This episode is sponsored by a company I've used for well over a decade and that is 511.
I wore their uniforms back in Anaheim, California and have used their products ever since.
From their incredibly strong yet light footwear to their cut uniforms for both male and female
responders, I found them hands down the best workwear in all the departments that I've worked for.
Outside of the fire service, I use their luggage for everything and I travel a lot and they are
also now sponsoring the 7X team as we embark around the world on the Human Performance Project.
We have Murph coming up in May and again I bought their plate carrier. I ended up buying real
ballistic plates rather than the fake weight plates and that has been my ride or die through
Murph the last few years as well. But one area I want to talk about that I haven't in previous
sponsorship spots is their brick and mortar element. They were predominantly an online
company up till more recently but now they are approaching 100 stores all over the US.
My local store is here in Gainesville Florida and I've been multiple times and the discounts you see
online are applied also in the stores. So as I mentioned 511 is offering you 15% off every
purchase that you make but I do want to say more often than not they have an even deeper discount
especially around holiday times. But if you use the code SHIELD15 you will get 15% off your order
or in the stores every time you make a purchase. And if you want to hear more about 511, who they
stand for and who works with them, listen to episode 580 of Behind the Shield podcast with
511 regional director Will Ayres. Welcome to the Behind the Shield podcast as always my name is
James Gearing and this week it is my absolute honor to welcome back onto the show author
Johann Hari. Now for those of you who listen to episode 317 we took a deep dive into his books
Chasing the Scream and Lost Connections discussing mental health and addiction. Well Johann has a
brand new book called The Magic Pill where he details his own experience with the weight loss
drug Ozempic and as you will hear we dive into a host of topics from the psychology behind obesity,
how these drugs have the potential to replace gastric bypass surgery thus making weight loss
much safer, deconstructing the health of the food in our stores, some incredible ideas from overseas
and so much more. Now before we get to this amazing conversation as I say every week please just take
a moment go to whichever app you listen to this on, subscribe to the show, leave feedback and leave
a rating. Every single five star rating truly does elevate this podcast therefore making it easier
for others to find and this is a free library of well over 900 episodes now. So all I ask in return
is that you help share these incredible men and women stories so I can get them to every single
person on planet earth who needs to hear them. So with that being said I introduce to you Johann Hari.
Enjoy. Well Johann I want to start by saying I am so so glad to get you back on the show. We were
just talking before we hit record. Ironically I tried reaching out several times and as people
will hear in these conversations there are reason why you away from your devices but you have already
had one great book out Stolen Focus. You're about to release Magic Pill so I just want to start by
welcoming you back onto the Behind the Shield podcast today. Oh I'm so glad to be with you.
Cheers James. So the last time we sat down was May 30th 2020. Interesting time in the last few years.
I can't remember anything that happened in between now and then. Sure there were some world events.
I believe so. I wish I could remember the name. There was a podcast you did I think it was recently
with three Australian hosts. Oh the Imperfix. I love those guys. Great great conversation especially
for three of them. They weren't interrupting or stepping over each other but one of them was
telling a story. I forget who it was they said now but someone went into a oh it's Jared Leto
went into a meditation retreat right when before Covid hit and then came out 30 days later
wondering what the hell had happened to the world because you've been in some monastery for a month.
Yeah I was in Vegas for a lot of Covid because I'm writing a book about a series of crimes that
are happening in Vegas. I've been researching them for god 13 years now. It's the next book in the
queue. It's the next one I'm going to write and Vegas was an absolute headfuck during Covid. It
was completely bizarre. There was a period when everything shut down so Steve Sisolak the governor
shut everything down a few weeks into the pandemic but so in Vegas if you've got a gaming license
by law you have to be open 365 days a year 24 hours a day. You can never close right. I think
you're allowed by law to close for like six hours a year for cleaning and that's it right.
So there was this bizarre thing where when everything had to shut down no one had any
keys to lock the doors. Caesar's Palace opened in 1966 and has never closed right. So there was this
sudden bizarre like anyone seen those keys since 1966. It was completely surreal. There's also a
period when it reopened when they were very strict on the mask mandates in Vegas. There's a period
where it reopened where the strip clubs reopened where it looked like it was going to be that there
there would be strippers and the only thing they would be wearing was going to be face masks
because by law they had to right. So it was a completely surreal I mean I mean it was surreal
everywhere but I think it was Vegas always gives an extra surreal edge to everything in life.
Absolutely well while we're on that topic just for a second Chasing the Scream an incredible book on
addiction actually just sat back down with Zhao Guilao a few months ago for our second interview.
Oh I love Zhao what a great man. Amazing and one of the most impressive people I've ever met.
Yeah really great man. It's so humble as well but then you have they obviously lost connections.
Now we all know what happened and the way it was handled during the pandemic. The way I navigated
those years as I put lots and lots of extra episodes out on health nutrition mental health
etc. So people had autonomy in their homes they had actionable things to do even though they were
being told to you know stay in your house and we'll tell you what to do. That time is already gone
and we had a captive audience and an amazing opportunity to really move the needle on a lot
of wellness issues and they just didn't. So rather than being critical of that time
with all the the areas that you've written about up to this point if everyone listened today
what were the the lessons that you wish people to learn from the last four years
if they were listening right now?
Well everyone knows they have natural physical needs. You need food, you need water, you need
shelter, you need clean air. If I took those things away from you you'd be in real trouble real fast
but there's equally strong evidence that all human beings have natural psychological needs.
You need to feel you belong. You need to feel your life has meaning and purpose. You need to feel that
people see you and value you. You need to feel you've got a future that you understand and that
makes sense and our culture is great at many things. I'm glad to be alive today but we've been
getting less and less good at meeting these deep underlying psychological needs for a very long
time throughout my lifetime in fact and then obviously during the pandemic the ability to get
your psychological needs met just collapsed. We had to physically separate because of the virus.
There's a massive increase in loneliness. We were already the loneliest society in human history.
They had a huge increase in loneliness, huge increase in stress, a huge increase in people
not having a sense they understood the future or had a future. So I think what it shows us
is that being deprived of your underlying psychological needs makes you feel terrible.
It makes you feel anxious. It makes you feel depressed or at the very least it makes you
feel much less good than you otherwise would have and there's all sorts of ways that I write
about in my book Lost Connections that I saw being played out all over the world that we can
together change the way we're living to get our deeper needs met and when you do that it reduces
depression and anxiety massively. It's not the only thing you can do to reduce depression. There are
many things that I talk about in the book and that people will know about. But yes, I guess
the main thing is someone wrote to me, a friend of mine, Andrew Sullivan, the writer, wrote to me
at the height of COVID when it had just been reported that depression had doubled in Britain.
He said, it's like we ran an experiment to see if you were right, if your book was correct.
Now there were bigger things going on in the world than worrying about whether I was right or not.
But I think there's a truth in that. The book is called Lost Connections because we've lost
our connections to many of the things you need in life and in the pandemic we lost our connections
even more and it was a disaster. Now, of course, there was a good reason for us to physically
separate during the pandemic, right? But that can teach us something going forward. Okay, if
massive increase in loneliness and stress and anxiety and loss of a sense of the future was
making us feel terrible during the pandemic, well, that might help us understand why depression and
anxiety were hugely rising before the pandemic and why since the pandemic, if we want to get out of
this spiralling depression and anxiety and addiction, which has very similar causes,
the core of addiction is about not wanting to be present in your life because your life is too
painful a place to be. If we want to get out of that spiral, we've got to do many things,
but one of them is you've got to deal with the deep underlying causes of these problems, right?
Which can sound very fancy, but like I say, I went to places that have done it. I've seen how
it's done in practice. Absolutely. I remember quoting you many times when it came to hearing
about all the mental health elements from the pandemic. And again, ultimately it was about
resilience. And so what should have happened is that we should have fought to make the people in
our own nations as healthy as possible and as happy as possible because the more scared and
isolated they are, the less resilient they are, the more immunocompromised they are. Therefore,
the higher chance there is of having a greater response to the virus. So when you talk about
the opposite of addiction isn't sobriety, the opposite of addiction is connection.
Well, during the pandemic, alcohol didn't get stronger. People just connected less. So I think,
again, underlining your work, this is what I think really need to be brought out of this whole thing
is we've got to make people healthier because another thing is going to come. But also we've
got to understand exactly like you said, that the disconnection, the pigeonholing and dividing of
communities and countries only further adds fuel to the fire of addiction, depression,
suicide, homelessness, and all the other things that we see crushing our men, women, and children.
Well, there's a wonderful couple called Professor Anne Case and Professor Angus Dayton
have done some of the best work looking at the places where addiction is highest in the
United States. And I've been to a lot of them mostly for my research. And they describe those
deaths as deaths of despair. And as you know, we had a lot of addiction in my family. So this really
rings true to me. Yeah. And interestingly, I've been thinking about these issues in a very different
way about health in the last year because I've been writing a book about these new weight loss
drugs that have come along. And I've spent a year traveling all over the world taking these drugs
interviewing the leading experts on them, the scientists who play key roles in designing them
and making them possible, their biggest critics, their biggest supporters all over the world from
Reykjavik in Iceland to Minneapolis to Tokyo. And it's been so interesting because
with my previous books, which we've talked about, I ended up with a very strong sense of,
this is what we should do now. I went to places that I felt had found the answer.
Of course, there's a lot we don't know, but a huge sense of this is the way forward. This is what we
should do. With these weight loss drugs, it's been really interesting. The subtitle of the book is
the extraordinary benefits and disturbing risks of the new weight loss drugs.
