Upstream - [UNLOCKED] Capitalism and the Weight Loss Industry w/ Johann Hari

Episode Date: August 8, 2024

Weight loss has become a fully fledged industry in the United States—another classic trick by the capitalist class: manufacture a problem to make profits, and then sell a half-solution back to the population to purportedly address that problem. Are you experiencing health issues from the poisonous food manufacturing industry in the United States? No problem, we got you. Here’s a drug.  You might have heard of a drug called Ozempic—if not, don’t worry, we’ll bring you up to speed soon, but for now, all you need to know is that it’s a brand new weight loss drug that swept its way through Hollywood a couple of years ago and has now found its way into the bathroom mirrors of people around the world. Some predictions actually suggest that in a few years, a quarter of the U.S. population will be taking these drugs. In fact, it’s become so widespread that there’s been a decline in the stock value of companies like Krispy Kreme, the doughnut brand, which analysts have directly attributed to the growing popularity of drugs like Ozempic.  But what problem are these miracle weight loss drugs really trying to solve? If they are meant to increase our health and well-being, how do they actually impact health indicators? And what if the ultimate solution to the problem of increasing stress under capitalism and a poisonous food industry is more complicated than injecting yourself with appetite suppressing hormones?  These are the same questions that led today’s guest on a journey from Iceland to Minneapolis to Tokyo to find some answers about the impacts of industrial food manufacturing and “miracle” drugs. The answers aren’t black and white, and they take us through a deep and widely varying conversation that spans from body positivity movements, to weight loss drugs, fast food, anorexia, body dysmorphia, health and healing, and much more.  Johann Hari is the author of the books Lost Connections: Why You’re Depressed and How to Find Hope, Stolen Focus: Why you Can’t Pay Attention, and, most recently, Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs. In this episode Johann tells us about his experience experimenting with Ozempic, the benefits and drawbacks of the drug, what it taught him about shame, willpower, and healing, and whether these magic little pills are a pathway towards liberation from diabetes, cancer, and an early death, or if they’re just another symptom of and false solution to a system that poisons us for a profit. Further resources: Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs, by Johann Hari Related episodes: Upstream: Stolen Focus with Johann Hari Upstream: The Political Economy of Food with Eric Holt-Gimenez Upstream is a labor of love — we couldn't keep this project going without the generosity of our listeners and fans. Subscribe to our Patreon at patreon.com/upstreampodcast or please consider chipping in a one-time or recurring donation at www.upstreampodcast.org/support If your organization wants to sponsor one of our upcoming documentaries, we have a number of sponsorship packages available. Find out more at  upstreampodcast.org/sponsorship For more from Upstream, visit www.upstreampodcast.org and follow us on Twitter, Instagram, Facebook, and Bluesky. You can also subscribe to us on Apple Podcasts, Spotify, or wherever you listen to your favorite podcasts.

A quick note before we jump into this Patreon episode. Thank you to all of our Patreon subscribers for making Upstream possible. We genuinely could not do this without you. Your support allows us to create bonus content like this and to provide most of our content for free so that we can continue to offer political education media to the public and build our movement. Thank you comrades. Hope you enjoy this conversation. What's happened is an unregulated food industry has developed foods that profoundly fuck up us and our children, right, and catastrophically harm our health.

And they actively promote this to children. More three-year-old children know what the McDonald's M means than know their own last name. So even before you can speak or think clearly, the message is in, right? And I quote in the book an incredible leaked memo from within the food industry where they're like, we've got to get kids young. We get them young, we've got them forever, right? So you have this unregulated capitalism. Now, clearly a big part of the solution is you've got to therefore regulate capitalism, right? And indeed, progressively over time eradicate many of these forces, right? But instead the only kind of solution that's ever promoted to us

or allowed to gain traction in this system is where there's an alternative profit center that can win, right? So weight loss drugs are going to be one of the biggest industries in the whole world. You are listening to Upstream of the biggest industries in the whole world. You are listening to Upstream. Upstream. Upstream. Upstream. A podcast of documentaries and conversations that invites you to unlearn everything you thought you knew about economics. I'm Robert Raymond. And I'm Della Duncan. Weight loss has become a fully fledged industry in the United States. Another classic trick by the capitalist class, manufacture a problem to make

profits and then sell a half solution back to the population to purportedly address that problem. Are you experiencing health issues from the poisonous food manufacturing industry in the United States? No problem, we got you. Here's a drug. You might have heard of a drug called Ozempic. If not, don't worry, we'll bring you up to speed soon, but for now, all you need to know is that it's a brand new weight loss drug that swept its way through Hollywood a couple of years ago and has now found its way into the bathroom mirrors of people around the world. Some predictions actually suggest that in a

few years a quarter of the population will be taking these kinds of weight loss drugs. In fact it's become so widespread that there's been a decline in the stock value of companies like Krispy Kreme, the donut brand, which analysts have directly attributed to the growing popularity of drugs like Ozempic. But what problem are these miracle weight loss drugs really trying to solve? If they are meant to increase our health and well-being, how do they actually impact health indicators?

And what if the ultimate solution to the problem of increased stress under capitalism and a poisonous food industry is more complicated than injecting yourself with appetite-suppressing hormones? These are some of the same questions that led today's guest on a journey from Iceland to Minneapolis to Tokyo to find some answers about the impacts of industrial food manufacturing and quote, miracle drugs. The answers aren't black and white, and they take us through a deep and widely varying conversation that spans from weight loss drugs to fast food, anorexia, body dysmorphia, health and healing, and much, much more. Johan Hari is the author of the books Lost Connection, Stolen Focus, and most recently, Magic Pill, the extraordinary benefits and disturbing risks of the new weight loss drugs.

In this episode, Johan tells us about his experience experimenting with Ozembic, the benefits and drawbacks of the drug, what it taught him about shame, willpower, and healing, and whether these magic little pills are a pathway towards liberation from diabetes, cancer, and an early death, or, alternatively, if they're just another symptom of and false solution to, a system that poisons us for profit. And now, here's Della in conversation with Johan Hart. So welcome, welcome back. Good to see you again. How might you introduce yourself today? Hey, Della. So happy to be with you again. It's funny, whenever I get asked to do this, I have a sort of weird existential blank. I'm like, who am I? How should I introduce

myself? What do I do? I have an identity to exist really. My name is Johan Hari. I'm the author of several books, Chasing the Scream, Lost Connections, Stolen Focus, and my most recent book is called Magic Pill, the Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs. Before we dive in, these can be difficult topics to cover. They can be quite sensitive for folks. So how might we frame it or what notes upfront might we just present just to make sure that we're having this conversation with the care that it deserves?

