189. The Psychology of Ozempic, Obesity, and Weight Loss feat. Johann Hari

May 8

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Today's guest is Johann Hari—a British-Swiss writer and journalist who has written three New York Times best-selling books and is set to release his forthcoming book, Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs, on May 7th. He has also served as the Executive Producer of an Oscar-nominated movie and an eight-part TV series starring Samuel L. Jackson, delivered TED talks that have been viewed more than 93 million times, and has written for some of the world’s leading newspapers and magazines, including the New York Times.

In this episode, we discuss:

+ Why Johann wanted to investigate weight-loss drugs like Ozempic

+ The physical & psychological effects he experienced after taking Ozempic

+ The five unexpected reasons why we eat & how these change with weight-loss drugs

+ Research on the connection between trauma & weight gain

+ How weight-loss drugs curb hunger & activate addiction areas in the brain

+ The reason why exercise programs can actually lead to weight gain for people

+ Why evolution has made it difficult for humans to lose weight

+ The consequences of normalizing weight-loss drug use on teenage body image

+ The impacts of celebrities such as Oprah speaking up about weight-loss drugs

+ Debates surrounding kids & teens being prescribed weight-loss drugs

+ Differences in nutritional standards for kids across the world

+ The predicted impact that weight-loss drugs will have on the economy

+ What Johann wishes people knew about mental health

+ so much more!

Johann's Instagram: https://www.instagram.com/johann.hari

Mentioned In The Episode…

+ Johann's new book

+ Johann's website

+ Lost Connections

SHOP GUEST RECOMMENDATIONS: https://amzn.to/3A69GOC

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About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted is the Teen Mental Health Podcast made for teenagers by a teen. In each episode, I'll bring you authentic, accessible, and relatable conversations about every aspect of mental wellness.

You can expect evidence-based, teen approved resources, coping skills, including lots of D B T insights and education in. Each piece of content you consume, she persisted, Offers you a safe space to feel validated and understood in your struggle, while encouraging you to take ownership of your journey and build your life worth living.

So let's dive in this week on She persisted.

Johann: let's say my weight goes up.

As my weight goes up, my body takes my highest weight as my new biological set point, and it will fight very hard to keep me at that higher weight. With all sorts of mechanisms.

It slows down your metabolism. It makes you crave more sugary foods. It makes you feel more lethargic. So you don't want to exercise as much all sorts of biological changes kick in to stop your weight dipping. And first when I learned that, I kept saying, well how could that be?

Why would our evolution endow us with something that's so harmful to our health, and lots of scientists explained it to me.

Hello, hello, you guys. Welcome back to She Persisted. Happy Tuesday is likely when this has gone live. We are late this week because I was out of town this weekend for work. I went on my first ever business trip. I went to Dear Media Live. And we got to meet up with a bunch of clients and it was really fun to just be in the podcast space and meet a ton of people that I've listened to or followed since almost the beginning of She Persisted, which was incredible.

And it's also finals week, so things are so busy. So Everything is going all over the place, But I've had this episode in the content bank for a while now. It's one of my favorite interviews that I've ever done.

And I'm just so incredibly excited for you guys to listen to this conversation. If you have been in the She Persisted world for a while at this point, then maybe you know I was a production assistant for Alexis Nyers. Her podcast is called Recovering from Reality. And it's a really great podcast, talking all about mental health and addiction and she touches on spirituality and relationships and she was the first person I ever worked in the podcast space with outside of She Persisted. She was the first person to hire me and take a chance on me and let me use these skills that I'd gained from running She Persisted alone, and since then done so many things in the podcast space. We're kind of going on a tangent here, but all this to say, she is a huge fan of Yohanari and his books and his work as a whole and she just raved about the book Lost Connections. And I remember reading it and just immediately it became one of my favorite books that I'd read within the mental health space. It's all about depression and anxiety and all of the different causes that come into play here, whether it is having a sense of purpose, feeling disconnected, being in touch with your values, trauma, feeling respected, being in touch with the natural world, having a sense of hope, and chemical genetics and brain changes. This was a book that I absolutely highlighted almost every single page.

Still one of my favorite books to this day that I am constantly recommending if you're interested in depression and anxiety. All this to say, I have been pitching Johan since I read this book, and I've been a huge fan of his work, and I'm just so excited to have him on the podcast. And when I pitched him, he said that he was actually coming out with a new book, which, as you're listening to this, you can go and buy Magic Pill. I was so excited to pick a sprain about this book, discuss all of the mental health implications, and then also touch a little bit on his work from Lost Connections. So if you're not familiar with Johan Hari, he is a writer and journalist.

He's written three New York Times bestselling books and his new book, Magic Pill, is out as of today.

His TED Talks have been viewed over 93 million times and he's written for some of the world's leading newspapers and magazines, including the New York Times. This was such a fun episode and really a hot topic that we've briefly touched on on the podcast before because if you're on social media and if you're anywhere within like the body image, self confidence, self esteem space, you've definitely heard people giving their hot takes on ozempic and weight loss medications and how that impacts the body image space. And so I was really impressed with how nuanced of an approach Johan took when writing this book and how many different mental health aspects he explored. And it was really incredible to unpack that a little bit more and hopefully you guys will get kind of a good understanding of his perspective on this and kind of our two cents on this whole conversation.

So we talked about first and foremost Why he was interested in researching and investigating GLP 1s such as ozempic or semaglutide. We talked about both the physical and psychological effects that he experienced after personally taking them.

We talk about the psychology of eating, which I have never talked about on the podcast before, but it's really interesting, when we talk about disordered eating and body image and the role and purpose that food plays in our life. And so I loved getting his thoughts on this. I think you guys will enjoy that as well.

We talked about how weight loss and weight gain can be correlated with trauma. We talk about how GLP 1s are connected to areas in the brain that are connected with addiction and what that new research is looking like with potentially using GLP 1s to help with addiction and curbing those symptoms, which is super fascinating.

We talk about one of the hottest topics in this area of discussion, which is what happens when we normalize weight loss drugs, and what that does to teenage body image, and also the positive and negatives of individuals Being open and being like, this is my experience, like Oprah talking about, her own personal experience.

And then as we recorded this episode, Oprah had done her special , and she actually interviewed a teenager who had taken GLP one. So we kind of talk about what the implications are there, pros and cons, et cetera. And then just wrapping up his predictions for how this will impact the medical field as a whole, and then some general mental health tips because he's done so much work and research in this space. So, one of my favorite interviews, again, that I've done. He is incredible, hilarious. I know you're going to love this interview as much as I did, and I'm sorry for the really long intro.

I just had so much to say and so much to tell you. But with that, let's dive into it.

