0:00

Wait, have I ever told you about Steakhouse or

0:02

Gay Bar? Oh, pffft. Hang on. I

0:04

want to look it up just because it's... Yep. Is it? Here

0:06

we go. What does it have? Uh, Magic

0:08

Castle. Oh, it's gotta be Steakhouse. Yeah,

0:10

correct. Stockyards.

0:13

Oh, that's a gay bar. Incorrect, Steakhouse.

0:16

What? Excelsior.

0:19

That's either a bad Steakhouse

0:20

or a bad gay bar. Oh, gay bar. Fuck

0:22

yes. Oh, Juicy Lucy's. That's a Steakhouse.

0:24

Thick cock in my asshole. Oh, Steakhouse. Wow.

0:28

Charlie Brown's. I'm

0:30

not touching that. I'm not touching that. Let's

0:32

move on.

0:33

It was a Steakhouse. Aubrey,

0:35

why can't we do a fun episode? Why can't we just do this

0:37

for an hour instead of talking about Ozempic?

0:50

Welcome to Maintenance Phase, the podcast

0:53

that works in the short term but has never been tested

0:55

for more than two years. That's

0:59

kind of true, actually, accidentally. That

1:01

is a pretty accurate thing to

1:03

say about our podcast. It hasn't been tested

1:06

in long term. People go back to where they were. I'm

1:09

Michael Hopps. I'm Aubrey Gordon. If

1:11

you would like to support the show, you can do that at patreon.com

1:14

slash maintenance phase or you can subscribe on

1:17

Apple Podcasts. It's the same audio content.

1:20

Michael.

1:20

Aubrey, let's start with your nervousness.

1:24

My nervousness. We're going to talk about

1:26

it. Your complicated feelings. So

1:29

today

1:29

we are talking about Ozempic, Wegovy,

1:33

and their active ingredient,

1:35

semaglutide. Wait, I thought it was semaglutide.

1:38

I thought it was too. And then I heard a million

1:40

doctors say semaglutide. Semaglutide?

1:43

Doesn't that seem wrong? Yeah,

1:45

but sure. I mean, they're made up words anyway. And then on

1:47

some level, every

1:48

word is made up. So whatever. Well, listen, from

1:50

Mr. Denowment. Yeah.

1:55

It's a safe space for

1:57

creative pronunciation. The thing is.

1:59

much of the fucking feedback to this show

2:02

is about my pronunciations of words.

2:04

No one ever wants to give me feedback on like

2:06

the content of the show. Michael.

2:12

This episode is actually a little different than how we usually

2:14

do things. I'm gonna walk

2:16

us through the drug and its origins.

2:19

You're gonna walk us through the clinical

2:22

trials into this

2:24

sort of class of drugs. And

2:27

then we're gonna talk about what

2:29

I think is the thorniest part of all of this,

2:31

the discourse around those drugs.

2:34

The discourse. This is a big

2:36

one. It feels like a really high

2:38

stakes conversation. So I'm curious

2:41

about for you, what

2:44

are some of the things that you're sort of like bringing to

2:46

that? I think my weirdness with this episode

2:48

is the culmination of my

2:51

weirdness with every episode of the show

2:53

where both of us are interested

2:55

in

2:56

public health, in the kinds

2:58

of things that are prescribed, how drugs

3:00

get approved, what they mean societally.

3:03

Whereas because Americans

3:06

have been trained by health media

3:08

for our entire lives to see everything

3:10

through an individualistic lens, we

3:13

are going to be spending basically this entire

3:15

episode talking about the narratives

3:18

around Ozempic and Wigovi.

3:21

We have this new generation

3:23

of weight loss drugs that as of now appear

3:25

to deliver much more weight loss than

3:28

any previous generation of weight loss drugs. And

3:30

we've had this immediate huge

3:33

wave of media being like, is this

3:35

the end of obesity? Does this invalidate

3:38

body positivity? And like being

3:41

a dietician in the age of Ozempic

3:43

and all this just insufferable

3:45

kind of end point prediction

3:47

stuff based on very little information.

3:50

And what we are interested in

3:52

and like what we have been talking about behind

3:54

the scenes nonstop for the last like couple months

3:57

is like how poisonous.

4:00

these narratives are. But what

4:03

people tend to hear is like individual health

4:05

advice. Mike and Aubrey think you shouldn't take

4:07

osempic. Or Mike and Aubrey think you should take

4:09

osempic. And like, that is

4:11

just not something that we are interested in. We've

4:14

said on the show before that if you

4:16

wanna lose weight and you wanna do keto or a

4:18

cleanse,

4:19

you can do that. We don't have opinions

4:21

on that. And if people

4:23

don't want to do that,

4:25

they also shouldn't be pressured to do

4:27

so. And I just know that this is like a big

4:29

topic

4:30

for a lot of people, right?

4:32

For me included both because I'm engaging

4:35

with all of this media and fat people writ large

4:37

are engaging with all this media that is like, could

4:40

we finally be rid of fat people?

4:42

Is like the framing of a lot

4:44

of this conversation. But

4:46

like on top of that, I mean, we've

4:49

talked about this before on the show

4:51

that one of my very best friends was diabetic

4:53

and passed away because she couldn't access

4:56

treatment. Right? That

4:59

was like facilitated by a lot of things. It was

5:01

facilitated by capitalism and anti-blackness

5:03

and transphobia and lots of things. But

5:06

it was also facilitated by our sort

5:08

of cultural disregard and disdain for

5:10

people who have diabetes or any health

5:12

conditions that we deem as quote

5:15

unquote doing it to yourself.

5:16

For many folks, this is like a matter of body

5:19

image, which is really tender and personal.

5:21

For other folks, for people who are on this

5:23

medication for their diabetes, this can very

5:26

literally be a matter of life and death. Right.

5:29

We're talking about like a wide range

5:33

of big feelings and it's

5:35

like understandable, right? This is one of the

5:37

most intense and sort of widespread

5:40

moments of body related discourse we've

5:43

had in quite some time, right? People

5:46

who are taking this for weight loss are

5:48

told that they're sort of taking the easy way out,

5:50

which they absolutely are not. And

5:52

which also presumes that people are fat because

5:54

they don't try hard enough, right? And

5:57

when those people are fat, they're often being forced into.

6:00

this kind of weight loss in order to access

6:02

healthcare treatments, surgeries, other

6:04

like super basic needs, right?

6:06

This just feels like huge that

6:08

way. I think a fun bit for the show

6:10

would be to just do a bunch of table setting

6:13

and like caveats and then just never get to

6:15

the top.

6:16

Another thing we want to say right off

6:18

the bat. We have gotten

6:20

dangerously close to an entire

6:22

piece of caveat. We're working toward

6:24

it. So for part one, we're just

6:26

going to talk about the drug itself. We're going to talk about

6:29

samaglutide, which is the active ingredient

6:31

in Ozempic and Wigovi. Ozempic

6:35

and Wigovi are injections that are produced

6:37

by Novo Nordisk, which is a big pharmaceutical

6:39

company. They're part of a group of

6:41

medications that are called GLP-1

6:45

agonists. GLP-1

6:48

helps regulate our hunger and satiety

6:50

signals and production

6:52

of other hormones like insulin.

6:55

There are other GLP-1 agonists

6:58

sort of on the market, most of them approved

7:00

for diabetes treatment. Those

7:02

are Ribelsus, Manjaro, and there

7:05

are about another dozen that are sort of coming

7:07

down the pipeline. Samaglutide

7:10

has been on the market as a treatment for type 2 diabetes

7:12

in the US since 2018 under the name Ozempic.

7:15

When it's prescribed for weight

7:17

loss, it's prescribed under the name

7:20

Wigovi. It's the same thing.