You know, I spent a lot of time thinking about this. Almost from the first moment I learned about these new weight loss drugs, Azempic, Wigovine, Manjaro. For people who don't know, we now have a new kind of weight loss drug that works in a new way that really does produce very, very large amounts of weight loss. As soon as I learned about them, I felt really conflicted and ambivalent for reasons that

I'm sure we're going to get into. I was very excited about some aspects of them and really disturbed by others. And one of them, I think, relates to some of the things I think you're raising quite rightly right up from, which is is immediately thought, well, what about all the progress we've made with body positivity? What about, you know, we finally seem to be getting somewhere with that. Will this undo that progress? I even worried about kind of the language we use, right? Is it appropriate to use words like obese or I was a person who really helped me to think about this. So when we were kids, I think we're about the same age, Della, when we were kids, I think you were a little bit younger than me actually. The only time you ever saw fat people on television, they were kind of the butt of the joke, right?

Particularly fat women. I remember growing up and it just being kind of taken for granted that there was this kind of cruelty directed towards fat people. And the first person I ever heard challenge this was an amazing woman called Shelly Bovey, who I got in touch with when I wanted to think this through. So Shelley was the woman who introduced really the concept to kind of fat pride or body positivity. And the slight differences between those meanings, but they're both umbrellas would apply to her. She was the person who really introduced it into Britain, as you know, from my Downton Abbey accent, I am in fact British. And I remember when I was 10, seeing her on television talking about this

and she was treated like a lunatic, right? She was mocked and derided, but she became a really important figure in British public life. And I can't tell you, so Shelley had grown up in a working class town in Wales called Port Talbot. It's, I guess an American equivalent

would be like Wilmington, Delaware. It was a steel town, right? The biggest steel works in Europe. And so it's big working class town. And as she put it to me, she was the only fat girl in her school. So this was the 60s. And one day after class,

one of her teachers said to her, "'Bovie, stay behind after class. "'I need to talk to you.'" So she's sort of sitting there thinking, was 11 she was sitting there thinking what have I done wrong and the teacher said to her you are much too fat it's disgusting go see the school nurse she'll sort you out. So kind of dazed Shelley went to see the school nurse the nurse said why are you here she said my teacher says I'm too fat the nurse said take off your clothes I'm gonna inspect you and she

said yep it's disgusting start pinching her flesh. She said, disgusting, you're a pig, you're so greedy. And just berated her and then sent her out. And that was how Shelley was treated all the time, right? Constantly being told you're disgusting. Thank God I'm not like you. And this really, really disfigured her life. You know, she was really smart, working class girl. She was advised to apply to Cambridge. She's like, I just can't do it. They'll just bully me. It'll be horrible. And really all through her life, she was soaking up this abuse. When she got pregnant, the first thing her doctor said to her was, well, you shouldn't be pregnant when you're as fat as you are. When she gave birth, she was lying there. She had quite a difficult birth. She was lying there covered in blood. And the midwives looked

at her and said, you know, you really need to lose some weight. When her baby wouldn't attach she wasn't feeding properly she took him to the doctor the doctor said well what are you trying to do mate the baby is fat as you are and this is very common more than 40 percent of women with a higher a BMI higher than 35 get insulted every single day right so she's soaking this up and Shelly was just kind of believing she deserved it. Right? This is how I should be treated. She hated her body. In fact, she told me she'd never even looked at her own body naked. And then she learned that in the United States, there had been this kind of movement called

Fat Pride. And she began to think, well, this is just a form of kind of bigotry. It's just a form of cruelty. And she began to challenge it and wrote a really influential book in Britain that challenged this. But something else also happened to Shelley. She was turning 50 and her doctor said because of her very, very high weight, she was having problems with her heart, he was worried about that.

She was actually losing the ability to walk. She had to be in a wheelchair. And she was extremely physically uncomfortable all the time. And she was really reluctant to talk about this because she thought well Am I betraying this anti stigma work I've done if I talk about the harm that obesity is doing to my physical health She really grappled with this and after a while she kind of came to the conclusion Why do we always frame it as either or? either you're in favor of reducing stigma which form a bullying and cruelty or

You're in favor of improving people's health where you can, surely she said it's both, right? Anyone listening who's got someone they love who's obese, I'm guessing you want two things for them. You wanna protect them from bullying and cruelty and if possible, you wanna protect them from cancer, heart disease, diabetes, stroke, back pain, knee pain, all these things, which the science is very clear are made significantly more

likely by being overweight or obese. There's no guarantee of course, like some people, my mother smokes 70 cigarettes a day and she's alive and well at the age of nearly 80, but she's an outlier, right? So Shelly did lose a lot of weight through diet and exercise. She's the first person to point out that's extremely hard and it doesn't work for most people. I'm sure we'll explore why in this conversation. But she lost a lot of weight and her health improved and her heart problems went away and she went from barely being able to walk to being able to run. And she said, I can't tell you that having a functioning heart and being able

to run isn't better, it's better, right? She stands absolutely by everything she ever said about opposing stigma. She passionately believes it. And she believes both of these things were forms of self-love, right? And I found that a really persuasive way of thinking about it. Now, there are some people in the body positivity or fat problem, and it's not majority of them, who argue that obesity does not actually cause these health problems, right, that that's a myth, it's a fat phobic myth. I looked at an open mind with that, as you know from my previous books, I'm very happy to challenge scientific ideas that aren't true. Unfortunately, the scientific evidence is absolutely overwhelming that obesity on average harms health. There's few things around which

there is such a strong scientific consensus as that. It's as strong as the consensus that greenhouse gas emissions cause global warming, for example, or that HIV causes AIDS. It's very, very clear. We can go into the arguments that that's not the case and why virtually all scientists don't agree with it. But yeah, so that's why I continue to use the word obesity. Obesity is a word that describes an actual physical phenomenon that does actually harm health and in fact has harmed my health most of my adult life and in fact killed many of my relatives. So I continue to use that language because even if we got rid of that word, we would still have to describe that physical condition.