Sadie: Well, thank you so much for joining me today, Johan. I'm so, so, so excited to have you on the podcast and talk about your new book. I'm such a huge fan of your work and I can't wait to pick your brain about all of the different areas that you've studied, , and all of your books.

Johann: I'm so happy to be with you. I'm also very impressed that your bedroom is so tidy. I can see it behind you. So I only realized how untidy I am when I see other people's bedrooms. I'm like, Oh my God, I'm a pig. So yeah, I'm very impressed by the tidiness of it. It's the dorm room life. If it wasn't like Riverside doesn't zoom, like blur the background.

Sadie: So I'm like, it has to make the bed, it has to look nice behind me. But yeah, such a situation. I wanted to start with the background of your most recent book, Magic Pill, and talk a little bit about the psychology of eating and obesity, because you've Did a lot of research on this, which I had never heard before.

And I think it's so much helpful context for individuals that struggle with their weight or body image. I remember in an abnormal psychology class, , my professor said something like the reason why eating disorders are so challenging for people to stay in that state of anorexia is that you're fighting against your body.

Like your body's drive is to eat and you're doing everything possible to go against those, like. Basic urges and I remember hearing that being like that makes so much sense And I I think a lot of mental health challenges when you understand the research and the science and why we do these things It gives people a lot of freedom and there's less unknown, but I wanted to start with kind of explaining Why we eat you talked about some really interesting psychological reasons whether you'll dive into it But how it protects us how it relates to parenting styles, but I would love to kind of Get your thoughts on that because I've never heard that perspective before and obviously goes hand in hand with the rest of your book.

Johann: Yeah, I mean This is a topic that massively surfaces when you start to take these drugs So for the minute I heard about these new weight loss drugs, like Izempic, Monjano, Wigovi and so on. I remember feeling intensely conflicted Because you know, I'm someone whose weight has yo yoed all my life from being underweight to being obese I knew that on average, although there are of course exceptions, obesity generally can cause very significant harm to health.

So obviously something that reverses that would be a good thing. But I was also aware, you know, every diet drug up to now has been announced as a miracle drug and that has to be withdrawn because it has some horrific effect that emerges down the line. I was very worried about what this might do to body positivity, to people with eating disorders, or a whole range reasons I could see for it and reasons I could see against it.

So I spent a whole year taking these drugs and traveling all over the world to investigate, you know, really interview the, the leading experts, the biggest critics, the biggest supporters. And at the end of all that, I'm still really conflicted. If I'm honest, I know a lot more. I know a lot about more about the benefits and the risks, but anyone who tells you this is a simple story, either that it's simply good or simply bad, I think is, is, , Not leveling with you or not being honest about what the facts are.

And I think this is particularly true about one of the whole sets of effects in relation to these drugs that I kind of didn't see coming. Which is the psychological effects of taking these drugs, right? and there are really significant psychological effects. So, I mean for me, I remember for the first six months or so, I was having this enormous loss of weight.

And I was getting what I wanted, right, that's why I took it. Partly to improve my health, you know, I'm older than my grandfather ever got to be, because he died of a heart attack. My dad had heart problems, my uncle had heart problems. In fact, my uncle died of them. But also I wanted to, you know, feel fitter and, and I was getting what I wanted.

And if I'm honest, I, I felt quite emotionally muted, Sadie. I don't want to overstate it, I wasn't depressed, but It was a bit weird. I didn't quite understand why I felt sort of dulled. And I started looking into the research about how food makes us feel and why we eat right. And I learned that there's scientific evidence for five reasons why we eat.

, the first and most obvious one is, you know, to sustain your body. Right. And if you'd asked me when I started doing the research for magic pill, you know, why do you eat? I would have looked at you like you're an idiot. I would say, well, obviously I eat to keep my body going. Right. But here we are, you know, more than a year later.

And You know, I used to eat 3, 200 calories a day, roughly. I now eat about 1, 800 and my body is being sustained. In fact, it's significantly healthier than it was. So, That's a whole lot of calories that we're doing something else than sustain my body, right? And, , of course one of the reasons we eat is for pleasure.

We know that these drugs diminish pleasure in food for a lot of people. Didn't do that to me, I can explain why, but for a lot of people they do. But one other reason we eat, and we can go into depth on some of the other psychological reasons if you like, but one key reason is very simple. We eat to comfort ourselves and to manage our emotions.

Right? And there's a huge amount of evidence for this. 32 percent of women and 18 percent of men say they eat when they feel stressed to soothe and calm themselves. There's loads of evidence for this. Whenever there's a traumatic event, sales of shitty junk food massively increase. After 9 11, the night Donald Trump won, sales of shitty junk food went up much more in blue states than red states, right?

We, massive increase in the sales of tacos in Los Angeles, for example. So we respond to stress. You know, the way one person put it in a scientific study was, food soothes me like a baby, like, like it soothes a baby, right? And one of the things that happens when you take these drugs is that you, you can't come for eat, right?

So I remember one day I was in Vegas where I spent a lot of my time and it was, about six months after I started taking, , a Zen pic and I had a bad day. , and I went to almost literally an autopilot. I went to this skeezy branch of KFC in Vegas that used to go to a lot. And, , I gave my standard order, which is so disgusting.

I won't repeat it. And it was in front of me and I just couldn't eat it. Right. I had like a few mouthfuls, but I just couldn't eat it. And I remember thinking, Oh, You're just going to have to feel your feelings, right? And it was, I remember Colonel Saunders was on the wall like he was in all KFCs and he was looking down at me and it was like he was saying, Hey buddy, what happened to my best customer, right?

So, one of the really interesting psychological effects of these drugs is that when you're eating patterns are radically disrupted, which these drugs will do for most people, for better and for worse, when you're eating patterns are disrupted, You begin to see the underlying psychological reasons why you were eating the way you did all along.

Now, in some ways that can be a good thing. It's brought to the surface, you can begin to deal with it, you can begin to, feel those feelings and find better outlets for them. But for a lot of people, that can be really unmanageable. In fact, it can be catastrophic after bariatric surgery, for example.

Which is obviously a very extreme intervention for people who are very severely obese. Bariatric surgery You know, the suicide rate almost quadruples after you have bariatric surgery, right? It still remains low, and most people who have bariatric surgery benefit from it overall. But that's, that's a big increase, right?

so many, 17 percent of people who have bariatric surgery are so distressed afterwards that They have to have inpatient psychiatric care. Now, some of that will be distressed at the actual physical effects of the surgery, which is very, grueling. But I think a lot of it is some of the stuff we're talking about.

It's also, as Coral LaRue, who works very closely on bariatric surgery, put it to me, a scientist. A lot of us imagine, if only I was thin, my life would be better, right? And then a lot of people through bariatric surgery or through these drugs get to be thin and suddenly you've still got the same lousy husband and you've still got the job you hate and actually you've still got the life you live and you have this kind of awakening.

