By Soma Das
Rarely in history does a medicine become a hot cake. The latest generation of weight-loss drugs—the likes of Wegovy, Ozempic and Maunjaro from the stables of Novo Nordisk and from Eli Lilly, two pharma majors—has attained that cult status, thanks to the obesity epidemic sweeping across the globe, the effectiveness of the jabs in reducing appetite and shedding kilos, and a supply-crunch.
In a brilliant page-turner anti-obesity epic Magic Pill, journalist and author Johann Hari delves deeper into the science, business, psychology, and philosophy of anti-obesity drugs and obesity as a phenomenon. Weight-loss drugs have been the reason Barclays Bank has urged investors to keep off the snacks markets; stocks of processed food companies like Krispy Crème have tanked; Morgan Stanley predicts that the booze market will shrink; experts foresee companies selling hips and knee replacement devices losing value; Jefferies Financial sees airlines saving millions as they fly slimmer people and burn less fuel; jewellers are seeing wedding ring sizes going down.
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No wonder weight-loss drugs have been dubbed by some as the ‘holy-grail’ with impact only comparable to that of smartphones. Nearly half of Americans are willing to take these drugs, and a third of British will be on them in the next decade.
Hari embeds himself into the context, starts injecting Ozempic for losing weight, and parallelly dives into research on questions like why do we need these drugs in the first place; what’s the connection between processed food and anti-obesity drugs; risks of being obese versus taking drugs; what’s the track record of earlier weight-loss drugs and risk profile of latest ones; why exercise and diet may not be solutions for obesity; the body is losing weight but what are weight-loss drugs doing to your mind; the curious case of the only country which doesn’t need these drugs, among others.
As Hari turns into a subject, and loses his appetite, he speaks to the scientists who discovered the drug. Here the heroes of the story, the tiny gut hormones (GLP 1, GIP, Glucagon) that regulate our hunger, make a special appearance. GLP 1 spikes after we eat, a natural signal asking us to stop eating. Pharma companies used lizard venom and other copies of gut hormones to make drugs that artificially induce the feeling of being full. But it’s a drug you must keep taking for life to work, and in author and others, despite the effortless weight-loss, it did leave behind side effects like nausea, and ‘not so happy’ feeling nudging him to ask— why did I get so fat? Why did we as a culture get so fat in such a short time?
Obesity was rare before 1979. Between 1979-2020, the share of obese people in the US doubled, and WHO estimates that since 1975, obesity has tripled globally. The change was quick enough to be shocking, and slow enough for us not to fight back.
In these years, food companies have worked to flood us with chemical concoctions where scientists worked on ‘bliss points’—moments where a sugar kick and wildly exciting after-taste leaves us craving for more. This world of sugary, fatty, processed food, Hari calls ‘The Cheesecake Park’, surrounds us where it is hard to stop eating, and a food ingredient could mean a chemical used in your ‘fly-spray’. He turns the narrative into a war between food factories vs home kitchen, processed junk food vs fresh vegetable, food manufacturing vs cooking, in which the former has defeated the latter. With a disarming sense of humour, the author fits in his parents’ wedding tale, as a culinary battle to suggest that his dad, who represented growing fresh food, loses to his mom, who chose junk food for convenience.
The food industry has redesigned food that has killed our natural instinct of ‘satiety’—stopping cue for eating. This ultra-processed food needs less chewing, killing the brake on overeating; is a heady combo of sugar, fat, carbs that reminds us of breast milk, and gets us hooked; causes energy spikes and crashes and lacks protein and fibre triggering more hunger; has separated flavour from underlying quality of food wrecking our GPS—the nutritional wisdom we had inbuilt to decipher that sweetness meant fruit. Our guts are malfunctioning, our animals mass-fattened, and if ultra-processed food was a drug, it would be off-market, an expert says in the book. What the food industry has taken from us in the last four decades, the weight-loss drugs are promising to give us back artificially—the satiety.
The author explores how earlier generations of weight-loss drugs have proved to be dangerous and had to be banned after they caused severe health issues. This generation of drugs, though appear safer on surface, are fraught with potential risks too. For some, it has caused faces and buttocks to sag, some drug regulators are monitoring them for potentially causing thyroid cancer. There is a higher risk of pancreatitis, a danger of losing muscle-mass and malnutrition. And then there may be unknown risks for taking it long-term yet to surface. The author also shares the grim findings on research around diet and exercise, which he finds are good for health but not great for weight-loss. What exercise-diet fail to achieve, a culture can. Japan is the only country that got rich without getting fat. Japanese food culture is about simplicity, natural ingredients and mindful eating. Even children and policies are geared towards junking processed food. Interestingly, this culture isn’t ancient and has been cultivated consciously only since 1920s—giving hope that other countries can emulate this too.
Through his Ozempic journey, Hari discovers feeling ‘emotionally dulled’ after the jabs, and launches into discovering what the drug is doing to the mind? Even as initial findings seem to indicate that the drug may be curbing desire for booze and smoke, making it a potential anti-addiction drug candidate for compulsive behaviour from gambling to pornography, drug regulators are disturbingly probing whether these drugs are causing suicidal thoughts in some. The narrative digs out that for many overeating is a psychological coping mechanism, such as many sexually abused individuals gain weight to protect themselves from predators, and raises questions—what will these drugs do to body-images, eating disorders patients and what if they eventually stop working?
Hari is a master-storyteller who treats an urgent subject with outstanding wit, making complex research not only accessible but a compelling read. He fuses personal histories with research so effortlessly, that the narrative is at once intimate and objective. This knack of being emotional and yet unbiased about his subject will likely catapult him into one of the most readable non-fiction authors of our time, who can simplify research for the mainstream readers. If you discount a technical crib that the Magic Pill is actually an injection, not a pill, the book is knowledge packed, relevant, and entertaining. It is, in fact, such a pacy, and addictive read that you may need a jab of Ozempic to kill the appetite to go on binge-reading.
Soma Das is the author of ‘The Reluctant Billionaire’ and an adviser to agencies in the development space.