰满的约翰·坎迪（John Candy）能撑到最后。因此，演化赋予我们的本能是：一旦体重增加，身体就要誓死守住脂肪储备，因为饥荒随时可能来临。节食并非完全无效，意志力确实存在，但任何时候都有 17% 的人正在节食。过去 40 年全社会不断鼓吹“管住嘴、迈开腿”是唯一解药，人们却越来越胖。科学家如奥雷利奥·戈尔迪诺教授（Prof. Aurelio Gómez）推测，GLP-1 类药物（如 Ozempic）的核心机制可能正是从生物学层面“重置”了体重调定点，相当于调低了身体设定体重的“恒温器”，从而避免了节食时新陈代谢骤降和强烈饥饿感的反扑。 - 人类漫长进化中最大的生存威胁是饥荒而非热量过剩，因此演化机制天然偏向“保留体重” - 当人体重增加后，调定点上移，身体会通过减缓新陈代谢、加剧糖盐渴望、降低精力来阻止脂肪流失 - 过去 40 年提倡单纯依赖意志力节食运动，然而全球肥胖率却持续飙升 - 减重药物可能通过直接调低大脑的生理调定点，使得体重下降时不再触发机体的抗拒反应 --- ### [39:29](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2369s) 现代压力、进食心理与 Johann 的自身体验主持人提出，现代人生活在充满弹窗通知、社交媒体、高屏幕使用时间的狂躁高压环境中，儿童 ADHD 激增、皮质醇水平飙升，压力与食欲之间存在直接联系，这构成了对抗意志力的巨大“重力”。Johann 完全同意，并坦言这也是他在新书《Magic Pill》中梳理该药 12 项潜在风险时最担忧的一点，而且他自己就亲身经历了这种心理变化。 Johann 在用药大约一年多的时间里减重了三英石（约 42 磅），体重呈平稳的直线下降。在此期间，他恰好经常碰到怀孕的朋友 Danielle，两人形成了鲜明对照——一个在逐渐膨胀，另一个在持续缩水。然而大约在用药六个月时，Johann 忽然产生了一种异样的感受：自己明明达成了梦寐以求的减重目标，却感觉不到应有的快乐。他并没有陷入真正的抑郁，而是整个人变得麻木、情绪钝化（dulled）。随着深入研究进食心理学，Johann 发现人类进食有五大原因。除了最基础的维持生命（sustenance）和享受愉悦（pleasure）外，最重要的一个功能是**情绪抚慰（comfort）**。每当群体遭遇重大危机或个人面临心理重创时，垃圾食品的摄入就会暴增： - “9·11”恐怖袭击发生后，全美比萨和炸鸡的外卖订单激增； - 特朗普赢得大选当晚，蓝州（支持民主党的州）的外卖平台上墨西哥卷饼（tacos）等高热量垃圾食品订单暴涨； - 男性失业后体重显著飙升，很大程度上是因为借由暴饮暴食来寻求心理抚慰。然而，Ozempic 这类药物剥夺了暴饮暴食的能力，使得习惯通过食物安抚负面情绪的人失去了最直接的心灵“避风港”。 ```mermaid flowchart TD accTitle: 进食驱动力与情绪应对机制 accDescr: 展示人类进食的多重原因及减重药物剥夺情绪抚慰后的心理链条 subgraph HungerReasons ["进食的核心动因"] S["维持生命 (Sustenance)"] P["味觉愉悦 (Pleasure)"] C["情绪抚慰 (Comfort / 应对高压)"] end subgraph StressTriggers ["外部压力源"] T1["高压日常与数字化过载"] T2["社会突发事件 (如911、选举)"] T3["个人危机 (如失业、挫折)"] end StressTriggers -->|诱发负面情绪| C C -->|传统应对| Eat["暴饮暴食 / 高糖高脂食物"] Med["GLP-1 药物 (Ozempic)"] -.->|阻断暴食机制| Eat Eat -.->|无法再获取食物抚慰| Numb["情绪平淡 / 麻木迟钝 / 需寻找替代宣泄"] ``` --- ### [42:41](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2561s) 减重手术的前车之鉴与成瘾转移 Johann 指出，要评估这类药物长期的心理和身体后果，最好的现实参照物是减重代谢手术（Bariatric Surgery，如胃束带、胃缩小等）。以往想要快速且持续减掉 20% 以上的体重，减重手术是唯一的途径。手术在生理上的益处极具震撼力： - 术后 7 年内，死于心脏病的风险降低 **56%**； - 癌症死亡风险降低 **60%**； - 糖尿病相关死亡风险降低 **92%**； - **全因死亡风险整体降低 40%**。但手术伴随着严峻的代价：手术本身死亡率约为千分之一，更严峻的是术后的心理崩塌。由于生活里最核心的抚慰机制（过度进食）被瞬间剥离，多达 **17%** 的患者在术后需要接受精神科住院治疗；术后**自杀风险几乎翻了四倍**。如果一个人能平稳重建生活、找到新的舒缓途径固然很好，但对很多人来说，突然失去这一依靠极其痛苦。主持人补充道，Johann 在书中第 8 章提到，做完此类手术的人中有 **十分之一（10%）** 会发生“成瘾转移”（addiction transfer），转向酗酒、赌博、强迫性购物或药物滥用。这直观证明了心理层面的抚慰需求并未消失，只是转移了阵地。Johann 也分享了他采访过的案例，比如一位名叫 Robin Moore 的女性，体重曾达到 303 磅，由于别无他法且感觉自己沦为了进食的奴隶而选择手术，最终深刻体会到了这种抚慰机制剥离后的复杂与剧痛。 ### [45:32](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2732s) 成瘾转移与心理机制的浮现 Johann 讲述了一个令人心碎的案例：一位女性在童年时期曾遭受性虐待和强奸，但她从未向任何人吐露过这个秘密。为了保护自己免受男性的侵犯，她刻意让自己极度发胖，内心深处的逻辑是：“如果我非常胖，我就不太可能受到袭击。” 这种心理机制在严重肥胖群体中意外地普遍。后来，她通过医疗干预减掉了大量体重，身体状态明显好转，周围人对她的态度也大有改善。然而，一种危险的成瘾转移发生了：原本极少饮酒的她迅速演变成严重的酗酒者，在多伦多机场附近上班期间，往返路上都在喝酒，最终因工作时醉酒而被解雇。使用 Ozempic 等减重药物时，虽然并非所有人都会经历成瘾转移，但这些药物会彻底打破人们以往用来压抑或应对心理创伤的进食行为，导致潜藏在底层的心理原因浮出水面。Johann 分享了自己的亲身体验：他在拉斯维加斯调查一起极其阴暗可怕的案件时心情非常低落，在下意识的习惯驱使下走进了西撒哈拉大道（West Sahara）那家全城最破旧的肯德基（KFC），点了一大堆以往必点的炸鸡。然而坐在那里，他惊恐地发现自己竟然吃不下去，墙上的山德士上校画像仿佛都在俯视着他，困惑着“我的常客到底怎么了”。被剥夺“情绪性进食”（Comfort eating）的能力是一件极其痛苦且艰难的事情。正如 Johann 一位患过癌症的朋友所言：“并不是药物制造了这个问题，而是药物让原本的问题变得清晰可见，现在你必须用其他方式去面对它。”Johann 强调，关于这类新型减肥药的真相极其复杂，任何单纯高呼“药物太棒了能拯救全人类”或抨击“药物是魔鬼”的二元论观点都是不诚实的，人们必须直面其中的各种潜在风险。 - 成瘾转移（Addiction transfer）：个体停止暴饮暴食后，深层的创伤与焦虑未被化解，可能转移至酗酒、赌博或强迫性行为。 - 情绪盾牌的剥离：食物不仅是热量来源，也是许多人应对心理压力的麻醉剂；减重药消除了生理食欲，却让心理创伤直面现实。 ```mermaid flowchart TD accTitle: 创伤、进食与药物干预后的成瘾转移机制 accDescr: 展示了从童年创伤到暴食自保，再到减重干预后潜在的成瘾转移路径。 subgraph TraumaLoop ["创伤与代偿进食"] A["童年创伤 / 性虐待"] --> B["心理防御机制：增重自保"] B --> C["过度进食与情绪抚慰"] end subgraph Intervention ["药物与减重干预"] C --> D["体重骤降 / 进食冲动被阻断"] end subgraph Outcomes ["后续心理走向"] D --> E["进食防御机制失效"] E --> F["深层创伤浮现"] F --> G["成瘾转移：转向酗酒或其他上瘾行为"] F --> H["正视创伤：寻求新的心理应对机制"] end ``` ### [48:38](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2918s) 文森特·费利蒂的研究与创伤性暴食主持人询问，是否存在明确的科学数据能证明童年创伤会导致这种过度的代偿性进食。Johann 提到了他在撰写《Lost Connections》时结识的知名医生文森特·费利蒂（Dr. Vincent Felitti）。20世纪80年代初，加州大型非营利医疗机构 Kaiser Permanente 找到在圣地亚哥行医的费利蒂，表示当时肥胖率正在大幅飙升，但常规的饮食和运动方案毫无成效，于是向他提供充裕的资金开展开创性研究。费利蒂医生招募了200名重度肥胖患者，并尝试了一个看似荒谬的严苛方案：在严密医疗监护下让患者完全绝食，仅注射维生素以防止坏血病等营养缺乏症，促使其消耗体内储存的脂肪。起初，该方案取得了惊人成效，一位被称为“苏珊”（化名）的女性体重从超过400磅骤降至138磅。然而，意想不到的事情发生了——在家人欢呼医生拯救了她之后不久，苏珊突然心理崩溃，再次冲进肯德基疯狂暴食，体重急剧反弹。在深入面谈中，苏珊透露崩溃当天她在酒吧里被一名男士搭讪。尽管对方非常礼貌，却令她感到极度惊恐。顺着线索追问，费利蒂发现苏珊10岁开始发胖，而那正是她开始被祖父强奸的年份。费利蒂随即调查了项目中所有患者，得出了一个令人震惊的数据：该项目中60%的女性患者，其极度肥胖是在遭受性虐待或性侵犯后开始的。正如苏珊所解释的：“肥胖等于被忽视，而那正是我所需要的安全感（Overweight is overlooked, and that's what I need to be）。”当人们通过药物迅速减重时，部分人会产生强烈的恐慌感，感觉自己重新变回了那个脆弱、容易再次遭受创伤侵害的受害者。 - 费利蒂医生的临床数据：极度肥胖绝食疗法干预组中，60%的女性患者其严重体重增加可直接追溯至童年性侵害或性虐待。 - 生理保护机制：严重超重在心理层面上被受害者潜意识当作防御侵害的“盔甲”。 ### [52:25](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3145s) 致肥胖环境与工业超加工食品对话转向了环境对现代人身体的影响。主持人提到书中出现的一个概念——“致肥胖环境”（Obesogenic environment），类比于致癌物（Carcinogenic），现代社会的生活环境几乎让人“只要活在当下就会被传染肥胖”。不仅如此，数据表明，当人们摄入超加工食品（Processed food）时，平均每天会在不知不觉中多摄入500卡路里的热量。主持人对现代社会能否摆脱这种环境感到悲观，好奇政府是否可能介入、加税甚至禁止垃圾食品。 Johann 肯定了主持人的观察，并指出所谓的“致肥胖环境”就是一种诱导你变胖、同时让你极难维持健康体重的环境：健康营养的食物稀少且昂贵，而让人发胖的劣质垃圾食品不仅廉价、唾手可得，还充斥着无孔不入的营销轰炸。正如迈克尔·劳（Michael Lowe）教授对 Johann 所言：“我们生活在人类可能设计出的最具有致肥胖特性的环境之中。”在《Magic Pill》一书中，Johann 详细梳理了超加工食品破坏人体停止进食机制的七大途径。面对这种普遍的悲观情绪——毕竟连米歇尔·奥巴马（Michelle Obama）那样富有号召力和魅力的人物推行的全民运动倡议都举步维艰——Johann 却认为变革并非不可能。他以反吸烟的历史作为类比：几十年前香烟无处不在，他的母亲曾经每天要抽70支烟，甚至有一张老照片记录着母亲一边抽烟一边给他哺乳（当时他大约六个月大）。社会规范与致病环境的重塑虽然阻力重重，但历史证明深远的环境变革完全有可能发生。 - 超加工食品的摄入差异：食用超加工食品导致个体每日平均多摄取约 500 卡路里。 - 劣质食物的系统性优势：高糖、高脂的超加工食品具备低成本、高可及性以及铺天盖地的商业推广，反衬出健康新鲜食材的昂贵与稀缺。 ### [54:48](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3288s) 烟草控烟的历史奇迹与食品改革的政治阻力 Johann Hari 分享了一段带有黑色幽默的童年往事：他母亲在喂他（当时仅几个月大）时，一边抽烟一边把烟灰缸直接搁在他的小肚皮上。当他后来把这张照片拿给母亲看、以为她会心存愧疚时，母亲却理直气壮地说：“你小时候是个混蛋难搞的婴儿，我当时必须抽根烟！”这在当年的苏格兰是司空见惯的常态。在他七岁左右的英国，超过半数的人口吸烟，地铁、飞机、电视游戏节目上烟雾弥漫，甚至连医生给病人看病体检时手里都夹着烟。 ```mermaid flowchart TD accTitle: Public Health Transformation from Tobacco to Food accDescr: Diagram showing how tobacco consumption was dramatically reduced through policy and how food culture could follow a similar path. subgraph TobaccoHistory["英国控烟历程 (1987至今)"] A["1987年: 烟雾弥漫 超50%人口吸烟/随处可见烟灰缸"] --> B["转折契机: 1987国王十字站大火 地铁及室内全面禁烟立法"] B --> C["现状与趋势: 吸烟率降至12% 按年龄逐步推进终身禁烟"] end subgraph FoodReform["食品体系改革的困境与出路"] D["政治阻力: 决策者如同风向标 民意不倒向改革则不敢得罪利益集团"] --> E["摆脱双重困境: 肥胖 vs GLP-1药物的12种健康风险"] E --> F["学习日本经验: 通过环境与教育重塑健康饮食"] end TobaccoHistory -.->|"证明公共健康可以彻底转型"| FoodReform ``` 1987 年伦敦国王十字站（King's Cross）发生严重火灾，起因是有乘客在自动扶梯附近丢弃烟头，导致 50 多人丧生。Hari 回忆，多年后他和母亲聊起这场悲剧，母亲感叹那是她“人生中最糟糕的一天”；当 Hari 询问是否有熟人遇难时，母亲却答道：“不是，那是他们禁止在地铁里抽烟的第一天。”然而短短几十年过去，英国的吸烟率暴跌至 12% 左右，年轻人几乎不再吸烟，政府甚至在推进按年龄逐步终身禁烟的法案。当年若有人预言烟草行业会被如此重创，大家一定会斥为无稽之谈。这证明公共卫生习惯完全可以在短时间内发生天翻地覆的转变。当被问及“既然政府明知超加工食品和高糖对人有害，为何迟迟不采取行动”时，Hari 引用了作家 Rebecca Solnit 的名言：“政客是风向标，而我们的职责是成为风。”政治家总是在权衡“做一件事能换来多少赞誉，又会招致多少骂名”。在缺乏广泛社会认知的情况下，对食品巨头动刀会招致极大反弹。必须先改变大众认知，才能促使政策打破肥胖与长期依赖新型减肥药（及相关 12 种潜在重大健康风险）的两难境地。 - 1987 年英国超过 50% 的人口吸烟，室内公共场所及交通工具普遍允许吸烟。 - 国王十字站火灾因未熄灭的烟头引发，夺走 50 多条生命，成为地铁全面禁烟的催化剂。 - 目前英国吸烟率已降至约 12%，公共场所全面禁烟，并正探索按出生年份永久禁售香烟的法律。 - 面对肥胖流行，公众目前常被迫在“严重肥胖的疾病风险”与“长期服用减重药物带来的 12 种主要副作用风险”之间做选择。 --- ### [58:08](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3488s) 日本的破局范例：并非基因彩票，而是环境重塑为了打破“国家变富就必然走向全民肥胖”的宿命论，Hari 将目光投向了全球唯一的特例——日本。当前西方主流论调往往极其悲观，认为富裕社会充斥着廉价卡路里，肥胖不可避免，唯一的出路就是让 40% 到 50% 的国民终身注射减肥药物。然而，日本却做到了“变富裕却不发胖”。很多人直觉认为日本人不发胖纯粹是“中了基因彩票”，但移民数据彻底推翻了这一假设。19 世纪末大量日本人移民至夏威夷，如今繁衍至第四、第五代。这些在夏威夷长大的日裔人群，其肥胖率是日本本土居民的五倍之多，几乎与夏威夷当地其他群体一样胖。这充分证明：基因没有改变，一旦生活环境改变，日本人同样会严重肥胖。剑桥大学东亚史教授 Barak Kushner 指出，20 世纪 20 年代以前的日本普通人饮食结构极差，每周仅能吃到一次蛋白质，鱼肉摄入极少。当时日本政府为了扩充军队兵源，主动在全国范围内重构了整个国家的饮食文化与健康体系。 | 地区 / 人群 | 肥胖率 (Obesity Rate) | 超重及肥胖合并比例 | 核心环境特征 | |:--- |:--- |:--- |:--- | | **日本本土** | 约 4.5% | 显著处于低位 | 杜绝超加工食品、注重多样性与进食节律 | | **英国** | 约 26% | 普遍超标 | 高度普及超加工食品 | | **美国** | 约 42.5% | 超过 70% | 卡路里过剩、超加工食品主导 | | **夏威夷日裔人群** | 本土日人的 5 倍 | 接近夏威夷全州水平 | 脱离本土饮食文化，融入美式高热量环境 | --- ### [01:00:31](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3631s) 日本学校的午餐革命：营养师法案与“腹八分分” Hari 亲自前往日本探访了一所涵盖 5 至 18 岁学生的弘道学校（Kohoku/Kōhoku School）。在这里，孩子们从 5 岁起就独立步行上下学，每天早晚自然完成了大量基础身体活动。一进校门，营养教谕（School Nutritionist）Harumi Tate 便接待了他们。根据日本法律，每一所学校都必须配备专业的持证营养师。该资格极难考取，需要在常规教师资格之外额外攻读整整三年的营养学专业。在制度与文化上，日本学校构建了一套严密而科学的饮食体系： - **严格禁止超加工食品**：学校食堂所有餐食必须在当天清晨从天然原材料开始从头制作（cooked from scratch），彻底杜绝任何深加工食品。 - **禁止外带便当**：所有学生一律在校统一食用新鲜现做的午餐，确保营养摄入的公平与均衡。 - **“腹八分分”（Hara Hachi Bu）文化**：深入骨髓的文化规范教育孩子们只吃到八分饱。因为大脑接收饱腹感信号存在延迟，如果吃到感觉完全饱了，实际上就已经过量。 - **多小碟分餐与交替进食法**：标准午餐通常包含五种不同小碟（如味汁汤、新鲜鱼肉、刺身、配菜等），食物种类丰富极大地促进了肠道微生物健康。不同于西方“吃完一块千层面再吃胡萝卜”的单一进食方式，日本学生被教导轮流各吃一口，这种进食节律大幅减缓了整体用餐速度。 - **具象化的营养启蒙**：营养师会在讲台上用彩绳道具进行直观教学（例如红绳代表钙质、强健骨骼；其他颜色代表碳水化合物提供能量），最后将所有彩绳系在一起，向孩子们生动展示一餐如何达成营养均衡。 Hari 惊叹地表示，在那所容纳了上千名学生的学校里走了一整天，竟然找不到一个肥胖的儿童。这直观展示了通过制度化的健康食物供给与系统的生活教育，现代社会完全能够从源头阻断肥胖危机的蔓延。 ### [01:03:35](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3815s) 日本的饮食教育与西方司美格鲁肽狂热的鲜明反差谈到如何重塑人与食物的关系，约翰·哈里（Johann Hari）分享了他在日本实地考察时的震撼经历。日本的儿童肥胖率极低，哈里在与当地小学生交流时询问他们最喜欢的食物，第一个孩子回答是“西兰花”，第二个说是“海苔”，第三个则说是“白米饭”。哈里一度怀疑这些孩子是在联合翻译故意捉弄他，但身旁的翻译却一脸困惑地反问：“我们从小就教育孩子喜欢吃健康食品，难道你们不这样吗？”为了证明这种文化差异，哈里拿出手机给孩子们看典型的英国学校午餐照片，结果孩子们当场尖叫起来，那种惊恐的反应“简直就像看到了极端组织的斩首视频”。他们难以置信地质问哈里：“你以前每天都吃这种东西？里面的沙拉在哪里？”这种从极幼年起就刻意构建的健康饮食文化，构成了日本对抗肥胖的第一道防线。对比之下，西方社会却陷入了依赖司美格鲁肽（Ozempic）注射笔的狂热之中。主持人史蒂文·巴特利特（Steven Bartlett）在现场好奇地拿起哈里随身携带的注射笔端详。哈里指出，研发该药的丹麦制药巨头诺和诺德（Novo Nordisk）已一跃成为全欧洲市值最高的公司，甚至凭借这款药物的爆炸式普及直接拉动了整个丹麦的宏观经济增长。与此同时，美国制药巨头礼来（Eli Lilly）也在该赛道全力角逐，预计到本十年末，全球减重药物的市场规模将达到惊人的2000亿美元。 ### [01:05:51](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3951s) 获取渠道的失控与进食障碍群体的致命风险针对普通人获取此类处方药的门槛，哈里表达了极度深刻的忧虑。尽管正规医疗标准要求使用者的身体质量指数（BMI）必须超过27且属于脂肪超标，但现实中监管漏洞百出。在如今的线上远程问诊中，任何人都可以轻易在Zoom屏幕前对医生谎报BMI体重数据，两天后药品就会直接邮寄到家；即便远程问诊偶遇阻碍，网上泛滥的非正规甚至伪劣仿制药也能轻而易举买到。哈里认为，这种获取的便利性正在酿成巨大的公共卫生隐患，其中最令他恐惧的便是“进食障碍”（Eating Disorders）的恶化。自疫情暴发以来，年轻女性中绝食厌食的倾向本就急剧上升，而司美格鲁肽堪称人类有史以来发明的“最高效的自我饥饿工具”。许多进食障碍治疗专家对此深感恐惧。全美顶尖进食障碍专家金伯利·丹尼斯医生（Dr. Kimberly Dennis）向哈里呼吁，必须对该药实施最严格的线下物理监管：药物绝不能在网上随意开具，必须由线下执业医师当面评估并开具处方，且该医生必须接受过专业的进食障碍识别与转诊培训，以防止广大年轻女孩将其滥用为自残式的节食凶器。 ### [01:07:43](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4063s) GLP-1的偶然发现史与心血管健康的意外红利司美格鲁肽的前身研究最初并非为了减肥，而是源自对糖尿病生理机制的探索。1984年，科学家丹尼尔·德鲁克（Daniel Drucker）在研究胰腺内的胰高血糖素基因（Glucagon Gene）长链时，尝试切下链条末端的GLP-1（胰高血糖素样肽-1）分子，并在麻省总医院的培养皿实验中意外发现，该分子与胰岛素结合能显著刺激胰岛素的分泌。随后，斯韦特兰娜·莫伊索夫教授（Svetlana Mojsov）在大鼠身上证实了这一特性，哥本哈根的研究团队也在猪的胰腺中验证了其促进胰岛素生成的效果。后来，位于伦敦的哈默史密斯医院（Hammersmith Hospital）在进行人体注射试验时，才进一步偶然揭开了它能强效抑制食欲的面纱。 ```mermaid flowchart TD accTitle: GLP-1药物机理与演进历程 accDescr: 展现从1984年GLP-1基因片段发现，到实验室胰岛素刺激，再到食欲抑制与心血管保护的多重演进 subgraph Discovery ["分子发现与机制验证"] A["1984年 Daniel Drucker 从胰高血糖素基因分离 GLP-1"] --> B["实验室培养皿研究 证实可协同刺激胰岛素生成"] B --> C["Svetlana Mojsov (大鼠实验) 及哥本哈根团队 (猪胰腺实验)"] end subgraph Applications ["双重医疗功效突破"] C --> D["糖尿病治疗应用 有效调节血糖水平"] D --> E["伦敦 Hammersmith 医院研究 偶然发现人体食欲大幅受抑"] end subgraph ClinicalBenefits ["长期健康红利"] E --> F["肥胖干预与体重控制"] F --> G["心血管保护效应 BMI>27患者5年中心脏病与中风风险降20%"] end ``` 这种双重效应带来的医学价值不可估量。哈里坦言，尽管自己使用该药带有外貌焦虑的虚荣成分，但由于家族有心脏病病史，他极其看重该药的临床硬指标：长期追踪数据显示，BMI高于27的超重人群在服用该药5年内，突发心脏病或中风的风险可直降20%。民意调查显示，仅在美国就有多达47%的成年人明确表示渴望使用此类药物。 ### [01:10:43](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4243s) 潜在的严重安全警讯：让-吕克·法伊教授的研究当面对庞大的潜在使用人群时，该药物潜藏的健康风险同样不容忽视。尽管德鲁克等先驱科学家认为，糖尿病患者已经使用此类GLP-1受体激动剂长达18年，若有灾难性副作用理应早已显现，但针对非糖尿病肥胖群体的长期反应仍存在未知的认知空白。为了探寻更确凿的长期安全性真相，法国国家药品安全局（ANSM）委托蒙彼利埃大学附属医院的让-吕克·法伊教授（Professor Jean-Luc Faillie）展开专项流行病学审查。法国拥有全球最为详尽完善的公共卫生数据库之一。法伊教授团队锁定了在2006年至2015年间连续服用此类药物至少3年的海量糖尿病患者，并设立了一个各项体征严格匹配但从未服用过该药的对照组，以深挖隐藏在长期用药背后的潜在致命风险。 ### [01:12:12](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4332s) 甲状腺癌风险与“奥秘之脸” Johann Hari 详细讨论了司美格鲁肽（Semaglutide）等药物所带来的深层健康风险。早期动物实验表明，大鼠在摄入此类药物后患甲状腺癌的概率显著升高。基于此，研究人员对人群数据进行了针对性追踪，结果令人警惕：服用该药物的人群，甲状腺癌风险增加了 50% 到 75%。Hari 强调，这一数据并不意味着“50% 到 75% 的服药者会得甲状腺癌”——若真如此，药物早已被紧急下架。真实的含义是：在个体原本既有的终生甲状腺癌发病基准上，风险相对上升了 50% 至 75%。虽然目前欧洲药品管理局（EMA）尚未完全认可这组关联性结论，科学界内部也存在争议，但考虑到全人群原本有 1.2% 的终生患癌概率（其中生存率约为 84%），当全球有数以千万计的人群长期使用该药时，这一增幅所对应的绝对病例数将非常惊人。随后，主持人询问起外界热议的“Ozempic 脸”（Ozempic Face）。Hari 风趣地表示自己对此完全不担心，因为他的脸天生极度圆润，“婴儿总是对着我笑，大概以为我是他们的国王，像一个莫名其妙学会了到处乱走的巨型婴儿”，即便面部大幅减脂也不会显得干瘪。但他承认，对许多普通人而言，体重在短时间内骤降会导致面部软组织与脂肪迅速流失，呈现出憔悴、眼窝凹陷、皮包骨的病容。虽然“Ozempic 脸”纯属外观与虚荣心范畴的问题，并不造成生理健康危害，但人们不愿让自己看起来像生了重病一样消瘦，这种担忧完全可以理解。 --- ### [01:14:02](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4442s) 胰腺炎的剧痛与真实案例比起外貌变化，胰腺炎（Pancreatitis）是更为凶险且极度痛苦的副作用。Hari 分享了北卡罗来纳州默特尔比奇（Myrtle Beach）一名叫 Michelle Stancil 的女性的惨痛经历。Michelle 开始用药时，医生曾随口提及罕见的胰腺炎风险，她当时还开玩笑自嘲“以我的运气搞不好真会碰上”。用药六周后，减重效果令人欣喜，然而当她前往匹兹堡探望女儿时，清晨突然从剧痛中醒来。从乳房下方一直穿透到后背的撕裂性绞痛让她瞬间崩溃，伴随剧烈的呕吐与失禁，痛到撕心裂肺地尖叫。她的女婿紧急呼叫救护车时，一度以为她快要痛死了。送达急诊室后，医生发现她的胰腺严重紊乱。医护人员的第一句问话是：“你平时酗酒吗？”在得到否定的答复后，医生的第二个问题便是：“你在打 Ozempic 吗？”这个迅速的联想揭示了临床医生对该药并发症的警觉。不列颠哥伦比亚大学（University of British Columbia）的一项研究显示，使用 Ozempic 会将急性胰腺炎的患病风险直接推高至原来的 9 倍。尽管乘以 9 之后在绝对概率上仍属罕见，但其临床痛苦程度极其可怕——医学上常将胰腺炎比作“腹部被刺刀反复捅入”，而 Michelle 直言这比分娩还要痛苦数倍，最终医院不得不为她注射强效镇痛剂芬太尼（Fentanyl）才得以勉强缓解。 --- ### [01:15:41](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4541s) 肠道激素军备竞赛：从 Ozempic、Mounjaro 到“三靶点”新药关于药物名称的发音，现场发生了一段有趣的插曲。主持人将 semaglutide 念成直觉式的发音，Hari 笑称自己以前也是这么念的，直到被科学家们反复纠正。Semaglutide（司美格鲁肽）是活性分子化学名，而 Ozempic 和 Wegovy 则是同一种药物针对不同适应症的商品名：两药由同一家工厂生产、成分完全一致，只是 Ozempic 获批用于 2 型糖尿病，而 Wegovy 被核准用于肥胖症，且在部分国家被允许采用更高剂量。 ```mermaid flowchart TD accTitle: GLP-1 减重药物发展代际演进 accDescr: 展示从单靶点 GLP-1 到双靶点、三靶点药物的减重效果对比与机制差异。 subgraph Gen1["第一代：单靶点（GLP-1）"] A["司美格鲁肽 Semaglutide (Ozempic / Wegovy)"] A --> A_Eff["作用于单一肠道激素 GLP-1 年均减重：~15%"] end subgraph Gen2["第二代：双靶点（GLP-1 + GIP）"] B["替尔泊肽 Tirzepatide (Mounjaro / Zepbound)"] B --> B_Eff["协同激活 GLP-1 与 GIP 年均减重：~21%"] end subgraph Gen3["第三代：三靶点（GLP-1 + GIP + Glucagon）"] C["三靶点新药 (Retatrutide / Triple G)"] C --> C_Eff["同时调控三种肠道代谢激素 年均减重：~24.2%"] end Gen1 --> Gen2 Gen2 --> Gen3 ``` Hari 指出，科学界正迎来减重药物的爆发期，目前的司美格鲁肽仅仅是个开端： - **第一代（单靶点）**：Ozempic / Wegovy 仅模拟 GLP-1 一种肠道激素，年均平均减重约 15%。 - **第二代（双靶点）**：礼来公司（Eli Lilly）推出的 Mounjaro（替尔泊肽 Tirzepatide）在 GLP-1 的基础上引入了 GIP 激素，双管齐下，平均减重达 21%。 - **第三代（三靶点）**：即将问世的“Triple G”（如 Retatrutide），同时调动三种肠道激素，临床数据显示平均减重可达 24.2%。南非前沿学者 Carel le Roux 将这比作婴儿学步：“婴儿在地上爬行了很久很久，随后突然站立并行走——我们当前正处于这一跨越时刻。”遗传学家 Tim Spector 和临床学者 Robert Kushner 甚至赞叹这犹如“找到了控制体重的圣杯”、“终于砸开了掌控体重的肠道激素藏宝箱”。人体内已知有大约 37 种肠道激素与食欲调节相关，未来将涌现出更多机制不同、副作用特征各异的药物。与历史上那些带来严重心脑血管致命反噬的旧时代减肥药相比，科学家普遍确信，这批基于肠道内分泌调控的新药开辟了完全不同的时代。 --- ### [01:18:08](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4688s) 骨骼肌流失：隐秘的老龄化定时炸弹与心理隐患随着药物普及，一个更为隐秘但广泛存在的副作用正在显现——瘦体重（Lean Muscle Mass）的大幅流失。主持人提及自己的一位生物科技亿万富翁朋友：此人一直狂热地尝试各种最前沿手段来“优化生命机能”，近期也开始注射 Ozempic。虽然他在短时间内变得极度精瘦，但两人在健身房一起锻炼时，主持人震惊地发现对方的体能和绝对力量出现了断崖式下滑。 Hari 指出，肌肉量流失是其新书《Magic Pill》重点剖析的 12 项重大风险之一。人体从 30 岁起肌肉量就会自然衰退，而任何快速大幅的体重缩水都无法避免肌肉的消耗。在部分人群中，使用 Ozempic 所减掉的体重中有多达 20% 至 30% 是瘦肌肉组织： - **老龄肌少症风险**：对于原本就不算肥胖、仅为了追求极致骨感而滥用药物的群体，大量流失核心肌肉群将提前埋下“肌少症”（Sarcopenia，希腊语意为‘肉体的贫困’）的隐患。迈入老年后，缺乏肌肉支撑会导致难以爬楼梯、平衡能力恶化、跌倒率飙升，而在高龄群体中跌倒往往直接引发高致死率。 - **个体差异与自嘲**：Hari 坦言自己的体脂率虽然从 33% 降到了 22%，且几乎减掉的全是纯脂肪，但他打趣道这或许仅仅是因为自己“底子太差，一开始身上本来就没什么肌肉可以流失”。在梳理完甲状腺癌、急性胰腺炎和肌肉流失等生理威胁后，对话随即转向更为敏感的心理与神经精神层面——关于使用 GLP-1 药物后个别患者出现自杀意念（Suicidality）和重度抑郁倾向的警示案例。 ### [01:20:43](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4843s) 减重药引发自杀意念与抑郁的争议关于 GLP-1 药物（如 Ozempic）是否会增加焦虑、抑郁甚至自杀倾向，目前学界存在激烈争议。一种观点认为，在任何庞大人群中，本身就有一定比例的人会出现心理危机甚至自杀倾向，而部分人恰好在服用该药，早期阶段很难厘清其中的因果关系，因此有科学家坚称目前并无实证。但在担忧其自杀风险的科学家群体内部，解释机制主要分为心理层面的落差与神经生理层面的改变。心理层面的一种常见诱因是剥夺了食物带来的抚慰或快乐。肥胖医学专家 Carel le Roux 博士向 Johann Hari 阐述了另一种残酷的心理机制：很多长期受肥胖困扰的人总有一种认知——“我的人生之所以一团糟，全是因为我太胖了；只要瘦下来，一切都会变好”。然而当他们真的成功减重后，却发现讨厌的丈夫依旧惹人厌，讨厌的工作依然令人窒息。这种巨大的“反高潮（anticlimax）”会引发剧烈的心理危机，人们突然意识到阻碍人生的根本不是体重，而是现实生活本身。正如常言所说，幸福感取决于现实与期望的差距；一旦过高的期望破灭，随之而来的心理痛苦是极其猛烈的。在神经生理层面，另一派学者则指向大脑奖赏系统的受损。