Oh actually it wasn't being overweight that was sort of may have had many negative effects but it's not the magic solution I thought it was. So I think there's all sorts of complicated psychological factors going on. I mean there's lots of others I can talk about but I'm conscious this has been an insanely long answer.

Sadie: No, I love it. And I think It's a really interesting side of this that we don't often hear about, , and that you don't expect. And I think a lot of us frame our mental health in that kind of equation that you mentioned, where it's like, once this happens, then everything else will get better. And if we know anything from the research, that's not how it works.

Our environment can impact individuals completely differently. It's more how we process things and relate to the stressors around us. Yeah. And I think this again amplifies those emotional challenges like you're talking about it brings them to the surface It forces you to address them you also mentioned a really interesting element, , or purpose that eating serves and A really interesting study with what happens if we don't actually eat and we just fill our nutritional needs which is like the idea that eating protects us and that kind of putting on more weight, , Can be like a protective factor and that also ties into self esteem as well Can you speak a little bit to that because I read I believe you mentioned it in lost connections And I still remember that example because it was just crazy interesting and I'd never heard it before

Johann: Yeah, the The scientist who discovered this is one of the most amazing people I've ever met.

He's a guy called Dr. Vincent Felitti. And in the early 1980s in San Diego, he was contacted by Kaiser Permanente, who are one of the big not for profit medical providers in California. And they said to him, look, we've got a problem. We don't know what to do. We'd like your help. And the problem they had was at that time obesity was very significantly rising.

In fact, it was very low by our standards now, but it was rising. And that, of course, brought with it many health challenges. And they were like, look, nothing we do works. We give people diet plans, it doesn't work. We give people personal trainers even, it doesn't work. Can we give you Blue Skies funding to just figure out what the hell we can do?

So Dr. Felitti agreed, and he started to work with 200 severely obese people. People who weigh more than 300 pounds, and, , he starts working with them. And he, he really just doesn't know what to do. And one day he has an idea that seems, in many ways, is quite dumb.

He said, what would happen If really really overweight people just literally stopped eating and we gave them, you know Vitamin shots so they didn't get scurvy or whatever Would they burn through the fat supplies in their bodies and get down to a healthy weight? So obviously backed with a huge amount of medical supervision.

They started to do this and incredibly In one sense, it worked. They did in fact burn through the fat supplies in their body and did in fact get down to a much lower weight. There was a woman in the program, I'm going to call her Julie, that's not her real name, who went down from being more than 400 pounds to 138 pounds, which is just a staggering fall, right?

And literally, Julie's family are ringing Dr. Felitti saying, God, you've saved her life, this is amazing. And then, one day something happened that nobody expected. she cracked. She went to KFC or wherever it was. I don't think it was KFC. That's me projecting my own experience, but she went wherever it was.

Sadie: love the chicken friend typo that you mentioned in the book. I was like, that is such a mood.

Johann: All the way through the book, I kept misjudging the words fried chicken as a friend chicken. I was like, oh, you don't need to be Freud to figure that one out, right? But so wherever Judy went, I don't think it was KFC, but it was, , she started obsessively eating, overeating again.

And quite quickly, she was back at a very, you know, dangerous weight, not where she'd been, but, Back at a dangerous weight. And Dr. Felitti called her in and he said Judy, what happened? And she looked down, she said, I don't know. I don't know. He said, well tell me about the day you cracked. Did anything in particular happen that day?

It turned out something happened that day that had never happened to her before. She was in a bar and a guy hit on her. Not in a nasty way, in a nice way, but she just felt completely freaked out and wanted food. Right? And then Dr. Felitti asked her something that he'd never asked his patients before. He said to her, When did you start to put on your weight?

In her case, it was when she was 11. He said, well, did anything happen when you were 11 that didn't happen when you were, you know, 10 or 14? Anything in particular happen that year? And she looked down and she said, Well, that's when my grandfather started raping me. when Dr. Felitti, Interviewed everyone in the program, he discovered that 60 percent of them have made their extreme weight gain in the aftermath of being sexually abused or assaulted.

And at first he's like, how can that be? That doesn't make sense. Why would one cause the other? And Judy put it to him really well. She said, overweight is overlooked and that's what I need to be. This thing that seemed irrational, overeating to get to a very high weight, was in fact performing a profoundly protective function.

It was protecting her from sexual attention of most men, right, and you know the way one of the scientists who worked on this program, another scientist called Dr. Robert Ander put it to me, is he realized, you know, it's like we were looking at a house that was on fire and we've been focusing on the smoke and not on the fire, right, and this is obviously very relevant to these drugs, because Someone like her, when she suddenly loses weight Obviously, there'll be a benefit to her health on average.

Very significant benefit if she goes from being the way she was. But there'll be a terrible psychological cost, right? , so I think we need to think in it. And this is something I learned about all the elements of these new weight loss drugs. You know, the subtitle is, The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs.

There really are extraordinary benefits. There really are disturbing risks. 12 disturbing risks in the book. I think we need to think about them in an honest, complex, non shaming, truthful way rather than this kind of slightly simplistic rah rah way we're being sold at the moment.

Sadie: Yeah. A hundred percent.

And that was one of the things that I really loved reading because there has been so much press and publicity about the physical benefits and like you're talking about the initial studies where people. lost weight more effectively than any drug ever before, and how, , whether it's used for diabetes or at times like off label for weight loss, now it's prescribed for weight loss, there's been so much coverage of that, but these other benefits that aren't as publicized, which I'm going to ask you about self control next because it's so fascinating.

And then these risks as well, , which you bring up a lot of really nuanced ones that I hadn't considered or thought of before reading this. So I think it's just an, an incredible perspective and provides a lot more depth than I've seen, at least in the media, which is really incredible. But one of these benefits, yeah, one of these benefits may be a risk depending on how you frame it, is the idea of self control.

And I loved reading this section because I nerd out over all things psychology and you interviewed someone at the University of Pennsylvania, which is where I'm at, and I was like, oh my goodness, , so exciting. But there's anecdotally you experience some changes in self control and motivation isn't the right term But almost like how you related with food and rewards and then as you kind of tease that apart and did more research There's been some newer studies and anecdotal evidence from doctors and alcohol usage and drug usage and how these medications could be potentially applied in that arena.

And this isn't talked about as much. It's definitely a newer thing that's being explored. And you mentioned in the book that studies are still being done on this. It's very early days. But can you speak to this phenomenon of Ozempic and GLP 1s and how they impact our self control and reward pathways?