7:22

They're just different doses. Interestingly,

7:24

the weight loss one requires a slightly

7:26

higher dosage of samaglutide. So

7:30

this drug started to

7:32

be sort of studied, its

7:34

glimmers begin in 1984

7:38

with an endocrinologist at the University

7:40

of Toronto. His name is

7:42

Dr. Daniel Drucker, and

7:45

he discovers a new hormone

7:47

in humans, which is GLP-1.

7:49

It's called glucagon-like

7:52

peptide one. As

7:55

he and other researchers tried to figure out how

7:57

GLP-1 functioned in the human

8:00

body, it starts to show

8:02

real promise as a treatment for type 2

8:04

diabetes, but they have this problem, GLP-1 sort

8:08

of disappears from your

8:10

system very quickly. So

8:13

it makes it really hard to study, much

8:15

less sort of reproduce it. So they start looking

8:18

for alternate sources of GLP-1

8:20

that might last a little longer than the human version,

8:23

right? And that's when

8:25

the Gila monster

8:28

comes in. Mike, have

8:30

you ever heard of the Gila monster?

8:33

Yeah, they're like a cute little lizard. They're

8:35

kind of like a sick, robust

8:38

lizard. I did not know

8:40

about them before this episode. I didn't know

8:42

a thing about them. They're the largest lizard

8:44

in North America. They're almost juicy. I've

8:47

never seen one in real life, but I've seen them in zoo books and

8:49

they're really cute. Well listen, Dr. Drucker

8:51

had one shipped to him in

8:54

Toronto. Okay. Because

8:57

it goes through long periods

8:59

without food and it has the ability

9:01

to slow down its appetite and

9:04

metabolism. Okay. And

9:06

Drucker wanted to know how they were

9:08

able to do that. And he discovers

9:10

that those Gila monsters have genes

9:13

for something called Xtenden-4, which

9:17

when sort of synthesized in a

9:19

lab, eventually became ozmpic.

9:21

How ironic that a sick lizard gave

9:23

us thin women. Interesting.

9:27

So researchers don't totally know

9:29

the mechanism for

9:31

what makes GLP1 agonists

9:34

work the way that they do, but

9:36

we do know that samaglutide

9:39

sort of mimics that GLP1

9:42

hormone that is, again,

9:44

released after you eat. It's part

9:46

of what makes you feel full and

9:48

it's part of what signals your brain that it's

9:51

time to stop eating. And so it works

9:53

by you end up eating less because you just basically

9:55

feel full after each meal.

9:58

Yeah. hormones so

10:00

ordinarily you'd be hungry again two hours

10:02

after breakfast but now it's like three or four hours after breakfast

10:05

and so over the course of a day you just

10:07

end up eating like I don't know 20, 30% less. Yes

10:10

and on top of that it's holding

10:12

that food longer in your stomach so you are

10:15

physically full for a longer period

10:17

of time, right? And

10:19

it's triggering a release of insulin

10:22

and also it may help grow

10:25

pancreatic beta cells which are

10:27

the cells that produce and release insulin.

10:30

So it's not just that it helps

10:32

you release insulin in the short term,

10:34

it's also sort of like building up your ability

10:37

to release insulin in the middle of the term. Oh interesting, so it's like

10:39

flexing a muscle, it's actually like building the muscle that secrete

10:41

insulin. It seems like it, it seems like it might

10:43

be.

10:44

The results for people

10:46

with diabetes in clinical trials

10:49

are really incredible.

10:52

So for diabetic people

10:54

the most important measure of your blood glucose

10:57

is your A1C. That's

10:59

a measure of the amount of hemoglobin

11:01

in your blood that reflects

11:03

your blood glucose levels over the

11:06

last like few months. Most

11:09

guidance for people with type 2 diabetes

11:12

suggests that they should keep

11:13

their A1C below seven to

11:15

minimize

11:15

complications but people

11:17

whose blood sugar isn't well managed can

11:19

have A1Cs that are like 10, 11, 12, 13, like really high. It

11:25

can lead to damage to

11:28

that person's eyes including possible

11:30

blindness, their kidneys including

11:32

kidney failure to their nerves and to

11:34

their heart. With the introduction

11:36

of these GLP1 agonists,

11:39

the results are kind

11:41

of miraculous. There are stories

11:44

that are told about the initial presenting

11:46

of the research on these at the

11:48

American Diabetes Association conference

11:51

and people were weeping and gave

11:53

it a standing ovation because

11:56

what they're talking about is people whose

11:59

A1Cs were... went from like 11 to seven,

12:01

right? From like

12:04

really heightened, urgent risk

12:07

down to like a pretty safe

12:09

range just with this one drug,

12:11

right? I do think one of the fundamental,

12:14

like difficult things to process about

12:17

any of these

12:17

kinds of health conditions is that like we

12:19

all kind of hate pharmaceutical companies

12:21

like under a system of capitalism, it's like

12:23

these are big global profit maximizing

12:25

entities. But then on the other hand, they

12:28

deliver a product that is genuinely life-saving. Yeah.

12:31

We just get kind of weird whenever people like

12:34

praise pharmaceutical companies, I'm like, I don't

12:36

know about that. But then whenever people

12:37

overly criticize pharmaceutical companies, I'm also

12:39

like, I don't know either. So

12:42

in the trials for Ozempic,

12:45

they start noticing pretty significant weight loss

12:48

and researchers start going, well, what if we could just

12:50

use this as a weight loss drug? So

12:53

they created Wegovi, it's the same drug

12:55

at a higher dose. It uses more of

12:57

the active ingredients, samaglitide. And

13:00

because of that, it costs more.

13:03

Diabetic version hovers at around $900 a month. And

13:08

it costs more for weight loss. It costs like $1,300 a month out

13:10

of pocket and

13:12

most insurers do not cover

13:14

it. Not that like my main purpose with the show is to

13:16

like widen the availability of weight loss drugs,

13:18

but like there is something fascinating about

13:21

how we've gotten all this stuff about

13:23

like the obesity epidemic is so bad, it's like killing our

13:25

kids. And then it's like, we get a drug that

13:27

ostensibly treats it

13:28

and they're like, that's too expensive. Yeah, it is

13:30

really wild that this is an issue where we

13:33

like talk out of both

13:35

sides of our mouths constantly

13:37

as a culture. In a lot of ways,

13:39

the experiences of people who are taking Wegovi

13:42

for weight loss or Monjaro or Rebelcis

13:44

or whatever the other ones are that are getting prescribed

13:46

off label, right? That like a lot

13:49

of folks are being told that they're like taking

13:51

the easy way out. Yeah, that's really

13:53

bizarre. That's the kind of rhetoric

13:56

that reveals itself to be not

13:58

about concern. not

14:00

about your health, just about

14:03

I want you to suffer for looking

14:05

the way that you look. We're doing discourse, Aubrey.

14:07

We're adding to the discourse. We're doing discourse and we're not even

14:09

into the discourse section. I know, we haven't. We haven't.

14:12

Michael. I know. I know. I'm

14:14

keeping my discourse powder dry, but

14:16

PBR. We're discoursing. So,

14:19

Wigovi was approved for weight loss

14:21

by the FDA in June 2021, almost

14:26

as soon as Wigovi was approved

14:28

for weight loss, both Wigovi

14:31

and Ozempic went into shortage.

14:34

That impacts both people

14:36

seeking the drug for weight loss and

14:38

the people using it to manage their blood glucose

14:41

for diabetes, because what happens is

14:43

that Wigovi goes into shortage

14:45

first, right? That's the weight loss one.

14:48

And then doctors start prescribing

14:50

Ozempic, the diabetes medication,

14:53

off label to people who want to hurt

14:55

people who lose weight. Right. Then

14:57

that goes into shortage too.

