‘India has a tradition of eating fresh foods, so a reset is far easier’: Author Johann Hari

Look at diet before Ozempic, says British-Swiss author Johann Hari, who champions the need for right food choices before opting for weight loss drugs

British-Swiss author Johann Hari book suggests that obesity has nearly tripled globally since 1975 (Credit: Kathrin Baumbach)

When British-Swiss author Johann Hari gained weight during Covid lockdown, he was surprised by the noticeably gaunt people he met at a Hollywood party in the winter of 2022. He wondered if everybody had taken up Pilates while he continued to be slothful. “They seemed to have altered themselves on Snapchat. Then a friend told me all about the Ozempic pen (a semaglutide injection that mimics a hormone, called glucagon-like peptide1or GLP1, which stimulates the pancreas to produce more insulin, in turn lowering blood sugar, and reducing hunger by slowing digestion). This blockbuster weight loss drug has taken the world by storm and has become a potent tool for managing obesity and diabetes.

“With the latest drugs reducing your existing body weight by 15-21 per cent and the new drugs next year expected to reduce it further by up to 24 per cent, it seemed like a magic pill indeed,” says Hari. Yet, having seen earlier miracle weight loss drugs, leaving a trail of broken people battling side effects, he was conflicted. After researching about it across continents and talking to experts, he realised that at the moment, the benefits outflanked the risks for somebody like him who was obese. “My body mass index (BMI) was 30. In our heads, we don’t think we are as fat but given my family history of the men dying of heart attacks and my dad surviving with a quadruple bypass, I was exposed to co-morbidities. There’s enough evidence that obesity worsens over 200 diseases, including dementia, heart disease, cancer and stroke. I could see the implications and took the shot,” says Hari, who dropped from 90 kg to 73 kg in a year. He has documented his experiences in a new book titled, The Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs (Crown). In it, he questions if there are ways to avoid getting to the drug phase at all by reimagining the way we think about food. Excerpts:

In your book, you talk about wrong food choices that lead to weight gain.

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What we eat is the most crucial part of the weight loss puzzle because food controls our brain. Drugs are just an artificial solution to an artificial problem. Why become obese in the first place? Paul Kennyhead, Chair of Neurosciences at Mt Sinai, New York, did an experiment with lab rats, who were first given healthy food. Using natural nutritional wisdom, they would stop when full. But when fed on fatty and carb-rich cheesecake and Snickers, they ate and ate and ate. Within a few days, they became obese as manufactured foods had changed their body conditioning.

However, when they were taken off junk food and given healthy food, they shunned it with such severity that they went back to having it only when they were driven to the point of starvation. Something about the food we are eating daily is undermining our ability to know when to stop. That explains the WHO data, saying obesity had nearly tripled globally since 1975. This has never happened before in the 300,000-year history of our species. The weight loss drug Ozempic gave me back some sense of satiety… I can now have four mouthfuls of my favourite food and feel full.

India is also battling a rising lifestyle-induced obesity. Can it reverse the tide?

Most Indians are not in the weight trap yet. And India is taking some policy decisions like eliminating trans fats. We know processed and ultra-processed foods trigger weight gain and India has a tradition of eating freshly-prepared, whole foods and seasonal produce. So a reset for you is far easier before dependency creeps in. If you are obese at the age of 18, you have a 70 per cent chance of developing diabetes during a lifetime.

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The book asks readers to reimagine the way we think about food

Based on your research, what is your assessment about the safety of these weight loss drugs like Ozempic and WeGovy?

The drug could be magic in three ways. One, when it solves the problem quickly and effectively. My whole life I have had junk food and now I know a weekly injection in the leg can keep me away from it. Second, it is like a card trick, so you do not see what goes on behind. Third, you ask the genie for a wish and you never get it the way you want… The conveniences are huge but then we are seeing risks of addictive behaviour. Scientists say there is a good reason to be assured of safety of this class of drugs considering they have been used by diabetics to control blood glucose for the last eight years and short to medium effects would have showed up among them.

But Jean-Luc Faillie, of the University of Montpellie, France, who was asked by French medical agencies to look into drug safety, found that mice fed on these drugs had increased their existing risk of developing thyroid cancer by 50 to 70 per cent. This means a higher chance of whatever chance you already have. Then people said that only 1.2 per cent of people get thyroid cancer anyway. But the results show a big increase in a small risk. Now weigh it with Cancer Research UK’s warning on how excess weight means more fat cells. These are not inert and send signals to cells to multiply faster. That’s why obesity is the biggest cause of cancer in the developed world. So you have to measure comparative risks and benefits.

As Dr Shauna Levy of the Tulane School of Medicine told me, we don’t know the effects of these drugs but we do know the effects of obesity. If you are overweight to the extent that exercise isn’t working, you need help. Similarly, if you are using these to be just skinny, then you are taking risks, which will need another five years to understand, with none of the health benefits. I would say it’s better not to use it unless your BMI is really high.

What about tolerance to Ozempic?

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We do know that diabetics do not develop a tolerance to it, which means you don’t need a higher dose. I would compare it with bariatric surgery. Your weight could go up but you would still be lower than average.