I came upon Johann Hari’s book on semaglutides, Magic Pill, via an interview he did with on Radio National with Phillip Adams. I had not read any of Hari’s books before nor heard him speak. After listening to George Chidi share his journey on the Guardian podcast, I was intrigued in a book that balanced between the personal reflections of taking Ozempic, as well as an investigation into what semaglutides are and what they might mean for society.

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In the introduction, Hari posits that there are three types of possible forms of magic made possible by the new semaglutide drugs, like Ozempic:

1. They could be the solution to obesity issues.
2. They could serve as an unintended illusion.
3. They could have effects we could never have imagined at the start.

Throughout the book, he sets out to explore what sort of future we have entered into.

Hari begins by exploring the origins of these new drugs. He examines the way in which the hormone GLP-1 boosts satiety, the sensation of feeling full.

Satiety (/səˈtaɪ.ə.ti/ sə-TYE-ə-tee) is a state or condition of fullness gratified beyond the point of satisfaction, the opposite of hunger “Hunger (physiology)”). Following satiation (meal termination), satiety is a feeling of fullness lasting until the next meal.[1] When food is present in the GI tract after a meal, satiety signals overrule hunger signals, but satiety slowly fades as hunger increases.

Source: Satiety – Wikipedia

The problem is that in its natural form the hormone is short lived in our bodies and would require people to inject themselves several times a day. Inspired in part by the lasting effects of lizard venom of the Gila monster, scientists developed a copy of the hormone which instead remained in the body for longer and meant that users would only need to inject themselves once a week.

The problem found is that although people often see a significant lose in weight, they often put two-thirds back on after going off the drug, returning to the bodies pre-defined default. In addition to this, there are many strange side effects associated with being on the drug, such as constipation, burping and nausea.

[Carel Le Roux] likes to say that there are two kinds of drugs: drugs that don’t work, and drugs that have side effects. You become constipated because the surge of GLP-1 slows down your gut and its emptying. The food and waste sit inside you longer and find it harder to get out. Similarly, you burp because “the valve that sits at the bottom of the stomach doesn’t open as quickly. The air must go somewhere, so instead of it going down into the small intestine, people start burping.” You become nauseous because the drug creates a sensation of extreme satiety—that you are full and can’t eat any more. The human brain struggles to distinguish between extreme satiety and sickness: the two signals get easily mixed up, which is why, even for people who aren’t taking these drugs, after a really big meal you often feel a little nauseous.

Source: Magic Pills: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs by Johann Hari

Although semaglutides may serve as a possible solution to obesity, the question that remains is how and why we even got into the predicament we are in. Reflecting upon the competing cultures of his upbringing, sandwiched between his healthy eating Swiss father and fast-food loving Scottish mother, Hari examines the way these two diets have changed over the years. Over time, the high sugar and fat diet associated with the processed food coming out on top in the West. The problem with this is that the copious amounts of chemicals and additives used to sustain such a life-style meant that ‘food’ is not really food at all. (This reminded me of Jamie Oliver’s demonstration of how chicken nuggets are made using the whole chicken.)

The problem that we face is that processed food industry and the weight loss drugs are both responding to the same thing, satiety. Hari explains how processed food undermines satiety in seven ways:

1. You chew it less.
2. The unique combination of sugar, fat, and carbs seems to activate something primal and we go crazy for it.
3. It affects your energy levels differently.
4. It lacks protein and fiber.
5. Processed drinks contain chemicals that may be actively triggering us to be more hungry.
6. Flavor is separated from the quality of the food.
7. It seem to cause our gut to malfunction.

Interestingly, this change to food begins from the start of the food chain, with big agriculture is doing to animals what the processed food industry is doing to us.

Thirty years ago, it took twelve weeks for a factory-farmed chicken to reach its slaughter weight, but now it only takes five to six weeks. Broiler chickens are three times higher in fat today than they were when I was born, and the standard factory-farmed turkey now has such an obese chest that it can barely stand up.
So how did they do it? It turns out it was partly by restricting the animals’ movement—lots of them can’t even turn around in their cages. But even more importantly, they totally transformed their diets. If you feed a cow the whole food it evolved to eat—grass—it will take a year longer to reach its slaughter weight than if you feed it something different: a newly invented kind of ultra-processed feed, made up of grains, chemicals, hormones, and antibiotics. Because the animals don’t like the taste of this fake food, the agricultural corporations often add artificial sweetness to it—Jell-O powder is popular, especially with a strawberry-banana flavoring. When you mix a sweet-tasting formula like this into their processed food, lambs will rapidly add 30 percent to their body weight.

Source: Magic Pills: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs by Johann Hari

With this all in mind, Hari suggests that semaglutides can be considered as an artificial solution to an artificial problem. The problem though is that although obesity maybe in part a cultural creation, the consequences are still real. They include an increased risk of diabetes, heart issues, joint problems and inflammation. Benefits therefore are simple, reverse obesity, reverse the health harms.

There are clear benefits with weight loss, but there is also a long history of similar such solutions in the past, each with their own issues. These include Redusols, ‘mother’s little helper’ amphetamines, sleeping pills (you can’t eat if you are not awake?), wiring the jaw and Fen-phen. Although each of these solutions demonstrated the ability to help with weight loss, they all came with their own significant drawbacks. With semaglutides, Hari summarises twelve possible risks:

1. Saggy face.
2. Saggy buttocks.
3. Increased risk of Tyroid cancer.
4. Nine times more likely to get pancreatitis.
5. Stomach paralysis where your digestive system slows down and your body struggles to move food from your stomach to your small intestine.
6. Potential lose of lean muscle mass.
7. Malnutrition.
8. Unable to purchase the drug.
9. Purchasing an off-brand knockoff version.
10. Unknown unknowns. For example, it took years a lifetime to discover the long term trends of anti-psychotics and the long term trends.
11. Anhedonia and the potential of self-harm.
12. Eating disorders and the supercharging of starvation.

