Ozempic AI transcript and summary - episode of podcast Maintenance Phase

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Episode: Ozempic

Author: Aubrey Gordon & Michael Hobbes
Duration: 00:58:21

Episode Shownotes

Ozempic is being hailed as “the end of the Obesity Epidemic.” This week, Mike and Aubrey dig through the sensational claims. But will they make it past the caveats?Links: How a Canadian scientist and a venomous lizard helped pave the way for Ozempic The Discovery and Development of Liraglutide and

Semaglutide Ozempic and Wegovy maker courts prominent Black leaders to get Medicare's favor Insurers clamping down on doctors who prescribe Ozempic for weight lossOzempic prescriptions can be easy to get online. Its popularity for weight loss is hurting those who need it most Glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes: real-world evidence from a Mediterranean areaSemaglutide in Patients with Heart Failure with Preserved Ejection Fraction and ObesityReal-world weight change, adherence, and discontinuation among patients with type 2 diabetes initiating glucagon-like peptide-1 receptor agonists in the UKSafety of SemaglutideSemaglutide for the treatment of overweight and obesity: A reviewOnce-Weekly Semaglutide in Adolescents with ObesitySemaglutide 2.4 mg for the Treatment of Obesity: Key Elements of the STEP Trials 1 to 5Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Risk of Gallbladder and Biliary DiseasesReal-World Adherence and Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists Therapy in Type 2 Diabetes Mellitus Patients in the United StatesMedications and conditions associated with weight loss in patients prescribed semaglutide based on real-world dataThanks to Doctor Dreamchip for our lovely theme song!Support the show

Summary

In this episode of "Maintenance Phase," hosts Aubrey Gordon and Michael Hobbes critically examine Ozempic and Wegovy, medications promoted as solutions to obesity. They discuss the sensational narratives surrounding these drugs, emphasizing the simplification of complex health issues into individual choices, and the cultural implications of prescribing weight loss medications. The hosts address concerns about accessibility and safety, including the challenges related to compounding pharmacies during supply shortages. They critique fat bias in healthcare and media, advocating for a more nuanced understanding of weight loss that considers individual health needs rather than societal pressures.

Go to PodExtra AI's episode page (Ozempic) to play and view complete AI-processed content: summary, mindmap, topics, takeaways, transcript, keywords and highlights.

Full Transcript

00:00:00 Speaker_01
Wait, have I ever told you about Steakhouse or Gay Bar? Hang on. I want to look it up just because it's, yep. Is it? Here we go. What does it have? Uh, Magic Castle.

00:00:09 Speaker_00
Oh, it's gotta be Steakhouse.

00:00:10 Speaker_01
Yeah, correct. Stockyards.

00:00:13 Speaker_00
Oh, that's a gay bar.

00:00:14 Speaker_01
Incorrect. Steakhouse.

00:00:16 Speaker_00
What?

00:00:17 Speaker_01
Excelsior.

00:00:19 Speaker_00
That's either a bad steakhouse or a bad gay bar.

00:00:21 Speaker_01
Oh, gay bar.

00:00:22 Speaker_00
Fuck yes.

00:00:22 Speaker_01
Oh, Juicy Lucy's. That's a steakhouse.

00:00:24 Speaker_00
Thick cock in my asshole. Oh, steakhouse. Wow. Charlie Brown's. I'm not touching that. I'm not touching that. Let's move on. It was a steakhouse. Aubrey, why can't we do a fun episode? Why can't we just do this for an hour instead of talking about Ozempic?

00:00:51 Speaker_00
Welcome to Maintenance Phase, the podcast that works in the short term, but has never been tested for more than two years. That's kind of true, actually, accidentally.

00:01:01 Speaker_01
That is a pretty accurate thing to say about our podcast. It hasn't been tested in the long term.

00:01:06 Speaker_00
People go back to where they were.

00:01:08 Speaker_01
Uh, I'm Michael Hopps. I'm Aubrey Gordon. If you would like to support the show, you can do that at patreon.com slash maintenance phase, or you can subscribe on Apple podcasts. It's the same audio content. Michael.

00:01:21 Speaker_00
Aubrey, let's start. Let's start with your nervousness.

00:01:23 Speaker_01
My nervousness. We're going to talk about it. Your complicated feelings. So today, We are talking about Ozempic, Wegovy, and their active ingredient, semaglutide. Wait, I thought it was semaglutide.

00:01:38 Speaker_01
I thought it was too, and then I heard a million doctors say semaglutide. Semaglutide? Doesn't that seem wrong?

00:01:45 Speaker_00
Yeah, but sure. I mean, they're made up words anyway, and then on some level, every word is made up, so whatever.

00:01:49 Speaker_01
Well, listen, from Mr. Denowment. It's a safe space for creative pronunciation.

00:01:58 Speaker_00
The thing is, so much of the fucking feedback to this show is about my pronunciations of words. No one ever wants to give me feedback on like the content of the show. Michael.

