A couple of days after starting to take Ozempicsays the journalist and writer Johann Hari (Glasgow, 46 years old), he woke up with a strange sensation, unknown to him: he was not hungry. He got out of bed and went out to have breakfast at the bar, the usual breakfast, a chicken sandwich with mayonnaise. He took a couple of bites and couldn’t finish it. It was full. The medicine, belonging to that generation of drugs that have revolutionized The fight against obesity by imitating the effect of a hormone (GLP-1) that tells us when we are full, was restoring a lost perception: that of satiety.
Hari tells this and other anecdotes about his experience with these medications in his new book Lose weight at any price. How Ozempic and other drugs are going to revolutionize our diet and our physical and mental health (Península), which reaches bookstores today. In these pages, the journalist, who has been overweight since he was young, embarks on a journey, accompanied by obesity experts and scientists who have participated in the development of the new drugs, for the benefits and risks of these treatments, the uncertainties that surround them and the uncertain scenarios that open in the field of health and beyond it. The journalist attends EL PAÍS by videoconference from London.
Ask. He has spoken to many scientists. What has impressed you the most about what they have told you?
Answer. Which obesity it really does you. Since I was seven years old I knew that being overweight is not good for your health, but I was surprised by the evidence of how serious it is. If you are obese, you are much more likely to suffer a heart attack, stroke, dementia and cancer. If you are obese by the time you are 18, you are 70% more likely to develop type 2 diabetes. And diabetes is the leading preventable cause of blindness in the UK and limb amputation in the US.
Q. He assures that these anti-obesity drugs are destined to be the defining medicine of our time, like birth control pills or Prozac at other times in the last century, for example. Why do you say it?
R. Because obesity is the biggest cause of death in the Western world. And now we have a medicine that, if you take it, reverses it and puts an end to it. It’s amazing. So all of us who are overweight or obese have a choice, but we have to compare the risks of remaining obese with the risks of these medications and think about it a lot. (These drugs) They are going to have enormous effects.
Q. How can they change our lives and our culture?
R. The change is enormous. Jefferies Financial, which is a financial consulting firm, made a report for American airlines saying that they may have to spend much less money on jet fuel, because it costs more money to fly with heavier people and that is going to be a much smaller population. Also in Los Angeles there has been an increase in demand for jewelers to change and adjust wedding rings because people have lost so much weight that the rings no longer fit on their fingers. Approximately 20% of Americans have already tried these medications. This is huge. This is an astonishing scientific advance that will profoundly change society for better and worse.
“The foods we eat are undermining our ability to feel full”
Q. Regarding this negative part, he exposes some issues that the consumption of these medications entails, such as the risk of losing the culture of body positive or what would happen if people with eating disorders access these drugs that help them lose weight. Have you found answers to these questions?
R. The invention of these drugs is like the discovery of fire. Fire is a great tool if I use it to heat my house, but it is terrible if I use it to burn my house down. And in the same way, when something as powerful as this is discovered, it will have great positive effects and great negative effects. If you are overweight or obese and start taking these medications, for example, you are 20% less likely to have a heart attack or stroke in the next 18 months. But you also mentioned something that worries me a lot: when you take these medications, you eat much less; and that’s good if you’re obese like me, but people with an eating disorderanorexia for example, if you are thin and start taking these medications, you can kill yourself with them. Therefore, one of the things we must do is regulate these medications very strictly.
Q. The book also delves into what makes ultra-processed foods so addictive. Do they cause a kind of short circuit in our brain systems?
R. If you look at a photograph of a beach in Spain in 1979, the year I was born, everyone is very thin and you wonder: where are the obese people? So, obesity was very low. Modern humans have been around for 300,000 years, but obesity was extremely rare. And basically, during my lifetime, it exploded. What happened? We know the answer: Obesity skyrockets everywhere people make a change, when they go from eating mostly fresh foods they prepared that day to eating primarily processed and ultra-processed foodsThat is, food is made up of chemicals in factories in a process that is not even called cooking, it is called making food. This new type of food affects us in very different ways. The foods we eat are undermining our ability to feel full and what these new medications do is restore the feeling of satiety.
Q. And what about the industry’s responsibility in this context?
R. Need regulate the food industry to prevent children from being exposed to these foods that make them sick and undermine their ability to feel full. I’m talking about a long-term solution and we need to build a movement that demands it. When I started taking the medications, I felt a real dilemma. Because I thought, could I write this book about how we should address the deep, underlying causes of our problems, not just the symptoms? Here I am with a problem, obesity, clearly caused by the environment, and what am I doing? I am treating the symptom. I went to a friend and told her I thought she should stop taking these medications because she was being hypocritical. And she gave me a very good analogy: If your house is on fire, you can propose that we need to change building codes so that houses are built with less flammable materials and that we need to have smoke detectors and water sprinklers. And those are all very good ideas. But if your house is on fire, you have to call the fire department and then we’ll figure out the building regulations. I think we need to do both: we need to deal with the immediate emergency and prepare to deal with the long-term problem.
“We must very strictly regulate medications like Ozempic”
Q. How much does stigma weigh on obesity and in this context with new drugs?
R. I felt like I was cheating. I felt like I was doing something wrong and looked at the history of how we think about obesity. The idea that obesity is a sin is deeply rooted in our culture. We admire weight loss if it involves suffering: if you go through the agony, if you starve yourself and do those extreme exercise rules, it’s almost like you go to purgatory and then let them forgive you. So I think one of the reasons we feel so uncomfortable on these medications is because it’s like you get away with it without the punishment. But where do we get the idea that obesity is a sin that must be punished? I didn’t invent processed food. The difference between the beach in Spain in 1979 and the way we live now is not that we suddenly became immoral, it’s that we were exposed to foods that undermine our ability to feel full. It is not a moral judgment. Therefore, I think we need to reframe the way we think about these issues to understand the reason why many of us gain weight. There is, of course, some personal responsibility, but it is due to a big change in the environment.
Q. The expansion of these drugs is beginning; others that are even more effective will probably arrive. To what new world are we heading?
R. As one of the scientists who developed these drugs told me: we have cracked the code that controls human appetite. They are intestinal hormones and there are many intestinal hormones that are related to appetite, so we can have more sophisticated medications with fewer and fewer side effects. I think we’re going to be able to control human appetite in a way that we haven’t been able to control it before. And I think we will see a really significant reduction in obesity and associated health problems, assuming we don’t discover some catastrophic effect that was previously unknown, which I see as quite unlikely given that diabetics have been taking the drugs for almost 20 years, but they are not can discard. And we’re going to see all kinds of unpredictable effects on culture, on people’s opinions about their bodies, and on the economy.