Johann: Yeah, so you should definitely go and talk to Patricia Grigson, who's at Penn State, because she's literally the cutting edge research on this is being done on your doorstep, so you should, , definitely, definitely go and, and, and talk to her, a wonderful person and a wonderful scientist.

So when these drugs were first, , invented it was thought that there was an obvious mechanism and that they primarily worked on your gut. So the way it was explained to people is, , when you eat, so let's say you had a meal now. Some way into the meal, your gut would produce a hormone called GLP, in fact your pancreas would produce a hormone called GLP 1.

And that hormone is basically like a natural signal saying, you've had enough, Sadie, stop eating, right? And generally, when you get that signal, you'll stop, right? I mean, you can power through it, the signal will wash away within a few minutes, you can power through it if you want, and then you can eat even more.

But generally, most people will stop then. But as I say, only stick around in your system for a very short amount of time. What these drugs do, these, they're called GLP 1 agonists, this is Zympic, Wegovy, Mojano, all the ones that are getting so much coverage. What they do is they inject into you, or you can take them as pills, they, they get into your system a kind of copy of that GLP 1, that hormone, kind of artificial replica of it, which instead of getting washed away within a few minutes, sticks around in your system for a whole week, which has this weird effect.

I remember the second I was taking it, I went to, there's a cafe just around the, I'm in my apartment in London at the moment. It was a cafe just around the corner I used to go to for breakfast every morning. And I ordered the same thing that I would order every day, which was this huge kind of brown bread roll with lots of chicken and mayo in it.

Basically like a subway and I had like three or four mouthfuls and I was full and I just Didn't want to eat anymore and it was like bizarre to me and I remember for lunch I went to this Turkish restaurant near my office that I also went to every day Well, I ordered like at the Mediterranean lamb. I always ordered and again I ate like a fifth of it and I just didn't want anymore.

This is like it was bizarre So you feel full very quickly It was initially thought that was primarily because of this gut effect and the gut effect is very real Partly because of work at Penn State and other places, , there's now been a kind of shift in the science. So, the gut effects are real, but we also have discovered and we know, we actually know this going back to the 90s, but the significance of it is becoming greater and greater.

You have GLP 1 receptors not just in your gut, but in your brain. And these drugs seem to be having an effect primarily, not on your gut, but primarily on your brain. They change your preferences. They change what you want. they change how your brain works. Robert Kushner, who's one of the scientists who's been involved in many key stages of these drugs, said to me, you know, if you tag the compound, , and give it to an animal, and then you cut the animal's brain open, obviously you can't do this with humans, it's not ethical, you see that this drug goes out.

everywhere in the brain, into almost every part of the brain, right? So, this is a drug that is working primarily by affecting the brain. Now that opens up a new set of risks, obviously, we can talk about them. Also opens up a new set of potentials. What we know, partly due to Professor Grigson, near you, from animal experiments is that there's a possibility that these drugs will have a really profound effect on addiction.

So, people like, , there's a professor at the University of Gothenburg in Sweden who I interviewed Jarlhag, who, , she's always been fascinated by the fact that if you look at brain scans, people with obesity, their brain scans look very similar to people who are addicted to drugs like cocaine.

So, aha, that seems quite significant. So, a fair early hypothesis to guess it may be that something that works well for obesity could also be beneficial for people who have a problem with cocaine. So she did these incredible experiments with, rats. In fact, she was initially focusing on, on alcohol.

But what they do, so they get rats, They give them loads of booze, right? And they, they like it, and they wobble around, and it looks a bit like a dive bar in Las Vegas, , and they get the rats acculturated to alcohol, they start to like it, they use it for a long time, they get drunk, and then, they just inject them with a GLP 1 agonist, you know, basically ozempic, , or the equivalent to ozempic, , and when they do that, the rats like the alcohol more.

Way less in some of the experiments they drank 50 percent less of it and they modified the experiment They seem to want the alcohol less they enjoyed it less They found it less rewarding just a fascinating change and this has been studied and then they thought well, okay Maybe that's because there's calories in alcohol.

This reduces your desire for calories. Maybe it's just that which is where Professor Grigson, , Penn State comes in because she then tested it with rats that were using heroin and fentanyl. Again, really huge fall in how much they would use heroin and fentanyl and they have no caloric component.

Then a brilliant scientist called, , Dr. Greg Stanwood at Florida State did it with cocaine. Again, huge fall in cocaine use. The human studies are a bit more ambiguous at the moment. , These drugs do reduce smoking, but only if you pair them with a nicotine patch. They enhance the power of the nicotine patch.

They do reduce alcohol consumption, but only if you had an alcohol problem going in. Not for casual drinkers. We're going to know a lot more. There's now a huge number of experiments going on all over the world. But yeah, the brain effects of these drugs open up a whole fascinating and bizarre Potential tentative way of thinking about it and and some risks as well that obviously if you're chronically activating brain areas that brings with it a whole other set of Risks as well that we need to think about and that I go into in the book.

Sadie: Yeah, it's it's really fascinating and Especially from like a psychological research front, the idea that for so long it was like people knew what they had to do, they just weren't able to do it, whether it was alcohol consumption, there's obviously, primarily implications for diet, but it's, it's really crazy that there is potentially a pharmaceutical intervention that does impact that self control, and like you mentioned, it seems to for some reason be these negative aspects of our life, whether it's overeating or in those studies, , alcohol consumption, drug use, it's really, really interesting.

And I think I want to go to one of the most common criticisms that people bring up when they hear about these drugs that you talk about, which is that people say, well, you know, Why just eat less and exercise more? Like, why aren't people just doing that? The solution exists.

It's accessible to everyone, theoretically. And you mentioned a really interesting study that was done in Iceland with kids and exercise and there was a A lot of positive aspects that related to this and they originally did it because of underage Well, I don't know if it's underage there, but in the United States, it'd be underage alcohol consumption And how exercise played into that and it was a really interesting concept.

Can you kind of talk to me about how Exercise plays a role in this and then also that specific example, which I thought was so crazy

Johann: The icelandic example was so fascinating. I went to Reykjavik to research this so In the 1990s, Iceland had this massive problem with teenage drug use and alcohol use. I mean, just off the scale, right?

Something like 50 percent of Icelandic kids were getting drunk every week. I don't mean, , by kids I don't mean like 20 year olds, I mean like 14, 15 year olds. It was an extraordinarily high, by far the worst in Europe. , and this was, you know, causing all sorts of problems as you can imagine.

