Johann Hari On Ozempic And Big Food

He’s back on the pod with another smashing book.

My old and dear friend Johann just released his latest book, Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs. That follows Chasing the Scream: The First and Last Days of the War on Drugs (2015), Lost Connections: Uncovering the Real Causes of Depression (2018), and Stolen Focus: Why You Can’t Pay Attention (2022), which we covered on the Dishcast.

You can listen right away in the audio player above (or on the right side of the player, click “Listen On” to add the Dishcast feed to your favorite podcast app). For two clips of our convo — on the ways Big Food gets us hooked, and the biggest risk of Ozempic — pop over to our YouTube page.

Other topics: Johann’s struggles with food growing up; how his Swiss dad’s healthy eating habits clashed with his Scottish mom’s processed food; how the obesity crisis started in 1979; the comfort and convenience of junk food; 78 percent of calories consumed by kids today are ultra-processed; how ads hook them at an early age; why the government should regulate food companies like Japan does; Johann’s own experience with Ozempic over the past year; how such drugs boost satiety; nausea and other side effects; the dangers for those with thyroid issues and anorexia; ten other risks he highlights; the ease of getting Ozempic; how people on it lose the pleasure of eating; how the disruption of food habits surface psychological problems; bariatric surgery; Fen Phen and its $12 billion settlement; the dangers of obesity that include diabetes and cancer; how victims of sexual abuse put on weight as a deterrent to abusers; the resilience of fatphobia; why The Biggest Loser is an “evil fucking show”; why weight-loss drugs feel like cheating; why they might inhibit reform in the food industry; when Johann was fat-shamed by the Dalai Lama; why exercise is great for your health but not really for weight loss; and why I might start taking Ozempic myself.

In fact, I just started. Took my first dose yesterday. I’m struck by how utterly simple it is. A teeny-tiny injection from a teen-tiny needle once a week. I’ll keep you posted if anything interesting happens.

Browse the Dishcast archive for an episode you might enjoy (the first 102 are free in their entirety — subscribe to get everything else). Coming up: Nellie Bowles on the woke revolution, Adam Moss on the artistic process, Oren Cass on Republicans moving left on class, Noah Smith on the economy, Bill Maher on everything, George Will on conservatism, Elizabeth Corey on Oakeshott, and the great and powerful Van Jones! Please send any guest recs, dissents, and other comments to dish@andrewsullivan.com.

Our latest episode — with Kara Swisher on Big Tech and media — was a huge hit:

Just a quick note from a subscriber to let you know that while I enjoy nearly all of your episodes, I found the one with Swisher a special delight. She is a hoot, and your exchanges were both informative and hugely entertaining. I’ll be interested to learn whether others share my enthusiasm.

This one does: “I’d say the best one yet, sir!” Another fan:

What I loved about it was that it was a conversation in the best sense of the term. Two people — one sort of on the right, the other sort on the left, but neither dogmatically so — listening to each other, giving each other time to speak, and then offering complementary perspectives. Sometimes in conversation, harsh disagreement and conflict is necessary when there are major differences. But most conversations work really well when people come at issues from various perspectives that — although not the same — enrich the other person’s understanding and viewpoint. This episode was a masterclass in that sort of brilliant conversation.

Shucks. From a “longtime fan” of the Dish:

This was actually the first time I’ve listened to your podcast, and it was truly delightful. I work in the AI/data industry (whatever that means), and I admire Kara’s work. The discussion was marvelous and insightful, and it was clear there was real history and affection between you two. As a fellow Gen X’er, there was some wonderful nostalgia in this exchange, as well as a keen eye on the future. I’m going to go back through your earlier episodes and listen to more of them.

But another listener feels that I “let Kara off far too lightly”:

Especially when discussing NPR, she repeatedly conflates the term “liberal” with a “progressive” or “woke” approach — the attempt to oversee an Oppression Olympics in which the contenders are politically-determined, arbitrarily-promoted identity groups. In the past, you yourself have characterized the latter approach as illiberal, and I was surprised and disappointed that — despite numerous opportunities — you didn’t make a more focused effort to pin her down on this rudimentary point. This doesn’t apply only to NPR, and it isn’t only about race.

Another listener dings me on a professional point and a personal one:

Subscriber here; I listen every week. However, this week was more fun than usual because Kara Swisher gave you some of your own medicine: she over-talked you and actually directed the flow of discussion several times. It was refreshing. Sometimes you have too tight a grip on the wheel and your guests clam up, right at points where their unique take on things is about to come out. I can’t point to one specific incident of this, but it happens a lot. It’s like they are too polite to interrupt you — not the case with Kara Swisher! She bulldozed you verbally, and made you do a lot more thinking on your feet than often happens. Anyway, it was a great show.