15:01

So, as we record this,

15:03

Wigovi and Ozempic are both in

15:05

shortage, according to the FDA's

15:08

sort of drug shortage database. When

15:10

a drug goes on the FDA's shortage

15:13

list, the FDA then

15:15

allows what are called compounding pharmacies

15:18

to mix up what is basically their own

15:20

version of that drug without

15:23

prior FDA approval or screening.

15:27

When Ozempic and Wigovi

15:29

went into shortage, compounding

15:32

pharmacies across the country started

15:34

compounding their own versions of

15:37

samaglitide. Here's

15:39

the problem. Novo

15:42

Nordisk has patented

15:44

the samaglitide molecule. Oh.

15:47

And only they can produce

15:49

it until 2032. So

15:52

the active ingredient simply

15:54

isn't available to those compounding

15:56

pharmacies. These compounding

15:59

pharmacies are... prescribing something, they're

16:01

calling it samaglitide. Okay.

16:04

It's not ozempic

16:06

and it's not wigovi. It might

16:09

be a watered down dose of

16:11

those things. It could be something

16:13

called samaglitide sodium. Okay.

16:16

It's called samaglitide, but

16:18

it's used in lab animal experiments

16:21

and is not cleared for use in

16:23

humans. Oh, that's like when people were

16:25

taking like horse antibiotics

16:28

that you could buy on Amazon because

16:30

they couldn't get like human antibiotics

16:32

because they're like roughly the same thing. Well, except this

16:34

is not roughly the same thing and is hazardous

16:37

to human's health. Oh. The

16:39

maglitide sodium is not cleared for use in humans

16:41

because it is bad for humans. Oh, fuck.

16:44

And the third option is that it's something else

16:46

entirely. Right. Because this is

16:48

in shortage and because there is less

16:51

FDA oversight. Right. These

16:53

compounding pharmacies are not required to

16:55

tell anyone. Right. And the drugs

16:58

that they are giving people. Right.

17:00

This may sound niche. These compounding

17:02

pharmacies may sound niche. This is

17:04

every web advertisement

17:07

you see that

17:07

says, ozempic for $99 a month or $499 a

17:09

month or

17:13

whatever.

17:14

Oh. All of these, all of the little startups

17:16

that are like, just call

17:17

and talk to a doctor and you'll have it the next day.

17:20

All of that stuff is powered

17:23

by compounding pharmacies.

17:25

No way. So this

17:27

got so bad, the compounding pharmacy

17:30

stuff has gotten so bad that the FDA has issued

17:32

a number of official warnings about this.

17:35

And specifically has warned against buying

17:37

from these startups. This is such a

17:39

bizarre system. It's so

17:42

weird. It's like there's a shortage of this drug,

17:44

so we're just gonna like let people

17:47

buy it from like weird fly-by-night

17:50

carnival barker ass companies selling

17:52

whatever the fuck on the internet. We're not

17:54

gonna regulate it at all. There's not an enforcement

17:56

mechanism beyond these letters so

17:58

far. They're

18:01

not doing more than that yet, at

18:03

least not in reporting. Do you have any

18:05

sense of when this could resolve itself?

18:07

Like as Novo Norda said, that they're massively

18:10

ramping up production? Basically, the goalposts

18:12

just keep getting moved for when the shortage

18:14

will end. You know, I checked a couple months

18:17

ago, it said it would be over by the fall.

18:20

I checked again, it said it would be over by the end of the

18:22

year. Oh, it's like self-driving cars. It's always

18:24

five years away. Right on the horizon.

18:27

As we're talking about these compounding pharmacies,

18:30

big

18:30

weight loss companies are buying

18:33

up these startups.

18:33

Oh. Weight Watchers

18:36

bought one of these and their stock price jumped

18:38

almost 60% in a day. Oh,

18:40

from like 12 cents to like 16 cents or

18:42

something? Yeah, I mean, listen, Weight

18:44

Watchers stock was not doing great, but

18:47

a 60% increase is a 60% increase, you know? They've

18:49

gone from a limp to a gate. And I

18:51

would say because the

18:53

discourse around this is all

18:56

focused on like the real housewives are taking

18:58

it and frivolous rich people and celebrities

19:01

are taking it, it makes the issue

19:03

seem like it isn't incredibly pressing

19:06

and important, particularly

19:08

for people with type two diabetes, particularly

19:11

for people who can't access health care and

19:13

other basic needs at their current weight.

19:16

This is the other thing about this discourse that drives

19:18

me utterly fucking bananas is that

19:21

there's not meaningful acknowledgement

19:23

of the straight up income

19:26

barriers to getting this medication. Yeah,

19:28

yeah, yeah, yeah. That this is a shortage that is largely,

19:31

presumably created by people with

19:33

the disposable income to

19:35

pay out of pocket for

19:37

a weight loss medication that almost no

19:39

insurers are covering. Right. You

19:42

and I have discussed this until we're blue in the face. Like neither

19:44

one of us wants to litigate individual behaviors,

19:47

but like that is one that really

19:50

doesn't sit right with me. My views on

19:52

this are also very contingent. Honestly,

19:53

like once we get to

19:55

a point where these are super duper available,

19:57

if you want to take one to lose 10 pounds, genuinely.

19:59

I don't give a shit. In the same way, I don't give a shit if

20:02

you want to get a nose job. Yeah, but like, in

20:04

time of a shortage. The same thing, there's an Adderall

20:06

shortage. If you're not prescribed Adderall,

20:08

don't take Adderall right now. If you don't

20:11

need Sriracha... HAHAHAHA! I've

20:13

been doing my part. I'm buying slightly

20:15

less Sriracha than usual. Dude, the Sriracha

20:17

shortage has been a big topic

20:20

of conversation in our household. Are you

20:21

still doing it? Can I cancel you for

20:22

eating Sriracha in a time of need? We had a bottle,

20:25

it was about halfway done. Mm-hmm. I got

20:27

another one. Hypocrite. Totally.

20:30

You're hoarding Sriracha. One

20:32

and a half bottles. Come take them

20:34

from my cold, dead end. No, I'm just kidding.

20:36

So,

20:38

Michael. I breathe. This is unusual

20:40

for us, but this

20:42

topic was so big and expansive

20:46

that you and I both actually researched

20:48

this one, and I dug in on sort of the discourse

20:50

side and the recording side, and

20:53

you really dug in on the research side. So,

20:55

can you walk us through, just like, what

20:57

do we know from the research? This is a

20:59

weird format break for us because ordinarily,

21:02

like, one of us researches and one of us listens, but like, it

21:04

would be

21:04

odd to pretend that we haven't

21:06

both been following this, like, obsessively for the last

21:09

couple months. Yes. I have deliberately avoided

21:11

the discourse

21:11

because I find the discourse annoying, but

21:14

I have been following the research,

21:17

and like, I have a literal spreadsheet of like, the

21:19

various studies that have been done, and for

21:21

these drugs, there's actually a quite

21:23

finite amount of information, and I

21:26

just,

21:27

for the love of God, just want to like,

21:29

walk through what we know

21:32

and what we can expect

21:32

from these drugs. Yeah, sounds

21:34

great. So, basically, the trials

21:36

of semaglutide for weight loss

21:39

are all grouped under this heading

21:41

of the STEP trials, which

21:43

is the semaglutide treatment effect

21:46

in people with obesity, which should

21:48

be step O, but is actually step. Step

21:50

O, what, the fifth Mark's brother?