Very high rates of teenage smoking. and cannabis use and they set up this really, this wonderful man called Thorlundsson who I got to know, set up this amazing program and it was based on the idea that if you want kids to, use less of these drugs and so on, terrorizing them, the kind of DARE model which doesn't work, there's so much evidence that doesn't work, in fact the DARE program makes kids slightly more likely to use drugs, , the yeah yeah there's a good study of that, , what He came up with this idea, partly working with an American psychologist called Harvey Miltman.

that what you should do is set up a program that offers them what are called natural highs, right? So if you don't want them to get high that way, offer them programs where they can go out into the fields and they can do mad forms of exercise and take risks. So they set up this big big program where every Icelandic kid could do all sorts of kind of, it was funded, really well funded to do loads of exercise and it became, it's called the Youth in Iceland program.

It became by far the most successful youth exercise program in the whole world. All Icelandic kids take part in it with very few exceptions and it's amazing. I went to one of the stadiums in Reykjavik, it's like an Olympic level stadium. You go from one bit where kids are doing like an amazing flash mob, choreographed dance, it's another bit there.

Trampolining so high you can barely see them and other bit they're doing, you know, like ice hockey in the middle of the night. It's an amazing thing. And it worked incredibly well so they went from having almost half the kids regularly getting drunk to something like five percent. The smoking almost ended.

It was incredibly successful. Except for one thing, on obesity, it completely failed. In fact, Icelandic kids are more obese now than they were at the start of the program. And we're thinking, well, how can that be, right? That doesn't make sense. We know that exercise, you know, we've always been told exercise reduces, obesity and, and lowers your weight.

What, why, how, how could, and I think there's a few things going on. One is, as Professor Tim Spector, who's a genetic epidemiologist, At the University College in London puts it, you can't outrun a bad diet. So, at the same time the Icelandic kids were exercising more, they were eating worse.

And, bad diet, exercise isn't going to do that much for, right? I mean, the figures are kind of incredible. If you eat a large Big Mac meal, you have to run non stop for two hours without a break to burn off those calories, right? So we really underestimate the relationship between calories consumed and the exercise it requires to burn them.

This, this is, and this is backed by a much wider body of evidence. There was a really interesting study at Arizona State University. They got 83 women, middle aged women, to run on a treadmill three times a week for half an hour, and to see the effect on their weight. And they did it for quite a long time.

And at the end of it, most of the women gained weight. And it seems to be also where, after we exercise, we treat ourselves by, you're like, I mean, we've all done this, I went to the gym, oh, I'll have a Snickers bar. But the chances that you burned off an entire Snickers bar in the gym are quite slim, right?

Yeah. And this fits with a wider body of evidence because the whole time I was taking these drugs I'm learning about the Benefits of the drugs which are really significant in many ways You know your chances of having a heart attack or stroke are 20 percent lower Over five years if you take these drugs if you started with a BMI higher than 27 for example And that's just one of many benefits Versus the very big risks and we can talk about them But one of my friends said to me one night when we were having dinner Why the hell do you keep talking about it like this?

Okay, if there's risks on both sides, choose the third option. Go on a diet, right? And I had gone on many diets in my life and I had almost always lost weight when I did them. And overall, I was almost as overweight as I'd ever been. I was thinking, well, what's going on here?

And one of the people who really helped me to understand this is an amazing scientist called Professor Tracy Mann. She's at the University of in Minneapolis, where I interviewed her. In fact, we met in a, Amazing bakery called Buns Inn. The first thing that happened when I walked through the doors, they said, have you ever been here before?

I said, no. And they gave me a free massive cinnamon bun covered in like icy sugar. I thought, Oh, great place to discuss diet. , and Professor Mann started studying the science of dieting years ago in the year 2000. And at first, when she looked at the evidence, it was actually very clear, overwhelmingly, diets worked.

So she looked at the study and she, she studies many, hundreds and hundreds of studies, and she found, if you go on a diet, you will lose weight, right, on average, of course, there's exceptions. But she noticed something a bit weird about these studies. Almost all of them looked at people over a three month period.

Some of them looked at people over a six month period. And what they seemed to assume was, oh, You start the diet, you lose weight for three months, and then you remain at this lower weight for the rest of your life. And she's like, well, it doesn't seem to fit with most of the people I see around me. So she started to do a meta analysis, an overarching study of all the studies that have ever been done that looked at the effect of diet, not over three or six months, but over a longer period, two years in most cases.

And there were a couple of studies that looked at five years. And when you look at the longer term, the picture is completely different. In the long term, over two years, the average person who goes on a diet will lose two pounds, right? So not nothing, but a really, really, it's close to nothing, right? It's just on the cusp of statistical significance.

And she was like, well, what's going on there? Why would that be? Because We know if you burn more calories than you take in you do lose weight and there's a big debate about why diets overwhelmingly fail not in every case There's a small minority for whom it succeeds, but the vast majority of people they fail and some scientists really help me to understand it and some people also think this Thing that I learned is very closely connected to the why these drugs work, although that's much more controversial So I In the 60s and 70s, scientists used to think that when you were born or possibly even in the womb, you had within you a sort of biological set point, a level of body fat that your body wanted you to be, and that you were basically fixed at that level throughout your life, and you could go a little bit below it or a little bit above it, but basically your weight was fixed.

The best analogy for that is your body temperature, right? Your body wants you to be whatever it is, 40 degrees centigrade. If you go above that temperature, if your body temperature goes above that, you will sweat, You'll desperately seek out shade. You'll feel awful, you know, and if you go below that, you'll shiver to get your body weight back up.

Your body works really hard and actually involuntarily to keep you at that body temperature in that sweet spot at the body temperature. So they thought there was a kind of, internal thermostat for your, for your weight that was like that. But then, starting pretty much in the year I was born, 1979, weight started to massively rise in the United States, right?

The average American is 23 pounds heavier than the average American was before that. A staggering rise. , unprecedented in the entire history of the human species and so they first they thought well set point theory must have just been wrong, right? We must that that it was junked but then actually what they discovered It's that you do have a biological set point, but it rises as your body weight rises.

So let's say, you know, I start off as 12 stone, I'm sorry, I'm terrible at doing the conversion into pounds.

Sadie: Do not worry.

Johann: So let's say I start out as 12 stone and my weight goes up to 16 stone, right? Which is in fact how my weight is varied in my life. although I'm below 12 stone now, so they said, well you've got to think about the circumstances where human beings evolved.

In the circumstances where we evolved, the situation we now find ourselves in, never happened. The situation where for the whole of your life, you would just have a massive amount of abundant calories to consume, right? That risk, it might have happened for very short periods, but over the long term, it never happened.

The risk that did happen quite a lot in the circumstances where we evolved was something very different. It was the risk of famine, right? There was a big risk that, yeah, you might have food now, but tomorrow you won't and you'll starve. And if you think about the situation of a famine, there's a very good reason to get you to hold your fat and stay as fat as you can as long as you can if the risk is a famine might come along.

