Air Date 5/24/2024

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JAY TOMLINSON - HOST, BEST OF THE LEFT: [00:00:00] Welcome to this episode of the award winning Best of the Left podcast in which we will assess the impact of the new diet drugs on physical and mental health in the context of our unhealthy food system and societal fatphobia. Sources on our front page today include The Gray Area, Today, Explained, Consider This, What the Actual Fork, and The Majority Report. Then in the additional sections half of the show, we'll dive deeper into the business of desire, bias and risk, and body neutrality.

The world after Ozempic - The Gray Area - Air Date 5-13-24

SEAN ILLING - HOST, THE GRAY AREA: Let's start with the basics here. What is Ozempic, for people who don't really know anything about it? 

JOHANN HARI: I remember the exact moment I asked this question for myself. It was the winter of 2022 and it was the end of the pandemic and I got invited to a party for the first time in all those months. And I decided to go and in the Uber on the way there, I was feeling a bit self-conscious because I gained loads of weight. So I was going to a party that was thrown by an Oscar-winning actor. I'm not saying this just to name drop, [00:01:00] it's relevant. I suddenly thought, Oh, this is going to be fascinating because everyone I know gained weight. It's going to be so interesting to see these actors kind of looking different, right? With a bit of podge on them. And I arrived, and it's not just that they hadn't gained weight, everyone was gaunt, everyone was thin, and I was kind of wandering around in a bit of a daze, and I bumped into a friend of mine, and I said to her, Wow, looks like everyone really did take up Pilates during lockdown. And she laughed at me and I said, what are you laughing at? And she said, well, you know, it's not Pilates, right? And she pulled up an Ozempic pen on her phone. And I don't remember ever feeling so conflicted about anything as what I learned, the kind of basics I learned in the next couple of days. 

So we have a new kind of weight loss drug, which works in a completely new way, on new mechanisms in your gut and in your brain that produces massive weight loss. The average person who takes Ozempic loses 15 percent of their body weight. The average person who takes Minjaro, which is the next in this class of [00:02:00] drugs, loses 21%. And for the next one that's coming down the line that will be available next year, the average person loses 24 percent of their body weight, which is only slightly below bariatric surgery.

And I remember as soon as I learned this, I don't remember any topic I ever learned about where I felt so profoundly conflicted as I did about these drugs. Because I immediately thought, well I know that obesity causes all sorts of health risks. I'm older now than my grandfather ever got to be because he died of a heart attack when he was 44. Loads of the men in my family get heart attacks. My dad had bad heart problems. My uncle died of a heart attack. So I thought, wow, if there's a drug that reverses obesity, that could be really big for me. But I also thought, come on, I've seen this story before, right? Every 20 years or so, a new miracle diet drug is announced, millions of people take it, and then we always discover it has some terrible side effect that means it's pulled from the market, leaving a wave of devastated people in its wake.

So to really [00:03:00] investigate this, I ended up going on this really big journey all over the world, from Iceland to Minneapolis, to Tokyo, to interview the leading critics of these drugs, the leading defenders of these drugs, and really dig into what actually what. are these drugs and what are they going to do to all of us?

SEAN ILLING - HOST, THE GRAY AREA: Well, you mentioned how we've had these miracle drugs in the past. Again, it's perhaps too soon to say, but what makes this one different, or potentially different? 

JOHANN HARI: Lots of things. So the first is that it works on a completely new mechanism. If you ate something now, Sean, your gut would produce a hormone called GLP 1. And we now know that's part of your body's natural signals, just saying, Hey, Sean, you've had enough, stop eating. But natural GLP 1 only stays in your system for a few minutes. So what these drugs do is they inject into you an artificial copy of GLP 1, but instead of lasting for a few minutes, it stays in your system for a whole week. So it has this bizarre effect. I'll never forget the second day I took [00:04:00] it because I took it to research it for the book. I was lying in bed, I woke up, and I had this really strange sensation. And I couldn't locate in my body what it was that I was feeling. And then I realized I wasn't hungry. I had woken up and I wasn't hungry. I don't remember that ever happening before. And I went to this diner near where I live and I ordered what I used to order every day which was a huge brown roll with loads of chicken and mayo in it. And I had three or four mouthfuls and I couldn't eat anymore. I felt full. So one of the things that's different is we know that these drugs produce a feeling of satiety that lasts, the feeling of being full and having had enough. And we know that they produce sustained weight loss over a significant period of time. 

SEAN ILLING - HOST, THE GRAY AREA: How confident are we in these early results? 

JOHANN HARI: Well, there's an extremely high level of confidence that it produces significant amount of weight loss. There's been hundreds of studies involving tens of thousands of people. And that's just in its use for obesity. These drugs have also been used for diabetics, for other purposes, which gives us some insight onto [00:05:00] the safety risks around the drugs as well. So yeah, huge numbers of people. Yeah. As robust a finding as you get with any new drug.

The Ozempic economy - Today, Explained - Air Date 2-23-24

NOEL KING - HOST, TODAY,EXPLAINED: Okay, so last summer I saw you tweeted, "10 years from now, it'll be obvious GLP 1 drugs were a way bigger deal than AI". Okay, so you're saying Ozempic is going to be a bigger deal than ChatGPT and the end of the world and everything. That's a major thing to say. Can you make the case? 

JOSH BARRO: Well, sure. So, first of all, I think AI and software more broadly have generally been oversold in terms of their economic effects, and I think that GLP 1 drugs are a really important advance because being overweight is so common. A majority of U. S. adults are overweight, and so I think these are drugs that are ultimately, they're going to be appropriate for more than half of American adults, and I think people are going to have good results from them, and in the long run, they're not going to be prohibitively expensive and difficult to obtain, like they have been in the last few years. So, I think. it's going to be a really widely used medical intervention that is going to have a lot of positive effects for people.

NOEL KING - HOST, TODAY,EXPLAINED: [00:06:00] And so, for someone who says, who's listening to this and says—Yeah, that's actually really great. Like half of all people potentially could get this drug—make the case that this is a big deal for the economy, for people whom that might slide past. 

JOSH BARRO: Well, so I think it's in a few ways. One is that being overweight, and especially being obese, is a significant medical risk factor. And that has costs. It has costs in terms of medical care that people need because of conditions that are related to that, whether that's heart disease or diabetes or even joint problems. And then it also causes an increase in risk of disability. And that, you know, that obviously is a human problem, but it's also an economic problem. It means that people can't work in the way that they once did, either that they can't work as many hours or they can't work as long into their lives. And so, because I think it will reduce the disability rate, I think that will show up in productivity. 

And then it's also going to change the way people consume. There's [00:07:00] been this sort of weird fixation in a lot of the press coverage on things that people might consume less of. 

CLIP: Well, switching gears here, Walmart, seeing a slight pullback of shoppers. The company's U. S. CEO has told Bloomberg that they're seeing an impact on shopping demand from people taking the diabetes drug Ozempic.

JOSH BARRO: And that might be true on some micro levels, and there are specific businesses that you might be in where this drug is probably bad for you. But the thing is that people, if they're not going out and spending their money on Doritos, they still have that money. And in fact, maybe they have a little bit more money because they're a little bit more productive. And then they can go out and find other new things to spend that money on. 

So, basically, if you're not in an industry that has specifically negative effects on consumption and demand from Ozempic, you should tend to be thinking of that as an industry where there will be positive effects. People will have more money around, more time around to spend on your product.

Weight loss is a huge source of frustration for people. It is widely desired. People who are overweight, you know, they want to lose weight. But most things [00:08:00] don't work well. 

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JOSH BARRO: People bang their heads against the wall and they end up feeling bad about themselves and they spend tremendous amounts of time and money on things in an often futile pursuit of weight loss. And if you instead have this intervention that works quite well and requires much less effort on the part of the consumer, that frees up time and money again to go spend on other things. 

NOEL KING - HOST, TODAY,EXPLAINED: Okay, so business and Wall Street are paying attention to Ozempic. Business and Wall Street are not the same thing. But I want you to kind of untangle those two for us. What has that looked like so far? Is it entirely hand wringing? Who's looking at the optimistic side of this and saying, Oh, guys, all this money could be good. 

JOSH BARRO: Yeah, well, I mean, so obviously the first answer is the drug companies that make these drugs, that they, you know, this is a tremendous business for them. [00:09:00] And we're just seeing, you know, a small part of the addressable market here. And of course, it's, you know, weight loss is one of the major indications for these. They're also, they're diabetes treatments, and there's, you know, diabetes is a tremendous problem, and that is also a huge market. And so, you know, you see Novo Nordisk, Eli Lilly, potentially Pfizer, which has a drug in the pipeline, you know, they're going to make a lot of money off this. And the prices that people are seeing right now are eye watering. List prices over $`1,000 a month. The effective pricing for Wegovy seems to have come down this year. Zepbound, which is the Eli Lilly competitor to Wegovy, that's going to be pricing at approximately $550 a month for people whose insurance is not paying for it.

And so, you know, if the Pfizer drug comes onto the market and as Eli Lilly and Novo Nordisk ramp up production, I think there will be price competition that pushes those prices down somewhat farther, but the market's very big. So those drug companies are obviously going to make a lot of money from that. I mentioned the junk food thing, you also see, you know, Wall Street analysts have been interested in asking questions about this on earnings calls. [00:10:00] 

CALLER: I'm wondering your perspective on the GLP1 drugs and the impact on restaurant demand, maybe Darden's restaurant demand. I'm not going to ask your average BMI for your customers, but, um...any perspective? I know it's something that's on investors' minds, so I figured I'd ask. 

JOSH BARRO: There was a discussion that United Airlines might save millions of dollars a year, because of passengers being lighter and therefore taking less fuel to carry them.

CLIP: One study done by the Jefferies Financial Group found that if the average airline passenger lost 10 lbs., it could dramatically impact how much fuel planes need to fly, equating to 80 million dollars in savings in annual fuel costs per airline. 

JOSH BARRO: So, it's sort of an interesting fact that you'll have millions of dollars in fuel savings a year, but it's not that large relative to the overall cost of running an airline. I think part of the reason that you've had this fixation on the negative economic effects is that it's very easy to identify, you know, [00:11:00] Doritos and products like that where you'll have the decline in consumption, and basically you're likely to see the increase in basically every other category. So it's not necessarily going to be a large increase. You're not going to look at the income statement of a company and say these profits were due to Ozempic, but you should see a broad-based improvement in the areas where people are going and spending their time and their money that they used to spend on other things on those 

NOEL KING - HOST, TODAY,EXPLAINED: Just this morning, I was reading a story in Fortune Europe. The CEO of Novo Nordisk says that scared CEOs are calling him to, like, just discuss. And he didn't, he wouldn't tell Fortune who it was. And so they speculate that it's a lot of, like, potentially fast food companies, basically companies that deal with what we put in our mouths. But, like what you're saying sounds so sensible to me and I try hard to think of CEOs as sensible people who, like, game things out. Why do you think they seem so shook? 

JOSH BARRO: Well, I think first of all, it's uncertainty, and, you [00:12:00] know, people, they know their business. They have a view on their customers. Their customers are about to change in some way. I mean, I don't know what it's like to run a fine dining restaurant in New York right now where, because, you know, the market penetration for these drugs is not that high yet. But if you have, you know, certain settings with, you know, especially affluent customers who might be trendsetters in certain areas, you might be seeing a lot of your customer base on this. Are they sending back way more food than they used to on their plates uneaten? So I'm sure you're starting to see some industries where you're at actually starting to see critical mass with customers. And the customers are different. And even if in the long run it's going to be an opportunity ,they have to figure out how to capitalize on that opportunity, and that's challenging. 

There's also a specific matter in the United States, which is that employers pay for healthcare expenses. Right now, the drugs are very expensive, and they are sometimes being covered by insurance, even though they're very often not being covered by insurance. And that's a really large expenditure for whoever is the payer. And so that could be a private company if you have someone with private health insurance. In the long run, this is also going to be an issue for the US government and [00:13:00] therefore for taxpayers. 

Have the new weight-loss drugs changed what it means to be body positive - Consider This - Air Date 5-13-24

JUANA SUMMERS - HOST, CONSIDER THIS: There is a lot of noise, particularly for women, around what it means to have a healthy body: how you get it, and how you keep it. Don't eat carbs, don't eat fat, do eat protein, run, do yoga, lift weights. But at the end of the day, having a healthy body has been synonymous with one thing: being thin.