00:02:12 Speaker_01
this episode is actually a little different than how we usually do things. I'm going to walk us through the drug and its origins. You're going to walk us through the clinical trials into this sort of class of drugs.

00:02:26 Speaker_01
And then we're going to talk about what I think is the thorniest part of all of this, the discourse around those drugs. This is a big one. It feels like a really high stakes conversation. So I'm curious about

00:02:42 Speaker_01
For you, what are some of the things that you're sort of like bringing to that?

00:02:47 Speaker_00
I think my weirdness with this episode is the culmination of my weirdness with every episode of the show, where both of us are interested in public health, in the kinds of things that are prescribed, how drugs get approved, what they mean societally.

00:03:03 Speaker_00
Whereas because Americans have been trained by health media for our entire lives to see everything through an individualistic lens, we are going to be spending basically this entire episode talking about the narratives around Ozempic and Wigowi.

00:03:21 Speaker_00
we have this new generation of weight loss drugs that as of now appear to deliver much more weight loss than any previous generation of weight loss drugs. And we've had this immediate huge wave of media being like, is this the end of obesity?

00:03:37 Speaker_00
Does this invalidate body positivity? And like being a dietician in the age of Ozempic and all this just insufferable kind of end point, prediction stuff based on very little information.

00:03:50 Speaker_00
And what we are interested in and what we have been talking about behind the scenes nonstop for the last couple of months is how poisonous these narratives are. But what people tend to hear is individual health advice.

00:04:06 Speaker_00
Mike and Aubrey think you shouldn't take Osempic or Mike and Aubrey think you should take Osempic. And that is just not something that we are interested in.

00:04:13 Speaker_00
We've said on the show before that if you want to lose weight and you want to do keto or a cleanse, you can do that. We don't have opinions on that. Yeah, totally. And if people don't want to do that, they also shouldn't be pressured to do so.

00:04:28 Speaker_01
And I just know that this is like a big topic for a lot of people, right?

00:04:32 Speaker_01
For me included, both because I'm engaging with all of this media and fat people writ large are engaging with all this media that is like, could we finally be rid of fat people is like the framing of a lot of this conversation.

00:04:46 Speaker_01
But like, on top of that, I mean, we've talked about this before on the show that one of my very best friends was diabetic and passed away because she couldn't access treatment.

00:04:57 Speaker_00
Yeah, right.

00:04:58 Speaker_01
That That was like facilitated by a lot of things. It was facilitated by capitalism and anti-blackness and transphobia and lots of things.

00:05:05 Speaker_01
But it was also facilitated by our sort of cultural disregard and disdain for people who have diabetes or any health conditions that we deem as quote unquote doing it to yourself.

00:05:17 Speaker_01
For many folks, this is like a matter of body image, which is really tender and personal. For other folks, for people who are on this medication for their diabetes, this can very literally be a matter of life and death. Right. Right.

00:05:29 Speaker_01
We're talking about like a wide range of big feelings. And it's like understandable, right? This is one of the most intense and sort of widespread moments of body related discourse we've had in quite some time, right?

00:05:45 Speaker_01
People who are taking this for weight loss are told that they're sort of taking the easy way out, which they absolutely are not. And which also presumes that people are fat because they don't try hard enough. right?

00:05:57 Speaker_01
And when those people are fat, they're often being forced into this kind of weight loss in order to access health care treatments, surgeries, other like super basic needs, right? This just feels like huge that way.

00:06:08 Speaker_00
I think a fun bit for the show would be to just do a bunch of table setting and like caveats and then just never get to the topic. Another thing we want to say right off the bat.

00:06:19 Speaker_01
We have gotten dangerously close to an entire episode of Coffee House.

00:06:24 Speaker_00
We're working toward it.

00:06:24 Speaker_01
So for part one, we're just going to talk about the drug itself. We're going to talk about semaglutide, which is the active ingredient in Ozempic and Wegovy.

00:06:34 Speaker_01
Ozempic and Wegovy are injections that are produced by Novo Nordisk, which is a big pharmaceutical company. They're part of a group of medications that are called GLP-1 agonists.

00:06:47 Speaker_01
GLP-1 helps regulate our hunger and satiety signals and production of other hormones like insulin. There are other GLP-1 agonists sort of on the market, most of them approved for diabetes treatment.

00:07:02 Speaker_01
Those are Ribelsis, Manjaro, and there are about another dozen that are sort of coming down the pipeline. Semaglutide has been on the market as a treatment for type 2 diabetes in the US since 2018 under the name Ozempic.

00:07:15 Speaker_01
When it's prescribed for weight loss, it's prescribed under the name Wegovy. It's the same thing, they're just different doses. Interestingly, the weight loss one requires a slightly higher dosage of semaglutide.