And right from when I first heard about these drugs, and I can tell you how it happened,
the moment I first heard about them, it was kind of weird experience. But right from the moment I
heard about them, I don't remember ever feeling so conflicted about a subject. I could see the
argument for them. The scientific evidence is very clear that obesity very seriously harms your
health on average, and these drugs reverse obesity for lots of people. And that has incredible
positive effects. If you take these drugs and you started off obese, in the next five years,
you're 20% less likely to have a heart attack or stroke, for example, and that's just one of the
many health benefits. And I could see, we've been torturing ourselves with diets for years,
God knows I have. Someone whose weight has always yo-yoed from underweight to obese
throughout my adult life. And I kind of thought, well, if there's a solution here,
if there's something you can do that's relatively painless and that reverses obesity,
wow, this could be amazing. And lots of the scientists I spoke to really reinforced that.
They were like, no, this is a game changer. One of them described it and said, we found the holy
grail, right? We found a drug that reliably and safely causes weight loss. But there were other
scientists, and honestly, my own opinion, at the start, I thought, well, you know, I felt very
anxious. Every previous miracle diet drug has been announced in similar ways and then pulled from the
shelves because it caused some horrific effect that meant that it had to be removed, usually
in a hail of lawsuits. So I was very conscious of that. But even more, I was conscious, look,
there's been a massive increase in obesity just in my lifetime, right? Extraordinary increase.
The average American weighs 23 pounds more than they did shortly before I was born, right?
That's an extraordinary increase, unprecedented in human history. In the world, obesity has
tripled since 1975. And it didn't increase because there was some biological problem,
that needed to be fixed with a medicine. It increased because the food supply changed in
ways that have really fucked us up and made us sick, right? And of course, I thought, well,
you know, my books are all about, we've got to deal with the causes of problems. That's what
we were just saying in relation to, you know, what COVID has revealed about depression and addiction.
I thought, well, we've got to deal with the causes of this problem. Isn't this just sort of
treating the symptom in what could potentially be a very risky way? So I ended up looking at
the risks of these drugs and the benefits of these drugs. And there are a lot of benefits,
and there are 12 quite big risks that I go through in the book. And then lots of implications for
these drugs in all sorts of directions. You know, Barclays Bank commissioned a very sober-minded
financial analyst called Emily Field to go away and give them guidance for investors on what these
drugs are going to mean for investors, right? The kind of investments people should be making.
And she came back and said, well, you know, I'm going to go through this, you know,
the kind of investments people should be making. And she came back and said, if you want to,
if you want a comparison for something similar in terms of its effect on the economy and the
society, you've got to look back to the invention of the smartphone in 2007, right? This is going
to have massive effects on our society. We've now got a drug that causes you to lose 15% of
your body weight on average over a year. In fact, that's just a Zempic stroke regovi. The
next generation, Monjano, which is also now available, causes 21% body weight loss on average.
And the next generation to come down the line, Triple G, that will probably be available next
year, causes 24.2% body weight loss after a year. I mean, that's only slightly less than bariatric
surgery. This is going to be massive for good, for bad. It's something we really need to, in my view,
deeply, deeply think about and reckon with. When you talk about bariatric surgery,
I'm sitting here now, my wife's in the other room and she lost her best friend just over a year ago.
And the kind of, I would say the cascade of ill health began with bariatric surgery. There's a guy
I went to fire school with who had complications of bariatric surgery. And he was way back 10 years
younger than me when I went to school, I think. And he lost a lot of weight as well. And now he's
no longer with us. How did he die, James? There was something where they ended up, part of his
intestine actually started dying, basically, to put it in layman's terms. So they didn't discover
until it was too late. And I think he literally was gone within days of them figuring out what
was going on. So when I think of bariatric surgery, like you said, and the weight loss
element of it, that absolutely is a thing. But as you said, there are 12 startling things about
these pills. It's the same with bariatric surgery and it terrifies me because when you think about
what you're doing to the human body, it's extremely unnatural. I think that's really important,
James, because what bariatric surgery shows in an extreme and heightened form is a dilemma. Because
why would anyone have bariatric surgery? Bariatric surgery is horrific, physically horrific surgery.
About one in a thousand people die during the operation. So why would they do it?
And the reason is, and the reason why many doctors recommend it for people who are
severely obese and have tried other ways and they haven't worked, is because you get... Because
bariatric surgery reverses or hugely reduces obesity. And that leads to, for the people who
don't die and the people who don't have the horrific complications, and that's a big caveat,
but for the people who don't, it leads to staggering improvements in health. So if you have
bariatric surgery, over the next seven years, you're 56% less likely to die of a heart attack,
you're 60% less likely to die of cancer, you're 92% less likely to die of diabetes-related causes.
And in fact, the effect is so powerful, you're 40% less likely to die of any cause. Now, I'm
not waving a flag for bariatric surgery. Bariatric surgery is horrible. I don't think I would do it.
But what that shows us in a very extreme way is the dilemma, right? Because if you just look at
the harms of bariatric surgery, you'd be like, well, this is insane. Why would anyone ever do this?
Right? You're having part of your stomach remediated. I mean, there's different forms
of bariatric surgery, but you're having an extraordinarily invasive form of surgery.
It's very painful. As I say, a negligible number of people die during the surgery, one in a thousand.
Why would you do it? It's because severe obesity is sadly, on average, catastrophic for human
health. Now, what these drugs do is they take that dilemma and slightly alter it. Obviously,
most people taking these drugs are not severely obese. But as I say, you've now got these drugs,
which come with a whole series of risks, but everyone, I think, would agree the risks are
significantly less than for bariatric surgery, right? No one is claiming that these drugs kill
one in a thousand people. Even the worst critics don't claim that. So what you've got is drugs that...
And there's a lot of other downsides to bariatric surgery that I think are interesting to think
about in relation to these new weight loss drugs as well. Perhaps we can come back to that. But
the good news in that respect is, okay, you're going to be able to get bariatric surgery type
weight loss without the operation. I mean, I can't see why once GGG is available, unless you were
someone who, for some reason, couldn't take these drugs, I can't see why anyone would have bariatric
surgery once the next generation of the drugs, which have already been tested in clinical trials,
are available. I think what really breaks my heart about this is that it's not just the
drugs that are available. What really breaks my heart about these two is neither of them,
I would argue, were even probably labeled obese, certainly not severely obese. I mean, one,
my wife's friend was just overweight. She was overweight, but not even obese. And then the
other one, he might have been scraping it, but he was kind of a big boned lad anyway. So I think
this is the problem is, like you said, I agree. I have been on literally a thousand pound patient
with a fire paramedic that was the pancake on the bed that we see in the reality shows. That
gentleman, who I'm sure is no longer with us now, that would be his only option, lying in a bed,
not able to move, the only thing that maybe would save his life. But just like cesarean sections
with pregnancy, now fast forward in America in 2024, I'd like to have my baby on Tuesday at
7.30 in the morning, please. All right, yeah, we'll just slice you open and off you go. Right,
to me is an abuse of that surgery. CSEC is absolutely pertinent in certain areas. There's
a dangerous birth or very, very petite mother and that application is warranted, but we have
allowed it to devolve to all these CSEC births now. They're not getting the bacteria that the
baby should be getting from a vaginal birth. And so that's, I think what really I struggle with is,
as a last resort, I understand bariatric, but I don't think it's being used like that in 2024.
I mean, the good thing is that that dilemma is, people aren't going to be worrying about that
dilemma in a couple of years because of the extraordinarily potent effect of these drugs.
And I think it's worth thinking about how these drugs work. And we now know much more, even than
we did a year ago, about how these drugs work. So when you eat, you get a, so let's say you had a
meal now while we were talking, your gut would produce, would release a hormone called GLP-1.
And that is one of the natural signals in your body that would just say, James,
you've had enough, stop eating, right? Just stop now. And most people, when they get that signal,
they do stop. But that signal only remains in your body naturally for less than 10 minutes.
It washes away. So if you kind of power through it, you can carry on eating. And obviously then
you'll overeat, right? So what these drugs do, and I interviewed the scientists who made all
the breakthroughs that made this possible, is they, and they're mostly not pills at the moment,
they're mostly injections. They inject into your system a copy of the, of GLP-1, a kind of
artificial replica of it. But instead of being washed out of your system in 10 minutes, it stays
in your body for a whole week, which means that I can tell you from my own experience,
you, when you start eating, you know, remember the couple of days after I started taking a
Zempik, I woke up and I had this weird feeling. I wake up and thinking, what do I feel? There's
something strange here. And I could, I lay there for like five minutes and I couldn't place it.
And then I realized, oh, I'm not hungry. But my whole life, I don't remember a day when I didn't
wake up hungry, right? I would often be woken up by my stomach rumbling. I woke up and I wasn't
hungry. I thought, this is a bit weird. And I went to the cafe, the road from here, where I used to
always go for breakfast. And I ordered my standard breakfast, which was a chicken roll with lots of
mayonnaise, a brown bread, huge roll with lots of mayo. And I had a couple of bites, you know, a
little bit, you know, I had maybe three or four bites, which is quite, actually quite a lot when
it's a big thing. And then I just felt full. It was the strangest sensation. And I left, I remember
Tatiana, the Brazilian woman who runs the cafe, sort of saying, are you sick, you're okay? And then
I went for lunch to this Turkish restaurant I used to go to for lunch most days, up the road,
next to my office, which, and I had my standard order, which was the Mediterranean lamb. And again,
had like a third of what I would normally have. And then I just wasn't hungry. And it was like
the kind of shutters had come down on my appetite. So one of the things these drugs do is they make
you fuller, faster. We now know, it used to be thought that was primarily because of an effect
on your gut and your stomach. It's not, it's primarily because of an effect on your brain,
which I'm sure we can explore and talk about. But it was, it was a, I was fascinated by how
rapid the transformation was in my appetite. There was certainly unpleasant side effects as well.