My second point is personal. In your discussion with Swisher, you revealed that you are a smoker. I assume tobacco? You seemed to indicate that you feel the timber you think tobacco is giving you in your voice is an asset.

Stop smoking, I implore you. I just lost my sister last week to tobacco, and it was not pretty. She was a life-long smoker, having started back in high school in the ‘60s. Over the past 30 years, I listened as the raspiness in her voice turned into a slight cough, almost imperceptible, then something more ominous, coupled with wheezing. When she drowned in her own liquids last week, from emphysema, it was a horrible death. She did not want to die, but she lost ten years of life to the addiction. Once she told me that she had no control over the impulse to smoke.

So Andrew, if you can possibly stop, please do.

I have never smoked cigarettes. I smoke weed daily though. I balance the damage to my lungs with the benefit to my general health and psyche. And thank you for the criticism of my podcasting. I’m still learning how to do this and I’m sure I miss the mark sometimes. But I do want these podcasts to be more than interviews.

This next listener has a bright outlook:

Such a fun and engaging episode with Kara Swisher. It’s so refreshing to listen to people debate — even vigorously — who clearly like and respect each other as well. This episode is like medicine for my soul.

You and Kara expressed concern that kids today don’t spend time with each other and don’t want to, making them increasingly awkward. I can’t necessarily dispute the first part, but from what I see, there is still a yearning for kids to get together, even if they do it less. Case in point: my daughter regularly hosts parties at our house. She just had her 17th birthday party yesterday. My daughter has a flair for the dramatic. Her parties go all out: dress codes (and often themes), decorations, potluck feasts, etc. Not only do people come, but we usually have to squeeze 10-15 extra bodies in to accommodate everyone who wants to be a part of it. There’s no drinking, and they’re usually done by 8 pm.

My daughter’s zeal for hosting and planning may be an anomaly. But that desire from kids to be together, engage in healthy fun and to look nice is still strong, apparently. Know hope!

Speaking of the children, another listener looks to our episode with Abigail Shrier on kids in therapy:

As a person who has followed your work but not exhaustively, I was unaware of your own mental health struggles. When you mentioned your father’s admission to you later in life that he wasn’t there for you, I started crying myself. What a beautiful and human story to share. I appreciate you sharing that, as well as being upfront about how you realized how you needed to address your own behaviors if you wanted to have healthy relationships with people.

Broadly, I’ve found myself wondering about the intersection of mental health struggles and success. I only recently began taking inventory of my own struggles as I near 40, and I’ve been surprised at how conflicted I feel about some of the things I’m finding. I am by no measure the most successful person you’ll meet, but I’ve carved out a professional story that I’m incredibly proud of. When I look at things honestly, I have a hard time discounting the positive impact that my worst tendencies in life have had on my professional life even while they contributed to my personal life essentially being blown apart.

Have you ever had this same realization, and if so, how do you deal with this conflict? Or do you think I’m just completely full of shit and telling myself a story? As someone who has found great success as a writer and thinker for many years, I’d love to hear your opinions on that.

Oh man. Where do I start? My work ethic is doubtless linked to my low self-esteem which sometimes tips into self-hatred. I’m never satisfied by my work, but place it as my core activity in life. I’ve managed sustained intimacy only once in my life, for about a decade with my now ex-husband. I’d love to experience it again, but doubt I will. The title of my second book, Love Undetectable, was not an accident.

Another listener on another episode:

It’s taken me a little while to ponder the episode with Eli Lake. I felt like there was a lot of special pleading on Israel’s behalf? God promised this land? Does any other group get a nation based on that argument? The counterargument would be maybe you made God unhappy and that’s why he took the land away from you for centuries?

The more disturbing argument is the one about Hamas hiding behind human shields. When those shields are Palestinians, even children, there seems to be no number of casualties too shocking. The blame is laid on Hamas. But when the shields are Israeli hostages, then care must be taken to preserve every precious life. From a purely tactical, meeples-on-the-board perspective, trapping Hamas inside the tunnel network and wiping them out is worth losing 150 people.

I’m still waiting for a podcast with someone who can explain tactics when your foe is in tunnels. In other parts of the world, people get trapped below ground and it takes days or weeks and special equipment to save their lives. Why is it so difficult to trap Hamas? Even if they run out another entrance, now you know another spot to attack.

Thank you for continuing to cover this challenging topic!

A reader writes:

I might have once posted this on Facebook, but now I lob missives into the ether here on the Dish. Maybe that’s progress, in terms of building a more nuanced and impactful dialogue?