包括成瘾神经科学前沿专家 Patricia Grigson 教授在内的研究人员指出，药物抑制大脑多巴胺奖励机制的机制，很可能会顺带削弱个体感知快感与生活动力的能力。虽然目前尚无定论，但 Johann Hari 坦言，这种“数百万人在不知不觉中充当小白鼠”的未知状态令人深感不安。 ```mermaid flowchart TD accTitle: GLP-1 药物与心理健康问题的潜在诱因分析 accDescr: 图表展示了可能导致服药者出现焦虑、抑郁及自杀意念的三条主要假说路径。 subgraph Psychological ["心理机制 (Psychological Paths)"] A["剥夺进食快感"] --> D["情绪失控与心理危机"] B["期望落差 (Anticlimax) '瘦下来生活依旧一团糟'"] --> D end subgraph Biological ["生理机制 (Biological Paths)"] C["奖赏系统钝化 (Dampening Reward System)"] --> E["多巴胺抑制与快感缺失"] end D --> F["焦虑、抑郁与自杀意念"] E --> F ``` --- ### [01:22:49](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=4969s) 减肥药的黑暗血泪史：从一战炸药到绝望的下颌绑扎回顾现代减肥药的历史，Johann Hari 直言其“可怕到超乎想象（grim beyond belief）”，每一次人们都狂热涌入，随后又在灾难中仓皇逃离。第一款现代减肥药诞生于第一次世界大战：法国弹药工厂的工人因为在生产中通过皮肤和呼吸吸入二硝基苯酚（DNP，一种烈性黄色炸药粉末），体重出现暴跌。一战结束后，斯坦福大学的科学家将其改造成减肥药“Redusols”，在 1934 年风靡全美，服用人数多达 10 万人——在当时肥胖率极低的背景下，这是个天文数字。随后可怕的毒性爆发：大量服用者失明，患上严重白内障，随后身体陷入致命高烧，如同被“从身体内部活活烤熟”，最终该药物被紧急下架，日后仅被用作毒性极强的杀虫剂。紧随其后的是二战催生的苯丙胺（Amphetamines，安非他命）狂潮。二战期间为了让枯燥注视雷达屏幕的雷达兵保持清醒敏锐，军方配发了苯丙胺，士兵随之暴瘦。战后制药公司将其包装成减肥灵药推向大众，甚至被称为“母亲的小帮手（Mother's Little Helper）”。到了 1970 年，全美整整 8% 的处方都是用于减肥的苯丙胺。然而，人体对苯丙胺极易耐受，患者需要越来越大的剂量来维持抑食效果，而超高剂量的苯丙胺会直接摧毁精神健康，导致严重的失眠、狂躁甚至精神分裂发作，最终招致监管的全面收紧。为了抑制食欲，医学界甚至一度采取过匪夷所思的极端酷刑——“下颌缝合固定术（Jaw wiring）”。医生用钢丝将肥胖病人的上下颌死死绑在一起，使其物理上无法摄入任何固体食物。但致命隐患随之而来：一旦绑住下颌的病人在日常中发生呕吐，呕吐物无法排出，便会直接窒息身亡。 --- ### [01:25:28](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5128s) 芬-芬（Fen-Phen）危机与无法预料的“未知的未知” 20 世纪 90 年代初，医药界迎来了新型 GLP-1 出现前最畅销也是最具灾难性的减肥神药——“芬-芬（Fen-Phen）”。科学家将两种老药结合：氟苯丙胺（Fenfluramine，抑食效果好但会导致严重嗜睡）与芬特明（Phentermine，一种能抵消嗜睡的中枢神经兴奋剂）。该组合效果极其惊人，减重幅度堪比今天的 Ozempic，瞬间登上《时代周刊》封面，被奉为“全新医学奇迹”，年处方量一度高达 1800 万张。直到北达科他州法戈市的普通基层医生率先拉响安全警报，公众才惊觉药企长期隐瞒的致死风险：芬-芬会导致致命的原发性肺动脉高压（肺血管剧烈收缩导致窒息）及不可逆的心脏瓣膜损伤。典型受害者包括马萨诸塞州年仅 28 岁的年轻女性 Mary Linnen。为了在婚礼上穿上漂亮婚纱，她开始服用芬-芬，仅数周后便在上坡时出现严重气喘。确诊肺动脉高压后，虽然立即停药，但肺部损伤已不可逆，她余生离不开吸氧机并被剥夺生育能力，最终不幸窒息离世。该丑闻引发了当时制药史上最大的赔偿案，药企被迫支付了高达 120 亿美元的巨额赔偿。Hari 强调，虽然 Ozempic 的临床研究规模远非当年仅基于 120 人单一试验就草率上市的芬-芬可比，但历史教训不容忽视。佛罗里达州立大学研究该药物的科学家 Greg Stanwood 指出，Ozempic 这类药物眼下面临的最大隐忧是“未知的未知（unknown unknowns）”——借用前美国国防部长唐纳德·拉姆斯菲尔德（Donald Rumsfeld）的名言，有些风险我们甚至不知道自己不知道。 - **孕妇与胚胎毒性未知**：目前针对孕妇长期服用 GLP-1 的影响知之甚少；而在非人哺乳动物实验中，胚胎暴露于该药会显著提升先天出生畸形的概率。 - **不可逆的远期神经隐患**：Stanwood 教授警示，正如 1950 年代抗精神病药最初被视作安全灵药，许多深层病理可能需要数年乃至数十年的人体普遍暴露后才会浮出水面。 ### [01:29:02](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5342s) “未知的未知”：脑部影响与肥胖本身的长期危害许多药物在临床应用数十年后，才会被人们揭开其隐藏极深的远期风险。典型的例子就是抗精神病药物：患者在使用了数十年、步入七八十岁后，研究才发现长期服用此类药物的人群患阿尔茨海默病及其他痴呆症的概率大幅上升。这种在用药之初根本无法预见的“未知的未知”（unknown unknowns），正是当下对于 Ozempic 等新型减肥药最深层的忧虑所在。这些药物深度干预大脑中负责记忆处理、味觉感知以及肠道蠕动的关键区域，我们目前尚无法获知其几十后的远期后果。杜兰大学医学院（Tulane University School of Medicine）的沙欣·阿拉维博士（Dr. Shauna Levy）向 Johann Hari 指出：“我们虽然不知道这些药物的长期风险，但我们确实清楚肥胖的长期危害，而那些危害是极其可怕的。”人们对肥胖并发症的认识往往停留于表面，例如很多人误以为糖尿病只要注射胰岛素就能像常人一样生活。但现实极为残酷：如果青少年时期就患有肥胖症，一生中罹患糖尿病的概率高达 70%；一旦确诊糖尿病，平均预期寿命会被削减整整 15 年。 - **远期神经系统未知风险**：GLP-1 类药物深度参与大脑记忆、味觉和胃肠动力调控，可能存在类似抗精神病药物数十年后显现的迟发性神经系统风险。 - **糖尿病的致命代价**：平均缩短 15 年寿命，且是英国第一大致盲原因。 - **全美截肢主因**：美国每年因糖尿病并发症导致的截肢人数，甚至超过了因枪击受伤而截肢的人数。 - **医生的惊人抉择**：Johann 的好友麦克斯·彭伯顿医生（Dr. Max Pemberton）直言，若在糖尿病与 HIV 阳性之间选择，他会毫不犹豫选择 HIV，因为现代医学已能让接受治疗的 HIV 患者享有与常人无异的寿命，而糖尿病则会带来毁灭性的全身多器官衰竭。 ### [01:31:24](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5484s) 艰难的权衡：两害相权取其轻在罗列所有与肥胖相关的健康危害时，糖尿病甚至还排不到榜首。正因如此，每次谈及这类药物的副作用，Johann 都会强调必须仔细筛查个人与家族病史：如果家族中有甲状腺癌病史，或本身肌肉量严重不足，绝不建议使用。然而，对许多肥胖患者而言，真实的现实往往并非“用药 vs 完美健康”，而是在“持续肥胖的巨大确定风险”与“新型药物的未知风险”之间做抉择。面对家族中多位男性长辈过早死于心脏病的历史，Johann 在通盘评估医学证据后，选择承担 Ozempic 的潜在风险以摆脱肥胖。不过他也坦承，如同当年名噪一时却因心血管毒性最终被勒令下市的减肥药“芬-芬”（Fen-Phen）一样，未来完全有可能爆出某种意料之外的严重灾难；其他人读完他的新书《神奇药丸》（Magic Pill）后得出“坚决不吃”的相反结论，也完全合情合理。 ```mermaid flowchart TD accTitle: 持续肥胖与减肥药物的风险权衡决策 accDescr: 对比持续肥胖导致的确定性致死病症与使用 Ozempic 面对的潜在副作用，最终形成两害相权取其轻的个人抉择。 subgraph ObesityRisks["持续肥胖的确定性危害"] A1["心血管疾病 / 心脏病早逝"] A2["2型糖尿病 (预期寿命-15年)"] A3["截肢、失明及全身并发症"] end subgraph DrugRisks["Ozempic 的潜在风险"] B1["已知的副作用 (肌肉流失 / 甲状腺肿瘤风险)"] B2["心理问题 (成瘾转移)"] B3["未知的未知 (大脑长期改变 / 类似芬-芬结局)"] end Decision["个体评估与权衡 （家族病史、肥胖严重度）"] ObesityRisks --> Decision DrugRisks --> Decision Decision --> Choice["个人抉择：承担药物风险换取摆脱肥胖 （或反之选择拒绝用药）"] ``` ### [01:32:26](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5546s) 物理守恒与“天下没有免费的午餐” 主持人 Steven Bartlett 对此表达了不同立场的审慎态度。在长年访谈大量健身、心理学与精神病学专家的过程中，他形成了一种强烈的直觉信念：“天下没有免费的午餐，生命本质上就是一种权衡。”如同能量守恒定律中能量无法被消灭、只能被转移一样，医学上的“灵丹妙药”或捷径，往往只是把现有的问题打包转移到了另一个不可见的地方——正如前文所讨论的心理依恋被转移到新的恶习上。 Steven 提到身边有朋友服用莫达非尼（Modafinil）等所谓的“聪明药/无极限药片”（Limitless pill），宣称不仅效率翻倍而且“没有任何副作用和代价”。历史一再证明，只要时间拉得足够长，代价必然会浮出水面。当面对 Ozempic 这种被吹嘘为毫无缺点的神药时，由于无法在当下精确量化远期的代价，Steven 反而感到更加警惕。 ### [01:34:43](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5683s) 终生用药困境与《神奇药丸》的社会涟漪并非所有长期用药都利弊难辨。Johann 以全美乃至全英处方量名列前茅的他汀类药物（Statins）为例指出，这类药物通过抑制体内胆固醇生成来预防心血管疾病，绝大多数医生一致认为其降脂收益极为确凿，远超其潜在副作用。然而 Ozempic 面临着一个极其棘手的现实：一旦停药，患者往往在一年内就会反弹并恢复约 70% 减去的体重。这意味着使用者很可能必须终生用药，而其长期安全边界远不如他汀类药物清晰。在《神奇药丸》付印前，出版团队两极分化的反馈生动体现了该议题的复杂性：一部分人读完后迫不及待想要注射 Ozempic，另一部分人则深信只有疯子才会去碰这种药。这种宛如“当年那条蓝黑/白金连衣裙”般的认知割裂，恰恰证明了书中呈现事实的客观与冲突感。 GLP-1 药物的崛起不仅是个人健康的十字路口，更正在重塑整个社会经济生态。巴克莱银行（Barclays）的资深分析师艾米丽·菲尔德（Emily Field）将这一变革直接类比为“智能手机的发明”。这种波及效应已经开始在华尔街显现： - **食品工业承压**：Krispy Kreme 甜甜圈股价下挫；雀巢（Nestlé）首席执行官马克·施奈德（Mark Schneider）公开对旗下的冰淇淋与糖果业务线表达忧虑。 - **航空燃油节约**：杰富瑞金融集团（Jefferies）为美国主要航空公司出具的研究报告预测，随着全美搭乘人群的体重大幅减轻，航班消耗的航空燃油费用将显著降低。 - **医疗器械重创**：生产膝关节与髋关节置换铰链配件的医疗器械公司股价大跌，因为大量关节置换手术是由长期肥胖压迫引起的，体重的广泛下降将直接缩减关节置换手术需求。 - **时代巨变前夜**：如同 2007 年史蒂夫·乔布斯（Steve Jobs）首次揭开 iPhone 序幕时世人无法预见移动互联网的滔天巨浪一样，当下人类对于减重新药将要引发的全球连锁反应，恐怕连十分之一都尚未参透。 ### [01:37:37](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5857s) 变革前夕：剑桥咖啡馆的顿悟与社会分化隐忧在世界各地奔波采访顶尖专家的过程中，约翰·哈里（Johann Hari）经历过一个极具冲击力、甚至有些超现实的时刻。当时他正坐在一家咖啡馆里，采访一位研究该领域的剑桥大学核心神经科学家。透过窗户，他看着街上熙熙攘攘走过的英国普通路人，其中许多人正如他过去一样超重或肥胖。哈里心中突然涌起一阵强烈的战栗：“天哪，你们根本不知道即将降临在我们所有人头上的是什么。”他深切地意识到，无论结果是好是坏，这批减重药物必将彻底改变每一个人的生活轨迹。 ```mermaid flowchart TD accTitle: 减重药物普及的两种未来图景 accDescr: 对比减重药物普及过程中的阶层极化与全民日常化两种未来演变路径。 subgraph Dystopia1 ["反乌托邦场景一：阶层极化"] A["高昂价格与注射门槛"] --> B["极少数富人维持纤瘦"] A --> C["普通大众与儿童深陷肥胖及糖尿病"] end subgraph Transition ["技术与专利拐点 (2032年)"] D["口服药片研发成功 消除注射心理抗拒"] E["专利到期与仿制普及 生产成本仅约$40/月"] end subgraph Dystopia2 ["反乌托邦场景二：全民服药"] F["廉价且无痛的日常药丸"] --> G["超半数人口长期依赖药物"] G --> H["未服药者在致肥环境中沦为弱势群体"] end Dystopia1 --> Transition --> Dystopia2 ``` 基于这一时代变局，史蒂芬·巴特利特（Steven Bartlett）指出，现代人正变得越来越久坐不动，整个西方世界的肥胖率持续攀升，而司美格鲁肽（Semaglutide）等药物的兴起让人们得以走捷径抑制食欲、维持纤瘦。巴特利特预测，随着下一代药物从注射剂迭代为口服药片，大众的心理抗拒将彻底消除——许多人晕针或害怕自行注射，但一旦变成廉价便利的药丸，使用门槛便不复存在。在一个被超加工食品充斥的致肥环境中，社会可能急剧分裂为两个阵营：50%的人顺应趋势每天服药并保持苗条，另外50%的人则继续在恶劣的食品环境中苦苦挣扎，甚至在某种程度上被视为“低人一等”。哈里对此分析称，目前我们正面临两种可能演变的反乌托邦景象： - **第一种反乌托邦：富人专属的极化社会**。这正是眼下的现实写照——“新泽西真正的贵妇们”花重金用药变得极其纤瘦，而“新泽西真正的公立学童”却在12岁就早早患上2型糖尿病。 - **2032年专利拐点与生产成本**：诺和诺德（Novo Nordisk）的专利将于2032年到期。虽然药厂以研发风险高昂为由攫取巨额暴利，但该药实际的生产成本仅为每月40美元左右。届时仿制药口服片剂的月费降至数十美元，第二种“全民服药”的场景极可能全面成真。 ### [01:42:47](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6167s) 致肥环境下的被动沉沦与食品工业的原罪面对全民依赖药物的未来，哈里表达了深层的忧虑与期盼：最理想的结局是药物不发生灾难性的长期副作用，需要的人能得到救治，更重要的是，这场危机能够成为一记警钟，唤醒整个社会去追问：“我们究竟是如何落到这一步的？怎么会沦落到考虑让孩子们终身服药、却完全不清楚长期后果的地步？到底是谁把我们害成这样的？” 现实情况却令人沮丧。年轻一代正承受着前所未有的心理与生理危机：TikTok 上的年轻女孩焦虑指数与自杀倾向激增，男性也正经历着前所未有且极少被公开谈论的身体畸形恐惧症（Body Dysmorphia）。对于大量稍微有点腹部脂肪的普通人来说，去健身房锻炼既辛苦又反人性，面对炸鸡与汉堡的致命诱惑，他们很容易寄希望于“既能吃炸鸡又能保持苗条”的药物神话。哈里以自身经历纠正了这一幻想——曾经自封为“肯德基之王”的他坦言，服药后你甚至连尝两三口的食欲都会消失殆尽，你对垃圾食品的渴求会随着时间推移自然减退，但这依然没有解决根本机制问题。哈里愤怒地指出，这场迫使全社会考虑给孩子进行大规模药物治疗的公共卫生困局，本就不该发生： - **食品工业的系统性操纵**：大众之所以普遍发胖，根源在于食品工业无节制地向食物链注入超加工成分，而政府部门长期缺乏严厉监管。 - **儿童用药潮的蔓延**：在美国，部分因孩子严重肥胖而束手无策的父母，已经开始给未成年人注射 Ozempic。 ### [01:44:41](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6281s) 他山之石：制度干预与食品重组的破局之道要扭转这一溃败局面，核心出路在于政府对食物供应体系的强力干预。哈里在为新书做调研期间，走访了全球多个成功通过制度改革逆转肥胖与慢性病趋势的国家和城市： | 地区/国家 | 干预举措 | 取得的实际成效与经验 | |:--- |:--- |:--- | | **墨西哥** (Mexico) | 推行含糖饮料税（Sugar Tax） | 显著降低了全国人口对精制糖分的整体摄入量。 | | **美国明尼阿波利斯** (Minneapolis) | 将健康食材纳入处方系统 | 由医疗体系为无力负担优质食材的贫困群体开具健康食品，取得良好反响。 | | **芬兰** (Finland) | 开展全国性的食物供应链大改造 | 从宏观源头上整体优化食品供应质量，大幅降低国民心血管风险。 | | **英国** (UK) | 面包降盐“食品配方重组”（Reformulation） | 格雷厄姆·麦格雷戈教授（Prof. Graham MacGregor）推动政府向食品巨头施压，在消费者毫无察觉的情况下大幅下调面包盐分，每年直接为英国减少了 6,000 至 9,000 例中风发作。 | 哈里强调，食品重组完全可以在不牺牲口感、不让大众感到痛苦的前提下推行。然而，某些国家的极端做法也引发了争议。例如在肥胖率本就极低的日本，2008年由于肥胖数据出现极其微弱的抬头，政府便陷入恐慌并出台了针对代谢综合征的严苛法规——《大都会法》（Metabo Law，メタボ法），强制要求企业和地方政府对成年人进行腰围测量并设定超标惩罚，这种激进的管控手段则是西方社会难以直接复制的。 ### [01:46:04](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6364s) 日本的企业减重法则与冲绳的长寿奇迹约翰·哈里（Johann Hari）谈到了极度肥胖所带来的糖尿病等严重并发症，并介绍了日本在国家层面上推行的制度。在日本有一项法律规定，全国每家企业在每年的固定日期，必须为每位员工称量体重。如果员工的体重上升，就必须与雇主共同制定减重计划；若整家公司的平均体重上升，公司甚至会被政府处以巨额罚款。为了亲眼见证这种模式如何运作，哈里探访了严格执行该规定的知名健康器材与测量企业百利达（Tanita）。那里的职场生态让哈里大开眼界，甚至感到有些匪夷所思：员工早晨步入办公室，对着视频屏幕刷脸，系统就会播报“嗨，斯蒂芬，你昨天走了 14,000 步，步数在全公司排名第 121 位”；每个人都佩戴着类似 Fitbit 的计步穿戴设备，每顿饭吃什么都必须拍照上传到公共系统；更夸张的是，当英国办公室里的人们还在喝着咖啡、嚼着甜甜圈时，日本员工却准时聚在一起集体跳早操。哈里忍不住对当地员工直言：“如果你们敢在英国搞这套，我们绝对会把整座办公室给一把火烧了！”然而日本员工却完全无法理解他的愤怒，困惑地反问：“为什么呀？” 这种巨大的文化鸿沟虽然无法直接照搬到西方，但日本在对抗肥胖方面的成就却揭示了解决该危机能带来的巨大回报——日本拥有全球首屈一指的预期寿命与健康寿命。哈里在撰写《神奇药丸》时，走访了位于日本冲绳南部、被誉为“世界最长寿之村”的大宜味村（Ogimi）。全村大约 2,000 多户人家中，有 190 户都住着 90 岁以上的老人。哈里在社区中心见到的第一位老人是 102 岁的福地松（Matsu Fukuchi）。她满脸布满慈祥舒展的皱纹，神采奕奕地解释自己不能久留，因为她还得回家照顾前几天修屋顶摔下来的儿子——哈里当场惊呼：“天哪，你儿子得多大年纪了？！”福地松老人满怀对生活的挚爱，前一天刚陪孙辈看了排球赛，当天独自步行来到活动中心。伴随着现场响起的传统音乐，她换上一袭鲜红的和服翩翩起舞，引得其他近百岁的老妇人也纷纷共舞。哈里与她牵手起舞时百感交集：这位老人出生时日本甚至还没有无线电广播，而此刻自己正用 iPhone 录下她的音容笑貌。 - 日本法律规定企业每年对全体雇员进行腰围与体重审查（即著名的“Metabo Law”代谢法则），若超标需专人干预，整体不达标的企业将面临政府罚款。 - 百利达等企业推行极其透明的健康监控：人脸识别考勤播报步数排行、每餐拍照上传打卡、晨间全员有氧操。 - 冲绳大宜味村的高龄人口极为密集，长者不仅长寿，更享有极高的“健康寿命”（Healthspan），远离失能与慢性病折磨。 - 现代环境对儿童的毒害触目惊心：当下认识麦当劳“M”形金拱门标志的 3 岁幼童人数，比知道自己姓氏的还要多。 --- ### [01:50:46](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6646s) 停药后的反弹风险、耐受性与代谢放缓看着主持人斯蒂芬·巴特利特（Steven Bartlett）手里摆弄着那支司美格鲁肽（Ozempic）注射笔，哈里打趣道，感觉两人像是置身于某个反乌托邦版本的电视购物频道（QVC）。当被问及如果停药是否还能维持目前的体重时，哈里坦诚地承认“恐怕不行”。临床试验数据表明，大约 70% 的人在停药后一年内体重就会迅速反弹。哈里认为虽然自己改变了生活习惯，可能不至于全盘打回原形，但若彻底停药，大部分体重必然卷土重来，这意味着可能必须终身注射。终身用药随即引出了关于“耐受性”（Tolerance）的激烈争议。历史上安非他命类减肥药大多会随着时间推移产生耐受，导致药效越来越低。针对 GLP-1 药物是否会出现同样问题，科学界目前莫衷一是：支持不会产生耐受的一方指出，糖尿病患者长期使用该药控制血糖，从未需要为了维持疗效而不断加大剂量；但另一派专家认为，人类对绝大多数药物都会产生适应与耐受，GLP-1 很难成为例外。南非著名肥胖症专家卡雷尔·勒鲁（Carel le Roux）向哈里指出，最贴切的参照或许是减重手术（Bariatric Surgery）：术后体重会呈断崖式下跌，随后几年略有回弹，最终在一个相对稳定的平台期维持下去。 ```mermaid flowchart TD accTitle: GLP-1 停药与代谢机制假设流程图 accDescr: 描述减重期间代谢率下降与停药后可能引发的体重剧烈反弹路径 subgraph Phase1["用药期 (Medication Phase)"] A["规律注射 GLP-1 药物"] --> B["食欲受到显著抑制"] B --> C["热量摄入剧烈下降"] C --> D["体重迅速减轻"] end subgraph Phase2["生理代偿与风险 (Metabolic Adaptation)"] D --> E["机体基础代谢率大幅放缓"] E -.-> F{"是否终身用药 / 耐受?"} end subgraph Phase3["停药结局 (Discontinuation)"] F -- 停止注射药物 --> G["食欲与肠道警报迅速复苏"] G --> H["进食量剧增且代谢维持低位"] H --> I["70% 使用者在一年内大幅反弹甚至更胖"] end ``` 此外，斯蒂芬提出了一项担忧：长期依赖外源性 GLP-1，身体自身合成该激素的能力是否会萎缩？哈里回应称，更大的实质风险在于代谢损伤。正如节食往往会迫使身体的基础代谢率骤降，导致许多人节食结束后反而比从前更胖；如果未来医学界突然发现司美格鲁肽存在严重未知的隐患而被迫下架召回，那些已经适应了药物且代谢机制严重变慢的人群，很有可能会面临更加失控的暴饮暴食与严重肥胖。 --- ### [01:53:12](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6792s) 进食障碍危机与历史悲剧的重演斯蒂芬结合《柳叶刀》（The Lancet）等权威医学期刊的统计数据指出，在西方世界尤其是年轻群体中，神经性厌食症和贪食症等进食障碍（Eating Disorders）正在大规模蔓延。自 2020 年 3 月疫情暴发及隔离封锁以来，13 至 16 岁少女的厌食和暴食发生率比预期高出 42%，17 至 19 岁人群的患病率也攀升了 32%。在社会对外貌和苗条极度焦虑的背景下，如果这类强效食欲抑制剂落入心智尚未健全或已有进食障碍倾向的青少年手中，后果不堪设想。哈里对此表示完全赞同，并指出这种担忧绝非杞人忧天，因为历史早已上演过惨痛的前车之鉴。20 世纪 90 年代初，安非他命类减肥药在美国风靡一时，大批青春期女孩争相滥用。当时时任众议员罗恩·怀登（Ron Wyden）主持召开了针对该现象的国会听证会，其中的听证记录至今读来仍令人毛骨悚然： - **芭蕾舞演员的绝食悲剧**：20 岁出头的芭蕾舞者杰西卡·麦克唐纳（Jessica McDonald）在听证会上作证，讲述在行业对体型的极致苛求下，她疯狂滥用安非他命减肥药来强行阻断饥饿，甚至常常服药直到整个人虚脱昏厥，只为维持毫无脂肪的芭蕾舞身材。 - **少女的身材畸形恐惧**：来自爱荷华州州中心镇（State Center）的托尼·史密斯（Tony Smith）痛陈，他的女儿诺埃尔（Noel）自幼便被时尚杂志上骨感模特的照片所绑架，陷入严重的“肥胖恐惧症”，反复哭着询问父亲：“爸爸，你觉得我很胖吗？为什么我不能长得像杂志上的女孩那样？” 这些历史档案清晰地表明，一旦一种能轻易阻断生理食欲的药物被商业化狂潮裹挟，并与社会对年轻女性严苛畸变的身材审判结合在一起，就会迅速演变成一场吞噬生命的公共健康灾难。 ### [01:55:06](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6906s) 进食障碍的致命风险与亲情带来的当头棒喝减肥药物与进食障碍（Eating Disorders）结合时所引发的灾难性后果并非凭空推测，而是有血淋淋的历史前例。Johann Hari 提到此前有人读过的一首令人心碎的诗：一位患有进食障碍的年轻女性拿到了这类减肥药，导致极端节食挨饿，最终因心脏病发作离世。她在诗中写道，自己明明极度饥饿、渴望进食，内心的声音却拼命压抑着“还不行，现在还不行”。这成了 Johann 最深切的几大担忧之一。尽管通过严格监管——例如规定只能由医生当面面诊开方——可以筛除一部分风险，但这依然无法彻底阻断隐患。除开极端的生理风险，更隐秘的心理冲击往往以意想不到的方式袭来。Johann 坦言，在撰写《神奇药丸》（*Magic Pill*）期间，最令他难受的并非早期的生理副作用，而是与自己侄女的一次视频通话。他的侄女 Erin 刚满十九岁，是家族里最小的女孩，也是他从小呵护备至的宝贝。在 Johann 注射 Ozempic 几个月后的一天，Erin 在利物浦的一家酒吧给他打来 FaceTime 视频，惊呼他瘦了非常多：“天哪 Johann，你瘦了好多！我都看到你的下颌线了，以前我都不知道你还有下颌线！” 就在 Johann 心里暗自得意受用时，侄女突然低下头，轻声问了一句：“你能帮我弄点 Ozempic 吗？” 这句话瞬间击碎了 Johann 的得意。Erin 一直拥有极其健康的正常体重，从小到大，Johann 倾注心血想传递给她的核心观念就是“不要以貌取人，不要被外表所评判”。然而仅仅因为自己戏剧性的减重展示，他多年来想要树立的健康价值观仿佛瞬间崩塌。虽然 Erin 最终打消了这个念头，但这一幕让 Johann 陷入了深深的自责与反思。 - 进食障碍患者使用食欲抑制类药物存在极高致死风险，极度营养不良可直接诱发致命的心脏骤停。 - 面对公众人物与亲友的急速消瘦，正常体重的年轻女性极易产生体相焦虑，萌生不必要的药物滥用冲动。 --- ### [01:57:21](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7041s) 好莱坞名人集体缩水与“减肥即作弊”的道德审判当今社会对身材的审美标准正经历剧烈剧变。在 Johann 童年时，电视上几乎看不到胖人，除非他们被当成取笑的丑角；而 Erin 这一代原本见证了公众视野中体型多样化的进步。然而在过去两年里，公众视野中稍微丰满的知名女性几乎全部离奇地“大幅缩水”。正如 Johann 讽刺的那样：“除非马里布（Malibu）突然暴发了某种痢疾，否则我们都很清楚发生了什么。” 主持人 Steven Bartlett 随即指出，好莱坞众多知名人士在极短时间内暴瘦，但在自传和采访中却清一色归功于“规律去健身房、吃健康餐、找到了好教练”。面对 Steven“他们是否在撒谎”的提问，Johann 毫不犹豫地回答：“显而易见，是的。”但这背后针对女性的苛刻舆论环境同样不可忽视。男性谈论减重往往能全身而退，而女性名人一旦公开使用减肥药物就会遭到口诛笔伐与群嘲——哪怕是国民级影响力的 Oprah Winfrey（奥普拉·温弗瑞）也难逃恶毒攻击。这种苛责折射出人类潜意识中深固的文化烙印： 1. **原罪与救赎模型**：公元 6 世纪教皇格里高利一世确立“七宗罪”时，“暴食”（Gluttony）就被具象化为肥胖如猪的形象。现代社会所推崇的减肥叙事本质上是天主教式的“犯罪—受难—救赎”闭环。大众乐于看到胖人在《超级减肥王》（*The Biggest Loser*）这类节目中承受极端的肉体折磨与羞辱，仿佛只有受尽酷刑，社会才会施舍一句“好吧，我们原谅你了”。 2. **作弊心理机制**：Ozempic 彻底打破了这种“受难救赎”逻辑。如果是心脏病人吃他汀类降脂药，没人会觉得他在作弊；但减重被赋予了强烈的道德色彩。无数人（绝大多数是女性）在生活中长期忍饥挨饿、压抑欲望以维持苗条，当她们看到别人每周只需轻松扎一针就能达到同样的效果时，产生的心态就像清白参赛的自行车手看到依靠违禁药物夺冠的兰斯·阿姆斯特朗（Lance Armstrong）一样，认定这是一种“投机取巧的背叛”。 ```mermaid flowchart TD accTitle: 传统减重道德审判与 Ozempic 模式对比 accDescr: 展示了传统社会所推崇的罪与受难救赎循环，与 Ozempic 无痛瘦身引发作弊指控的逻辑差异。 subgraph Traditional["传统道德化减重闭环"] A["暴食与肥胖 (被视为道德原罪)"] --> B["痛苦节食 / 严苛折磨 (肉体受难)"] B --> C["自我救赎成功 (获得社会道德原谅)"] end subgraph Modern["Ozempic 颠覆模式"] D["肥胖状态"] --> E["每周注射一次 GLP-1 药物"] E --> F["跳过受难直接变瘦"] F --> G["公众道德审判: 判定为『作弊』与虚伪"] end ``` --- ### [02:00:44](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7244s) 真正的罪魁祸首与被名人减重刺痛的群体创伤大众在社交媒体上如同“麻袋里的老鼠”互相撕咬撕扯，却忽视了肥胖危机的真正元凶。Johann 指出，真正犯下暴食原罪并从中作弊发财的既不是 Oprah，也不是普通肥胖者，而是用超加工食品彻底破坏人类代谢环境的现代食品工业。回顾 1975 年英国海滩的历史老照片，当时的人群普遍非常纤瘦。人类基因在几十年间不可能突变，整个社会的急剧膨胀完全由食品工业的环境剧变所驱动。公众对名人暴瘦的激烈反弹，还交织着更深层的心理防御机制。当 Adele（阿黛尔）在生日派对上晒出暴瘦后的自拍，或是 Rebel Wilson（瑞贝尔·威尔森）为了备孕听从医嘱大幅减重时，互联网上涌现的不是祝福，反而是排山倒海的愤怒与“被背叛感”。这种反常的仇恨源于弱势群体的心理寄托被撕裂： - **无处不在的日常羞辱**：数据显示，BMI 超过 35 的女性中，有整整 45% 在公共场合每天都会遭受当面的言语侮辱与歧视。她们被迫在充满敌意的世界中承受巨大的耻辱感。 - **拟社会人际关系（Parasocial Relationship）的坍塌**：在陷入自责与无力减重的绝境中，许多肥胖女性将 Adele 或 Rebel Wilson 视为同盟与精神图腾——“看，有她们在，我们胖女孩依然可以如此耀眼并被世界认可”。然而当这些精神代表也突然通过减重跨入瘦人阵营时，留在原地的群体便感到被无情抛弃，自身的创伤与无助被进一步残酷地放大。 ### [02:04:00](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7440s) 肥胖羞耻与减重背后的“背叛感” 谈到公众对名人减重往往表现出剧烈的愤怒（就像有人觉得 Adele 变瘦是对肥胖群体的“背叛”），Johann Hari 坦言，虽然那种“你个叛徒，去你的”式的攻击极不理智，但他完全能理解其背后的心理根源。在这个充斥着致胖诱惑的现代文化中，每个人从出生那一刻起就被系统性地推向超重，同时又被灌输了对肥胖无休止的羞耻感。任何重新掀开这层伤疤的事物——尤其是像 Ozempic 这样的新型减重药物——都会不可避免地把深藏在人们心底的愤怒、创伤与不安全感彻底翻扯出来。 Johann 承认，即使是自己作为用药者，在整个减重过程中也时刻被自我怀疑折磨，常常会在某些日子里叩问自己：“我这样做是不是大错特错？”他认为面对恶语相向的人，最省事的做法是直接指责他们的刻薄，但更有价值的姿态是看清那种攻击本质上源于深不可测的痛苦。那些因 Adele 变瘦而感到被背叛并怒骂的人，内心承受着本不该由他们承担的残酷创伤。 --- ### [02:05:37](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7537s) 成瘾杀手：GLP-1 药物对酒精与毒品渴望的抑制主持人话锋一转，提到书中一个极为反直觉的发现：Ozempic 不仅能平息大脑中喋喋不休的“食物杂音”（food chatter），似乎还在对抗各类传统成瘾行为上展现出惊人的效果。尽管科学界目前对此仍有巨大争议，但多项先锋实验呈现出的现象令人瞠目结舌。 ```mermaid flowchart TD accTitle: GLP-1激动剂在动物成瘾实验中的抑制表现 accDescr: 展示GLP-1受体激动剂对大鼠与小鼠在酒精、阿片类与可卡因摄入中的削减效果。 