Thank you so much for joining me. Im so excited to talk about this book. This conversation about antiobesity medications and ozempic has been dominating the news in the us and its something that i cover every single day and its kept me quite busy. Like there is just constant news about this. So im actually i was really curious, you know, when you were writing this book, how did that factor to the writing process . Because i can imagine that, you know, in the in the process of writing this book, there was news and things were changing constantly. And i know that you addressed this the sort of questions that are still lingering out there. But, you know, was was it difficult to sort of render with the constant news flow about these drugs and yeah, i mean, that was a really big and fascinating challenge. Its like documenting a kind of explosion. And 47 of americans want to take these drugs. And were learning more and more about them with every day that comes. And i think it kind of fed into this wider approach that i had all these new developments, because i remember from the moment i learned about these drugs, i felt so divided about them. I dont remember any subject where i felt so conflicted, so when i learned about a topic i remember exactly the moment when i learned about them. It was the winter 2022, and it was that moment when the world was opening up again, after everything weve been through and i got invited to party, it was thrown by an oscar actor. Im not saying that just to name drop. Theres relevance to this and and i was the uber on the way there and id gained a lot of weight during lockdown and ive been quite the star and i was feeling a bit selfconscious. And then i suddenly remembered, oh, loads of people i know weight during the pandemic this going to be fascinating. Im going to go to this party, see loads of hollywood people with a bit of like chub on them. Right. Ill be some interesting and. I arrived and i started Walking Around and it was really weird. Not only are they not going away, everyone was like skinny. Everyone was gone. Everyone was markedly thinner than they had been before. And i was kind of Walking Around a bit of a daze and i bumped into a friend mine by the dance floor, and i said to her, wow, looks like everyone really did take up palazzos during lockdown. And she laughed at me and i didnt know why she was laughing. And she said, johann, you know, its not palazzos, right . And i had no idea what she was talking about as she pulled up on phone and ozempic pant. It was the first time i learned that we now a new form of weight loss drug that causes the average person who uses it to lose 15 of their body weight for the next. In this class drug, you actually get 24 loss of body weight on average staggering is going to be available next probably and as soon as i learned it i immediately thought well can see the benefits right you know im older now than my grandfather ever got to be because he died of a heart attack when he was 44. Lots of the in my family get Heart Disease i knew that obesity makes it much more likely youll get over 200 known diseases and complications. So i thought well if theres a drug that can actually reverse or hugely reduce obesity, thats going to have all sorts of advantages. But i also thought, wait a minute, wait a minute, ive seen this story before, right . Theres about every 20 years a new weight loss drug is announced. Were told its going to save the world. Huge numbers of people take it. We always up discovering it has some kind catastrophic side effect always gets pulled from the market, leaving a trail devastated people in its wake. I was also worried about body positivity, the progress weve made with that, with eating disorders. So i thought super, super conflicted, which is why i went on the big journey to write the book all over the world from iceland to minneapolis to japan to interview the leading experts on the drugs, leading critics of the drugs. And all through that journey. Like you say, were getting all these new developments. Were learning more every. So it was thrilling and daunting. Yeah. And what the experience like of, you know, like you said, youve traveled all over the world, interviewed you know, the leading experts, the people that were there at the very beginning of the discovery of glp one. But this is also a very personal journey for you throughout book and you know, your own friendships and your own experiences are weaved throughout the book. And what was that experience like . Because this is, you know, an issue that is highly stigmatized and, you know, was that a scary or difficult to sort of bury your own soul and your own experiences in this book . Yeah, theres so much emotion tied up with these topics with fear food, with obesity, with the new antiobesity drugs and and its a very charged and febrile. So i was dealing with you know, i thought if im going to write about these drugs, ive got to take them. So i was taking them pic and there was just the actual physical and psychological effects of taking ozempic. What pretty big. Then theres interviewing all the experts, realizing, oh, this is actually an experiment on millions of people and im one of the guinea pigs. And then theres the kind of effects on the culture that are playing out. I mean, to start with the first one with just the physical effects, it was the weirdest feeling. Ill never forget the second day i was on ozempic, i woke up and i was lying in bed and i thought, oh, i feel something strange. What is it . And i couldnt. I couldnt locate in my body what it was that felt strange. And then i suddenly realized i had woken up and i wasnt hungry. I dont remember that ever happening before in my life. I used to get woken up often with a kind of raging hunger, and i went to this diner just up the street from where i live, and i ordered what i used to order every morning for breakfast. Im slightly embarrassed to say, which was a huge brown with loads of chicken and loads of mayo in it. And i used to eat the whole thing and still be hungry. And on that morning i had like three or four mouthfuls and i was full. I didnt want any more fat when i left the diner. The woman who runs it, tatiana, the woman shouted after me, hey, are you okay . Because she was so puzzled that i left food and it really was like the kind of shutters had come down on