I implore you to say something about the oral arguments in Trump v US. We have to create a drumbeat of intellectual and political honesty in this country, on the off-chance some of the justices may actually be listening.

I ask you, how is it possible that a sitting elected official attempting to overturn the results of an election that they “know” they lost can ever act within their “official” capacity entitling them to immunity? This is the question the Jan. 6 complaint raises, and it is what five justices can’t seem to get their heads around. I’m a perfectly fine lawyer, and I can’t touch the brilliant minds on the bench. But this is so glaringly obvious to me that hearing the right flank of the Court was entertaining Trump’s argument beggars belief.

You can argue that there were “issues” with the vote count. Hell, you can even argue that Trump’s narcissism rendered him incompetent to have the mens rea needed to comprehend that he lost (“my client is insane, your honor, so clear the way to make him our next president!”). Both of these are questions of fact for a jury of our peers. To say that a president is entirely immune is to say that he has no peers to judge him — a proposition entirely antithetical to our republican form of government.

The president needs freedom to act against our enemies. But we aren’t talking about a decision he took to protect the country; vague hypotheticals about assassinations are of no moment. Taking the allegations as true, we’re talking about an official who knowingly sought to undermine the peaceful transition of power. If he is immune from that, then I don’t think it’s hyperbolic to say that we have put the future of our democracy on the craps table.

Just imagine for a moment that in under-a-year’s time, it’s Biden who has lost and is asking the army to seize election machines due to alleged Russian interference. I’m a committed Democrat, and I’d want him to have some damn good evidence that would hold up in a court of law before he tossed that grenade into our system. If he is immune, only “norms” will be there to stop it, and we have seen what those are worth.

Last thing: my instinct has always been to defend our judiciary as imperfect, but relatively non-partisan. If this case goes the wrong way, I don’t think I can make that argument with a straight face anymore. The Roberts Court will be just one more institution that Trump has irretrievably corrupted, and we will be well and truly fucked.

I pray their hypotheticals remains as such. We have to wait for the ruling. On the topic on constitutionalism, here’s a guest rec for the pod:

I’d like to recommend Akhil Reed Amar of Yale Law School. He’s maybe the leading constitutional scholar in the country. He’s the author of a number of awesome books and law review articles and has his own podcast, Amarica’s Constitution.

Topics you could discuss: originalism, the importance of close textual reading, structural arguments, history, the Electoral College, the scope of presidential immunity, insurrection as grounds for removal, and impeachment. On abortion, he takes the interesting view that any abortion law passed before women got the right to vote should be declared unconstitutional. Or the idea of desuetude: can an old, unenforceable law, like a 19th century law on abortion, be disregarded as dead letter?

Was the passage of the 14th Amendment after the Civil War constitutionally legitimate, or was it passed with a gun to the head of the defeated Southern states rejoining the Union? Amar has some thoughts on that — in debate with his colleague at Yale, Bruce Ackerman. And should Colorado have been permitted to throw Trump off its ballot as an insurrectionist? Amar says yes; Court said no, 9-0.

Another rec:

Please consider having journalist George Packer on the Dishcast. I’ve read a number of his articles and just finished The Unwinding, released in 2015, which looks at the rigging of the American Dream. It is not a polemic, just a very insightful book at what makes America tick. Packer is one of the most astute observers of present-day America as anyone out there. He would be an outstanding guest with whom to discuss politics, society and the upcoming election.

I’ve long admired his work. Another reader sends a window view from Tel Aviv, taken around noon:

Another reader and listener digs up some history:

I love your podcast, column, and commitment to open discourse. I’m a center-left, atheist, “recovering Catholic” who finds you to be so passionate, honest, and civil in your writing and conversations. While there are some topics about which we disagree, I think we generally agree on things more than not: the dangers of woke-ism and Trump, for instance.

I read this recent article in The Chronicle of Higher Education, titled “How Queer Theory Turned Its Back on Gay Men,” and you’re referenced specifically. I know your position on how LGB is different from TQ — an area where you and I agree — but I’d be interested in knowing your thoughts on whether there is anything edifying in queer theory (past or present). For example, what are the divergent strands, if any, in queer theory that are insightful or beneficial for creating a more tolerant society vs. ones that are toxic and wrongheaded?

Let me address the specifics of that piece. Here’s the money quote:

[Q]ueer theorists tended rather to position their varying politics as constituting one pole of a binary by which sophisticated and radical thinkers opposed mainstream, conservative, assimilationist members of sexual minorities who merely wished to be considered “normal.”