subgraph Lab["动物成瘾实验模型"] A["高酒精摄入大鼠 （哥德堡大学）"] B["海洛因 / 芬太尼自给大鼠 （宾夕法尼亚州立大学）"] C["可卡因摄入小鼠 （佛罗里达州立大学）"] end subgraph Intervention["药物干预"] GLP1["注射 GLP-1 受体激动剂 （司美格鲁肽）"] end subgraph Outcome["行为改变"] A --> GLP1 --> D["饮酒量锐减 60% 重度饮酒鼠降幅最显著"] B --> GLP1 --> E["阿片类药物自给量 降低约 50%"] C --> GLP1 --> F["可卡因使用量 降低约 50%"] end ``` 瑞典哥德堡大学的 Elisabet Jerlhag 教授将实验大鼠关在笼中并提供无限量的酒精，直到它们喝得东倒西歪、整个笼子宛如拉斯维加斯的廉价酒吧。随后，研究团队给这些大鼠注射了 GLP-1 受体激动剂（即司美格鲁肽）。结果令人震惊：大鼠的饮酒量瞬间暴跌了约 60%，而且此前酗酒最严重的大鼠减量最猛。为了排除“大鼠只是不想要酒精热量”的假设，宾夕法尼亚州立大学的 Patricia Sue Grigson 教授用完全没有热量的海洛因和芬太尼进行了测试，同样观察到了大鼠主动注射毒品行为减少 50% 的现象；佛罗里达州立大学的 Greg Stanwood 教授在小鼠的可卡因实验中也得出了 50% 降幅的类似数据。这一现象背后的机制至今尚未完全查明，许多科学家推测这与大脑多巴胺奖赏回路的受抑制有关。更神秘的是药物所表现出的“选择性”（selectivity）：它能精准地让你不想吃麦当劳巨无霸，却不会抑制你吃沙拉的欲望；它似乎只削弱对人体有害之物的渴望。Johann 幽默地打趣道：“这感觉太不可思议了，如果我是 Elton John，快乐源于弹琴，药物是怎么做到只叫我少吃果酱三明治，而不会阻止我尽情弹琴（jamming）的？” 目前，针对人类成瘾的研究正在全面铺开： - **现实个案**：加拿大一名叫 Tracy 的护士在遭遇情感破裂后，陷入了疯狂的强迫性购物（囤积从未翻过的书籍和从未穿过的衣服）、严重的强迫性抠皮症（skin picking）以及暴食症，但在使用 Ozempic 后，这些成瘾冲动几乎同时奇迹般消失。 - **早期临床数据**：小规模人体试验显示，该药能帮助戒烟，但需要配合尼古丁贴片；它也能降低人类饮酒量，但主要见效于实验前就已是重度酗酒者的人群。 - **核心争议与假说**：最激进的药物支持者甚至提出，人类找到的或许根本不是一种单纯的“食欲调节剂”，而是一种“全方位提升自控力的广谱药物”。不过 Johann 也提醒，必须警惕药企与狂热者对新药的过度推销。 --- ### [02:10:25](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7825s) 减重 3 英石与直面恶心副作用当主持人问及 Johann 自身的用药效果时，Johann 分享了自己的身体蜕变：他在一年内体重减轻了整整 3 英石（约 19 公斤 / 42 磅），更为震撼的是体脂率的骤降。刚开始时，他的体脂率高达 33%，健身教练 Josh 测出这个数字时忍不住倒吸一口凉气，Johann 当时甚至自嘲：“如果我是一块三明治，你绝对不会想吃我。”后来他查阅资料才发现，庞大的鲸鱼体脂率也才不过 35% 左右。在一年的药物辅助下，他的体脂率从 33% 一路直降至 22%。关于用药剂量与不良反应，Johann 解释道： - **递增给药**：所有人都必须从 0.25 毫克的极低剂量起步逐步加量，原因在于该药最常见且几乎人人都会遭遇的副作用——恶心。 - **严重反胃体验**：对于部分严重不耐受者来说，恶心感完全无法承受。Johann 曾采访过佛蒙特州的 Sunny Newton，对方形容那感觉就像“一只异形钻进了体内，在肚子里发疯似地翻滚撕扯试图冲破身体”。有相当比例的人正是因为这种剧烈的反胃而被迫停药。 - **适应与代价**：Johann 表示自己的恶心反应如今已经彻底消退。他非常认同代谢专家 Carel le Roux 博士的通透论断：“关于恶心，你必须对大众实话实说——世界上只有两种药，一种是有副作用的药，另一种是根本不管用的药。” --- ### [02:11:38](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7898s) 奥普拉的减重救赎与公开坦白主持人提到传媒巨头奥普拉·温弗瑞（Oprah Winfrey）一直是自己职业生涯的楷模，而她近期公开坦承借助 Ozempic 减重，将这种药物视作自己终生与体重抗争的救星。主持人向作为奥普拉好友的 Johann 询问，奥普拉究竟是如何解释自己放弃传统节食转而选择减重药物的。 Johann 回应称，奥普拉在接受《People》杂志专访以及为 ABC 电视台录制的特别专题节目中，非常动情而坦诚地剖析了心路历程。在整个现代流行文化史中，没有任何一个公众人物像奥普拉那样，在几千万观众的众目睽睽之下通过极其严苛的节食反复“自我折磨”。最著名的一幕莫过于当年在《奥普拉秀》舞台上，她拉着一整车象征着自己减掉的肥肉推上台来向全世界展示。在漫长而痛苦的节食与反弹循环后，她终于在这类新药面前放下了对自身意志力的苛求与自责。 ### [02:12:37](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7957s) “魔法药丸”的三种寓意：奥普拉的抉择与药物的复杂性在谈到奥普拉·温弗瑞（Oprah Winfrey）公开分享自己的减重历程时，约翰·哈里（Johann Hari）感慨她比任何人都更擅长表达那种为了体重而长期苛待自己的痛苦。奥普拉曾尝试过市面上几乎所有极端的节食与运动方案，却无一例外地陷入体重反弹的“溜溜球效应”。随着年龄增长，她不得不接受膝关节手术，对自身健康的担忧与日俱增，最终促使她做出了注射药物的决定。哈里坦言，尽管此类药物存在许多令人忧虑的隐患，但当他面对那些真正饱受肥胖折磨的人——例如旧金山的杰夫·帕克（Jeff Parker）或是奥普拉——看到他们因减重而获得惊人的健康改善时，他根本无法去反驳他们的选择。如果一个人在用药后身体状况有了质的飞跃，那么这项决定对他们而言就是完全正确的。当然，哈里也接触过大量后悔用药的人，他们承受着严重的副作用与潜在风险。正是这种双面性，促使哈里将自己的新书命名为《魔法药丸》（*Magic Pill*）。他解释道，大众口中的“魔法”其实有三种截然不同的理解层面： 1. **奇迹般的解药**：它如此迅速、高效地解决了困扰半生的难题，让人惊叹宛如神迹； 2. **魔术师的障眼法**：它表面上看似解决了问题，实则并没有真正根治，甚至暗中诱发了新的连锁反应； 3. **寓言中的精灵许愿与失控魔法**：如同经典动画《幻想曲》（*Fantasia*）或神灯寓言那样，你确实如愿以偿，但实现的方式却完全出乎意料，最终魔力失控并向着不可预测的方向疯狂蔓延。人类目前仍在摸索，这种药物究竟属于哪一种魔法。 ### [02:15:03](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8103s) 运动与省事的诱惑：我们会因为减肥针而停止锻炼吗？在访谈间隙，史蒂文·巴特利特（Steven Bartlett）低头凝视着桌上的注射笔，这一神情引得哈里打趣道：“你刚才拿着注射笔看着我的样子，简直像《龙穴之创业投资》（*Dragons' Den*）里挑剔冷酷的评委，我心里还在犯嘀咕：天呐，我到底该怎么说服他投资我？”史蒂文笑着解释了自己的内心挣扎：他当天还没吃午饭，原本打算录完节目去健身房挥汗如雨一个半小时，目的就是减掉小腹脂肪、保持肌肉力量并维持良好体态。同时，运动能给大脑带来极佳的情绪奖赏。但当他看着那支小小的药笔时，一个念头油然而生——既然一针就能轻松消灭腹部脂肪，何必那么辛苦？然而，这也让他深感担忧：如果大家因为有了捷径而放弃运动，身体与心理健康将会承受怎样的代价？哈里毫不犹豫地肯定了史蒂文的担忧：人们确实会因为依赖注射而减少运动，并带来极为负面的连锁反应。如今人类的生活方式本就越来越缺乏活动，仿佛生活在苹果 Vision Pro 头显构筑的虚拟静态世界中。哈里强调，运动对人体有着完全独立于“减重”之外的巨大价值： - **延年益寿的硬指标**：科学数据显示，一个人每年即使只进行累计 270 小时的规律运动，即便体重毫无变化，也能让预期寿命直接延长 3 年。 - **不可替代的生理机制**：运动在预防慢性疾病、延缓机体衰老以及改善心理抑郁方面的功效，是任何降糖减重药物都无法提供的。 - **两难的心理博弈**：如果只需每周一针就能换来短期或中期的身材收益，极易诱惑大众放弃锻炼，从而剥夺了运动带给心血管和大脑的情绪保护。 ```mermaid flowchart TD accTitle: 运动与减重药的价值取向抉择 accDescr: 对比传统锻炼与依赖减重药物在短期体态和长期健康维度的不同影响 subgraph 传统运动锻炼 A["规律运动与抗阻训练"] --> B["消耗脂肪 / 维持肌肉"] A --> C["心血管保护 / 延缓衰老"] A --> D["多巴胺与心理健康奖赏"] end subgraph 药物注射捷径 E["注射 GLP-1 药物"] --> F["快速抑制食欲并减重"] F -.-> G["运动意愿降低 / 肌肉流失"] G -.-> H["错失延寿 3 年等运动健康红利"] end ``` ### [02:17:07](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8227s) 谁该用，谁不该用？BMI界线与洛杉矶的“绝食社交” 谈及具体的使用建议，哈里给出了几条非常明确的红线与考量标准。他坚决反对体重正常的人盲目跟风用药。对于非超重或非肥胖人群来说，注射这类药物等于“承担了所有的健康风险，却享受不到任何实质的医疗收益”。曾任格温妮丝·帕特洛（Gwyneth Paltrow）创办的生活方式品牌 Goop 首席内容官的伊莉斯·洛嫩（Elise Loehnen）曾向哈里吐槽，她现在甚至不想在洛杉矶跟熟人出去聚餐，因为餐桌上所有人几乎都不碰食物，大家围坐在一起如同在集体挨饿，正所谓“传统的节食已经过时，极端的‘排除摄入’才是当下的新风潮”。结合临床风险与收益，哈里梳理了不同人群的决策逻辑： - **BMI < 25（体重健康人群）**：绝对不应使用。面临包括甲状腺髓样癌、胰腺炎、胃轻瘫在内的潜在风险，纯粹为了追求极度干瘪的审美而用药是极其不负责任的。 - **BMI > 35 或体脂率极高的人群**：只要家族中没有甲状腺髓样癌病史、且近期没有备孕计划，在尝试传统饮食运动失败后，哈里明确倾向于推荐用药。因为此时重度肥胖引发的心脏病、中风与糖尿病死亡风险，已经远远超过了药物本身的副作用风险。他对自己身边符合该条件的至亲也是这样建议的。 - **BMI 在 27 至 35 之间的灰色地带**：因人而异。使用者必须逐条权衡心血管风险与潜在副作用，不同的人即便同样理性，也完全可能得出截然相反的结论。史蒂文还敏锐地指出了一种滑稽的社会文化演变：未来如果有人完全依靠纯粹的意志力、严格的饮食控制与疯狂跑步减掉了三四十磅体重，大众也根本不会相信他们，只会一口咬定“你绝对偷偷打了 Ozempic”。 ### [02:18:58](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8338s) 供不应求的伦理困境：挤占糖尿病患者的救命药随着减重神药在全球掀起狂潮，网络上也爆发了激烈的道德质问：健康或轻度超重人群为了瘦身疯狂抢购，导致真正需要该药物维持生命的二型糖尿病患者面临严重的断药危机。很多糖尿病患者因无法配到药品，健康状况急剧恶化，甚至被迫提前使用风险更大、副作用更多的胰岛素治疗。哈里在为新书调研时采访过多位身陷困境的糖尿病患者，他坦言这种对话令人心碎，且反对者的指责切中要害。他认为，英国政府和卫生系统原本应该效仿当年新冠疫苗（COVID vaccine）的分发模式，由官方实施严格的梯队配给制度，而不是任由市场自费抢购陷入丛林法则： ```mermaid flowchart TD accTitle: 理想状态下的 GLP-1 药物配给层级机制 accDescr: 展示应依据医疗紧迫程度自上而下分配药物的三级配给金字塔 subgraph 第一优先级：最迫切医疗需求 T1["二型糖尿病患者 & 重度肥胖症患者 (BMI > 35)"] end subgraph 第二优先级：中度共病风险 T2["超重伴随心血管家族病史人群 (如哈里本人)"] end subgraph 第三优先级：单纯美容减重 T3["无严重并发症的轻度超重人群"] end T1 -->|优先足额保障| T2 T2 -->|富余产能供给| T3 ``` 哈里十分诚恳地表达了自己的愧疚与反思。他承认自己之所以急于用药，是因为家族有严重的心脏病早亡史，自己的年龄甚至已经超过了当年祖父突发心脏病去世时的岁数。但这无法掩盖残酷的现实：如果不是成千上万像他这样并不极度危急的人争相自费购买，药品供应链绝不至于如此吃紧。他特别提到了一位名叫扎米尔·贾利勒（Zamir Jalil）的 41 岁音乐人，作为二型糖尿病患者，扎米尔当时跑遍各地都无法配到救命的 Ozempic。哈里动容地表示，站在扎米尔面前，他深切地感受到一种道义上的羞愧，因为对方的生存需求显然远比自己的减重愿望更加迫切。在访谈行将结束前，史蒂文真诚地向哈里致谢，回忆起当年哈里第一次做客节目时，自己还是个几乎没有听众的“初生牛犊般的微型播客主播”，而两人的深刻对话从那时起便结下了不解之缘。 ### [02:20:55](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8455s) 录制初心与《魔力药丸》的平衡叙事主持人斯蒂芬·巴特利特（Stephen Bartlett）深情地回顾起两人最初相识的场景。当年斯蒂芬读完约翰·哈里的著作《失去的联结》（Lost Connections）后深受触动，便邀请他录制播客。那时《CEO日记》默默无闻、没有录像设备、音频效果糟糕且技术故障频出，而哈里却欣然前往斯蒂芬在伦敦的公寓，成了最早愿意给他机会的嘉宾之一。斯蒂芬坦言，哈里在多年后依然保持联络并受邀重返节目，让他由衷感激。斯蒂芬特别赞赏哈里即将于 2024 年 5 月 2 日出版的新书《魔力药丸：新型减肥药的惊人益处与令人不安的风险》（Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs）。斯蒂芬指出，听众对 Ozempic 等减肥药的关注度极高，而哈里作为一名亲身注射该药物的使用者，并未像许多人预期的那样盲目偏袒或极力辩护。相反，他在书中展现出令人惊叹的客观与微妙平衡，既不预设立场，也毫无偏见地罗列了利益与风险的权衡，将最终的选择权完全交还给读者。斯蒂芬感叹，哈里的叙事能力极具穿透力，能把晦涩难懂的科学议题转化为引人入胜的探索旅程，这种写作风格在多年间深刻启发并影响了自己的创作。 - **早年结缘**：哈里曾在节目起步初期、没有任何听众基础时就前往斯蒂芬伦敦的公寓录音，给予初创时期的播客极大的信任与支持。 - **著作特点**：新书《魔力药丸》全面剖析新型减重药的“两面性”，哈里虽为用药者，但坚持保持中立，提供全面的知情权而非给出单向推销。 - **出版节点**：访谈录制时距离《魔力药丸》正式发售（2024 年 5 月 2 日）仅剩数日。 --- ### [02:23:10](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8590s) 压轴问题：人类为何应当继续存在？按照播客的传统惯例，上一位神秘嘉宾为哈里留下了一个直击灵魂的问题：“人类究竟为何应当继续存在？”面对这一庞大的终极命题，哈里并没有从抽象的哲学或艺术切入，而是分享了一段来自拉斯维加斯下水道的真实故事。哈里透露，过去十二三年里他一直在调查并撰写一部关于拉斯维加斯系列罪案的书籍，期间结识了曾长期栖身于城市地下排洪渠的两位流浪汉——罗布·班哈特（Rob Banghart）与保罗·维诺（Paul Veno）。拉斯维加斯地底庞大的防洪隧道中生活着数千名无家可归者。罗布曾被称为“流浪汉圣诞老人”（Hobo Santa），靠小偷小摸救济他人，并做点极底层的毒品交易。2017 年，一群古巴竞争对手用斧头劈开了罗布的头骨，将他拖到铁轨上任由火车碾压。所幸有人及时发现并将他拉开，罗布才奇迹般生还。在长达半年的康复期中，罗布彻底扭转了人生，加入保罗创立的慈善组织“照亮前路”（Shine a Light）。这个由地下隧道幸存者组成的团队，每月都带生活必需品深入下水道，为滞留地下的人提供手电筒、卫生棉条以及脱离地底生活的实际支持。有一次，罗布得知老友皮克特（Picket）在隧道内因吸毒过量身亡，哈里便陪同他下到地底。在安顿现场后，罗布依然不忘给周围人分发物资。当他询问另一条隧道里住着谁时，一位流浪妇人劝阻道：“你可不想去那儿。”罗布却坚持走过去留下了物资。几天后哈里追问原因，罗布平静地透露，那处隧道里住着的正是当年用斧头劈开他头颅、企图置他于死地的仇人。哈里震惊地问他为何还要去救助要杀自己的人，罗布回答：“因为他们是人类，他们正在受苦，他们需要帮助。”（"Because they're human beings and they're suffering and they need help."）哈里动情地总结道，罗布和保罗本拥有出众的才华和智慧，完全可以离开下水道去赚大钱、享受物质优渥的生活，但他们却日复一日重返肮脏黑暗的排洪渠，去帮助那些被社会遗忘的人，只因他们坚信“这是正确的事”。哈里坦言，若有人问起人类继续存在的理由，自己不需要空谈宏大理论，只要看看罗布与保罗的所作所为——他们展现出的极致宽恕与博爱，正是人类值得存在于这个世界的终极答案。 ```mermaid flowchart TD accTitle: 救赎与宽恕的地下隧道历程 accDescr: 展现罗布从下水道流浪汉转变为救援者并宽恕昔日仇人的完整历程 subgraph Trauma["危机与转变"] A["栖身拉斯维加斯排洪隧道 （绰号'流浪汉圣诞老人'）"] --> B["2017年遭仇家斧劈重伤 被弃于铁轨险些丧命"] B --> C["获救幸存并历经6个月康复 决心彻底扭转人生轨道"] end subgraph Mission["隧道救援行动"] C --> D["加入保罗创办的机构 '照亮前路'（Shine a Light）"] D --> E["定期深入地下排洪系统 运送必需品并协助流浪者走出泥潭"] end subgraph Redemption["宽恕的极致"] E --> F["重返旧地悼念药物过量故友"] F --> G["主动向当年行凶仇家提供援助物资"] G --> H["信念：'他们是人类，正在受苦，需要帮助'"] end ``` ## Notable quotes > [01:58](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=118s) 你该不会真以为这是普拉提的效果吧？ — 好莱坞派对女伴 > [14:15](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=855s) 以前和你一起吃饭压力很大，因为你吃得飞快，却又看起来完全没有享受食物；但现在，你看起来是真的在品尝一顿饭。 — Johann Hari 的朋友 > [16:05](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=965s) 你到底是谁？你把真正的 Johann 弄到哪里去了？ — Johann Hari 的教子 > [27:33](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1653s) 这些药物是用人工手段去解决一个人工制造出的问题。 — Michael Lowe 教授 > [27:33](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=1653s) 如果你发起那场运动，我举双手赞成，但等你们真正改革成功那天，我早就进棺材了；我等不起，我现在就想活下去。 — Jeff Parker > [48:38](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=2918s) 肥胖等于被忽视，而那正是我所需要的安全感。 — 苏珊（Susan） > [54:48](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3288s) 政客是风向标，而我们的职责是成为风。 — Rebecca Solnit > [01:03:35](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=3815s) 我们从小就教育孩子喜欢吃健康食品，难道你们不这样吗？ — 日本翻译 > [01:29:02](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5342s) 我们虽然不知道这些药物的长期风险，但我们确实清楚肥胖的长期危害，而那些危害是极其可怕的。 — Shauna Levy 博士 > [01:37:37](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=5857s) 天哪，你们根本不知道即将降临在我们所有人头上的是什么。 — Johann Hari > [01:55:06](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=6906s) 你能帮我弄点 Ozempic 吗？ — Erin（Johann 的侄女） > [02:10:25](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=7825s) 世界上只有两种药，一种是有副作用的药，另一种是根本不管用的药。 — Carel le Roux 博士 > [02:23:10](https://www.youtube.com/watch?v=0YMnHNIuK3M&t=8590s) 因为他们是人类，他们正在受苦，他们需要帮助。 — Rob Banghart ## Mentioned Johann Hari, Steven Bartlett, Ozempic, Wegovy, Mounjaro, Zepbound, Retatrutide, 司美格鲁肽 (Semaglutide), 替尔泊肽 (Tirzepatide), GLP-1, GIP, Magic Pill, Lost Connections, Jens Juul Holst, Jay Rayner, John Wilding, Aurelio Galli, Paul Kenny, Carel le Roux, Michael Lowe, Tracy Mann, Vincent Felitti, Barak Kushner, Daniel Drucker, Svetlana Mojsov, Jean-Luc Faillie, Kimberly Dennis, Greg Stanwood, Shauna Levy, Max Pemberton, Emily Field, Graham MacGregor, Elisabet Jerlhag, Patricia Sue Grigson, Oprah Winfrey, Adele, Rebel Wilson, Novo Nordisk, Eli Lilly, FDA, EMA, KFC, Tanita, Shine a Light, Rob Banghart, Paul Veno ## Video description Johann Hari is a New York Times best-selling author, his books include, ‘Chasing the Scream’, ‘Lost Connections’, and ‘Stolen Focus’. He has written for the world’s leading newspapers and magazines, and has twice been named ‘National Newspaper Journalist of the Year’ by Amnesty International. 00:00 Intro 01:46 How Did You Find Out About Ozempic 06:37 What Is Ozempic & How Much Is It? 09:51 How Does Ozempic Work 16:03 The Impact of Ozempic on the Brain 26:17 The Cheesecake Park Experiment 31:16 Obesity Is a Choice 44:53 Addiction Transfer 52:25 Obesogenic Environment 01:04:55 Where Can You Buy Ozempic 01:07:43 The Origins of Ozempic 01:10:15 Why You Shouldn't Take It 01:13:56 Is The Ozempic Face Real? 01:18:08 The Risk of Muscle Loss 01:20:36 Suicide Risk and Fatalities 01:29:49 How Do We Undo Stress 01:30:01 Diabetes Is More Deadly Than Weight Loss Drugs 01:32:24 Downsides 01:39:21 Will Everyone Be on Ozempic? 01:42:47 Should the Government Intervene? 01:50:46 Weight Gain After Ozempic 01:53:59 Children and Ozempic 01:57:21 Celebrities Taking Ozempic and Hiding the Truth 02:05:37 Ozempic Is An Addiction Killer! 02:12:34 Oprah Taking About Her Losing Weight Journey 02:15:03 Will People Exercise Less If They Can Just Take Ozempic 02:18:58 High Demand Of Ozempic & Issues Caused 02:23:10 The Last Guest Question You can purchase Johann’s newest book, ‘Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs’, available on 2nd May 2024, here: https://amzn.to/3Qm8AJl Follow Johann: Instagram - https://bit.ly/4bfqkyj Twitter - https://bit.ly/44ixqjd YouTube - https://bit.ly/3Uzccdr Follow me: https://beacons.ai/diaryofaceo Join this channel to get access to perks: https://www.youtube.com/channel/UCGq-a57w-aPwyi3pW7XLiHw/join Follow our Shorts channel for more content: https://www.youtube.com/@TheDiaryofaCEOShorts Sponsors: WHOOP: https://join.whoop.com/en-uk/CEO [Source](https://www.youtube.com/watch?v=0YMnHNIuK3M)

Source quotes

[1:58] 好莱坞派对女伴: 你该不会真以为这是普拉提的效果吧？ [14:15] Johann Hari 的朋友: 以前和你一起吃饭压力很大，因为你吃得飞快，却又看起来完全没有享受食物；但现在，你看起来是真的在品尝一顿饭。 [16:05] Johann Hari 的教子: 你到底是谁？你把真正的 Johann 弄到哪里去了？ [27:33] Michael Lowe 教授: 这些药物是用人工手段去解决一个人工制造出的问题。 [27:33] Jeff Parker: 如果你发起那场运动，我举双手赞成，但等你们真正改革成功那天，我早就进棺材了；我等不起，我现在就想活下去。 [48:38] 苏珊（Susan）: 肥胖等于被忽视，而那正是我所需要的安全感。 [54:48] Rebecca Solnit: 政客是风向标，而我们的职责是成为风。 [63:35] 日本翻译: 我们从小就教育孩子喜欢吃健康食品，难道你们不这样吗？ [89:02] Shauna Levy 博士: 我们虽然不知道这些药物的长期风险，但我们确实清楚肥胖的长期危害，而那些危害是极其可怕的。 [97:37] Johann Hari: 天哪，你们根本不知道即将降临在我们所有人头上的是什么。 [115:06] Erin（Johann 的侄女）: 你能帮我弄点 Ozempic 吗？ [130:25] Carel le Roux 博士: 世界上只有两种药，一种是有副作用的药，另一种是根本不管用的药。 [143:10] Rob Banghart: 因为他们是人类，他们正在受苦，他们需要帮助。

Source quotes

[0:00] Johann Hari: the most effective tool for self-starvation human beings have ever come up with. [15:43] Johann Hari's godson: Who are you and what have you done with Johann? [26:17] Judy: When I had cancer, we know there is something in the environment that is triggering breast cancer in women... But you didn't say to me when I got breast cancer, 'Well, fuck me, all this environmental problem has caused this breast cancer and now you want to inject yourself with another poison, chemotherapy, in order to deal with it?' No, you said, 'Okay, we've got an environmental problem, obviously that environmental problem needs to be dealt with, but you've got to stay alive or you can't deal with it.' [45:36] Johann Hari's friend: It's not that the drug is causing this problem; the drug is making this problem visible to you, and now you can deal with that in other ways. [52:25] Rebecca Solnit: politicians are weather vanes, and it's our job to be the weather. [80:36] Carell le Roux: A lot of people who are overweight for a long time say... 'The reason my life is [terrible] is because I'm overweight. If I finally lose weight, my life will be good.' And then they lose weight and they've still got the same hassle husband, and they've still got the same job they don't like, and they suddenly go into this crisis. [89:08] Shauna Levy: We don't know the long-term risks of these drugs; we do know the long-term risks of obesity, and they are horrific. [89:08] Max Pemberton: If you gave me a choice between getting diabetes or becoming HIV-positive, I would choose HIV every time [113:59] Erin: Will you get me some Ozempic? [118:16] Johann Hari: There is a sin and there are people who are cheating, but it's not Oprah... it's the food industry that fucked all of us, that's why we're in that race. [125:37] Johann Hari: What we found is a drug that boosts self-control across the board... the animal research is mind-blowing and really is highly, highly exciting. [130:25] Carel le Roux: When it comes to nausea, you've got to level with people: there are two kinds of drugs—there are drugs that have side effects and there are drugs that don't work. [135:03] Johann Hari: If you are not overweight or obese, you definitely shouldn't take these drugs. [135:03] Elise Loehnen: dieting is out, elimination is in. [143:10] Rob Banghart: Because they're human beings and they're suffering and they need help.