But I remember just being really quite shocked by how dramatic the, dramatic the effect was on my
appetite and how rapid the weight loss was, right? I've lost three stone in just over a year. I'm
terrible at converting to pounds. I need to memorize this before some of the other interviews,
but what's that three stone in pounds for American listeners?
46, I think, 46 pounds.
46, something like that. Yeah. So it's a huge amount of weight loss. I was 14 and a half stone
when I started, I'm 11 and a half now. And actually, and I'm unusual in this respect,
all of my weight loss has been fat. I was 33% body fat when I started. I'm now, I haven't done
it in about a month, but I was, I think it was 23 when I last checked. So, you know, I've gone from
33, which is only slightly below the body fat composition of a whale to, I mean, I gained a
lot of weight during COVID, like a lot of people to now, you know, in the BMI charts, I'm in the
BMI charts. I'm in the nice soothing green zone, the middle of the, the slightly upper end of the
green zone, which is a nice place to be. 42 pounds, I correct myself. I'm not good at
doing maths on the department. Spontaneous maths is my, my like stress stream.
Well, you touched on, you know, on the effects on their brain as well,
just to reverse engineer for a second, you talked about the kind of yo-yo weight struggles that you
had. I think it was an amazing part of, I think it was chasing the screen when you talked about the,
the woman in the weight loss study who was on the IV nutrition and then discovered that she was abused
by her grandfather when she was young. And that was a psychological reason for the weight gain.
I thought that was such a powerful, you know, anecdote because we always kind of chastise
the overweight. When I say we, some, some people in the fitness industry, well, if you just, you
know, ate salad and go for a run every day, then you'll look like me. And obviously there's a,
there's a whole psychology behind our eating as well. So when you look back with this lens now
at your journey, what psychologically do you think contributed to you struggling with,
with your weight and body dysmorphia? I wouldn't say I have body dysmorphia, but the,
I definitely didn't, but the, well, for obesity, there's three kinds of cause,
as with many conditions, there's biological causes, the psychological causes and their social causes.
Right. So biological causes are things like your genes, changes that happen in your brain,
psychological causes are how you feel about yourself and the world. And environmental causes are
things like in this case, the food supply system. Right. So I would say all three of them in different
ways were playing out with me, but you've asked about the psychological ones. So let's home in
on that for a sec. And it was one of the strangest things that happened to me during the,
during the working on the book, a kind of surfacing of these issues. Right. So if you'd
asked me when I started working on the book, magic pill, when you'd asked me, if you'd asked me,
you know, your home, why do you eat? I would have said, well, I eat to sustain my body. Right. I
eat to keep going. Obviously that's why I eat. But you know, before I took these drugs, I was
taking about, I was eating about 3,200 calories a day. And now I eat about 1,800 sometimes between
1,800 and 2,000 a day. So that's a lot fewer calories. Right. So, and here I am, my body is
sustained. It's alive. In fact, it's healthier than it was. So something else was going on with a
huge amount of my eating. And I looked a lot at the evidence about why people eat. Right. And
obviously sustenance is the primary or rather the most important one, but there's lots of other
psychological reasons why people eat. One of them is pleasure, right? Huge numbers of people get a
lot of pleasure out of food. And one of the issues around these drugs is for a lot of people, not me,
I have to say, but I can explain why if you want, but it really strips the pleasure out of foods.
For example, there's a British food critic called Jay Rainer, brilliant food critic, who, you know,
has talked about, he went on these drugs, goes to like some of the best restaurants in Paris and
just cannot enjoy the food. Even one of the scientists involved in designing the drugs,
Jens Jolls-Holst said in an interview with Wired magazine that, you know, for a lot of people,
they take these drugs and it just strips the pleasure out of food. And after a year or two,
life is so boring. They just can't go on. They have to say, it didn't have that effect on me.
But I don't think for particularly good reason. One of the things I realized, so I grew up in a
working class family and I grew up eating absolute shit. I mean, I ate nothing but junk food for my
entire childhood and teenage years. I mean, that's an exaggeration, right? The day the microwave,
I was mostly raised by my grandmother, who was an amazing woman. And the day the microwave was
invented was the happiest day of my grandmother's life, right? And it's funny, I remember the first
time I took a Zempik, you know, like a lot of people when they're about, a lot of people who've
nearly died and, you know, been revived describe near death experiences. I feel like I had a sort
of near death experience with food where I could picture all the food I'd ever, as I was injecting
myself, I was pictured all the food I'd ever eaten in my life, right? And I pictured, you know,
so much shit, like so many like, you know, there's little foam sugary bananas you used to get when
you were a kid, I pictured like, loads of just in staggering amounts of KFC and McDonald's,
there's 38,000 branches of McDonald's in the world, and I felt like I could see them all flicking
through my mind. And I realized, when it comes to pleasure, partly because I grew up in a very violent
and crazy environment when I wasn't with my grandmother. For me, the primary pleasure I got
from food was actually from kind of stuffing myself. I would sort of, I wouldn't have thought about
it this way, but looking back, I would sort of deliberately overeat. So everyone would have been
stuffed at some point in their life, Thanksgiving dinner or something, you know, and stuffing is a
particular kind of pleasure, it is a kind of physical pleasure when you're stuffed, it's
uncomfortable, but it's also pleasurable. You know, it's where you feel, you can feel sort of
pressure outwards on your stomach and upwards on your esophagus. And I think most of the pleasure
I got from food was sort of stuffing, I would overeat to stuff myself. And when I was on a
Zempik, I couldn't, you can't really do that when you're on a Zempik, you would just throw up if
you did that. So for me, I actually had to slow down my eating when I started taking these drugs,
which actually for me meant that I kind of tasted my food a bit more. And actually, I think I enjoy
food slightly more, I don't want to claim I'm some great foodie now, I'm never going to be
now, I'm never going to be that guy. But I think I've actually had an increase in pleasure from
food admittedly from a very low base. Of course, if you're someone like Jay Rayner, the food critic,
is coming from a different direction with a different relationship with food, he's going
to have a different experience. And I think more people are like Jay than they are like me, I
suspect, on these drugs. But that's one thing is pleasure. But another thing, which is a big thing
that we're playing out for loads of people, is just comfort. We eat to comfort, to stabilize our
emotions, to lift our moods if we're feeling down. There's lots of evidence about this. There's a
brilliant study of 475 NFL games. And it found that if the home team wins in a town, sales of shitty
junk food go down by 9% in that town over the following week. And if they go down, if they win,
and if they lose, the sales in shitty, comforting junk food go up by 16%.
And this is true of all traumatic events. There was a massive increase in shitty junk food after
9-11. There was a massive increase in shitty junk food purchases in blue states after Trump won.
So comfort eating is a very common thing. If you lose your job, you're very likely to gain a lot
of weight, partly through a big increase in comfort eating. And of course, that's another
thing that's taken away when these drugs kick in. Your ability to comfort eat is much more limited.
I remember one day about six months into taking them, probably a bit less actually,
I had a bad day. Nothing terrible. Not an awful day, but I had a bad day. And kind of on autopilot,
I was in Vegas, I went to KFC, a particularly rough KFC in Vegas that I love. And I remember
sitting there with this bucket of fried chicken in front of me, which a year before I would have
just eaten on autopilot and felt comforted by, and just thinking, shit, I can't eat this.
Like, I mean, I just literally couldn't eat it. And I remember seeing Colonel Sanders staring down
at me from the wall. And it's like he was going, hey, buddy, what happened to my best customer?
So one of the things that happens when you take these drugs is the underlying psychological
components that drive your eating are disrupted and therefore come to the surface. Now that can
be a good or bad thing. I remember going to one of my best friends and just saying, yeah,
this is making me feel like shit, I can't come for eat. I'm going to stop taking them. And her
saying to me, you know, this isn't creating this issue. These drugs are not creating this issue,
right? This is an issue that's there the whole time. What these drugs are doing is making it
visible to you. So yeah, you can stop taking the drugs and go back to that. And you'll incur all
sorts of health costs in the long term, and you'll be comforted in the short term. Or you can try to
change your relationship. You can try to understand these feelings and change your relationship with
food and try to see food, begin to see food as something you use to feed your body and make you
healthy, not something you use primarily to manage your emotions. And that's what I decided to do.
And I think it was a very conscious effort and it's been hard work, but I think I've made
a huge amount of progress in that. I did notice when I was writing the book, I kept mistyping
fried chicken as a friend chicken. And I thought, you don't need to be Freud to figure out that one,
right? But yeah, so I would say to anyone who's thinking about taking these drugs,
think about your relationship with food, because whatever your emotional relationship with food is,
these drugs will lay it bare in ways that can be quite challenging and ultimately,
for many people, quite positive. That's really interesting to hear. I'm so glad that we went
down that road because when I listened to that, it reminds me of a Dutch model I had on Doris
Maus and she was an alcoholic and then ended up literally like cold turkey in her sobriety.
