The Magic Pill Paradox

A review of Johann Hari’s new book on weight loss drugs

This, like Stolen Focus and Lost Connections is a great read. In short, it is a rich exploration of the rise and rise of GLP-1 agonists such as Wegovy, Ozempic and Mounjaro (magic pills) in a world of obesity and metabolic disorder. Hari, a self-confessed obese junk food addict takes the drug and then wrestles with the questions. Is obesity a problem? Are weight loss drugs safe and effective? Why have we gained so much weight? Why do sensible lifestyle approaches to weight loss fail in most cases? Should 70% of us take them from childhood onwards?

The magic pill forces us to confront a disturbing paradox. In pursuit of profit, we are jamming endless processed and deadly food into people and now we profit from pills to remedy it. Here are the key points.

Obesity is not new. Yet, it has gone from rare to a third of people. It has tripled globally since 1975. In the US obesity and diet kill between 112,000 and 678,000 people per year. We are eating ourselves to death through 200 diseases and complications. They include diabetes, heart disease, joint damage, cancer and inflammation.

Sugar, fat and salt with chemical-induced bliss points are wonderful to consume. Being fat, is a terrible fate. On top of the health risks, shortened life, and inability to enjoy daily activities, there is the shame and the fat shaming to bear.

Diets and lifestyle approaches have been largely ineffective. Previous ‘magic pills’ have been withdrawn due to serious side-effects. Our massive food industry continues to capture and shape our desires for their products from childhood. Like rats, driven to push the levers shovelling unhealthy, unnatural and addictive product into our bodies.

Processed food blocks satiety—less chewing, glucose spikes, salt, fat, sugar, less protein and fibre, chemical addiction and destruction of the gut biome. It is the perfect obesity and sickness storm.

Most governments, parents, schools and lifestyle change have failed to confront and solve this abuse of humanity. Many of us who have advocated for rational lifestyle change understand how hard it is to succeed. Even Weight Watchers is on its knees.

Surely a drug that can solve this must be a panacea.

Magic Pill research got going in 1984 when GLP-1 was found. In the 1990’s it was found to reduce appetite and weight and improve diabetes in humans. With the help of long-lasting lizard venom, in 2005 magic injections were approved for diabetes. Blood sugar control improved. Patients lost weight. In 2022 Novo Nordisk was able to publish a trial showing an average 15% reduction in body weight. They also found that it was to be taken forever. If you stop, the weight returns. Mounjaro (Eli Lilly) has achieved 21% weight loss and Triple G, 24.2%.

Over 70 similar drugs are in development and pill forms have begun. They currently cost about USD$1,000 a month but costs will surely come down. Novo Nordisk is the most valuable company in Europe. At the same time, processed food products are already in decline, along with alcohol, and joint replacements. Airlines will save millions. The evidence is that the health risks of obesity and diabetes decline rapidly on the drugs.

Five to ten percent of people get side effects—nausea, light-headedness, stomach discomfort, constipation—but they appear at this stage to be very safe. The signal benefit and reason for success is that GLP-1 agonists reduce hunger and craving. They produce satiety—fullness.  You sit over that milkshake and fries with very little desire to consume.

Now it is being proposed for children as young as six. If your child was sufffering the risks of obesity, would you support it? Probably.

The health benefits of magic pills are undisputed. It reverses the damage of diabetes and obesity over 28 measures. Are there side effects and dangers? Yes, wasting of face and butt, small increase in thyroid cancer and pancreatitis, digestive slowing, loss of muscle mass, malnutrition and limited supply. It is too early to define long term risks.

Hari talks through some successful alternatives such as Iceland’s Youth experiment and Japan’s focus on healthy eating and risk factor monitoring in schools and businesses. He suggests that losing the joy of junk food may lead to some loss of joy. Indeed, the brain effects of GLP-1 agonists is not just a sense of fullness but loss of the desire for other addictive substances. Alcohol consumption can drop by 60%. Heroin, cocaine, nicotine and fentanyl addictions appear to reduce.

There is an interesting dialogue on the role of over-eating for joy, comfort, calming and countering adversity. Clearly, our eating is related to our emotions. Perhaps magic pills are covering up unmet emotional needs. The stories of celebrities and body builders using magic pills to meet their narcissistic impulses is a sad case in point.

The paradox posed by Hari is whether we simply take the magic pills or do we try to regulate junk food, educate people in nutrition and lifestyle and find a long term solution to consumer society obsessed with instant pleasure and profit.

In conclusion, GLP-1 agonists are big business estimated by JP Morgan to be worth $7.6 billion in 2024 and $100 billion by 2030 with 30 million users. They are reversing the serious risks of diabetes and obesity. The benefits for those who choose to take them are life changing. The impact on healthcare costs will be significant. The food, beverage and healthcare sectors will suffer.

It is indeed an interesting dilemna. Your thoughts are welcome.