As an alternative to the risks associated with drugs, Hari also examines less intrusive responses. The sad reality is that research has found that exercise rarely causes sustained weight loss.

“You can’t run off a bad diet.”

Source: Magic Pills: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs by Johann Hari

While the long term benefits of dieting is approximately 10kg. One of the reasons for the limited returns is that obesity is often a complex problem. Hari uses the bio-psycho-social model to examine some of the different factors at play. For example, some use food to solve the problem of a bad day, some stuff themselves based on poor development, or use obesity as a way of controlling the world around them and how people see them. It has been found that with bariatric surgery, another common weight loss treatment, the addiction with food can transfer to other things or produce an increase in anxiety, as such surgery does not solve any psychological problems. The challenge though is that at the end of day in an ‘obesogenic environment’, the odds are always stacked against individual willpower.

Rather than think this or that, the solution maybe instead multifaceted. Instead of seeing semaglutides as the sole solution, maybe they are simply part of a wider solution to a healthier life? Often those who are obese struggle to exercise, therefore the benefits gained from using semaglutides offer a kickstart to a wider set of changes for a healthier life. This includes appreciating our bodies for what they can do, as well as exploring ways that we can be better.

We have two tasks ahead of us—to learn to love our bodies however they are, and to learn to make our bodies as healthy and functional as we can.

Source: Magic Pills: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs by Johann Hari

In contrast to all this, Hari investigates Japanese culture and why they do not necessarily need semaglutides. From the perspective of food, he shares the following lessons he learnt:

1. Each meal should have “five tastes, five skills, and five colors.”
2. Meals should be eaten in a triangular manner, where you take small bits of the different parts, rather than eating sequentially.
3. Combine the different ingredients in your mouth as a way of enjoying the different tastes and textures.
4. Stop at 80 percent, so you are never full.

This eating practice is supported from the ground on up, with schools hiring chefs who prepare nutritious meals for staff and students each day, as well as in the supermarkets, where the shelves are predominantly lined with fresh produce.

In addition to eating, Metabo Law enforces workplaces to weigh and measure staff once a year and work with them to develop a health plan if they have gone up. Associated with this, companies often put in place different strategies, such as measuring steps, doing collective exercise together or sharing meals they are eating, as a way of fostering a healthy workforce.

In conclusion, Hari proposes five scenarios moving forward with the semaglutides revolution:

1. Semaglutides are fen-phen Mark 2, where we a signficant heatlth risk is uncovered that we were not aware of.
2. Semaglutides become like chemical antidepressants where the initial effect fades in time.
3. Semaglutides become like statins which provide an ongoing benefit to elites who can afford them.
4. Semaglutides are like statins and that they become freely available to anyone who needs them.
5. Semaglutides provide a kickstart to wider cultural reset as to how we got into this situation and what a better future might look like.

As Hari elaborates:

There’s a fifth scenario—the most optimistic. It’s that many of us start to take these drugs, and experience significant weight loss, and see our health improve—and it wakes us up to ask: How did we get into this situation in the first place? How did we end up with a food system so dysfunctional that we need to engage in a program of mass drugging to protect us from it? Do we want our kids to have to drug themselves in this way?

Source: Magic Pills: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs by Johann Hari

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I entered Magic Pill intrigued to find out more about Ozempic. However, this book is as much about obesity as it is about semaglutides being used to counter this problem. Previously, I had thoughts that we would all end up on these drugs at some point in the same way that we will eventually take drugs to fix degenerative knee injuries. However, this book now has me thinking that such ‘magic’ is never simple and always comes at a cost. As Carel Le Roux suggests, there are “drugs that don’t work, and drugs that have side effects.” 

I was particularly left perplexed by the world the Hari captured, one filled with buckets of fried chicken and cafe meals. I was left wondering what happens when you may already cook your own food? Don’t drink soft drinks? Drink black coffee? Do intermittent fasting? And you don’t eat KFC every day, if at all? (Personally, I feel that the Thermomix has been the best investment with respect to this.) Clearly my doctor’s advice to get off the station before my stop is possibly naïve?

I remember when I started drinking meal supplement shakes at work, a colleague who I was close with commented that even after months of drinking them that there was no visible sign of change, no magical weight loss. However, after reading Hari’s book, I wonder if there was something more to the story? I wonder if there are benefits beyond the cosmetic? Benefits to health? As a friend of Hari’s critiqued:

“If you were worried primarily about health, you would be talking to me about exercise and writing a book about that,” she said. “Exercise doesn’t lead to much weight loss, but my God, it leads to increased health, across the board. But you’ve barely mentioned exercise. Because it won’t make you more conventionally hot. So you talk about drugs, not exercise.”

Source: Magic Pills: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs by Johann Hari

I also wonder if the ease of shakes is as much of a problem in that it strips us of the enjoyment of eating? In part, I had turned to them as a means of having to organise one less lunch the night before. Although it does not have the same high fat and sugar make-up, it is still a part of the easily consumable processed food revolution, right?

It also had me thinking again about Norman Swan’s assertion that Coronavirus was largely a ‘political pandemic’. I wonder then if the same could be said about obesity? This definitely has me seeing discussions of food advertising in a new light.

The Australian government has been investigating whether we should ban unhealthy food advertising online, and how it could work. In the United Kingdom, a ban on unhealthy food and drink advertising online will start in October 2025.

Source: Junk food is promoted online to appeal to kids and target young men, our study shows by Christine Parker and Tanita Northcott

All in all, it was an interesting book and proposed as many questions for me as it did clarity. I guess it is best to say, it’s complicated.

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