‘I can’t really explain it’: Ozempic works, so why is writer Johann Hari conflicted?

This story is a part of the April 27 edition of Good Weekend.See all 17 stories.

Johann Hari, 45, is a British writer. He’s written three bestselling books: Chasing the Scream, about addiction; Lost Connections, which investigates depression; and Stolen Focus, which explores the loss of deep focus and attention in modern life. Since early 2023, he’s been taking the weight-loss drug Ozempic; his book about weight-loss medications, Magic Pill, is published next month by Bloomsbury. I interviewed Hari via Zoom. He spoke from a book-lined room in his London flat at 11.30pm his time. He was clearly tired, but funny, charming – and slim.

You’ve just written a book about both the global phenomenon Ozempic, and your personal journey while taking it. Talk us through that decision; tell us your stats. My stats! I feel like a contestant in Miss World! I
remember the first time I ever heard about these drugs: it was late 2022, and I went to a party thrown by an Oscar-winning actor. I’d gained loads of weight in lockdown, but I thought “Oh well, all these Hollywood types are going to have gained loads of weight, too.” But when I arrived they all looked like their own Snapchat filters: cleaner and clearer and crisper – and thinner!

What about you? Well, I weighed 92 kilograms and my BMI [body mass index] was 30, so I’d passed through overweight and was [just] obese. It wasn’t the fattest I’d ever been, but I was obese. And at that party my friend explained to me about this new weight-loss drug – Ozempic – that causes an average 15 per cent loss in body weight within a year. And there’s now another one, Mounjaro, which causes 21 per cent, and an even newer one is coming next year, [nicknamed] Triple G, that causes 24 per cent, which is only just below bariatric surgery.

I have a terrible history of heart disease in my family – Dad, grandad, two uncles – so I could see all the benefits straight away. But I also thought, “Wait a minute, I’ve seen this film before.” Can you really get all those benefits without any cost? What about horrendous side effects? How will these drugs affect the body positivity movement? Eating disorders? I just immediately felt this kind of maelstrom of conflict. So when I decided to take Ozempic to lose weight, I also decided to write about it. I spent a year researching and interviewing people – and to be honest, I’m still almost as conflicted as I was at the start.

But you have lost weight. I have lost weight! Now I’m a bit more than 73 kilograms. And my BMI is 23. So I’ve gone from [obese] red through [overweight] orange into [healthy] green. I do feel physically better, and it’s lowered my risk of heart attack by 20 per cent, which is the clincher for me, along with – I’ll be honest – a bit of vanity.

That question of vanity is interesting. Did you get a sense of how many people are taking Ozempic, not for health reasons – not because they’re obese or overweight – but for, let’s call it vanity? It’s difficult to tell. I mean, those people at that party, none of them was obese! There are lots of people who are taking these drugs to be super skinny. I don’t want to shame or judge those people – they are victims of a culture that’s constantly telling all of us our bodies aren’t good enough. And I feel that, too. I mean, a few months after I started taking Ozempic, my neighbour’s really hot gardener hit on me: am I going to pretend to you that that wasn’t a great moment? No. It was one of my happiest moments taking the drug!

The worry I have is that [being too skinny] is really bad for your health. There are many things I’m unsure of, but one thing I’m confident of is if you are not overweight or obese, I beg you not to take these drugs. You’re incurring all the risks and none of the benefits.

So let’s talk about the benefits of taking Ozempic. What are they? Well, we know that if you have successful bariatric surgery, you’re 56 per cent less likely to die of a heart problem; 60 per cent less likely to die of cancer [some research suggests it’s closer to 50 per cent]; 92 per cent less likely to die of diabetes-related causes. In fact, it’s so good for your health to reverse obesity that you’re 40 per cent less likely to die of any cause at all. Now, obviously people having bariatric surgery are severely obese – someone who’s just a bit overweight would not have the same risks. [Basically, once you are overweight, as your weight goes up, your health risks go up.] And that’s really important to bear in mind. As one expert put it to me, we don’t know the long-term risks of Ozempic. We do know the long-term risks of obesity, and they are very serious.

So how have so many of us – two-thirds of Australians – ended up either overweight or obese, and facing these risks? Talk to me about what’s happened to Western diets in the past 40 years, and how we’ve ended up in a position where we need something like Ozempic. It does seem staggering. We have to start with just acknowledging how big the explosion in obesity has been. The year I was born, 1979, 6 per cent of British people were obese: now it’s 26 per cent. In the past 20-odd years, severe obesity has doubled in the world. That’s never happened in the history of the human species. I always think about this in relation to Australia. If you look at the footage of the beach when Harold Holt drowned – it’s on YouTube – it’s really weird: everyone is thin! It’s like, “Where was everyone else that day?” Then you realise, “Oh, that’s what everyone looked like then.” And that was in 1966 – not that long ago.