And she made a comment, it's like, when you are sober, you have to face all your emotions.
I mean, that's a very obvious statement, but it's also very pertinent because I mean, I myself,
I went to this ball with my wife last night and I drank. So I'm always very, very clear about my
reliance on alcohol in some areas. I don't drink binge drink or anything, but I drink frequently.
But when you remove that crutch, and you wouldn't have thought of that for a weight loss drug,
but the way you've described it when you remove that crutch, and you hopefully couple it with
an understanding of the toolbox that you actually have at your disposal to start unpacking what it
is behind the eating, that then becomes another positive element of this drugs I wouldn't have
thought of before. Yeah. And I think so most people who take these drugs, it seems, experience
improvement in health and I really needed that. I'm older now than my grandfather ever got to be.
I'm 45. He died when he was 44 of a heart attack. My dad had bad heart problems. My uncle died of
a heart attack. I was conscious that particularly with my family's history, it would be a very bad
idea to carry on carrying excess weight given what we, the overwhelming evidence about heart
disease and weight gain. For every 3.6 inches you gain on your waist, you increase your chances of
having a heart attack by 27%. It's a big increase. So I was very conscious of that. And most people
experience a kind of boost in health. There does seem to be a significant minority who are
experiencing distress, right? I think there's a range of reasons why. In fact, there's even a
much debated safety signal around suicide. So a safety signal is where doctors notice that some
of their patients who were on a particular drug appear to be getting a particular reaction.
And so some doctors notice that some of their patients appear to be developing suicidal
feelings after taking these drugs. So they raised a signal about it. Now, most safety signals turn
out to be nothing, just like most times your smoke alarm goes off, your house is not on fire. So the
fact that there's a safety signal doesn't mean that it's happening. But there's a big debate
about this and the FDA requires a warning on these drugs that it may cause suicidal ideations. The
European Medicines Agency is looking into it. Now, that would be for a small minority. Stress,
stress, that's important. Obviously, it's a big risk for a small minority. And there's a big debate
about why that might be. So some of it might be the psychological components that we've just talked
about. Some of it may be something else, which I spent a lot of time discussing with the leading
scientists who are doing some of the kind of cutting edge research on this, which is when these
drugs were first developed, people thought, oh, this is a gut hormone. We're injecting people
with the simulation of a gut hormone. These drugs are mainly having an effect on your gut. They
must be slowing down gastric emptying and all sorts of other things. And they do indeed clearly
have an effect on the gut. But there is a growing scientific consensus. In fact, these drugs
primarily do not work through an effect on your gut, real though the effect is, they primarily
work on your brain. So it was discovered that in your brain, it was discovered by scientists here
in London at Hammersmith Hospital that in your brain, you have GLP-1 receptors. So GLP-1 is that
hormone that the drug simulates. You don't just have receptors for it in your gut. You have them
in your mouth, in your thyroid, and most crucially in your brain. And so when you tag a Zempic,
for example, and then you give it to an animal, and then you cut open the animal's brain to see
where it went, you obviously can't do this with humans, but if you do it with an animal,
a non-human animal, what you see is that the drug goes everywhere in the brain. As Professor
Robert Kushner said to me, this drug goes everywhere in the brain. This affects everything in the brain.
It seems to affect some brain regions most importantly. And slightly disconcertingly,
scientists do not really understand what the brain effect is yet. So there's different theories,
and I go through the different theories, and I'm happy to talk about them because they all have
potentially different risks and benefits. But when you take these drugs, you are taking a drug that
changes your brain, and that feels like a deeper change and a more potentially disturbing one.
It may help explain some of the extraordinary benefits as well. So yeah, it's one of the
fascinating things about these drugs. The more you look, the more complex and interesting the
picture becomes, both biologically, in terms of the effect on the culture, in terms of the effect
on your psychology. I just found this such a fascinating subject with so many weird alleyways
and corners and different things that I think we really need to know. And we really need to know
this because there was a poll recently, 47% of Americans want to take these drugs, right?
And the price is going to come down relatively soon. I can explain why. So that is a staggering
number of people who want to take this drug. And due to the staggering levels of obesity and
overweight in the United States, very recent problem, very recent. Essentially, it's in my
lifetime that the obesity crisis has happened. It essentially did not exist prior to my lifetime
or ever in human history. And so you might even be thinking, well, I'm not really interested in
these drugs for myself. Okay, but go back to what that Barclays analyst said, comparing it to the
birth of the smartphone. In 2007, you might not have wanted to have a smartphone either,
the year Steve Jobs launched it, but the iPhone changed the society all around you,
even if you never bought one, right? If we were talking in 2007, we could never have predicted
the effects on attention or Trump or TikTok or anything, all the crazy different things that
flowed from the invention of the iPhone. And this is going to really revolutionize our societies in
complex ways. And I think we can begin to see some of the threads of how this is going to affect us
now. And we're going to see it more and more as time goes by.
What is the philosophy? And it might be different in different countries as you're having this
conversation with people on the prescription of these meds. And the reason I ask that,
I am a huge believer in the body's incredible innate ability to heal. So for example, if someone
has the psychological ability to really dive into a plant-based diet for six months, I truly believe
that they would see their blood chemistry improve, some of the inflammation in the body would improve,
do they need to be on that the rest of their life? Of course not. But you're giving the body all the
tools it needs to start healing itself and you're removing all the toxins and carcinogens and
processed foods that were causing the issue in the first place. When as a firefighter and a
paramedic, I see a lot of people here in the US, which is what I know now. What I see and even in
my fellow firefighters is, oh, you've got high blood pressure, you're going to be on this the
rest of your life. Here's the statin, here's a beta block or whatever it is. And so there's not
an application of a medication being used simply as a bridge between where you are and where we
want you to be through exercise, diet, sleep, meditation, et cetera. So I see with these
pills as a phenomenal application of, all right, Stephanie or Steve, you're at this weight now,
you're at this body composition, we're worried about these things, these disease processes.
We're going to give a two-year plan to get you with this pill down to here, but then we're also
going to work on getting you off the pill and now hopefully getting you to the point where you can
self-stabilize with a healthy, holistic diet. What worries me with any application of pharmaceuticals
in a profit-based system like America is economically you want people to be taking your
pills the rest of their life. So what have you seen as far as the nuances in different countries
with the application of this incredible medication? I think there's a few different questions there
and you raised some really interesting points, James. So I would start with that question about
how long do you need to take them for? So I noticed with myself, the first six months I was taking them,
to put it crudely, I was eating smaller portions of the same shit, right? So I would, you know,
go to the same place that I always went, but I would eat a little bit, you know, and that's
clearly was an improvement, right? As we see from the fact that I lost loads of weight and all sorts
of health indicators improved, but it didn't feel like I was... Well, one of the things we don't know
is whether you develop tolerance to these drugs, right? So it's possible if you look at, for example,
there are 60 months, the longest term studies we have go a little bit longer than 60 months.
And if you look at the graph of weight loss over 60 months, basically, a bit more than 60 months,
basically what happens is you lose an enormous amount of weight, then you plateau, you stop losing
weight, which is of course what we'd want. You wouldn't want a drug that would make people
literally waste away, that has to plateau, has to happen. And then at the very end of the 60 months,
it starts to slightly tick up again. Now I want to be clear, it's ticking up a little bit, so
you're still vastly lower than you were at the start. And then the studies stop and the studies
were always designed to stop at that point, but nonetheless, you're a bit like, oh, what's going
on there? And as with so many things in relation to these drugs, the scientists involved just do not
agree on the question of tolerance. So some scientists said to me, well, it does seem quite
likely there'll be some tolerance that will be developed. Some drugs people never develop
tolerance to, antihistamines, for example, you can take them your whole life, you'll never develop
tolerance to them. So there's a debate about that. The biggest argument that we won't develop
tolerance is that diabetics have been taking these drugs now for more than 18 years, because they,
in addition to having these effects we've been talking about, GLP-1 in your pancreas stimulates
the creation of more insulin. So obviously for diabetics, it's great, both type 1 and type 2
diabetics. So they've been taking it for 18 years and they don't seem to be developing tolerance.
If they were developing tolerance, they would need higher and higher doses to achieve the same
benefits for their blood sugar, and that isn't happening. So I mean, it could be that it has
different effects for diabetes compared to obesity. There's a big debate about this,
but all of which is to say, given that we don't know that about tolerance, we don't know yet about
tolerance, it's possible that this is just opening a window of change that will close,
right? That eventually the effects of the drug will wear off, in which case there's a strong case
for doing what you're saying. And even if there isn't tolerance, there's a strong case for doing
what you're saying, because there are significant risks to taking any drug, and particularly a drug
where we don't know the long-term effects. And actually there are some effects we do know that
we should be worried about in relation to these drugs that I'm sure we'll talk about.
So given that, yeah, it makes more sense, most sense to do what you're saying, which is
use it as an opportunity to interrupt your unhealthy patterns and build a load of change
into your life. So I did that to some degree. I should stress I'm still taking the drug, but
I learned how to cook. Embarrassingly, I was in the middle of my 40s, I'd never learned how to cook.
I started learning how to dance, which is really good fun, it turns out. I made all sorts of
changes in my own life. So what we know about when you stop is at the moment, the studies that look
at when you stop, and we should stress these studies are funded by the drug companies who
have a vested interest in encouraging people to take the drugs forever. So take them with a pinch
assault, but they were done by reputable scientists. What those studies found is if you take the drugs,
lose weight, and then stop taking the drugs, you regain 70% of the weight you've lost within a year.