Because in a famine, the fattest guy at the start Is going to be the last man standing at the end if there's a famine tomorrow timothy chalamet is going to die very quickly, right? And a very fat guy is gonna still be standing right so you can see in the circumstances where we evolved our bodies Evolved with them to train us To want to stay as fat as we can as long as we can if we gain weight, right?

That's why as we gain weight all these biological changes kick in that make it so much harder to come back This is one key reason not the only one why diets seem to fail so much now Some people argue and this is much more speculative And there are people who strongly disagree with it along with reputable scientists who suspect it's true Some scientists think there's a huge debate about okay, given that these drugs do work in the brain You What are they actually doing to your brain?

And some scientists suspect what they're doing is they're lowering your biological set point within your brain. Or as Aurelio Galli, who's one of the leading scientists who works on this, said to me, that it's sort of like taking your brain back to the original factory settings, right, for your iPhone.

It's resetting your biological set point to a lower level. Now, as I say, there are people who disagree with that. That's speculative. But yeah, so, When you learn that, you're suddenly like, okay, dieting is certainly worth trying, right? And there's a minority who do succeed that way. But for most people, given that it's not going to work, we've got to look at Okay, what do we do now?

And for a lot of people in the situation we now live in, it does seem to be a choice between ongoing obesity or these weight loss drugs. Now, we can change our environment so the next generation don't have to face that shitty choice, and I'm passionately in favour of that, and I talk in the book a lot about how we can do that as well, but yeah, that's, that, those are things, some of the things we need to know in relation to that.

Sadie: Yeah, it really goes back to that feeling of like you're fighting against yourself and you're fighting against your body when you're in that dieting experience. And when I took Abnormal Psych and we learned about eating disorders and we talked about the groups that were at risk of developing eating disorders, of course, Teenage girls is, like, one of the biggest ones, but another that I hadn't realized before taking this class was people on diets are at a very, a significantly higher risk of developing an eating disorder than the general population who's not watching their weight or trying to make these changes, and so Eating disorders and individuals with eating disorders is one of the groups that you mention in this book and one of those 12 risks that are associated with these drugs being available and gaining popularity and one of the downsides for sure and one of the big things that we need to Be aware of and increase.

I don't know if regulation is the right word. but really give some thought to how to be intentional about that process. And it's a very big topic of discussion on social media, especially with these celebrity figures of like, do they disclose that they're taking these medications? Because then you're potentially giving the message of, if you want to look like me, if you want to look like these people that you look up to and admire, then the only option is to take a medication.

And this medication is the path towards the BD standard. And if you don't, then People are striving to look this way, and they're never going to get there because they're not having the help of, again, like this medical, , assistance or artificially adjusting these bodily processes. And so I would love to get your thoughts on how kind of like the teenage girl demographic, and you had a really beautiful anecdote that you included with your niece, but how this kind of complicates this whole, , situation and how the history of diet pills and medications associated with dieting have really strong implications for ozempic being on the market when it comes to people that struggle with eating disorders.

Johann: This is my second biggest worry about these drugs.

Sadie: Yeah.

Johann: And I think the worst moment for me in the whole, process of writing the book was a moment when I, , It must have been about, I don't know, four or five months in, I forget. niece phoned me. So my niece is the baby in my family. She's the only girl in her generation and, , no one makes me more protective than her, right?

, and in my head she's always six years old. She's actually 19 now, but whenever she has a boyfriend, I want to go get away from her, you pedophile. But actually, I'm like, Oh yeah, she's an adult woman now. But one day she, and she's always had a normal, healthy weight. Right. And one day she, we were facetiming.

And she was like, oh my god, you've lost so much weight. And I was like, yeah, yeah, it's great. And I preening a little bit. And she's like, wow, I can see your jawline. I never knew you had a jaw. And we were like laughing. And then she looked down and she said, will you get me some Ozempic? And I laughed because I thought she was kidding.

And then I realised she was being serious. And I was like Oh, fuck, right. All her life I've been trying to prime her, you know, to not think she had to be bone thin, to not think she had to compare herself to these kind of super skinny people on Instagram, to value herself however she looked, and I thought, have I just counteracted all these messages, right?

, And so, I really worry about, we know that when there is a change, in the body images that people see, it can lead to people starving themselves or getting eating disorders. So for example, between 1966 and 1968, there was a, 25 percent increase in, , how many girls thought they were overweight, right?

Even though, obviously, weight did not rise in those two years, , or not significantly. And it was because there was this new fashion model called Twiggy, who was extraordinarily thin, who was presented as the new face of beauty. It wasn't Twiggy's fault, she was just naturally thin. Just seeing this image of beauty made loads of girls think, Oh shit, I'm not good enough, right?

In fact, I was thinking about someone like my niece, you know, In her life, she sees a far bigger range in body shapes in women on the, in the public eye than there was when I was a kid, right? But suddenly, most of those women who were, you know, outside the kind of very, very narrow Hollywood norm are suddenly incredibly thin themselves, right?

And, that's no disrespect to the people making that choice for themselves, but I worry about the effect there, and, I spoke to lots of eating disorders experts, they're very worried, they're seeing young women, and it is overwhelming the young women, come in, although of course you get some men, young women coming in who've got eating disorders who are using these drugs, and these drugs give you a tool to amputate your appetite.

We know there are lots of people who want to starve themselves, we know it hugely increased during COVID anyway, for all sorts of complicated reasons, so I'm really, really worried about that. , we know from the past about diet drugs, there was a congressional inquiry the early 90s that was led by Rob Wyden, who's the, at the time, a congressman for Ohio, that looked at, there was an amphetamine based diet drug that was available at the time, and loads of young women were just starving themselves with it.

Testimony at that congressional hearing is so moving, there's this really heart breaking testimony from this guy called Tony Smith, who was from State Center in Iowa, whose daughter, Noelle, from when she was really young, became obsessed with the idea that she was fat. , and was constantly looking at fashion magazines, saying, Daddy, why do I look like this?

How can I lose weight? And when she was a young teenager, she starts taking these diet drugs, and, when she was 20, she died of a heart attack induced by anorexia. And he read this completely heartbreaking poem that she'd written where she's like I'm hungry, I want to eat, but not yet, not yet. , so I'm worried that , while there are many benefits to these drugs as well, we may have a horrific kind of opioid crisis like death toll among young women, which is unbearable.

Now, there is something we can do that would massively reduce, , it won't completely end the pandemic. Risk of it, but it will massively reduce it at the moment You could go online to a doctor on zoom and get these drugs incredibly easily, right? you wouldn't have to see a physical doctor. You could lie about your weight on zoom It's very hard to tell what people's weight it is.