Original transcript

[0:00] we've not spoken for 2 years but I have [0:02] to say you look remarkably different so [0:05] I lost three stone in a year and there's [0:07] secret to that statement Johan Hari the [0:11] bestselling author who's using his own [0:13] body to unearth the extraordinary [0:15] benefits and disturbing risks of the new [0:17] weight loss drugs OIC it is literally [0:20] the hottest drug in the country right [0:22] now I really worry about the risk of [0:24] these drugs you're nine times more [0:26] likely to get this particular condition [0:28] which is excruciatingly pain for and [0:30] these drugs are working very hard on key [0:33] parts of your brain in fact there are 12 [0:35] significant risks and we'll get into [0:36] that but it seems extraordinary that we' [0:38] reached the point where we would inject [0:40] ourselves with a potentially risky drug [0:41] to stop us from eating and we've had 40 [0:44] Years of relentlessly promoting diet and [0:46] exercise as the only solutions and only [0:48] 10% of people really do lose huge [0:51] amounts of weight on diets and keep it [0:52] off but now we have the most effective [0:54] tool for self- starvation human beings [0:56] have ever come up with when I started [0:57] taking zpic I was literally 80% % less [1:00] hungry than I normally am these drugs [1:02] really do massively reduce or reverse [1:04] obesity and a few years from now we'll [1:06] have 50% of the population taking it the [1:08] new miracle drug now this is when I go [1:11] through the 12 big risks some of which [1:13] have not really been explained to the [1:14] public So within a year of stopping you [1:17] regain 70% of the weight you've lost [1:19] muscle mass loss is a real problem [1:21] there's concern that it may be causing [1:23] suicidal feelings and then there's one [1:24] of the really big risks and it's [1:26] absolutely Grim beyond belief and that [1:28] is [1:30] congratulations Dio gang we've made some [1:33] progress 63% of you that listen to this [1:35] podcast regularly don't subscribe which [1:38] is down from [1:40] 69% our goal is 50% so if you've ever [1:44] liked any of the videos we've posted if [1:46] you like this channel can you do me a [1:47] quick favor and hit the Subscribe button [1:49] it helps this channel more than you know [1:50] and the bigger the channel gets as [1:52] you've seen the bigger the guest get [1:54] thank you and enjoy this [1:57] [Music] [1:58] episode Yan we've not spoken for 2 [2:03] years but I have to say you look [2:06] remarkably different there's a secret to [2:09] that Stephen really we can dig into yeah [2:13] what is the [2:14] secret so for me it started it's a kind [2:17] of weird story it started in the winter [2:19] of 2020 so it was that weird period when [2:22] kind of the world was opening up again [2:24] after the [2:25] pandemic and i' gained a lot of weight [2:27] in lockdown like loads of people [2:30] and because of that kind of weird moment [2:32] of reopening I went to a party for the [2:34] first time in like I don't know a year [2:36] and a half two years and it was a party [2:38] thrown by a kind of famous Hollywood [2:40] actor and on the way there I remember [2:42] thinking oh this is going to be kind of [2:44] funny because all these Hollywood people [2:46] are going to put on weight as well right [2:48] they're going to have gained weight what [2:49] are they going to look like so I [2:52] remember getting there looking around [2:55] and having this really weird feeling [2:59] because it's not just they hadn't gained [3:00] weight everyone was gaunt right like [3:03] everyone looked like their own Snapchat [3:05] filter like they had like higher [3:06] cheekbones they looked cleaner and [3:09] clearer and [3:10] sharper and I was kind of wandering [3:12] around feeling bit like oh [ __ ] and I [3:14] bumped into a friend of mine on the [3:16] dance floor and I said to her what it [3:18] looks like um looks like everyone really [3:20] did do Pates during [3:22] lockdown and she laughed and then she [3:24] looked at me and I S looked at her and [3:26] she said well you know it wasn't Pilates [3:28] right and I sort of looked at her [3:31] blankly and she pulled out her phone and [3:35] she showed she Googled an image and she [3:36] showed me an OIC pen and I didn't know [3:39] what it was and I said what are you [3:41] talking about and said it's a drug [3:42] everyone here is on this drug right not [3:44] just the Stars like their wives their [3:46] agents their agents kids everyone right [3:49] and I've been really thrown and then [3:51] over the next few days I I read a lot [3:53] about these these new weight loss drugs [3:55] and I've never I don't remember ever [3:57] coming across a topic where I felt so [4:02] deeply conflicted from the very [4:04] beginning and that conflict remained all [4:06] the way through right the subtitle to my [4:07] book is the extraordinary benefits and [4:10] disturbing risks of the new weight loss [4:11] drugs and that's even right from the [4:14] start I was I was aware that was that [4:17] was the the tension so the benefits are [4:19] kind of obvious right you know I'm older [4:21] than my grandfather ever got to be [4:23] because he died of a heart attack loads [4:24] of the men in my family get really fat [4:26] and die of heart attacks my uncle died [4:28] of a heart attack my dad had a lot of [4:29] heart problem problems um there's a lot [4:32] of evidence that obesity unfortunately [4:34] does cause a whole range of health [4:36] problems over 20000 diseases and [4:39] complications uh there's a lot of [4:40] evidence these drugs really do massively [4:42] reduce or reverse obesity the average [4:45] person who uses them as z p wovi loses [4:49] 15% of their body weight in a year with [4:51] the new generation of the drugs the next [4:52] ones that are coming down the line the [4:54] average person loses 24% of their body [4:57] weight it's staggering it's just below [4:59] barrier atric surgery so I could see the [5:01] obvious health benefit and I could see [5:04] that the Alternatives that most of us [5:06] have been pursuing diets have not worked [5:08] well for most [5:10] people but at the same time I thought I [5:13] mean just I had so many doubts straight [5:16] away I thought well we've seen this [5:19] story before there have been lots of [5:21] miracle diet drugs that have been [5:22] announced they caus dramatic weight loss [5:24] at first and we always discover some [5:26] horrendous side effect that causes you [5:29] know cat Ric outcomes that mean the [5:30] whole thing has to be pulled I thought [5:33] that I [5:35] thought well we know what causes obesity [5:37] right the reason obesity is massively [5:39] increased is because of a complete [5:41] change in the food supply we eat [5:42] completely different food to what our [5:44] grandparents ate we need to deal with [5:46] that not kind of drug everyone I also [5:49] thought well what will happen to people [5:50] with eating disorders when they get a [5:52] hold of this what will this do to the [5:54] kind of positive changes that were [5:55] happening in accepting a kind of broader [5:57] range of Weights so I was [6:01] really deeply conflicted so to really [6:03] get to the bottom of this for my book [6:04] magic pill I I spent a year taking the [6:07] drugs and going on this big Journey all [6:09] over the world from rekovic in Iceland [6:11] to Minneapolis to Tokyo to interview the [6:14] leading experts in the world on these [6:16] drugs the biggest supporters the biggest [6:18] critics all sorts of uh kind of alleys [6:21] and avenues that follow from them and at [6:23] the end of it it's really weird I know [6:26] far more than I did before I know far [6:28] more about benefits and risks and far [6:29] more about what this is going to do to [6:30] the culture and it will be [6:33] massive but I'm still really [6:35] conflicted so if we if we start there [6:37] then you're at the party someone [6:39] mentions this zmek thing to you can have [6:41] you got the zmek um pen on you I have it [6:44] as a a prop you've got it here okay so [6:47] it's very simple um you it's just a [6:50] little pen it's like um an epip pen so [6:52] you take that you uh put on the little [6:55] lid I won't take it out because I need [6:56] this one later but the um although this [6:58] one's empty you put a little you twist a [7:01] little needle onto there and you inject [7:04] yourself with it and you inject yourself [7:05] once a week and it's really strange the [7:09] effect it has I remember the first day I [7:12] took the [7:14] injection couple of days later I [7:16] remember waking [7:17] up and I was lying in bed and I had this [7:20] weird feeling you know feeling when you [7:21] wake up and you're not quite with it and [7:23] you think what am I feeling and I was [7:24] struggling to articulate it and I I was [7:26] I thought I felt mly nauseous which [7:28] everyone gets when they start taking but [7:29] that wasn't the thing that was puzzling [7:31] me and then I [7:33] realized I'd woken up and I wasn't [7:35] hungry I don't remember that ever [7:37] happening to me before I mean don't mean [7:38] that as an exaggeration I I used to be [7:40] woken up every day like really hungry [7:43] often I would be woken up by hunger by [7:46] my stomach rumbling and I went on my [7:49] kind of typical routine for the day I [7:51] went to this Cafe just around the corner [7:53] from where I live and I ordered the same [7:55] thing I would always order which was a [7:57] kind of big kind of a Brown roll with [8:00] lots of chicken and mayo in it and I had [8:03] like three mouthfuls and I was full I [8:05] just didn't want to eat [8:06] anymore I remember leaving I remember [8:08] Tatiana the woman who works in the cafe [8:10] kind of shouting after me to see if I [8:11] was Ill or [8:12] something and then for lunch I went to [8:14] the same place I always go or went at [8:16] the time next to my office there's a [8:18] Turkish kind of restaurant I went there [8:21] I ordered a Mediterranean lamb again I [8:24] had like three or four mouthfuls I [8:26] wasn't hungry it was like the kind of [8:29] had come down on my appetite I was [8:31] literally 80% less hungry than I [8:32] normally am and it basically stayed that [8:36] way from then on it was a very uh [8:39] physically and psychologically strange [8:41] experience so on the on the on the pen [8:44] itself cuz I just want to make sure I [8:45] fully understand this is that that [8:47] little pen you have in your hand for [8:48] people that can't aren't watching on [8:49] video there's a it kind of looks like a [8:51] big sharpie yeah exactly and is that one [8:54] dose yeah there's load of doses in there [8:56] so you twist the base yeah and [9:00] um that each time you twist it it would [9:02] release with this pen 1 milligram okay [9:04] yeah and how many twists you get out of [9:06] one pen uh I think each one contains [9:09] four dozes yeah and how much does that [9:11] cost so it varies massively because as [9:14] you know I live half in the US half in [9:15] Britain a lot of the time um so in [9:17] Britain this cost you at the moment [9:19] about £250 a month in the US it's way [9:22] more like $800 a month so £250 a month [9:25] how many sort of doses do I get for that [9:27] £250 you that would cover your whole [9:29] month so each month you'd have to pay [9:30] £250 you get four doses in each one and [9:33] you said in the US it's way more way [9:35] more how much more so it's about $800 [9:37] between 800 and 1,200 bearing in mind [9:39] there' have been lots of shortages which [9:40] I'm sure we'll talk about so the price [9:42] has kind of been a bit sensitive to how [9:44] much is actually available at any given [9:46] time okay interesting and are these [9:49] drugs [9:50] new relatively so I interviewed the [9:53] scientists who played the key role in [9:55] the breakthroughs that led to the [9:56] development of the drugs and then [9:57] scientists who worked on it at every [9:59] stage [10:00] so in one sense they're not that new [10:01] diabetics have been using them on [10:03] license now for 18 years so for obesity [10:07] they're relatively new for diabetes [10:08] they've been around for nearly 20 years [10:10] and it was fascinating talking to the [10:12] scientists involved because one of the [10:15] things that's really weird about this is [10:16] there's a huge debate about how they [10:17] even work so there's certain things that [10:19] we know for sure so if you now ate [10:23] something right you it don't matter what [10:25] it is after a while a hormone would [10:28] start to be produced it in your body [10:30] called [10:30] glp1 and that is one of many gut [10:33] hormones that would start to be created [10:35] and it's basically glp1 is a natural [10:37] signal saying Stephen you've had enough [10:39] stop eating right just stop now right [10:41] but gp1 natural glp1 only remains in [10:43] your system for a couple of minutes and [10:45] then it's washed away so if you sort of [10:46] push through it you can carry on eating [10:48] right most people do stop when they get [10:50] the signal um so what these drugs do is [10:54] they simulate glp1 they inject into you [10:57] an artificial copy of glp 1 but instead [11:00] of that glp1 remaining in your system [11:02] for a few minutes and then disappearing [11:03] it stays in your system for a whole week [11:06] so when I go to that cafe and I eat the [11:08] thing I'd normally eat my system is [11:11] filled with signals that say you're [11:12] already full Johan you don't need [11:14] anymore right so that was initially that [11:17] is definitely a key part of how it works [11:19] and it was initially thought that these [11:21] drugs worked on your gut right these gp1 [11:24] is a hormone that's made in the gut um [11:27] it's thought that the effect was it [11:28] slows down your gut it slows down [11:30] gastric emptying that is definitely [11:32] happening but The Cutting Edge science [11:34] and the kind of leading neuroscientists [11:36] that I interviewed now believe actually [11:38] it primarily has an effect on your brain [11:40] it changes what you want and how you [11:43] want it which brings with it a huge [11:46] parallel set of both benefits and risks [11:48] interesting so it's once a week and you [11:51] basically feel Fuller for a whole week [11:54] from one injection yeah not everyone [11:57] gets to that state immediately some [11:59] people it takes longer some people the [12:00] side effects are just intolerable and [12:02] they can't take it at all or they can't [12:04] continue to take it and I interviewed [12:05] plenty of people who were in that [12:07] position but for most [12:09] people the best way I can describe it is [12:13] imagine you just had Christmas dinner [12:15] yeah and I came up to you so you're [12:16] completely bloated you're lying on the [12:18] sofa and I came up to you and said hey [12:20] Steven I got you a Big Mac here it is [12:22] and you be like I mean you could [12:24] physically force yourself to eat that [12:25] Big Mac you might throw up but you [12:26] probably could eat it but you just don't [12:28] want to you feel full so it creates a [12:31] very rapid sense of fullness in response [12:33] to far so I used to eat 3,200 calories a [12:36] day roughly I now eat about [12:39] 1,800 there a huge drop and the benefits [12:43] are kind of obvious of that but there [12:45] are really big costs I discovered [12:47] there's in fact 12 really big risks and [12:48] there's all sorts of Cu at first when [12:51] you hear all this you're like well this [12:52] is just kaching win win right who [12:53] wouldn't want this but there's a lot of [12:56] risks and downsides as well so I want to [12:58] get on to all those risks and downsides [13:00] but one of the I think rebuttal that [13:02] some people would have when they hear [13:03] this um is kind of contrary to the [13:05] reaction I think you expect which is [13:08] Johan I really love eating food I really [13:11] really enjoy the process of eating food [13:12] aren't you losing happiness because food [13:15] gives a lot of people happiness in [13:17] various ways so aren't you a little bit [13:19] annoyed now that you've lost your desire [13:21] to have you know that role that you used [13:24] to have for breakfast in the morning [13:25] hasn't that taken something from you [13:27] this is a big drawback for lots of [13:28] people I think I'm quite unusual so I'll [13:30] explain how most people feel about this [13:31] then I'll explain how I feel about it um [13:33] you're absolutely right even yenil Holst [13:35] who was one of the scientists who [13:37] developed o zenic said look for most [13:40] people it's just a life without pleasure [13:43] in food is just unbearable and after a [13:45] couple of years they just give up [13:46] because they want to enjoy life right [13:48] and one of the key things that gives us [13:50] pleasure throughout the day is eating uh [13:53] and a lot of people feel that way if you [13:54] look at for example Jay Raina a [13:56] brilliant food critic here in Britain [13:58] you know he just described how he [14:00] started taking it he would go to the [14:02] best restaurants in Paris places he [14:05] loves and he [14:07] just couldn't get any pleasure out of it [14:10] so for him it was just awful it's a very [14:13] common complaint that it drains pleasure [14:14] from [14:15] food honestly I I had almost the [14:18] opposite experience but I want to stress [14:19] I do think I'm quite unusual so I [14:22] realized when I started taking these [14:23] drugs one of the fascinating things [14:25] about these drugs is they will bring to [14:27] the surface whatever psychological [14:29] issues you had with food right because [14:31] it so radically interrupts your eating [14:33] patterns um and that can be very [14:36] challenging for a lot of people I'm sure [14:37] we'll get into that but for me I [14:39] realized how much of my eating from when [14:42] I was very [14:43] young the pleasure I got from food was [14:46] not primarily from like tasting it and [14:48] savoring it the pleasure I got from food [14:51] was mostly from kind of a feeling of [14:52] stuffing myself so stuffing is like you [14:55] you do it at Christmas din we all do it [14:57] sometimes stuffing is when you sort of [14:59] eat deliberately beyond the point at [15:01] which you're full and you feel it as a [15:02] physical sensation you can feel it sort [15:04] of pushing up on your esophagus and out [15:05] on your stomach and I think from when I [15:08] was very young I grew up in a very [15:09] violent and crazy environment I think [15:12] one of the ways I learned to cope with [15:15] that there are many productive and [15:17] positive ways I learn to cope with that [15:18] but one of the kind of downsides is I [15:20] learned to really eat to soothe myself [15:21] and I would stuff and when I started [15:23] taking o zenic I actually couldn't eat [15:25] like that anymore you you can't stuff [15:27] yourself I would literally throw up if I [15:29] you know tried to stuff myself so [15:31] actually for me it massively slowed down [15:34] my eating and I actually enjoy food a [15:36] fair bit more now I don't want to [15:37] overstate it I'm not a foodie I'm never [15:39] going to be that person but like I [15:41] remember going for dinner with one of my [15:43] friends I know maybe three or four [15:45] months after I started taking it and I [15:47] saying to me you know it's always been a [15:48] bit stressful to eat with you because [15:49] you eat so quickly but you don't seem to [15:52] really enjoy it and now you do actually [15:54] look like you're enjoying your [15:56] food but I stress again I don't think [15:59] I'm typical in that respect there are [16:00] far more people like J Raina than there [16:02] are like me I really want to go [16:05] into why people you know people's [16:07] relationship with food more generally um [16:10] but I wanted to close off on that what [16:11] you were saying about a Zex impact on [16:13] the brain you talked about gp1 in the [16:15] gut and the you know the impact that [16:17] hasn't making you feel satiated but you [16:19] also alluded to there's now research [16:21] that suggests it's doing something to [16:22] the brain as well this is totally [16:24] fascinating it opens up a whole new set [16:26] of potential benefits for these drugs in [16:28] relation to add [16:30] and a whole set of potential risks for [16:31] these drugs in relation to depression so [16:34] I want to stress there is very big [16:37] scientific disagreement about what is [16:39] happening in the brain in relation to [16:41] these drugs and it's a bit like when you [16:43] interview people it's like it's like [16:44] looking at a picture that's just coming [16:46] into shape so a year from now we'll know [16:48] much more than we do now but what was [16:52] discovered this actually discovered in [16:53] the 90s um here in London at Hammer [16:56] Smith hospital was that in fact we don't [16:59] only have glp receptors in our guts we [17:02] have glp receptors in our brains in fact [17:04] glp one can be made in the brain right [17:07] which is fascinating it could also made [17:08] in your thyroid which is very [17:09] significant I'm sure we'll come back to [17:11] um so when you take these drugs um as [17:16] John Wilding one of the key figures in [17:18] the development of these drugs said to [17:19] me you can tag the drug which means that [17:21] you can sort of D it and you can give it [17:23] to animals and then cut open their [17:24] brains obviously you can't do that with [17:26] humans and when you do that when you [17:27] just give them the drug and you in their [17:29] brain afterwards what you find is this [17:31] drug goes everywhere in the brain it's [17:33] going all over the brain it is primarily [17:36] having a brain effect right and it [17:38] definitely also much more anecdotally [17:40] feels that way when you take it it feels [17:43] like you want different things right it [17:45] doesn't just feel like a physical [17:47] sensation of I'm full it feels I [17:49] remember taking my godsons to McDonald's [17:51] maybe a week after I started taking it [17:54] and I didn't want a McDonald's and then [17:55] one of my godsons saying to me who are [17:57] you and what have you done with Yan [17:58] right was so contrary to my preferences [18:01] and my fact um one of my low points in [18:04] life was Christmas Eve [18:06] 2009 I went to my local branch of KFC [18:09] just around the corner from where we are [18:10] now cuz I used to live in here and I [18:12] said to the guy behind the counter my [18:13] standard order which is so gross I won't [18:15] repeat it and the guy behind the counter [18:17] said oh yoan I'm really glad you're here [18:18] wait a minute I was like all right and [18:20] he went off behind where they fry the [18:22] chicken and everything and he came back [18:24] with a massive Christmas card and [18:26] everyone was working that day and they'd [18:28] written to our best customer and they [18:30] all clapped me and one of the things [18:32] that was so terrible is I thought this [18:34] isn't even the Fried Chicken shop I come [18:35] to the most right how can this be [18:37] happening to me but so when you speak to [18:39] the The Cutting Edge neuroscientists and [18:40] I interviewed them in great depth [18:42] there's basically three theories about [18:45] what these drugs are doing to your brain [18:47] right very broadly I mean they this is a [18:49] quite crude way of putting it um so one [18:52] is you have in your brain something [18:54] called the reward system the reward [18:56] system is what motivates you to do [18:57] anything so you know you have sex you [19:00] eat you meet up with a friend your [19:02] reward centers hum right it's what makes [19:04] you feel good when you do something [19:06] pleasurable and one theory about these [19:09] drugs is they dampen your reward system [19:12] so the reason I don't want a Big Mac is [19:13] that a Big Mac is not as rewarding to me [19:15] as it would have been before I took [19:16] these drugs right that obviously brings [19:19] with it a set of risks because then you [19:22] go okay if it's dampening my reward [19:24] system for Big Mac is it dampening my [19:27] reward system for the things I love [19:29] writing reading there's a big debate [19:31] about this there's concern that in some [19:33] people it may be causing suicidal [19:35] feelings and in some people it may be [19:37] causing depression there is a warning on [19:38] the drug to that effect required by the [19:41] FDA the the fin drug agency in the [19:43] United States that's one concern but [19:46] there are other scientists who say that [19:48] we don't that that's not correct that um [19:51] that the suicide risk is not accurate [19:54] and that they don't work by dampening a [19:56] reward system some people like aelia G [19:59] who's at the University of um Alabama in [20:00] Birmingham said to me what he thinks [20:02] that it does is it resets your [20:04] preferences it's almost like taking your [20:06] phone back to the factory settings it [20:08] resets key elements of the kind of food [20:10] you want to a healthier level can I just [20:12] say on that sorry to interrupt but um I [20:14] was thinking constantly as you were [20:15] talking about your trip to McDonald's [20:17] and not wanting the McDonald's anymore I [20:19] I've come to see in my life that if I [20:21] have something unhealthy if I have sugar [20:23] or a cookie today I'm I feel like I'm [20:26] much more compelled to have another one [20:27] tomorrow I feel like I I I look back on [20:31] certain periods of my life where I [20:33] almost get into a bit of a sugar spiral [20:35] and it could be because of stress or [20:36] some other Factor but it made me think [20:37] that the sugar itself is somewhat [20:39] addicting so when you were talking I was [20:40] thinking is it is it not just a case [20:42] that you're consuming less sugar and you [20:46] know some of these addictive food [20:48] substances so you want it less the next [20:51] day if you know what I'm saying yeah [20:53] there's an experiment that proves you're [20:54] right but in a complicated way um can I [20:57] just finish off one thing about the [20:58] brain and then come back to that raised [20:59] a super important and and truthful point [21:03] the third theory about how it could be [21:04] working in the brain and this comes from [21:06] a scientist called Professor Paul Kenny [21:07] who actually did the experiment relates [21:09] to what you just said he argues that in [21:12] your brain you don't just have a reward [21:13] system you have something called the [21:14] satiety system and this is a crucial [21:17] concept for people who want to [21:18] understand these drugs and what's gone [21:20] wrong with our diets more generally to [21:21] understand satiety is just the feeling [21:23] of having had enough right we've all had [21:25] the feeling of being sated you're like [21:27] okay I'm done I don't want anymore we [21:28] get that with food sex all sorts of [21:30] things right you're just sated um he [21:33] argues that in your brain there there's [21:34] basically alongside the reward system [21:36] there's also a satiety system A system [21:38] that just says Stephen you've had enough [21:41] stop now and he argues that what these [21:43] drugs do is they dial up your satiety [21:45] system they don't dial down your reward [21:47] system right there's a huge and ongoing [21:49] debate about that what we do know is [21:51] they're having some really significant [21:52] effect on the brain and that has all [21:55] sorts of implications that we need to [21:56] think about when I was learning about [21:58] this [21:59] I remember [22:00] thinking this is a much more intimate [22:04] and risky transformation than when you [22:06] first hear oh I'm taking something that [22:07] affects my stomach right so there's a [22:10] lot there about the brain and [22:11] implications for addiction as well which [22:13] we can talk about but to come to the [22:14] thing you asked about which is so [22:16] important of all the things I learned [22:18] there was an experiment that kind of [22:20] freaked me out about this um because [22:22] obious I was trying to figure out well [22:24] how did we get to this point because at [22:26] first glance I can see how it seems [22:27] crazy in a way it did to me you know we [22:31] gained an enormous amount of weight in [22:33] the last 40 years I was born in 1979 the [22:36] year I was born 6% of British people [22:38] were obese it's now 26% right staggering [22:42] increase unprecedented in human history [22:45] and it seems extraordinary that we've [22:47] reached the point where we would inject [22:50] ourselves with a potentially risky drug [22:51] to stop us from eating it seems so [22:53] unnatural and so wrong and I was trying [22:56] well how did we get here right what [22:57] happened [22:59] which is why satiety is so important so [23:01] it's this experiment that I think helps [23:03] to understand that thing you were saying [23:04] about sugar it's done by this guy [23:06] Professor Paul Kenny who's the head of [23:08] neuroscience at Mount siai in New York [23:10] and a brilliant [23:12] neuroscientist so Paul grew up in Dublin [23:16] and he moved to the US when he was in [23:18] his 20s to do his PhD I think and he [23:20] moved to San Diego first and it quickly [23:23] clocked Americans do not eat like Irish [23:25] people right they eat much more sugar [23:27] much more fat they eat just much more [23:29] right and within being within like a [23:31] year of being there he'd gained I think [23:33] a stone and a half or something uh so he [23:35] gained I think it was 23 pound so it [23:37] gained a lot of weight and he started to [23:39] wonder sort of like the question you [23:40] were asking does this food when you [23:44] consume it change your brain in ways [23:47] that compel you to consume it more [23:49] what's going on so he designed an [23:51] experiment that sort of investigated [23:53] this uh which I've nicknamed cheesecake [23:55] park that's not its official name right [23:58] um you get a load of rats and you raise [24:00] them in a cage and they've just got the [24:02] kind of food that rats evolved to eat [24:04] over thousands of years it's pellets [24:05] based on their natural diet and if you [24:07] do that even though they've got far more [24:09] pellets than they could actually eat [24:11] they will eat enough to deal with their [24:13] hunger and then they just naturally stop [24:15] right so when they've got the kind of [24:16] food they evolve to have they never [24:18] become overweight or obese they just [24:20] stabilize their weight they've got a [24:22] kind of natural nutritional wisdom then [24:25] Professor Kenny introduced the American [24:27] diet to them [24:28] he fried up some bacon he bought some [24:30] Snickers bars and crucially he gives [24:32] them a load of cheesecake and they come [24:34] along and they nibble the cheesecake and [24:35] the other stuff and quite quickly they [24:38] just go wild for it they shun the food [24:41] they evolved to have and they just start [24:43] obsessively eating the cheesecake the [24:46] fried the fried bacon the Snickers bars [24:49] he described to me how they would like [24:50] he would put the cheesecake in and they [24:51] would just hurl themselves into the [24:53] cheesecake and then like eat their way [24:55] out and emerge like completely slicked [24:57] with the cheesecake so given this kind [24:59] of food all their nutritional wisdom [25:01] disappeared just went away and they [25:04] became obsessed with this new kind of [25:06] food um and as he put it to me within a [25:10] couple of days they were different [25:11] animals their all their health [25:12] indicators were worse they were [25:14] obsessively eating within a few weeks [25:16] they were their health was really bad [25:17] they became extremely obese and then he [25:20] varied the experiment even more in a way [25:22] it seemed to me as a former junk food [25:23] addict a little bit cruel he took all [25:26] the American diet away and they just [25:28] have the food they evolved to have the [25:30] food they used to eat right and he was [25:31] quite sure he knew what would happen [25:33] that they would eat a lot more of the [25:35] kind of natural food than they had [25:37] before and this would prove that junk [25:39] food expands your appetites that isn't [25:41] what happened what happened was much [25:43] worse they completely shunned the [25:45] natural food it was like they no longer [25:48] recognized it as food at all they just [25:50] refused to eat it they starved and it [25:52] was only when they were really starving [25:54] that they went back to eating the [25:55] natural food there's lots of human [25:57] examples of but there's something as [25:59] Professor Gerald M who's a nutritionist [26:01] at Harvard said to me there's something [26:03] about the food we're eating which I [26:05] think you're getting out in that [26:06] question which is undermining our [26:08] ability to know when to stop which is [26:10] how we got to the point where we so many [26:13] people 47% of Americans want to take a [26:15] drug that will make them stop I was [26:17] reading about this um thing you call the [26:20] Cheesecake Park in your book in Chapter [26:23] 2 and the other sort of Step he took the [26:26] experiment to was the whole idea of [26:28] electrocuting the animals when they ate [26:30] certain foods and you say in the book [26:33] that he then um would electrocute the [26:35] animals while shining a yellow light in [26:37] their eyes so that they would eventually [26:38] become scared of this yellow light and [26:40] in the case of um the natural food when [26:42] he Shone the yellow light in their eyes [26:44] they would run away but even if you [26:46] Shone the yellow light in their eyes [26:47] while they were eating the junk food [26:48] they would stay and continue to eat the [26:50] cheesecake which kind of the conclusion [26:52] in Chapter 2 of your book as I've [26:53] written it here is and the thing this [26:56] came from the researcher if you're [26:58] exposed um to this food for a while Paul [27:00] concluded the desire for it is so great [27:03] that you will ignore all sorts of [27:04] negative consequences to eat it as we [27:07] know as I know in my own life right my [27:09] KFC Obsession had obvious negative [27:11] consequences in my life and the reason [27:12] this is so important in relation to [27:14] these drugs so for a long time I was [27:15] looking at two things right I was [27:17] looking at why did we so many of us gain [27:20] so much weight so rapidly obesity has [27:23] trebled globally in my lifetime right [27:25] completely unprecedented human history [27:27] why did that happen [27:28] and how do these drugs work and at first [27:30] I thought they were like parallel lines [27:32] right but actually I realized they were [27:33] like kind of braided plats the answer is [27:35] completely densely interconnected what [27:38] we know is the kind of food we eat [27:40] profoundly undermines our sense of [27:42] satiety it completely disrupts just like [27:45] it did with the rats it we don't get [27:47] that signal you're full you've had [27:49] enough stop from the kind of food we're [27:51] eating and what these drugs do is they [27:54] res restore a sense of satiety Carell [27:56] Laro another one of the key scientists [27:58] who develop these drugs said to me what [28:00] these what these drugs give you is [28:02] satiety hormones they give you back a [28:04] sense of being full and in a way at [28:06] first I thought well that makes the [28:10] whole thing seem crazy right because [28:12] there's a guy called Michael low [28:13] brilliant Professor um at Drexel [28:15] University in Philly he said to me look [28:18] you got to understand these drugs are an [28:20] artificial solution to an artificial [28:22] problem we've artificially created this [28:24] problem through a catastrophic food [28:27] system that is screwing bring us up from [28:29] childhood and then Along come these [28:31] drugs as the artificial solution to that [28:33] and the first thing you think is right [28:36] we' got to deal with the fear system [28:37] right and that is absolutely true and [28:39] correct and I remember going to one of [28:41] my closest friends um I call her Judy in [28:43] the book it's not a real name who you [28:46] know she'd had cancer seven years before [28:48] so I've been with her all through that [28:49] kind of really grueling process and it [28:51] was an absolute nightmare she's a single [28:52] mom and you can imagine how how Grim [28:55] that was um and I said to her I feel [28:59] like a complete fraud taking these drugs [29:01] right I'm always talking about how we [29:02] need to deal with the causes of social [29:04] problems I can see very clearly the [29:06] cause of this problem and this is just [29:09] sort of dealing with the symptom and she [29:11] said to me look [29:15] Johan you can stop taking this drug [29:17] that's fine do it if you want to but [29:20] when I had cancer we know there is [29:22] something in the environment that is [29:24] triggering breast cancer in women right [29:26] one in seven women in now get breast [29:28] cancer that didn't happen in the past [29:30] it's not happening in Japan where it's [29:32] only one in 38 women something is really [29:34] wrong in Britain and the US in the way [29:36] we're living that is triggering breast [29:37] cancer right but she said to me you [29:39] didn't say to me when I got breast [29:42] cancer well [ __ ] me all this [29:44] environmental problem has caused this [29:46] breast cancer and now you want to inject [29:47] yourself with another poison [29:49] chemotherapy in order to deal with it no [29:51] you said okay we've got an environmental [29:53] problem obviously that environmental [29:54] problem needs to be dealt with but [29:56] you've got to stay alive or you you [29:58] can't deal with it right the analogy she [30:00] gave me that really helped me was she [30:02] said if your house is on fire right you [30:05] could say well look we need to build [30:08] houses that aren't made of flammable [30:09] materials and we should make it the law [30:12] that you've got to have Sprinklers and [30:13] of course I agree but the first thing [30:16] you got to do is put out the fire in [30:17] your house right and I after that [30:20] conversation it was just after it I I [30:22] met a guy called Jeff Parker he's in San [30:24] Francisco he's a 66 year old lighting [30:27] designer who was about 16 Stone when I [30:30] when when he first started taking weight [30:32] loss drugs and he was in real trouble [30:34] heart problems liver problems kidney [30:36] problems it was very painful for him to [30:38] walk and he got mjo which is the next [30:41] Generation up of these weight loss drugs [30:43] and he lost loads of weight and all his [30:46] health problems reversed and now he [30:47] walks his dog over the Golden Gate [30:49] Bridge every day and is really happy and [30:51] said look I feel like now I'm going to [30:52] enjoy my retirement and I said to him [30:54] but Jeff I'm don't you feel like we [30:57] should be dealing with the environment [30:58] mental causes and he said absolutely I [31:00] totally agree with you you start that [31:02] campaign sign me up but I've got to tell [31:04] you by the time we achieve that I'm [31:06] going to be dead right we're not going [31:08] to get there in the next few years and I [31:10] want to live and I found [31:13] that I found it hard to [31:15] dispute what what if people say well you [31:17] know you could um you could just not [31:20] choose the role at the coffee shop in [31:23] the morning you could have just gone for [31:24] I don't know a salad or something yeah [31:26] it's a choice you're making Johan [31:28] make better choices so this was [31:29] completely the voice in my head I [31:31] remember another one of my friends when [31:33] I was at dinner and I was doing this I [31:35] was talking through everything I've been [31:36] learning and I was talking about you [31:37] know the r What You Got Away here I [31:40] thought was the risks of obesity which [31:42] are really disturbing when you learn [31:44] about them I was actually surprised we [31:47] all know obesity is not good for your [31:48] health but I was actually stunned when [31:50] you look at the evidence about how bad [31:52] obesity is view in relation to not just [31:54] diabetes but cancer dementia across the [31:57] board we can come back to that so I was [31:58] like well you got to weigh these risks [32:00] of obesity against the risks of these [32:03] drugs and I learned that there are 12 [32:04] significant risks associated with these [32:06] drugs and he said what are you talking [32:09] about you haven't got to weigh those [32:10] risks at all there's a third option go [32:13] on a diet exercise right and he said [32:15] I've seen you do it you've done it [32:16] plenty of times right do that and of [32:19] course I had this voice in my head I [32:20] thought I was cheating um and I thought [32:23] well why don't I do why why am I not [32:25] doing that right um and I really began [32:28] to get an insight into this when I I [32:30] went to interview an amazing person [32:31] called Professor Tracy man who's in [32:33] Minneapolis where I met her um who's [32:36] done some of the most important research [32:37] on diet ever I remember actually I met [32:40] her I interviewed her in a place called [32:41] is bun which is um cinnamon bun shop [32:44] famous cinon bun shop in Minneapolis [32:46] when I arrived the guy on the door said [32:48] have you ever been here before and I [32:49] said no and he said I will give you a [32:51] free cinnamon bun then they gave me this [32:53] like 2,000 calorie massive cinnamon bun [32:55] that sat there the whole time we were [32:56] talking about diets and Professor man [32:58] she began to research this in the year [33:00] 2000 and she wanted to figure out how [33:03] much do diets work right are they [33:05] effective and at that time the science [33:07] was very clear diets are really [33:10] effective if you go on a diet you will [33:12] lose weight right but she looking she's [33:15] looking at all these studies almost [33:16] 24,000 studies and she noticed as part [33:19] of this big it's called a [33:20] metaanalysis and she discovered [33:22] something a bit weird which is most of [33:25] these studies the overwhelming majority [33:27] would follow people who were on a diet [33:29] for 3 months so you you exercise your [33:32] willpower you go on a diet for three [33:33] months you lose a load of weight and [33:34] then they just stopped and the [33:36] implication was you stay at that lower [33:37] rate forever she' be like I know quite a [33:40] lot of people who are not in that [33:41] position that doesn't happen to them so [33:43] she looked in more detail and discovered [33:45] there were 24 studies that had followed [33:46] diers not just over this short period [33:49] but for two years and in a handful of [33:50] cases five years and when you look at [33:52] the longer picture the picture is really [33:55] different after 2 years [33:58] the average person on a diet has lost 2 [34:00] pounds in weight right so it's not [34:03] nothing but it's pretty close to nothing [34:05] right it's it's extraordinarily low so [34:08] what we know from the research on [34:09] dieting is there's a very small number [34:11] of people around 10% of people who [34:14] really do lose huge amounts of weight on [34:16] diets and keep it off we all know people [34:18] like that I've got someone in my family [34:19] like that right but for the vast [34:21] majority of people it doesn't work and I [34:23] remember saying to Professor man and [34:24] loads of other scientists who looked at [34:26] this well how can that be because we [34:29] know you only have to know the laws of [34:31] physics to know if you consume fewer [34:34] calories than you burn obviously you [34:36] will lose weight to dispute that you [34:37] have to dispute the laws of physics [34:39] right so how can it be that these people [34:41] are dieting but they're not losing [34:42] weight and BR man and other people [34:45] explained to me um something that's sort [34:47] of missing in this picture that I think [34:49] really helps us to understand it and is [34:51] actually important for understanding [34:52] these drugs I think so a lot of the [34:55] scientists explained that there are [34:57] biolog iCal changes that happen as you [35:00] gain weight which make it harder for you [35:02] to find your way back in a in a way that [35:03] you can sustain so in the 60s and 70s [35:06] there was this theory about weight that [35:08] was almost universally accepted it's [35:11] called set point Theory it sounds a bit [35:13] complex but it's pretty simple if you [35:14] think about your temperature your body [35:15] temperature right your body wants you to [35:18] be at the temperature you and me are at [35:19] right now right and if our temperature [35:21] goes higher than that if we get a fever [35:23] or if we go to the Sahara Desert our [35:25] body will work really hard involuntarily [35:27] to bring us down it'll make us sweat it [35:30] will make us really uncomfortable and [35:32] again if you're and also if your [35:33] temperature goes below the temperature [35:35] we're currently at your body will start [35:37] to shiver again it will make you really [35:39] crave heat right so your body has a set [35:42] level at which it keeps your temperature [35:44] and it works extremely hard to keep you [35:46] in that zone for your whole life and it [35:49] was thought for a long time that your [35:51] weight was a bit like that that when [35:52] you're born or possibly even in the womb [35:54] you have a biological set point for your [35:56] weight that That Remains the Same [35:58] throughout your life and you can go a [35:59] bit higher or a bit lower but basically [36:02] you're fixed there but then the Obesity [36:05] crisis happened starting in the late 70s [36:06] early 80s there's a huge weight rise in [36:09] such a large part of the population and [36:11] it looked like oh set point theory is [36:13] just wrong right that can't be correct [36:15] because if it was true then you couldn't [36:17] possibly have this but then Professor [36:19] low at Drexel and other places and other [36:22] people um discovered what what is really [36:25] happening in my view I think they [36:27] produced very compelling evidence for [36:29] this as you gain weight your body's set [36:32] point Rises right so let's say my body [36:35] wanted me to be 18% body fat as I get to [36:38] 30% body fat my body will then fight [36:41] very hard to keep me at that higher [36:43] level right which seems really weird at [36:45] first why would that be so if you if you [36:47] let's say you gained three stone right [36:49] and then you tried to lose weight we [36:51] have think of a hypothetical Robert [36:52] dairo for the movie Raging Bull gained [36:55] you know three or four stone right and [36:57] then tried to cut back but what you'd [36:59] find was your metabolism would massively [37:02] slow down so it would you'd have to burn [37:05] far more to get the same number of [37:06] calories as you do now uh you would [37:08] crave far more sweet and salty foods you [37:11] would have lower energy so you would [37:12] find it harder to exercise so your set [37:15] point has risen and it's trying to keep [37:17] you there and I remember saying to loads [37:19] of scientists well that just seems [37:21] bizarre why would Evolution endow us [37:23] with that that's such a maladaptation [37:25] right why would why would um [37:28] why would it be and they explained to me [37:30] well you have to think about the [37:31] circumstances where we evolved in the [37:33] circumstances where humans evolved in [37:35] fact every human circumstance pretty [37:36] much until like 100 years ago there was [37:40] never a situation where you would have [37:41] completely abundant calories in fact [37:44] hyper abundant calories for your whole [37:46] life you'd have far more calories around [37:48] you than you could ever possibly eat [37:49] that never happened so your body didn't [37:51] Evolution didn't prepare us with good [37:53] instincts for that what you did have [37:55] what was a big risk was famine [37:57] right there was a big risk that at some [38:00] point in your life food would run out [38:02] and you would be in real trouble and in [38:04] a famine the fattest person at the start [38:07] is going to be the last man standing [38:08] right Timothy shalomay will die in week [38:09] one of a famine and you know John Candy [38:12] will still be alive at the end of it Al [38:14] not a great example because John Candy [38:15] has died but you get the point right um [38:17] so actually that's why our Evolution [38:20] prepared us that oh if you gain weight [38:23] fight to hold it cuz sooner or later [38:25] you're going to have to lose it in a [38:25] famine anyway so evolve with this [38:28] Instinct that when we gain weight we [38:30] experience these biological changes that [38:32] make it harder to go back it's not [38:33] impossible willpower is a real thing [38:36] some people can do it but when you try [38:39] you are fighting against your own [38:41] biology you're also fighting against [38:42] your psychology and your environment for [38:44] different reasons we can explore so it's [38:46] not that dieting doesn't work but we've [38:48] got to be honest at any given time 177% [38:51] of people are on a diet we've really [38:54] tried that route right we've had you [38:55] know 40 Years of relentless ly promoting [38:58] dieting as the o or diet and exercise as [39:00] the only solutions and we've gotten [39:02] fatter and fatter and fatter so there's [39:04] something missing in that picture I [39:05] think it's partly set point Theory it's [39:07] also important for the drugs because [39:08] some people argue like the guy I [39:09] mentioned before in relation to the [39:11] brain Professor orelio G some of them [39:14] argue that what the drug may be doing is [39:16] actually resetting your biological set [39:17] point lowering the kind of temperature [39:20] at which your body tries to keep your [39:22] weight it's bringing your set point down [39:24] so that you don't get those effects like [39:26] the metabolism slowing and all the other [39:27] things that kick in when you try to lose [39:29] weight I think on average and this might [39:31] not be accurate but I think on average [39:33] we live more stressful lives than we [39:34] once did as well and I wonder the [39:36] relationship that are more stressful [39:38] more frantic more busy notification [39:40] filled social media driven screen time [39:42] lives are having on our relationship [39:45] with food and if there's a relationship [39:47] there at all you know more more kids [39:49] have ADHD now than ever you know [39:51] cortisol level seems to be skyrocketing [39:53] and it seems there's a relationship [39:54] between stress and appetite which is as [39:57] a gravitational force against our [39:59] willpower no you're totally right and [40:01] this is when I go through the 12 risks [40:04] of the the drugs in the book this is one [40:07] that I really worried about one that [40:08] played out for me so I noticed I had [40:10] this weird thing about six months since [40:13] taking the drug I had this realization [40:14] so I was losing a lot of weight right I [40:16] lost a huge amount of weight I lost [40:17] three stone three stone in what period [40:19] of time from from now to when I started [40:21] so just over a year and how quick how [40:23] quick was that weight loss just out of [40:25] Interest before we move on PR pretty [40:27] straight linear line downwards from from [40:29] the start but I had this strange [40:31] sensation I had a a my friend Danielle [40:33] was pregnant at the time I kept bumping [40:35] into her and it was like we we were on [40:37] opposite trajectories like she was [40:38] swelling and I was shrinking um I [40:41] remember walking away from her once and [40:42] thinking this is really weird I'm [40:44] getting what I want why don't I feel [40:47] better about this right I I didn't [40:49] actually feel that much better for quite [40:51] a long time for about six months [40:53] thinking why is that so what you mean by [40:55] better I felt quite m [40:57] in my emotions I [41:02] felt I felt I wouldn't say I definitely [41:04] wasn't [41:05] depressed but I felt a little bit dulled [41:09] I thought this is strange I thought [41:10] maybe it's just other things going on in [41:11] my life you never know when it's just an [41:13] individual but lots of people are [41:15] reporting this most people are very [41:16] happy when they take drugs but there's a [41:17] significant minority and so I started [41:20] looking at exactly this question the [41:21] psychology of eating and it turns out [41:23] there's kind of five the scientific [41:24] evidence for five reasons why we eat [41:27] um and obviously the first and most [41:29] important one is sustenance right I [41:31] would have thought if you'd asked me a [41:32] year ago why do you eat I would said [41:33] well the main reason is to sustain my [41:35] body but here I am eating so much less [41:37] than my body is sustained so all those [41:39] other calories I was consuming were [41:41] doing something else right and one of [41:43] the things one of the reasons we eat and [41:44] another one is pleasure which we've [41:45] talked about but another reason why [41:47] people eat is Comfort right people get a [41:50] tremendous amount of comfort out of food [41:52] particularly overeating can be very [41:54] comforting we know this partly because [41:56] whenever there's a stressful event uh [41:59] junk food orders massively go up after [42:01] 911 there was a huge increase in [42:02] ordering people ordering pizzas and [42:04] fried chicken the night Trump won the [42:06] election in blue States on Uber Eats and [42:08] the other kind of delivery apps there [42:09] was a massive increase in people [42:11] ordering tacos you know um shitty food [42:15] right um if you if you're you're a man [42:17] and you lose your job your chances of [42:19] gaining weight massively increase partly [42:21] because it's so upsetting and you eat to [42:22] comfort yourself um and one of the [42:25] things that happens when you take these [42:26] drugs [42:28] is your ability to comfort eat is taken [42:29] away from you you can't Comfort eat and [42:33] we've got a good analogy I think a good [42:36] precedent for helping us think about how [42:38] that affects you so the best comparison [42:41] for these drugs if we're trying to [42:42] figure out their effects I think is [42:44] bariatric surgery right so up to now it [42:47] was very hard to sustainably lose like [42:49] more than 20% of your body weight the [42:51] only way it was possible to do it very [42:54] quickly was bariatric surgery I think we [42:55] have to look at the outcomes that's [42:57] stomach stapling there's four different [42:59] kinds of it but it's basically what we [43:00] think of a stomach stapling stomach [43:02] operation exactly that's one form of it [43:04] right and so I think you have to look at [43:06] the evidence from gastric surgery and in [43:08] some ways it's very encouraging so we [43:10] know that gastric band surgery and other [43:12] forms of gastric surgery massively boost [43:15] your health if you have one of these [43:17] operations over the next seven years you [43:20] are 56% less likely to die of a heart [43:22] attack 60% less likely to die of cancer [43:26] and 92% % less likely to die of diabetes [43:28] related causes in fact it's so good for [43:30] your health that of you are 40% less [43:34] likely to die of any cause over the next [43:36] seven years right so we know reversing [43:38] obesity massively boosts physical health [43:42] in most cases right sometimes very [43:45] dramatically but we also know from [43:47] bariatric surgery there's plenty of [43:48] downsides to bariatric surgery it's a [43:50] horrendous operation and one in a [43:51] thousand people die during the operation [43:53] it's Grim but we also know where I think [43:55] it's really important to the thing [43:56] you're asking about is that it has an [43:59] effect on your psychology so a lot of [44:00] people are much happier most people who [44:01] have that surgery are glad but 177% of [44:05] people who have that surgery have to [44:07] have impatient psychiatric treatment [44:09] afterwards because they're so depressed [44:10] or distressed your chances of committing [44:12] suicide almost quadruple after you've [44:14] had bariatric surgery and I think [44:16] there's lots of reasons why some of it [44:17] must be the grimness of the operation in [44:19] the aftermath but I think a lot of it is [44:22] you know you take away Comfort eating [44:24] from people right if you go through life [44:27] especially people who had gastric band [44:28] surgery or the other surgeries you know [44:30] those are people who were very severely [44:32] obese so they would have had this effect [44:33] very powerfully in their lives most of [44:35] them if you take away something that is [44:37] a key way of soothing [44:40] people when that goes well you can [44:43] rebuild your life you can find other [44:44] ways to get that soothing and that's [44:46] really valuable and important but a lot [44:48] of people just experience it as [44:50] profoundly painful and distressing and I [44:52] inter a lot of people like that when [44:53] people have those surgeries I read in [44:55] your book in chapter eight that one in [44:57] 10 people then pick up a different type [44:59] of addiction to alcohol or gambling or [45:01] shopping or drugs or something else so [45:04] that's pretty clear evidence that [45:05] there's the psychological soothing is [45:07] just moving somewhere else it's [45:09] fascinating and and and distressing and [45:11] OB I spoke to people who'd been through [45:12] those what called an addiction transfer [45:14] um I spoke to this amazing woman called [45:15] Robin Moore who uh had been [45:20] 303 she'd had um bariatric surgery [45:24] because just nothing else had worked and [45:25] she felt she was really a slave to that [45:27] was how she put it and it had this [45:29] incredible effect she she knew why she [45:32] had gained her gained weight so much in [45:36] her case it was she when she was a child [45:38] she had been sexually abused she'd been [45:39] raped and she'd never told anyone and [45:42] she quite deliberately gained weight in [45:44] order to keep men away from her she [45:45] thought well if I'm if I'm really fat [45:47] I'm less likely to be [45:48] attacked um which is surprisingly common [45:52] and she lost all this weight and she [45:55] felt great she felt physically much [45:57] better people were treating her much [46:00] better but she had this shift where she [46:05] she'd never been much of a drinker she [46:06] had a periods when she was at College [46:08] where she drank a fair bit but you know [46:09] she'd never been a heavy drinker and she [46:12] just quite rapidly became a very [46:14] full-blown alcoholic she used to work [46:15] out by the airport in Toronto and she [46:18] would you know drink on the way there [46:20] drink on the way back and she got fired [46:22] because she was drunk at work [46:24] eventually and um for her she she kind [46:27] of realized you know and I think it's [46:30] interesting ways to think about this in [46:31] relation to these [46:32] drugs I want to stress this is not going [46:34] to be everyone I don't think there's [46:35] even going to be a majority of people by [46:37] any [46:38] means [46:39] but when you take these [46:43] drugs the underlying psychological [46:45] reasons that drove your eating are [46:48] profoundly disrupted and in many cases [46:50] come to the surface and for me that was [46:53] help painful at first but helpful I [46:55] remember having a day in Vegas as you [46:56] know SP lot of time in Vegas cuz writing [46:57] a book about a series of crimes that [46:59] have been happening there I had dayse [47:01] investigating something really grim and [47:03] I I felt really bad and it was relating [47:04] to someone it's a long story but [47:06] something terrible and I went to the KFC [47:09] on West Sahara it's the grimmest KFC in [47:11] the whole world I have a secret love for [47:12] it and I on kind of [47:15] autopilot I ordered what I would always [47:17] have ordered you know like a load of [47:18] fried [47:20] chicken and I sat there and I thinking [47:23] oh [ __ ] I can't eat this I remember [47:27] Colonel Sanders was on the wall looking [47:28] down and was like he was going to be [47:30] what happened to my best customer right [47:33] so being deprived of comfort eating is [47:35] is quite apart from the being deprived [47:37] of pleasure which I think is sort of [47:38] related but a bit different is is is [47:41] very difficult and again my friend who [47:43] I'd spoken to had cancer went to her and [47:44] said this is really hard right and she [47:47] said look it's not that the drug is [47:50] causing this problem the drug is making [47:52] this problem visible to you and now you [47:54] can deal with that in other ways right [47:56] and that's I've been trying to do and [47:58] write about how in the book but yeah so [48:00] one of the things that fascinated me [48:01] about all the research for for my book [48:03] magic pill [48:04] was how incredibly complex this is every [48:07] time you look at one effect it seems to [48:08] have another effect this is a really [48:12] complicated difficult topic and anyone [48:14] who's coming in telling you either rah [48:16] rah these drugs are great and they're [48:18] going to save us all or these drugs are [48:20] devils it's terrible um I don't think [48:23] it's leveling with people I think it's [48:24] complicated I think there's risks every [48:26] turn and I think we need to think [48:28] through the complexity together in a way [48:29] that's honest and and and honors the [48:33] complexity you talk there about the [48:35] impact that early childhood trauma has [48:37] on our relationship with food and eating [48:38] um I remember reading a little bit about [48:40] that in your previous book lost [48:41] connections as well but what is what [48:43] what is the sort of data in the stats [48:45] that that prove that trauma can cause us [48:47] to have this kind of excessive comt [48:51] seeking relationship with food is there [48:53] any particular studies that stand out [48:54] for you oh yeah I mean a guy that I got [48:56] to know quite well when I worked on Lost [48:58] connections and I thought about this [49:00] Research In a Different Light when I [49:02] worked on this book there's a guy called [49:04] doctor Vincent felitti and in the early [49:07] 1980s he was a doctor in San Diego and [49:10] he was contacted by kaisa Permanente who [49:12] were a big not for-profit MediCal [49:14] provider in the [49:15] state and they said to him look we got a [49:18] problem we don't know what to [49:19] do obesity was massively Rising actually [49:22] it was very low by our standards but it [49:23] was hugely rising and they were trying [49:26] giving people diet plans and exercise [49:28] plans and nothing was working and they [49:29] said we don't know what to do can we [49:31] give you a load of money to just do blue [49:32] skies research go away figure out what [49:35] we can do and he said okay so he took a [49:37] load of money and then he's like what [49:38] can I do and he started working with 200 [49:42] very very obese people people who were [49:43] severely obese who had tried all sorts [49:45] of ways to cut back and it hadn't worked [49:48] and he's sitting there working with them [49:49] and he's thinking what can I do and he [49:51] had an idea that sounds and actually is [49:53] quite stupid he said well what would [49:56] happen if really obese people literally [49:58] stopped eating and we medically [50:00] supervised it and we gave them vitamin [50:02] shots so they didn't get like scurvy or [50:04] whatever would they would they burn [50:06] through the fat stores in their body and [50:07] get back to a healthy weight so with a [50:09] shitload of medical supervision they did [50:11] it and Incredibly at first it worked [50:14] there was a woman who I'll call Susan [50:15] that's not her real name who went from [50:16] being more than 400 to 138 it was [50:20] incredible right and you know her family [50:22] are ringing the doctor and saying you [50:24] saved Susan's life she's really thrilled [50:27] and then one day something happened that [50:29] no one [50:31] expected she cracked she went to KFC or [50:35] wherever it was she starts obsessively [50:37] eating and after a while she's back [50:39] where she was not exactly where she'd [50:40] been but [50:42] similar and Dr feli called her in he [50:45] said [50:46] Susan what happened she looked down she [50:49] was obviously really ashamed she I don't [50:50] know I don't know he said well tell me [50:53] about that day right the day you cracked [50:56] did anything happened that day that [50:57] didn't happen any other day it turns out [51:00] something happened that day that had [51:01] never happened to season before um she [51:04] was in a bar and a man hit on her not in [51:05] a nasty way in quite a nice way but she [51:07] just felt completely freaked out and she [51:09] went and started eating and that's when [51:11] Dr feli said to her well Susan when did [51:14] you start gaining weight in her case I [51:15] think it was when she was 10 he said [51:18] well did anything happen when you were [51:19] 10 that didn't happened when you were 9 [51:21] or 11 or anything happened that year she [51:24] looked down and said well that's that's [51:26] when my grandfather started raping [51:28] me Dr Fel interviewed everyone in the [51:30] program he discovered that 60% of them [51:33] had made their extreme weight gain in [51:35] the aftermath of being sexually abused [51:37] or assaulted which is a staggering [51:38] figure right 60% of the women um and it [51:42] was like well how could this be he was [51:44] really puzzled and Susan explained it to [51:46] him really well she said overweight is [51:48] overlooked and that's what I need to be [51:51] right if you're severely overweight [51:52] you're much less likely to to be [51:54] sexually attacked right it's obviously [51:56] can happen but it's it's rarer um and [51:59] when you understand that you begin to [52:01] see again in relation to these drugs [52:04] um why some people get really freaked [52:07] out when they take these drugs because [52:08] some of them experience it as suddenly [52:11] oh my God I'm really vulnerable to this [52:13] traumatic event being reenacted again [52:15] and again now that's one example there's [52:17] lots of if we go down the the list of [52:19] reasons why people eat like I do in the [52:21] book there's lots of other ones that get [52:22] triggered and activated as and disrupted [52:24] as well you talk in the book about this [52:26] this word I've never really come across [52:28] before which is um it's a phrase I guess [52:30] you say the environment is [52:32] oogenic I I've only ever heard of that [52:34] term cogenic carcinogenic carcinogenic [52:38] yeah which basically means something can [52:39] give you cancer but you're saying that [52:40] the environment we live in is I mean the [52:44] way that I read it was like that that [52:45] it's almost contagious like it's going [52:48] to give me obesity just by being alive [52:50] in the modern world um one of the stats [52:53] that really stood out to me when you're [52:54] talking about processed food is that on [52:56] average when we eat processed food we we [52:58] end up eating 500 more calories every [53:00] single day and um that again is [53:04] startling you know I've had a few guests [53:05] on this podcast that I've talked about [53:06] processed food and the rise of it and I [53:09] do Wonder to myself if there's ever [53:13] going to be a change in society if we if [53:15] there's any indication that at some [53:17] point I don't know government will step [53:19] in and ban it or tax it more or [53:21] something will happen what's your what's [53:23] your view on if we talk about the [53:25] optimism of the penic environment [53:27] changing do you think it can change do [53:29] you think it will so crucially I went to [53:31] a country that had completely [53:33] transformed its diet and as a result has [53:35] very low obesity Japan we can talk about [53:37] that and I went to loads of countries [53:39] that are making the changes you're [53:41] talking about so prompt me to come back [53:42] to that but I would start by saying well [53:44] a you're totally right we live in an [53:45] obesogenic environment an obesogenic [53:47] environment is an environment that [53:49] primes you to be obese and where it's [53:51] hard to be a healthy weight right it's [53:53] hard to get healthy food healthy food is [53:55] expensive and rare whereas shitty food [53:58] that makes you obese is cheap abundant [54:00] and constantly promoted to you right so [54:03] that's an obesogenic environment and [54:04] there's loads of evidence that well as [54:06] Professor Michael L put it to me we live [54:08] in as obesogenic an environment as human [54:11] beings could possibly design right um [54:13] and there's seven ways in which [54:15] processed food undermines your ability [54:17] to stop eating that I go through in the [54:19] book so if you're feeling pessimistic [54:21] and I'm [54:22] clearly you're right to feel pessimistic [54:25] someone is charismatic and bril as [54:26] Michelle Obama could not even get us to [54:29] join a campaign to physically move so I [54:31] get it there's big obstacles here but [54:34] when you feel pessimistic about it the [54:37] first thing I would say is think about [54:39] smoking right my mother smokes 70 [54:41] cigarettes a day there's a photograph of [54:43] me and her where I'm [54:45] um she's breastfeeding me I'm about six [54:48] months old she's smoking and resting the [54:50] ashtray on my stomach and when I showed [54:53] her this photo I thought she'd feel [54:54] guilty she said you were a [ __ ] [54:56] difficult baby I needed that cigarette [54:58] um but you think about that that was [55:00] normal right when I mean in Scotland [55:01] that was normal when I was a kid right [55:04] um so you think about smoking when I was [55:06] seven years old um more than half of the [55:08] population of Britain smoked right and [55:10] people smoked everywhere people smoked [55:13] on the tube people smoked on planes [55:16] people smoked on game shows the doctor [55:18] would smoke while he was examining you [55:20] I'm not joking I remember that happening [55:21] right so if I could take you back to the [55:24] Britain of 1987 and you could walk [55:26] around you would just you would feel [55:28] sick because the smell of smoke was [55:30] everywhere right and there were just [55:32] ashtrays everywhere funny enough I was [55:33] with my mother when it was the [55:35] anniversary of there was a terrible [55:37] catastrophic fire at King's cross [55:38] station here in London in 1987 I think [55:42] and I was with my mother when it was the [55:43] anniversary a few years ago and uh it [55:45] was a terrible disaster there was a fire [55:47] someone had put out a cigarette near an [55:48] escalator and it killed more than 50 [55:51] people it was awful uh and my mother [55:53] said oh that was the worst day of my [55:55] life and I said oh were you there did [55:57] you know someone who died she said no [56:00] that's the day they banned smoking on [56:01] the [56:02] tube anyway the so if I could take you [56:05] back and I said to you right how many [56:07] years we are on from that now um only [56:11] 12% of British people will be will smoke [56:13] it will be falling and the British [56:15] government will be about to [56:16] progressively ban smoking you won't be [56:18] allowed to smoke indoors anywhere except [56:20] your own home the rates will have tanked [56:23] young people will there'll be almost no [56:25] cigarette smoking among young people and [56:27] they're going to progressively ban it by [56:29] age that would have seemed ludicrous [56:31] right you would have said well tobacco [56:32] industry is one of the most powerful [56:33] Industries in the whole world uh you've [56:35] got a very motivated half the population [56:38] are addicted it's never going to happen [56:40] these things can change that's a huge [56:42] Public Health uh transformation in a [56:45] very short period of time these things [56:47] can change and I've seen how it can [56:48] change with food so that we're not in [56:50] this situation where we have to choose [56:53] as we are at the moment between for many [56:55] of us not all between the risk of [56:57] obesity and the 12 big risks associated [57:00] with these drugs what are they waiting [57:01] for because the government knows this [57:03] the government knows that processed [57:05] foods and you know the sugar quantities [57:08] that the average person's eating is bad [57:09] so they could presumably get something [57:11] done this year so but they won't there's [57:14] a brilliant writer called Rebecca solnet [57:16] who says politicians are weather veins [57:18] and it's our job to be the weather if [57:20] you're a politician you're constantly [57:21] making a calculation right if I do this [57:24] thing how much praise will I get and how [57:26] much [ __ ] will I get for it right and [57:29] you know some of them are good people [57:30] many of them are good people but you're [57:31] constantly making that calculation in a [57:34] democracy and right now if you do the [57:36] right thing on food and there are loads [57:38] of things we do I saw in Japan we can go [57:40] down the list of all the things we need [57:41] to do um that could transform Health [57:44] particularly for our children you'd get [57:46] some praise but you get a lot of [ __ ] [57:48] right you get a lot of [ __ ] for it and [57:51] for many years of my life I would have [57:52] been one of the people who gave them [57:54] that [ __ ] right so I I understand it [57:57] we have to change that calculation by [57:59] helping people understand and make [58:02] better choices in ways that I saw happen [58:04] so I can explain how they did it if you [58:06] want please Japan is really important I [58:08] think for thinking about how we get out [58:10] of this trap because at the moment um [58:13] the way it's often presented is look [58:16] we're just screwed right there's just [58:18] this huge obese population that's the [58:20] product of being rich if you're a rich [58:22] country you've got lots of calories [58:23] around you inevitably we're going to [58:25] have loads of obesity and inevitably [58:27] we're just going to need to give loads [58:29] and loads of people these drugs forever [58:31] and you know a few years from now as [58:33] many people predicted to me we'll have [58:34] 40% 50% of the population taking these [58:37] weight loss drugs right and what Japan [58:39] showed us is we don't have to choose [58:41] that fate right so if you look at Japan [58:44] Japan is the only country that got rich [58:47] without getting fat 4.5% of Japanese [58:51] people are obese compared to 26% in [58:53] Britain and [58:54] 42.5% in United States and it's actually [58:57] 42% 42% 4.5% are obese 70% are obese are [59:01] overweight right Jesus the norm is to be [59:04] obese or overweight right whereas in [59:06] Japan it's completely the opposite it's [59:07] kind of weird that when we picture Japan [59:10] we often picture sumo wrestlers it's a [59:11] bit like expecting the average American [59:13] to look like a bald eagle or something [59:15] right seers are completely atypical and [59:18] I learned a huge amount about what's [59:19] happening there so the first thing you [59:20] think when you hear