21:54

Yeah. And these

21:56

are sort of classic pharmaceutical

21:59

company. randomized controlled trials. They

22:01

are global. They comprise 5,000

22:03

people. All of them are 68

22:06

weeks long. One of them is a little bit longer, we'll

22:08

get to it. They are funded by Novo

22:10

Nordisk, of course. And the

22:13

way that they structure these, they sort of do it like moon

22:15

missions. You

22:16

notice there's like Apollo 1 and Apollo 2. These

22:19

large pharmaceutical trials

22:20

are like, there's step one, step two,

22:23

step three, and they break them down into like specific

22:25

things

22:25

that they want to know. And step one,

22:28

step two, step three are not different

22:30

phases in the same study, right?

22:33

They are separate studies. So step

22:35

one is like the overall, just like we're

22:37

going to give fat people somaglutide

22:40

for weight loss. Step two is

22:42

the same thing, but on people with type two diabetes. Step

22:45

three is somaglutide

22:47

with intensive behavioral therapy. BLTs!

22:50

And then the rest are kind of like

22:52

smaller shading. So step four

22:54

is

22:55

they put people on somaglutide for

22:57

a while

22:58

and then they switch half of them to a placebo.

23:01

Step five is a two year trial.

23:03

Step six and seven are the same thing, but they're done on Japanese,

23:06

South Korean, and Chinese people. And

23:08

step eight is testing

23:10

somaglutide versus one

23:12

of the other GLP1. So it's

23:13

somaglutide versus loraglutide.

23:16

So when you say- I hate these fucking names. Step

23:18

six and step seven are focusing on East

23:20

Asian folks. It's worth mentioning that most

23:23

of these trials for

23:26

Wigovi in particular are

23:28

just overwhelmingly white

23:30

as many diet studies are. One

23:34

of the sort of leading meta-analyses of

23:37

studies involving over 11,000 participants was 80%

23:40

white, 10% black, and 5% AAPI. Although

23:47

for diet studies, I mean, we

23:49

both see diet studies, they're like 97%

23:51

white fairly frequently. So it's

23:53

funny, 80% white, I'm like, ooh, not

23:55

bad.

23:56

The bar is

23:58

in hell. Yeah, like Biden.

23:59

standards of fucking diet research, it's

24:02

like, well, very diverse sample. The

24:04

results of these semaglutide trials

24:06

are quite consistent, remarkably

24:09

consistent. So

24:11

roughly 80% of people who take semaglutide

24:14

lose some amount of weight, roughly 5% of

24:16

their body weight. And roughly

24:18

half of people who take semaglutide

24:20

lose 10% to 15% of

24:22

their

24:22

body weight. So a one in two chance of

24:24

losing a moderate amount of weight. And

24:27

then the biggest number and the thing that

24:29

is like sent the entire like

24:31

weight loss industry into

24:33

overdrive on this is that roughly one

24:35

third of people who take semaglutide lose

24:38

more than 20% of their body weight, which

24:41

is roughly on par with like bariatric

24:43

surgery.

24:44

And then another thing that is like a

24:46

pretty big deal about these drugs is that

24:48

like the results seem to hold up. So

24:50

there's one trial where people took semaglutide

24:53

for two years.

24:54

And like by the end of it, 36%

24:57

of people had

24:57

lost more than 20% of their body weight. So

24:59

for about a third of patients,

25:02

they're losing maybe three times

25:04

as much weight as previous interventions.

25:06

We should also note that like, there

25:08

are pretty significant health effects of

25:10

these drugs. So even in the shorter

25:12

term trials, people have better

25:14

blood pressure, they have better cholesterol,

25:17

they have improved A1C levels.

25:20

We also with the longer term trials, we've

25:22

seen modest but also like kind

25:25

of big deal reduction in

25:27

heart attacks and strokes. So that's

25:30

really exciting. Yeah. If there is a drug

25:32

that people can take and they're less likely to

25:34

die. Yeah, I am pro

25:37

that drug. I actually look this up. It's roughly

25:39

in line with the effect of statins.

25:41

So this is this is genuinely like a big deal. Like

25:43

even if you take the weight loss stuff

25:44

off the table. Yeah, we should also talk

25:46

about the side effects. The

25:49

side effects of the drugs seem to be almost

25:51

universal. Some studies

25:53

find I think the lowest one I found was like 60%

25:56

of people have like gastrointestinal symptoms. But

25:58

then some of

25:59

percent of people. So it's like nausea,

26:03

constipation, diarrhea,

26:05

vomiting, the sort of tummy

26:08

stuff that you would associate with like pretty significantly

26:11

fucking with your like hunger and satiety

26:13

hormones. In addition to all of those side

26:16

effects, there is sort of this whole

26:18

class of side effects that get covered

26:20

mostly in like beauty

26:22

media and like gossip blogs

26:25

like Ozumpic Face. Have

26:27

you heard about Ozumpic Face? From you

26:30

like 10 minutes ago right when we started recording. Some

26:33

of us were trying to keep the illusion

26:36

alive, Michael. So

26:39

it's basically just the appearance

26:41

of aging when taking

26:43

Ozumpic and it's just the result of rapid

26:45

weight loss. However you did it, it's not unique

26:47

to Ozumpic, it's just when you lose

26:50

a lot of weight really quickly, you end up with

26:52

loose skin and some of that loose skin

26:54

will be on your face and that is

26:56

also the same kind of thing that happens when people age

26:59

so you look older. So Ozumpic Face is just like you

27:01

lost weight face. Yeah totally. These

27:03

ones just strike me as we were talking about beforehand

27:06

like these ones just strike me as so fucking

27:08

mean. It's also so fucked up because it's like our culture

27:10

is telling you to lose weight all the fucking time and it's like

27:12

you finally do lose weight.

27:14

It's like what's happening to your face? Yeah totally.

27:16

Well and people treat it as like some kind of

27:18

like

27:18

come up and for like taking

27:20

a drug or daring to lose weight or being

27:22

too vain or whatever.

27:25

It's just steeped in so much judgment

27:28

that I'm like could we just set that one down? There's

27:31

also a bunch of very

27:33

rare side effects. So

27:35

there's been some worry about pancreatitis.

27:38

Some trials find that it like increases

27:41

but then there's a trial of the raglottide that finds

27:43

that it actually decreases. There's

27:46

concern about thyroid cancer

27:49

but that's based on rodent studies

27:51

and there haven't been any signs of that in the data

27:54

but we don't know kind of

27:55

any longer than one and a half to

27:57

two years. There's slightly

27:59

elevated rates of gallbladder

28:02

disease, acute kidney injury,

28:05

there's two cases in

28:07

Iceland of suicidal ideation

28:10

and the European Medicines Agency is now

28:12

looking into that. And just this

28:15

week, the FDA updated

28:17

the label on samagotide

28:19

to include this thing, Ilias,

28:22

which is basically when like digested

28:25

food

28:25

builds up in your intestine

28:27

and backs up and the

28:30

only way

28:30

to deal with it is surgery

28:32

and it's fatal. So we have 33

28:35

cases of this that have been reported

28:37

to the adverse events database and two deaths.

28:40

But

28:40

we don't

28:42

sort of know what to make of those things because the adverse

28:44

events database is like as we've

28:46

discussed on the show before is

28:47

like anyone can submit cases with basically just like

28:49

a hotline. And so it's something that

28:51

is like people are looking into more and there's

28:54

a study out of China last year that shows

28:56

that this mechanism exists

28:59

in mice where it like basically stops

29:01

bowel function and there was some kind of warning

29:04

in that study of like, this might show up in humans and

29:06

it might show

29:07

up around the sort of 18 months

29:09

mark, meaning like after these studies

29:11

would have concluded. But that's also like animal

29:14

studies, super preliminary, we

29:16

don't know it's sort of like people don't really know what to

29:18

make of this yet. Yeah. And you

29:20

know, two people dying is

29:23

nothing to – Yeah, it's a huge deal. That's a big deal.