Yet in recent years, that idea has been challenged by body positivity activists who have preached a message of 'healthy at any size'. And now with the arrival of a new class of weight loss drugs, often referred to as miracle drugs, is the body positivity movement at risk of fading away? It's a question that New York Magazine contributing writer Samhita Mukhopadhyay grapples with in her recent article, "So, Was Body Positivity All a Big Lie"?

She joins me now to talk about her article. I want to start by talking about this idea that being healthy and being thin are the same thing, which is one of the main things that [00:14:00] you get into in this article. Let's start there. How do you see it? 

SAMHITA MUKHOPADHYAY: The conventional wisdom has long been that, you know, no matter what your health problem is, if you go to the doctor, the doctor is going to tell you to lose weight, right? Like, irrelevant of, you know, how your blood work may be or how your mobility issues are or your fitness level. And in the last couple of years, starting with body positive activists, but then also, you know, there's been quite a bit of research on this in medical science, they are seeing that the relationship between the size of your body and your health is not as linear as we have long thought, right? And, so, your fitness level really matters. Your proportions matter, your blood work matters. And I think that one of the things that we're really grappling with this in this moment is that we're still a culture that loves thinness, right? And so it's really hard to separate that from health. We have so internalized this idea that if you're fat, you're [00:15:00] unhealthy. And if you're thin, you're healthy. 

JUANA SUMMERS - HOST, CONSIDER THIS: I mean, as you're talking, I'm sitting here thinking about so many interactions I have had with healthcare professionals over the years, where you come in with an ailment and it's like, well, How many calories are you burning? Or are you active enough? Or what's your normal lunch or dinner routine look like? And it can just be so frustrating. How do you think it is that we got to a point culturally where these two things are so intertwined in what I think many would argue could be a problematic way? 

SAMHITA MUKHOPADHYAY: You know, we have a culture that worships thinness, right? And so, you know, Hollywood reinforces this, media reinforces this, and it's really always been the, like, thin at any cost, right? Like, we've never criticized what people have to do to get thin or how healthy that may be, whether that's physically healthy or healthy from a mental perspective, from like a psychological perspective, right? But I do think that, you know, both this media reinforcement of a type of, you know, what is considered the ideal body size, really fused with also [00:16:00] this idea of taking weight and our health, which, let's be honest, there are personal factors that lead to our health outcomes, but a lot of them are systemic, right? Like access to healthy food, having grocery stores in your neighborhood, living in an environment where you feel comfortable going for a walk, right? Like, all of these things that are really systemic issues that impact health outcomes. I do think it's both this internal process of, you know, we judge ourselves if we gain a little weight where, Oh, I'm like losing control. I'm not eating right. I need to do this. And those might be true also, right? Like we know when we're not being our best selves and we're not taking care of ourselves. But the way that the systems, both our society, our culture, and the medical system, continue to reinforce that, I think has made it very hard to disentangle those two things.

The world after Ozempic Part 2 - The Gray Area - Air Date 5-13-24

SEAN ILLING - HOST, THE GRAY AREA: Another part of the book that I do want to discuss a little bit here, is the story of how we got to this place as a society, and the main character here is the modern food industry. What did you want to say about this in the book? [00:17:00] What should people know about this dimension of the problem? 

JOHANN HARI: So I guess the most important thing to know is just how recent and unusual the obesity crisis is. You have 300,000 years where obesity is exceptionally rare. So what happened? We move from eating mostly whole foods that are prepared on the day, to eating mostly processed and ultra-processed foods that are assembled in factories, made out of chemicals in a process that isn't even called cooking, it's called manufacturing food.

And it turns out that processed food affects our bodies in a completely different way to the kind of food that human beings evolved to eat. There's a brilliant scientist called Professor Paul Kenny, who I mentioned before, head of neuroscience at Mount Sinai. He grew up in Dublin in Ireland and he moved in his twenties to San Diego to do his PhD I think. And he quickly clocked, Whoa! Americans do not eat like Irish people did at the time. They eat much more processed food, much more junk food, much more sugary and salty food. And like many a good immigrant, he assimilated, [00:18:00] and within a year he'd gained 30 pounds. And he started to feel like these foods weren't just changing his body, they were changing his brain, they were changing his cravings, they were changing what he wanted.

So he designed an experiment to test this. It's very simple. He got a load of rats and he raised them in a cage. And for the first part of their life all they had was the kind of nutritious whole foods that rats evolved to eat for thousands of years. And when they had that food and nothing else, they would eat when they were hungry and then they would stop. They never made themselves fat. They seemed to have some kind of natural nutritional wisdom when they had the food they evolved for that just said, okay, stop now. 

Then, Professor Kenny introduced them to the American diet. He fried up some bacon, he bought some Snickers bars, and crucially, he bought a load of cheesecake. And he put it in the cage. And they still had the option of healthy food, but the rats went crazy for the American diet. They would literally dive into the cheesecake and eat their way out. Just [00:19:00] completely, kind of, slicked and caked in this cheesecake. They ate, and ate, and ate, and ate. The way Professor Kenny put it to me, within a few days they were different animals. And they all became very severely overweight quite rapidly.

Then Professor Kenny did something that to me as a former junk food addict seems pretty cruel. He took away all that American food and left them with nothing but the healthy food again. He was pretty sure he knew what would happen, that they would eat more of the healthy food than they did before, and this would prove that junk food expands the number of calories you eat.

That is not what happened. What happened was much weirder. They refuse to eat anything at all. When they were deprived of the American food, they would rather starve than go back to eating healthy food. It's only when they were literally starving that they went back to eating it, right? 

Now all this shows, and we have a huge amount of evidence for this in humans, there's something about the food we're eating that is profoundly undermining our ability to know when to stop. It is destroying our satiety. And what these drugs do is they give us back [00:20:00] that satiety, right? The way one scientist put it to me, Is there satiety hormones? And when you see it like that, you realize, one professor, Michael Lowe in Philly said to me, they're an artificial solution to an artificial problem.

SEAN ILLING - HOST, THE GRAY AREA: The point you were making earlier about how disevolved or maladapted we are to this environment, we evolve under conditions where salty, sugary, starchy foods were very hard to come by. And now these unhealthy, super processed foods are cheap and omnipresent. And I'm not saying it's impossible to be healthy in the modern world, but as you say in the book, we have built a system that almost deliberately poisons us. Which is insane.

JOHANN HARI: Yeah, it's catastrophic and it's profoundly harming our health. And it didn't have to happen, it's not an inevitable effect of modernity. It's the effect of allowing the food industry to systematically poison the minds and bodies of the country. 

Now, they're not doing that because they're wicked Bond [00:21:00] villains. They're doing that to make money. But we've allowed them to do it and they have lobbied to prevent laws that would have sensibly prevented this, and they've massively pumped our heads full of bullshit. So you think about from the moment we're born, we are bombarded with imagery telling us to eat things that are really bad for us. And I include myself in that, by the way. 

SEAN ILLING - HOST, THE GRAY AREA: Well, they kind of are the Bond villains, right? I mean, some of them are. There's a bit in the book where you talk about an internal memo from 1998 from a company that makes biscuits. The memo was talking about how to market their shit food to kids. 

JOHANN HARI: And they're literally saying we've got to get them when they're young. We've got to get them to shape their tastes before they're making rational choices, right? And they talk about well, let's use cartoon characters, let's advertise in kids TV, let's give our shitty food free to school so that when they go home, they demand it. Yeah, these are reprehensible people. 

As angry as I am with the food industry--and [00:22:00] I am very angry with them, I think it's despicable and they should have made different moral choices--I'm more angry with the society that didn't regulate them, right? Because those companies are maximizing profit for their shareholders. That's what the company is built to do. The bigger issue is not just moral condemnation of them. I don't think that gets us very far, they're not going to morally change. The issue is why have we not regulated them, so we end up with this shitty choice of do I continue with a risky medical condition or do I take this risky drug? That choice didn't have to happen, and that choice does not have to be the choice for the next generation of Americans, if we get this right. We can fix this. We don't have to let our kids grow up in this trap. It's really important that people know that. 

And if that sounds very pie in the sky, I would say, think about smoking, right? Think about when we were kids. When we were kids, people smoked everywhere. People smoked on the subway, people smoked on planes, people smoked on game shows. The doctor used to smoke while he examined you. I remember that when I was a kid. There's a photograph [00:23:00] of me and my mother where she's breastfeeding me, smoking and resting the ashtray on my stomach, right? Now, I'm speaking to you from Britain. The British government has just begun the criminalisation of smoking. That's an enormous public health transformation. 

We can make similar changes like this. I've been to places that have begun to do it, but it requires first an honest reckoning with how this happened and what it is physically doing to us. 

Body Neutrality - What The Actual Fork Podcast - Air Date 8-11-23

JESSI KNEELAND: So, I used to work in the fitness industry when I lived in New York City. And I had, it was pretty successful. I went under, my business name was Remodel Fitness. I got a lot of media and press. I worked with a lot of kind of big names for clients. I worked with actresses, models, like, it was awesome. Because I love strength training and I love how empowering it is. And honestly, when the modeling agency would send me a new girl who had literally never set foot in a gym before, and I like introduced her to dumbbells or whatever, it was just the best feeling. Like, there was so much about it that I really loved. And I'm a total [00:24:00] nerd for the science of training and all of that stuff. But what never sat right with me was the fact that pretty much every single person who walked in was looking to change how they looked, in order to change how they felt. Like, that was the plan. If I could just change XYZ about my body, I know I would feel confident and happy and all of the things. 

And, like, some of those changes weren't realistic or sustainable or whatever. And so there were times where I was giving people advice that I was like, I mean, if you want to get there, this is how you can do it, but I don't recommend it. Like, think of all the things you have to give up. Like, why would you do that? And it never quite felt right, but I was very much in the diet culture world. So I was like, you know, had not heard of intuitive eating or anything like that. 

So, I did what I did and then I eventually realized that, like, all of the same conversations were happening across the board, whether you were a Victoria's [00:25:00] Secret model or a mom trying to get in shape after a baby. Like, we were always having the same kinds of conversations about body image. And it just didn't feel good to be, like, Yeah, sure, I can help you with that by changing your body. A: not always! Like, that's not true all the time. In fact, a lot of the time what they wanted wasn't possible. And then also I would see people hit those goals and still not feel good.

So clearly it wasn't about how you actually looked or all the models would feel amazing all the time, right? And that wasn't happening. So, eventually I discovered things like intuitive eating, health at every size. I just started learning a lot more about where this stuff comes from and decided that that wasn't the path I wanted to take. The fitness and strength training can be an amazing tool, but they're just one tool and I wanted to have a whole bunch of tools to help people feel good in their bodies. So, I got my life coaching certification and started doing the work I do now. 

[00:26:00] But body neutrality was not a term at the time, so it was like body positivity, body acceptance maybe. So, it kind of evolved. I mean, as I learned the term, I was like, Oh, yeah, that's like what I do. But until you know the name of something, you don't necessarily know how to talk about it. 

So it's evolved over time, but a lot of the work that I do now is stuff that I've just observed in my coaching practice, 'cause I've been doing this for like a decade now, this kind of work around body image, and learned a lot, you know? And I really was obsessed with figuring out what body image issues are actually about. If they're not about how you look and they can't be solved that way, then what can solve them? What are they really about? 

So, yeah, that led into the content that got me the book deal, which is the 4 Body Image Avatars, which is just a system I used, honestly, to help people like understand that there was something else going on, that it wasn't just about how you look, and also to help people identify what that [00:27:00] might be for them quickly and easily. So, I started putting that content out into the world. It led to a book deal and my book just came out like a month ago. So yeah. 

JENNA WERNER - HOST, WHAT THE ACTUAL FORK: Congratulations! 

JESSI KNEELAND: Thank you! 

JENNA WERNER - HOST, WHAT THE ACTUAL FORK: That is incredible. Tell us more about the book. What it is, what it's about, and maybe can you backtrack a little bit and define what is body neutrality?

JESSI KNEELAND: So, when I first heard the term 'body neutrality', it was presented as like an alternative to body positivity, because the mainstream messaging around body positivity was, like, that you should be able to love every inch of your body, you know, just like feel sort of a constant stream of goodness and affection and warmth towards your body.

And that again just started to feel unrealistic and unsustainable and it made people feel worse about themselves. So, I was like, okay, that can't be it. Body neutrality was sort of an alternative where you could just sit in the middle. You're not too attached to how you look, so [00:28:00] therefore you don't get too upset when you don't like it.