Factions formed inside and outside academe. The conservative commentator Andrew Sullivan, for example, called for mainstream acceptance of homosexuality in Virtually Normal (1995) on the grounds that there exists no significant difference between homosexuals and their heterosexual counterparts that could justify the former’s marginalization. In contrast, the activist lawyer Urvashi Vaid emphasized in Virtual Equality (1995) that gays and lesbians should remain sensitive to various types of marginalization such as race, gender, and sexuality, which she saw as intimately interconnected.

Queer theorists tended to erode the possibility of productive dialogue between such points of view, underwritten by a common investment in the flourishing of sexual minorities with distinct but related interests. Instead, they generally accepted the terms of the binary between normal and anti-normative, defining gay men and other sexual minorities by their relation to social norms about sexuality and gender rather than in terms of their characteristic experiences and history as minorities. Michael Warner, for example, attacked Sullivan’s pioneering advocacy for gay marriage in The Trouble With Normal (1999), framing the “putative ‘right to marry’” as an escape from marginality into the heterosexual mainstream (which is indeed how Sullivan had seemed to understand it) rather than as a contribution to the preservation of gay lives, relationships, and culture.

Although framing marriage as a problematic institution for all, Warner and other queer theorists were not particularly interested in abolishing heterosexual marriages (who has campaigned for that?) but rather in critiquing gay marriage as a political project for gay men. Without an alternative form of relationality that would confer similar legitimacy, however, gay relations would simply remain powerless and unstable. Neither the conservative nor the radical appeared able to imagine that gay marriage might be desirable for gay men because it might help gay men to flourish not only as individuals and couples but also as a particular community with its own material interests.

It seemed that for both Sullivan and Warner, for conservative pundit and queer theorist alike, gay men, lacking a specific and legitimate collective identity, will eventually have to either disappear into the “normal” or merge into a coalition of the oppressed. Such patterns of argumentation, in fact, remain visible to this day in such commonplace statements as “I’m more than my sexuality” and “labels are limiting” employed by conservatives and progressives alike. Both groups summon gays to disappear.

If you read Virtually Normal, or even the first draft of it, you’ll see I always placed the flourishing of gay men and lesbians as integral to the argument for marriage equality:

There’s a less elaborate argument for gay marriage: it’s good for gays. It provides role models for young gay people who, after the exhilaration of coming out, can easily lapse into short-term relationships and insecurity with no tangible goal in sight.

Here’s a passage from the second draft of the book:

The euphemisms — and the brave attempt to pretend that gay people don’t need marriage — do not successfully conceal the true emotional cost and psychological damage that this signal exacts. No true progress in the potential happiness of gay teenagers or in the stability of gay adults or in the full integration of gay and straight life is possible, or even imaginable, without it.

I always always drew a distinction between integration and assimilation, favoring the former, not the latter. I always believed that gay and lesbian marriage would be different than straight marriage, but within the boundaries of its various hetero variations. I think it’s become impossible for some in the “queer” space to accept the nuances of my work, because it contrasts so strongly with the crude nihilism of queer theory. The idea that I “summoned gays to disappear” is preposterous. I wanted to expand our avenues for happiness — as a group. “Queerness” was, in my view, a dead end of self-imposed marginalization.

Here’s a reader on why he “abandoned NPR”:

It was always my radio station. I always knew they were somewhat left of my politics, but generally they were balanced. I would give to the annual campaign, as I used their services. But after Trump and especially after Covid, I found very little difference between NPR and MSNBC, other than maybe the more subdued tone of reporting. It is sad, as I now am forced to get my radio news fix from the talking heads on MSM, rather than one quality source where all things are considered.

On separate note, one of my former students who now attends Columbia University decided to take an American flag to a pro-Palestinian rally … watch what happened.

Another keeps a thread going:

Your reader wrote, “[The Big Bang theory] not only allows for, but essentially necessitates, the existence of something ‘supernatural’ (i.e. outside the understanding of science and scientific laws as we understand them).”

No cosmologist would agree with this. There are plenty of scientific models of pre-Big-Bang cosmology. The most popular (among cosmologists) is some form of eternal inflation, but there are others, such as Roger Penrose’s conformal cyclic cosmology. These models are all grounded in known physics and represent straightforward extensions of it; nothing “supernatural” needs to be invoked. Furthermore, beginning in the early ‘90s, and now at a highly refined stage, measurements of the cosmic microwave background radiation have killed off whole rafts of other cosmological models. This is all science proceeding as usual.