But of course, I oppose all the stigma and bullying associated with that word. And I believe we all should because it's hateful and it actually makes the problem worse. Thank you so much. That's great framing up front. And yeah, just to say that back in the quote from your book, we need to reduce the stigma and at the same time, the excess weight that harms people's bodies. Both are forms of love, right? Both are forms of love. Yes. And one thing that I love in all of your books is that you really do take it away from the individual and you look at the environmental and the systemic. So just with drug addiction or other addictions and with depression. So yes, thank you for that framing. Very, very helpful.

and with depression. So yes, thank you for that framing, very, very helpful. Oh, thank you. So, you know, it's interesting, I'd love for you to set the stage for us around what do we need to know about drugs like Ozembic and Wigovia and, you know, why have a conversation about them. And I'll just share, you're so on like what's hip or what's relevant,

because as soon as I heard about your latest book I started to get ads About was Zembik and with Gobi I had someone in close to me who was hospitalized twice for complications due to one of the drugs I had other people who were considering taking the drugs So it was like all of a sudden when I was reading your book It was really everywhere and it still is really present So for for the maybe few folks who still haven't heard of it, but will now you'll get ads shortly.

What is it that we need to know to just start with to introduce Ozempik and Wachovie and why should we have this conversation about them? Yeah, I remember really vividly the moment I first learned about their existence. It was that moment in the winter of 2022 when the world was opening up again and I got invited to a party and I was like wow parties I remember them they used to exist and decided to go and this party was thrown by an Oscar-winning actor I'm not saying that just to name drop it's relevant to what happened next and in the Uber on the way there I kind of felt a bit um self-conscious because I'd been quite

overweight at the start of the pandemic and I gained quite a lot of weight during COVID, like so many people. And I thought, oh, this is going to be a bit awkward, you know, like I felt a bit kind of schlubby. And then, and then I thought, oh, wait a minute, this is actually going to be really interesting because loads of people gained weight during COVID. I'm going to see all these Hollywood stars with a bit of like chub on them. This is going to be super interesting. And I arrived at the party

and I started walking around and it was the weirdest thing. It's not just that people hadn't gained weight. Everyone was like gaunt and not just like the stars, like people I knew, like the screenwriters, their kids, their partners. Everyone looked like their own Snapchat filter. You know what I mean? Like kind of sharper and clearer. And I was like, huh. And I bumped into a friend of mine on the dance floor. And I said to her. Wow, it looks like everyone really did take up Pilates during lockdown.

And she laughed and I must have looked puzzled. I was like, what are you laughing at? And she said, you know, it's not Pilates, right? And she pulled up an Azempic pen on her phone. And as soon as I learned what Azempic was, like I said a minute ago, I felt so conflicted because the very first thing I thought was, well, this could save my life because I was about to turn 44 which is the age my grandfather was when he died of a heart attack. Loads of the men in my

family get really fat and die of a heart disease. My dad had terrible heart problems that didn't kill him, my uncle died of a heart attack, my grandfather died of a heart attack and I thought, wow, if there really is a drug that can reduce or even reverse obesity, that's going to be a big deal for health, right? I knew, I think even then I knew that obesity contributes to or makes worse or causes over 200 known diseases or complications. I wouldn't have known this stat, but Professor Gerald Mann at Harvard University who I interviewed, who designed the food label that's on all food that's sold in the US calculates that 678 thousand Americans die every year as a result of obesity or food related illnesses

Staggering that's almost ten times the number of people killed by gun violence and you will notice we've got a lot of gun violence, right? So I felt this way of optimism and then I immediately had all these doubts and so I ended up going on this big journey for the book all over the world from Iceland to Minneapolis to Okinawa in the south of Japan to interview the leading experts, the biggest defenders of the drugs, the biggest critics of the drugs. And really to understand how we got to this point that 47% of Americans want to drug themselves to stop eating. What happened to us? How did we get here? Is this really the best way out? If it isn't, what are the alternatives? Yeah, so it ended up turning into this kind of slightly crazy, crazy journey. Yeah. Yeah, absolutely. And the show is called Upstream because it's about going upstream from the challenges of our time to the root causes.

And I really felt your whole book is an upstream journey from the challenges of obesity. And, you know, one thing I love about you is that I think of you as a Heath Ledger of journalism in the way that you get in character. You really dive in to the text. And I remember Stolen Focus, you actually go and put yourself, whether it was on an island or a cabin and you cut yourself off from social media. And so in this book, you take Ozembic and you follow that journey. So maybe let's start with your personal experience. How did it feel for you physically? And then also, like you said, what were the waves of understanding or realization or worry or concern that came over you as you were taking it?

This is so weird because this is the second podcast I've done today and the first podcast I did the host compared me to River Phoenix and you've just compared me to Heath Ledger two of the hottest men who've ever lived both of whom died horribly so I'm just like I don't know whether to take this as a compliment or as a horrific disturbing warning but I'll take I'll take the good from that. Poor Heath Ledger. I've got to tell you, taking SMP is really weird. So I'll never forget the second day after I injected myself with it for the first time,

or actually I got one of my friends to inject me, I was too much for worse to do it myself. I was lying in bed and I woke up and I thought, oh, I feel something really weird, what is it? And I couldn't figure out what it was and then I suddenly realized that I had woken up and I wasn't hungry. Like my whole life I've woken up hungry, right?

This is weird. And I went into, there's a diner just up the street from where I live. And I went in and I ordered what I'm slightly embarrassed to say I used to order every morning, which is a huge chicken sandwich with loads of chicken and mayo in it. And normally I would wolf that down and still want some potato chips. And that morning I had like three or four mouthfuls and I was just full.