And frankly, most places don't even check anyway, right? I mean, in Vegas, I get, I divide my time between Britain and the United States. I initially got the drugs in Britain. I lost a lot of weight by the time I went to get them in Vegas. I was actually below the BMI at which you should get them. Now, obviously it's okay because I was taking them to maintain my lower BMI, but they don't know that, right?

they don't care. They just gave me the drug, right? Sold it to me. , So, I would say that we need to really urgently change the rules. These drugs should only be available on prescription. With an inpatient doctor's appointment with a doctor who is trained in detecting eating disorders, right?

Because we've really got to get that, that under control before it balloons into a massive crisis as I fear it will. I think, frankly, I think it's already started.

Sadie: Yeah, yeah, 100%. And I think that's being echoed by whether eating disorder specialists, whether it's dieticians, whether it's, , psychiatrists, like it is really being echoed that this is a new phenomenon and whether it's just how we view body image, but also like you're talking about who has access to these as well, which is really important.

And one of the things I wanted to ask you about, because as we're recording this a week or two ago, Oprah has done her whole special. about weight loss drugs. And she has been one of the big individuals who's come out and said that she's taken them and that she's publicly struggled with her weight for a lot of her life and stepped down from the board of Weight Watchers because they now offer these.

It's a whole thing. Everyone's discussing it in this world. And one of the things that she talks about and on this special and one interviewees that she has on is a mom and her daughter because these medications are now being studied and prescribed to kids. And you mentioned in your book that there's a study going on right now with kids as young as six.

And obviously, childhood and teenage years are a critical period for so many things, whether it's trauma, eating disorders, addiction, Weight gain, all of these things kind of set you on a trajectory for the rest of your life. , and so, like you're talking about, there are benefits, but there are also a lot of risks.

And you mentioned that hearing about kids potentially using these really changed your outlook on the whole issue. kind of industry and idea of prescription weight loss medication, specifically osempic. Can you speak a little bit to that? Because it is such, , a crazy philosophical question to consider, , that it's not, it's not just adults that have the autonomy to make these decisions, but it's also kids whose parents are making these decisions on behalf of them.

Johann: Yeah, , I'd just say about Oprah, this is the weirdest sentence I ever get to say in my life, but I am actually friends with Oprah and , I had this bizarre experience where she read like, five years ago, I think it was, she read my book about depression and anxiety, Lost Connections, and like phoned me out of the blue and was like, I love your book, do you want to come to my house?

I was like, Yes! At that point, I had no idea where in the world her house was, I was like, yeah, and I, she's a completely incredible human being, and she, you know, she's doing a lot of good on this, she does a lot of good on everything, , and I think she can talk about this, this is a person who's been bullied about her weight her entire career, it is shocking when you look back at the things that have been said about her, and how she, in return, tormented her own body, and I, I, you know, I feel very proud of her for, fighting back against that shame that she's, you know, she internalized for so long And I think she deserves a lot of credit for that.

I think she's also highlighting a really difficult

aspect of this debate so after i've been researching this for a year and I I felt like I There's a lot of uncertainty, but I felt like i'd sort of got to A point where I was like, okay Every individual is going to have to weigh the risks and benefits for themselves I could see there were some people for whom I believed the benefits outweigh the risks if you're You Severely obese, for example, because of what we know, sadly, about the risk of severe obesity in terms of massively increasing all sorts of problems from diabetes to dementia.

For you, the balance of risk is probably in favor of taking these drugs. if you're, not even overweight, then definitely you shouldn't be taking them. If you're just overweight, there's a much tougher decision. But then I started looking at the science around giving it to kids. And at that point you're like, Oh, all the, cause you know, I feel like, well, I can take a risk for my own health, but if you're making a decision for a child, that's much harder.

And I spoke to mothers like them, the mother who Oprah spoke to who, I mean, I have no idea what I would do in that situation. Right. Right. I spoke to a mother called Deborah Tyler in Connecticut , a really lovely woman, she's a nurse. Her daughter was severely obese. I mean, she was like seven when she started having liver problems.

, she got a Zempic for her daughter. The daughter's liver got worse. Got much better, but then the insurance threw her off the Ozempic, and it was just like a nightmare. And as you say, Novo Nordisk are now, the company that make Ozempic and Wegovia, doing a trial for children as young as six, and it, in a sense, there's a debate about weighing the risks there.

Also, that makes me really angry about a different thing, which is, you know, this obesity crisis didn't happen by accident. This happened because the food industry has screwed us over. It's invented these bizarre forms of factory. Assembled foods that bear no relationship to the way we ate a few generations ago.

They are the cause of the obesity crisis , and they spend a billion dollars a year marketing the shittiest food to our children More three year old children know what the mcdonald's there means than know their own last name and, and they are poisoning our children and putting us in this situation where we have to make this choice.

And the main thing we should do is deal with the food industry so that they're not poisoning our kids and this doesn't keep happening. And I went to countries that have done that, like Japan, and I explained how they did it. And many countries that are taking steps, from Mexico to the Netherlands. , so I feel really angry.

angry that our kids are being put in this choice that isn't a fact of nature it doesn't have to happen we can sort this out but given that choice given that we are where we are and one individual parent can't solve the entire food crisis although together we can i think it really underscores how difficult a choice this is and it's a weird feeling having researched this for a year having spoken to you know the scientists who played a key role in creating these drugs talking to their biggest critics it's weird that i'm still so unsure right i know so much more than i knew at the start but i'm still Very conflicted.

I mean it tells you something that I'm continuing to take the drugs Tells you something about where my balance of risk is But plenty of reasonable people with the same health profile as me would look at the risks and say I know this is crazy I'm not gonna do it. So I get it even if you think about with kids So one of the big risks with these drugs is what to borrow a phrase from Donald Rumsfeld the unknown unknowns, right?

so, I'll give you an example. Now, I'm not saying these drugs will have this effect, but it just helps us to think about it. Starting in the 1960s, doctors started to give anti psychotics to people, anti psychotic drugs, the current class of anti psychotic drugs. And there's a huge controversy about these drugs, but set that aside.

At the time, doctors judged that those drugs were worth, that the benefits outweighed the risks, right? And it was only 50 years down the line, That it was discovered that if you start taking antipsychotics when you're quite young, you are way more likely to develop dementia when you're older, right? Now there was no way to know that at the start, they couldn't have known that, you had to have people using them for 40 50 years before you could figure that out, right?

Now I'm not saying these drugs will give people dementia, there's no reason to suspect that. But there may just be some completely unpredictable thing like that, an unknown unknown that we can't game out now, but will play out. And obviously the longer you take them, the more you increase the chance of unknown unknowns.

And if you're a six year old and you start to take these drugs, you may well be taking these drugs for 80 years. We just have no idea. So we should be doing everything we can to make sure that kids don't have to face that very difficult choice to obesity which is, I mean, if you're obese when you're 18, you have a 70 percent chance of developing diabetes in your life and diabetes will knock on average 15 years off your life.