And I really loved that, but I think it was also at the time kind of posed as like focusing on what your body can do, which is a good start for sure, but is not in my understanding now in any way a complete definition of body neutrality, because if you're attaching to what you can do, you're still attaching to your body and that sets you up for the same issues.

So it's about really just stripping away all the false or inflated, like, significance and meaning and interpretation and narratives and beliefs about your body that sit on top and make us, basically, give our body so much power that it can ruin your day, ruin your month, send you down unhealthy spirals. By stripping those things away, you kind of end up in a place where your body doesn't have any power over you. Therefore, whether or not you prefer how you look to be how you look, it just doesn't really matter. It's like, you can look in the mirror, have a bad hair day and you're like, roll your eyes and move on, right? You don't be like, Why is [00:29:00] my hair so shameful and bad? Like, most people, anyway. It's the same thing with your body. Like, if you can get to a place where you look in the mirror and go, this isn't how I prefer to look today, but it is what it is, and then you move on, that's great. That's a huge improvement. And for most people, it's a lot more realistic than looking in the mirror and preferring what you see every day. 

So, to me, that's what body neutrality has evolved into. And my book is called Body Neutral: A Revolutionary Guide to Overcoming Body Image Issues. And it's about sort of introducing the concept of body neutrality, as I understand it, and then also giving like a step by step instruction for people to move toward it, to move from the body image suffering place where it has all this power, to the place where you're free from all that power. And you can just, you know, say to yourself, This isn't my favorite thing, but it also doesn't have the power to like ruin my day, ruin my life, like, my self worth is not attached to this, so I can just move on.

Examining America's Unhealthy Obsession With Fitness w. Natalia Mehlman Petrzela - The Majority Report - Air Date 6-24-23

EMMA VIGELAND - CO-HOST, THE MAJORITY REPORT: What you wrote about, and I haven't really thought about the fitness industry as [00:30:00] broadly as, of course, you did in your book, and you also worked in it as well. The idea that the private sector has essentially created this explosion of gyms, fitness classes, equipment, everything kind of in the private space, and that is really what is associated with fitness, specifically in the United States, as opposed to outdoor public spaces where everyone can work out together for free. I mean, what was your take on that, particularly because I know you've worked at places like Lululemon that are clearly at the center of this. 

NATALIA MEHLMAN PETRZELA: [Laughing] Slightly privatized, part of that sector. Um, yeah, no, absolutely. So, like, there's this kind of two big picture narratives that I try to trace over more than a century. And one is how exercise went from being something considered sort of like shady and weird and suspicious and narcissistic, you know, for men and [00:31:00] women in different ways, it was considered inappropriate, to being something that in a culture where, we are so divided on basically everything, most people agree exercise is good for you. Like, I don't care who you voted for, that's kind of a consensus position. 

On the other hand, what's so sad to me is exactly what you hint at there, which is that despite these moments in our history, when that consensus almost yielded like great public infrastructure for recreation, for physical education, pools, parks, all that kind of stuff. Instead, it's actually a private industry that has run with that idea that exercise is good for you. It makes you a good person. It's like, you know, integral to mental health and to spiritual health and to community and all that. And for the most part that's something that we're sold as a product, as opposed something as opposed to something that were guaranteed as kind of a right of humanity or citizenship.

And so, you know, part of this book is I kind of look at, I don't want to say the rise and fall, but the rise and kind of, you know, dubious [00:32:00] state of the physical education profession. And also like what happened to some of these policy initiatives, you know, like in the Cold War where the idea was introduced that fitness is part of being a good American. And there were some real problems with the assumptions of like the way that works, but it was considered to be a public priority. We've largely lost that. 

EMMA VIGELAND - CO-HOST, THE MAJORITY REPORT: Yeah. And that's what I think maybe drive some of the resentment or pushback like, well, one, when Michelle Obama was saying there should be healthy eating in schools, a lot of that's just like, Well, you're a Black woman, so there's resentment there, right? Like, just general racism about anything she does. But, also because it's not introduced to the public as a public good, providing for the fitness and nutrition of human beings. But it's such a privatized space at this point that I think there's natural gatekeeping and frustration from average people. I mean, you talk about how only 20 percent of [00:33:00] Americans actually fall under the category of exercising regularly and are able to use these systems and that's because we have a sickness in this country called capitalism that keeps people out of these spaces. But like that alienating element, I think there's a connection there.

NATALIA MEHLMAN PETRZELA: Oh, absolutely. I mean, I think one of the reasons that the whole exercise ethos is so appealing in our country is because it's so individualistic, right? There's this appealing mythology, everything about the myth of the self-made man and self made fashioning. What more appealing place to think that's really possible than the gym? All you need is to get outside and have some motivation and willpower. And if you don't do that, it's on you. And that is so dominant in our kind of fitness culture. So, I try to say, Actually, that's a really unfair assumption. And that's so disempowering and doesn't even account for why 80 percent of people are not, you know, getting the recommended daily minimum of exercise. And with the books about fitness, you know, it's connected to all these [00:34:00] other aspects of inequality in our country. Like if you live in a neighborhood without tree cover, it's that much hotter to go outside and run however many days of the year. If you live in a body where you're considered suspicious or vulnerable when you go out for a job, I don't care if you have all the willpower in the world, you're going to be less likely to do that safely. Very similarly, if you even think about housing and, you know, how long it takes you to get to work, or if you work unpredictable shift labor, like, how hard is it to be able to work this into your life? And so, you know, that's something that I really try to, like, stay on topic with fitness. I would say this is connected to so many other aspects of inequality and like more individual willpower and gumption, though yes, you do need that whoever you are to get off the couch and work out, we probably all sometimes need that reminder, that is not the solution here or the problem. 

What Ozempic can't fix - Today, Explained - Air Date 2-26-34

NOEL KING - HOST, TODAY,EXPLAINED: There's a knee-jerk reaction I've seen to almost everything that you just laid out. And the knee-jerk reaction [00:35:00] is there are now drugs that can fix this. What was your first reaction when you started reading that there is a class of drugs that really seem to be helping people lose weight? 

KATE MANNE: So I want to be clear that I'm not against these drugs in any blanket way. But when it comes to weight loss, I do worry that these drugs are getting a bit overhyped for a bunch of reasons.

One is just in terms of the math of it. So these drugs do have a greater effect, at least in the short term, than diet and exercise, which tends to take between five and 10 percent of people's weight off, and then the weight comes back really inexorably. Whereas these drugs look like they lead to an average of about 15 percent weight, according to pretty optimistic estimates under pretty ideal conditions with a pretty select group of patients. So it's more than diet and exercise, but it's not vastly more. And it does look like the weight comes back again, really [00:36:00] inexorably following discontinuation. 

NOEL KING - HOST, TODAY,EXPLAINED: What is it that we're actually thinking when we're thinking, Oh, Ozempic is the solution to everything? 

KATE MANNE: I do think there's a lot of anti-fat bias that can be betrayed by that reaction of, Oh, fantastic, we can eliminate an entire class of people. And it's complicated because many people who are in that high weight category do want to lose weight. And I don't want to be dismissive of that desire and it's being based in something real, which is, I think, mostly fatphobia. But there are also a lot of us who are happy with our bodies the way they are. And the expressive potential of having this message around that says, you really need to change your body because now we can, and why wouldn't you want to change? It doesn't just feel insulting sometimes, it can feel like we're not really welcome in the world anymore, that people just look at our bodies and wonder why we haven't [00:37:00] availed ourselves of a solution to what for many of us seems like a bodily non-problem in simply having more flesh in our bones. 

NOEL KING - HOST, TODAY,EXPLAINED: And it's not as though, if we're talking about the US today, it's not as though when we talk about people in bigger bodies that we're talking about this tiny, tiny, tiny minority. 

KATE MANNE: No.

NOEL KING - HOST, TODAY,EXPLAINED: We're talking about many, many, many people. 

KATE MANNE: It's between two thirds and three quarters of Americans, upwards of 70 percent of Americans are either overweight or obese, according to the BMI charts, which are super problematic, but nonetheless, about 70 percent of Americans have a claim to be somewhat fat.

And yet, it is something where that doesn't necessarily drive more acceptance of fatter bodies, rather it drives a sense that we're a crisis, we're a problem, we need to be fixed or else, in ways that don't always track the epidemiological evidence that suggests that people in the quote unquote overweight categories aren't at greater health risks in [00:38:00] terms of all cause mortality than their so-called average weight counterparts.

NOEL KING - HOST, TODAY,EXPLAINED: I want to draw kind of a crude comparison here, but bias or prejudice against minorities is a thing that happens, you encounter people who are different, who are not like you, and your back goes up and you think there's something wrong with them, and then more of those people move in, and then a couple years down the line, the biases seem to go away. Like, in polite society, we don't stare crosseyed at people in interracial marriages, for example, because we're used to this now. America is this constantly changing society. And yes, we still do have racism and biases, but there are, I think there are theories that if you interact with people more, you become less likely to be prejudiced against them.

Why do you think that is not happening with people in bigger bodies?

KATE MANNE: What you've just laid out is a very good summary of what's called the contact hypothesis, that contact with members of marginalized groups [00:39:00] will have this effect of diminishing prejudice. And I think, in fact, the empirical evidence suggests that the contact hypothesis is not especially reliable for any form of marginalization.

But when it comes to fatness in particular, I think it doesn't work for a couple of additional reasons too, which is that a lot of fat people ourselves feel like there's a thin person waiting to come out triumphantly, like after the next diet or exercise plan, or set of Ozempic shots or whatever it is, that we're really not fat people deep down, that somehow the thin person is going to emerge victorious. And so we don't really identify as fat people and lobby for political change and momentum. We don't demand thin allies stand up for us. And we don't really necessarily see this political platform building where people of a certain size, despite our ubiquity, we're not really standing together in solidarity.

So, [00:40:00] yeah, I think the fact that a lot of fat people feel kind of ashamed and isolated and are trying to change, not the world, but our bodies, means that we don't always get the political coalition building that would be desirable in this arena. 

NOEL KING - HOST, TODAY,EXPLAINED: Earlier this month, an article came out in New York Magazine, and this article asked rhetorically --it was written by a person in health care--and it asked rhetorically, what if Ozempic is just a good thing?

Do you think it's possible at all that we may be freighting this with too much confusion over whether it's good or bad, or if I celebrate the existence of it, does that mean that I don't like fat people? Do you think possibly there's a simpler way to cut through this? 

KATE MANNE: So I think we're suddenly worried about this drug for some of the wrong reasons. So one point that that article made that I did like is, look, why should we insist that people do this the hard way, when for [00:41:00] many people losing weight through diet and exercise is not just hard, but nigh on impossible? Easier is actually better. It's just a fallacy to think that harder is better. I call this the harder better fallacy in my work.

NOEL KING - HOST, TODAY,EXPLAINED: It's very American. 

KATE MANNE: Yeah. If it's harder, that's actually worse, all else being equal. So, that particular story featured a patient of that physician who had a lot going on. She was unhoused, she was a wheelchair user, she was a Type 2 diabetic, and she was put on Ozempic and she'd lost 10 pounds over a month.

Why was the focus on her weight loss rather than the things that this woman obviously needed in her life, like access to fresh foods and reliable health care and a home? She needed housing. And yet, the idea was, let's celebrate, Ozempic is such a good thing because she lost 10 pounds. I'm just not sure this relentless focus on [00:42:00] weight would do such a patient many favors.

The world after Ozempic Part 3 - The Gray Area - Air Date 5-13-24

SEAN ILLING - HOST, THE GRAY AREA: One of the reasons I identified pretty early on in my life as on the political left is I would constantly see these arguments about this or that societal problem. And I thought conservatives overestimated the role of agency and choice, and liberals seemed more tuned to the realities of the incentive structure that we live in and how those constrain our actual choices. And this is the same dynamic I struggle with here, right? Like, sure, people need to make wise life choices. I get that. We need to exercise more. We need to eat as well as we can. But if you're poor or working class, eating healthy is expensive. Finding the time to work out, if you're a single mom or working two jobs or whatever, is hard. So I guess what I'm asking is how do we avoid tumbling into a post-Ozempic world that's even [00:43:00] more unequal than the world we already live in? 