I didn't want any more. I thought this is weird. And Tatiana, the lovely Brazilian woman who runs the diner, like literally shouted after me when I was leaving, are you okay? Because she'd never seen me leave any food before. And that was how it felt from then on. Like shutters had kind of come down on my appetite. It's a very different experience to dieting. When you diet, you know, you're hungry and you deny yourself, right? What these drugs do is they make you feel very full, very fast. And we know the core mechanism, although there's a huge amount I learned from

interviewing the scientists that's debated about what's happening with these drugs, a lot of it very disconcerting that the core mechanism is well known. So if you ate something now, it doesn't matter what it is, Della, after a little while, your pancreas will produce a hormone called GLP-1. And GLP-1 is one of many gut hormones that basically just like the signal from your body going, hey Della, you had enough, stop eating, right? But natural GLP-1 only sticks around in your system for a couple of minutes and then it's washed away. What Ozempic and Wigovie, which are essentially the same drug, do to you is they inject you with an artificial copy of GLP-1 that instead of sticking around for a couple of minutes,

sticks around in your system for a whole week, which is why when I ate that chicken sandwich, I was really full really quickly, right? So it just, it creates this remarkable sense of satiety, the feeling of having had enough and not wanting anymore. So yeah, that, that was the kind of first and immediate effect of the lots of other things obviously happened to me when I took it as well. Many of them not so nice. Yes. And just to follow on that thread for a minute, what I found so interesting about your experience of that feeling and like I've had Enough or I'm not hungry anymore is what you talked about with it suppressing our desire for comfort

So the idea that it somehow dampens our reward pathways the ways that we turn towards that chicken sandwich Not just for the protein and sustenance that it gives us but but for the joy of it or even the comfort, right? Comfort eating. So, wow, I actually brought this to my Dharma group after reading it, because I was like, what would happen, as you say, if we no longer have the kind of desire or want, right? This coping mechanism, and we have to, as you say,

the potential to face our shit, right? And so what did you learn there and what do you think is the possibility as we lose this coping mechanism for comfort food? In the research for the book, I learned that there's 12 big risks associated with these drugs, as well as lots and lots of benefits. And for me personally, this was the one that I found most difficult. And I'm not talking about the side effects, that those are fairly well known, the drugs make you nauseous at first, they can make you pretty constipated or give you stomach upset.

That generally goes away pretty quickly for most people, but I'm talking about risks, which are a different thing. And one of the risks, it was another one of the really weird things about the drugs. So for the first six months I was taking the drugs. I lost a huge amount of weight I was getting what I wanted my back pain went away my neighbors hot gardener hit on me loads of great things happened But weirdly I didn't actually feel psychologically better if anything. I actually felt slightly worse And I was learning the evidence that this is contested, I want to stress that, but some

doctors are concerned that these drugs may in a minority of people who use them be causing depression or even suicidal feelings. That certainly wasn't that bad for me, but I did feel emotionally dulled. I was thinking, what's going on? And of course that could just be a coincidence, other things go on in my life. And there's a debate. So we know the evidence is increasingly clear that these drugs don't just affect your gut.

Indeed, they primarily work by affecting your brain. We have GLP-1 receptors, not just in our gut, but in our brains, and there's a big debate. Maybe this is part of the brain effect, right? But I actually think for me, it was something much more, in some ways simple. I had a real epiphany about it in a branch of KFC in Las Vegas. So my nephew said to me recently, it's weird how many of your epiphanies in life happen

in branches of KFC. I was like, that's a good point. But it was, I think maybe seven months into taking the drugs and I was in Vegas because I was researching a different book that I've been researching for a ludicrous amount of time, 13 years about a series of crimes that have been happening in Vegas. And I was researching the murder of someone that I knew and really loved. And it was, as you can imagine, a very painful thing to do. And I went into the, for people in Vegas, I'm sure you've got some Vegas listeners, I went into the branch and KFC branch on West Sahara, which is one of the roughest KFCs in the whole world as well. And I went in and really on autopilot, I ordered what I would have ordered before I started taking

Ozempic. I ordered a bucket of fried chicken and I got the bucket and I ate one of the chicken drumsticks really quickly and I looked at the bucket and I thought, shit, I can't eat this. When you're on Ozempic, you can't overeat, you would vomit. I like imagine I came to you after you had a huge Thanksgiving dinner and I said great news Della, I got you a bucket of KFC. You'd just be like, oh, take it away from me, right? That's how you feel quite quickly. And I remember, you know, sometimes you have insights and it almost feels like someone else is saying it to you. I suddenly thought, oh, you're just going to have to feel bad. And I go through my bit magic pill that five

reasons why we eat, only one of them is like the obvious one to sustain your body, to get nutrition. The rest are all psychological. And I realized for me, you know, I grew up in a family where there was a lot of addiction and craziness. And I mean, I had some awareness of this before, but I realized going right back to when I was a small child, one of the ways I coped with that was by deliberately overeating, by stuffing myself. And stuffing is a particular form of eating. It's where you eat beyond the point of being full.

And I kind of realized what these drugs do is they radically interrupt your eating patterns. Obviously, that's a good thing. That's why you lose so much weight. That's why I lost 42 pounds in a year. But what that can do in addition to health benefits if you take them because you were obese or overweight to get down to a healthy weight, which is very different to people who are taking them to be super skinny, that's a different thing.

But what it can also do is it bring to the surface some of the deep underlying reasons why you eat in the first place. Now again, that can be a good thing. There are clearly better ways for me to deal with my distress than Colonel Sanders in a bucket of greasy chicken. But that can be a difficult adjustment period, a difficult process.

And I think in a way, like with so many things with these drugs, actually there's a parallel that really helps us to think about this, right? Because these drugs have only existed for weight loss for a couple of years. They've actually been around for diabetics for longer, for nearly 19 years. But for weight loss, they've only been used for a couple of years. So I actually think if we want to think about the effects of these drugs, a very good comparison is to look at a different form of weight loss. So think about bariatric surgery, right? Things like stomach stapling, gastric vans. That's been around for quite a long time now. And we can

look at the effects and I think there's really interesting parallels. So what do we know about bariatric surgery? First thing we know it's a horrible operation. One in a thousand people dies during the surgery. It's no joke. But the reason people go through this absolutely horrendous gruelling operation is because of what happens to your health next. So if you have bariatric surgery in the seven years that follow, you are 56% less likely to die of a heart attack.