00:07:29 Speaker_01
So this drug started to be sort of studied, its glimmers begin, in 1984 with an endocrinologist at the University of Toronto. His name is Dr. Daniel Drucker, and he discovers a new hormone in humans, which is GLP-1.

00:07:49 Speaker_01
It's called glucagon-like peptide 1.

00:07:53 Speaker_00
Girl glucagon.

00:07:54 Speaker_01
As he and other researchers tried to figure out how GLP-1 functioned in the human body, it starts to show real promise as a treatment for type 2 diabetes, but they have this problem GLP-1 sort of disappears from your system very quickly. Oh.

00:08:13 Speaker_01
So it makes it really hard to study, much less sort of reproduce it. So they start looking for alternate sources of GLP-1 that might last a little longer than the human version, right? OK. And that's when the Gila monster comes in. Oh.

00:08:29 Speaker_01
Mike, have you ever heard of the Gila monster?

00:08:33 Speaker_00
Yeah, they're like a cute little lizard.

00:08:34 Speaker_01
They're like a kind of like a thick, like robust lizard. I did not know about them before this episode. I didn't know a thing about them. They're the largest lizard in North America. They're almost two feet.

00:08:47 Speaker_00
I've never seen one in real life, but I've seen them in zoo books and they're really cute.

00:08:50 Speaker_01
Well, listen, Dr. Drucker had one shipped to him in Toronto. Okay. Because it goes through long periods without food and it has the ability to slow down its appetite and metabolism. Okay. And Drucker wanted to know how they were able to do that.

00:09:09 Speaker_01
And he discovers that those Gila monsters have genes for something called Xtendin-4, which when sort of synthesized in a lab, eventually became ozempic.

00:09:21 Speaker_00
How ironic that a thick lizard gave us thin women. Interesting.

00:09:26 Speaker_01
So researchers don't totally know the mechanism for what makes GLP-1 agonists work the way that they do, but we do know that semaglutide sort of mimics that GLP-1 hormone that is, again, released after you eat.

00:09:46 Speaker_01
It's part of what makes you feel full and it's part of what signals your brain that it's time to stop eating.

00:09:52 Speaker_00
And so it works by you end up eating less because you just basically feel full after each meal. Yeah. So like it triggers your satiety hormones.

00:10:00 Speaker_00
So like ordinarily you'd be hungry again two hours after breakfast, but now it's like three or four hours after breakfast. And so over the course of a day, you just end up eating like, I don't know, 20, 30% less.

00:10:10 Speaker_01
Yes. And on top of that, it's holding that food longer in your stomach. So you are physically full for a longer period of time, right? And it's triggering a release of insulin.

00:10:23 Speaker_01
And also it may help grow pancreatic beta cells, which are the cells that produce and release insulin.

00:10:29 Speaker_01
So it's not just that it helps you release insulin in the short term, it's also sort of like building up your ability to release insulin in the midterm.

00:10:38 Speaker_00
Oh, interesting. So it's like flexing a muscle. It's actually like building the muscle that secretes insulin.

00:10:41 Speaker_01
It seems like it. It seems like it might be. Yeah. The results for people with diabetes in clinical trials are Really incredible. So for diabetic people, the most important measure of your blood glucose is your A1C.

00:10:58 Speaker_01
That's a measure of the amount of hemoglobin in your blood that reflects your blood glucose levels over the last few months.

00:11:08 Speaker_01
Most guidance for people with type two diabetes suggests that they should keep their A1C below seven to minimize complications. But people whose blood sugar isn't well managed can have A1Cs that are like 10, 11, 12, 13, like really high.

00:11:25 Speaker_01
It can lead to damage to that person's eyes, including possible blindness, their kidneys, including kidney failure to their nerves and to their heart. With the introduction of these GLP-1 agonists, the results are kind of miraculous.

00:11:43 Speaker_01
There are stories that are told about the initial presenting of the research on these at the American Diabetes Association conference, and people were weeping and gave it a standing ovation.

00:11:56 Speaker_01
Because what they're talking about is people whose A1Cs went from like 11 to 7, right? From like, really heightened urgent risk down to like a pretty safe range just with this one drug, right?

00:12:12 Speaker_00
I do think one of the fundamental like difficult things to process about any of these kinds of health conditions is that like we all kind of hate pharmaceutical companies like under a system of capitalism it's like these are big global profit maximizing entities but then on the other hand they deliver a product that is genuinely life-saving.

00:12:31 Speaker_00
I always just get kind of weird whenever people like praise pharmaceutical companies. I'm like, I don't know about that. But then whenever people overly criticize pharmaceutical companies, I'm also like, I don't know either.

00:12:41 Speaker_01
So in the trials for Ozempic, they start noticing pretty significant weight loss and researchers start going, what if we could just use this as a weight loss drug? So they created we go V it's the same drug at a higher dose.

00:12:56 Speaker_01
It uses more of the active ingredients, some agletide, and because of that it costs more diabetic version hovers at around $900 a month and it costs more for weight loss. It costs like $1,300 a month out of pocket and most insurers do not cover it.

