Johann Hari, journalist: ‘It’s so ingrained in our culture that obesity is a sin’

A couple of days after starting to take Ozempic, says journalist and writer Johann Hari (Glasgow, 46 years old), he woke up with a strange feeling, unknown to him: he was not hungry. He got out of bed and went out to have his usual breakfast at his local bar, a chicken sandwich with mayonnaise. He took a couple of bites and could not finish it. He was full. The medication, belonging to that generation of drugs that have revolutionized the fight against obesity by imitating the effect of a hormone (GLP-1) that warns us when we are full, was giving him back a lost perception: that of satiety.

Hari recounts this and other anecdotes about his experience with weight-loss drugs in his new book Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs. In these pages the journalist, who has suffered from weight problems since he was young, embarks on a journey with the help of obesity experts and scientists who have participated in the development of these new drugs, exploring the benefits and risks of such treatments, the doubts that surround them, and the uncertain scenarios that they open up in the field of health and beyond. Hari spoke to EL PAÍS by videoconference from London.

Question. You have spoken to many scientists. What impressed you most about what they told you?

Answer. What obesity actually does to you. I’ve known since I was seven that being overweight is not good for your health. I was stunned by the evidence about how bad it is. If you’re obese, you are much more likely to have a heart attack, a stroke, to develop dementia, to develop cancer. If you’re obese by the time you’re 18, you have a 70% chance of getting diabetes, type 2 diabetes. It’s the biggest preventable cause of blindness in Britain. And it’s the biggest cause of amputation of a limb in the United States.

Q. You say that these anti-obesity drugs are destined to be the defining medicine of our generation, like birth control pills or Prozac at other times in the last century, for example. Why do you believe that?

A. Because obesity is the biggest killer in the Western world. And now we have a drug that, if you take it, reverses and ends obesity. Staggering. So all of us who are overweight or obese have a choice, but we need to weigh the risks of continuing to be obese against the risks of these drugs very carefully. [These drugs] are going to have huge effects.

Q. How could our lives and our culture be changed?

A. It’s huge. I mean Jefferies Financial, a financial consultancy, did a report for the airlines in the U.S. saying they’re going to have to spend much less money on jet fuel, because it costs more money to fly bigger people and it’s going to be a much smaller population. In Los Angeles, there’s been a huge increase in demand for jewellers to change and tighten people’s wedding rings. People have lost so much weight that their wedding rings don’t fit on their fingers anymore. Roughly 20% of Americans have already tried these drugs. This is not a craze. This is a staggering scientific breakthrough that is going to change society profoundly, in good and bad ways.

Processed and ultra-processed food — that is, food built out of chemicals in factories in a process that isn’t even called cooking, affects us in very different ways. It undermines our ability to ever feel full

Q. On the negative side, you raise some issues that come with taking these drugs, such as the risk of losing the “body positive” culture, or what would happen if people with eating disorders had access to them. Have you found any answers to these questions?

A. The invention of these drugs is like the discovery of fire. Fire is a great tool if I use it to warm up my house. It’s a terrible tool if I use it to burn down your house. 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 you start to take these drugs, just to give you one 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 drugs, you eat much less. That’s a good thing if you were obese like I was. If you have anorexia, there’s conflict inside you. That’s the part of you that wants to live and therefore wants to eat. And then there’s a complex psychological part of you that wants to starve yourself. And what these drugs can do is massively empower the part of you that wants to starve yourself. If you’re thin and you start taking these drugs, you can kill yourself with them. So one of the things we need to do is very tightly regulate these drugs.

Q. In the book you also delve into what makes ultra-processed foods so addictive. Do they cause a kind of short circuit in our brain systems?

A. If you look at a photograph of a beach in Spain in 1979, the year I was born, everyone is very skinny, and you ask yourself: where are the fat people? Obesity was very low back then. Human beings have existed for 300,000 years in a modern form. But obesity was extremely rare. And then basically, in my lifetime, it exploded. What happened? We know the answer: Obesity skyrockets everywhere people make a change, when they go from eating mostly fresh whole foods that they prepared that day to eating mostly processed and ultra-processed food — that is, food built out of chemicals in factories in a process that isn’t even called cooking. It’s called manufacturing food. This new type of food affects us in very different ways. It undermines our ability to ever feel full. What these drugs do is give you back that sense, but with some risks and a cost.

Q. And what about the industry’s responsibility in this context?

A. We need to regulate the food industry to prevent our children 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 that. When I started taking the drugs, I felt this real dilemma. Because I thought, could I write these books about how we need to deal with 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’m treating the symptom. I went to one of my best friends, and I said I think I should stop taking these drugs and I’m being a hypocrite. She gave me a really good analogy. She said, ‘If your house is on fire, you can make a really good argument for saying we should change the building regulations, so houses are built out of less flammable material and that we need to have smoke alarms and water sprinklers.’ Those are all really good ideas. If your house is on fire, that’s a fucking issue. You call the fire brigade, douse the house, and then we have a conversation about the building regulations. I think we need to do both. We should deal with the immediate emergency. I’m ready to deal with the longer-term problem.

We admire weight loss if it involves suffering: if you go through agony, you starve yourself, you follow these extreme rules of exercise, it’s almost like you go to purgatory and then we let you be forgiven

Q. How much does the stigma of obesity weigh in the context of these new drugs?

A. I think this is a really important question. And I felt like I was cheating, and I looked at the history of how we think about obesity. It’s so ingrained in our culture that obesity is a sin. We admire weight loss if it involves suffering: if you go through agony, you starve yourself, you follow these extreme rules of exercise, it’s almost like you go to purgatory and then we let you be forgiven. And this is one of the reasons we feel so uncomfortable about these drugs; it’s like you get away with the crime without the punishment. Where did we get this idea that obesity is a sin to be punished? I didn’t invent processed food. The difference between the beach in Spain in 1979 and the how 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. That’s not a moral judgement. So I think we need to reframe the way we think about these problems to understand the reason why so many of us gained weight. Of course, there is some personal responsibility, but it’s because of a big change in the environment

Q. The expansion of these drugs is just beginning, and even more effective ones will probably arrive. What new world are we heading towards?

A. As one of the scientists who developed these drugs told me, we’ve cracked the code that controls human appetite. It’s gut hormones, stimulating gut hormones. There are many gut hormones that relate to appetite so we can have more sophisticated drugs with fewer and fewer side effects. I think we’re going to be able to control human appetite in a way we’ve not been able to control it before. I think we will see a really significant reduction in obesity and the healthcare problems associated with obesity, assuming that we don’t discover some catastrophic effect that’s previously unknown, which I think is quite unlikely given that diabetics have been taking the drugs for nearly 20 years now, but it can’t be ruled out. And we’re going to see all kinds of unpredictable effects on culture, on people’s views of their bodies, and on the economy.

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