my appetite. I was 80 less hungry than i had been before. I was full really fast. I later learned, of course, the science of why that was happening. Me but just, it was such a dramatic effect. I lost so much weight so quickly, lost about 42 pounds in a year. So i was sort of dealing with the physical transfer and the transformation in my habits, as well as absorbing years of my training, the sciences at Cambridge University to to really absorb the science around this into a deep dive into. It it was head spinning in a positive way in a negative way. They were real and incredible, high points, incredible, low points. And real intellectual excitement. Actually is going to have such a huge effect on not just the people, the drugs, obviously, which is going to be, i would predict, half of americans, ten years from now provided some of the really catastrophic side effects that im worried about dont end up being worse than we think. But also just just what its going to do to how we think these very deeply, as you say, very charged issues. And how did you figure out how to strike this balance of talking about potential benefits and also the potential risks . And what are some of those risks . I think . Actually, if you just look at the facts, people should be very wary of people whose response to these drugs, after looking at it in detail, is either, yeah, theyre going to save us all or boo that the devil. The truth is, this is really complicated and anyone whos in a position like i was, i was obese. Realistically was going to continue being obese. I had tried dieting a thousand times. I usually ended up fatter than i was at the start. Thats not true of everyone who tries diets. If you never tried diet, try it first. But most people, 90 of people are going diets. It doesnt work so realistically i was going to continue being obese. So really i realized i was facing two choices. There was. The risk of continuing to be obese with sadly all the Health Problems that that poses or the risks of these drugs. Right. And i think there is a kind of magic calculator that can tell you that. I think you have go down the risk of obesity that i lay out in magic pill and the 12 big risks that these these drugs and really look at them in relation to yourself. I guess the place to start though is i think before we get to the risks which im very concerned about and actually i think is to start with the benefits because the benefits are really significant. And if want to think about both the benefits and the risks of these drugs, i think it might help to look at apparel area of science. People have only been taking these drugs to treat obesity for a couple of years. Obviously for diabetes, theyve been taking them much longer. And so helps to look at a different a different area, which bariatric surgery up to now its been very hard to lose a lot weight and keep it off over the long term some people can just through calorie and exercise might come its actually one of the best analogies is with things like stomach stapling, gastric. And theres a few things we know about that for sure. This has been very well studied. The first thing we know is that bariatric surgery is a horrible, grueling nightmarish operation. One in 1000 people die. The operation, its no joke, but people go put themselves through that because of what happens next. If you reverse, youre obesity or massively reduce it through this surgery. The benefits to your health are staggering. In the seven years that follow the surgery, you are 6 less likely to die of a heart. You are 60 less likely to die of cancer. Youre 92 less likely to die of. Diabetes related causes. In fact, its so good for your that youre 40 less likely to die at all those seven years. So this fits with a much wider body of evidence. Obesity, sadly, should never be stigmatized, but is very bad for your health on average. Of course there are exceptions, but on average and reversing it massively improves health. And were seeing that with these drugs, right . If you these drugs and you started with a bmi higher than 27, you are 20 less likely to have a heart attack or in the next couple of years, which is a subject very close to my heart, literally very close to my heart. Right. So the benefits are very clear, but the risks are also very alarming. Some of them actually emerge from looking at bariatric surgery. So as i say, theres a big risk. But theres a really interesting other effect to bariatric. Surgery isnt often about if you have bariatric surgery in the aftermath, your risk of committing suicide almost quadruples and your risk of depression is really quite significant. 17 of people who have bariatric surgery need inpatient Psychiatric Care in the aftermath. And you think that seems really weird, right . Whats going on here . Why would that be . And i think its lots of reasons, but one which is very relevant to these drugs, we know a significant minority of people who use these drugs seem to be becoming depressed or this even concerns some people may become suicidal. You think, well, why would that why would that be . Theres a debate about other drugs affecting your brain. We know these drugs primarily work not on your gut, but your brain. I think there is something going on there. But actually, my own experience kind of help me to to think about this. I think whats happening for a lot of people and theres good evidence for this is. One of the things these drugs do is they radically interrupt your eating patterns. You cant eat like you did before. And i had a real epiphany about this i was in las vegas. Im writing a book about a series of crimes that been happening in vegas. Ive been working a long time. So i spend a lot of time there. And i was researching the murder of someone that i knew and really loved he was an amazing person. So it was very painful, as you can imagine. Very painful thing to be working on. Im really on autopilot. This was seven months into taking the drugs on autopilot. I went to a branch of kfc. Its the one on west sahara for the people in vegas. Its one of the grimmest kfc in the world and i went in, i ordered just instinctively to make myself feel better. I ordered what i would have ordered a year before a bucket of fried chicken, and i had it in front of me and i had a chicken drumstick and. Then i looked down at the food and i thought, oh, i cant