You are 60% less likely to die of cancer. You are 92% less likely to die of cancer. You are 92% less likely to die of diabetes-related causes. In fact, it's so good for your health to dramatically reduce obesity that you're 40% less likely to die at all of any cause in those seven years. And we know that these drugs are having a similar benefit. For example, if you take them and you had a BMI higher than 27, you are 20% less likely to have a heart attack or stroke. But we also know, interestingly, if you have bariatric surgery, you're almost four times more likely to commit suicide, which seems to me a really, it's still quite a low risk because

obviously suicide is in general a low risk. But that's a really big increase, right? And I suspect there's a big debate about why there is some of it may be actually the gruelling effects of the surgery in the aftermath that must play some role. But I suspect it's these things, right? It's predominantly these things. It's the psychological factors that come to the surface in complicated ways. It's the thing I'm, there's loads of things

I wish I had known before I started taking a Zempik, but the one I most wish I had been forewarned about is this, right? That it doesn't just affect your body, it affects your psyche really profoundly for many people, not everyone. Yeah, thank you. That's definitely a really interesting piece of it. And one thing that you do is you ask us to reflect. You say, what job is overeating and being overweight doing for you? What did it get you out of that's positive and improves your life? So yeah, just inviting all of us, as you say,

to think about the mental and emotional effect that taking away a reward pathway can have or to dampen a reward pathway. Yeah, and I'll give you another example that really haunts me. There's a doctorate interview called Dr. Vincent Felitti, wonderful man in San Diego. And he was a doctor in the early 1980s

and he was approached by Kaiser Permanente, one of the big not-for-profit medical providers in California. At that time, and they said to him, look, we've got a problem, we don't know what to do. Obesity is really rising. In fact, it was very low by our standards, but this is the birth of the obesity crisis. And they

said, look, everything we do doesn't work. We give people diet advice, it doesn't work. We give people exercise plans, it doesn't work. Could we give you a load of money to do blue skies research and just figure out what would solve this problem? So he agreed to do it and he started to work with 200 severely obese people. And he was like, what can I do? And he had an idea that sounds, and in fact is kind of dumb. He said, what would happen if really obese people literally stopped eating? And we gave them like vitamin C shots

so they didn't get scurvy or whatever. Would they just burn through the fat supplies in their body and get down to a healthy weight? So with a shit ton of medical supervision, they tried it and incredibly at first it worked. So there was a woman in the program, I'm gonna call Susan, that's not her real name, who went down from being I think it was more than 400 pounds to 138 pounds. Incredible. Massive weight loss. You know her family are ringing Dr. Fleety saying you saved her life. It's incredible.

And then something happened that no one expected. Susan cracked. She went to KFC or whatever it was. I don't think it is KFC. Actually It's me projecting it somewhere like that though, and started hugely over eating again, and quite quickly got back to a dangerous weight. Not where she'd been, but a dangerous weight. Dr. Fleti called her in. He said, Susan, what happened? And she looked down.

She said, I don't know, I don't know. She was obviously really ashamed. He said, well, tell me about the day you cracked. Did anything in particular happen that day? It turned out something had happened that day that had never happened to Susan. She was in a bar and a man hit on her, not in a nasty way, in quite a nice way, and she just felt super freaked out. That was when Dr. Felitti asked Susan something he'd never thought to ask his patients before. He said to her, when did you start to gain weight?

In her case it was when she was 11 if I remember rightly. He said, her, when did you start to gain weight? In her case, it was when she was 11, if I remember rightly. He said, well, did anything happen when you were 11 that didn't happen when you, I don't know, 10, 14, anything in particular happen that year? And Susan looked down and she said, well, that's when my grandfather started raping me. Dr. Filihti interviewed everyone in the program. He discovered that 60% of them had made their extreme weight gain in the aftermath of being

sexually abused or assaulted. He's like, oh, that's really weird. What's going on there? Susan explained it to him really well. She said, overweight is overlooked and that's what I need to be. You know, that of course people at any weight can and do get sexually assaulted, but many of the women believe they were less likely to be raped if they were overweight. It gave them protection from the male gaze from predatory men. And I thought

about this a lot when I interviewed people who would take Yosemite and suddenly, particularly women who were survivors of sexual abuse, who suddenly felt incredibly vulnerable and frightened and didn't know why, right? Some of them didn't know why. So there's all sorts of positive psychological roles that either obesity plays or that the behaviors that produce obesity play. They did that for me with overeating, stuffing myself, that calmed me down, and I go through lots of those other things that it can do for us. So while also, of course, the scientific evidence is clear, it does on average significantly harm health. So we've got to be truthful to the complexity of this situation and that you gain things

and you lose things in turning to these weight loss drugs. And I'm really hearing the necessity for having healthcare access or mental healthcare access when taking these drugs so that one can do healing work, right? Therapeutic or healing work or at least, you know, as you say, giving you a space to maybe reflect on your life and choices and patterns. therapeutic or healing work or at least, you know, as you say, giving you a space to maybe reflect on your life and choices and patterns. So yes, if we go upstream, these kind of traumas that are unhealed are one of the reasons why we have an obesity epidemic and also our desire to comfort ourselves. And I'm wondering if you can take us upstream to some of the other reasons why we're noticing

so much obesity and also why obesity is rising. And I'll just offer a quote from the book. Someone who you interviewed said, these weight loss drugs are an artificial solution to an artificial problem. Something is wrong anytime a society has a problem that everyone acknowledges is heavily based on the environment and turns increasingly to treating it in a medical way. So tell us more about the root causes of this epidemic that we're seeing. Yeah it's to me the most important question of all and leads us to the deepest set of solutions here. So

I would just urge everyone listening pause this podcast for a second and do something for me. Just Google photographs of beaches in the United States in 1979, the year I was born. Go look at them and come back. Okay, if you've just done that, you will have noticed something kind of weird. Pretty much everyone in those pictures looks to us to be either skinny or jacked, right? You look at it and go, that's weird. Where's everyone else? Was it like a skinny person convention on Miami Beach that day? And then you look at the figures. That's what Americans look like in 1979, not like a thousand years ago, the year I was born, right?

Something absolutely extraordinary has happened in my lifetime. Human beings existed for about 300, 350,000 years in our modern form and obesity existed but was exceptionally rare. And then literally in my lifetime, it has blown the fuck up, right? Between the year I was born and the year I turned 20, obesity doubled in the United States. In the next 20 years, severe obesity doubled again, right?