JOHANN HARI: You know, you're totally right. My grandmother left school when she was 13. She raised three kids on her own because her husband died when he was very young of a heart attack. And, my grandmother came home dog tired from a day cleaning toilets, working bars. And the one comfort she had in her life was eating stodge and carbohydrates, and she ate a lot of them and became very obese. And anyone who criticizes her is an asshole. So, you're absolutely right. There's the inequality of access to healthy food, and then there's just, it's really stressful to be poor. And you don't have many comforts when you're poor. And one of them is food. With Ozempic, there's some possible scenarios for how this might play out now, and one of them is a pretty dystopian one, which is that these drugs work, that the benefits outweigh the risks, but they are only accessible to a tiny elite. So you have the real housewives of New Jersey get to be super skinny, and the real school children of New Jersey get to be diabetic at the age of 12, right? That's a real risk. I [00:44:00] think it's possibly the most likely scenario, given the current configuration.

It's not because the drugs are inherently expensive. The drugs cost about $40 a month to manufacture. It's because of the patenting system and the insane way the American medical system works. I live half the time in the US, half the time in Britain. When I'm in Britain, I buy these drugs for about 200 pounds a month. What's that, $280, something like that? When I'm in Las Vegas, it costs me like $1,000 a month, right? This disparity in drug prices happens in the U. S. the whole time. It's madness and it's insane that the United States tolerates this. It doesn't have to be that way. There are all sorts of ways that we can bring down the price. And the price will come down anyway in eight years time, because in 2032, Ozempic comes out of patent. So eight years from now, these drugs will almost certainly be in pill form. You can already get the pills, but the pills will be more effective. At that point, I anticipate, if we don't find really horrific side effects, I would guess half the American population will be taking them. 

SEAN ILLING - HOST, THE GRAY AREA: Wow. 

JOHANN HARI: And don't take my word for it. Look at the markets and what they're [00:45:00] saying. Jeffrey's Financial just did a big report for the airlines saying prepare for the fact that you're going to have to spend far less money on jet fuel, because the population is about to become much thinner and you're going to have to spend a lot less money on it. The CEO of Nestle, Mark Schneider, has been making very nervous noises about the future of their ice cream market. Even think about little things. There's a company that manufactures the hinges for hip and knee replacements. Their stock is down, because fewer people are going to be having hip and knee replacements, because the main driver of those operations is obesity, and a lot fewer people are going to be obese.

SEAN ILLING - HOST, THE GRAY AREA: I mean, some of that sounds really overstated to me, in terms of the impact. Talk me through that a little bit. If even if half the country is taking this drug and losing 20, 25 pounds or whatever the case may be, is that really going to be significant enough to tank airline prices and up in the market in that way? That seems wild. 

JOHANN HARI: I think you have to think about it in the wider context. In terms of the consequences of this, by [00:46:00] many measures, obesity is the biggest killer in the United States. If you can massively reduce the biggest killer in the country, yeah, that has enormous consequences. It also has huge cultural consequences, by the way, in all sorts of complex and much more worrying ways about what young women aspire to be like, what the young women they see around them look like.

But yeah, I don't think it's overblown to say, if you can reduce the biggest killer in the society, and you can transform how people look, and how they move, and how their bodies work, and what kind of illnesses they get, that's pretty, pretty big. 

SEAN ILLING - HOST, THE GRAY AREA: If 50 percent of the country is taking this, then presumably that will include kids--young kids and teenagers. And I read what you wrote about this in the book. And it is appropriately nuanced, but man, I just--I don't know what to think about that. 

JOHANN HARI: The first thing I feel when I think about this is profound anger. It was the angriest I got when writing the book. 

So the first thing we should say is, it is an outrage that parents are being put [00:47:00] in the position where they have to make this choice. It isn't happening in countries that made better societal choices. We shouldn't allow it to continue. 

But my biggest worry about these drugs, for myself and for these kids, is we just have no idea about the long term effects. These drugs are activating key parts of the brain, right? I had a quite chilling conversation with one of the neuroscientists. She was explaining to me which brain regions we know are affected by these drugs. And I remember saying to her, so what else does that brain region do? And she said, oh, memory processing, control of your gut. And I was like, oh, well, just the trivial stuff then. 

Of course, this raises the question, if you are chronically activating these parts of the brain and you think about an eight-year-old child, to have the benefits throughout their life, they will have to take it for, what, 80 years? What will be the effect of that? The answer is, we have absolutely no idea. 

SEAN ILLING - HOST, THE GRAY AREA: Is that the biggest concern for you in terms of the risk? Just simply the unknown? 

JOHANN HARI: It's the biggest risk for me personally, [00:48:00] because a lot of the risks don't apply to me. I'm obviously not going to get pregnant. I've never had thyroid cancer in my family. I didn't experience a loss of pleasure in food. The one that I'm most worried about, this is not for myself, but eating disorders in young women. 

So prior to the pandemic, we already had historically high levels of eating disorders among American girls. It is overwhelmingly girls, although there are of course some boys. And then during the pandemic, incredibly, it rose from the already historically high level. And I am extremely worried about what happens when people who are determined to starve themselves get hold of an unprecedentedly powerful weapon to amputate your appetite. My biggest worry is that we will have an opioid-like death toll of young women who starve themselves to death using these drugs who would not have been able to without these drugs. 

Now, there's a lot we can do to prevent that. At the moment, you can get these drugs from a doctor on Zoom. Doctors on Zoom are not good at assessing your BMI. These [00:49:00] drugs should only be prescribed in person, by doctors who have training in detecting eating disorders. That's not perfect. There's still holes in that system, but it would prevent a lot of this harm. 

Have the new weight-loss drugs changed what it means to be body positive Part 2 - Consider This - Air Date 5-13-24

JUANA SUMMERS - HOST, CONSIDER THIS: You've written in this piece and in others about your decision to go on Mounjaro. You've described it as a choice that you struggled with and you've now been off of that medication for months. I'm curious, how do you personally think about that? How has that experience changed, if it has, the way you feel about your body?

SAMHITA MUKHOPADHYAY: Yeah, it's been really hard. The medication does a lot of different things. You don't crave food as much. Your relationship to food really changes. So fried food is really hard to digest. If you eat too many sweets, you get really sick. And so there were certain things that happened while doing it, where my body would have a really exaggerated reaction to something that I would have normally just eaten and been like, Oh my God, I'm being so bad. And it was like, no, you're being real bad, girl! [00:50:00] Stop eating this! And so that did force me to eat fresher foods and more vegetables and more fruit. And I was craving, like I always wanted something crunchy, so I wanted crunchy salads and things like that. And that did actually have an impact on my behavior, even coming off the medication and without it, I can tell how I feel when I'm eating well or I decide to indulge, which I do. I'm human. I love food. And I'm the child of immigrants. We have delicious food. I eat rice, all of these things. But really figuring out how to balance that. 

And what my doctor had originally said about increased mobility was true. I had gotten to a point where, for me and for my body, the size of my body was impacting my mobility in very subtle ways, but they were painful. And as I get older, I was feeling knee pain and ankle pain. And as I started to move more, really all I did was I started walking, I started going on these five to seven mile hikes and walks.

And that mobility really changed my outlook. It changed my mental health. It changed my body. [00:51:00] And so even as I am gaining back some of the weight, I've managed to maintain some of the lifestyle changes. And I think that that's a really key piece of this that we don't talk about as much, which is, how can this actually be used strategically to support people that do want to take better care of themselves.

JUANA SUMMERS - HOST, CONSIDER THIS: You've been open about this. You've written multiple times about your experience on Mounjaro. And since then, what has that experience been like for you? 

SAMHITA MUKHOPADHYAY: It's been really hard. It took me two months to write this piece. And I think part of it is, it is very hard to color within the lines that have been drawn for us in this conversation. It's either that you completely support it. You want to take it. It's a great medical intervention. We should all want to be thin, right? That's the dominant narrative. 

But then the counter narrative is also that we accept our bodies as we are. And as I write about in the piece, a lot of pressure within the community to say that any move [00:52:00] towards weight loss is perpetuating this idea that thinness is the ultimate ideal.

And so, part of what I wanted to, I was like, this is messy. I don't even have all the answers. But I just know that the way that I am navigating this as somebody who is a feminist, someone who is committed to body positivity, but also somebody who was facing some serious health-related concerns that I wanted to address and get ahead of, I could not be alone in this experience. And so, yeah, it's been challenging, but it's been overwhelmingly positive in terms of the outreach that I've gotten and how many people have shared their own personal stories. My DMs are paragraphs and paragraphs of heartbreaking, gutting stories of people going to the doctor, the experiences that they've had, or mobility issues, or just so many different experiences that people have had, or even celebrities have reached out to me and said, I was feeling really judgmental about these drugs. And this really helped me understand how I should really be thinking about it. So it's been good.

Note from the Editor on the metaphor of the new show format

JAY TOMLINSON - HOST, BEST OF THE LEFT: We've just heard clips starting with The Gray [00:53:00] Area, in multiple clips, speaking with Johanne Hari about the benefits of Ozempic and the food system that necessitates it. Today, Explained looked at the impact of Ozempic on the economy of its home country, Denmark. Consider This discussed weight and health. What the Actual Fork explained body neutrality. The Majority Report looked at the privatization of exercise and fitness. Today, Explained examined fatphobia through the new lens of Ozempic. And Consider This discussed a personal experience with weight loss, drugs, and body positivity. 

And that was just the front page. There's a lot more to dive into in the additional sections of this audio newspaper. But first, a reminder that this show is supported by members who get access to bonus episodes, featuring the production crew here, discussing all manner of important and interesting topics often trying to make each other laugh in the process. 

To support all of our work and have those bonus episodes delivered seamlessly to the new members only podcast feed that you'll receive, sign up to support the show at [00:54:00] bestoftheleft.com/support (link in the show notes), through our Patreon page, if you prefer, or from right inside the Apple podcast app. If regular membership isn't in the cards for you, shoot me an email requesting a financial hardship membership, because we don't let a lack of funds stand in the way of hearing more information. . 

And now before we continue onto the sections half of the show, just a couple comments on the existence of the sections half, which, today, happens to be a little bit less than half, while on other days it might actually be far more than half. The feedback on the new format of the show has been pretty good, few exceptions. So, we're going to keep going with the experiment. However, the constructive criticism that I definitely agree with the most is, I received a text message from a commenter who said it would be wise to use a more modern metaphor for the show than a newspaper with a front page, and then the further sections deeper in. 'Cause like sooner or later, there won't be anyone who remembers that that's how [00:55:00] newspapers used to work. But this commentator, like myself, admitted to not being able to think of a better metaphor. And the thing is with the rise of algorithmic newsfeeds, there's basically no metaphor that can bridge the gap between information organized by type and information organized by a black box into a single, endless scroll. For instance, it might be a good idea to liken the time codes to navigate between sections of the show, to something like a navigation bar, similar to how a news site will provide quick links to various news topics. That's newer than a newspaper, however, I'm in my forties and I feel like I can count the number of times I've actually used one of those new site navigation bars on one hand. And I'm sure that number drops to zero for many. In fact, full disclosure. I had to look up what that bar was called because not only do I not use it, but I don't even think about it enough to know its name. And then, you know, for the young people in my life, if they want to learn about [00:56:00] something they just searched for it a couple of times in their social media app of choice to train their personal algorithm to passively feed information to them on that topic until they think to pay attention to something else or until the algorithm decides to throw them a curve ball and they get distracted by something else and they go down a new rabbit hole. In any case, you know, none of that is something I'd like to build a metaphor out of. 

But speaking of metaphors, you know, about like 10 years ago, there was a big fight inside Apple about whether their iOS operating system needed to be designed with visual metaphors that make digital things on the phone look like real world things. Like, I think the most famous example is the note pad app had a bit of torn paper at the top, the way a real notepad does to signal to you the user that this is like a note pad. And design a thing [00:57:00] to be similar to other things, but made of different material is called skeuomorphism and to be anti-skeuo morphism people at Apple ended up winning that debate. They're like, look, we don't need metaphors anymore. Things that are on the phone just are things that are on the phone and people know how to use them. 

So, perhaps that's the real lesson here. Maybe it's just that people don't really need metaphors as often as some designers fear they do. I designed the longer format of the show and felt that urge to create a metaphor to explain it less people be confused. Also, I thought that newspaper idea was sort of fun in like a nostalgic kind of way, but I guess that'll only get you so far. So, maybe instead of a metaphorical newspaper, what you heard in the first half were the key points or top takes or something like that. I'm happily accepting suggestions on what to call that, but you know, like the key ideas, the big thoughts, [00:58:00] the... anyway, send your recommendations for what to call that. 