Another reader has a “bit of a delayed reaction” to another thread:

I’ve been thinking about your noise column ever since it ran, because noise pollution has been a big issue for me over the past few years. One reader in your first set of replies (on March 29) mentioned a famous public-noise scene in Star Trek IV: The Voyage Home. A reader in your next set of replies (on April 5) mentioned the way people put their phones on speaker and hold them up to their mouths. I actually have a theory that Star Trek might, in fact, be partly to blame for normalizing this practice, because the people who use their phones this way are basically holding them the same way Captain Kirk and his fellow Starfleet officers held their communicators on the original series. It pains me to say this, because I’m a lifelong Trekkie, but the resemblance is what it is.

At least in Kirk’s day, everyone could see where the electronic voice was coming from: Kirk was clearly speaking to — and listening to — the communicator. In all the later shows (The Next Generation, etc.), voices emerged from the badges that Starfleet officers wore on their chests. You know how it sometimes seems like a person is talking to himself, until you notice the Bluetooth earpiece? That’s bad enough as it is, if the person is speaking too loudly, but we could be looking at a Picard-like future in which everyone hears both sides of every conversation, and no one is looking at anyone or anything in particular, and it’s impossible to tell who is engaging with whom as we wander through a haze of tinny, overlapping, disembodied voices.

One last thought: I assume you’ve read C.S. Lewis’ The Screwtape Letters? There’s one passage in that book (written from the perspective of a demon) that comes to mind when I think about this issue:

Music and silence — how I detest them both! How thankful we should be that ever since our Father entered Hell — though longer ago than humans, reckoning in light years, could express — no square inch of infernal space and no moment of infernal time has been surrendered to either of those abominable forces, but all has been occupied by Noise — Noise, the grand dynamism, the audible expression of all that is exultant, ruthless, and virile — Noise which alone defends us from silly qualms, despairing scruples, and impossible desires. We will make the whole universe a noise in the end. We have already made great strides in this direction as regards the Earth. The melodies and silences of Heaven will be shouted down in the end. But I admit we are not yet loud enough, or anything like it. Research is in progress.

Apparently that research included consumer electronics.

One more email for the week:

Please keep it up on the scandal of transing kids, which will go down in history alongside the Tuskegee experiments. I’m glad you have the guts to volunteer yourself as a lightning rod for this.

I work closely with someone I would call a successful example of transition, as someone who understands that for some people it can be the right solution and can be carried out successfully. The guy I know — nobody has problems thinking of him as a guy after his transition — was born female to a stereotypical small-town/rural Arkansas family, “conservative,” dysfunctional, highly religious, and prone to substance abuse through multiple generations.

I don’t have the impression that my colleague felt she was a man trapped in a woman’s body. I think she felt so miserable being a woman that she couldn’t see a bearable path forward. Like most in her family, and almost certainly by genetic predisposition, she was obese. She seems to have been attracted to men (and as a man, still seems to be), but she had little or no success attracting any. She was tormented by gross familial problems and by stereotypical expectations, and found approval only for having a nice voice for singing in church. And — here’s the unusual part — notwithstanding the lack of any similar models in family or community, she was intellectually curious and super smart.

At some point, this then-miserable person conceived the idea of a better future as a burly guy than as a fat woman tethered to the life she had led so far. She had some “guy” hobbies and skills, and also the academic chops to pursue advanced degrees at prestigious institutions, and made the radical — but adult — decision to wipe the slate of her life clean and try a start-over.  It hasn’t been easy medically — his experience is definitely no exception to becoming a “lifelong patient” — but it has been a social and psychological triumph. This is now a person who faces the world with confidence, holds down jobs, makes friends readily, and interacts with intellectual peers in a community as far removed from his God-forsaken home as imaginable.

Could he have stayed with his biological sex and come through it all successfully?  Maybe so! But he couldn’t see that path, and again, as an adult, nearly 30, chose another. I gladly rally round the traditional liberal flag of giving full acceptance and support to people like this.

But seeing it close up over a period of years makes me even more furious at the notion of offering “transition” to little kids as a rosy choice. It’s a tremendously difficult path that nobody should choose who isn’t mature enough to comprehend fully. Presenting it lightly to a child is a crime, plain and simple. Everything you said about the Hippocratic oath and the inevitability of a brutal judgment on the perpetrators is right.

It is a shame that in the discussion of children, we can lose sight of the fact that transition as an adult can be transformative and humanizing. It’s an individual’s choice, but I would never misgender someone who has transitioned or treat them in any way differently. There are some minor issues — like sports and some shelter spaces — where we can make distinctions between trans women and women, but they should always be a minor exception to the general rule of acceptance and affirmation.

But leave gender-dysphoric children alone!

Thanks as always for the great emails, and you can send yours to dish@andrewsullivan.com. See you next Friday. Now, off to walk Truman:

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