And we know why this happened, because it happens everywhere in the world that makes one change. It's not where people suddenly become lazy or weak-willed or all the mean bullying things we say. It's where people move from mostly eating a diet of fresh whole foods that are prepared on the day to mostly eating a diet of processed and ultra-processed foods, which are foods that are constructed out of chemicals in factories in a process that isn't even called cooking, it's called manufacturing food. And it turns out this new kind of food, which our great grandparents never once ate, affects our bodies in a process that isn't even called cooking, it's called manufacturing food. And it turns out this new kind of food,

which our great grandparents never once ate, affects our bodies in a completely different way to the old kind of food. And I go through lots of things it does to us, but the core is it undermines our ability to ever feel full and to feel like we've had enough. And there's lots of evidence for this and lots of reasons why,

but there's an experiment that to me just totally distilled it. In the book I nicknamed it Cheesecake Park, it's not the official title. It was carried out by a brilliant scientist I interviewed called Dr. Paul Kenny who's the head of neuroscience at Mount Sinai in New York. So Dr. Kenny grew up in Dublin in Ireland and when he was in his I think his early 20s he moved to San Diego and Quickly noticed that Americans don't eat like Irish people right they ate much more processed and ultra processed foods and like many a good immigrant

He quickly assimilated and within a year. He gained like 30 pounds. It was like whoa What's going on? And he felt like this new kind of diet wasn't just changing his gut. It was changing his brain It was changing what he wanted. So we designed this experiment to test it. It's very simple. He got a lot of rats and he raised them in a cage. And all they had to eat was the kind of natural whole foods that rats evolved to eat over thousands of years. And when that's all they had to eat,

the rats would eat when they were hungry and stop when they were full. They seemed to have some kind of natural nutritional wisdom that said, hey guys, you've had enough, stop eating now. When they had the kind of food they evolved for, the rats never became fat or obese. Then Dr. Kenny introduced them to the American diet, get ready to salivate. He fried up some bacon, he bought some Snickers bars, and crucially, he bought a load of cheesecake. And he put it in the cage alongside the healthy food. And the rats went apeshit for the American diet. I

don't know if rats can go apeshit, is that a mixed metaphor? But you know what I mean? The rats went crazy for the American diet. They would literally dive into the cheesecake and eat their way out completely slicked with cheesecake. They ate and ate and ate and ate. The way Dr. Kenny put it to me was within a couple of days they were different animals. All their natural nutritional wisdom disappeared and they very rapidly all became severely obese. Then Dr. Kenny tweaked the experiment again in a way that to me feels pretty cruel as a former junk food addict. He took away the American diet and left them with nothing but the healthy food they'd evolved to eat. And he was pretty sure he knew what would happen. They would eat more of the healthy food than they had at the start. And this would prove that exposure to processed and ultra processed foods increases

the number of calories you eat in a day. That is not what happened, Della. What happened is much weirder. Once they'd had the American diet and it was taken away, they refused to eat anything at all. It was like they no longer recognized the healthy food as food. They would rather starve than eat it. It was only when they were literally wasting away that they finally went back to it. Now I would argue we are all living in a version

of Cheesecake Park right now. 67% of the calories the average American child eats in a day are from ultra processed foods. Staggering, right? So the food we're eating is profoundly undermining our ability to feel full. And of course what these drugs do is they give you back your sense of fullness, but at a cost. And when I was first learning all this, I went to one of my closest friends and I said to her, I've got to stop taking these drugs because I'm being a complete

hypocrite here. You're very much in tune with the theme of your podcast. One of the reasons we get on so well is, you know, I write books about the big social factors that cause our problems and how we should deal not with the isolated individual symptoms, but with those big factors. Right. I've done that with depression, addiction, attention problems. And I said, well, here I am. This is a problem that very clearly has social causes. Right. As we see from looking at the picture of that beach, those beaches. And

here I am just dealing with the individual symptom. This is crazy. I'm being a fraud. And this friend that I went to, my closest friend, she, so seven years before she got breast cancer, she's a single mother. And it was awful, as you can imagine. And I was there with her through the chemo and the double mastectomy and the hysterectomy. And she said to me, Johan, you could have said to me at the time, well, this is crazy. We know there's something in the environment that's causing breast cancer. Because one in seven women in Britain get breast cancer now, one in eight women in the United States. That wasn't the case in the recent past, that's not the case in countries like Japan where it's one in 38 women. Something is going on in our environment that is driving up cancer rates, particularly among younger women.

And you could have said to me, well, what? The environment poisoned you and gave you cancer, and now you're injecting another set of poison into you? This is madness. She said to me, you didn't say that. You said, we are where we are. We've got to make sure you survive to fight another day. If you survive to fight another day, then we can be part of the campaign to deal with the environmental causes of cancer. But if you die, we can't do any of that, right?

And I really reflected on that. Because the expert you mentioned, who I interviewed, an amazing man called Professor Michael Lowe, who is at Drexel University in Philly, one of the leading experts on hunger and research into hunger in the whole world, he said to me, look, these drugs are clearly, as you quoted, an artificial solution to an artificial problem, right? Processed and ultra-processed foods created this unquenchable hunger in so many of us,

and the drugs come along and artificially fill that hole. And that's completely true. And clearly the deeper solution is to deal with that underlying crisis. And I went to places that have done that, like Japan and Mexico and the Netherlands, I'm sure we'll talk about that. But for someone like me, I've been obese almost all my adult life. You know, I spoke to a guy called Jeff Parker, right? Lovely guy. He's a 67 year old retired lighting engineer in San Francisco. And he was very severely overweight and he had a gout. He was in huge pain. He was finding it difficult to walk. He was taking fistfuls of pills every morning. And he started to take Mungiro, which is one of these drugs, and he lost an enormous amount of weight. And now he walks his dog over the

Golden Gate Bridge every day, almost all his medical problems have gone away. He told me, I feel like I'm going to really enjoy my retirement now. And I said to Jeff, I was in the middle of researching all this, I said, don't you think we should be dealing with the social factors? He said, 100% sign me up for that campaign. I'm totally down for it. But he said, I've got to tell you, by the time we sort that out, I'm going to be dead. And I want to live. And I thought about in relation to gun control, right?

I am passionately in favor of gun control. The person I mentioned who was murdered was murdered in gun crime, right? I'm sure you'll be amazed if you weren't in favor of gun control, right? But if someone is shot in front of me, I'm not going to stand over them and say, you know, we need to reverse the Supreme Court ruling on bump stocks and we need to close the gun show loophole and we need to... I'm not going to say that.

I'm going to phone an ambulance, right? And again, just like there's no contradiction between being against stigma and being in favor of improving people's health, I don't think there's a contradiction between saying we need to deal with the deeper social factors and in the immediate crisis we're in, we need to provide people with the best healthcare they can. Absolutely. We've done two documentaries, one on worker co-ops and the other one on universal basic income. Two of my favourite things.