eat this right. Like on ozempic cant overeat. You would you would throw up right . You cant comfy in the way that you did before. I remember very clearly thinking, oh, im just going to have to feel bad, right . I go through in the book the five psychological drivers of of overeating and a lot of them me it was eating. I realized that since i a small child, ive been using food to kind of numb my emotions, calm myself down. And when i couldnt do that in the long term, that was a good thing. It brought those to the surface. Ive tried to find better ways to deal with them, but it was a difficult transition. It was painful. I felt it was hurtful, was difficult, and i think that happens with bariatric surgery. I think that happens here. Its one of the many kind of unexpected effects that are emerging of these drugs. Yeah. And i mean, were learning about so many other unexpected effects. And, you know, what were the scientific surprises you discovered or the really interesting things that you discovered scientifically about these drugs . Well, delving into of the research and the scientists that have spent decades and dedicated their career to, you know, bringing these drugs life that so many surprises. Its a great question. And i think a lot of them relate to the 12 big risks associated with these drugs that i go through in the book. So, for example, one of them, if youre asking experts about safety in relation to these drugs, generally what theyll say and its an important point and that good scientists is actually, we know quite a lot about the short and medium term effects of these drugs because diabetics have been taking these drugs now for 18 years. Right. The people who dont know in addition, having these effects on your appetite, these drugs also stimulate the creation of insulin, which is what diabetics, both type one and type two. Diabetics need. So diabetics been taking them for a long time. And what the experts say is, well, if the drugs had some catastrophic short, medium term effect beyond the wellknown side effects like nausea, we would know by now, to put it more crudely, than they would you know, if the drugs made you grow horns, the diabetics would have grown horns now. And thats an important point. And it should give us some reassurance. But some other scientists said, well, wait a minute, if were going to base a lot of our confidence on the safety of these drugs when theyve been used by diabetics, lets dig a bit more deeply into the diabetics. Lets see whats going on there. So, for example, theres a brilliant expert in france, professor jeanluc faye. Hes at the University Hospital in montpellier who was commissioned by the french medicines to look into the safety of these drugs for the french market. And so he started looking at whats called the preclinical literature, the research on animals first noticed something really disturbing, which is that these drugs when theyre given to rats the active component, when its given to rats, it makes them much more likely develop Thyroid Cancer. And we know these drugs work by changing by stimulating a hormone called glp one that im sure well talk about more. And we know you have receptors for glp one, not just your gut and in your brain, but in your thyroid. So kind of make sense of your screen with glp one, it might screw with the thyroid. So what he did is he looked at the data, but he did a big analysis of the databases in france and he compared diabetics whove been using drugs between i think it was 2006 and 2012 to diabetics who had not been using these drugs but what otherwise similar and why he calculated this is contested. What he calculated is that these drugs make you 50 to 75 more likely to develop Thyroid Cancer. Now, its important understand what that doesnt mean. It doesnt mean if you take these drugs, you have a 50 to 75 chance of getting Thyroid Cancer. If that was the case, we would be having bonfires of ozempic all over the world. What it means is whatever your Thyroid Cancer risk was at the start, if hes right, the risk goes up by 50 to 75 . Now, Thyroid Cancer is relatively rare. 1. 2 of people get it in their lives. Nonetheless, its a big increase in that risk right now against that. And this is where you begin to see, again, the surprising here against that, some of the scientists said to me. Well, even if hes right, you got to compare that to the cancer risk just from being obese, you know, as Cancer Research uk, the biggest british cancer group, warns, when you carry excess weight in your body. That fat doesnt just sit. Its not inert, its active. It sends signals through your body and one of the signals that it sends is for your cells to divide more rapidly, which, of course, can cause cancer. This is why, in fact, obesity is one of the biggest causes of cancer here in the United States. And we dont think of it that way. You think, oh, my auntie died breast cancer, but actually obesity is may well be what killed your auntie. The obesity may well have triggered the breast cancer. Its not the cause of all of it, but its the cause of a lot of it. So, again, you see at every stage youve got to be weighing the complexity here. And i think people really need to go down the risk of obesity that i lay out in book and the 12 risks associated with the drugs and see, well, which of these apply to me . Some of them dont apply to me. Right. And one risk im really worried about is pregnancy. We know that when you give these the component in these drugs to rats, theyre much more likely to have fetuses with birth deformities. Right pregnant women are told not to use these drugs, but of course, some people dont know theyre going to get pregnant for all sorts of reasons. Right. And im very worried about that risk. That doesnt apply to me, obviously. But thats a thing im very worried about and im very worried about eating disorders. We already had an epidemic of eating disorders in this country that disproportionately obviously mostly young girls, eating disorders, experts are really worried about whats happening when young girls are getting hold of these drugs and using them to starve themselves. Theres a lot we can do to prevent that. I can talk about. So theres a very broad range of risks alongside the significant benefits. Yeah, i mean, theres theres a couple of different questions that i have now out of what have you, wh