So how did this happen? One key change. In the past 40 years, we’ve begun eating food that would be completely unrecognisable to my Swiss farming grandparents. Not food that we grow or kill, in other words, but products manufactured in factories out of chemical components. Think of a strawberry milkshake: the strawberry flavouring alone contains 50 different chemicals, none of which comes from a strawberry. That’s what we’re eating: on average, 78 per cent of the calories American children eat every day come from ultra-processed foods.

Since starting Ozempic in 2023 Hari is almost 20 kilograms lighter.Credit: John Davis

What we now understand is that this new “food” undermines something called satiety: the feeling of having had enough. And these drugs give you back your sense of satiety. They contain an artificial version of a hormone called GLP-1, which our pancreas produces naturally to tell us we’re full. But whereas our natural GLP-1 washes away after a few minutes, the drug version lasts a week. So you’re just not hungry. I remember two days after I started taking Ozempic, I ordered my normal breakfast – a huge brown bap [bread roll] with lots of chicken and mayo – and I ate four bites. It was like the shutters had come down on my appetite.

And was only your appetite affected? You talk in the book about dizziness, nausea – and also low mood. Yeah. It’s slightly disconcerting interviewing the leading researchers in the world, and realising even they don’t really know quite how these drugs work. For instance, the science is now increasingly shifting to the idea that these drugs are not just affecting your gut, but predominantly your brain: changing your preferences; your reward centres. [And as well as that, from a psychological perspective], I realised how much heavy overeating was a way of comforting myself and managing my emotions. I would stuff myself when I didn’t feel good, or even just to kind of calm myself down. This is very common. But one of the things that happens when you take these drugs is you just can’t comfort eat.

Why not? What happens if you try? I can’t really explain it: I psychologically want to eat, but physically I don’t. And I could force myself, but I suspect I would vomit. So what are the psychological implications of that? Well, with bariatric surgery, your risk of committing suicide nearly quadruples. It remains low, but quadrupling, that’s a pretty big thing. And one thought is that [severely obese] patients believe – understandably – that their weight is the biggest problem in their life, and if only they sorted that out, everything would be great. But then, as one expert put it to me, you do lose all this weight – but you’ve still got the same arsehole as a husband and you’ve still got the same job you hate. So while your health is better, weight loss is not the magic panacea you imagined it would be. [Plus, you’ve lost a major coping strategy to deal with those things.]

When it comes to drugs like Ozempic, some credible scientists believe they may be contributing to suicide in a small, but not negligible, number of people. That’s why the [Food and Drug Administration] in the US requires a suicide warning on the labelling. It’s contested, and there’s a lot going on, but it’s something to be conscious of: whatever the problems in your life, and whatever your underlying psychological issues with food, they’re going to come to the surface with these drugs.

People do often ask the question in relation to Ozempic: why do we need to enter this world of unknown risks at all? What about good old-fashioned diet and exercise? Well, exactly. This really haunted me. But what diet research tells us is that in the long term, very few people manage to keep the weight off. And there’s a theory that this might be because your body has very powerful in-built drivers to defend weight gain. What experts think is that you are born with a natural healthy weight – your set point, if you like – that your body tries to keep you at. But if you put on 10 kilograms, your body adapts, and makes that heavier weight your new set point it tries to keep you at. Your metabolism slows down so you burn calories more slowly; you crave fatty and sugary foods; you feel more lethargic and don’t want to exercise.

This all happens because evolution has not prepared us for super abundance; evolution is about protecting us from famine. The fattest man at the start of the famine will be the last man standing, right? [Actor] Timothée Chalamet will die in week one, and me at my most KFC-loving will still be alive at the end. No disrespect to Timothée Chalamet – I hope he has a long, happy life. But I think that helps us to understand why diets so frequently and so profoundly fail.

One of my favourite parts of the book was when you tried to learn to cook, and discovered that a leek was not a Welsh myth, but a real thing … Oh yes! And an eggplant – not just an emoji that represents sexual arousal, but a physical object in nature! I was amazed. And I would like to tell you my cooking – and my healthy eating – has been a linear story of progress, and that now I’m going to be entering MasterChef, but it’s definitely not.

So you haven’t learned to cook – but you have been on Ozempic for just over a year. You can’t keep losing weight forever, surely? No, or the drugs would kill people! What seems to happen is it’s a pretty sharp line downwards, and then you plateau. So I’m not losing any more weight now: I’ve now stabilised at very slightly above 11.5 stone [73 kilograms]. And one very loose hypothesis – I want to stress that this is really just a very tentative theory suggested by a few people – is that these drugs restore your original set point.