And what you're about to hear now in the second half is something like the deeper dives. I don't know, that sounds modern enough.

DEEPER DIVE A: BUSINESS OF DESIRE

JAY TOMLINSON - HOST, BEST OF THE LEFT: And now we'll continue with the deep dives and the rest of the show separated into three categories. The business of desire, bias and risk. And body neutrality.

Examining America's Unhealthy Obsession With Fitness w. Natalia Mehlman Petrzela Part 2 - The Majority Report - Air Date 6-24-23

EMMA VIGELAND - CO-HOST, THE MAJORITY REPORT: It's become a symbol of affluence right in the way that other say, you know, say diamonds were in the housewife era or the right kind of dress like, um, uh, or in the pre Jack Lane era before it became more mainstream, like the it's amazing how quickly it turned from a, uh, an empowering branding to something that causes like general, Uh, alienation or like a, uh, another sense of anxiety about not being enough.

Absolutely. And I mean, you 

NATALIA MEHLMAN PETRZELA: [00:59:00] see, like, starting really in like the late 1950s with some of the early kind of chain gyms. I talk about these tanny health spas. There's so much effort and there's so much. smart to realize this, that these entrepreneurs put into like selling the idea that exercise is not this like gross, weird thing that happens in basements with like big dudes pumping iron.

This is about an affluent lifestyle and they're like tropical fish tanks in the gyms and like they sit, they all say they have like, which I think is disgusting, but that's supposed to be this kind of sign of luxury that goes with exercise. But, you know, you see versions of that well into today. And to me, like big picture, it really speaks to how we think about exercise in this country as like somewhere between labor and leisure.

I think as opposed to like the diamonds or the fancy car or the expensive. cocktails, like people are actually more comfortable in some ways, spending a lot of money on exercise because like, well, that's work and that shows that you are, you know, investing in yourself and in [01:00:00] health and those are virtuous things.

Whereas the kind of overt conspicuous consumption of more flashy things, you know, there are people who are into that, but there are more people who are uncomfortable with it. One moment just recently, I think that might interest like your particular audience is like, one thing that I realized is like, you know, we have the financial crash in 2008, 2009, obviously so many people losing their homes, foreclosures, all the rats.

It's also the rise of boutique fitness in that moment, which is like the highest price point at that time. And one of the ways that I argue that I think that that actually makes sense is that. It's also the moment when social media really comes out and people are pressured to perform their lives all day, their consumption habits.

It's no longer really tasteful to show off a lot of money and spending and fancy life if you have it, but to show off, Oh, I spent, you know, 30 on this exercise class because I care about health or a hundred dollars on these yoga pants. That's sort of as a little bit more culturally acceptable because we so sanctify the pursuit [01:01:00] of health and fitness.

EMMA VIGELAND - CO-HOST, THE MAJORITY REPORT: Yeah, the, the, the sanctifying part is, is fascinating to me. Um, but it's just like, can you expand on that point about it, uh, becoming a consumptive, uh, performative element? Because, it, it, Fitness being consumption, I don't necessarily think is a concept that might come naturally to people when they think about it.

NATALIA MEHLMAN PETRZELA: Yeah, so I mean, if you think there's this really big turning point in the 1950s in the Cold War where, you know, exercise had been suspicious and weird for all the reasons that we said, and then there's this sense that Well, actually like the good life that Americans are living and that we say to the, you know, the Soviet union, like we've got all these great things.

We've got suburbs and cars and TV sets and frozen food and all these things. There's some people who look at the results of that on American bodies. And they're like, actually this thing that you Trump it as an example of American strength is actually making us weak and like. [01:02:00] Eisenhower and JFK jump right on this.

JFK is like, um, you know, condemning the soft American and the pages of sports illustrated. And they start to have this kind of, um, promotional program to have fitness programs, recreation, physical education in schools, like to be a good American is to be fit. That kind of falters, like it's never really very well funded.

The kind of pressures of the cold war change all these people who are actually like, what are you doing? We shouldn't be preparing like, you know, these fit people. We should be spending on science and technology. That side of like the cold war pressure kind of wins out. But what you have is this whole generation of entrepreneurs who are like, yeah, it makes you a good American.

And it also shows that you have money to spend. And it's also almost a little bit of like, you know, a kind of Protestant work ethic. Like you can show off that you're working hard, come spend money and do that and come join these communities, gyms, health clubs, et cetera, to [01:03:00] find like minded people who want to work on their bodies in the same way.

And so that's kind of like the general idea. And then it takes different shapes. Like you see, you know, um, This idea that like working on your body is part of like a fully actualized self and that it's up to you, the individual to take your health in your hands. That is so appealing across the political spectrum.

And, you know, I write about like feminists who are like, yeah, like take the power back from these doctors in white coats. Black Panthers saying versions of the same thing. And then you've got these like hardcore libertarians and people at Oral Roberts University who are like, yeah, like, you know, you know, it's up to you, personal responsibility.

Don't wait for some government like healthcare handout, get out there and run on the open road. And you really see that ideology with, with exercise at its center. Being something embraced across, um, you know, the political landscape landscape and thus marketed really, really effectively, especially as we get into an era of austerity politics, [01:04:00] when a lot of funding for all kinds of public programmings, he and otherwise fall away.

And, uh, yeah, it's, it's great. It's really something and it's really depressing. Like I read all these PE journals, physical education journals, and like in the late seventies, early eighties, they're like, our time has come, you know, for our profession, like this is going to be the boom moment for phys ed.

And it never really happened in part because a lot of those programs were defunded and people who would have gone into PE, I heard again and again in my interviews were like, Oh, Actually, I can make all this money making VHS and, you know, connecting with all these communities in other ways. Can you imagine I would have been a phys ed teacher?

And to me, that's so sad, because that's where most Americans will first encounter exercise. And it's seen as this kind of, you know, depressing path. And I think that's 

EMMA VIGELAND - CO-HOST, THE MAJORITY REPORT: unfortunate. And, 

NATALIA MEHLMAN PETRZELA: you know, we don't pay our teachers 

EMMA VIGELAND - CO-HOST, THE MAJORITY REPORT: enough, right? Like that's, it's a part of We've commodified this space so entirely, as you lay out so well in your book, that it, it's, it keeps, uh, people who might be talented in that sphere from entering [01:05:00] into the public sector, because what is the public sector, um, for exercise?

And something that you said really reminded me of, like, when you talked about how there's the Protestant work ethic, uh, being displayed physically, if you're physically fit. It's that. It's that. It's also the fact that you're, as you also, I'm kind of reiterating, you're wealthy enough to have the time to do this.

Uh, you're also wealthy enough to probably go to a boutique fitness club like Equinox or Lifetime. Um, or, the third thing here too is, I've read about this in connection to like, analyzing the Kardashians and their social, um, what, what they kind of epitomize about our culture, is that, um, There's this new era of, like, beauty and fitness where displaying the work and money that goes into your body is a big part of the beauty standard, which is why when people say, oh, they look fake, that's kind of the point, because it's showing I have the money and the funds to make my face [01:06:00] contoured in a way through surgery, through injections, whatever, that can also display my wealth.

The Ozempic economy Part 2 - Today, Explained - Air Date 2-23-24

NOEL KING - HOST, TODAY,EXPLAINED: Okay, so you guys export the groundbreaking medication and the United States exports the culture trash. Tell me about the company that makes Ozempic Entwigovi. Novo 

MICHAEL: Nordisk is worth about 530 billion dollars at the moment.

Totally staggering numbers. It's in the top 20 most valuable companies in the world right now. 

CLIP: Novo Nordisk is Europe's most valuable company. It takes the top spot away from luxury goods giant LVMH which sells Louis Vuitton handbags and Hennessy cognac. 

MICHAEL: And for a small country like Denmark, that is a, like, a huge thing and something that I don't think any economist or analyst would have expected just, like, five years ago.

CLIP: Novo's market capitalization has surged from about 100 billion in 2020 to a high of 461 billion earlier this month, bigger than [01:07:00] Denmark's entire GDP. 

MICHAEL: Novo Nordisk has more than doubled its market value for in the last three years. Wow. So it was a big, it was a big company in Danish terms, but it was nowhere near the top of the world when we look at market value.

NOEL KING - HOST, TODAY,EXPLAINED: What does Denmark's economy look like in this height of Ozempic kind of age? 

MICHAEL: A good way to just to describe that is just to referring to an interview I did with a Top analyst in the Danish National Bank a few months ago. He said basically if it wasn't for Denmark's pharmaceutical Industry and by that he really means Novo Nordisk Because they are by far the biggest.

The Danish economy wouldn't have seen any growth last year. 

CLIP: If you strip out the pharmaceutical sector which is now dominated by Novo, the Danish economy actually shrank by 0. 3%. 

MICHAEL: We have seen countries close to us in Europe, um, where the economy has not looked great at all for the last [01:08:00] year or so. Um, so it makes a huge difference for Danish economy, um, at the moment.

And You know, on top of that, Novo Nordisk is by far the largest taxpayer in this country and it also is contributing a lot to Danish education, to Danish science, so it plays a huge role in the Danish economy these years. 

NOEL KING - HOST, TODAY,EXPLAINED: Do you see those changes? 

MICHAEL: Do the average Dane feel that the country is becoming richer?

Maybe they don't, but they can see that in certain parts of the country where Novo Nordisk has its largest activity, um, Novo Nordisk is completely reshaping these parts of the country. I myself grew up in a country where Quite small town where Novo Nordisk has its largest factory. And they have invested hundreds of millions of dollars into that small town for the last couple of years.

When I go back to visit my mom who lives in Kelombo, when you drive into the city now, there [01:09:00] is like huge factories. 

CLIP: Located just one hour drive from the capital city of Copenhagen, You will find the industrial cluster of Kalimbor, home to the world's largest insulin manufacturing plant, where Nova Nordisk employ around 3, 500 staff.

MICHAEL: For a lot of years, Where you would see young people, when they go to high school or go to college, they would move away from the city. There have really been not many reasons for them to return. I think that has changed a lot.

When you get closer to the city, you can see buildings, you can see huge cranes, a lot of trucks are driving past you. When you go there in the afternoon, a lot of cars is there, people are commuting to uh, Calambo, and that is a huge difference from what you saw before. 

CLIP: There are so many jobs already for engineers.

That's, that's the good part about [01:10:00] having the education here in Calambo, is because we have all these companies, so we are surrounded, so it's so easy to get a job afterwards. 

MICHAEL: This is, um, has become a city that is, um, thriving. People are suddenly speaking English, English at the bakery and, um, and they are demanding, you know, like international schools and even in, in the suburbs.

So it has brought about a lot of change.

NOEL KING - HOST, TODAY,EXPLAINED: Do you know the concept of resource curse? 

MICHAEL: Um, let me in on that. 

NOEL KING - HOST, TODAY,EXPLAINED: That is when an economy becomes over, It becomes over dependent on one thing. So you will see this in the Middle East with a country that only has oil. Yeah. Um, does anyone ever say, what if we become too dependent on Wegovy and Ozempic? What if we're an Ozempic economy in 10 years and then bop, bop, bop?

MICHAEL: Some economists stress that there is a risk to countries who is significantly dependent on [01:11:00] just one or a few companies. And one example of that is, um, The country very close to us is Finland, who in the 2000, the early 2000, heavily dependent on their biggest company at the time, uh, Nokia, the cell phone manufacturer, as I'm sure you know.

But, um, when Apple and other producers overtook Nokia, um, in the late 2000s, the Finnish economy stagnated for almost 10 years.

Most economists does not consider this as an very, as a very imminent threat to, uh, the Novo Nordisk, but more as a thing worth fighting for. Thinking about, and the reason for Novo Nordisk and Danish businesses to stay frontrunners on pharmaceutical issues, but also other high technology, uh, businesses.

NOEL KING - HOST, TODAY,EXPLAINED: This has me wondering about your predictions for this drug because, um, So many people [01:12:00] want it and so many people could be helped by it. It seems to me that there is no end to just how big we'll go via and Osempic could be. What are your predictions for what this might mean in, in five years, in 10 years for your country's economy and for its people?

MICHAEL: The market for weight loss drugs, uh, if you ask most analysts is, you know, like 

CLIP: huge. The market potential is, uh, I would say almost unlimited. The demand outlook is incredible and the biggest problem right now for Nordisk is producing enough. They cannot meet demand. 