It's a pretty dramatic effect right now. What those studies didn't look at is, well, what if
you combine them with lifestyle changes and all sorts of other things, right? And I suspect,
although I don't know this, I can't prove this, that the people who didn't regain the weight,
in those studies, made some other changes, right? I suspect that's what happened, it seems like,
common sense. So yeah, that's a broad overview. In terms of different countries,
so different countries are more strict or more relaxed about how easily you can get these drugs.
So in Australia at the moment, you can only get them if you've got diabetes. In Britain,
you can get it for obesity, but in theory, at least, you're meant to have a BMI over than 27,
which wouldn't actually even be obese, that's overweight. And you've got to see a doctor and
all sorts of things. In the US, it's pretty lax. I mean, as I say, I'm in Vegas a lot of the time,
can basically go to any beauty spa in Vegas and get a compounded version of these drugs.
They don't really check anything. I suspect if I went in and I was bone thin and I asked for it,
they would give it to me. I mean, I had actually started taking it in Britain and I had to get it
a few times in Vegas. And yeah, I went in, by the time I went in, because I'd taken the drug and
I'd lost a load of weight, I was not obese. If I had been at that weight when I was starting,
the clinical guidance is to not take the drug, right? Obviously, I was taking it to maintain
that lower weight, which a clinical guidance does allow. And they didn't even ask me anything,
and they didn't ask me anything, I don't care. They also charge you an absolute fortune in the
US. In Britain, you pay 200 pounds a month, which is what about $260, something like that.
In the US, it's like $800 to $1,200 a month. So yeah, different countries are adopting different
strategies with different risk levels, obviously. Yeah. I mean, I think that's, we won't dive into
this too deeply, but I'm a huge fan of the philosophy of the national health system. I mean,
I really am. I think that everyone chipping in to take care of the people who need it at that time
is, in my opinion, the most Christian, Hindu, you know, whatever philosophy you subscribe to,
it's the most kind, compassionate way to do it. Take care of everyone, just like you would in an
ancient tribe. I don't think they were asking for insurance cards and, you know, the Incas back in
the day when Inca Steve got sick and needed, you know, attention. So I love that philosophy.
And I always- I mean, to be fair, the Incas are probably not the best example, because they
probably were sacrificing them to the gods. Maybe that's what it was. Yeah. Super sticks.
The wider point you're making, but I totally agree.
But yeah, but you know, and I try and get people to understand, like when you have a profit-based
system, just economically at its base, you want your customers to keep buying. So where are the
checks and balances for making the nation healthy? If the NHS was run the way it really is supposed to,
the taxpayer contributes a certain amount. The absolute emphasis should be on making the British
as healthy as possible. So we use as little taxpayer's money. And then the elderly,
the newborns, whatever group that needs our money collectively, we have the facilities, the beds,
the doctors, the nurses for them. This is a kind of interesting segue, because I want to get your
take on this. I moved to the US 22 years ago now, and it breaks my heart because I feel like every
time I go home, my, you know, original countrymen and women and children seem to be getting more
and more overweight and obese, something that I don't remember seeing when I was young. And if
you did, it was an anomaly really. What have you seen as far as the UK specifically and the overweight
slash obesity epidemic? Well, the year I was, how old are you, James? I am about to be 50 on Friday.
Wow, you're looking good for it. So I'm slightly older than me. I'm 45. So I was born in 1979.
Year I was born, 6% of British people were obese. It's now 26%. It's a staggering increase,
literally unprecedented, not just in the history of this country, but the entire history of the
human species. And we know, and interestingly, the answer to this question is key to understanding
something at the heart of these drugs. So we know why this happened. And there's an experiment that
I think distills it down. There's a brilliant guy called Professor Paul Kenny, who is from Dublin
in Ireland. He's a brilliant neuroscientist. He's now the head of the Department of Neuroscience at
Mount Sinai in New York. And Professor Kenny moved when he was in his 20s to do his PhD from Dublin
to San Diego in California. And within, I think a year, he gained 30 pounds, right? Quickly noticed,
huh, American people eat differently, right? Like there's different food, a lot more of it,
and it seems to work differently, right? And he really was finding it very hard to control what
he ate. And he started to wonder if this different American diet with foods that just at the time did
not exist in Ireland, like cheesecake, or were extremely rare, if that diet in some way affected
your brain and your body to make you eat more. So he designed an experiment, which I have nicknamed
Cheesecake Park. Very simple experiment. Exactly. So very simple experiment. You get a load of rats
and you raise them in a cage. And the only food source they have is pellets that are based on the
kind of natural food, the kind of whole foods that rats evolved to eat over many thousands of years.
And they've got way more of these pellets than they could ever possibly eat. In that cage,
they'll eat when they're hungry, and then they stop. They never become overweight or obese.
They have a kind of nutritional wisdom. When they've got the kind of food that they evolved to eat,
they'll eat enough of it to keep their bodies going, and then they just stop and do something
else, right? Then he introduced into the cage the American diet. He gave them cheesecake,
he gave them Snickers bars, he fried up some bacon, and very quickly something changed in the rats.
The kind of wisdom they had had, knowing when to stop eating, seemed to disappear. He would put down
the cheesecake and they would hurl themselves into the cheesecake, and they would like eat their way
out of it. They would emerge just absolutely slicked with cheesecake, with their whiskers
thick with it, and they would just eat and eat and eat and eat. And very quickly they were extremely
obese. The way he put it to me is within a couple of days, they were physically and psychologically
different animals, right? They're all sorts of indicators of poor health were starting to shoot
up, and they just did not stop, right? And the whole way they had this junk food, they also had
their old diet, but they just shunned it. They just stopped eating it almost entirely. Only 5% of their
diet came from the pellets once they had the cheesecake and all this other stuff. And then
Paul, Professor Kenny, tweaked the experiment again in a way that seemed a bit cruel to me as a former
junk food addict. He took away all the shitty junk food, and again they only had the healthy whole
foods they'd evolved to have. And he was sure he knew what would happen. What he believed would happen
is that they would now eat far more of the pellets, so the junk food would have expanded their
appetites. That's not what happened. What happened is once they loved the junk food, they'd eaten it
for a long time and it was taken away, it's like they didn't even recognize the old food as food
at all. They shunned it, they wouldn't eat it, they just starved. And it was only when they were
really literally starving that they started to eat the pellets again. To me this is like a parable
about, and there's lots of evidence about this happening to humans, as Gerald Mand, who's a
professor of nutrition at Harvard who designed the food label that's on all American food,
said to me, there is something about the food we're eating that is undermining our ability to
know when to stop. I actually go through the evidence that there's seven ways in which
processed and ultra-processed food profoundly undermines our ability to know when to stop.
And so we become like those rats, right? We just stop recognizing healthy food as food and we
gorge and gorge. It's funny, Professor Kenny said to me, ever since he did that experiment,
he's never been able to eat cheesecake again. Every time he looks at it, he just gets this
mental picture of the rats literally eating their way out of the cheesecake. And this really
importantly loops us back to the drugs because for a long time I was researching why we gained
weight and the effects of these drugs. And at first I thought, oh, these are kind of,
there's obviously a connection at the end, right? But these are sort of parallel lines,
they're sort of different topics. But there was a word that kept coming up when I researched both
topics. And it's a word we don't often use in everyday English, but it's a word we all know,
satiety, right? So the feeling of being sated is the feeling of just having had enough and not
wanting anymore, right? And we get it with food, we get it with sex, we get it with all sorts of
things. You might have, you've just had sex and the hottest person in the world might walk into
the room and you'd be like, oh, I just don't want it right now, right? I mean, I'm sure if Keanu
Reeves came in, I would find a way, but in general, right? We've all had that feeling of being sated.
And you can be sated with food, right? And what this food is doing, this ultra-processed food,
and 78% of all the calories consumed on an average day by an average American child come from
ultra-processed food, which is horrifying, and certainly would have been true of my childhood.
That profoundly undermines your satiety. And what these drugs do is they boost your sense of
satiety. In fact, one of the scientists who developed them played a key role in developing
them. Karel LaRue, a South African psychiatrist, said to me what these drugs really are is they're
giving you satiety hormones. They're giving you your sense of satiety back, right? And once you
see it that way, of course, you begin to see the connection between processed food and these drugs
is very clear. As Michael Lowe, who's a professor at Drexel University and one of the leading
experts in the world on hunger, put it to me, these drugs are an artificial solution to an
artificial problem, right? We could put it differently, a man-made solution to a man-made problem,
right? These foods undermine our satiety and these drugs give us back our satiety, which of course
begs the question, why the fuck are we accepting these being the two choices, right? Why aren't we
changing the food system so that our kids don't face those choices? And I went to countries that
have done that, like Japan, I can talk about how they did it. But yeah, you begin to see what's
going on here is deeply connected to the change in food that is very big and very recent. We eat
foods that our grandparents would not have recognized as food, right? And this has happened very
rapidly. And it's why when you come back to Britain, when we were kids in Britain,
obesity was very rare. Childhood obesity was extremely rare. It's now, you know, not quite
the norm, but it's very, very common, right? So yeah, that's a huge change in a very short
period of time because overwhelming, it's a few other factors, but overwhelmingly because of this
change in our diet. Yeah. Yeah. I'm going back to the NHS and this is the problem. So the bigger
people get, the sicker people get, the more we drain the resources, the more 999 calls there are.