Although, if, for whatever reason, you stop taking it, the evidence seems to show you put the weight back on. In that sense, it’s like every other diet in the world. Exactly. You slowly but surely regain the weight. And there’s also debate about whether people develop tolerance – which is basically where your body gets used to a drug, and you have to take higher and higher doses to get the same effect. And no one knows whether that will happen here. Diabetics have been taking these drugs now for 18 years. (Ozempic was originally developed to treat diabetes; its GLP-1 stimulates the secretion of insulin.) And they don’t need higher and higher doses.

That’s encouraging. But it might affect overweight and obese people differently to diabetics, right? Diabetics don’t produce enough insulin, and these drugs help produce it. But if you already have sufficient insulin, aren’t these drugs introducing even more into your system? And presumably there are other physiological differences between diabetic people and overweight or obese people, too? That sounds intuitively right. It’s one of the really disconcerting things about this: to loads and loads of the questions I asked, the answer was, “We don’t know.” It’s disconcerting to think, “God, this is an experiment on millions of people and I’m one of the guinea pigs.” And to keep looking at diabetics for a moment – in that group, Ozempic [may] cause an increased risk of thyroid cancer. Now the incidence of thyroid cancer is low, and there’s big debate about it, but that seems to me pretty shocking. But then some scientists would say, reasonably, “Well, compare that to the cancer risks from obesity.”

Let’s zoom back a bit. What did your research tell you about the future of these drugs? One of the leading cardiovascular experts in Britain is confident that in a few years from now, 30 per cent of people in Britain will be taking these drugs – 20 to 30 per cent. So this is about to blow up. Your readers might be thinking, “Well, I’m not going to take these drugs; I’m not interested in this.” But these drugs are going to change the world around you. Financial advisers are saying that airlines in the US are going to spend significantly less money on jet fuel quite soon, because it takes less jet fuel to fly a thinner population; jewellers in the US are getting [more business] because people’s fingers are shrinking because they’re losing weight in their hands. Who would’ve thought of that? It’s like having this conversation the day Steve Jobs launched the iPhone in 2007: we just can’t imagine the ways it’s going to change the future.

Okay. But take a guess! Right! Well, one of the reasons I called the book Magic Pill is that it feels like there are three ways in which Ozempic [and other drugs like it] could be a magic pill. The first way is it could just be something that solves a problem really quickly and easily. There were days when I took these drugs, when it really did feel like magic. I was like, “Wow, all my life I’ve stuffed my face and now once a week I do a little jab into my right leg and I don’t want to do that anymore.” That felt like magic. The second way is it could be a magic trick in a much more negative sense: it could be an actual trick, like a contra illusion, which appears to give you something, but it’s actually taking away more than it gives. Someone who picks your pocket while he shows you a card trick, right? Or, finally – and I suspect most likely – it could be the kind of magic we read about in classic stories: Aladdin, Fantasia. What happens? You get what you wished for, but you don’t get it in quite the way you imagined. You unleash this force and it becomes something beyond your control that has all sorts of effects you never saw coming.

One final thing? I really enjoyed Magic Pill … Oh! Thank you!

And part of the reason was because of your personal involvement in the story. But did you have any qualms about telling your own story in this context? Unveiling yourself in this way? Oh yeah. It felt humiliating. It felt exposing. I mean, I had written about personal things, the addiction in my family, depression. Those are quite intimate things, but this felt much more…

Like you were going to be judged? You’ve had a lot of career dramas. [Hari was an award-winning journalist in London with The Independent newspaper until 2011, when he was suspended for plagiarising quotes in his stories and maliciously altering the Wikipedia pages of colleagues. He later apologised and resigned from The Independent.] You’ve been judged and been in the public eye over a lot of stuff in your career. But this felt different? It felt like, I suppose, I was describing something that has not felt entirely under my control: my eating. But I don’t really know why that feels more exposing. I’m conscious that this is a topic which for so many people brings so much pain and shame and humiliation. And I really don’t want to reawaken those feelings for people. But it’s not like addiction and depression are not subjects on which people are sensitive and have a lot of pain, too. So maybe that’s not a full answer either.

I wondered if it was something to do with the ambivalence about Ozempic and similar drugs: the uncertainty. We actually don’t know what the right answer is – and that’s hard. Especially it’s hard for journalists. We like to come to a conclusion that feels true and incontrovertible. Yeah, I think that’s interesting. That might be true. Because what I couldn’t truthfully do was do the thinking for the reader. I couldn’t really skip to the conclusion like in a lot of social science books and go “Now, dear reader, do the following three things.” You can’t really do that with this. It’s much more the case that we have really got to go down the list of the benefits and risks, and we’ve got to weigh them for ourselves.

This conversation was edited for length and clarity.

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