29:25

That's a big deal. And I think especially in

29:27

the context of previous

29:29

diet drugs having sort of gone this

29:32

way. Yeah. But then one

29:34

thing that really stood out to me was, you know, we

29:36

have these like near universal side effects,

29:38

we have these like much more rare, much more severe

29:41

side effects. But the dropout rates

29:44

in these studies are like really low. What

29:46

you find in most of the studies is almost

29:48

everybody is getting some side

29:50

effect or another and they typically happen

29:53

in the first couple weeks of the study when you're like

29:55

upping your dose. It actually takes four months to

29:57

get up to the 2.4 milligrams

29:59

like weight

29:59

But it typically goes away

30:02

as people kind of get used to the drugs. And

30:04

so in the two-year study,

30:06

there were 150 people who completed

30:09

the two-year trial, and only 10 of them dropped

30:12

out due to adverse effects, which is only 6%.

30:14

So what

30:16

this indicates is that people are getting

30:17

side effects, but most,

30:20

like the vast majority of people, are willing to

30:22

push through the side effects and complete these trials.

30:25

Yeah, so what you're saying is folks are more

30:27

likely to stay in these studies

30:29

than other studies into sort

30:31

of like how folks can lose weight. Yes.

30:34

So, so far, I've kind of been

30:36

presenting like the case for

30:38

semaglutide, like the way that you read

30:40

about it in these clinical

30:42

trials. I've been reading a lot of

30:44

things from like, you know, people in like the weight loss

30:47

world and like this is how they talk

30:49

about the drug, right? Is that it's delivering

30:52

very significant weight loss, the dropout rates

30:54

are relatively low. And before

30:56

we get to like complicating that picture

30:59

a little bit, I think it's important to

31:01

first of all, just like acknowledge that like that

31:03

is the data that we have. And like, I think this

31:06

new generation of weight loss drugs is like genuinely just a

31:08

big deal. At the same time, to

31:10

me, like the most bizarre

31:11

thing about the discourse, especially

31:13

recently, but you know, since the results of these

31:15

trials started coming out, it's like the

31:18

weird victory lap that

31:20

people have been doing. It's like, okay, we know we

31:22

have something now that works for weight loss, right?

31:24

We finally have an effective weight loss drug.

31:27

And then there's this weird sort of second order

31:29

thing where they're like, what are the fat activists gonna

31:31

do now? Yeah, just ruined body

31:34

positivity. And there's all this weird shit

31:36

of like, well, now we have a cure

31:38

for obesity, right?

31:39

And I feel like just to sort

31:42

of take these results, as

31:44

we've been presented with them, right, like the quote

31:47

unquote best possible version of

31:49

these events, right, all of the weight loss, all of the benefits,

31:51

everything, it's like, we're talking

31:53

about a drug that 50% of

31:55

people who

31:57

take

31:59

it will lose 15% of

32:01

their body weight. And like, that

32:04

is not a world without fat people. This

32:06

is like the aspect of the drugs that drives me absolutely

32:08

fucking nuts. It's not going to end

32:11

the quote unquote obesity epidemic. It just isn't.

32:13

Yeah, we still as a society need to

32:16

work on like stigma against fat people,

32:18

improving medical care for fat people, all

32:20

of the things we say on this show, right

32:23

are still fucking true if every single

32:25

person in America loses 15% of

32:27

their body weight. And that is a dramatic

32:30

overestimation of what's even about to happen,

32:32

right? Yeah, even if as you say, even if they

32:34

work exactly as they are projected

32:36

to, even if the data doesn't

32:38

change one bit with future trials,

32:41

someone my size

32:44

goes from being 330 pounds to being 280 pounds. That would

32:46

take me from being a

32:52

person with an obese BMI to

32:54

being a person with an obese

32:57

BMI. Yeah, this whole thing

32:59

about like, you know, is this the

33:02

end of the obesity epidemic? Like,

33:04

a no, it's not as you've pointed out,

33:07

but be that is the

33:09

meanest fucking thing to say,

33:11

we currently have this fucking nightmare bullshit, which

33:13

is like the whole fucking show is dedicated this where it's like

33:16

a fat person goes into the doctor for a migraine. And they're

33:18

like, I have a migraine and the doctors like you should go on a diet.

33:20

Yeah.

33:21

And then it's like, you haven't asked me what I do. You haven't asked

33:23

me if I eat fast food. You haven't asked me fucking anything.

33:25

You're giving me this bullshit ass advice. And all I want is fucking

33:28

advice from my migraine, right? Yeah. We're now going

33:30

into a scenario where you go into the doctor with

33:32

a migraine.

33:32

They're like, you should go on a zempic. Yeah. And you're like, well,

33:34

I've already been on a zempic three times. And I

33:36

was half I was one of the half of people

33:39

who lost less than 10% of

33:40

my body weight. It was costing me more than my fucking

33:42

rent. I was having weird side effects. People

33:45

report like not enjoying food anymore, which is like

33:47

really sad to think about. Yeah. And then

33:48

the minute I went off of it, I gained all the fucking weight

33:50

back and I've done that four times.

33:53

And when I'm going in, you're giving me this generic bullshit fucking

33:55

advice to go on a zempic. You haven't asked

33:57

me whether I've been on it before. You haven't asked me about weight cycling.

33:59

You haven't asked whether I tolerate the drug or if it intersects

34:01

with some like antidepressant that I'm taking. We're

34:03

just redoing the same fucking thing, except

34:06

instead of go on a diet, it's go on ozmpic.

34:08

And like,

34:09

in the same way that it's not possible for everyone to

34:11

go on a fucking diet or they've been on a million already, it's

34:13

not possible for everyone to go on fucking ozmpic and it's not gonna

34:15

work for everybody. I mean, I told,

34:17

listen, I told you this off mic,

34:19

but I think this is the

34:21

darkest episode that I have

34:23

researched for us. Yeah, it's really bad.

34:25

It is really upsetting,

34:28

and I will say it like not just on an individual

34:30

level, but also like

34:33

systemically, like I

34:36

stopped seeing doctors for like eight

34:38

years. I've written about this a bunch of times. And

34:41

that was at the height of like

34:43

the bariatric surgery craze. Yeah.

34:46

And that really fucking fueled

34:49

how doctors would talk to me and what treatments

34:51

they would offer me. And it was like a very

34:53

frequent conversation of me being

34:56

like, hey, I'm 24 and I have

34:58

an entry level position at a nonprofit

35:01

where I feel fortunate to have health coverage at all.

35:04

No I don't have 25 grand

35:06

for a weight loss. Yeah. Right.

35:09

Yeah. But that still became a thing, right,

35:12

amongst healthcare providers who we already know are more

35:14

likely to think of fat patients as non-compliant,

35:17

as slovenly, as unattractive,

35:19

as weak-willed, as all of these things,

35:21

right? This becomes another

35:24

reason for that group of people

35:26

also to stop listening to fat people.

35:29

It's going to get harder for me to get healthcare.

35:33

That's part of what's about to happen. This

35:35

is why I wanted to go out of my way

35:37

to like insufferably

35:39

present the results of these trials

35:41

as if they will hold up. Because

35:44

even in a world in which that happens,

35:47

that doesn't call anything into question about

35:49

the need for equal treatment.

35:51

And at the same time,

35:53

the results of these trials are extremely

35:56

unlikely to pan out in the real world.

