In the winter of 2022, the global pandemic seemed to finally be subsiding, so for the first time in two years I went to a party in London. I felt clumsy and a little self-conscious, because I had gained 30 pounds since the world shut down.
The party was hosted by an Oscar-winning actor and I was surprised that no one else had gained weight. They all looked like their own Snapchat filter. Their cheekbones were higher and their stomachs were tighter. I ran into an old friend and told her, in a kind of embarrassed murmur, that I assumed everyone was actually doing Pilates while locked down. She laughed and stared at me, stunned that I didn’t know what was really going on.
He pulled up a picture on his iPhone of a light blue plastic tube from Ozempic with a small needle protruding from it. My weight has fluctuated several times in my life, from being slightly underweight to being obese.
My first instinct was to resist Ozempic: I’ll do my millionth diet and do it myself, I thought, without the risky option of drugs, although I had to admit to myself that it seemed to get harder as I got older. But there was one thought I couldn’t get rid of. I realized that I had become older than my grandfather became: he died of a heart attack at 44 years old.
My dad has had serious heart problems that required surgery and my uncle died from them. The science is clear that obesity significantly increases the chances of heart disease, diabetes, cancer and dementia. It is, by some estimates, the leading cause of preventable death.
Johann weighs 14 stone in 2022 vs John after a year at Ozempic in 2024
So I reluctantly decided to try these drugs (paying £300 a month for them privately (although they are available on the NHS)) and at the same time delve deeper into their science, spending a year interviewing over 100 experts and other people from all over the world, from Iceland to Minneapolis to Tokyo, who told me that we now have a new wave of medications that produce an astonishing amount of long-term weight loss.
In early 2023, two days after getting the first shot with Ozempic, I opened my eyes and immediately felt something strange. Hitting my alarm clock to silence it, I stood there for five minutes, trying to figure out what it was. I felt mild nausea, but it wasn’t serious; If it had happened on a normal day, it wouldn’t have stopped me from doing anything. So it wasn’t that.
It took me a while to realize what it was. I always wake up ravenously hungry, but that morning I had no appetite. It is gone.
I got out of bed and, on autopilot, followed my normal North London morning routine. I left my apartment and went to a local cafe run by a Brazilian woman named Tatiana, where my order is always the same: a large, toasted bun filled with chicken and mayonnaise.
As I sat reading the papers, the food was placed in front of me and I looked at it. I felt like I was looking at a block of wood. I managed four bites and couldn’t eat any more. I felt as if the shutters had closed on my appetite and now only small flashes of light could pass through. I was about 80 percent less hungry than I normally am and went from eating 3,200 calories a day to about 1,800.
The feeling of mild nausea continued to come and go, and only completely disappeared after almost a year. I lost three kilos in those 12 months and my BMI went from obese (represented in a menacing red on the NHS graph) to healthy (a lovely, relaxing green).
We know that if obesity is reversed, health is greatly improved. For example, after dramatic weight loss from bariatric surgery, a study of more than 15,000 people found that the chance of dying from coronary heart disease is reduced by 56 percent, and the risk of dying from cancer is reduced by 60 percent.
These effects are so dramatic that in the seven years after the operation, for people who had suffered from severe obesity, the probability of dying from any cause is reduced by 40 percent.
The evidence emerging from this research appears to be that both medications and surgery are moving people in the same direction: One study found that they reduce the risk of having a heart attack or stroke by 20 percent. I kept thinking about my grandfather and kept poking myself. The weight fell off so easily it seemed almost like magic.
But I was wondering: can it be that easy? Can you really get all these benefits without side effects? In the past, other weight loss drugs were launched with comparable fanfare, but ended up having some terrible, unforeseen effect on health that led to their withdrawal.
Most scientists I interviewed are confident that these new-generation drugs are generally safe, because they have been used to treat diabetes for more than 15 years, without many negative effects; this is an important point. But by studying the science, I learned that, in fact, these drugs (Ozempic and other drugs in the same class) pose several important potential risks that should be taken seriously.
During development it was discovered that when these drugs are given to rats, they are much more likely to develop thyroid cancer. Therefore, a group of French scientists began to investigate whether this could also happen with humans.
