I OPENED MY EYES and immediately felt that something was off. Thwacking my alarm clock into silence, I lay there for five minutes, trying to figure out what it was. It was two days since I had started taking Ozempic. I felt very mildly nauseous, but it was not severe – if it had happened on a normal day, it wouldn’t have stopped me from doing anything. So that wasn’t it. It took me a while to realise what it was. I always wake up ravenously hungry, but on that morning, I had no appetite at all. It was gone.
I got out of bed and, on autopilot, went through my normal morning routine. I left my flat and went to a local cafe run by a Brazilian woman named Tatiana, where my order is always the same: a large toasted bread roll, filled with chicken and mayonnaise. As I sat there reading the newspapers, the food was placed in front of me, and I looked at it. I felt like I was looking at a block of wood. I took a bite. It tasted fine. Normal.
I took three or four more bites, and I felt full. I left almost all of it on the plate. As I hurried out, Tatiana called after me, ‘Are you sick?’
I went to my office and wrote for three hours. Normally, by noon, I would have a snack, something small and sugary, and then at about 1 p.m. I would go down the street to a local Turkish cafe for lunch. It got to 2 p.m. and I wasn’t hungry. Again, my sense of routine kicked in, and again, I went to the cafe and asked for my standard order, a large Mediterranean lamb with rice and bread. I managed to eat a third of it. It seemed to me for the first time to be incredibly salty, like I was drinking seawater.
I wrote some more, and at 7 p.m. I left my office to go and meet a friend in Camden Market, one of my favourite parts of London. We walked between the stalls, staring at food from every part of the world. Normally, I could stuff my face from three different stalls, but that night, I had no hunger. I couldn’t even manage a few mouthfuls. I went home, feeling exhausted, and went to sleep at the unprecedentedly early time of 9 p.m.
As that first week passed, it felt like the shutters had come down on my appetite, and now only tiny peeks of light could get through. I was about 80 per cent less hungry than I normally am. The sense of mild nausea kept stirring and passing.
When I got on the bus or in a car, I felt a kind of exaggerated travel sickness. Whenever I ate, I became full startlingly fast. The best way I can describe it is to ask you to imagine that you have just eaten a full Christmas dinner with all the trimmings, and then somebody popped up and offered you a whole new meal to get started on.
Some people say Ozempic makes them find food disgusting. To me, it made food, beyond small quantities, feel unfeasible.
On the fifth night, a friend came by to watch a movie, and we flicked through Uber Eats. The app suggested all my usual haunts. I realised I couldn’t eat any of this food now. Instead, she got a kebab, and I had a bowl of vegetable soup. On the sixth day, I took my godsons out, and they wanted to go into McDonald’s. When they got Happy Meals and I got nothing at all, one of them said suspiciously: ‘Who are you and what have you done with Johann Hari?’
I wanted to understand what was happening to my body.
I figured that the best people to educate me were the scientists who made the key discoveries that led to the development of Ozempic and other new weight-loss drugs. So I began to track many of them down and interview them, along with many other key scientists working in the field. Almost all of them have received funding from the pharmaceutical companies that now profit from these drugs, and we should bear that in mind as we hear what they say. They taught me that these extraordinary effects were coming from manipulating a tiny hormone named GLP-1 that exists in my gut and my brain, and in yours.
Author of ‘Magic Pill’ Johann Hari.
Throughout my first six months on Ozempic, my friend Danielle was pregnant, and as her pregnancy developed, she would say it was like we were on opposite trajectories. While her belly swelled, mine was shrivelling. I lost a stone and a half.
On the BMI chart, I went from obese (marked in a bright red) to the middle of overweight (yellow), and as the months passed and I lost another stone, I got to the upper end of a healthy weight (depicted in a soothing green). My body fat percentage fell from 32 per cent to 22 per cent. It was the fastest and most dramatic weight loss of my life.
I felt lighter and quicker on my feet, and that boosted my confidence enough that I started to strut a little. People began to notice. ‘Wow, you’re losing weight,’ acquaintances said when they saw me in the street. One of my godsons said: ‘Hey, Johann, I didn’t know you had a neck!’ In the third month, my neighbour’s hot gardener hit on me and asked for my phone number.
I realised it was exactly what I had wanted, and I was thrilled (especially about the gardener). I had told myself going in that I was concerned primarily about my health – but I now saw that a desire to look better had been a big driver for me all along. I felt genuinely grateful as I interviewed the scientists who’d developed this drug. While they told me about their discoveries, I could literally feel the effects playing out by placing my hand on my stomach.