that is it must just [59:22] be genetic right theyve just they've won [59:24] the genetic Lottery that must be what's [59:25] going on on but we know that's not true [59:28] because in the late 19th century loads [59:30] of Japanese people went to live in [59:31] Hawaii where I just was um and there's [59:33] now this settled Japanese population in [59:35] Hawaii who've been there for four or [59:37] five generations and they're almost as [59:40] fat as other Hawaiians right so they're [59:42] five times fatter than they're five [59:44] times more likely to be obese than [59:46] Japanese people in Japan so actually [59:48] when the environment changes Japanese [59:50] people become obese like everyone else [59:52] so there's something else going on so I [59:54] wanted to understand how did Japan do it [59:57] and one of the really interesting things [59:59] is it was very consciously done there's [60:01] a guy called Professor Barack kushna [60:02] who's a professor of East Asian history [60:04] in um in Cambridge University who's [60:07] talked about how actually if you go back [60:09] to the 1920s Japanese people had one of [60:11] the worst diets in the world they only [60:12] ate protein once a week they almost [60:14] never ate fish right they only ate fish [60:15] once a week they had a terrible diet and [60:18] the Japanese government at the time [60:20] wanted a healthy population so they [60:22] could form armies that would go and [60:24] invade the rest of Asia [60:26] so they deliberately transformed the [60:28] food culture in Japan very consciously [60:30] so I want to see how do they do that now [60:31] right what's going on so I went to a [60:33] school called COI school um which takes [60:36] kids from 5 to 18 and it was totally [60:39] fascinating so when I arrived there I [60:41] went with my [60:42] translator uh the first you arrive and [60:45] all the kids walk to school on their own [60:47] from the age of five all Japanese [60:49] children just leave the house and walk [60:51] to school on their own so they get a lot [60:52] of exercise in the morning and they walk [60:54] home on their own as well and we were [60:56] greeted at the entrance by a woman [60:57] called harumi tati who's the [60:59] nutritionist at the school by law every [61:03] Japanese school has to employ a [61:04] professional nutritionist it's a [61:06] difficult qualification to get it's [61:07] three years of study on top of learning [61:09] to be a teacher and your job is to [61:12] design and oversee the creation of the [61:13] food in the school all processed food is [61:16] banned no one is allowed to have Pro [61:17] there's no processed food in any [61:19] Japanese schools ever every meal has to [61:21] be prepared from scratch at the start of [61:23] the day um and no one is allowed to [61:25] bring it a pack lunch so every kid has [61:27] to eat the food that's prepared in the [61:29] school uh her job is also to use those [61:32] meals to educate the children about how [61:35] to eat healthily so they teach them all [61:38] sorts of key principles one of them is [61:40] in Japan this is a very deep cultural [61:42] norm you should only eat until you're [61:44] 80% full so it it takes a while for your [61:47] body to realize you're full so if you [61:49] get the signal that you're full while [61:50] you're still eating they're like you've [61:52] eaten too much right so you should eat [61:54] until you're 80% full and then stop [61:56] um there's all sorts of norms that are [61:58] very different to ours so if you look at [62:00] a typical Japanese meal it will have [62:03] five portions significantly more than [62:04] USS but they're pretty small right so [62:06] you might have some fish some Mis miso [62:08] soup a whole range of things um and you [62:12] which is important for your gut health [62:14] because there's a bigger variety of [62:15] ingredients which makes your gut much [62:17] healthier but also you eat it [62:19] differently if you gave us you know a [62:22] meal with three bits generally you'd eat [62:24] all of one then all of another then all [62:26] of another you'd have all the lasagna [62:27] then you have the carrots or whatever in [62:29] Japan that's regarded as like a crazy [62:31] way to eat you have a mouthful of the [62:33] Miso soup then you have a mouth full of [62:36] the white fish then you have a mouth [62:38] full of the sashimi and you you have it [62:40] slows your eating [62:42] down massively if you eat that way um [62:45] they're also taught I remember her [62:47] standing there so the the meals in all [62:48] the schools are designed to be [62:49] nutritionally balanced through these [62:51] five components and so she stands in [62:54] front of the class and teaches the kid [62:55] kids you know okay this is a red rope [62:58] this represents calcium what does [62:59] calcium do kids it makes your bone [63:01] stronger like yes that's this on your [63:03] plate this represents carbohydrates what [63:06] do they do they give you energy and the [63:08] kids yell out so then and then she ties [63:10] the rope together she goes you see now [63:11] it's all tied together now it's a [63:13] balanced meal so they use this healthy [63:15] food to educate the children about how [63:18] to eat healthily it's a very um [63:21] beautifully designed system and it was [63:22] fascinating looking at them I mean got [63:25] tast stepen it was really weird this is [63:27] a school of a thousand children I walked [63:29] through that school all day there was [63:31] not one fat child it it it was it's odd [63:35] like it's jarring when you go right that [63:38] they have you know they have [63:39] extraordinarily low childhood [63:41] obesity and I remember with these kids I [63:44] was asking them their favorite foods the [63:47] first kid I asked said my favorite food [63:48] is broccoli it's like all right the [63:51] second kid said my favorite food is [63:53] seaweed and the third one's like I like [63:55] white rice and I said to CH my [63:57] translator are these kids trolling me [63:59] right like what their favorite foods are [64:01] broccoli and like white rice and she [64:04] just looked kind of puzzled and every [64:05] Japanese person I asked [64:07] said but we teach our children to like [64:09] healthy food don't your children like [64:11] healthy food and I was so taken about by [64:14] these kids I I brought up on my phone [64:17] some pictures of like typical British [64:18] school dinners and showed it to them and [64:21] they literally reacted like I had shown [64:23] them an Isis beheading video they like [64:24] screamed they were like [64:26] what is this and one said did you eat [64:27] this every day I was like yes they're [64:29] saying where's the salad I said there is [64:31] no salad they're just completely baffled [64:34] so they partly start with [64:36] this very strong culture creating a very [64:41] deliberate culture of how to eat [64:43] differently that begins at a very very [64:45] young age there are some other steps [64:47] that are a bit more dodgy that we can [64:48] come to I'm sure but that that was the [64:50] kind of um first um that was the first [64:53] pillar of it that I saw and then over [64:56] here we're in we're in this sort of [64:57] craze of injecting ourselves with this [64:59] thing called a zek can I see the pen [65:01] actually I've never actually seen one [65:02] before I won't open it or anything sure [65:03] course I W contaminate it Z I've just [65:06] been so intrigued to see what these [65:07] things are [65:08] like once [65:10] weekly Nova nordis Nova Nordisk now the [65:14] most valuable company in the whole of [65:15] Europe what what are they give me some [65:17] context on Nova Nordisk they're a Danish [65:19] pharmaceutical company so there's two [65:21] companies that are kind of pushing the [65:23] main drugs in this pushing sounds too [65:25] there you know what I mean so Novo [65:27] Nordisk who a Danish company the entire [65:29] Danish economy has had a massive growth [65:31] because of the popularity of these drugs [65:33] since they came out they've become the [65:35] most valuable company in Europe um the [65:38] market for these drugs is predicted to [65:40] be $200 billion do by the end of this [65:42] decade and the other one is Eli [65:44] Lily and if I how do I get this do I [65:48] have to go to a doctor and get a [65:49] prescription or can I just go buy this [65:51] on online or something so this is part [65:53] of the problem and this leads to one of [65:54] the really big risks associated with the [65:56] drugs which is eating disorders I am [65:58] really really worried about this so [66:00] there are lots of young girls in [66:02] particular some boys but it's mostly [66:03] girls who want to starve themselves [66:05] right we know that it hugely Rose during [66:08] the pandemic and this is the most [66:10] effective tool for self- starvation [66:11] human beings have ever come up with so I [66:13] interviewed a lot of Eating Disorders [66:15] experts who are terrified about what's [66:17] coming down the line and the truth is it [66:19] is very easy to get hold of it I went [66:22] you know you could go online now you [66:23] clearly do not meet the criteria for [66:25] getting these drugs right you've got to [66:26] have a BMI of higher than 27 which is a [66:28] BMI that comes from fat Mass not muscle [66:30] mass so you would not meet the criteria [66:32] at all if you went online you could go [66:35] and see a doctor on Zoom lie about your [66:37] BMI and you would get it in the mail two [66:39] days later right um they're meant to [66:42] check your BMI but on Zoom that's very [66:45] hard to do if in the unlikely event you [66:47] were turned down by a doctor on Zoom you [66:49] can just order effectively counterfeit [66:51] ones online very very easily so I'm EXT [66:55] extremely wide I think we're going to [66:57] have a there are many downsides to these [67:00] drugs possibly the worst from my point [67:02] of view one of the two or three worst is [67:05] you're going to have a huge wave of [67:10] young women who get hold of these drugs [67:12] and and do a lot of harm to themselves [67:14] now that is something we can immediately [67:16] do to massively limit that harm uh lots [67:19] of the Eating Disorders experts I [67:20] interviewed like Dr Kimberly Dennis [67:22] who's one of the leading experts in the [67:23] US said to me these drugs should only be [67:27] given by prescription if you go to a [67:29] physical doctor and the doctor you [67:31] physically go to to get them needs to be [67:33] trained in detecting eating disorders [67:35] and referring people for help with [67:37] eating disorders if that's what they [67:38] think they've got so these were [67:40] initially created for people that had [67:42] diabetes they have a dual effect so glp1 [67:46] the hormone gp1 and this kind of replica [67:48] of it uh stimulates the creation of [67:51] insulin which is obviously what [67:53] diabetics are lacking either type one or [67:54] type two diab ICS so it was the whole [67:57] thing was discovered by accident I [67:58] interviewed the guy who discovered it a [68:00] guy called Daniel draer amazing man so [68:02] they discovered he was just looking at [68:04] um so your whole body is made out of [68:05] cells right and in the 70s it was [68:08] discovered there were new ways of [68:09] looking inside cells that human beings [68:11] had never had before so by the 80s 1984 [68:14] was when he made a breakthrough they [68:16] were just going through different cells [68:17] in the human body trying to figure out [68:19] what they do and they got to the [68:20] glucagon Gene which exists inside your [68:23] your pancreas and they were trying to [68:25] figure out the glucon gene is a long [68:26] chain and at the end of it is gp1 and [68:29] they were trying to figure out well can [68:30] you break off that little bit of the [68:32] chain or if you break it off does it [68:34] just wither and die and he discovered Dr [68:37] duer discovered you can break it off and [68:39] then he was like well what does it do so [68:41] he starts experimenting in lab dishes in [68:43] Massachusetts General Hospital and he [68:46] discovered that if you combine it with [68:48] insulin it produces more insulin so [68:51] that's why it's so valuable for [68:52] diabetics and immediately he was like [68:54] whoa that's really significant so then [68:56] other people in the lab um Professor [68:58] spana mjoy um gave it to rats put it in [69:02] rats and discovered it in fact produced [69:04] insulin in rats a team in Copenhagen put [69:07] it into the pancreas of pigs discovered [69:09] it produced insulin there and that [69:11] setting set in train what later became [69:14] giving it to diabetics so that's the [69:15] most one obviously greatest benefit of [69:18] these drugs that was initially [69:19] discovered is they hugely helped [69:21] diabetics then the effects around [69:23] appetite were discovered separately [69:25] initially here in in London in the [69:27] Hammer Smith hospital that was when they [69:29] discovered oh if you inject people with [69:30] gp1 this is before they had copies of it [69:33] if you inject people with gp1 it reduces [69:35] their appetite oh okay you can see where [69:38] their thinking went from there so [69:39] there's dual uses and the Dual uses are [69:41] kind of incredible if you look at uh the [69:43] effects on diabetics obvious but um if [69:46] you look at the health effects we that [69:47] are emerging around these drugs and this [69:50] is very close to my heart literally [69:51] because of the heart problems in my [69:53] family um if you take these drugs if you [69:55] started with a BMI higher than 27 and [69:58] you take these drugs over the next 5 [70:00] years you are 20% less likely to have a [70:02] heart attack or stroke so we're talking [70:03] about this is some people are like oh [70:05] this is Vanity and there's an element of [70:07] vanity in me and in most people taking [70:09] these drugs I'm sure but this is having [70:12] massive health benefits for lots of [70:14] people how many people are willing to [70:17] take it because as you as we discuss [70:19] this now say that there's I don't know a [70:21] million 10 million people that listen [70:23] what percentage of those people on [70:24] average would go do you know what that [70:26] sounds like the thing I've been looking [70:27] for if they're Americans and the polling [70:29] is Right 47% of Americans have said they [70:32] would be willing to take they want to [70:33] take these drugs actively want oh they [70:34] want to so about 50% of this a the [70:36] audience will be actively wanting to [70:39] take it as we sit here now yeah and now [70:41] tell me [70:43] why they shouldn't well there's a huge [70:46] array of risks um some of which are very [70:49] very serious so I'll give you a few [70:52] examples I go through Lots in the book [70:54] there's a professor in France called [70:56] Professor Jean Luke F who works at the [70:58] University Hospital in melier who was [71:00] commissioned by the French medicines [71:01] agency to investigate these drugs and [71:03] the safety around these drugs and one of [71:06] the reasons lots of people have felt [71:07] very happy about the safety of these [71:08] drugs and it's a good reason is that in [71:11] their roll out for obesity if people [71:13] have said like Daniel duer for example [71:14] who I mentioned who discovered [71:16] gp1 they say quite rightly well look [71:19] diabetics have been taking these drugs [71:21] for 18 years [71:23] now if there was some catastrophic [71:25] effect we would know it would have [71:26] emerged in diabetics right now he would [71:28] also add well it could affect obese [71:30] people a bit differently than diabetics [71:32] so there's some gaps in the knowledge he [71:34] said look we this drug has been used by [71:37] enormous numbers of people all over the [71:39] world without some huge safety concern [71:43] emerging but others have said okay let's [71:46] really dig into those diabetics then so [71:48] that's what Professor f e did so they've [71:50] got they've got very good health [71:51] databases in France the best in the [71:53] world so he decided to look at diabetics [71:57] who' taken these drugs for three years [72:00] sometime between 2006 and I think 2015 [72:03] so he looks at loads of the diabetics [72:05] who' taken them and then he compared [72:06] them to a group of other diabetics who [72:09] were very similar in every other way but [72:10] had not taken these drugs to see are [72:12] their differences and outcome and he was [72:13] particularly looking for one outcome we [72:16] know that when you give these drugs to [72:17] rats they are much more likely to [72:19] develop thyroid cancer so he's looking [72:21] okay is there a difference in thyroid [72:22] cancer risk in this population [72:26] and what he discovered was very sobering [72:27] it was published so the people who' [72:29] taken the drugs had a 50 to 75% increase [72:33] in their risk of thyroid cancer now when [72:34] I first said that I was like what the [72:35] [ __ ] you have to understand what that [72:37] doesn't mean that doesn't mean 50 to 75% [72:40] of people who take the drug get thyroid [72:42] cancer if it was that outcome they would [72:44] pull it immediately and no one would [72:45] ever take it again what it means is [72:48] whatever your thyroid cancer risk was at [72:50] the start it will go up by between 50 to [72:53] 75% if this res Arch is correct right [72:57] this then is being further investigated [72:59] there are some scientists who dispute it [73:01] the European medic medicines agency has [73:03] not been persuaded by the evidence so [73:05] far but that's pretty sobering right [73:09] that's you know 1.2% of people get [73:10] thyroid cancer in their lifetime 84% of [73:13] them I think survive you know a big [73:15] increase in people getting thyroid [73:16] cancer when you're talking about [73:18] millions of people across the world [73:19] taking it is is very [73:21] alarming what about this thing called [73:23] zmek face yeah I'm not worried about [73:26] that purely purely for a selfish reason [73:28] so a zic face is where um I'm worried [73:31] about it for other people a zic face is [73:34] where you lose so much weight that your [73:35] face looks really gaunt and you look [73:38] kind of hollow and a bit my face is so [73:40] naturally round like babies always smile [73:42] at me I think because they think I'm [73:43] their King I'm just like a baby that [73:45] inexplicably got to walk around um I'm I [73:47] could lose so much weight in my face and [73:49] not look G I'm not worried about that [73:50] myself it's there's no um health problem [73:53] with OIC face it's just it's the vanity [73:55] thing well vanity is too negative a word [73:58] it's you know people don't want to look [74:00] gone and Ill that's fair enough [74:02] pancreitis pancreatitis is a rare side [74:04] effect but it's very very unpleasant so [74:07] um pancreatitis is basically where uh [74:10] your pancreas just goes Haywire as a [74:12] result of taking these drugs I [74:14] interviewed a woman called Michelle stnc [74:16] who's in mytle beach in North Carolina [74:18] she she started taking these drugs and [74:20] her doctor said to her you know there's [74:21] a few side effects one of them is [74:23] pancreatitis and she said go no my luck [74:26] I'll probably get it she starts take it [74:27] was really happy with the weight loss [74:29] six weeks later she went to Pittsburgh [74:31] to visit her daughter she woke up in the [74:34] worst Agony she's ever been in she had [74:36] this excruciating pain running all from [74:39] below her breast around to her back she [74:41] was vomiting she was [ __ ] herself [74:44] she was screaming in pain and her [74:46] son-in-law phoned for an ambulance he [74:49] thought she was about to die she was in [74:50] such a state of distress she arrives at [74:52] the hospital and they um discover gone [74:55] really wrong with her pancreas they said [74:57] are you a heavy drinker she said no then [74:59] they said are you taking OIC and it's [75:02] kind of revealing that was the second [75:03] question they asked so we know that um [75:07] if you take OIC there's a study by the [75:09] University of British Columbia that [75:11] found it increases your risk of [75:12] pancreatitis by a factor of nine so [75:14] you're nine times more likely to get it [75:15] it's still rare you're very unlikely to [75:17] get pancreatitis even when you times it [75:20] by nine it's still a very rare outcome [75:22] but you know doctors often compare it to [75:24] the pain of being stabbed Michelle said [75:26] to me it was much worse than the pain of [75:28] child birth right they had to give a [75:30] fenil to take the pain away so if you [75:32] get medical care you recover but so it's [75:34] worth people knowing that is a [75:36] significant risk uh of just an [75:38] excruciatingly painful condition one of [75:41] my friends has started taking a zmek you [75:44] know there's this word on the side of [75:45] this pen in front of me semaglutide [75:48] semaglutide yeah what did I say it's you [75:51] said it the way it's intuitive the way [75:53] the scientist say I think it says it [75:55] looks like semaglutide exactly that's [75:56] how I said it until all the scientists [75:58] kept correcting me in a slightly [75:59] patronizing way but yeah what's the [76:00] actual word semaglutide and is that the [76:03] chemical and is thenex the brand yeah [76:05] exactly so semaglutide so there's [76:07] there's several Brands um so there's [76:10] seaglide which is the drug which has [76:12] this gp1 Agonist effect um OIC is the [76:15] one for diabetes wovi is the one for [76:17] obesity that exactly the same drug [76:19] they're made in the same Factory they're [76:21] identical it's just that wovi is [76:23] marketed for obesity and you you can in [76:25] the US not here yet prescribe wovi for [76:28] higher doses than you would for for for [76:30] diabetics and then there's other drugs [76:32] that are coming along the line so [76:33] there's munaro which is made by Eli Lily [76:35] so oena wovi produces an average of 15% [76:40] loss of body weight over a year mojarro [76:43] causes a loss of 21% on average and the [76:47] next one that will come down the line is [76:48] probably going to come out next year [76:49] Triple G causes 24.2% the reason mararo [76:53] Works differently so this only works on [76:55] gp1 munaro adds another gut hormone Gip [76:59] so it works on two gut hormones not just [77:00] one and Triple G works on three gut [77:03] hormones and there's going to be more [77:04] and more drugs I mean there's 37 gut [77:06] hormones that can affect appetite they [77:08] think so there's going to be lots of [77:10] variance of these drugs with different [77:13] side effect profiles different risks [77:14] different benefits so yeah this is you [77:16] know one of the South African [77:18] psychiatrist called Carell laru who's [77:21] been at the absolute Forefront of the [77:22] developments and they said to me you [77:24] know when a baby starts to walk it's [77:27] been crawling for ages and then it just [77:28] stands up and it walks and we are at [77:30] that point and it was striking how how [77:33] much the scientists kept describing it [77:36] as a game changer you know one of them [77:38] Tim Spectre who I think you might have [77:39] had on described as um it's like they [77:41] found the Holy Grail they found the [77:43] thing that causes weight loss right uh [77:45] Robert Kushner said that to me who's [77:47] another one of the scientists been at [77:48] the heart of it said we cracked open the [77:50] treasure chest we found the thing that [77:52] controls weight it's your gut hormone B [77:56] so I worry about the parallels with [77:59] previous diet drugs and we can talk [78:00] about that these are new drugs working [78:02] in a new way and the the overwhelming [78:05] feeling in the science is no this really [78:07] is different my friend is um a biotech [78:10] billionaire and um when I when I saw him [78:12] so he's at the very Forefront of all of [78:14] these things he takes so many different [78:16] things to optimize his life one of them [78:18] he started taking as a zek and last time [78:19] I saw him he was um we're in the gym [78:22] together and he was significantly weak [78:25] he was significantly skinnier but I [78:28] noticed when we did our exercises he was [78:30] significantly weaker as well and that [78:33] strikes me as a bit of an unspoken about [78:35] side effect is muscle loss it's one of [78:37] the 12 big risks that I write back in [78:38] the book so muscle mass loss is a real [78:41] problem people who don't know muscle [78:42] mass is the total amount of soft tissue [78:44] that you have in your body and it's [78:45] essential for doing anything that [78:46] requires movement and strength basically [78:49] and any form of weight loss causes a [78:51] reduction in muscle mass so if you if [78:53] someone's bur overweight and they lose a [78:55] huge amount of weight on a diet they [78:57] lose a lot of muscle mass hopefully you [78:58] lose more fat mass than muscle mass but [79:00] you lose a lot of muscle mass you can't [79:01] control that right you just there's no [79:03] way to lose a lot of weight that doesn't [79:04] involve some muscle mass loss unless [79:06] you're very very lucky right um so [79:09] obviously this triggers a huge amount of [79:11] muscle mass loss and there's real [79:14] worries with that right um if you lose [79:17] muscle mass so you naturally lose muscle [79:18] mass from when you're 30 onwards anyway [79:20] you lose quite a lot every year it's [79:21] incredibly depressing when you look at [79:23] the figures you lose muscle mass natur [79:25] every year anyway um but if you lose too [79:28] much muscle mass you won't you'll be a [79:30] bit weaker now but the real risks are [79:31] when you're older so if you have really [79:35] low muscle mass when you're older you're [79:37] at risk of a condition called sarcopenia [79:39] which is Greek for poverty of the flesh [79:41] basically just means you'll really [79:43] struggle to climb the stairs do any kind [79:45] of physical activity you're more likely [79:48] to fall if you do fall you're more [79:49] likely to die it's it's quite a serious [79:52] thing and this I think is particularly [79:53] going to be an issue for people who are [79:56] already skinny like the people at that [79:58] party we were talking about right at the [79:59] start none of them were fat at the start [80:01] right people who were already skinny who [80:03] are taking it to be super skinny they're [80:05] going to see they're going to have real [80:06] issues with their muscle mass likely [80:08] when they're older so this is a very [80:10] serious problem we could be building up [80:11] a time bomb of more frail older people [80:14] further down the line you lose up to 20 [80:17] to 30% of your lean muscle mass when you [80:19] start taking a zet says in your book as [80:21] one of the RIS Prof that's for for some [80:22] people yeah not actually weirdly was 33% [80:25] fat Mass when I started and I went down [80:27] to 22% I think it is now so I lost [80:29] nothing but fat Mass but I suspect that [80:31] might be for the slightly humiliating [80:32] reason that I had no muscle to start [80:34] with but I'm not sure and then on the [80:37] psychology the mental health side of [80:38] things suicidality there's some cases [80:41] where suicidality things like feelings [80:43] of anxiety and depression increase is [80:45] that because of the underlying reasons [80:47] why we're eating the self- soothing [80:49] stuff or is that a separate side effect [80:51] so it's hugely debated there isn't even [80:53] agreement that the drugs C caus that [80:54] effect in a minority of people you got [80:56] to bear in mind at any given time some [80:59] of the population becomes suicidal some [81:01] of them will be taking these drugs so [81:03] it's very hard to disentangle that [81:05] especially early on uh so some [81:07] scientists would say there isn't even [81:08] any evidence they cause suicidality [81:11] among the scientists who fear that it [81:12] may cause suicidality there's a big [81:14] debate some of it will be you're [81:16] deprived of comfort food uh or pleasure [81:19] some of it will be as Carell Laro put it [81:22] to me a lot of people who are over wait [81:24] for a long time say you know the reason [81:27] my life is [ __ ] is cuz I'm overweight if [81:29] I finally lose weight my life will be [81:31] good and then they lose weight and [81:32] they've still got the same assle husband [81:35] and they've still got the same job they [81:36] don't like and they suddenly go into [81:38] this crisis where they're like oh it [81:40] wasn't the weight that was blocking me [81:41] it was everything else right they say [81:43] don't they that um the difference [81:44] between like happiness is your [81:46] expectations and reality so you can [81:48] imagine if you have that expectation [81:49] that losing this weight is going to make [81:51] me happy and you fall short of the [81:52] expectation because it doesn't the [81:55] anticlimax can cause so much [81:58] psychological discomfort yeah and I [82:00] spoke to people who've been through that [82:02] and I think that's that that can be a [82:03] really a really big issue there's also [82:05] with Su suicidality so some other people [82:07] who would say well okay the [82:08] psychological effects are probably real [82:10] but it might come back to what we were [82:12] saying about dampening the reward system [82:13] in the brain right there were people [82:15] like um Professor Patricia grigson who's [82:18] done some of the really cutting edge [82:19] research on effects with addiction in [82:21] this who said to me you know that's a [82:23] real concern now she stress we don't [82:25] know yet no one definitively said yes it [82:29] is causing these problems we know how it [82:31] was weird it was like a um like I said [82:34] before it's you're seeing this picture [82:36] form it was fascinating that you're [82:37] there's so much we don't know which [82:39] makes it kind of disconcerting it's like [82:41] oh so this is an experiment on millions [82:42] of people and I'm one of the guinea pigs [82:44] great right so it's disconcerting how [82:46] much we don't know um but yeah that is a [82:49] big worry and we've been here before [82:50] with diet drugs as you alluding to where [82:53] we kind of rush into party and then [82:55] everyone rushes out of the party because [82:57] we realize that the history of diet [82:58] drugs Steven is absolutely Grim beyond [83:02] belief so the first kind of modern diet [83:04] drug was something called dinitrophenol [83:06] so there were a load of um people in [83:08] France who were working in ammunition [83:09] factories during the first world war and [83:12] people noticed that they lost loads of [83:14] weight right not that they had didn't [83:15] have weight problems at the start but [83:16] they lost a huge amount of weight and it [83:19] turned out they were ingesting this [83:20] explosive powder you know through their [83:22] skin and breathing it in so after the [83:24] war a load of scientists at Stanford [83:26] were like oh maybe this can be a weight [83:27] loss treatment so they made it into a [83:29] pill called redu alls uh which were very [83:32] popular there was 100,000 people taking [83:34] them in 1934 which when you consider [83:36] there was very low obesity back then [83:38] that's a huge number of [83:40] people and then they discovered just I [83:43] mean it's it it's almost unbelievably [83:45] terrible what happened so loads of the [83:48] people taking them went [83:49] blind and then they went into this [83:51] horrific fever where their bodies were [83:53] burning up so it's an explosive right so [83:55] it was discovered that the way it works [83:57] is it massively speeds up your [83:58] metabolism but when you take a high dose [84:01] it gives you cataracts makes you go [84:03] blind and then your body goes into a [84:04] fatal fever and the way one person put [84:07] it is you become cooked from the inside [84:10] so they stopped marketing that one it [84:11] continued to be used as a pesticide for [84:13] like years and years because it is so [84:14] good at killing anything it comes across [84:17] so then there was a craze for amphetamin [84:19] so during again during the a war during [84:21] the second world war radar um people are [84:24] to watch Radars soldiers who had to [84:26] watch Radars were extremely bored so [84:28] they gave them amphetamines to sort of [84:30] keep them on the job keep them active [84:32] mentally alert and it was discovered [84:34] they lost loads of weight as well so [84:36] after the war they started marketing [84:38] amphetamines as a weight loss drug right [84:39] and they became hugely popular they were [84:41] described as Mother's Little Helper by [84:44] the time you get to 1970 8% of all the [84:47] prescriptions in the United States were [84:49] F amphetamines for weight loss but it [84:51] was discovered that when you take [84:54] amphetamines you develop tolerance to [84:56] them your body gets used to them so you [84:58] need higher and higher doses to get the [84:59] same effect but if you take really high [85:01] doses of amphetamines you just lose it I [85:04] mean you can become psychotic you it has [85:06] a really bad effect on you you don't [85:08] sleep it's terrible so then there was a [85:10] real rolling back of amphetamines and [85:12] then there were some real horror shows [85:13] like Jaw wiring where they would wire up [85:15] the jaws of obese people so they could [85:17] they literally couldn't get any food [85:19] into their mouths but then it was [85:20] discovered if you vomit while your jaw [85:22] is wide you can choke to death I mean [85:23] just like nightmare marish horrifying [85:26] humiliating Solutions and then we get to [85:28] the worst of them all and also the most [85:31] popular of them all until these new [85:33] drugs which is called fenfen so this was [85:36] in the 1990s early 1990s a group of [85:38] scientists decided to combine two diet [85:41] drugs that had existed until then one [85:43] was called Flex fomine it's an appetite [85:45] suppressant but it was never very [85:47] popular because it makes you very drowsy [85:49] so they combined it with phentramine [85:51] which is an amphetamin so it had the [85:53] kind of it counteracted the drowsiness [85:54] and it had an additional weight loss [85:56] effect and it worked incredibly well [85:58] people taking it lost as much weight as [86:00] they lose on OIC and it's actually Eerie [86:03] when you go back and look at the [86:04] coverage front page of Time Magazine the [86:06] new miracle drug was the headline you [86:09] know by the time you got to the mid90s [86:11] there were 18 million prescriptions for [86:14] fenfen every year in the [86:16] US and then a group of ordinary doctors [86:19] in Fargo in North Dakota were like a lot [86:23] of our patients are getting really ill [86:25] when they take this and raised a safety [86:27] signal turned out the drug company had [86:29] known about this risk all along so it [86:32] was discovered that when you take these [86:33] drugs they cause something called [86:35] primary pulmonary hypertension it's [86:36] where the blood vessels in your lungs [86:38] massively contract and you can't breathe [86:41] properly they also damage your heart I [86:43] mean the stories were just horrendous [86:44] there was a um a young woman in [86:47] Massachusetts called Mary linen who was [86:49] about 28 wanted to lose weight for her [86:51] wedding day starts taking fenfen couple [86:54] of weeks later is trying to climb a hill [86:56] and just gets really breathless and it's [86:58] like so weird here goes home is really [87:01] breathless goes to the doctor he takes [87:03] her off the drug but by then she had the [87:05] problem um she needed oxygen her whole [87:08] life she was told she could never have [87:09] children and then one day she she [87:12] couldn't breathe and she died this [87:14] happened to lots and lots of people it [87:16] led to the largest payout in the history [87:18] of the pharmaceutical industry up to [87:19] that point they had to pay 12 billion [87:21] dollar to the people whose hearts and [87:23] lungs were harmed [87:24] and that is not that long ago now I want [87:26] to stress again that was given to people [87:29] with a very poor there was a single [87:31] study of 120 people of fenfen at the [87:33] point at which it was marketed to people [87:36] which is staggering this has a much [87:38] bigger body of evidence so this is not [87:40] going to be in the short-term fenfen but [87:43] when I looked at the 12 big risks [87:45] associated with these drugs some of [87:46] which have not really been explained to [87:47] the [87:48] public one of the ones that was most [87:50] disconcerting and was explained to me by [87:52] a brilliant scientist called Greg [87:53] Stanwood who Florida State University [87:55] and is researching these [87:57] drugs the biggest risk is what he called [88:00] unknown unknown so you remember that [88:01] Donald Rumsfeld thing right so when he [88:03] was talking about um the invasion of [88:05] Afghanistan but um when he was the US [88:08] Secretary of Defense said you know when [88:10] it comes to these things there are [88:12] things there are what called known [88:13] knowns there are things we know we know [88:15] there are known unknowns there are [88:17] things we know we don't know where is [88:19] Osama bin Laden and there are unknown [88:22] unknowns things we don't know we don't [88:24] know that might hit us out of the blue [88:26] and with these drugs there's a big worry [88:28] about longer term unknown unknowns so [88:31] for example we know very little about [88:33] what happens to pregnant women when [88:35] they're taking these drugs right we know [88:37] that in the animal studies um when [88:39] animals are