COMMERCIAL CLIPS: It's 

MICHAEL: quite difficult to get your head around what would this mean for Nordisk.

For Danish economy, how large can Novo Nordisk become, but also what do these drugs mean for our perception of what obesity is? Would we at some point get to [01:13:00] where almost everyone is taking some kind of medication to control your weight, and who's going to be selling that? Is that Novo Nordisk? It might be.

The world after Ozempic Part 4 - The Gray Area - Air Date 5-13-24

SEAN ILLING - HOST, THE GRAY AREA: So if we're talking about this, this hormone, that's not just in your gut, but also in your brain, does that mean that this drug could potentially be a general anti addiction drug, a drug that bolsters your capacity for self control, as opposed to just a weight loss drug. 

JOHANN HARI: Because this is a hormone that's made in your gut, it was thought that these drugs primarily affect your gut, that they work by slowing down your gastric emptying or some other mechanism.

And that's true, and there is certainly an effect on your gut. But we also know that you have GLP 1 receptors, not just in your gut, but in your brain. And so, It's increasingly clear that these drugs work primarily not on your gut, but on your brain. If you give these drugs to rodents and then you cut open their brains, you see that the drug goes everywhere in their brain and The [01:14:00] neuroscientists I interviewed and the science they produced strongly suggest that these drugs work primarily by changing what you want, by changing your cravings and your desires.

There's a huge debate about how that works and it's slightly disconcerting to interview the leading neuroscientists and say, Okay, you're saying this works primarily on my brain. What's it doing to my brain? And they all said a very erudite vision of ah, We don't really know. There's also a huge debate about both negative and positive effects that may be happening.

There is debate about whether it's causing depression or even suicidal feelings in a minority of users. So what we know at the moment is we have a huge amount of unbelievably promising evidence in animals. So I interviewed loads of scientists who've been doing experiments on this. Think about, for example, Professor Elisabeth Jarlhag, who's at the University of Gothenburg in Sweden.

What she does is they get a load of rats. And they get them to drink loads of alcohol and get used to it. And rats quite like getting drunk. They wobble around their little cages. And so they give rats alcohol for quite [01:15:00] long periods of time until eventually their cage looks like a bar in downtown Vegas.

And then they inject them in the nape of their neck with GLP 1 agonists, the active component in, in ozempic and wagovi. And what they find is a dramatic reduction. In how much alcohol they consume. It's usually about 50 percent. And we discover that they get less dopamine when they drink alcohol. They like it less, they crave it less, they'll put in less effort to get it.

It really does change the amount they want alcohol. But initially it was thought, okay, well that could just be it. These drugs reduce your desire for calories, obviously alcohol has caloric content, maybe it's just that. So other scientists then experimented with drugs that don't have any calories in them.

For example, Professor Patricia Grigson, who I interviewed, is at Penn State University, got rats to use fentanyl and heroin heavily. gave them GLP 1 agonists, found they used significantly less. Uh, Dr. Greg Stanwood, who's at Florida State University with mice, gave mice [01:16:00] cocaine. When they give them GLP 1 agonists, they discover the mice use far less cocaine, again, by around 50%.

We have very little amount of human evidence. We've got a lot of anecdotes, a lot of people I spoke to who started to take Ozempic and saw their addictions go away. But very little human evidence. We are a little bit of a mixed picture. We know that these drugs reduce smoking, but only if you combine them with a nicotine patch.

We know they reduce alcohol use, but only for people who are heavy drinkers at the start. We'll know a lot more in the next few years because there is a huge number of trials going on. But you've stated rightly, the most optimistic possible scenario, which we should probably Treat with caution, but equally shouldn't dismiss, which is that actually this is not an anti obesity drug, that this is a drug that boosts self control across the board.

Now we need a lot more evidence before we start backing up statements like that, but it's, I would say it's not totally implausible. 

DEEPER DIVE B: BIAS AND RISK

JAY TOMLINSON - HOST, BEST OF THE LEFT: Now entering deeper dive section B bias and risk.

What Ozempic can't fix Part 2 - Today, Explained - Air Date 2-26-34

NOEL KING - HOST, TODAY,EXPLAINED: Kate's first book was about misogyny. Her new book is [01:17:00] called Unshrinking, How to Face Fat Phobia. You will perhaps not be shocked to hear that she believes the two are related.

KATE MANNE: So during my final two years of high school, I entered an all boys school the year it integrated in Australia as one of three girls. Oh, I know. It was really a rude introduction to the subject of misogyny and it meant that for me as a then chubby teen, I really encountered an enormous amount of fatphobia, which was the way misogyny manifested itself.

Um, I was called a fat bitch. I had that scrawled on my locker as well, which was I was doused with fish oil to be the kind of ultimate expression of misogynistic disgust towards the female body. And I ended up being voted the person most likely to have to pay for sex at the final Oh my God. The high school leavers assembly.

NOEL KING - HOST, TODAY,EXPLAINED: What a horrible place. [01:18:00] Okay, so the idea I think generally for most of us is, okay, when you're a teenage girl, boys are terrible and then everybody grows up and they grow out of this. Is that what you 

KATE MANNE: found happening? So things suddenly got better for me personally, and I was relieved to find that what I had encountered in those forms of bullying and cruelty was usually not nearly as explicit when it came to ways I was treated as a fat adult, but it was still there.

And certainly my research into this back this up, that fat phobia in particular isn't really getting better. It's actually on the rise according to some measures. 

NOEL KING - HOST, TODAY,EXPLAINED: Right now there's a big body positivity movement underway. It definitely seems to have reached the mainstream. There are podcasts like Maintenance Phase, which is very, very popular.

CLIP: Guys, it's great over here. It is like genuinely so phenomenal. Whatever your size is to get right [01:19:00] with the body that you have is the body that you have. Why don't you take care 

NOEL KING - HOST, TODAY,EXPLAINED: of it? Companies will have plus size models. Fashion brands, fashion labels will have plus size models. It definitely seems if you're looking for evidence that things are getting better, I feel like you can definitely look around and be like, Oh yeah, I see it everywhere.

Things are getting better. You're saying data doesn't necessarily show that. What are you, what data are you looking at? What are you finding? 

KATE MANNE: Yeah, so Harvard researchers in 2019 published a really interesting study showing that when it came to prejudice and bias across various categories, they looked at race, skin tone, disability, age, sexuality, and weight.

And they found that Anti fatness, so weight bias, was the only form of implicit bias that was actually increasing. And it was also the form of explicit bias that was decreasing the most slowly. So one possibility is that we've seen more body positivity and more [01:20:00] representation, but also pretty bad backlash to those.

progressive social movements. 

CLIP: We know beauty standards. We know what's attractive and what's not attractive. It's not fatphobic to have a preference. It's not fatphobic to not be attracted to overweight people. You're not allowed to like yourself if you're thin, and God forbid you wear a bikini and say you're proud of your body when you're thin, then you get routinely attacked.

And at the same time, it's sending a signal to other women that they shouldn't want to better themselves. 

KATE MANNE: So I think it has a number of manifestations. and that makes it something systemic that occurs across different sectors of life. So it happens in education. It means that fat children are more likely to be bullied in school.

It's probably the most common basis for childhood bullying, according to the research I've seen. It's also something where teachers harbor negative stereotypes about fat students, holding that they're less able and less gifted as they gain weight, even though there are test scores. Objective measures of [01:21:00] achievement haven't changed.

It's something that we see in employment. And finally, we see huge gaps in terms of the treatment patients get within the healthcare system. So, fat patients are subject to a number of really pernicious stereotypes. We're seen as lazy, non compliant, weak willed, having done this to ourselves. And doctors tend to blame any and every symptom that we come to seek treatment for on our weight rather than looking at the true cause of those symptoms.

CLIP: It was very scary to sort of exist in a body that I thought was failing me and have medical professionals who didn't seem to take me seriously. 

KATE MANNE: So there was another really interesting and telling study of physicians that showed that physicians don't just harbor implicit bias against fat patients, they harbor explicit bias.

They will say that they are less willing to [01:22:00] help fat patients, that they regard fat patients as more of a waste of their time, and that fat patients are more likely to annoy them. 

The world after Ozempic Part 6 - The Gray Area - Air Date 5-13-24

SEAN ILLING - HOST, THE GRAY AREA: I'm always wary of treating symptoms, not causes, and in this case, it is one of the bigger risks that the availability of these drugs will prevent us from dealing with these systemic problems that we have with the food industry and pop culture and that sort of thing. And if it does in fact make it harder for us to deal with these systemic problems, what is the net good over the long haul?

JOHANN HARI: I wrestled with that myself and I still wrestle with that. One person I put that to, I said, you know, will it undermine the political pressure to deal with the food system? And this is a very prominent person, I won't say who, but said, what pressure to change the food system? You won't ever find a more popular person than Michelle Obama, a more charismatic and brilliant communicator.

Even Michelle Obama couldn't get any political [01:23:00] traction for this. She couldn't get any political traction for the idea that you should physically move your body. I mean, that was regarded as controversial. Let's get our children to move. I think that's too pessimistic. I do believe we can build political pressure around this, but I don't.

Feel I can say to people you should incur negative consequences now Because it will create more political pressure further down the line to make it better for future people 

SEAN ILLING - HOST, THE GRAY AREA: I I get it and I wouldn't I wouldn't tell that to anyone else either but we have Benefit of being able to think dispassionately about this in conversations like this.

We're removing ourselves from the immediate emotional impact of it But yeah, yeah. Yeah, that's just it's not there's not easy answers for sure I guess the dream scenario is many people start taking these drugs. They work. Our collective health skyrockets. And then, as you say in the book, that awakens us to the insanity of the situation we got ourselves into.

And then maybe that spurs reform. [01:24:00] I don't know if it's going to play out that way, but That's the timeline I would sign up for 

JOHANN HARI: in the range of scenarios from the most pessimistic to the most optimistic. Obviously, the most pessimistic is that this is like the diet drug fen fen in the 1990s, hugely popular front page of Time magazine said the new miracle weight loss drug, 18 million fen fen prescriptions, and then we discover It causes catastrophic heart defects and lung problems.

It gets yanked from the market, leads to the biggest compensation payout in the history of the pharmaceutical industry. That's quite unlikely, given what we know about the diabetics, but it's not inconceivable. If that's the most pessimistic, the most optimistic is precisely, as you say, that the drugs work, that the benefits outweigh the risks, and that we wake up and go, how did we get to this point?

Right? I think the probably most likely scenario is somewhere in the middle. That's very disconcerting. 

SEAN ILLING - HOST, THE GRAY AREA: I think what We don't know yet scares me as much as what we do know excites me and I guess I'm just conditioned to believe that there are no [01:25:00] biological free lunches be a smaller free lunch if it says one of the last things you write in the book is that these drugs are going to change the world for better or for worse.

So what do you think it'll be for better or worse? 

JOHANN HARI: I think it'll be both. I think it'll be better for people like me, who had heart attack risks. I think it'll be much worse for people with eating disorders. And I don't think there's a kind of moral calculator where you can put me not dying of a heart attack versus a person with eating disorders dying because they were able to starve themselves.

I don't think you can really make those calculations. We can definitely take the steps needed to protect those people with eating disorders now and many of the other risks, you know, warning people with thyroid problems, warning people who are pregnant, and, uh, whole range of things. It's definitely both, but I can't measure out the proportions yet.

SEAN ILLING - HOST, THE GRAY AREA: I'm inclined to say for the better. That's just a wild guess. 

JOHANN HARI: A hundred years from now, someone in the smoking ruins of our civilization will find this episode [01:26:00] of this podcast and go, Sean, did he get it right? They'll know. I mean, to 

SEAN ILLING - HOST, THE GRAY AREA: me, the big hinge is the access question, right? We have to get that right, that we have to get that right.

If we don't, if this becomes a drug for rich people, that will be a moral catastrophe. Yeah. 

JOHANN HARI: Oh, it'll be disgusting. That's an eight year window. Right? We've got an eight year window until Ozempic goes out of patent, at which point they'll be able to manufacture it for 40 a month, for anyone. So we've got eight years in which this could be confined to a small elite, and that's scandalous, and lots of people will die in that eight year window who could have lived.

And then 2032 onwards, we don't have that dilemma. 