And the first episode was like all the good things and the, you know, exploring it and everything. And then in both cases, the second episode was, but is it a bridge to a post-capitalist future? And we really came to a similar insight. And it was really from Catherine Trebek, who's a wellbeing economist, where she said, we need to be able to distinguish when our efforts are helping people survive today and when they're helping people build tomorrow. I just really hear that and what you're sharing that it's both important to transform a work space to make it more democratic and also to offer universal basic income to folks who are precarious and to support someone who's bleeding from a gunshot wound or experiencing health problems from obesity, and it's important

to change the system, to change the environment. I love that quote. I love that. I need to write that down because I think it's a temptation people with our politics to sometimes say, well, we need things to get really bad to prove the point. And then someone like Jeff Parker or indeed someone like me, it's like, what am I meant to die of a heart attack to prove that processed food is bad? Well, 678,000 Americans die every year of obesity and food caused illnesses.

If the point needs to be proved, believe me, it's being proved, right? I think you're totally right, but I also think this points to, I was thinking about this when I was listening to one of your interviews with my friend Jason Hickel, and I discussed this with Jason when I was doing the research for this book as well. The kind of solutions that are permitted under capitalism. So we've got this enormous

crisis caused by unregulated capitalism, right? What's happened is an unregulated, largely unregulated food industry has developed foods that profoundly fuck up us and our children, right, and catastrophically harm our health. And they actively promote this to children. More three-year-old children know what the McDonald's M means than know their own last name. So even before you can speak or think clearly, the message is in, right. And I quote in the book an incredible leaked memo from within the food industry where they're like, we've got to get kids young, get them young, we've got them forever. Right. So you have this unregulated capitalism. Now, clearly a big part of the solution is you've got to

therefore regulate capitalism, right. And indeed progressively over time eradicate many of these forces, right. But instead, the only kind of solution that's ever promoted to us or allowed to gain traction in this system is where there's an alternative profit center that can win, right? So weight loss drugs are going to be one of the biggest industries in the whole world, right? 47% of Americans want to take these drugs. And that's before most people know someone like Jeff, who becomes a walking advert, advertisement for the drug, right? I mean, these drugs have blown up so much that Novo Nordisk, the country that owns them,

is now not only the most profitable company in the whole of Europe, but the entire GDP of Denmark, the country where it's based, has massively spiked up because of the profits of Novo Nordisk because of these drugs, right? It's extraordinary. And this is just the beginning. But you think about that,

it reminds me a little bit of the debate, I remember talking to Jason about this, the debate about geoengineering, right? So we've got a crisis, I'm sure none of your listeners need me to tell them, but a catastrophic climate crisis driven by unregulated capitalism and the fossil fuel emissions, right?

I'm very conscious of this today, because as we're speaking, the place where I spent three months last year, an incredible fishing village in Jamaica, is literally being destroyed by a category five hurricane as we speak. We know that global warming is supercharging hurricanes obviously.

Instead of responding in the same way, which is, well, let's restrain our fossil fuel emissions, we're talking about these crazy, well, we're continuing to ramp up our fossil fuel production. And the kind of solution that's permitted to talk about is geoengineering, which is unbelievably risky. If for all sorts of reasons we go into, people who want to know about this, I'd really recommend reading my friend Naomi Klein's book. This Changes Everything, which has an amazing chapter about the risk of geoengineering that profoundly haunts me. But yeah, so you think about what solutions are we allowed or encouraged to talk about and what ones are actually effective

but kind of hidden from view. And I think of these weight loss drugs as in some ways analogous to geoengineering. They're quite risky. We don't know the longterm risks of these drugs, just like I think geoengineering is more risky to be clear. So I don't wanna take that analogy too far, but I do think there's a real kind of parallel there.

Yeah, I love that we're going upstream and finding we often find capitalism when we go upstream in our show. So I'm hearing, yeah, the lack of regulation, I'm hearing the profit motive and mechanism driving us towards sickness and ill health, both for the planet and for us. But I'm also hearing when I was reading the book, I kept coming up to the frontiers of capitalism, the frontiers of capitalism. So in one instance, it was that food that is fresh or healthy, it goes to waste and it doesn't cost a lot to create to produce as much as something artificially created. And so food as a frontier of capitalism, right? And like how can food gain even more profit, lack even more nutrients and be sold for more?

And then I also saw in the book or heard in the book your frontier for capitalism of the weight loss drugs in one of the last chapters you talked about giving the weight loss drugs to children, right? So it's like, it's just another way that capitalism continuously looks for these new frontiers to extract and to gain profit. Yeah, totally. And you mentioned UBI and workers cooperatives, both things I'm really passionate about and worried about in my book Lost Connections, which

about why we're so depressed and how we can get out of it. But I actually think these, those are part of the solution here because one of the things that's going on, there's many, many layers and many things going on, but one of them is we don't have time to cook. Who has time to do an hour's cooking a day? If you're fucking exhausted, you're working all the time. Look at the numbers, hours that the average American works in a day is staggering, right? So yeah, in a culture where you're constantly being exploited, you're strung out, you're working all the time, you're constantly stressed, you want to come home and just stuff your face, right? Of course, I've been there, right?

But I think you're right as well, if you think about kids. So the debate about kids, it's interesting, all the stakes around these drugs, stakes, S-T-A-K-E, that's not the delicious kind of state, all the stakes around these drugs are really accentuated when you look at the debate around children. Novo Nordisk is currently running a trial around giving these drugs to six-year-olds, which feels viscerally sickening. And you look at both sides of the ledger are accentuated when it comes to children, right? So unless we fix the environment, and I refuse to accept that we can't do that, we absolutely can,

and I went to places that have done it, In an unfixed environment, people face a choice in this profoundly dysfunctional environment in which we live. You have to compare the risks of obesity to the risks of these drugs. And that is a difficult choice and different risks apply to different people. I decided to continue taking these drugs because of the heart attack risk in my family is so great because so many of the men get heart attacks that for me the evidence these drugs massively reduce heart disease was just the thing that decided it and outweighs the significant concerns I have about the other things. But other people will have different risks and I'd recommend they go down the list of the, well, A, they should talk to their doctor and B, I'd hope they'd go down the list of the risks that