00:13:14 Speaker_00
Not that like my main purpose with this show is to like widen the availability of weight loss drugs, but like there is something fascinating about how we've gotten all this stuff about like the obesity epidemic is so bad it's like killing our kids and then it's like we get a drug that ostensibly treats it and they're like that's too expensive.

00:13:30 Speaker_01
Yeah, it is really wild that this is an issue where we like talk out of both sides of our mouths constantly as a culture.

00:13:38 Speaker_01
In a lot of ways, the experiences of people who are taking Wegovy for weight loss or Monjaro or Rebelsis or whatever the other ones are that are getting prescribed off label, right?

00:13:48 Speaker_01
That like a lot of folks are being told that they're like taking the easy way out.

00:13:52 Speaker_00
Yeah, that's really bizarre.

00:13:54 Speaker_01
That's the kind of rhetoric that reveals itself to be not about concern, not about your health, just about, I want you to suffer for looking the way that you look.

00:14:06 Speaker_00
We're doing discourse, Aubrey. We're adding to the discourse.

00:14:08 Speaker_01
We're doing discourse, and we're not even into the discourse section, Michael.

00:14:14 Speaker_00
I'm keeping my discourse powder dry, but here we are. We're discoursing.

00:14:18 Speaker_01
So Wegovy was approved for weight loss by the FDA in June 2021. Almost as soon as Wegovy was approved for weight loss, both Wegovy and Ozempic went into shortage. Okay.

00:14:34 Speaker_01
that impacts both people seeking the drug for weight loss and the people using it to manage their blood glucose for diabetes. Because what happens is that we go, V goes into shortage first, right? That's the weight loss one.

00:14:48 Speaker_01
And then doctors start prescribing Ozempic, the diabetes medication off label to people who want to lose weight. Then that goes into shortage too.

00:15:01 Speaker_01
So, as we record this, Wegovy and Ozempic are both in shortage, according to the FDA's sort of drug shortage database.

00:15:10 Speaker_01
When a drug goes on the FDA's shortage list, the FDA then allows what are called compounding pharmacies to mix up what is basically their own version of that drug without prior FDA approval or screening.

00:15:27 Speaker_01
When Ozempic and Wegovy went into shortage, compounding pharmacies across the country started compounding their own versions of semaglutide. Here's the problem. Novo Nordisk has patented the semaglutide molecule. Oh.

00:15:47 Speaker_01
And only they can produce it until 2032. So the active ingredient simply isn't available to those compounding pharmacies. Wow. These compounding pharmacies are prescribing something. They're calling it semaglutide. Okay.

00:16:04 Speaker_01
It's not Ozempic and it's not Wegovy. It might be a watered down dose of those things. It could be something called semaglutide sodium. Okay. It's called semaglutide, but it's used in lab animal experiments and is not cleared for use in humans.

00:16:24 Speaker_00
Oh, that's like when people were taking like horse antibiotics. that you could buy on Amazon because they couldn't get like human antibiotics because they're like roughly the same thing.

00:16:33 Speaker_01
Well, except this is not roughly the same thing and is hazardous to humans' health.

00:16:38 Speaker_00
Oh!

00:16:38 Speaker_01
Semaglutide sodium is not cleared for use in humans because it is bad for humans.

00:16:43 Speaker_02
Oh, fuck.

00:16:44 Speaker_01
And the third option is that it's something else entirely. Because this is in shortage and because there is less FDA oversight, these compounding pharmacies are not required to tell anyone what's in the drugs that they are giving people. Right.

00:17:00 Speaker_01
This may sound niche. These compounding pharmacies may sound niche. This is every web advertisement you see that says Ozempic for $99 a month or $499 a month or whatever.

00:17:14 Speaker_01
All of these, all of the little startups that are like, just call and talk to a doctor and you'll have it the next day. All of that stuff is powered by compounding pharmacies.

00:17:25 Speaker_00
No way.

00:17:27 Speaker_01
So this got so bad, the compounding pharmacy stuff has gotten so bad that the FDA has issued a number of official warnings about this, and specifically has warned against buying from these startups.

00:17:39 Speaker_00
This is such a bizarre system. It's so weird.

00:17:42 Speaker_00
It's like, there's a shortage of this drug, so we're just gonna, like, let people buy it from, like, weird fly-by-night carnival barker-ass companies selling whatever the fuck on the internet and we're not gonna regulate it at all?

00:17:55 Speaker_01
There's not an enforcement mechanism beyond these letters so far. They're not doing more than that yet, at least not in reporting.

00:18:04 Speaker_00
Do you have any sense of when this could resolve itself? Has Novo Nordisk said that they're massively ramping up production?

00:18:11 Speaker_01
Basically the goalposts just keep getting moved for when the shortage will end. I checked a couple of months ago, it said it would be over by the fall.