other non-human animals are [88:41] exposed to these drugs they're much more [88:43] likely to get birth defects so one thing [88:46] Dr Stanwood said that we should think [88:47] about and he stressed this is [88:49] speculative we don't know was think [88:51] about antipsychotics right in the 1950s [88:55] doctors started giving people antis [88:56] psychotics they were judged to be safe [88:58] lots of people dispute that but park [89:00] that for a second and people took them [89:02] for many many decades and then it was [89:04] discovered really late in the day that [89:06] when you get into your 70s and 80s if [89:08] you've been taking antis psychotics you [89:10] are much more likely to get Alzheimer's [89:12] disease and other forms of dementia like [89:13] much more likely now there's no way you [89:16] could have known that at the start it [89:17] was an unknown unknown you couldn't have [89:18] known that you had to have people taking [89:19] it for a really long time before you [89:22] could find that out now one of the [89:24] concerns about these drugs is that there [89:25] will be unknown unknowns that we can't [89:27] know about these drugs are working on [89:29] your brain they are working very hard on [89:32] key parts of your brain parts that [89:34] relate to memory processing taste [89:36] processing um gut motility right we [89:40] don't know but there's at least some [89:43] risk there now again you have to weigh [89:45] that against the risks of obesity as Dr [89:48] sha alevy who's at tillan school of [89:50] medicine put it to me we don't know the [89:52] long-term risks of these drugs we do do [89:54] know the long-term risks of obesity and [89:55] they are horrific really horrific and [89:59] much worse than I thought at the start [90:01] you know for example I'm actually quite [90:04] embarrassed to say this diabetes right [90:07] okay I knew that you were much more [90:08] likely to become diabetic if you were [90:10] obese um figures on that are kind of [90:12] shocking if you're obese when you're a [90:13] teenager your your chances of developing [90:15] diabetes are 70% in your life right [90:18] shocking but I thought all right [90:20] diabetics they get insulin and then [90:22] they're basically like the rest of us [90:23] right as long as you've got Healthcare [90:24] you're fine interviewing doctors they [90:26] were like no no no lots of people think [90:29] that if you get diabetes it it knocks on [90:31] average 15 years off your life there's a [90:34] doctor here Dr Max pton a close friend [90:36] of mine and a brilliant Doctor Who Says [90:39] something to me it seemed really [90:40] shocking when he first said it but then [90:42] he went through the evidence he said if [90:44] you gave me a choice between getting [90:45] diabetes or becoming HIV positive I [90:47] would choose HIV every time if you [90:50] become HIV positive as long as you get [90:52] medical treatment you live as long as [90:54] everyone else if you get diabetes you [90:56] know not only does it knock 15 years off [90:58] your life your chances of all sorts of [91:01] catastrophic complications in your life [91:03] are really high it's the biggest single [91:05] cause of blindness in Britain [91:07] preventable cause of blindness it's [91:09] massive cause of leg amputation more [91:11] people get an extremity cut off in the [91:13] US because of diabetes every year than [91:15] because of being shot right I mean it's [91:17] and you go down the list of all the [91:19] harms associated with [91:21] obesity diabetes isn't even number one [91:24] right so every time I talk about the [91:26] risk of these drugs I really worry about [91:28] the risk of these drugs right there it's [91:30] a lot of them people should go through [91:32] it very carefully if you have thyroid [91:34] cancer in your family for example I [91:36] would strongly recommend you don't take [91:38] them if you know you're already um [91:40] worried about your muscle mass don't [91:42] take them there's a whole range of [91:44] caveats and clauses but we have got to [91:46] be honest about the risk of obesity and [91:49] for me if I'm being honest I think the [91:51] choice was ongoing obesity or these [91:53] drugs and so for me personally I have [91:56] made the Judgment call after looking at [91:57] all of this evidence that I'd rather [92:00] take the risk of OIC than the risk of [92:01] ongoing obes it especially given my [92:03] family's history and how many men Die [92:05] Young of heart attacks but loads of [92:08] people will look at the evidence that I [92:09] present in Magic pill and take totally [92:12] the opposite point of view and they may [92:14] well turn out to be right and I might [92:15] well turn out to be wrong right I [92:17] wouldn't debar that there's a fenfen [92:18] like scenario down the road right I [92:21] don't it's not likely but you'd be a [92:23] fool to dismiss it it I am in a [92:26] different camp and I have to say before [92:27] I express my own opinion that I [92:30] understand there's a lot of people out [92:31] there where drugs like this will [92:32] literally save their life and if they [92:35] don't take these drugs then you know [92:36] you've gone through some of the stats [92:37] but they I mean they will probably die [92:40] from something you know some kind of [92:42] form of uh you know we talk about all [92:44] cause mortality a lot like something [92:46] will kill you in the next couple of [92:47] years whether it's a cardiovascular [92:49] issue or something related to another um [92:52] element related to obes [92:54] obesity my thing and this is I think [92:57] developed over time we're doing this [92:58] podcast and speaking to so many experts [93:00] in health and fitness and wellness and [93:01] psychology and psych Psychiatry is I [93:04] just have this really deep innate belief [93:07] that there's no such thing as a free [93:09] lunch in life and I've just The more [93:13] I've done these interviews The more I've [93:14] come to learn that everything is a [93:16] trade-off and I almost see life as like [93:18] a scale so if you if you if you if you [93:22] put a weight on one end there's going to [93:24] be an equal and an opposite Force [93:26] somewhere else you know like the what's [93:28] the law of physics is it Einstein that [93:29] said that that you can't like destroy [93:32] energy you can just move it and I think [93:34] about the same with like drugs often and [93:37] other things that seem like Miracles or [93:39] shortcuts you're you're moving the set [93:41] of issues somewhere else you've talked [93:43] about some of those movements uh today [93:45] like the psych psychological transfer of [93:47] a uh soothing Behavior to an addiction [93:49] for example that's always been my like [93:51] belief that um whenever one my friends [93:54] says Steve I'm taking this uh Limitless [93:56] pill mfil and it's making me super [93:59] productive and it's fixed all my [94:00] problems in life and I'm killing the [94:02] game now I go what's the cost yeah and [94:04] my friend said to me remember when he [94:06] started taking it he was like there's no [94:07] cost there's no side effects and my [94:09] brain goes history shows if you wait [94:12] long enough there's always a cost it's [94:15] just being conscious of the cost and [94:17] when you balance up as you've done in [94:19] your life the pros and cons you say okay [94:22] I'm willing to take the cost now when I [94:23] I see things like a zek and people say [94:25] to me there is no downside I get more [94:28] scared because I can't run the numbers [94:30] to see whether the cost is worth the [94:32] upside for me so I don't know what the [94:35] the big obvious downsides of a zek and [94:37] these magic drugs are but I feel like [94:40] logically there must be one we do know [94:43] there are some [94:44] medications where pretty dependably the [94:47] benefits outweigh the risk think about [94:49] statins right if you have a problem with [94:51] your cholesterol what statins do is they [94:54] block part of your body that makes [94:56] cholesterol right so it's the most [94:58] commonly prescribed drug in the US it's [95:00] pretty close to it in Britain almost [95:02] every doctor would agree there are some [95:03] downsides to statins but sometimes there [95:05] are just like you have to stay on them [95:07] for life right yeah you have toay like [95:08] with these drugs right the minute you [95:10] stop taking them so within a year of [95:12] stopping you regain 70% of the weight [95:15] you've lost right this is one of the big [95:18] questions around these drugs now that's [95:19] not 100% uh of the people regain it um [95:22] but it's most people seem to regain [95:24] their weight so I think there are [95:26] sometimes when a drug a medication I'm [95:27] not saying these drugs are that [95:29] definitely not but there are some [95:30] medications which do seem to be [95:33] just not that there's no cost but the [95:35] benefits are really unambiguous and [95:37] massively outweigh the cost this is a [95:39] much more finally judged thing and it's [95:40] interesting to me it's been funny [95:41] talking to people who read the book [95:43] because remember talking to the [95:44] marketing teams at both my Publishers [95:47] because some people who were the first [95:49] people to read the book apart from my [95:50] friends so some of them came up to me [95:52] and said oh yeah Han I loved your your [95:53] book it made me really want to take oen [95:55] piic someu came up to me and said Yan I [95:58] loved your book it made me think [95:59] convinced that you'd have to be [96:01] completely insane to take o zic and it [96:03] was a bit like you know the dress the uh [96:04] some people saw it as gold some people [96:06] saw it as [96:07] blue and I felt like that meant I'd done [96:10] my job because unlike pretty much [96:13] everything else I've ever [96:15] written I've ended this feeling as [96:17] conflicted almost as I was at the start [96:21] right this is a huge thing it's going to [96:25] change and we've talked a lot about the [96:26] personal dilemmas it's going to have a [96:28] huge social effect Barkley's Bank [96:30] commissioned a very sober-minded analyst [96:31] named Emily field to um make predictions [96:35] that could guide investment based on [96:37] these drugs and she said if you want an [96:39] analogy you have to think of the [96:40] invention of the smartphone right I mean [96:43] this is going to have so many [96:44] unpredictable effects um already crispy [96:47] K cream donut stocks have been tanking [96:49] the head of nestle Mark Schneider has [96:51] said we they're worried about their ice [96:52] cream and infection ranges and Jeff [96:56] Financial did a report for the airlines [96:58] in the US saying they're going to have [97:00] to spend much less on jet fuel pretty [97:01] soon because it cost takes so much less [97:03] jet fuel to fly a much thinner [97:05] population what I was fascinated by is [97:08] um companies that manufacture hinges for [97:11] knee and hip replacements are seeing [97:14] their stocks tank because people are [97:16] going to need far fewer neon hip [97:18] replacements cuz that overwhelmingly [97:20] that's driven by obesity right so not [97:22] entirely but overwhelmingly [97:24] um so yeah if we were talking in 2007 [97:27] when the day Steve Jobs unveiled the [97:29] iPhone I don't think we could have [97:31] gained [97:32] out you know one tenth of what was about [97:35] to hit us and I kept having these [97:37] moments traveling all over the world [97:39] interviewing these experts remember one [97:42] day I was in a cafe I was interviewing [97:44] one of the key [97:45] neuroscientists at Cambridge University [97:47] who was working on this we were in a [97:50] cafe and there were loads of people [97:52] walking past and it's you know just [97:53] random British people a lot of whom are [97:55] overweight or obese like I [97:57] was and I thinking wow you don't know [98:00] what's about to hit us all it was a [98:03] slightly weird unreal feeling I mean [98:06] this is is for better and for worse and [98:09] I think there will definitely be [98:10] positive effects and there will [98:11] definitely be negative effects and I [98:13] think we can see early on what quite a [98:15] lot of them are this will change the [98:18] lives of all of us in one way or another [98:21] how do you guys manage your stress this [98:23] is Stress Awareness Month and it's a [98:26] topic that I'm super passionate about [98:27] and we talk about a lot in this podcast [98:29] I personally manage my stress by [98:31] prioritizing my health and well-being [98:32] going to the gym is my number one form [98:34] of therapy and I couldn't be without [98:37] those two things as you guys know whoop [98:39] is a sponsor of this podcast and I'm an [98:40] investor in the company as well for [98:42] those of you that don't know whoop [98:44] actually created a stress monitor within [98:46] this device not only does this helped me [98:48] to identify periods of high stress in [98:49] real time throughout the day but it also [98:51] provides me with the tools I need to to [98:53] deal with stresses as they come up [98:55] throughout the day and it's based on [98:57] scientifically backed breathing [98:59] exercises and research that's been [99:01] developed by Leading neuroscientists [99:03] it's a feature that has been [99:04] gamechanging for me and I highly [99:06] recommend if you're someone that's [99:07] looking to manage your stress levels [99:09] then head over to join. woop.com [99:13] CEO where we'll give you 30 days [99:16] risk-free and zero commitment to try [99:18] whoop let me know how you get on I'm [99:21] just I was thinking as you were speaking [99:22] there about bunch of Statistics that [99:24] I've read recently humans are getting [99:26] more and more sedentary which means [99:27] we're moving a lot less um obviously [99:29] obesity is going up across the sort of [99:32] Western World um most [99:35] obviously uh and then you've got this [99:37] rise in a zmek which allows us to stay [99:40] skinny basically and suppress our [99:41] appetite I was just wondering there's [99:43] going to be it feels like there's going [99:44] to be two groups of people when these [99:45] drugs drop in cost and they become [99:47] really accessible and i' I've saw you [99:49] say in the book that the next sort of [99:51] iteration of these drugs is going to be [99:52] a pill a lot of people won't want to [99:53] inject something I'm one of the people [99:55] that just I'd get too squeamish about [99:56] having to inject myself so the minute [99:58] something becomes a pill it brings down [99:59] one of the psychological barriers it's [100:01] cheap it's a pill a lot of people are [100:04] doing it if you're not doing it in the [100:08] obesogenic whatever that long word was [100:10] environment we live in it's almost like [100:13] you're going to be a an inferior human [100:15] to some degree like there's going to be [100:16] two parts of society the 50% that are [100:18] down to take the pill and they're going [100:20] to be skinny and they're going to be [100:21] whatever and then the 50% that are [100:22] struggling in this this difficult food [100:24] environment we live in with the ultra [100:25] processed food um I can't I almost can't [100:29] play out a scenario where most people [100:32] aren't taking this magic pill so there's [100:35] a few assumptions of what you've said um [100:37] I think you're probably right but [100:39] there's a few assumptions so in a way [100:41] what you're saying there's sort of few [100:43] different dystopias that could [100:45] emerge one is actually that we don't [100:48] even get to where you are because it's [100:50] restricted to a tiny number of rich [100:51] people right so let's start with the [100:53] first like dystopian Vision we could [100:55] have the first is that we never even get [100:57] to that point let's imagine we basically [101:00] we have a situation at the moment where [101:01] the Real Housewives of New Jersey get to [101:03] be super super skinny and the real [101:05] school children of New Jersey get [101:07] diabetes at the age of 12 right so we [101:09] could have a situation where these drugs [101:12] exist and they work very well but they [101:14] are restricted to a tiny Elite of rich [101:16] people which is kind of where we are [101:19] it's not going to stay like that though [101:20] is it in the longer term it won't and [101:22] it's not that far off so 2032 The Paton [101:25] on OIC passes so then it's not actually [101:28] that expensive to make these drugs it's [101:29] $40 a month to actually make them it's [101:31] the rest is profits for NOA Nordisk who [101:33] argue understandably you know look we [101:35] took all the risks of developing this we [101:37] should cash in now um you can see that [101:40] argument although I don't think they [101:41] need to cash in quite as much as they [101:42] are uh so one scenario is it go it will [101:45] go out of patent in [101:46] 2032 by then it looks like the main way [101:49] of taking some agati will be pills [101:51] anyway so you can well imagine in a [101:53] situation where you've got $40 a month [101:55] to take a daily pill that will make you [101:57] much thinner I think in that scenario [101:59] you're right now what I'm most [102:03] hope is that a the drugs don't have a [102:05] catastrophic side effect obviously B the [102:08] people who want them get them and see it [102:11] wakes us up and we go how did we get to [102:15] this point how did we get to the point [102:18] where we're looking at potentially [102:19] drugging our children forever not [102:21] knowing the long-term effects [102:23] who did this to us and how can we be [102:25] more like Japan and all the other [102:26] countries that are making these changes [102:28] that's optimistic that requires a lot of [102:30] uh raising of Consciousness between now [102:32] and then but that's the most optimistic [102:34] scenario thing but you're totally right [102:35] there could be a a scenario it's [102:38] probably the most likely scenario if [102:39] there isn't some big risk that emerges [102:42] that we'll just have staggering amounts [102:44] of the population taking these [102:46] drugs unless the government intervene [102:49] that feels like the most likely scenario [102:51] unless the government introdu some laws [102:52] that put restrictions on what children [102:54] can eat at school and all those kinds of [102:56] things in a more severe way I can't see [102:58] a scenario where especially with this [103:00] younger generation you know you hear all [103:01] these stats around young girls on Tik [103:03] Tok being more anxious than ever before [103:05] the suicidality going up men are [103:08] struggling more than ever with body [103:09] dysmorphia which no one's talking about [103:12] I was reading some stats about that [103:13] yesterday yeah shocking the figures on [103:15] that and the antidote appears to be I [103:19] mean [103:20] this it's not a good solution right and [103:24] perfectly normal healthy people who just [103:26] have a little bit of belly fat and they [103:29] hear this you know they hear about this [103:30] stuff they go you know going to the gym [103:31] is hard and I do love those burgers and [103:33] that KFC is really nice it does tastes [103:34] really good so I could eat my KFC and I [103:37] could stay skinny I think that last bit [103:40] then they're wrong you you if you take [103:42] it you won't want to eat the KFC in the [103:43] burgers and believe me I have been the [103:44] king of KFC just three bites I got a [103:47] couple of bites though well but you [103:48] don't get you actually don't even want [103:50] that particularly right and huge numbers [103:52] of people seeing that I mean for most of [103:55] the time I have been eating smaller [103:56] portions of similar [ __ ] but um actually [103:59] even your taste for that tends to kind [104:01] of Wayan over time right so the last [104:03] bit's wrong but I think yeah you it's [104:06] one of the things it's funny I [104:07] didn't it's one of the things that made [104:09] me really angry in [104:12] Japan I was [104:13] thinking all this agonizing I've done [104:16] all this worrying and I worry even more [104:19] about the fact we're almost certainly [104:20] about to start a mass wave of drugging [104:22] children with asmic already begun in the [104:25] US I interviewed parents who drugging [104:26] their kids because their children are [104:29] obese and I thought this whole dilemma [104:32] never had to happen right this happened [104:35] because the food industry screwed us [104:37] over and we didn't regulate them and we [104:39] didn't stop them and we can start to do [104:41] that and I went to places that have done [104:42] it I went to Mexico where they [104:43] introduced a sugar tax usually reduce [104:45] the amount of sugar that people consume [104:47] I went to Minneapolis where they [104:49] prescribe healthy food for poorer people [104:51] who can't afford it has a a really [104:53] positive effect I went to Finland where [104:55] they had a huge transformation in the [104:56] food supply I went to Japan there's load [104:59] here in Britain there was a really [105:00] interesting experiment bread used to [105:03] have far more salt in it and a really [105:05] heroic guy called Professor Gran [105:06] McGregor who I interviewed persuaded the [105:08] government to just to get the food [105:10] companies to sort of lore them I mean [105:12] they would have they threatened [105:13] regulation which meant that the [105:14] companies gave in before they did it to [105:16] just massively reduce the amount of salt [105:18] in bread no one even noticed and it [105:21] reduced Strokes every year in written by [105:23] between 6,000 and 9,000 right and a [105:26] stroke is one of the worst things that [105:27] can ever happen to you now we could do [105:29] it's called reformulation there's loads [105:31] of other things we can do like that we [105:33] could reformulate loads of foods in ways [105:35] that aren't even painful to us right [105:37] there's so much we can do as so much we [105:40] can do to be like Japan I mean it was a [105:42] bit weird in Japan though because there [105:43] were things they did that we can't do [105:46] right so I'll give you an example this [105:48] was one of the weirdest days in the [105:49] research for the book in 2008 obesity [105:53] very slightly went up in Japan it was [105:55] still like laughably low and they had a [105:57] real panic and they introduced this new [105:59] law it's called the Metabo law um it's [106:02] named after metabolic syndrome which is [106:04] a really nasty combination of like [106:06] diabetes obesity and other problems you [106:08] can get when you're when you're very [106:09] overweight and um the law is very simple [106:14] every single company in Japan on a [106:16] particular day every year has to weigh [106:19] every single person who works there and [106:21] if their weight has gone up they have to [106:22] drop a plan with their employer to bring [106:24] their weight down and as a company [106:27] overall if your weight goes up you can [106:29] be fined by the government and I was [106:30] like how could this possibly work so I [106:32] went to a company that does it tanita [106:34] they all do it but a company that let me [106:35] go and see how it [106:37] works and it's really weird right you at [106:40] this workplace you arrive you show your [106:41] face to a video screen it says hi [106:44] Stephen you walked 14,000 steps [106:46] yesterday you're number 121 in the [106:49] company in terms of steps taken cuz [106:50] everyone has to wear like a Fitbit well [106:52] equivalent to a Fitbit everyone uploads [106:55] pictures of every meal they have to this [106:57] system where you can see it it was [106:59] bizarre right um and yeah explain to [107:02] Japanese people who kept going you know [107:04] every morning in this office when we'd [107:06] all be having donuts and coffee they do [107:09] aerobics together it was bizarre and I [107:13] sort of explain to these Japanese people [107:14] right if you tried to do this in Britain [107:15] we would burn the [ __ ] office down [107:18] right like and they would just go well [107:20] why why they couldn't understand why I [107:23] was so affronted by it and that okay [107:25] that's a big cultural Chasm and we can't [107:27] do that and I wouldn't want us to do [107:29] that but if you look at so many of the [107:31] other changes in [107:33] Japan I started to see like what you win [107:36] if you get this right so Japan has the [107:38] longest life expectancy in the whole [107:40] world and one of the best things I did [107:42] for the book One the most moving things [107:44] for me is I went to the oldest village [107:46] in the whole world it's in okanawa in [107:48] the deep south of Japan and there's a [107:50] village called ogimi where there's 20 15 [107:53] households and 190 of them have someone [107:55] who's over the age of 90 living there [107:57] right so it's the oldest place on Earth [107:59] um Japan has the by far the longest life [108:02] expectancy in the world and not just [108:04] that um you're far less likely to get [108:07] sick as you age so they have not just [108:09] more life but more healthy life and I [108:13] went to their little Community [108:15] Center and the first person I met was a [108:18] 102y old woman called Matsu fukuchi who [108:21] was this like almost like Kind of [108:23] Perfect crumple of wrinkles right she [108:25] was so cheerful chatting to her she was [108:28] like I can't stay for long cuz I'm [108:29] looking after my son who fell off the [108:30] roof the other day fixing it I was like [108:32] Jesus how old is your son um and she was [108:35] like oh I love you know she was so full [108:37] of joy she I love life I spent all of [108:39] yesterday watching volleyball with my [108:41] grandchildren it's so great she was so [108:43] happy she'd walked there on her own and [108:47] then there was this moment where they [108:48] put on some music she put on this red [108:51] kimono and she started dancing and all [108:54] these old in these women as old as a [108:56] century start dancing right and I danced [108:58] with her and I was thinking God this is [109:02] this woman was born before radio started [109:05] broadcasting in Japan and here I am [109:07] recording an interview with her on my [109:10] iPhone this is what you get if you get [109:13] this right if you sort out the Obesity [109:15] crisis you get to have more years of [109:18] health and joy and dancing right that's [109:22] what we're fighting for here I think [109:25] about how many people I know who died [109:29] young because of complications related [109:31] to obesity everyone listening and [109:33] watching will know someone who would be [109:35] alive now if we had sorted out the [109:37] Obesity crisis but has died everyone [109:41] right and it doesn't have to be this way [109:45] you know now part of that solution in [109:49] the short and medium term is going to be [109:50] these drugs in the longer term it [109:52] doesn't have to even be that right Japan [109:54] is a real country it exists they solved [109:57] this problem there are other countries [109:58] in the world that are solving these [110:00] problems we don't have to tolerate this [110:02] being done to our children we don't have [110:04] to accept us being made sick and our [110:06] children being made sick but it requires [110:09] an Awakening around what's really [110:11] happening who's doing this to us at the [110:12] moment you know whenever I my weight [110:15] goes up and down right it has gone up [110:16] and down throughout my life and whenever [110:18] I was fatter I would blame myself right [110:20] I wasn't angry with the forces that have [110:21] done this to us right [110:23] more three-year-old children know what [110:25] the McDonald's m means than know their [110:27] own last name right I didn't choose that [110:30] world I didn't choose to live in a world [110:32] where we were you know constantly [110:34] promoted and fattened and physically [110:37] changed such that it's hard to come back [110:39] right that don't mean I had no [110:40] responsibility in that I did but we [110:44] don't have to continue like this do you [110:46] think you could stay at the we you are [110:49] now without this as EK it's funny you [110:52] holding this I feel like we're in a [110:53] weird dystopian version of QVC right um [110:57] do I think uh honestly well if I'm [111:00] typical we know from the clinical trials [111:01] 70% of people regain the weight within a [111:04] year no I don't think so if I'm being [111:06] really honest with myself I don't think [111:08] so I think I have made lots of changes [111:10] in my life that mean I don't think I [111:11] would go back to quite where I was but I [111:14] think I would very rapidly regain a lot [111:16] of weight so you have to take this for [111:18] life now to stay the way you're at [111:19] therefore yeah and there's a big debate [111:21] about we mentioned before with the [111:22] amphetamin based um diet drugs from the [111:26] past that people develop tolerance one [111:28] of the big question marks around this is [111:30] do people develop tolerance does it mean [111:32] that over time it will have less of an [111:34] effect right now some scientists the [111:36] scientists asked about this just were [111:38] wildly all over the place some said no [111:40] we do know diabetics don't seem to [111:42] develop tolerance they because if they [111:44] did they would need higher and higher [111:45] doses to get the same level of control [111:48] for their blood sugar so that's a point [111:50] against tolerance but others said [111:53] it would seem quite likely we developed [111:54] tolerance we developed tolerance for [111:55] most drugs it would be surprising if we [111:58] didn't probably what's most likely again [112:00] Carell luro the South African [112:01] psychiatrist said to [112:02] me again probably the best comparison is [112:05] bariatric surgery you have bariatric [112:08] surgery you lose an absolute [ __ ] ton of [112:10] weight and then you regain a little bit [112:12] of it over the next few years and then [112:14] you sort of plateau at that higher point [112:17] but we don't know the truth is no one [112:19] knows I'm also concerned that if you is [112:21] there a world where if you stopped [112:23] taking this your body had become reliant [112:25] on your gp1 coming from this so your [112:28] body makes less glp1 itself don't think [112:30] it's so much I don't think that's the [112:32] concern I think but there is I think [112:33] you've gone to a really important point [112:35] we know all forms of diet slow down your [112:37] metabolism right that's a reality about [112:41] diet um which is why often people end up [112:44] fatter at the end than they were at the [112:46] start um I'm worried about and again I [112:50] asked lots of scientists and people just [112:51] said we don't know [112:53] I'm worried about [112:55] um is my metabolism slowing down as I [112:58] take this drug if I let's say they [113:00] discovered some terrible problem with it [113:02] and it had to be withdrawn would I then [113:05] have a slower metabolism and be fatter [113:07] than I was at the start yeah no one [113:09] knows that's a significant risk and the [113:11] other big sort of risk here is you've [113:12] talked about a few times is this eating [113:14] disorder um epidemic it seems I think [113:18] you talk about in your book that since [113:19] March 2020 rates of anorexia and bmia [113:21] were 42% higher than they would be [113:24] expected for teenage girls aged 13 to 16 [113:27] I think that's cuz of lockdown to be [113:28] fair that's not that's not a result of [113:29] the drugs that's because of the massive [113:31] stress of lockdown yeah some research in [113:33] the lon journal and 32% higher for those [113:36] aged 17 to 19 what I'm saying here is [113:38] that we we do have an issue with eating [113:40] disorders in in the Western World [113:42] especially um they they skyrocketed [113:45] after the the pandemic but when I think [113:47] about eating disorders and bulimia and [113:49] anorexia and I think about this and and [113:52] what it might mean for those Eating [113:55] Disorders I feel somewhat concerned [113:57] especially when kids get their hands on [113:58] them go beyond concerned and we don't [114:01] have to speculate about this we've been [114:02] here before so in the early '90s there [114:05] was a very popular amphetamin based diet [114:07] drug that was marketed in the United [114:08] States and it was huge and lots of [114:12] teenage girls used it and it led to a [114:13] catastrophe there was a guy called Rob [114:15] weyden who was a congressman for Ohio at [114:17] the time who held Congressional hearings [114:19] on this and they are really chilling to [114:21] read because they show what happens when [114:23] a popular diet drug combines with eating [114:26] disordered young women right so there [114:29] was a a woman called Jessica McDonald [114:31] who testified at the hearing she was um [114:34] she was in her early 20s at the time so [114:36] she was a ballet dancer obviously we [114:38] know about the horrendous pressures on [114:40] body shape for ballet dancers and she [114:42] would take this drug like this [114:44] amphetamin based drug until she passed [114:47] out to be thin she would take it to [114:48] starve herself because she wanted to be [114:50] that that ballet shap there's a guy [114:51] called Tony Smith from state center in [114:53] Iowa who testifies that his daughter [114:56] Noel from when she was very young became [114:58] obsessed with the idea that she was fat [115:00] she would go and look at these fashion [115:01] magazines and say daddy do you think I'm [115:03] fat why don't I look like these [115:06] women and she got hold of these diet [115:08] drugs massively starved herself and died [115:10] of a heart attack and he read out this [115:11] heartbreaking poem where she describes [115:14] like you know I'm [115:16] hungry I want to eat but not yet not yet [115:20] right so we know that when a diet drug [115:23] combines with eating disorders it leads [115:25] to catastrophic outcomes we don't have [115:26] to speculate so yeah that's one of my [115:29] three or four biggest concerns now like [115:31] I say we can introduce regulation now to [115:33] mean you only get it from a doctor the [115:34] doctor has to see you that will cut some [115:37] of that but I don't see how and and [115:39] that's really important and anyone we [115:41] save is worth saving but yeah I'm very [115:43] very concerned about that I'm also [115:45] concerned about a more subtle effect in [115:46] relation to that so the worst moment I [115:50] had in writing the book was not any of [115:51] the physical side effects for me [115:53] although there were some Grim moments [115:54] there early on it was a moment when um [115:59] so M I've got a niece called Erin and [116:01] she's 18 now although she's 19 actually [116:04] but in my head she's sort of six years [116:05] old all the time like CU she's the baby [116:07] of my family she's the only girl she was [116:08] the youngest so no one makes me more [116:10] protective and one day a few months into [116:12] taking these drugs I was FaceTiming with [116:14] her she was in a pub in [116:16] Liverpool and she was like oh Yan you've [116:18] lost so much weight and I was like [116:19] preining she's like oh look I can see [116:20] your drawer I never knew you had a [116:21] drawer and I was like oh yeah I was [116:23] looking you're happy and [116:25] then she looked down and she [116:29] said will you get me some oamic she's a [116:32] perfectly healthy weight she always has [116:35] been and I thought what the [ __ ] am I [116:39] doing all her life I've been trying to [116:41] give her this [116:42] message don't be judged by how you look [116:46] don't worry about that you know and I [116:48] thought I've [116:49] counteracted everything I wanted to [116:51] communicate [116:53] and we know and and she decided not to [116:56] take it and all and ended fine with her [116:58] but when I was a kid there were no fat [117:00] people on television except as the butt [117:01] of the joke and I think about my niece [117:03] she's grown up seeing actually quite a [117:04] lot of women who have a broader range of [117:06] body shapes in the public eye and in the [117:08] last two years almost all of those women [117:11] have massively shrunk now they're not [117:14] talking about a zic but unless there's [117:15] been some kind of outbreak of dentry in [117:17] Malibu I think we know what's happening [117:19] right some of them are talking about it [117:20] but most are not can I just ask on that [117:22] cuz we've seen a lot of very famous [117:25] faces suddenly shrink over the last [117:27] couple of years and when you read their [117:29] autobiographies they talk about like [117:30] going to the gym and eating getting [117:32] their lifestyle right do you think [117:34] they're lying I mean [117:36] obviously yes it does appear I wasn't [117:39] sure if it was just me but I look I look [117:41] think about a lot of people that were a [117:43] little bit bigger and it seems that [117:45] suddenly everybody's kind of [117:47] cracked weight loss and it's rapid and [117:50] it's super fast I don't want to name any [117:52] particular names cuz it's not my place [117:54] to talk about individuals like that but [117:56] it really does seem like Hollywood has [117:59] found a p a great personal trainer and [118:02] I'm I'm just like I'm wondering if um if [118:06] this is what it is yes although I think [118:10] I would say the people you and I think [118:12] about are almost all women and I do [118:15] think we should be I know you would [118:16] agree with this I'm not making this as a [118:17] point against you women get so much more [118:21] [ __ ] than men men for this sort of thing [118:23] right like actually one of my editors [118:25] said to me you know I was saying why has [118:28] no one else written a book about OIC yet [118:29] why am I the only one and they said cuz [118:32] only a man could write this because a [118:33] woman would be crucified for writing it [118:36] right she would be monstered and if you [118:37] look whenever even someone as [118:39] unbelievably popular and amazing as [118:41] Oprah slightly C is my friend um gets [118:45] Savaged for it right and there's lots of [118:47] deep underlying reasons for that that [118:51] came out for me as well actually that I [118:53] I I projected towards myself I remember [118:55] for a long time taking the [118:58] drug I felt like I I mentioned this a [119:00] little bit before but I felt like I was [119:03] cheating I felt like I was sinning [119:05] almost and I started to look at the kind [119:07] of deep ideas they're so deep in our [119:10] kind of collective unconscious if you [119:13] look at so for example in the 6th [119:15] Century the pope Pope Gregory the first [119:17] draws up the seven deadly sins right and [119:18] one of them is gluttony and it's this [119:20] image it's always depicted with an image [119:21] of some hugely fat person looking like a [119:24] pig you know and it's [119:26] horrible it's very deep in our culture [119:29] the idea that being obese is a sin right [119:32] if you look at the forms of weight loss [119:34] we admire they follow the pattern of sin [119:37] right the kind of classic Catholic [119:38] pattern of sin you sin then you have to [119:41] suffer and redeem yourself and then we [119:43] forgive you right so if you look at the [119:45] forms of weight loss we admire there're [119:47] ones where people are humiliated and [119:49] suffer terribly you starve yourself you [119:52] um you know you think about that show [119:54] The Biggest Loser which I hate uh you [119:56] know where severely obese people are [119:58] made to sort of compete and gring [120:00] horrific forms of exercise then we're [120:02] like okay Jabba we forgive you now you [120:05] know what I mean we use this kind of [120:06] stigmatizing ways of [120:07] thinking cheating is a bit more [120:10] subtle because I kept thinking I'm [120:12] cheating as I do this and I was like [120:13] well that's really weird if I if I had a [120:15] heart problem and I took statins I would [120:17] not think I was cheating right I said [120:18] why is that and I think it's partly so [120:21] people put in a huge amount of effort to [120:22] be thin right loads of women watching [120:25] this and it's disproportionately women [120:27] will suffer some privation and [120:30] deprivation in their life because they [120:31] are really trying to be thin and then [120:34] they hear a this [ __ ] just injects [120:36] himself once a week and he gets to be [120:38] thin like me it's like they feel the way [120:40] I imagine cyclists do when they look at [120:42] Lance Armstrong right and the only way [120:44] out of those that negative conversation [120:48] where we turn on each other like rats in [120:49] a sack is to realize [120:52] oh there is a sin and there are people [120:54] who are cheating but it's not Oprah it's [120:57] not someone who Jeff Parker that guy I [121:00] mentioned who you know didn't want to [121:02] die young it's the food industry that [121:04] [ __ ] all of us that's why we're in [121:06] that race right that's why you're [121:07] starving yourself that's why we feel [121:09] we're [121:10] Sinners okay well we can collectively [121:13] come together and challenge that shared [121:14] opponent if we want but if we're just [121:16] going to get into look it's very hard in [121:19] this age of social media Madness to not [121:22] have every conversation turn into a [121:24] toxic conversation and it's not [121:25] surprising that something is charged as [121:27] a debate about a zenic and weight has [121:30] become so toxic so quickly but again we [121:34] don't have to do that that the toxicity [121:36] isn't going to get us out of this right [121:37] we're in a shared crisis everyone [121:39] watching has someone they love who is on [121:41] course to Die Young because of the [121:43] problems associated with obesity because [121:45] obesity is so widespread in this Society [121:48] in a very recent amount of time look at [121:50] a picture of a beach in Britain [121:52] in 1975 not a million years ago everyone [121:56] is thin by our standards right this [121:58] happened in the blink of an eye in human [122:00] terms right again we don't have to [122:03] tolerate that part of it is also we [122:05] don't like when people lose weight some [122:06] of us because it shines the light on us [122:09] and I think about someone like Adele who [122:12] dropped a ton of weight very quickly and [122:14] the shocking thing when she when she [122:16] dropped that photo I think it was at [122:17] like a birthday party because she went [122:19] from like being you know a certain way [122:21] to then dropping weight very quickly so [122:23] we because we don't see Adele's private [122:24] life life much it was just this the [122:26] selfie she dropped and if you look [122:28] online at the reaction people were [122:30] betrayed they felt betrayed by Adele's [122:33] weight loss not because they're they're [122:35] assuming she used a zenic or anything [122:37] the fact she's now [122:38] not the way she was in terms of her [122:41] weight people were like almost angry [122:43] about it and the same happened with [122:44] Rebel Wilson When Rebel Wilson dropped a [122:46] ton of weight because in her book she [122:47] talks about you know she wanted to [122:50] increase her chance of having a kid so [122:52] her doctor advised her to lose lose the [122:53] we people were Ang like almost angry [122:56] that they lost someone they could maybe [122:59] relate to or that made them feel a [123:00] certain way about themselves which I [123:02] find to be really interesting that we [123:04] actually don't like it when [123:06] someone loses way we've got to [123:09] understand where that's coming from [123:10] obviously I don't support anyone being [123:13] cruel to people online and it's good for [123:15] both ad Del and Rebel Wilson that [123:16] they've improved their [123:17] health um but I think where it comes [123:21] from and a lot of these things that can [123:22] seem a little bit odd that that are kind [123:24] of said we've got to realize how much [123:28] shame people are soaking up on this [123:29] issue you know if you have a BMI higher [123:32] than 35 and you're a woman 45% of women [123:35] in that position get insulted every [123:37] single day in public every day right so [123:40] you're walking through the world [123:42] constantly being made to feel there's [123:43] something wrong with you being treated [123:45] like [ __ ] um and I can see how people in [123:48] that position develop a sort of [123:50] parasocial relationship with Rebel [123:51] Wilson or Adele like oh look we can look [123:54] to Adele and they feel trapped they feel [123:56] they can't lose weight and then they see [123:58] Adele and Rebel Wilson and they're just [124:00] like oh two brute [ __ ] you you know I [124:02] get it now it's not the right response I [124:05] would want to talk to them more about [124:06] okay what we want to think deeper about [124:09] this but I can see where it comes from [124:11] and I can see why some people look at me [124:13] and go you [ __ ] right I totally get it [124:17] I suspect I would have felt that anger [124:18] were I not me looking at me right so I [124:20] get where the anger this comes from from [124:23] the moment we're born in this culture we [124:26] are primed to be overweight and we are [124:29] primed to feel tremendous amounts of [124:31] Shame about being overweight right and [124:35] anything that comes along and brings up [124:37] those stories and forces us to think to [124:39] them brings them to the surface like [124:40] these new weight loss [124:43] drugs just leeches out of all of us so [124:48] many negative and angry and hurt [124:50] feelings and I felt it myself [124:52] right I felt so much self-doubt all the [124:55] way through this I still feel self-doubt [124:57] about it I still have days where I [124:58] wonder am I doing completely the wrong [125:02] thing so I do think we have to [125:04] understand where it's coming from and [125:05] not just sort of know you're not doing [125:07] this you're always interested in [125:08] understanding where people come from but [125:09] it's tempting to just condemn people and [125:13] go look at this bad behavior and I'm [125:14] always more interested when people are [125:15] behaving badly and it is cruel to say to [125:18] Adele you [ __ ] you betrayed us uh I [125:21] mean I would never say anything about to [125:22] Adell anyway because I love Adell but I [125:24] saw her in Vegas she's incredible but [125:26] um I do think we always have to try to [125:29] understand and it comes from a place of [125:30] profound pain and that's not a pain that [125:32] those people deserved right that and [125:34] that's a pain they should never have [125:35] been subjected to but one of the really [125:37] surprising things you talk about in your [125:39] book is the relationship that a zek has [125:40] on addiction and I couldn't quite figure [125:43] out why there'd be any impact on [125:45] addiction if we start taking AE drugs [125:47] you talk about the how it eases the food [125:49] chatter in our brains and the sort of [125:50] food cravings we have but then there's a [125:52] lot of research you go into that shows [125:55] um a zenek and these kinds of drugs can [125:57] actually have an impact on our um [125:59] addiction to things like cocaine and [126:01] alcohol so this is much disputed and [126:03] there are serious scientists on both [126:05] sides but I found it mindblowing and [126:08] totally fascinating so for [126:11] example woman called Elizabeth yog who's [126:13] a professor at the University of [126:15] gothenberg in Sweden has done some of [126:17] the pioneering work on this I [126:18] interviewed her a [126:19] lot they get a loot of rats and they put [126:21] them in a cage and they give them loads [126:24] of alcohol and rats will like alcohol [126:26] and they get hammered like the rest of [126:27] us and they wobble about and they love [126:29] it right so they put them in this cage [126:30] for a while they've got plenty of [126:31] alcohol they get drunk over many weeks [126:34] and then once it starts to resemble like [126:36] a dive bar in vas they do an [126:38] intervention they come along and they [126:40] inject them with gp1 Agonist the exact [126:42] drug you've got in front of you stide um [126:45] and then they watch and what they [126:46] discovered what professor yog and her [126:48] colleagues discovered is afterwards the [126:50] rats drink about 60% less than they did [126:53] before and the Rats who drank most [126:55] heavily are the ones who cut back on [126:56] their drinking the most like whoa what's [126:58] going on there but then they thought [127:00] okay maybe it's because alcohol's got a [127:02] caloric content it's like they want the [127:04] calories less right so then there were [127:06] experiments done with drugs that don't [127:08] contain any calories so Professor [127:10] Patricia grigson who's at Penn State [127:12] University gets rats heavily using [127:15] heroin and fenil gives them a GP Agonist [127:18] again finds the same thing 50% reduction [127:21] ction in the rats using the her self [127:23] administering the the heroin and the [127:25] fenil Then Greg stanard who I mentioned [127:27] before who's at Florida State University [127:29] does it with cocaine in it was mice not [127:31] rats for him again 50% reduction in them [127:34] using cocaine we don't know why again it [127:37] come some of the theories come back to [127:39] that question about the reward system [127:41] could it be dampening the reward system [127:43] one of the things a lot of the [127:44] scientists find fascinating is these [127:46] drugs appear to have what they call SEL [127:49] activity so SEL activity is where [127:52] the drug makes you want less of the Big [127:54] Mac but not less of a salad right so it [127:57] seems to it doesn't just generally [127:58] dampen you don't just not eat at all [128:01] some people do with malnutrition as a [128:02] risk but most people don't right so [128:05] given that it's some of them argue again [128:09] it's highly speculative at this point it [128:12] seems to be activating downgrading your [128:15] desire for things that are bad for you [128:17] but not things that are good for you [128:18] right I'm thinking how can that be that [128:20] seems so weird let's I'm Elton John [128:22] right and I get my pleasure from playing [128:24] music how can it know to tell me to eat [128:27] fewer Jam sandwiches but not to engage [128:29] in jamming right how can it do that and [128:31] they kept saying we don't know there [128:34] does seem to be a mechanism that does [128:35] that we're trying to explore it so [128:38] obviously hugely encouraging results in [128:40] animal studies with uh addiction so now [128:44] there's lots of experiments going on [128:45] with giving these drugs to humans to see [128:47] if they reduce addiction there there's [128:49] been a huge amount of anecdotal evidence [128:51] interview to a nurse in Canada called [128:52] Tracy who had a bad relationship breakup [128:55] and just became completely addicted to [128:57] shopping she would just obsessively buy [128:59] books she'd never read clothes she'd [129:01] never wear she was doing a lot of um [129:03] skin [129:04] picking um and obsessive eating she goes [129:07] on as mpic and all these addictions like [129:09] disappeared so there's now this debate [129:11] okay is it going to have this effect [129:13] more widely the early research is kind [129:15] of mixed so there's only very very small [129:18] studies on humans so far uh it found [129:20] that it reduce smoking but only if you [129:23] pair it with a nicotine patch they found [129:26] that it does reduce alcohol consumption [129:28] but only if you were a heavy drinker at [129:30] the start so we're going to know a lot [129:32] more we're going to get a lot of results [129:34] actually this year and definitely a lot [129:35] next year but it's a very promising so [129:38] some people argue so the most extreme I [129:40] want to stress this is [129:42] speculative the biggest cheerleaders for [129:44] the drug would say actually we haven't [129:46] found a drug that causes appetite [129:48] regulation what we found is a drug that [129:50] boosts self-control across the board [129:52] right now that's very contested I'm [129:55] always conscious you know of the [129:57] overselling of drugs [129:59] generally we want to be careful about it [130:01] but it's a possible scenario and the [130:02] animal research is mind-blowing and [130:04] really is highly highly exciting and you [130:07] don't normally see this right there's no [130:09] other drug that I'm aware of pretty sure [130:11] there isn't um that just reduces [130:13] addiction across the board in animal [130:15] studies right it's remarkable I mean [130:18] there's a debate about whether you can [130:19] even call it Addiction in animals but [130:20] you know what I mean heavy compulsive [130:22] use what impact has zek had on your [130:25] weight loss Journey how much have you [130:26] lost I me I just lost a huge amount of [130:28] weight so I lost three stone across a [130:30] year and actually it was even more [130:32] dramatic was the percentage of body fat [130:33] that I lost so at the start I was 33% [130:36] body fat I remember the day Josh my [130:38] trainer measured that and it sort of [130:40] looked winced as he saw it and um I said [130:43] oh God if you if I was a sandwich you [130:44] wouldn't want to eat me I later looked [130:46] up whales at only 35% body fat so it [130:48] started disconcerting so I went from 33% [130:51] body fat to 22% body fat so it's a [130:53] really dramatic fall and did you [130:54] increase your dose yeah so everyone [130:57] starts at 0.25 milligram partly because [130:59] the most common side effect by far is [131:01] nausea right almost everyone feels [131:04] nauseous a bit when they start taking it [131:06] for some people the nausea is unbearable [131:08] I interviewed someone called Sunny [131:09] Newton in Vermont who said you know it [131:11] felt like an alien had entered her body [131:12] and was thrashing and trying to get out [131:15] yeah a significant minority experienced [131:17] such extreme nausea they just have to [131:18] stop for me the nausea has now totally [131:20] gone away way um and Carell laru one of [131:23] the scientists who worked on there said [131:24] look when it comes to nausea you've got [131:26] a level with people there are two kinds [131:27] of drugs there are drugs that have side [131:30] effects and there are drugs that don't [131:31] work right and he's right about that but [131:33] yeah the nausey is pretty bad but but [131:36] for me it's all gone away now I really [131:38] do admire Oprah I've um watched her [131:40] she's kind of like a role model of mine [131:42] for how she's kind of conducted herself [131:43] throughout her career and as you say [131:44] she's a friend of yours and she's I [131:46] think recently come out and admitted to [131:48] using as zc she's talked about how she [131:50] struggled with with weight for her life [131:53] um andna zek has been a bit of a Magic [131:55] Bullet it seems for her in her weight [131:57] loss Journey um you know her as a person [132:00] I've not been paying enough attention to [132:02] her describing her decision to know why [132:05] she decided to take a zek verses I don't [132:08] know some other form of dieting has she [132:10] explained that yeah she talks about it [132:12] very movingly um she talked about an [132:14] interview with People magazine and then [132:15] a brilliant special for ABC I think [132:19] um I mean nobody has publicly tortured [132:22] themselves with diets more than Oprah [132:24] there's this famous clip that you've [132:25] probably seen where she comes on stage [132:28] on her show and she's Wheeling a a huge [132:32] bucket of fat and that's the amount of [132:34] fat she'd lost on this diet and she [132:35] describes very movingly in this special [132:37] she says it much better than I can how [132:39] she had starved herself to get that [132:41] right and you think about so she had [132:44] tried all the [132:47] extreme diet and exercise options that [132:49] were available and they'd always yyo [132:51] back for the reasons that we talked [132:52] about [132:53] before so and you know and she had to [132:55] have a knee operation I'm not giving [132:57] away anything she's she's disclosed this [132:59] you she had to have a knee operation and [133:01] she was very worried about her [133:03] health and so for those reasons she's [133:05] made this this Choice there are lots of [133:08] reasons to be worried about these drugs [133:09] but I have found it very [133:11] hard when you talk to people who really [133:15] struggled with this like that guy Jeff [133:18] Parker I mentioned before in San [133:19] Francisco like Oprah people who've made [133:22] the decision to do it and seen the [133:23] benefits of the weight loss staggering [133:26] benefits whatever the other arguments [133:28] are I've NE I don't want to argue [133:30] against them right if if you are taking [133:34] these drugs and experiencing an enormous [133:35] Improvement in your in your health as [133:38] they both have and as lots of other [133:40] people have then that's been the right [133:41] choice for you now that won't be right [133:42] for everyone I met people who really [133:44] regretted taking the drugs for all sorts [133:46] of reasons including many of the [133:47] terrible side effects and [133:49] risks but I think we have to be truthful [133:52] to the complexity of these drugs right I [133:54] mean one of the reasons it's called [133:55] Magic pill the book is because there's [133:58] three different ways you could think [133:59] about this as magic loads of people who [134:01] take the drug go this is Magic right so [134:03] the first form of magic is obvious it [134:06] seems to solve a problem so quickly so [134:08] effectively that you're like whoa It's [134:10] like a miracle right that's one way the [134:13] second way is it could be magic like a [134:17] conjures illusion right it could be like [134:19] a magic trick it seems to solve the [134:21] problem but doesn't or sets up and [134:23] trains something else or the Third Way [134:25] is think about almost every fable about [134:27] magic is you get what you want but then [134:30] you get what you want in a way you [134:32] didn't quite expect you you make a wish [134:34] with the genie and you get what you want [134:35] but the wish doesn't quite work out how [134:37] you thought most famous story about [134:38] magic is Fantasia you know the magic can [134:41] spiral away from you so I think one of [134:43] the things we're still trying to figure [134:44] out is what kind of magic is this is it [134:46] a magic solution is it a magic trick or [134:49] is it a magic solution that's going to [134:50] spiral in all sorts of unpredictable [134:53] directions I have to say when you know [134:54] when you were holding that pen looking [134:55] at me I got weird like you were doing [134:58] slightly judgmental Dragon's Den eyes [135:00] and I was like I was like [ __ ] how do I [135:01] persuade him to invest in me right so [135:03] funny I I was you I was thinking I was [135:06] thinking I was having a conversation [135:08] with myself and I staring at thinking [135:10] God this would be easier than going [135:12] because after you leave here I I haven't [135:14] eaten yet today I'm going to have my [135:15] lunch and then I'm going to go to the [135:16] gym for about an hour and a half and [135:18] much of the reason why I go to the gym [135:19] is to try and stay in shape you know I [135:21] want to keep my I want to keep my belly [135:22] fat off I want to keep my muscles strong [135:24] I want to be strong I want to look good [135:25] that's the that's the reasons I go to [135:27] the gym also the positive consequence of [135:31] me going to the gym later on after this [135:32] conversation is it will make my brain [135:34] feel really good yeah now as I was [135:36] looking down at the pen I was [135:37] thinking I could take this and then the [135:40] belly fat you know would wouldn't be [135:42] there but then I would lose the positive [135:44] upside of the exercise that I'm going to [135:46] get from going to the gym as well so I [135:47] was wondering to myself are people going [135:49] to exercise less and is there a [135:51] consequence to us not ex not exercising [135:53] as much um to our mental health and our [135:56] feelings of you know happiness and all [135:58] the things that exercise does for us [136:00] yeah the answer to both your questions [136:01] is yes people will exercise less and it [136:03] will have negative effects so we know I [136:06] want to add to that the point that I [136:07] alluded to earlier on people are getting [136:08] more and more sedentary we're living in [136:10] like a Vision Pro headset don't need to [136:12] move World well you know what I mean so [136:16] we're going to be able to inject to keep [136:17] the weight down but we're we're still [136:19] going to be moving less and there's a [136:20] lot of upside to moving and exercise [136:22] yeah so we know that there's there are [136:25] enormous benefits to exercise which [136:27] exist quite separate to the question of [136:29] weight loss right if you exercise for [136:31] 270 hours a year you add three years [136:34] onto your life even if it doesn't cause [136:35] weight loss right so that benefits in [136:38] terms of preventing disease slowing down [136:41] aging mental health are just enormous [136:43] from exercise and I think you've gone to [136:45] a really important drawback which is [136:48] yeah if you can get the benefit in the [136:50] short ter medium-term just from a [136:53] jab but that calculation you were [136:55] thinking through as you were holding the [136:56] pen in the slightly Sinister Dragon Den [136:58] way um is a calculation lots of people [137:01] were going to make and there's um [137:02] there's a lot of things I'm not sure [137:04] about in these drugs but there's a few [137:05] bits of advice which I am very sure [137:07] about if you are not overweight or obese [137:10] you definitely shouldn't take these [137:12] drugs right you are incurring all the [137:14] risks for none of the benefits so that [137:17] I'm certain of and there are lots of [137:18] people who are not overweight or obese [137:20] who are taking the drugs to be super [137:21] thin my friend Elise lonen who used to [137:23] be the chief content officer at goop [137:25] said she won't even go out for dinner in [137:27] LA with people we know now because no [137:29] one eats anything like why did we come [137:31] out for dinner you're all starving she [137:33] says you know dieting is out elimination [137:34] is in the way she put it so I'm [137:36] confident about that I'm also fairly [137:39] confident although slightly less but [137:41] fairly confident if your BMI is higher [137:44] than [137:45] 35 or your body fat percentage is very [137:47] very [137:49] high and you're not someone with thyroid [137:52] cancer in your family and you're not [137:53] trying to get [137:55] pregnant I would recommend taking the [137:57] drugs I think for you the balance of [138:00] risk and and assuming you've tried diet [138:03] and it didn't work I think for you the [138:05] balance of risk is is more towards the [138:07] benefits of taking the drug I'm not as [138:09] confident about that but I'm pretty the [138:11] people I love who have BMI higher than [138:13] 35 who are in that position I have [138:14] recommended the drug to them for people [138:16] between with a BMI between 27 and 35 I [138:20] think it's much more or um you've got to [138:22] just go down the list of the benefits [138:24] and drawbacks um and really think it [138:26] through for yourself and reasonable [138:28] people will reach completely different [138:29] conclusions it's going to be quite [138:31] interesting to see that people who do [138:32] decide to do exercise and they change [138:35] their diet and they've start running [138:36] marathons when they lose weight every [138:39] everybody is going to say no you didn't [138:41] that's so funny everyone's going to say [138:42] it was impc if some celebrity now drops [138:44] I don't know three stone or four stone [138:46] and they did it you know in the gym and [138:48] with a diet change no one is going to [138:50] believe them no one that's very funny [138:53] and I think think certainly yeah I think [138:54] you're right there I had thought of that [138:56] you wouldn't believe them of course you [138:57] wouldn't believe them no you're right [138:59] one of the big rebuttal that I see [139:01] online is that because people are now [139:03] taking these drugs people like you are [139:04] taking them to lose weight diabetics [139:07] can't get their hands on these drugs [139:08] anymore and I saw some articles that [139:09] said the um the drugs have been in such [139:12] high demand that diabetics who really [139:14] really need them to save their lives now [139:16] can't get access to them I think those [139:18] people have a really good point and I [139:20] interviewed some of them for the book [139:21] and it was a very painful conversation I [139:24] think the solution is what we should [139:25] have done right from the start and what [139:26] we should do now is what we did in [139:27] Britain with the covid vacine so we [139:29] should um ration the drug and the people [139:32] with the greatest need should be given [139:33] it first and everyone [139:36] agrees severely obese people and [139:38] diabetics together would be the people [139:40] who most need the drug and they should [139:42] be given it first people like me who've [139:45] got heart disease in my family but were [139:46] not hugely obese would probably be [139:48] around the middle and you know people [139:50] who don't have heart disease and are [139:52] just sort of overweight would be at the [139:53] bottom we didn't have that system what [139:55] we had unfortunately because the [139:56] government didn't set up that system was [139:58] a scramble which meant that you know [140:01] some diabetics didn't get the drug they [140:03] needed had to go on insulin earlier [140:05] which poses a real threat to their [140:06] health that's awful and I feel a bit [140:09] ashamed about it because of course if [140:10] people like me hadn't hadn't all [140:13] together bought it that wouldn't have [140:15] happened in practice for me [140:17] personally I was worried about my own [140:19] heart risk you know I mean year older [140:21] than my granddad was when he died um but [140:24] that's not much of an excuse and when I [140:26] met the diabetics in that position like [140:27] for example a guy called zami Jalil who [140:30] was exactly in that position he could as [140:32] a musician 41 couldn't get the the ASM [140:36] pick he needed for his diabetes for his [140:37] type two [140:39] diabetes I felt um ashamed you know [140:42] clearly his need was [140:45] greater Yan thank you thank you for a [140:48] few things I think it's worth saying [140:49] that the first time you came on my [140:51] podcast I had basically no listeners you [140:53] were like a tiny little baby podcaster I [140:55] remember it really clearly you came to [140:56] my flat I showed up at your flat in [140:58] London I'd read your book lost [140:59] connections I was so fascinated by it so [141:01] I reached out to you and asked you if [141:02] you'd come on and you said yes when I [141:04] was when no one was listening to the [141:05] podcast I don't I wasn't even videoing [141:06] it back then um and it was an incredible [141:09] conversation the audio was terrible [141:11] there was Lo we had loads of issues and [141:12] stuff like that but you were one of the [141:13] first people to really give me a chance [141:14] so it's so wonderful that that we can [141:16] still stay in touch and that I get to [141:18] cover your work still to this day so [141:19] thank you for giving me a chance back in [141:21] the day I really appreciate it oh my [141:22] pleasure and thank you for writing this [141:24] book because one of the the most sort of [141:26] popular things that our audience have [141:27] been seeking to understand is a zmek [141:30] we've seen that in all the data and the [141:31] way that you approach this even though [141:33] you are someone that's taking it so it's [141:35] easy to see how you would be biased in [141:37] various ways to defend it or whatever [141:39] that's not the approach you take and in [141:40] the book magic pill you're able to be [141:43] incredibly nuanced and how you look at [141:45] the pros and the cons in a way that I [141:47] was not expecting from someone who is [141:49] taking it themselves and I think that's [141:50] really important because you're right [141:51] you finished the book and in a weird way [141:55] you you have more information but I can [141:59] understand how the decision Still [142:00] Remains with the individual and I think [142:03] that's really what any book on this [142:05] subject should should aim to achieve it [142:06] should kind of not have a dog in the [142:08] fight but present you both sides of the [142:11] trade-off so that you can make a [142:12] decision for yourself and that's what [142:13] you do so skillfully and the real thing [142:15] you know as an author that you've taught [142:16] me over the years is you're just [142:18] remarkably good at writing and it's [142:21] really your your storytelling is [142:23] phenomenal it's influenced me profoundly [142:25] as an author myself and uh whenever I [142:28] read a book now I often wish that they [142:30] had written it like one of your books [142:32] because you take a you take a concept [142:33] that's difficult and widely discussed [142:36] and you take us on a journey and that [142:38] journey is so much more enjoyable than [142:40] just reading like a science book so I [142:42] recommend everybody to go and get magic [142:43] pill right now it's um it's obviously a [142:45] huge point of conversation at the moment [142:46] these these magic pills um and this is [142:49] the book to read on it magic pill the [142:51] extraordinary benefits and disturbing [142:52] risks of the new weight loss drugs it's [142:55] due to be released on the 2nd of May [142:57] 2024 so we're a couple of days away from [143:00] that now and um yeah I would just highly [143:03] highly recommend this book thank you so [143:04] much Johan oh I'm really touched by that [143:06] Stephen thank you so much I almost [143:08] forgot we have a tradition on this [143:09] podcast oh yes the question what is the [143:11] question who who posed this question I'm [143:13] not going to tell you who who this is [143:15] but the question that's been left for [143:16] you is it's a really interesting one [143:21] why [143:21] should [143:23] Humanity continue to exist so as you [143:27] know I've been writing for God 12 years [143:30] now 13 years a book about a series of [143:32] crimes that have been happening in Las [143:33] Vegas I'm not allowed to talk about but [143:34] it will come out next year and I promise [143:35] we'll finally talk about it I think [143:36] you're just saying this so you can hang [143:37] out in Vegas every time I see you say [143:39] You're Just in Vegas writing a book I'm [143:41] like where's the book your hand yeah [143:43] there are people many people in Vegas [143:44] have said to me yeah your book's been a [143:46] long time [ __ ] coming but so um I [143:50] know two people called Rob banghart and [143:52] Paul [143:53] Vino who um a lot of people won't know [143:56] but there's many thousands of homeless [143:58] people who live in the drainage tunnels [143:59] beneath Las [144:01] Vegas and Rob and Paul used to live in [144:03] the [144:04] tunnels and Rob lived in a particular [144:07] set of tunnels that I know very well and [144:08] have spent a lot of time [144:10] in and in [144:13] 2017 so Rob was known as hobo Santa he [144:16] would steal things and give them to [144:17] people and um he was also a kind of [144:21] low-level dealer very low-level and [144:23] there was a a group of uh rival Cuban [144:25] dealers who didn't like him and one day [144:28] in [144:29] 2017 they hit him in the head with an [144:31] axe split his skull open dragged him [144:33] onto the railway tracks and left him [144:35] there for a train to run him over but [144:37] fortunately someone spotted him pulled [144:40] him off the tracks and he survived and [144:41] he in the next six months as he [144:43] recovered he um turned his life around [144:49] and he began to volunt here for a group [144:51] that my friend Paul runs uh called shine [144:53] a light which is a group of people [144:55] overwhelmingly people who used to live [144:56] in the tunnels who managed to get out [144:58] turn their lives around who now help the [145:00] people who are still down there they [145:01] give them loads of practical things from [145:04] tampons to flashlights and they most [145:06] importantly give them support when they [145:08] want to leave and I've got lots of [145:09] people out and every month get people [145:11] out of the tunnels and I've seen them do [145:13] it with some people I really love who [145:14] were down [145:15] there and one [145:17] day few years ago I was I was with Rob [145:22] and [145:23] um [145:25] um so one day a few years ago I was with [145:28] Rob when he got word that uh a friend of [145:32] his from the tunnels called picket had [145:33] died he' ODed in in the tunnel they used [145:36] to live in so we went straight down [145:38] there and um picket stuff was still [145:41] there they'd taken away his [145:43] body and we bumped into a woman who also [145:46] lives down there and whenever Rob goes [145:48] to the tunnels even in a situation like [145:49] that he always BRS supplies you know [145:51] food and stuff and he said to [145:54] her who's in the tunnel over there and [145:57] she said oh you don't want to go there [145:58] and he said why and she named some [146:00] people and he said no I'll go there I'll [146:02] give them some stuff and he went and [146:03] gave them some stuff anyway I didn't [146:04] really think about it very much I was [146:05] thinking about pick it and what [146:07] happened and a few days later I said to [146:09] Rob what did she mean when she said you [146:11] don't want to go there and he said oh [146:13] it's just these guys and I said what [146:15] guys he said oh well they're the guys [146:17] who hit me in the head with an axe [146:18] they're the guys who tried to kill me [146:22] and I saidwell why did you go and help [146:24] them and he said because they're human [146:27] beings and they're suffering and they [146:28] need [146:30] help and [146:33] um I thought a lot about [146:37] Rob every day him and [146:40] Paul go back into those tunnels you know [146:42] they could do anything they could leave [146:43] and do a million things right they're [146:45] incredibly intelligent and talented [146:47] people every day they go back and they [146:49] help the people who got left behind and [146:52] they make no money doing it and they [146:54] don't have great lives doing it in any [146:56] material sense and I've say to them why [146:59] do you do it and they just they say [147:02] because it's the right thing to [147:03] do and if you said to me why should [147:06] human beings continue to exist I could [147:07] give you a load of abstract answers I [147:08] could talk to you about philosophy and I [147:10] could talk to you about art and I just [147:12] say come and meet Rob and [147:15] Paul there why humans should continue to [147:17] exist [147:21] thank you cheers Stephen [147:26] [Music]