Jean-Luc Faillie is a professor of medical pharmacology and toxicology at the Montpellier University Hospital. He explained to me that France has one of the largest medical databases in the world, so they went back and analyzed the data of all patients with type 2 diabetes who had taken these medications for one to three years between 2006 and 2018. Then they compared to those patients with a sample of diabetics who had not taken them.
Their findings were surprising.
He said: “We showed that there is an increased risk of around 50 to 75 per cent of developing thyroid cancer.” He told me that it is important not to misunderstand this. This does not mean that if you take the drug you have a 50 to 75 percent chance of developing thyroid cancer; It means that if you take the medication, your chances will be 50 to 75 percent better than if you hadn’t taken it. In general, the risk remains small even if you are taking these medications.
However, Professor Faillie added: “In epidemiology in general, when you have a 50 per cent increase, it’s a big deal.” When I raised these concerns with the companies making the drugs, they pointed out that the European Medicines Agency has not been convinced by this evidence.
Other experts expressed concern. Some are concerned about the effects on pregnant women because animal studies produced birth defects. Others are concerned that people often lose a lot of muscle mass on these medications, and if that happens, you may become less mobile as you age and more likely to be injured if you fall. Others still worry that people taking these drugs may eat so little that they develop malnutrition.
The more I looked, the more I realized that there are no simple answers here. The potentially serious risks of taking these medications must be weighed against the dangers of remaining obese. For example: Medications may pose a greater risk of increasing thyroid cancer, but continued obesity poses a greater risk of developing many different types of cancer.
Some of my friends kept asking me: why not choose the third, less risky option: lose weight by dieting and exercising? We all know people for whom this has worked. But when I looked at the science, I discovered that the truth is that they are a small minority.
Sharon Osbourne lost 42 pounds thanks to drugs
Professor Traci Mann at the University of Minnesota has conducted some of the most detailed research on diets and has found that after two years of starting a diet, you will weigh, on average, two pounds less than you did when you started. “They seem to work for initial weight loss and then regain it,” she told me. Other scientists explained why.
When you diet, your metabolism slows down and you crave more fatty and sugary foods. Professor Giles Yeo, an obesity researcher at the University of Cambridge, said: “Your brain hates losing weight.” He will drag you kicking and screaming back to where you were. I had felt like a huge failure for losing my own personal diet wars, but it turns out that was completely typical.
So here we are, faced with an unpleasant choice. It doesn’t have to be that way for our children and future generations. There are big changes we could make now to prevent them from facing this dilemma, and I saw how they have been implemented in countries like Japan, where there is little obesity.
For starters, we could ensure that all children have fresh, nutritious food at school. But it will take time and many of us will be left stuck in this difficult decision.
After a year of researching the risks, my weight has stabilized and I have decided to continue taking Ozempic. Because most people regain the weight they lost when they stop taking it, I plan to continue taking it for the foreseeable future.
But I’m 45 years old, I don’t have thyroid cancer in my family, and there’s no chance of getting pregnant. Others will have to weigh for themselves the many competing risks and come to their own conclusions.
Anyone who says this is simple or that there is an obvious option that is suitable for everyone is not being honest. We need to recognize the complexity of the situation we find ourselves in. These medications are not a magic bullet or a magic trick. They are a trap door for people who are caught in a trap and can’t see any other way out. Every escape route carries a risk, but so does staying trapped in obesity forever. I have made my choice. Now all the other overweight people will have to do their thing.
How Ozempic adds up
$556 billion: The 2023 market value of Novo Nordisk, the Danish company that makes Ozempic. Denmark’s GDP was $400 billion last year.
$13.9 billion: The amount earned from Ozempic sales in 2023 (66% was in the US).
27.8%: The proportion of the British population that is obese.
15%: the average body weight loss after one year.
£6.5 BILLION: How much the UK spends each year on treating obesity-related diseases.
magic pill by Johann Hari is published on 2 May (Bloomsbury, £20). To order a copy for £17 until May 5, go to mailshop.co.uk/books or call 020 3176 2937. Free UK delivery on orders over £25.