00:18:20 Speaker_01
As we're talking about these compounding pharmacies, big weight loss companies are buying up these startups. Weight Watchers bought one of these and their stock price jumped almost 60% in a day.

00:18:40 Speaker_00
Oh, from like 12 cents to like 16 cents or something.

00:18:43 Speaker_01
I mean, listen, Weight Watchers stock was not doing great, but a 60% increase is a 60% increase, you know? They've gone from a limp to a gate.

00:18:51 Speaker_01
And I would say because the discourse around this is all focused on like the real housewives are taking it and frivolous rich people and celebrities are taking it, it makes the issue seem like it isn't incredibly pressing and important.

00:19:07 Speaker_01
Particularly for people with type 2 diabetes, particularly for people who can't access healthcare and other basic needs at their current weight.

00:19:16 Speaker_01
This is the other thing about this discourse that drives me utterly fucking bananas, is that there's not meaningful acknowledgement of the straight-up income barriers to getting this medication.

00:19:28 Speaker_01
that this is a shortage that is largely presumably created by people with the disposable income to pay out of pocket for a weight loss medication that almost no insurers are covering. Right. You and I have discussed this until we're blue in the face.

00:19:44 Speaker_01
Like neither one of us wants to litigate individual behaviors, but like that is one that really doesn't sit right with me.

00:19:52 Speaker_00
My views on this are also very contingent. Honestly, like, once we get to a point where these are super duper available, if you want to take one to lose 10 pounds, genuinely, I don't give a shit.

00:20:00 Speaker_00
In the same way, I don't give a shit if you want to get a nose job. But like, in time of a shortage. The same thing, there's an Adderall shortage. If you're not prescribed Adderall, don't take Adderall right now. If you don't need sriracha.

00:20:13 Speaker_00
I've been doing my part and buying slightly less sriracha than usual.

00:20:16 Speaker_01
Dude, the sriracha shortage has been a big topic of conversation in our household.

00:20:21 Speaker_00
Are you still doing it? Can I cancel you for eating sriracha in a time of need?

00:20:24 Speaker_01
We had a bottle. It was about halfway done. I got another one. Hypocrite. Totally. You're hoarding sriracha. One and a half bottles. Come take them from my cold, dead hand. So, Michael. Aubrey. This is unusual for us.

00:20:41 Speaker_01
But this topic was so big and expansive that you and I both actually researched this one and I dug in on sort of the discourse side and the reporting side and you really dug in on the research side.

00:20:54 Speaker_01
So can you walk us through just like what do we know from the research?

00:20:59 Speaker_00
This is a weird format break for us because ordinarily like one of us researches and one of us listens but like it would be odd to pretend that we haven't both been following this like obsessively for the last couple months.

00:21:10 Speaker_00
I have deliberately avoided the discourse because I find the discourse annoying but I have been following the research and like I have a literal spreadsheet of like the various studies that have been done and for these drugs there's actually a quite finite amount of information and I just

00:21:27 Speaker_00
for the love of God, just want to like walk through what we know and what we can expect from these drugs. Yeah, sounds great.

00:21:34 Speaker_00
So basically, the trials of semaglutide for weight loss are all grouped under this heading of the STEP trials, which is the Semaglutide Treatment Effect in People with Obesity, which should be STEPO, but is actually STEP.

00:21:50 Speaker_01
STEPO, what, the fifth Mark's brother? Yeah.

00:21:55 Speaker_00
And these are sort of classic pharmaceutical company randomized control trials, they are global, they comprise 5,000 people, all of them are 68 weeks long, one of them is a little bit longer, we'll get to it.

00:22:09 Speaker_00
They are funded by Novo Nordisk, of course, And the way that they structure these, they sort of do it like moon missions. You know, there's like Apollo 1 and Apollo 2.

00:22:19 Speaker_00
These large pharmaceutical trials are like their step 1, step 2, step 3, and they break them down into like specific things that they want to know.

00:22:27 Speaker_01
And step 1, step 2, step 3 are not different phases in the same study, right? They are separate studies.

00:22:35 Speaker_00
So step 1 is like the overall just like we're going to give fat people somaglutide for weight loss. Step 2 is the same thing but on people with type 2 diabetes. Step 3 is semaglutide with intensive behavioral therapy. BLTs!

00:22:50 Speaker_00
And then the rest are kind of like smaller shading. So step 4 is they put people on semaglutide for a while and then they switch half of them to a placebo. Step 5 is a 2-year trial.

00:23:03 Speaker_00
Step 6 and 7 are the same thing but they're done on Japanese, South Korean and Chinese people. And step 8 is testing semaglutide versus one of the other GLP-1. So it's semaglutide versus loraglutide.

00:23:16 Speaker_01
So when you say, I hate these fucking names, step six and step seven are focusing on East Asian folks. It's worth mentioning that most of these trials for Wegovy in particular are just overwhelmingly white as many diet studies are.