I mean, it's all these areas that they're just getting dismantled along with, you know, budget
cuts and all those things. And to me, all these conversations, whether it was you and I talking
about addiction before, or now this, it's the proactive solution and the false economy of,
for example, the war on drugs, thinking that we're going to arrest our way out of addiction,
you know, all the money wasted there versus like Portugal did pouring resources into helping people
with their mental health challenges in the first place and job creation, all these things. It's the
same with this. And this is what was so disgusting about COVID is we came out and I don't know how it
was in the UK, but here in the US, there was no boosting of PE programs. There were no real food
being cooked in schools again and getting rid of soda machines. And we didn't do anything to fix
this crisis. We just furthered it. What's interesting about, you know, the obesity crisis,
and I've heard people say this phrase before as well, is that we are overfed yet malnourished.
And so I think one of the other maybe underlying elements that a lot of people have when they keep
eating is I wonder, and this is just simply my hypothesis, is the body also still craving
nutrition and say, no, you got to keep eating. I go through, there's really good evidence for this.
There's a brilliant guy called Professor David Rabenheimer, who's at the University of Sydney,
who's done really important work on this. I interviewed him. So he came up with this
theory. So actually, I should say before that, one of the things we know, and there's loads of evidence
for that, is that processed and ultra processed food contains far less protein than whole foods,
right? It's really chronically lacking in protein, partly because of the nature of food processing,
right? This processed and ultra processed food is assembled in factories, right, from chemical
components, many of which are disgusting when you look into them. Almost everyone listening has eaten
an artificial flavouring called Vanillin in the last week. It's one of the most common
products in our food. Vanillin is made, is a fake form of vanilla. It's in loads of food we eat
that is made out of petrochemicals and sawdust. It's pretty gross when you look at it.
But Professor Rabenheimer developed this theory. So obviously, we are hungry for food in general,
right? No surprises there. But also, we need protein, right? We need protein to build our
bones. It's essential for all sorts of things. And he began to wonder, does the fact that we are
lacking in protein, that this food we're eating is lacking in protein, mean that we overeat to get
the amount of protein we have? So his kind of theory was, what if we don't just have a hunger
for calories in general, but we have a hunger for protein in particular? And if we don't get enough
protein, we'll eat more and more until we've got enough protein. And he designed a series of
experiments which prove that that is in fact the case, right? That if you're eating food that's
low in protein, you'll eat much more of it to get the daily amount of protein that you need
for your body to function and for your bones to function. So you're absolutely right. If you're
eating food that is chronically lacking in key nutrients, your body will make you eat more of it
to at least get up to some level of those nutrients that you need. It's one of the seven
reasons that I go through in Magic Pill for why processed food and ultra processed food
make us overeat so much. Yeah, I think this is the thing. And I talk about this quite a bit as well.
Again, with that kind of, why don't you just get up at five, go for a run and eat a salad, kind of,
you know, rhetoric that's out there is say you grew up in, you know, the Bronx or somewhere and
the local, you know, park is just a concrete basketball court and, you know, you've only got
bodegas around you. That's a very different environment than I grew up. I grew up on a
farm in England, you know, but we had vegetables and we had animals on, you know, that we would
butcher. And so my understanding of food as a young English boy in 1980s was very, very different.
If I wanted an apple, I went to the orchard and grabbed one off the tree. I knew what it was and
where I could get it. And it wasn't sprayed with chemicals. And so we have created an environment
for failure the same way in addiction, you know, the same way. I mean, this multi-generational
trauma and the way that we view mental health and addiction and the gang membership and all these
things, we have created an environment for people to fail. And I think this is a really important
part of this whole conversation. And again, that's why it's so disappointing when it was
disregarded during COVID is, as you said, I mean, these are tools that we're talking about, you know,
with these pills. And it sounds like the application could be extremely promising,
but we also have to fix the environment. And if we're not having that food source conversation,
then that, as you pointed out, is why you'll gain 70% of it back when you come off the pill.
Well, you've raised a really important thing that's something I was asking myself a lot.
As I was working on the book and had to really dig deeply into, which is, you know, so I was
learning about the negative health effects of obesity, which are really significant, right?
There was one study in Britain that followed 2500 government bureaucrats over many years.
And at the start, the obese people in the study were no more like when they were younger,
were no more likely to develop health problems than the non-obese people. But as the years went on,
the obese people were in the end, eight times more likely to develop health problems than the
non-obese people, right? For all sorts of reasons that we can go into. So I was learning about that
and the risks of continuing to be obese, which I am sure I would have been had I not taken these
drugs versus the risks of obesity, sorry, versus the risks of these drugs, right? Which are really
significant, I go through 12 big risks from these drugs in the book that I'm worried about. And
they're pretty broad and there's, you know, a mixture of evidence for them. And some of them
are really worrying. And when I talked to my friends about it, I remember one night going out
for dinner with one of my friends and I ate almost nothing but and him saying, but what the fuck
are you talking about, Joha? And you keep saying, are you weighing these two sets of risks? Why
don't you just choose the third option? Why don't you just lose weight like everyone else? Why don't
you just go on a diet, right? And I did a lot of research on this because in my life, I had, you
know, many times in my life, I'd gone on diets and I'd often lost a significant amount of weight. And
then I kind of gained it all back. And I think it's particularly relevant to your podcast because
when I was looking at willpower, one thing really stood out to me.
I think we would all agree that firefighters have staggering levels of willpower.
There's nothing in the world that could make me run into a burning building, right? And I'm sure
most people are like me. Nothing, I mean, maybe if someone I loved was there and, you know, it was
the only thing, but short of that, you could not get me to run into a burning building.
What if Keanu Reeves was in that building?
A shirtless Keanu Reeves as he was on speed crying my name. All right, you've thought of the second
scenario, but it's got to be speed Keanu, right? Or possibly point break Keanu. But anyway,
so I think we'd all agree firefighters have unusually high levels of willpower. And yet also,
as you'll know better than me, firefighters are disproportionately more likely to be overweight
and obese, right? So if just having high levels of willpower protected you, that would make no
sense, right? There's something if, because they've definitely got willpower and yet they're more
likely to be overweight than the general population. So I think we've got to think about willpower in a
slightly different way. And willpower is very real, right? Willpower is a real phenomenon. There's
lots of scientific evidence for it. And everyone in their lives will have experienced willpower,
right? But the way I began to think about willpower when I looked at the evidence for it in
the relationship to weight at the moment, is I think willpower is a bit like having a pretty
strong umbrella in a really, really bad storm, right? Some people using that umbrella are going
to be able to get through the storm and get where they're going and not get soaking wet, right?
But for most people, the storm is so bad, it'll just break the umbrella and they're going to get
soaked, right? So willpower is real, but it exists in a context, a context that is beyond your will,
right? So I think it becomes clearer if you look at some of the science around dieting, for example.
So there's a very simple fact about dieting, is you have to dispute the rules of physics in order
to dispute. If you consume fewer calories than you burn, you will lose weight, right? So you hear that
and you're like, oh, the answer's obvious, right? And it's true. It will work if you can do that.
But I spent a lot of time interviewing a brilliant woman called Professor Tracy Mann,
who's at the University of Minnesota in Minneapolis. Actually, we met in a bakery
called Buns Inn. And the first thing that happened, I was there before her. First thing that happened,
as I walked in, they said, have you been here before? I said, no. They said, here's a free
cinnamon bun, a cinnamon bun, absolutely caked in sugar. That must have been like 2000 calories. And
even on the ozempic, I was able to eat some of it. But Professor Mann has been studying, has done,
I think, the most important research on diet in the world, which is why I went to see her.
So when she started doing this research in the year 2000, at that time, there were lots of studies
of dieting and the results were very clear. Diets work, right? Use your willpower, eat less, exercise
more, you'll lose weight. But she noticed something in these studies. Almost all the studies looked at
dieters for three months or six months, right? So what these studies seem to assume is you lose
weight over three months or six months, and then you just stay at that lower weight for the rest
of your life. That didn't seem to fit with most of the people that Tracy, the professor Mann knew.
So she then said, well, okay, let's look at the longer term, right? So she starts to look for
studies of longer term weight loss on diets. And at that time, there were only, I think it was 24
studies that had ever been done that looked at diets, weight loss on a diet over two years,
or there were a handful of studies that looked at five years. And what they found was very different.
Almost everyone relapsed when they were dieting. And the average weight loss for a diet after two
years was two, the average person lost two pounds. The average is slightly misleading because some
people, a very small minority did lose a lot and keep it off. And we'll all know people like that.
But for the vast majority of people, they regain weight over time. And I'm thinking, well, why would
that be, right? Even if you stayed on the diet in general, you restricted number of calories,
in general, you regained weight. And it turns out that if you gain weight and then lose it,
there's strong evidence that a series of biological changes happen in your body
that make it really hard to keep that weight off. So one of the ways to understand this is there
used to be a theory about weight, which sounds a bit fancy, but it's actually pretty simple to
understand, which is called biological set point theory. Basically what it is, is they used to
think in the sixties and even the seventies, that when you were born, your body, or even in the womb,
your body has a sort of innate level of body fat that it wants you to be. And it'll basically work
really hard to keep you there. You might get a little bit more, you can drop a little bit more,
but think about temperature and you get, you start to understand it. Your body has a set point for
temperature, right? I think it's whatever, it's 39 degrees centigrade. If you, and your body will
work really hard to keep you at that temperature. If you get hotter than that, you'll involuntarily
sweat, you'll pant, you'll be really physically uncomfortable. If you get below that, you'll
shiver, you'll feel horrible, you know, shivering makes you a bit warmer. So your body works very
hard to keep you in that sweet spot of temperature. And it used to be thought that there was something
like that for weight, but then the obesity crisis happened. And for a while, the theory just fell
apart. They were like, well, obviously that isn't right because look how, if your body has a set
point, how come so many people have gained so much weight so fast? But then actually a lot of the
scientists who looked at it figured out you do have a biological set point, but there's a twist.