36:00

So,

36:00

I have three reasons why

36:02

these drugs are very unlikely

36:04

to pan out and deliver

36:05

like the end of obesity or all the stuff that

36:07

the Inseparable Discourse has been telling

36:09

us. Oh, we're tucking into the debunk

36:11

bed. Yeah, you're, this is much more comfortable

36:13

space for us. The first is that the populations

36:16

that are being studied in these trials

36:18

are actually relatively

36:20

narrow. So

36:22

step one, which is the trial that's kind

36:24

of the overall like just normal weight

36:26

loss drugs being given to people. I'm

36:28

going to read you the exclusion

36:31

criteria. People were not able

36:33

to participate in step one if

36:37

they have a history of major depressive disorder, they

36:39

have a diagnosis

36:40

of a severe psychiatric disorder,

36:43

they

36:43

fill out the patient health questionnaire

36:45

with a score of over 15.

36:48

This is one of those, one of those questionnaires that

36:51

has like, you know, I have feelings of hopelessness

36:53

like rank from like every day to like never. Yeah,

36:55

yeah, yeah, yeah, yeah, yeah. It's basically a measure of like how depressed

36:58

you are. It's like, are you feeling tired?

37:00

One of them is, do you have poor appetite

37:03

or overeating? It's like a funny exclusion

37:05

criteria to include in this. They're

37:07

also excluding people with a lifetime

37:09

history of a suicide attempt, any

37:12

history of myocardial infarction,

37:15

stroke, hospitalization, any kind of existing

37:17

cardiovascular

37:17

stuff, known or

37:19

suspected abuse of alcohol or recreational

37:22

drugs,

37:23

and female who is pregnant,

37:25

breastfeeding, intends to become pregnant or is

37:27

of childbearing age and not using

37:29

a highly effective contraceptive method.

37:32

Holy shit, that cuts out so

37:34

many people, Michael. Well, the thing is, I mean, with

37:36

these studies, like I sort of

37:38

get why people who design studies do this

37:40

stuff because they want to start with a kind of baseline

37:42

of like, quote unquote, normal people

37:45

without a bunch of like pre-existing conditions,

37:47

which I get for the purpose of a trial.

37:50

I get why you want to have like a clean quote

37:52

unquote sample. However, once

37:55

these drugs get out into the real world, they're

37:57

going to be taken by people with

37:59

depression. Yeah, like when you're designing

38:02

a trial like this, I imagine you're walking a

38:04

real line, right? You want the trial itself

38:06

to be safe for the people who participate in

38:08

it. You want to eliminate things like

38:10

existing heart conditions, like anything

38:13

existing pancreatic conditions, anything

38:15

sort of related to the mechanisms involved in

38:17

this drug. I totally get that, right?

38:20

And you don't want it to make anything worse

38:22

for anybody, like just like a human level.

38:25

That totally makes sense to me. The

38:27

trick is all of that

38:30

gets translated into an assumption

38:33

that this is how it will play out for all people

38:36

who are not being monitored in a study

38:38

and provided the drug for free, and

38:41

all people who have all of these other

38:43

conditions that are extremely

38:46

prevalent in the US, right? Yeah.

38:48

And also, I mean, I probably should have started with this, but the

38:51

second

38:51

reason why it's unlikely that

38:54

these are going to deliver on the results that

38:56

we're seeing in the trials

38:57

is because there are real

38:59

world studies of samaglitide,

39:01

and they don't find the same results.

39:04

So there's a study in the US that

39:07

follows like people who went to weight loss

39:09

clinics and got these drugs for one year.

39:11

If you remember in the trials of

39:14

these drugs, the average weight loss was around 15%. In

39:17

the real world trial, people are losing 7.5% of

39:20

their body weight. And there

39:22

are other real world trials,

39:24

it's quite remarkable actually, that find almost the same thing

39:26

that like the weight loss, you know, 80% of people lose 5% of

39:28

their body weight or more.

39:31

In the real world, that tends to be around 40%. So

39:34

almost all of the numbers

39:35

that we're seeing in these randomized controlled

39:37

trials are half once we

39:39

get to the real world. They're not zero, right? So

39:42

this still is going to be, again, a big deal, but

39:44

we're not seeing in the real world those

39:47

results continue to show up.

39:49

Yeah. It's totally clear

39:51

why this is happening. One

39:53

of them appears to be that in

39:56

the randomized controlled trials, people aren't just

39:58

taking the drug. also getting

40:01

like dietary counseling. So

40:03

one of the trials is like super intensive behavioral

40:06

therapy where they're like meeting with dieticians once a

40:08

week, but in all of the other trials,

40:11

they're doing monthly check-ins

40:13

with counselors and they're having all of these,

40:15

you know, biomarkers taken and

40:17

I think there's something about like people just

40:19

being in a study, like you really wanna

40:22

finish, cause you're like, oh, I'm part of this like project, and it's

40:24

like experimental and super cool and

40:26

like the adherence rates for

40:29

these randomized controlled trials are like significantly

40:32

higher than we have in the real world. When

40:34

you

40:34

look at the real world trials, even among

40:37

people who have type two diabetes and

40:39

who like really need these drugs,

40:41

a lot of them are finding like 50% dropout rates

40:44

after two years and some of them, one of them find 70%

40:47

dropout rate. You can already see

40:49

as we're sort of like walking through this research,

40:52

the gap between the popular claims

40:55

that are being made about these drugs and

40:57

what the research actually says, that's

41:00

where we got to with Fensen, that's where

41:02

we got to with Ally, that's where we got to

41:04

with like, this is sort of a pattern

41:07

with weight loss drugs, is that we

41:09

get out over our skis culturally

41:12

with like this kind of magical

41:14

thinking excitement stuff. We

41:16

then make a bunch of policy decisions

41:19

based on the excitement and not

41:21

the data, and then we're kind of

41:23

stuck with these sort of adjusted

41:26

systems that were again changed

41:29

based on what we thought was possible,

41:31

not what we were actually seeing. Exactly,

41:34

and the other thing that again,

41:37

we have very good data on,

41:40

is that people tend to regain

41:42

all of the weight the second they stop taking these

41:44

drugs. So one of the step

41:47

studies switched people from

41:49

some agritide to a placebo at 20 weeks.

41:52

There's also a trial of another GLB1 tier

41:55

zepatide, these fucking tides, that

41:58

did the same thing after 36 weeks. They

42:00

switch people to a placebo and basically

42:02

it's like people start regaining the

42:04

weight

42:05

very quickly and like within a year they've

42:07

regained almost all of the weight. These

42:10

drugs seem to put people in the same cycle

42:13

as fad diets but just with like more dramatic

42:15

and like longer results. Well and

42:18

the people that I have heard talk about taking these

42:20

drugs are like I'm just going to take it until I get down

42:23

to x weight and then I'm going to stop it. Yeah, yeah,

42:25

yeah. Right? And that is people's

42:27

plan for how this is going to happen and that's not

42:29

how these

42:30

drugs work. I'm seeing this discourse

42:32

among like weight loss clinicians too

42:35

where they're like well ultimately it comes down to diet and

42:37

exercise and so we need to get beyond these drugs and then

42:39

teach them the diet and exercise

42:41

stuff and then once they know that

42:43

we can take them off the drugs.

42:45

But this trial of kerzepatide

42:47

the other drug had people

42:50

on an intensive behavioral

42:52

therapy program when they went

42:54

off the drug.

42:55

So people took it for a while and they switched

42:57

to a placebo while still doing

42:59

like exercise and like cooking classes

43:02

and all this stuff that everybody says is so fucking effective

43:04

and they gained all the weight back. This is another case

43:07

of

43:07

pump the brakes and ask a fat person. Yeah,

43:09

yeah, yeah. Does anybody try to teach you how to cook? Has anybody

43:12

offered you a gym membership? Has anybody

43:13

told you that your form was wrong while

43:15

you were working out? Right. This

43:17

is every day. The reason

43:19

that people think that in part is

43:22

that it reinforces our existing beliefs

43:24

about fat people. Right. Which

43:26

is just that they're too lazy

43:29

or they're too unintelligent or they're too uninformed

43:32

to just do it for themselves. So they

43:34

need a thin person to teach them how. This

43:36

is going on my Aubrey Gordon sound board. Yes. Ask

43:39

a fat person. I mean genuinely

43:41

that's going to be my advice. Like 80%

43:44

of the time is like have you even talked to a

43:46

fat person about this? This is another like

43:49

super fucking familiar pattern where

43:51

it's like okay everyone should go on Atkins because low-fat

43:53

diets work or low-carb diets work.