When I was talking with one of the scientists who’d worked on GLP-1 in a cafe in London and listening to her explain the drug’s potentially revolutionary effects, I watched people walking past us on the busy street. Most of them had not heard about Ozempic or other weight-loss drugs yet. Many of them were overweight or obese, and I thought: You don’t know what’s about to happen. You don’t know how this could be about to help you change
But I was surprised to notice that, at the same time, I also felt disconcerted and out of sorts a lot of the time. I wasn’t feeling an urge to recommend Ozempic to other people. In fact, I felt pensive, and tense. I didn’t understand it. I’d got what I wanted – a boost to my health, and a boost to my self esteem.
So why did I still feel so ambivalent about it? At first, I thought it was because of the side effects, which were surprisingly persistent. My nausea, which had been gentle at first, would suddenly surge at random moments and leave me feeling like I was on a boat in the middle of a storm. With Ozempic or Wegovy, everyone starts by taking a dose of 0.25mg a week, then after a month they go up to 0.5mg, and then a month later to a full 1mg. (Some people go to even higher doses after that.)
Every time I increased my dose, I felt significantly worse for at least a week. One evening I found myself dry-heaving next to a pot plant in Zurich airport while a Swiss woman, who clearly thought I was drunk, gave me dirty looks. This sickness was intermittent, and most of the time, I didn’t feel it at all, but when it came, it was horrible. It occurred alongside other strange effects.
Sometimes I would lie awake at night and find myself uncontrollably burping. At its worst, I was belching up bile and thought I was going to throw up. I also became constipated.
The grimmest side effects for me lay elsewhere. For many people, when they take these drugs, their resting heart rate increases. I would sit reading a book, or lie in bed, and feel my heart racing. My mind often interpreted this as anxiety and would start racing to match my elevated heartbeat. I had to cut back on caffeine to counteract this effect, and even that didn’t totally solve the problem – invariably, whenever I increased my dose, I felt anxious for at least a week, and even after that, I felt like I could more easily become anxious than before.
In addition, in the first week after increasing my dose, around late afternoon or early evening, I would persistently feel lightheaded and a little dizzy. I discussed this with my doctor and he said that this often happens when your calorie consumption drops significantly – your body isn’t getting its usual fuel source, so it’s confused, and the tank seems to be empty. Even after I got used to it, this feeling never entirely went away.
For between 5 and 10 per cent of people who take these drugs, the side effects are so extreme that they conclude it’s not worth continuing. I spoke with a woman in Vermont named Sunny Naughton, who is four foot ten, and when she hit 190 pounds (13.6 stone), she realised her weight was spiralling out of control. So in 2018, she sought out – in desperation – Saxenda, an early GLP-1 agonist drug that had to be injected daily. In the first two months, she lost more than thirty pounds, but, she told me, ‘I was sick all the time. Stomach cramps. Vomiting.’ She found herself burping uncontrollably, with ‘weird flavours’, and ‘there’s a metallic taste in your mouth all the time’.
At work, she would end up rolling on the floor beneath her desk with stomach cramps so crippling that her colleague would have to drive her home. ‘It just felt like someone was digging in and twisting your insides really tightly,’ she said.
It was so unlike anything she had experienced before that she felt ‘an alien had gone into my stomach and was doing something in my body … It felt like there was something living in my stomach that was tearing everything up and getting rid of whatever was in there, and then draining my body of energy.’ For eight months, Sunny made herself endure it because the weight loss was so dramatic.
But ‘it was the worst physical illness that I ever felt … From one to ten, it was fifty. It was just awful. And everyone around me was like, “Should you keep doing this?”
One day, she accidentally injected herself with a double dose. ‘I was supposed to teach a class two days later, and I was so sick, I couldn’t get out of bed. I was sweating. I was nauseous. I got myself into the bathtub. I was almost incoherent. I called my mother and said,
“I might have to go to the ER.” This medicine made me so sick.”
Not long afterwards, she told herself ‘I need to live a natural life’ and threw away her remaining pens. She rapidly put most of the weight back on, as does almost everyone who comes off these drugs, but the alien also seemed to leave her body. Yet I didn’t feel that my ambivalence could be fully explained by the side effects I was experiencing. Something more was going on, though it took me time to figure out what it was. Every time I upped my dose, the side effects got worse, but then they mostly eased off – so I felt confident that if I powered through them, they would, over time, diminish to little or nothing.
So why didn’t I feel as happy as I should? Why – in addition to moments of glee – did I feel moments of deep worry about what I was doing? Why was I looking a gift horse – effortless weight loss, the dream of humans down the ages – in the mouth? I began to see the answer when I decided to go right back to where this story, for me, began. I asked: Why did I get fat in the first place? And more importantly, why did we – as a culture – get so much fatter, in a very short period of time?
I learned that we can’t understand these drugs unless we first take a moment to understand the forces that made so many of us need them in the first place. It was only when I studied this question that some of the mysteries around these drugs began to be resolved.
This is an extract from Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs by Johann Hari, published by Bloomsbury, out now: $34.99
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