I talk about in the book. But with children, both sets of risks are hugely accentuated. If you're obese when you're 18, you have a 70% chance of developing type 2 diabetes in your life. And type 2 diabetes knocks 15 years off your life on average. So childhood obesity is no joke, right? That is devastating. To know your child is going to have 15 years less of life, and diabetes is the biggest preventable cause of blindness in the United States. More people have to have a limb or extremity amputated in the US because of diabetes

than because they got shot. And you will have noticed a lot of us get shot, right? So, and that's just one of the many factors made worse by obesity. And then you have to weigh that against the risk of the drugs to the kids. And one of the risks that really alarms me and worries me for myself, but particularly worries me for children is we have literally no idea about the long term effects of these drugs. We don't know. We know they're working on your brain. What does it do to you to chronically activate these brain regions? And bearing in mind that most scientists, although this is disputed, most scientists believe the drugs only work as long as you take them and then you just go back to being what you were before when you start you give these to an

eight-year-old they're going to be taking them for what 80 years what are the long-term effects we don't know now we do know the long-term effects of obesity and they're very serious you've got to weigh those two things but of course this raises the case right don't accept this being the shitty choice forced on our children i went to japan where there is literally no childhood obesity right almost literally they have 4% adult obesity compared to 42.5% adult obesity in the United States, right? I went there, I learned how they did it. They spend a huge amount of money on children's school meals. Children eat healthy fresh food and they use that healthy fresh food to educate the children about how to make themselves healthy.

I've got to tell you, it's a really weird experience going to a school of a thousand children as I did, walking around and then not being a single fat child. It's bizarre, right? And you realize how artificial this crisis is and how these unregulated companies and this unregulated system of capitalism where those companies own the lobbyists and own your senators and own the political system and therefore prevent and stymie any democratic regulation. How grotesque it is. 678,000 Americans a year dying is not a small matter, right? Like that's almost the COVID pandemic every year as a result of this.

And to go to places that have actually fixed it and see how they did it and see how we can do it by regulating the food industry, taxing sugar, investing in what children eat, really turning that around. There's loads of things that go through in the book. We absolutely can and must do that, but it requires us to stop kind of blaming ourselves. There's so much shame around this topic and stop being angry

with the forces that actually did this to us. So closing with our invitations for listeners going forward. So I really love what you just said about let's get angry at what's really causing this problem. Our food system, the profit motive, the profit mechanism, and also an invitation to reduce the stigma and at the same time, the excess weight that harms people's bodies. My takeaway about Ozembic is something you said, you said, if your BMI is lower than 27,

you definitely shouldn't take these drugs. And I love that you go into the risk to anorexia or folks who are experiencing body dysmorphia in that way. But if your BMI is higher than 35, you don't have a family history of thyroid cancer, you're not trying to get pregnant, then it could be a useful thing to explore. And then you also invite us to address the root causes,

looking at what is it we might need to heal around our relationship with food, right? What job is overeating and being overweight doing for us, but also addressing the food system, changing the food system, fighting for an environment where we don't face the bleak choice between obesity and drugs. So those are some of the key takeaways for me. I'm wondering if you can end with what are your invitations for listeners going forth? Besides, read the book.

No, I think you're totally right. I think the summary you just gave is great. That's exactly right. Like we're in a trap at the moment, a lot of us. These drugs are a kind of risky, rusty trap door. We face the difficult decision of whether to go through them, but we absolutely should not tolerate our children

growing up in this trap. We don't have to. This didn't happen in the recent past. It doesn't have to happen in the future. Don't accept it like it's just a force of nature or a fact of the modern world. Hard to think of a place more modern than Japan, the biggest economy in the world, super technologically advanced, no obesity right but almost no obesity. It's kind of weird that our mental picture of Japan is a sumo wrestler because it's like expecting an American to look like a bald eagle basically. But I guess what I would say is I saw what you win when you solve this crisis. When I went to Okinawa. So Japan has the longest life expectancy in the whole world, which is obviously closely related to the fact they have no obesity, because obesity shortens life.

And I went to this place that sounds almost mythical. It's called Ogemi. It's by some measures the oldest village in the world. They've got, I think it's 215 houses and 190 of them have someone over the age of 90 living in them. So I went to their little community center and the first person I met at the door, she walked in, was a 103 year old woman called Matsu Fukushi.

She walked there on her own. She said to me, first thing she said to me was, I can't stay for long because I'm looking after my son who fell off the roof the other day, trying to fix it. And I was like, Jesus, how old is your son? But anyway, and we talked and she talked to me about how much she loved life, you know, it was volleyball season, she loved watching her great grandchildren play volleyball, she talked about how happy she was and someone put on some Okinawan music and she put on a kimono and started to dance and I danced with her and these other people who were 100 years old, right, more than 100 years old and I thought wow, you know, you guys, you were born before they started doing radio broadcasts in Japan. And here I am filming us dancing on my iPhone.

That's what you get if you solve the obesity crisis. Of course, not everyone gets to live to be 103, but you get more years of health, more years of joy, more years of dancing, right? That's what we want for everyone. We shouldn't tolerate how many of the people we love being denied that. My grandmother should have lived a really long time. Your grandmother should, right?

I should have got to know my grandfather rather than him dying when he was the age I am now, younger than I am now. We shouldn't tolerate obesity fucking us up in this way. It's not a force of nature. And we want, we absolutely want everyone to accept and love their bodies. We don't want people to love and accept the harm that the processed food industry does to their bodies. That's a very different thing. I want my love,

my mother to love her body. I don't love the fact that she smokes 70 cigarettes a day and I don't want her to love her lung cancer if she eventually gets it, right? So I think we need to bear in mind what you gain if we sort this out. It's more health, more life, more love. You've been listening to an Upstream Patreon episode with Johan Hari, author of the books Lost Connection, Stolen Focus, and most recently, Magic Pill, the extraordinary benefits and disturbing risks of the new weight loss drugs. Please check the show notes for links to any of the resources mentioned in this episode. Thank you to Carolyn Rader for the cover.

Upstream theme music was composed by me, Ravi. Thank you to all of our Patreon subscribers for making Upstream possible. We genuinely could not do this without you. Your support allows us to create bonus content like this, and it also allows us to provide most of our content for free so that we can continue to offer political education podcasts to the public and build our movement. For more from us, visit upstreampodcast.org and follow us on Twitter, Instagram, Blue Sky, Facebook and threads at Upstream Podcast. You can also subscribe to us on Apple Podcasts, Spotify or wherever you get your podcasts.

And if you like what you hear, please give us a five star rating and review. It really helps get upstream in front of more eyes and into more ears. Thank you. I'm sorry. You