What Ozempic can't fix Part 3 - Today, Explained - Air Date 2-26-34

ALICE FULWOOD: For most of my life, as long as I can remember, I have felt like there is this sort of pressure or this idea that the sort of right way to be, the right sort of way to look is to be thin. 

COMMERCIAL CLIPS: Here's how I went from thick to thin in six months.

You want to keep the focus on vertical lines. 

KATE MANNE: Here's my easy breezy [01:27:00] diet routine. It's how I stay thin with minimal effort.

ALICE FULWOOD: It seems to be sort of all around us in the ether a lot of the time. And it's one of those things that I had sort of taken, uh, almost as a sort of given. And one day I was sort of at home working, um, and actually my husband, uh, called me into his office to show me a chart that he was looking at which was on the CDC website and it plotted BMI against income and all over the world there is a sort of negative relationship between BMI and income so the richer you are the thinner people tend to be and What was really striking about this chart is that they'd broken out that line into men and women.

And for men, there actually was no correlation at all. This sort of line was, was almost completely flat. Uh, but for women, the line sloped very sharply downwards. And I sort of, in that moment, had this realization that You know, there's this sort of pressure that [01:28:00] women feel, this sort of, you know, the, the, the vibes in the ether, I guess.

It's not just, you know, vanity or magazines. Actually, you know, perhaps there's this really powerful economic incentive that being thin as a woman, uh, helps you to become rich in a way that it maybe doesn't for men. 

COMMERCIAL CLIPS: Do you think that women are aware of this on some level? 

ALICE FULWOOD: Yeah, I think this is a sort of great point because I, it's obviously, you know, sort of a chicken and egg situation, well, sort of, why do beauty standards exist and why are they potentially enforced by the market?

And I think there sort of is an underlying awareness. There is a sense that people that do well on TikTok and social media, they tend to be, you know, thin and attractive. People who do well in the workplace. But I also think there is sort of an element of you either don't sort of fully recognize, or in some ways potentially sort of self deceive.

You know, a lot of the time when you talk to women about whether they want to be thin or whether they want to look a certain way, people say [01:29:00] that they're sort of trying to lose weight for sort of wellness and health. 

CLIP: The Daily Habits of Thin People. If you are solely focused on thinness, Losing weight and being skinny, you're not going to be successful in the long term.

As I always say, when you focus on health, you lose weight as a side effect, but when you focus on weight loss, you lose health as a side effect. 

COMMERCIAL CLIPS: I was thinking about how my friends and I, when we're talking about like, like expensive Pilates classes. We'll refer to it as like, it's an investment in me. And it's not like we're following that down the rabbit hole and being like, and next year I'm going to get paid more.

But there is the language of economics when we're talking about like, Oh, it's expensive. It's 50 bucks, but I'm going to do it. 

ALICE FULWOOD: It is interesting. I did start to think about it in that sort of, you know, okay, you're almost making like a capital investment in yourself that will pay dividends and you don't really know sort of when or sort of what those might be.

But I think sort of in general. the sort of that this way of thinking about the issue actually sort of makes a lot of sense. 

COMMERCIAL CLIPS: [01:30:00] All right. So you saw this chart and you decided to report on whether there is an economic penalty for not being thin. Where did you start? 

ALICE FULWOOD: I mean, the sort of first thing I did was I went off and I sort of looked to see whether this was true in other countries.

This sort of trend seems to hold in wealthy developed countries. It's very different in developing countries. countries, but it seems to hold sort of across the Western world. And then I started thinking about sort of the reasons that people often think that there might be this sort of negative relationship between weight and income because that was not a new piece of information.

So that's something that I think a lot of people are aware of. The sort of novel thing was that it only seems to hold true for women. And from that, sort of point I felt like a lot of the explanations people had sort of come up with in the past for why there might be a negative relationship between income and weight.

Um, you know, they didn't tell the whole story. So often they were things like, you know, if you live in poverty, it's very difficult [01:31:00] to carve out time to go to the gym. It's sometimes you don't have access to sort of fresh fruits and vegetables. It's sort of difficult to, to eat well. And I think all of those things are true, but they can't be.

be the sort of main reason for this correlation, because they would hold true sort of equally for men and women. So there sort of has to be something else going on here. Um, and then I sort of started reading a lot of the academic literature on, you know, in the workplace, if you look at women's wages and you sort of control for things like their degrees that they've taken, so your bachelor's, master's, doctoral degrees, if you control for the types of jobs they do, all these kinds of things, is there still a sort of wage penalty for Uh, BMI or weight, um, and a lot of the, the literature does sort of back that up.

Uh, there does seem to be a penalty for overweight women, uh, particularly highly educated overweight women in the workplace.

COMMERCIAL CLIPS: When we talk about, for example, like the gender wage gap, we can say, Oh, for every dollar that a man earns, a woman might be earning [01:32:00] somewhere between 60 and 80 cents. And those stats get like pretty firmly entrenched over time. Were you able to figure out if thin women make more money over time than women in bigger bodies.

Could, could you tell us how much more money we're talking about or what that adds up to? 

ALICE FULWOOD: Yeah, I didn't actually come up with a sort of neat as, uh, as neat a, uh, stat as the sort of like 80 cents on the dollar. Um, but the figure that I put in the piece at least was that for an overweight or obese woman, so someone with a BMI of above 30.

It is roughly as beneficial for her to lose 50, 60 pounds, um, in weight to get her BMI back into that normal range, uh, as it would be to do an additional year of education. So about sort of half as valuable as getting a master's degree. Wow. That seems to be the magnitude of the, um, of the penalty. 

COMMERCIAL CLIPS: And, and what you're saying is [01:33:00] the same does not seem to hold true for men.

ALICE FULWOOD: I think we have to be a sort of bit careful about that because there, there are papers that say that sort of, uh, especially for sort of very, very overweight men, there are penalties in the workplace. I'm sort of willing to believe that sort of men are discriminated against, especially if they're sort of very overweight, um, as well.

But I think that the distinguishing thing for me about how this seems to affect women is that, um, It seems to be sort of very pervasive across all kinds of careers at every level of income. The relationship is so strong, um, that it shows up at this macro level. That you can sort of look at this chart of sort of generalized population of women, um, and, and you can still see this sort of very strong relationship.

DEEPER DIVE C: BODY NEUTRALITY

JAY TOMLINSON - HOST, BEST OF THE LEFT: You've reached a deeper dive section C body neutrality.

The world after Ozempic Part 5 - The Gray Area - Air Date 5-13-24

SEAN ILLING - HOST, THE GRAY AREA: Well, I think this relates to another tension you deal with in the book, which is that, you know, on the one hand, the body positivity movement.

Has been good in lots of ways. We've shattered stigmas and around weight and all of that, [01:34:00] but on the other hand, it's just a biological fact that carrying too much weight leads to bad health outcomes. And if we can conquer that, that would be a pure unmitigated good. Can we embrace this medical revolution without unwinding some of that cultural progress we've made, which is connected to these issues with, with eating disorders and the like?

JOHANN HARI: I really agonized over this question, and one of the people who really helped me to understand it and think it through was an amazing woman named Shelley Bovey. He's basically the person who introduced body positivity into Britain. So, She grew up in a working class town in Wales, where she was, as she describes herself, the only fat girl in her school.

And one day when she was 11, her teacher said to her, Bovey, stay behind after class. So she stayed behind, thinking, what have I done wrong? And the teacher said to her, You're much too fat, it's disgusting, go see the school nurse, she'll sort you out. So kind of [01:35:00] shaken, Shelley went to see the school nurse.

The school nurse said, why are you here? She said, well, the teacher says I'm too fat. She said, take off your clothes, I'm going to inspect you. She took off her clothes, and the, School nurse said, this is disgusting. You're a greedy pig. Stop eating so much. Just berated her. So Shelly left and her whole life she was soaking up abuse and insults like this.

And it made her hate herself and hate her body. In fact, she, she told me she hadn't ever looked at her body when she was showering. Even she'd never looked at her body naked because she hated it so much. And then she learned about the Body Positivity Movement, which had obviously begun in the U. S., that was saying, this is just a form of bigotry and bullying and cruelty and we don't have to take this shit.

And Shelley introduced it to Britain, right? I heard of her for the first time, I remember seeing her on TV when I was 10 years old, when she was presented as this kind of laughable madwoman. And she really pioneered opposing stigma and she remains proud to this day of the work she did, rightly so in my view.

But Shelly also faced another problem. She was extremely obese and she was finding it hard to walk. [01:36:00] In fact, she was in a wheelchair a lot of the time and her doctor told her she had heart problems. And she really began to wrestle with, well, am I betraying my body positivity if I talk about the harm caused by obesity to my health?

And she began to say, well, what kind of body positivity would it be that would judge me for keeping my body alive? That doesn't seem like body positivity to me. She lost an enormous amount of weight through calorie restriction and exercise and became much healthier and she stands by everything She said about stigma, but she said it's not either or It's not either you're against stigma or you're in favor of reducing obesity where possible It's both and if you love someone who's obese You want to protect them from cruelty shaming and bullying and if possible you want to protect them from diabetes heart disease dementia So to me, there's no playoff You Between those two.

But I think your question goes to a wider and deeper problem. And actually, weirdly, of all the time [01:37:00] I spent writing the book, the worst moment for me was what might seem like a small moment in some ways. But I've got a niece called Erin. She's the baby in my family. She's the only girl in her generation.

And she's 19 now. But last year, when I first started taking the drugs, we were FaceTiming. And she was kind of teasing me about how good I look. She said, I didn't know you had a neck. I didn't know you had a jaw before. And she said, I was kind of laughing and we were, she was saying, Oh, you look really good.

And then she looked down and she said, well, you buy me some Ozempic. And I thought she was kidding. And I laughed. She's a perfectly healthy weight. And then I realized she wasn't joking. And I thought, Oh shit, have I undercut here all the advice I've been giving her since she was a little girl. And I think there's sort of two quite different things here, but they're very hard to separate culturally.

There's overweight and obese people who are taking these drugs to be a healthy weight. And then there are people who are already a healthy weight or indeed skinny. who are taking these drugs to be very thin. They're in fact incurring health risks in the opposite direction. Like 

SEAN ILLING - HOST, THE GRAY AREA: the actors at the party.[01:38:00] 

JOHANN HARI: Exactly. None of them were fat to start with, right? And again, we can look at historical examples. Between 1966 and 1968, the number of young women who felt they were too fat exploded. You think that's really weird? What happened between 1966 and 1968? It's a very short period. What happened is a new model known as Twiggy was presented as the face of beauty of the 60s.

Now it's not Twiggy's fault. She was naturally skinny. Very few girls look like Twiggy, right? A new thinner body norm was created and that made more girls hate their bodies. I'm very worried about that dynamic. I think that is in fact happening now. And it's not like young girls didn't already have a nightmare set of pressures on them.

Of course they did.

Body Neutrality Part 2 - What The Actual Fork Podcast - Air Date 8-11-23

SAMMY PREVITE - HOST, WHAT THE ACTUAL FORK: so obviously there's so much nuance to this conversation because you wrote a book on it. So there's a lot of density to it. But for those listening who are like, that sounds like a dream to not spiral and spend so much time hating my body, obsessing about my body.

I wish I could just be neutral. What are some of the biggest takeaways from your [01:39:00] book or tips or places for listeners to start with body neutrality? 

JESSI KNEELAND: So the first thing I think is really important, and this is where I start with every new coaching client, is we talk about how your body image issues exist for a reason.

Like there was. a very good reason that you developed, uh, this relationship where you gave your body so much power or it ended up with so much power over you. Um, a lot of it is just a, a really clever sort of adaptive coping strategy to solve something at some point, or offer you something that you needed, or at least try to do.

Try to offer you something that you needed at the time that it developed. And so what I think happens is a lot of people come in for this kind of coaching. They're like, I don't even know why I care about this. Like, I shouldn't care about this. I just can't stop obsessing over it. And I'm like, step one.

Yes, you should be obsessing over it. It served a purpose. Let's just find out what it is. That's all. Because if we treat it like the enemy, then it's really no different than [01:40:00] treating our bodies like the enemy. And there's very little wiggle room there. You can't do a whole lot. So the first step is to acknowledge that you have these body magicians for a reason and to kind of, kind of a weird way of putting it maybe, but like to give them the respect they deserve because they helped you or tried to help you survive in some way.

And then once you Come from that place. There's a lot more compassion, a lot more, um, like for yourself, you know, self compassion. There's a lot more curiosity that can enter the conversation. Like, instead of being like, why am I like this? I'm so broken, like, and so weak and, you know, whatever. Irrational.