As you gain weight, your set point rises. So let's say you were 11 stone and you go up to 15 stone.
Your body will then take that 15 stone weight as your new set point and it will work very,
very hard to keep you at that set point. As Giles Yeo, Dr. Giles Yeo, who's one of the leading obesity
experts at Cambridge University put it to me, your brain hates it when you lose weight and it will
fight to take you back to the highest weight you could have been. So when you initially lose weight,
your brain then fights to bring you back. So how does it do that? It slows down your metabolism.
It makes you crave far more sweet, sugary food that would bring your weight back up. It makes
you more lethargic so you want to exercise less. And I remember when I learned this and there's
loads of scientists who put forward evidence for this theory, I remember thinking, well, that
doesn't make sense. Why would evolution have equipped us with that? Why would evolution give
us this thing that makes us so unhealthy? And people like Professor Michael Lowe kept explaining
to me, took me a while to get it, you've got to understand the context in which we evolved.
So in the circumstances where human beings evolved, in fact, in every situation until like
50, 60 years ago, there was no situation where you were going to just have x-rayed your body
and excess abundant calories forever. That just never happened. Human beings were never in a
situation where they had far more than they could ever eat for their whole lives. When would that
ever happen? So evolution didn't prepare our bodies for that scenario because it didn't ever occur.
What evolution did prepare our bodies for was a very different scenario, which happened a lot,
which was famine. Very often, human beings would have food and then it would go away.
And in a situation of famine, the fattest guy at the start of the famine will be the last man
standing at the end, right? Timothy Chalamet is going to die very quickly in a famine and John
Candy is going to be the last guy standing, right? So there's, I mean, sadly, John Candy no longer
with us. That's not a great example, but you know what I mean, right? So actually there's a huge
evolutionary advantage in a situation where famine happens quite often. If you get food,
keep consuming it and stay as fat as you can for as long as you can because sooner or later a
famine is going to come along. But what our evolution has done is prepare us for a famine
that ain't coming, right? When you and I, barring some horrific event, are never going to be in a
situation where there's a famine. What we are in is a situation of calorie excess all the time or
potential calorie excess all the time, right? So you can see how this is a kind of quirk of our
biology that has ill prepared us for this environment. Also leads us back to the drugs,
because what some people think, and this is contested, it's certainly not a settled scientific
view, is that possibly what these drugs do is they lower your set point in your brain. They lower the
weight your brain is trying to keep you at. That may be actually the primary mechanism by which
they work, although it may not. And there's a debate about that.
That's so interesting to think about. And I'm to circle around to what you're saying about the
fire fires. The one other factor that a lot of people don't understand in fire, especially in
America, we do 24 hour shifts. But if you look at police and doctors and nurses and a lot of
life-saving occupations that actually end up being, you know, struggling with their own health,
is the shift work and the sleep deprivation. So going back to your umbrella analogy, now imagine
there's holes in the umbrella as well. That's another reason why their willpower is even more
diminished. But in that conversation, there's a term called circadian scarring. Yeah. And so,
I worked for 14 years and when I transitioned out, it literally took me about five years to be able
to sleep properly again. And that's only 14 years, a short career compared to some people.
So to parallel that, that seems to be what's happening with people that have been in the
world for a long time. And that seems to be what's happening with people that have gained a lot of
weight. There's almost a kind of scarring of, as you said, that baseline, because that should be
dynamic, really, you know, the feast and the famine, the John Candy caveman should then be
able to come down, you know, I want to see that movie, but you know, it should, it should be a
sliding scale, but obviously it gets locked in because like you said, it's, it's an abnormal
artificial, you know, feast versus, you know, an actual feast before a winter in some European
country. And one of the reasons we know that is actually a study of, you know, that horrific
game show, the world, the world's biggest loser. So people haven't seen it. I hate it. It's a
fucking evil show as far as I'm concerned, but it's, they get severely obese people
and they compete to lose weight throughout the show. And they lose very dramatic amounts of weight,
often through going through horrifying ordeals, which are actually not at all wise ways to lose
weight. So what there was a very good study done that went back and looked at these, the previous
contestants on the world's biggest loser. And one of the things they discovered is these people,
and obviously that's a very dramatic weight loss, but even years later, they had to consume far
fewer calories in a day to stay at the same weight as someone who had never been obese, right?
Because their metabolism works so differently. So the way Dr. Giles Yeo described it to me,
and there's a brilliant British doctor called Chris Van Tullaken who's written about this as well.
Imagine two identical twins, right? They're both 75 pounds, but one of them has always been 75
pounds as an adult. And the other one went up to 95 pounds and came back down. The twin who went to
95 and came back will have to eat far, far fewer calories per day to stay at the same weight as
then his brother does, right? Because his metabolism will be so damaged and so much slower. And because
his body is fighting through that set point to bring his weight back up. So yeah, I think what
is that? And you're totally on the money about sleep, James. The figures on this are incredible.
The National Sleep Foundation says that on average we sleep 20% less than people did a century ago.
In Britain, children sleep 85 minutes less a night than they did in 1945, which is, I mean,
staggering. And I interviewed lots of experts about this. And, you know, lack of sleep makes
you crave sugary shitty food, right? To give you energy. So lack of sleep is a huge factor in weight
gain and disturbed and interrupted sleep. There's a lot of evidence on our shift workers really
screws with your brain and partly has these food effects as well. So I think you're absolutely
right. There's a brilliant woman who should interview. I'll give you an intro to her if you
want. Professor Roxanne Prishad, also in Minneapolis at the University of Minnesota,
who's done really shocking work on this and is a great person. Beautiful. Yeah, that would be
amazing. Thank you so much. I've, people have listened to the show for a long time. Sleep
deprivation comes up all the time because it's the elephant in the room for the mental health side.
I mean, you think about not sleeping every third day and the inability to process, you know,
anything that we see and do. The cancer conversation, if you listen again to all the
greats in the sleep medicine world, I mean, shift work is a known carcinogen. So, but we shy away
from that because that involves staffing. That involves getting more human beings to become
first responders to give them more rest and recovery. And a lot of people in leadership,
and I use that term loosely, positions, you know, they just don't want to talk about that
because that's going to involve them actually being courageous and advocating for their people. So
I think it's a very important topic. Yeah, I totally agree with you. And it also, you know,
it involves taking on power, right? I mean, actually firefighters are pretty good at this
because it's one of the most unionized parts of the United, one of the few unionized parts of the
United States. So they're in a stronger position to do that than a lot of other people. But yeah,
I totally agree with you. And there's been enormous rising people working through the night
in the US and Britain, enormous rise in the last few years.
Well, I know where we're running out of time. I, you touched on Japan finding solutions to some
of the food issues. Now I lived there 22 years ago for about 15 months as a stunt man. And even then,
such a glamorous statement. It was pretty cool. But, you know, I, when I was there, there were
some fast food, but it was probably at a transition, you know, there was still mostly traditional
Japanese, you know, restaurants in Osaka. So what were you, what were they seeing in Japan? And then
let's talk solutions. What were they bringing to the table? So really often we're told there's
basically a choice here. It's just weight loss drugs forever or being obese forever. And at an
individual level for a lot of people are obese, that is actually the dilemma they're facing,
but that does not have to be the choice for our children, our grandchildren and future generations.
And one of the ways we know that is because of Japan. So Japan got rich without getting fat.
In the United States, 42.5% of people are obese. In Japan, it's 4.5% and projected to fall
without these drugs. And obviously wanted to understand, well, how did they do it? Right?
So I went to Japan, spent a lot of time there, it was riveting, it was totally fascinating.
And there's lots of answers, but you might think, oh, it's just their genes, right? They must just
have, they've won the genetic lottery. Actually, we know that's not true because in the late 19th
century, lots of Japanese people went to go and live in Hawaii. And Japanese Hawaiians now,
all these generations later, they can be studied and they're almost as overweight as other Hawaiians.
So we know that it's not their genes, because obviously their genes didn't radically mutate
in the space of a hundred years. So something else going on. We also know it's a relatively
recent invention, because actually Japanese people did not have the diet we think of as
the Japanese diet until really quite recently, until the 1920s, the Japanese diet and their
attitude towards it was actually deliberately invented by the Japanese government and kind of
encouraged in the people. So there's lots of reasons why Japan has this very different
level of obesity and very different health outcomes. I remember the first day I went,
I took one of my god-sons and we were staying in a hotel and in the center of Tokyo. And it was a
kind of tourist hotel, but it was about half the people there were tourists from other parts of
Japan and half were Western tourists. And they had two breakfasts laid out, right? There was the
Western breakfast, which was like piles of pancakes and scrambled eggs and everyone could
put bacon and sausages. And there was the Japanese breakfast, which was like tiny little bits of
white fish, like little bowls of miso soup. And my god-son came up to me, I'd already got my
breakfast, and I had the Japanese breakfast. And my god-son who went to get both came up to me and
said, I just saw the weirdest thing. And I was like, what? And he said there was a Japanese
woman and he pointed to her, not very discreetly. She went and she got breakfast from their kind of
food and then she came over to the Western section and she took one French fry and put it on her
plate. And then she came back a minute later and put that French fry back and took a smaller
French fry. And he's like, did you even know the concept of French fry existed in the singular?