43:56

And then of course after like six months everyone gains

43:58

their weight. And then it's like.

43:59

It's like, well, if you stayed on it, you would cut

44:02

the weight

44:02

off, which is true. Fine. If you can stay on it, but

44:04

no one can fucking stay on it. Yeah. Right? We know in the

44:06

real world, no one can stay

44:07

on these extreme low carb diets for very long. So

44:09

let's move forward on that basis that no one can fucking stay on

44:11

them, right? And with this, it's

44:14

going to be the same thing of like, well, osympic does

44:16

work if you can stay on it. Yeah. Okay, but people aren't

44:18

staying on it. We know from real world data that even

44:20

when it's fucking free, people are not staying on it. Well,

44:22

and if you do stay on it, people characterize

44:24

it as the easy way out. Yeah, and then you

44:26

have

44:26

this bullshit. Right? Like Oprah was just

44:29

saying the other day, like it's the easy way out,

44:31

so I'm not going to do it. And I'm

44:33

like, Oprah, you were in your sixties. How

44:36

hard do you think you need to have

44:38

appeared to have tried? Yeah. And

44:40

then like, listen, the discourse makes it worse

44:43

because when the discourse is like a bunch

44:45

of the reporting is like, we really need to tamp

44:47

down on the stigma facing people who

44:49

take osympic. And I'm like, is

44:51

that the stigma that

44:54

we need to clamp down on? What's so fucking

44:56

annoying to me about this discourse?

44:58

You have successfully

44:59

radicalized me on this in the last 72 hours. Oh,

45:01

hey. Because

45:02

as I've been reading this, it's

45:05

like this shows up everywhere. Like what about the

45:06

stigma of taking the drugs? But

45:08

the stigma of taking osympic

45:11

is fatphobia. It's the same fucking

45:13

stigma that fat people

45:14

are facing. But just like, oh,

45:16

you're taking the easy way out by using a weight loss drug.

45:18

That's the connection between fatness

45:21

and virtue. You should lose weight in the virtuous

45:23

way. Take the stairs. Yeah, take

45:25

the fucking stairs. It's like, well, you might

45:27

look thin,

45:27

but you're really a fat person. You

45:30

cannot muster any

45:31

fucking gumption

45:34

from anybody to like give a shit about

45:36

stigma against fat people. But they're super

45:38

chill to invoke fatphobia against

45:41

people who stop being fat. And they still

45:43

do the fucking stigma against fat people. And they still do it.

45:45

It's also been fascinating, I'll say, on the

45:47

discourse end that

45:49

like

45:50

there have been all of these bizarre hand

45:52

wringing pieces from thin people

45:55

being like, was body positivity

45:57

for nothing? I know. It was all a lie.

45:59

The vast majority of fat people

46:02

were under no illusions about broader

46:04

social acceptance. At best,

46:07

people said fewer unwanted

46:09

things about our bodies. It

46:12

never stopped. We were never lifted

46:14

up. We were never centered. We

46:16

got one lizzo out of it. Right?

46:20

And we don't even have that anymore. And we don't even

46:22

have that anymore. It's

46:25

like the degree to which this discourse

46:28

is thin

46:29

people telling themselves

46:31

stories that they want to hear. It's

46:33

funny to me that we meticulously

46:36

outlined this and planned it out, but neither one of us

46:38

can resist talking about the discourse. I

46:41

hate it so much. We're like fast

46:43

forwarding to that section. Okay,

46:46

Michael, we've talked about the drug.

46:49

Let's talk about the manufacturer of

46:52

the drug. Yeah. Wigovik and

46:54

Wigovik are both made by Novo

46:56

Nordisk. It's a big pharmaceutical company

46:58

from Denmark. From Denmark.

47:00

And their marketing practices have really

47:03

set the template for all the discourse

47:05

we've been seeing since. Okay. Wait,

47:07

are there ads for Wigovik and Ozempek?

47:10

You haven't seen the Oh, Oh, Oh,

47:12

Ozempek. That's like the cover songs that are in

47:14

all the fucking trailers now. The very slow

47:16

brooding cover of like, I whip my hair

47:19

back and forth.

47:21

I'm blue

47:23

badu dee da doo da. It's like super dark.

47:27

Yeah. No, as

47:29

we've discussed many times, we're on very different like

47:31

Instagram experiences and like

47:33

algorithms. And I've never seen

47:36

an ad for weight loss anything. I'll tell

47:38

you what, Mike, I might give

47:40

you homework at one point and be like, okay, so watch a half

47:42

an hour of TV and tell me what you notice about the ad.

47:45

You would know. Absolutely

47:48

not.

47:48

I watched terrestrial TV like

47:51

once a fucking year when I'm like visiting my grandma and I'm

47:53

like, this is like this is like actively making me

47:55

stupid. It's like shocking how bad it is. So

47:58

we're going to talk a little bit about the market.

47:59

practices at Novo Nordisk.

48:02

There is a lot here that leaves me feeling

48:05

icky. A very good example

48:07

of this is a campaign called It's

48:09

Bigger Than Me. Have you seen this

48:12

campaign at all? Is it like billboards? There

48:14

are ads, there are billboards, there are

48:16

branded segments on TV shows, there's

48:18

so many things. The slogan

48:21

is obesity, it's bigger

48:23

than me. Okay. The idea behind

48:25

the campaign is it's not your fault,

48:27

your fat, followed immediately

48:29

by it's because you have a disease

48:32

and that disease requires medical

48:34

treatment. And that medical treatment can only

48:36

be provided by one company. It's bigger

48:39

than me, it's $15,000 per year. Yeah,

48:42

that's right. As part of this campaign,

48:45

Novo Nordisk has specifically courted

48:47

black public figures and particularly

48:50

black women as spokespeople. Their

48:53

first spokesperson was Queen Latifah, their

48:55

next was Yvette Nicole Brown,

48:58

who was on Community, their

49:00

third was Roland Martin

49:03

from CNN, who

49:05

ran an hour-long segment

49:07

on fatness in black communities

49:10

that was listed as quote-unquote

49:12

powered by Novo Nordisk. That's

49:14

like when influencers say like, I

49:16

partnered with Nike or whatever. It's like, it's

49:19

just them paying you to say words.

49:21

Well, and on top of that, the

49:23

reporting around the

49:25

quote-unquote it's bigger than me campaign

49:28

is just rife with like

49:30

the most garbage messages

49:32

about fatness and body positivity

49:35

and all kinds of stuff. So I

49:37

read an interview with Yvette Nicole

49:39

Brown with the Greo. In

49:41

that interview she said quote, being

49:44

focused on your health does not mean that you're

49:46

not body positive. I think

49:48

it's actually the most exemplary way

49:50

that you can be body positive because you

49:52

need your body to continue to live.

49:59

This is like, this is reifying

50:02

everything you've said about the whole body positivity

50:05

thing that is all just like they're repackaging

50:07

the same shit and selling it back to you.

50:09

The article goes on to say that quote, Brown

50:11

said somewhere down the line, society

50:14

at large developed the idea that if you're

50:16

body positive, you can't care

50:18

about physical health. In

50:21

my notes, I wrote in all

50:23

caps, who is saying this? Who

50:25

fucking said this? Oh my god. Who

50:27

is saying this? And it's like trolls, right? It's like

50:29

that it's ceding a bad faith

50:32

argument. Right? To be like, we don't

50:34

think that's true. Look at what all those nutty

50:37

people are saying. They're wrong. This

50:39

is like when conservatives are like feminists don't

50:41

even want you to get married and have kids.