You can start going, oh, I wonder why I might have developed this. I wonder what problem my body image issues might be. be trying to solve for me. I wonder what needs my body image issues might be trying to get met for me. Like, when you can approach it that way, a whole world of interesting stuff opens up.

That's where your next step has to live. Like, you have to be able to start looking in the space of, [01:41:00] how are you trying to help me? Rather than, why are you here, you big jerk, I hate you. Like, it just doesn't work to do the work from that place, you know? So I would say the first big takeaway is really acknowledging that they serve a purpose.

Um, they showed up for a reason and they're trying to help or protect you. And then the next step is to figure out how. How they're helping you specifically. Cause there's so many ways that this can be. For example, like, if you, uh, became obsessed with, you know, dieting, counting calories, that kind of thing.

It could have been a strategy to distract yourself from pain or fear or uncertainty at a certain age that just stuck. It could be a way of, okay, if I can lose weight, I'll be accepted and, and feel like a sense of belonging and value. Great. That's like a whole strategy on its own to solve the problem of not feeling like you belong or not feeling like you have value.

There's so many things that could be going on, but until you identify it, you don't stand a single chance of actually being able to heal it, which is why so much of body positivity stuff, [01:42:00] like, you know, the goal may have felt unrealistic, but also there was no strategy to get there. It was like, you should love yourself.

Okay, go ahead. Um, and this is like a lot more practical and I'm so passionate about helping it feel practical so that people don't just feel overwhelmed by the process, like, almost like it's a choice. I just have to stop hating my body. Because it's not a choice. The thing serves a purpose. It's not going to go away until it no longer has a purpose.

So that's the work. 

JENNA WERNER - HOST, WHAT THE ACTUAL FORK: I love how you just framed that and I feel like it just reminds me of to put in like a Sammy analogy like it reminds me of like whack a mole right like we like identify why the mole is popping up like it's just going to keep popping up elsewhere so it's like instead of feeling the way I'm interpreting it is instead of feeling the guilt or shame or fear or embarrassment or whatever Feeling that you're feeling around your body or the coping mechanism that you used, it's like giving [01:43:00] it purpose almost.

Am I taking that the right way? 

JESSI KNEELAND: Yeah. I mean, I don't even know that we're giving it purpose. It has a purpose. Like we're just trying to identify what that purpose is. And obviously most people, because our lived experiences are so complex, the society we live in, there's so many factors happening. It's never this straightforward, but if it were as simple as just You developed an obsession with looking good in order to, um, make people be nice to you.

Let's say it was that, right? It's like a safety mechanism. You want kindness, you want connection. So you become obsessed with how you look in the hopes that looking a certain way will earn you those things. Well, you're definitely going to get really mad at your body. And feel really disappointed and betrayed by your body anytime someone's not nice to you.

Right. But the truth is your body just does not have the power to make people be nice to you. It was an impossible job you gave it. So it's no wonder then that over time with that kind of subconscious strategy, you end up. [01:44:00] Freaking hating your body. You're like, how could you do this to me? I gave you one job.

And it's like, I literally, I can't, like, no matter how thin you are, no matter how conventionally, like, you, it just doesn't have that power. And so it makes a lot of sense that you would end up, it would like, Maybe start as a coping strategy on a simple level and then get more and more of that hatred and baggage over time because you feel like it's letting you down over and over and over.

But through body neutrality, once you identify that, then you can start creating a different strategy for, uh, perhaps not making people be nice to you because that's not like a super, uh, possible, uh, strategy to create, but you could at least say like, I would like to build resilience when people are not nice to me.

For example, I would like to have built up the skill of handling that in a way that doesn't totally knock me down or make me question myself. And also, hey, I want more connection. That was another piece of it. I'm going to go create the skill [01:45:00] set or fear facing or whatever it is I need to do to have more abundant connection in my life.

Let's say you get to the You know, you're like moving into that at a certain point. You're never like, Oh, Hey, my body is great. Now you just stop thinking about it because when your needs are actually getting met, that you were hoping your body would meet for you, then your body doesn't have to meet them for you.

And it just fades. So that's when I say it doesn't have power anymore. Like on the other side of this body neutrality journey, it's really just the most anticlimactic ending of any story. Like all of my clients are like, Oh, you know what? I haven't even thought about that for months. I'm like, Did you ever think that would be possible and they're like no weird, but it's not like this big reveal like I feel Neutral all of a sudden it's more like I've just been thinking about other stuff and that hasn't crept in and this is why it's cuz Of course, it's gonna be a constant source of like obsessive thoughts when you have given your body a task to like Make your life be okay.

[01:46:00] 

The world after Ozempic Part 7 - The Gray Area - Air Date 5-13-24

SEAN ILLING - HOST, THE GRAY AREA: A huge part of the book is your own experimentation with Ozimbic and, you know, look, I should stress that your experience is your experience. It's a sample size of one. Uh, it may not be the experience someone else will have. Um, but it nevertheless is, Relevant. How long have you been taking it? 

JOHANN HARI: It's been a year and four months now.

SEAN ILLING - HOST, THE GRAY AREA: And how much weight have you lost? 

JOHANN HARI: 42 pounds. I went from being 33 percent body fat to 22 percent body fat. It's an enormous. 

SEAN ILLING - HOST, THE GRAY AREA: And one thing you talk about in the book is feeling not quite depressed, but feeling emotionally dulled. I think it's the phrase that you use in the book. How would you explain that distinction between not feeling depressed, but feeling emotionally dulled?

Because they're certainly similar. 

JOHANN HARI: Yeah, you know, it's funny, my friend Danielle was pregnant the first six months I was taking the drugs and every time I saw her it was like we were on reverse trajectories, like she was swelling and I was shrinking. And I remember saying to her one day, this is really weird, I'm getting what I [01:47:00] want, I'm losing loads of weight, but I don't actually feel better.

And there seems to be, although there's much debate about this, a significant minority of people who experience, you know, Something like that. And we know with a parallel bariatric surgery, which is the best form of medical assisted weight loss we've had up to now, after you have bariatric surgery, in fact, your suicide risk almost quadruples.

And 17 percent of people who have that surgery have to have inpatient psychiatric care afterwards. And I'll show you why that might be. So obviously one potential theory is the brain effects we've been talking about and other brain effects. I actually think for me, it was something different. Seven months into taking these drugs, I was in Las Vegas, I was researching for a different book I'm writing, and I went, really on autopilot, I went to a branch of KFC, I've been to a thousand times, the one on West Sahara, and I went in and I ordered a bucket of fried chicken, which is what I would have ordered a year before, and I ate a chicken drumstick, And I suddenly thought, shit, I can't eat the rest of [01:48:00] this.

And I really felt like an epiphany. Oh, I'm just going to have to feel bad. Right. And I realized, and there's a lot of evidence for this. What these drugs do is they interrupt your eating patterns. And one of the consequences of that for many people. Is they bring to the surface the deep underlying psychological factors that make us ovary in the first place.

So for me, I realize, you know, I had been using food to manage my emotions and calm myself down, going right back to when I was a very small child. I grew up in a family where there's a lot of addiction and mental illness. And one of the ways I dealt with that was just by numbing myself with food. And you can't do that Ozempic.

For a lot of people, that transition is very bumpy and some people never make that transition. They just remain feeling really bad. 

SEAN ILLING - HOST, THE GRAY AREA: Are you scared to stop using it? 

JOHANN HARI: I'm not going to stop using it. And for me, um, it's for a very simple reason. So I actually think some of the best evidence for what these drugs will do to us, we can get from looking at this parallel.

Because up to now, it's been extremely hard to lose huge amounts of weight and keep it off. I mean, some people can do [01:49:00] it purely by calorie restriction and exercise, but that's actually surprisingly rare. So we've got good evidence from bariatric surgery. And as we know, bariatric surgery is a horrible, horrifying thing.

Grizzly operation. One in a thousand people die in the operation. It's no joke. But if you have bariatric surgery and reverse your obesity, the benefits are absolutely staggering. In the years that follow, you are 56 percent less likely to die of a heart attack. 60 percent less likely to die of cancer, 92 percent less likely to die of diabetes related causes.

In fact, it's so good for you, you're 40 percent less likely to die of any cause at all. And we now know the drugs are moving us in a similar direction alongside some risks. And for me, that just decided it, right? So many men in my family have heart problems. I've been worried about that all my life. So I'm not going to stop taking it.

If. We ran out of supply, which I really worry about, not only that I would regain the weight and regain the heart risk, but I actually may gain more weight than I had [01:50:00] before. So yeah, I worry about that. 

SEAN ILLING - HOST, THE GRAY AREA: Are there any other potential downsides that researchers are thinking about? 

JOHANN HARI: When you talk about the risks, a lot of the scientists say, absolutely, rightly, actually, we've got quite a lot of evidence here on these drugs.

Diabetics have been taking them for 18 years. So they say, look, If they cause some horrific short to medium term effect, it would have shown up in the diabetics by now. If it made you grow horns, the diabetics would have horns, right? And that's a good point, and it should give us some sense of security.

But equally, some other scientists said, Okay, if we're going to base our confidence that these drugs are safe on the diabetics, let's really dig into the data around the diabetics. So, for example, there's a brilliant French scientist called Jean Luc Failly, and what he looked at was a very large group of diabetics who use these drugs, and then he looked at a comparable group of diabetics who were very similar in every other way but didn't use these drugs.

And what him and his colleagues calculated is these drugs, if they're right, [01:51:00] Increase your risk of thyroid cancer by between 50 to 75 percent. 

SEAN ILLING - HOST, THE GRAY AREA: That's significant. 

JOHANN HARI: Yeah, as he said to me, it's important to understand what that doesn't mean. That doesn't mean if you take the drug, you have a 50 to 75 percent chance of getting thyroid cancer.

If that was the case, we'd be having bonfires of Ozempic all over the world. What it means is, if you take the drug, whatever, if he's right, and this is highly disputed, If you take the drug, whatever your thyroid cancer risk was at the start, that risk will increase by between 50 to 75 percent. Now, other people say thyroid cancer is relatively rare, 1.

2 percent of people get it in their life, 82 percent of people survive. Nonetheless, I was extremely alarmed by that. Against that, lots of other scientists said to me, well look, even if that's right, you've got to compare it to what would happen to your cancer risk if you just remain obese, right? And actually.

I was stunned by the evidence about the cancer risk just from being obese. One of the biggest [01:52:00] preventable causes of cancer in the United States and Britain is obesity. So, the thing I think we have to do, you have to look at two competing sets of risks here. The risks of obesity and the risks of these drugs.

And there isn't a pat answer to that. It's a weird thing to start the book so divided and then go on this huge journey and read, you know, hundreds and hundreds of studies and interview so many experts. And here I am at the end of it. I know much more about the benefits and risks and what it's going to do to the culture.

But to be honest with you, Sean, and this hasn't happened to me with my books before, I'm still really, really conflicted. I don't really know. 

Closing Credits

JAY TOMLINSON - HOST, BEST OF THE LEFT: That's going to be it for today. As always, keep the comments coming in. I would love to hear your thoughts or questions about today's topic or anything else. You can leave us a voicemail or send us a text at 202-999-3991, or simply email me to [email protected]. The additional sections of the show included clips from The Majority Report, Today, Explained, The Gray Area, [01:53:00] and What the Actual Fork. Further details are in the show notes. 

Thanks to everyone for listening. Thanks to Deon Clark and Erin Clayton for their research work for the show and participation in our bonus episodes. Thanks to our Transcriptionist Quartet, Ken, Brian, Ben, and Andrew for their volunteer work helping put our transcripts together. Thanks to Amanda Hoffman for all of her work behind the scenes and her bonus show co-hosting. And thanks to those who already support the show by becoming a member or purchasing gift memberships. You can join them by signing up today at bestoftheleft.com/support, through our Patreon page, or from right inside the Apple podcast app. Membership is how you get instant access to our incredibly good and often funny weekly bonus episodes, in addition to there being no ads and chapter markers in all of our regular episodes, all through your regular podcast player. You'll find that link in the show notes, along with the link to join our Discord community, where you can also continue the discussion. 

So, coming to you from far outside the conventional wisdom of Washington DC, my name is Jay, and this has been the [01:54:00] Best of the Left podcast coming to you twice weekly, thanks entirely to the members and donors to the show, from bestoftheleft.com.