00:23:33 Speaker_01
One of the sort of leading meta-analyses of studies involving over 11,000 participants was 80% white, 10% black, And 5% AAPI?

00:23:46 Speaker_00
Although for diet studies, I mean, we both see diet studies that are like 97% white fairly frequently. So like, it's funny, like 80% white, I'm like, ooh, not bad. Come on! The bar is in hell!

00:23:59 Speaker_00
Yeah, like by the standards of fucking diet research, it's like, oh, very diverse sample. The results of these semaglutide trials are like quite consistent, like remarkably consistent.

00:24:10 Speaker_00
So roughly 80% of people who take semaglutide lose some amount of weight, roughly 5% of their body weight. And roughly half of people who take semaglutide lose 10-15% of their body weight.

00:24:23 Speaker_00
So like a 1 in 2 chance of losing like a moderate amount of weight.

00:24:27 Speaker_00
And then the biggest number and the thing that is like sent the entire like weight loss industry into overdrive on this is that roughly one third of people who take semaglutide lose more than 20% of their body weight, which is roughly on par with like bariatric surgery.

00:24:44 Speaker_00
And then another thing that is like a pretty big deal about these drugs is that like the results seem to hold up. So there's one trial where people took semaglutide for two years and like by the end of it,

00:24:56 Speaker_00
percent of people had lost more than 20% of their body weight.

00:24:59 Speaker_01
So for about a third of patients, they're losing maybe three times as much weight as previous interventions.

00:25:06 Speaker_00
We should also note that like there are pretty significant health effects of these drugs. So even in the shorter term trials, people have better blood pressure, they have better cholesterol, they have improved A1C levels.

00:25:20 Speaker_00
We also with the longer term trials, we've seen modest but also like kind of big deal reduction in heart attacks and strokes.

00:25:29 Speaker_01
So that's really exciting. Yeah. If there is a drug that people can take and they are less likely to die. Yeah.

00:25:36 Speaker_00
I am pro that drug. I actually looked this up that it's it's roughly in line with the effect of statins. So this is this is genuinely like a big deal. Like even if you take the weight loss stuff off the table. Yeah.

00:25:46 Speaker_00
We should also talk about the side effects The side effects of the drugs seem to be almost universal.

00:25:52 Speaker_00
Some studies find, I think the lowest one I found was like 60% of people have like gastrointestinal symptoms, but then some of them are finding like 93% of people.

00:26:01 Speaker_00
So it's like nausea, constipation, diarrhea, vomiting, the sort of tummy stuff that you would associate with like pretty significantly fucking with your like hunger and satiety hormones.

00:26:14 Speaker_01
In addition to all of those side effects, there is sort of this whole class of side effects that get covered mostly in like beauty media and like gossip blogs like Ozempic Face. Have you heard about Ozempic Face?

00:26:29 Speaker_00
from you like 10 minutes ago, right?

00:26:31 Speaker_01
When we started recording, some of us were trying to keep the illusion alive. So it's basically just the appearance of aging when taking Ozempic and it's just the result of rapid weight loss. However you did it, it's not unique to Ozempic.

00:26:48 Speaker_01
It's just when you lose a lot of weight really quickly, you end up with loose skin and some of that loose skin will be on your face. And that is also the same kind of thing that happens when people age. So you look old.

00:27:00 Speaker_01
So Ozempic Face is just like you lost weight face. Yeah, totally. These ones just strike me as we were talking about beforehand, like these ones just strike me as so fucking mean.

00:27:08 Speaker_00
It's also so fucked up because it's like our culture is telling you to lose weight all the fucking time and it's like you finally do lose weight. It's like what's happened to your face?

00:27:15 Speaker_01
Yeah, totally. Well, and people treat it as like some kind of like comeuppance. Right, right, right. For like taking a drug or daring to lose weight or being too vain or what, like whatever. Like it's just steeped in so much judgment. Right.

00:27:28 Speaker_01
And I'm like, could we just set that one down?

00:27:30 Speaker_00
There's also a bunch of like very rare side effects. So there's been some worry about pancreatitis. Some trials find that it like increases, but then there's a trial of the ragletide that finds that it actually decreases.

00:27:45 Speaker_00
There's concern about thyroid cancer, but that's based on rodent studies and there haven't been any signs of that in the data, but we don't know kind of any longer than one and a half to two years.

00:27:58 Speaker_00
There's slightly elevated rates of gallbladder disease, acute kidney injury, there's two cases in Iceland of suicidal ideation and the European Medicines Agency is now looking into that.

00:28:14 Speaker_00
And just this week the FDA updated the label on semaglutide to include this thing ileus, which is basically when like digested food builds up in your intestine and backs up and the only way to deal with it is surgery and it's fatal.

00:28:34 Speaker_00
So we have 33 cases of this that have been reported to the adverse events database and two deaths. But we don't

00:28:42 Speaker_00
sort of know what to make of those things because the adverse events database is like as we've discussed on the show before is like anyone can submit cases so it's basically just like a hotline.