50:44

It's the phenomenon that has built

50:46

Michael Hobbs' Twitter feed. Hey. Hey.

50:50

You're familiar with my work.

50:52

So our third section,

50:55

Michael, is the part that

50:57

I have realized is most

50:59

troubling to me. And that is the discourse.

51:02

There's been a lot of like garbage media about

51:05

this in the last like year. Here are

51:07

three

51:07

actual fucking headlines

51:10

from coverage of this. One,

51:13

will Ozumpik change how we think

51:15

of being fat and thin? Okay.

51:19

Life after food?

51:20

Yeah. And

51:22

Ozumpik settles the obesity

51:25

debate. Oh. That one's annoying.

51:27

It is just

51:27

bad faith proclamations

51:30

and bullshit question mark headlines.

51:32

Like as far as the eye can see. Yeah.

51:35

What I am worried about is that

51:38

when we see a wave of media

51:40

like we have seen around Ozumpik, we

51:43

also tend to see a wave of increased

51:45

anti-fat bias, right? Right. Right.

51:49

So the reporting that I have seen so far, the think pieces that I have seen so

51:51

far, none of them are grappling

51:54

with that. Right. Very

51:56

few people are asking fat people

51:58

what they need in this moment. nobody

52:01

is asking diabetic people what they

52:03

need in this moment. Like a thing that

52:06

I experientially

52:08

know in every bone in my body is

52:10

that when people I know start to lose

52:12

weight, the vast majority

52:15

of them start to see

52:17

themselves as more virtuous.

52:20

Whether they want to or not, whether they mean

52:23

to or not, whether or not they would say it out

52:25

loud. It's very common for people

52:27

to expect social reinforcement for

52:30

weight loss. And I would

52:32

say now, as I have said for

52:34

years now, which is you have

52:36

got to get people's consent

52:39

to do that. The best case scenario

52:41

is that you're sending a message that you're like not a very good

52:43

friend to a fat person, right?

52:47

And the worst case scenario is that you're increasing

52:49

the stigma that they face and potentially also

52:51

like triggering people's eating disorders. Like

52:54

this shit is not unthorny.

52:57

And the fact that you're hearing it everywhere doesn't

52:59

make it less urgent. I would argue

53:01

it makes it more urgent to like double

53:03

up on those boundaries. Like you have

53:06

got to give fat people an out

53:08

for this conversation and we've got to

53:10

stop presuming that this is like a

53:12

good and exciting conversation for

53:15

everybody. I am like not all

53:17

that invested in like the drugs themselves.

53:19

The drugs are the drugs. I don't know. I

53:21

mean, maybe they'll be effective weight loss drugs.

53:24

Maybe they won't. I don't know. But

53:26

like given what we know now,

53:28

the most likely scenario is

53:31

that like they're going to be

53:31

prescribed to millions, potentially tens of millions

53:34

of people. And like what you

53:36

said to me the other day is that like you

53:38

can see the number of people

53:41

who lost like 15 fucking pounds and then

53:43

all of a sudden are like really mean to fat people just

53:45

like exponentially increasing.

53:47

The other thing that I will say about the discourse around

53:49

this is that every like

53:52

celebratory story about

53:54

Ozempic that comes out now, that's

53:57

all going to be mirrored by future

53:59

panic. think pieces on the rising

54:02

costs of obesity and how fat people

54:04

are bankrupting us once again, right?

54:07

This is an unbelievably expensive

54:09

medication and all of that is

54:11

going to come back to scapegoating

54:13

fat people once again, right? That

54:16

like right now we're saying it's frivolous

54:18

housewives and whatever, when we get into

54:20

the insurance conversations we're not gonna be

54:23

scapegoating rich people, we generally don't do

54:25

that. We scapegoat poor people,

54:27

BIPOC, fat people, queer people,

54:30

you know what I mean? We've got a list of people we scapegoat.

54:32

We're also setting ourselves up for another round

54:34

of excruciating discourse in another couple years

54:37

when people look around and they're like, wait a minute, there's still

54:39

fat people. All the magazines

54:41

told me a couple of years ago that this was the end

54:44

of obesity and yet people

54:46

are still fat. We should also say like, listen,

54:48

you will face serious,

54:51

serious fucking stigma as a person

54:53

who stays fat. Trust me,

54:55

a person who has stayed fat through

54:57

all the interventions, right? Like I've

55:00

already like sort of started

55:02

shifting socially, you

55:05

know, I'm already a very homebody, indoorsy

55:07

kind of lady and I'm already

55:09

restricting who I socialize with

55:12

pretty dramatically because

55:14

of this kind of talk and because

55:16

I'm unwilling to be in spaces

55:18

where the shit will come up, right? And

55:21

for me that means functionally like a vast

55:23

majority of people I know who are

55:25

not fat and some people I know who are,

55:27

right? So I

55:28

just want people to understand like the stakes of

55:31

this as a fat person are I

55:33

feel like I don't belong in the world. When

55:36

people talk about how great it's gonna be when

55:38

I'm not around, that's not me

55:40

being too sensitive. That's not fat people

55:42

taking it too hard. That's you saying plainly,

55:45

everything will be better when you're gone. And

55:48

then fat people like

55:48

taking that message. That's

55:51

horrible. The fact that you have been

55:53

through so many rounds of this, it's like, why

55:55

aren't you on fen-fen? Why aren't you on bariatric

55:57

surgery? Why aren't you clean eating? Why aren't like

55:59

all? All this is, is just new

56:01

packaging for like, why aren't you thin?

56:04

Yeah. And like, that is worth listening to. This

56:07

isn't like a paranoid fantasy on the part

56:09

of fat people. This is something that they've been through numerous

56:12

times over the course of their lifetimes now. We're

56:15

just doing the same thing again, even when

56:17

the

56:18

data does not remotely indicate

56:20

that we're not going to have fat people anymore. It never has.

56:23

We're always going to have fat people. And there's always going to be

56:25

people, whatever the medical intervention

56:27

is, that can't use it or it doesn't

56:30

work for them or they've tried it already. That's

56:32

always going to be the case. The

56:35

fact that people are so obsessed

56:37

with asking the question, is this the end of obesity? Like,

56:39

really early. Yeah. Like,

56:42

oh, is this going to be the reason we don't have fat people anymore?

56:44

It's like, it's so fucking telling. So, moving

56:47

forward, we're going to continue to

56:49

get these drugs. We're going to continue to get

56:51

this sort of, quote unquote, gold rush. And

56:54

in that time, I think it is

56:56

worth being extra skeptical

56:59

and returning to the

57:01

voices of fat people and diabetic people

57:04

when media isn't doing that for

57:06

us, right? To like actually

57:09

return to the people who are most impacted

57:11

by this debate and to spend way the fuck

57:14

less time speculating

57:16

about Elon Musk and Kourtney Kardashian

57:19

and making celebrities defend themselves

57:22

and like trying to think through how

57:24

do we get these drugs to people

57:26

who need them? How do we design a better

57:28

discourse that isn't so wildly

57:31

dehumanizing to fat people and

57:34

again, to diabetic people, right? And

57:36

like, how do we just show up for people

57:39

a little bit more around this stuff and interrupt

57:41

some of this like dancing in the

57:43

street kind of energy that is like really

57:46

upsetting

57:46

to see as a fat person? Right.

57:49

Okay, we've done enough table setting. Let's

57:51

start. You ready? It's

57:53

been two hours and 45 minutes.