Has anyone ever eaten one French fry in the entire history of the United States? Right, never. So
they eat very differently. I spent a lot of time in the Tokyo School of Sushi, the great
chief chef there, the head of it, Masaru Watanabe, gave me some really great lessons there. So
obviously they eat much simpler food. They eat a lot of fish. They eat in a much simpler way.
The way he put it to me is, you know, he was grilling a mackerel and I was watching this
oil drip out of the mackerel. And he said, what you have in the West is an addition cuisine.
When you want to eat something, you add more to it. You add salt, butter, sugar, all sorts of things.
We have a minus cuisine. We subtract from our food to make it taste more like itself, which was a
really interesting way of thinking about it. And he said, because our food is so simple, you have
to put even more care into preparing it because you have to make every flavor fire. So in every
meal, Japanese people actually eat a much more diverse range of ingredients than us. You know,
we might have like a lasagna, but they'll have five small dishes. And actually you're meant to
eat them, I'm sure you saw this when you were there, James, in a triangle shape. So if you gave me,
you know, a lasagna, some cabbage and some French fries, I would eat probably all the French fries
first, then I'd eat all the cabbage, then I'd eat the lasagna, right? But we eat them in one after
the other. In Japan, you don't do that. You have a little bit of the fish, then you have a little bit
of the next dish, a little bit of the next dish, and you eat them in a triangle shape, which slows
down your eating. Also Japan, Japanese people are taught from when they're very young that you're
meant to eat until you're 80% full. So if you get the feeling of being full when you're still eating,
you've eaten too much because it takes a while to get the signals. Actually, we now know the GLP
one that tells you you've had enough, right? So you teach me all these different ways in which
Japanese people think about food. I was thinking, God, how would we ever integrate this into our
thinking? But crucially, this is taught from a very young age to children. I went to a school
called Koenji Middle School. Actually, I went to the whole school, but I spent most time in Koenji
Middle School. A school in Tokyo in a middle-class neighborhood, they showed me how to eat
and how they create this food culture, some of the key ways. So I was greeted at the door, me and my
translator, by the school nutritionist. His name is Harumi Tatebe. Every school by law has to have
a nutritionist. It's a really serious qualification. It's three years even after your teacher training,
and your job is to design the food, oversee the food. Everything every child eats in Japan in school
has to be completely non-processed, made from fresh on the day. And your job is to use this
fresh food to teach the children what a healthy diet is, and also to counsel any kids who might be
under-eating or overeating. So going to this school, I've got to tell you it was the weirdest
thing. There's a thousand kids at that school. I spent all day there. I didn't see one overweight
child. It was weird. So you're going through, so they have this delicious, amazing fresh food.
I mean it was probably more like Nobu than like anything I ever ate at school. And I'm sitting
talking to the kids and Harumi, while they're eating, she uses the food to teach them. So she'll
hold up like a red rope and she'll go, okay, this is calcium. What does calcium do? And they'll go,
ah, it makes your bones strong. She'll go, right, this blue rope, this is carbohydrates. What does
that do? It gives you energy in there. And every time she adds a rope, she'll tie the rope together.
And then she holds the rope up and go, you see, you need all these things to have a healthy meal.
She's constantly telling the kids, you have to eat with your brain. What you eat makes your
brain. You have to eat with your brain, right? And it was so weird speaking to these kids,
because I talked to them, it's like, I spent the most time with kids who were about nine or 10.
And I'd say to them, what's your favorite, one of the kids said, what's your favorite food? He said,
broccoli. I love broccoli. Another kid, I'm like, what's your favorite food? He's like salmon.
And after a while, I turned to Chie, who's my translator, and I said, are these kids taking
the piss out of me? Right? Like, well, their favorite food is broccoli. And Chie just looked,
every Japanese person I discussed it with just looked puzzled when I said that. I was like,
they were like, what do you mean? We teach our kids to like healthy food, they like healthy food.
They just couldn't. And at one point, I was like getting so vexed by how healthy these kids were,
that I took out my mobile phone, and I googled British school dinner, right? I just pictures of
a typical British school meal, the kind of thing I ate at school, and I showed it to them. And these
kids literally reacted like I'd showed them an ISIS beheading video, right? They began to scream,
they looked like horrified and disgusted, like where's the salad? I said, there is no salad.
Where's the vegetables? I was like, there are no vegetables. They looked like, ah, they were like
completely, and they were like, what, you would eat this every day? I was like, yeah, this little
10 year old girl put a hand on my arm, very sympathetic, she said, I'm worried about you.
So it was fascinating. I mean, there's lots of things they do in Japan, some of which we would
not approve of, and I wouldn't want to import as well. I'll give you an example of one of them,
which is quite hard to get your head around. So in 2008, they had a panic in Japan because
their obesity rate went up by like 0.2%. It was still like laughably low by our standards.
And they introduced something called the Metabolor, which is called that because when you're,
when you develop obesity, you're at risk of something called metabolic syndrome,
which is a combination of a whole series of really unpleasant problems. And
under the Metabolor, every business in Japan, every year on a certain day, has to weigh
all of its workers. And if your weight has gone up, you have to drop a plan with your employer
to bring it down. And if the overall weight of the company goes up, you can be fined by the
government, right? So it's pretty hard to get your head around. And so they introduced this
to the government, right? So it's pretty hardcore. So I went to a Japanese business to see how they
do this. And it's pretty intense, right? I went to one called Tanika. I mean, okay, so they make
health equipment. So they have a particular investment in, you know,
they're the most enthusiastic edge of this. But when you arrive at work, you stand in front of
video screen and it says, Hi, James, you walked 12,000 steps yesterday, because everyone has to
fit bit. These are the meals you ate, because everyone takes a photo of their meals and shows
them. Bob, who sits two desks down from you, hasn't weighed himself yet this week. Why don't
you remind him? Like, Whoa. So I go up every morning, they do collective exercise together,
they do yoga together at the time when everyone in an American office is eating bagels and donuts.
And it's, it's pretty intense, right? And, I mean, when I explained to people
at this workplace, you know, if you did this in Britain or the US, we would burn the office down.
And they were just like, baffled. They were like, why? They just didn't, you know, so there's some
aspects of Japan that are really different, but many which are not. And a lot of people will be
listening and thinking, okay, that's very nice for Japan, but we're never going to do that.
And it's a big change. I went to lots of places that have made changes. But I would just give an
example to anyone our age who, who thinks we're never going to make that change. Think about
smoking, right? When I was a kid, half of British people smoked. My mother smokes 70 cigarettes a
day. There's a photo of me and her when I'm a baby, she's breastfeeding me, um, smoking and resting
the ashtray on my stomach. Right. When I discovered this photo a few years ago, I thought,
or she'll feel guilty. I'll show it to her. She said, you were a fucking difficult baby. I needed
that cigarette. That was like typical Scottish parenting at the time. This should be a birthday
card. That was beautiful. Exactly. I was going to put the photo in my book and she said, you're not
putting my tits in your book. Um, but the, uh, she was very pissed off about it, but the, um,
so you think about how big that changes when we were kids, people smoked everywhere. They smoked
on trains, on buses, on planes. My doctor used to smoke while he was examining me when I was a kid.
I remember it right. And we've gone from that, obviously we have issues around vaping, but
you know, very few young people smoke now it's gone from, you know, 50% to 12% and enormous fall.
Right. So we can make these big changes if we want to. I believe we can, I believe we should,
I believe we will, if we band together and fight for it. Um, so we're not trapped in the choice
between these weight loss drugs and the 12 big risks that they cause that I go through in the book.
And the risks of obesity forever, we can make different choices. Um, but that requires bigger
social changes. So what I'm hoping at the end of the book, I go through five possible scenarios
for what might happen now with these drugs from the worst case scenario, which is that we find
out they cause some catastrophic health problem to the best case scenario. For me, the best case
scenario is that lots of people benefit from these drugs. And I think that's a good thing.
For me, the best case scenario is that lots of people benefit from these drugs, but they also
wake us up to say, how the fuck did we end up with this choice? But this, we shouldn't have to drug
ourselves to be healthy. Why don't we learn from Japan, change how we live and get to a point where
our kids don't face this risky and dangerous choice. Well, that is a beautiful place to round
off this conversation. I want to be mindful of your time. So the, the book is magic pill for
everyone listening out on May 7th. So it will be out by the time this drops. Where can people
around the world find it? If you want to know where to get the audio book, the ebook or the
physical book, you can go to my website. It's J O H A N N H A R I.com. And you can see where to get
that book or my previous books. Um, can see where to follow me on social media, though I don't look
at it that much. Um, and you can see a load of other things as well. Hooray. Beautiful. Well,
I want to thank you so much. I'd love to get you back on and talk about stolen focus one day,
because we dove into the magic pill and rightly so. Um, but it's been another amazing conversation.
I know how busy you are normally. So I want to be so thankful for you. Oh my God. I can't even
spit out my last, my last closing. So I want to thank you for being so generous with your time
and coming on the behind the shield podcast today. I always love talking to James. What a pleasure.
Thank you so much.