00:28:51 Speaker_00
And so it's something that is like people are looking into more and there's a study out of China last year that shows that this mechanism exists in mice where it basically stops bowel function.

00:29:02 Speaker_00
And there was some kind of warning in that study of like, this might show up in humans and it might show up around the sort of 18 month mark, meaning like after these studies would have concluded.

00:29:12 Speaker_00
But that's also like animal studies, super preliminary, we don't know. It's sort of like people don't really know what to make of this yet.

00:29:19 Speaker_01
Yeah, and you know, two people dying is nothing to... That's a huge deal. That's a big deal. And I think especially in the context of previous diet drugs having sort of gone this way.

00:29:32 Speaker_00
But then one thing that really stood out to me was, you know, we have these like near universal side effects, we have these like much more rare, much more severe side effects, but the dropout rates in these studies are like really low.

00:29:45 Speaker_00
What you find in most of the studies is almost everybody is getting some side effect or another and they typically happen in the first couple of weeks of the study when you're like upping your dose.

00:29:55 Speaker_00
It actually takes 4 months to get up to the 2.4 mg like weight loss dose. But it typically goes away as people kind of get used to the drugs.

00:30:04 Speaker_00
And so in the 2-year study there were 150 people who completed the 2-year trial and only 10 of them dropped out due to adverse effects, which is only 6%.

00:30:15 Speaker_00
So what this indicates is that people are getting side effects, but the vast majority of people are willing to push through the side effects and complete these trials.

00:30:25 Speaker_01
Yeah, so what you're saying is folks are more likely to stay in these studies than other studies into how folks can lose weight.

00:30:33 Speaker_00
Yes. So far I've kind of been presenting the case for semaglutide, the way that you read about it in these clinical trials. I've been reading a lot of things from people in the weight loss world and this is how they talk about the drug.

00:30:50 Speaker_00
is that it's delivering very significant weight loss, the dropout rates are relatively low and before we get to like complicating that picture a little bit, I think it's important to first of all just like acknowledge that like that is the data that we have and like I think this new generation of weight loss drugs is like genuinely just a big deal.

00:31:10 Speaker_00
To me, the most bizarre thing about the discourse, especially recently but since the results of these trials started coming out, is the weird victory lap that people have been doing.

00:31:21 Speaker_00
It's like, okay, we know we have something now that works for weight loss, right? We finally have an effective weight loss drug. And then there's this weird sort of second order thing where they're like, what are fat activists going to do now?

00:31:32 Speaker_00
Like this ruins body positivity and there's all this weird shit of like well now we have a cure for obesity, right? And I feel like just to sort of take these results as we've been presented with them, right?

00:31:45 Speaker_00
Like the quote-unquote best possible version of these events, right? All of the weight loss, all of the benefits, everything. It's like we're talking about a drug 50% of people who take it will lose 15% of their body weight.

00:32:03 Speaker_00
And like, that is not a world without fat people. This is like the aspect of the drug that drives me absolutely fucking nuts. It's not going to end the quote-unquote obesity epidemic. It just isn't.

00:32:13 Speaker_00
We still, as a society, need to work on stigma against fat people, improving medical care for fat people. All of the things we say on this show are still fucking true if every single person in America loses 15% of their body weight.

00:32:28 Speaker_01
And that is a dramatic overestimation of what's even about to happen. Right.

00:32:32 Speaker_01
Even if, as you say, even if they work exactly as they are projected to, even if the data doesn't change one bit with future trials, someone my size goes from being 330 pounds to being 280 pounds.

00:32:48 Speaker_01
That would take me from, uh, being an, a person with an obese BMI to being a person with an obese BMI. Yeah. This whole thing about like, you know, is this the end of the obesity epidemic?

00:33:03 Speaker_01
Like, A, no it's not, as you've pointed out, but B, that is the meanest fucking thing to say.

00:33:12 Speaker_00
We currently have this fucking nightmare bullshit, which is like, the whole fucking show is dedicated to this, where it's like, a fat person goes into the doctor for a migraine, and they're like, I have a migraine, and the doctor's like, you should go on a diet.

00:33:21 Speaker_00
And then it's like, you haven't asked me what I do, you haven't asked me if I eat fast food, you haven't asked me fucking anything. You're giving me this bullshit ass advice when all I want is fucking advice for my migraine, right?

00:33:29 Speaker_00
We're now going into a scenario where you go into the doctor with a migraine and they're like, you should go on Ozempic. And you're like, well, I've already been on Ozempic three times.

00:33:36 Speaker_00
And I was one of the half of people who lost less than 10% of my body weight. It was costing me more than my fucking rent. I was having weird side effects. People report like not enjoying food anymore, which is like really sad to think about.