So I'm not diminishing the agony of the dilemma that parents face are plenty of good arguments for giving them the drug. , especially since in the clinical trials these drugs Reverse obesity entirely in almost a majority of the kids who use them not a whole majority But so yeah, this is an agonizing agonizing And Oprah is one of the best people in the world.

There you go, there's my two concluding thoughts.

Sadie: Every now and then she texts

Johann: me. Every now and then she texts me and my friend and I'm like, SHUT UP EVERYONE! OPRAH NEEDS US! BE QUIET!

Sadie: I love it. No, she's doing a really great job of, well, she's extremely vulnerable with her own experience throughout this, but also giving people the platform to, to speak out on it and Positioning a lot of experts to be able to have that audience , and share that knowledge and have the public be aware of the research, which is really, really important.

, I love that you mentioned Japan because one of my favorite parts of the books, I literally laughed out loud, is when you were showing photos of the typical cafeteria meals in the UK and the US, and the kids in Japan were so, they're like, there's not a salad with that. And the girl was like, salad pairs well with meat.

Like you you should really try this. I was like, oh

Johann: my god When when I showed I was at this japanese school So japanese kids are taught to eat in a healthy way from when they're very young They're taught to really love and enjoy healthy food And when I showed them the kind of food that i'd eaten at school They literally they reacted like i'd shown them an isis beheading video.

They like screamed. They're like They just literally couldn't believe it, right? Yeah, and it was so moving in japan. So the u. s Every day They were literally like, these kids could not believe it. Yeah. But it was, in the US, , our obesity rate is 42. 5 percent and rising. In Japan it's 4. 5 percent and rising.

Set to fall, right? They don't, there's no market for a zempic in Japan because there's almost no obese people So I spent a lot of time in Japan learning like how did they do it, right? And it's absolutely fascinating They did not have a healthy diet until a hundred years ago In fact, they had a very unhealthy diet a hundred years ago and it's through very concerted government action that they moved to a healthy diet and this to me really encouraged me because

If Japan can do it, we can do it and think about a change that's happened in our societies You When I was a kid, right, I'm 45, when I was a kid, everyone, not everyone, but smoking happened everywhere, right? People smoked on the bus, people smoked on the subway, people smoked on the plane. The doctor used to smoke while he examined you.

This is not a joke. I remember my doctor doing it when I was a kid, right? My mother used to, my mother smoked 70 cigarettes a day. There's a photo of me and my mother. Where she's breastfeeding me smoking and resting the ashtray on my stomach, right? When I found this photo a few when I found this photo a few years ago, I thought she'd feel guilty She said you were a difficult baby.

I needed that cigarette, right? And you think about the change from now obviously we've got issues around vaping now, which I don't want to diminish That's a real issue. But you know We've gone from more than half of the population smoking to I think it's 12 percent now, and falling. Very few people your age smoke cigarettes, right?

Very few. There are some, but it's tiny. Much lower than when I was a kid. , that's an incredible improvement in public health that happened in a very short period of time. Frankly, I would not have believed it if you'd told me when I was 15. Britain is about to actually progressively outlaw smoking cigarettes.

I would not believe such a thing was possible when I was a child, right? So it's possible to have massive improvements in public health. If you have concerted public, action, I talk in the book about how we can do that to get us out of the trap of having to choose between the risks of obesity and the risks of the weight loss drugs.

But in the meantime, we do face this choice, and I hope people reading the book will be more equipped to make a choice for themselves. Also, they'll see a lot more of, of, uh, Okay, what will happen to if you do take the drugs positive and negative they can prepare more the things that might come to The surface also what the cultural effects of these drugs because even if you don't want to take these drugs You know Barclays Bank commissioned a very sober minded financial analyst called Emily Field to investigate How are these drugs going to affect people?

to guide their investment decisions. As she said, this is going to have such a big effect on the economy, if you want a comparison point, the best comparison is the invention of the smartphone in 2007, right? And if we've been talking in 2007, was the day Steve Jobs launches the iPhone, We would not have been able to out the vast majority of ways in which the smartphone is going to change our lives.

I think we can begin to see, so even if you don't want to take these drugs, these are going to transform the world around you. 47 percent of Americans want to take these drugs. Krispy Kreme doughnut stocks are already tanking. This is going to change the world. I hope this book helps us to understand a bit and prepare a bit for how it's going to change the world. ,

Sadie: I was going to do like a rapid fire for each of your books, but I'll do just one for Lost Connections. , because I don't want to keep you over time. , one of my favorite books, it is like so highlighted and marked up.

Oh, thank you. , but if there was, Yeah, if there was one takeaway that you wish people could implement and, one thing people thought differently about, and then what you wish to see as a society when it comes to depression and anxiety and, like, the environmental factors, what would those things kind of be super quickly?

Johann: I guess I would say to everyone, you all know you have physical needs. You need food, you need water, you need shelter, you need clean air. If I took those things away from you, you'd be in real trouble, real fast. But there's equally strong evidence that all human beings have natural psychological needs.

You need to feel you belong. You need to feel your life has meaning and purpose. You need to feel that people see you and value you. You need to feel you've got a future that makes sense. And our culture is good at many things, I'm glad to be alive today, but we have been getting less and less good at meeting these deep, underlying psychological needs for a long time now.

, and that is the primary, not the only reason why depression and anxiety are rising so much. So we need to have responses that are about getting your deeper psychological needs met. I go through in Lost Connections lots of things that we can do at an individual and social level to do that. But I guess we need to start by saying to people that depression and anxiety are not malfunctions.

They're signals, right? If you're depressed, if you're anxious, you're not weak, you're not crazy, you're not in the main, you know, biologically broken, although there's some biological contributions, You're not a machine with broken parts, you're a human being with unmet needs. And what you need is love and support to get your deeper needs met.

And I talk in the book about very practical ways we can do that as individuals and as a society. We need to completely reframe how we think about depression, from this very stigmatising and cruel way we have, we're talking about it now, to a way that's about helping people to understand you are responding perfectly normally to the abnormal circumstances of the society we've built, and we can fix that together.

And I went to places that have done it.

Sadie: I love it. Perfect note to end on, and I really appreciate you taking the time. This was so incredible. Where can everyone order your new book, find your past books, all of that?

Johann: Oh, well, thank you for asking such great questions. , if you want to know where to get the audio book, the ebook or the physical book, you can go to magicpillbook.

com. You can also go to my website, which is j o h a n n h a r i. com, where you can see where to get Lost Connections, the other book we're talking about and loads of other things. And, hooray! What a great I really enjoyed your questions, Sadie. Thank you so much.

Sadie: Yay!

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