00:33:48 Speaker_00
And then the minute I went off of it I gained all the fucking weight back and I've done that four times. And when I'm going in you're giving me this generic bullshit fucking advice to go on Ozempic. You haven't asked me whether I've been on it before.

00:33:58 Speaker_00
You haven't asked me about weight cycling. You haven't asked me whether I tolerate the drug or if it intersects with some like antidepressant that I'm taking. We're just redoing the same fucking thing except instead of go on a diet it's go on Ozempic.

00:34:08 Speaker_00
Yeah. And like in the same way that it's not possible for everyone to go on a fucking diet or they've been on a million already. It's not possible for everyone to go on fucking Ozempic and it's not going to work for everybody.

00:34:16 Speaker_01
I mean, I told listen, I told you this off mic, but I think this is the darkest episode that I have researched for us. Yeah, it's really bad. It is really upsetting.

00:34:28 Speaker_01
And I will say it like not just on an individual level, but also like systemically, like I stopped seeing doctors for like eight years. I've written about this a bunch of times. And that was at the height of like the bariatric surgery craze. Yeah.

00:34:46 Speaker_01
And that really fucking fueled how doctors would talk to me and what treatments they would offer me. And it was like a very frequent conversation of me being like,

00:34:56 Speaker_01
Hey, I'm 24 and I have an entry level position at a nonprofit where I feel fortunate to have health coverage at all. No, I don't have 25 grand for a weight loss. Right.

00:35:08 Speaker_02
Yeah.

00:35:08 Speaker_01
But that still became a thing. Right. Amongst health care providers who we already know are more likely to think of fat patients as noncompliant, as slovenly, as unattractive, as weak willed as all of these things. Right. Like this becomes another reason

00:35:25 Speaker_01
for that group of people also to stop listening to fat people. It's going to get harder for me to get healthcare.

00:35:32 Speaker_00
That's part of what's about to happen. This is why I wanted to go out of my way to insufferably present the results of these trials as if they will hold up.

00:35:43 Speaker_00
Because even in a world in which that happens, that doesn't call anything into question about the need for equal treatment. And at the same time, the results of these trials are extremely unlikely to pan out in the real world.

00:35:59 Speaker_01
Yeah, totally.

00:35:59 Speaker_00
So I have three reasons why these drugs are very unlikely to pan out and deliver like the end of obesity or all the stuff that the insufferable discourse has been telling us. We're tucking into the debunk bed.

00:36:12 Speaker_00
Yeah, this is a much more comfortable space for us. The first is that the populations that are being studied in these trials are actually relatively narrow.

00:36:21 Speaker_00
So step one, which is the trial that's kind of the overall like just normal weight loss drugs being given to people, I'm going to read you the exclusion criteria. People were not able to participate in step one

00:36:36 Speaker_00
If they have a history of major depressive disorder, they have a diagnosis of a severe psychiatric disorder, they fill out the patient health questionnaire with a score of over 15, this is one of those questionnaires that has like, you know, I have feelings of hopelessness.

00:36:53 Speaker_00
like rank from like every day to like never. It's basically a measure of like how depressed you are, it's like are you feeling tired. One of them is do you have poor appetite or overeating, which is like a funny exclusion criteria to include in this.

00:37:07 Speaker_00
They're also excluding people with a lifetime history of a suicide attempt, any history of myocardial infarction, stroke, hospitalization, any kind of existing cardiovascular stuff, known or suspected abuse of alcohol or recreational drugs,

00:37:23 Speaker_00
And, female who is pregnant, breastfeeding, intends to become pregnant, or is of child-bearing age and not using a highly effective contraceptive method. Holy shit, that cuts out so many people, Michael.

00:37:35 Speaker_00
Well, the thing is, I mean, with these studies, like, I sort of get why people who design studies do this stuff, because they want to start with a kind of baseline of like, quote-unquote, normal people.

00:37:45 Speaker_00
without a bunch of like pre-existing conditions, which I get for the purpose of a trial. I get why you want to have like a clean quote-unquote sample.

00:37:53 Speaker_00
However, once these drugs get out into the real world, they're going to be taken by people with depression.

00:38:01 Speaker_01
When you're designing a trial like this, I imagine you're walking a real line, right? You want the trial itself to be safe for the people who participate in it.

00:38:08 Speaker_01
So you want to eliminate things like existing heart conditions, like anything, existing pancreatic conditions, anything sort of related to the mechanisms involved in this drug. I totally get that. Right.

00:38:20 Speaker_01
And you don't want it to make anything worse for anybody, like just on like a human level. That totally makes sense to me.

00:38:26 Speaker_01
The trick is all of that gets translated into an assumption that this is how it will play out for all people who are not being monitored in a study and provided the drug for free and all people who have all of these other conditions that are extremely prevalent.

00:38:46 Speaker_01
in the US, right?

00:38:47 Speaker_00
Yes, and also I probably should have started with this, but the second reason why it's unlikely that these are going to deliver on the results that we're seeing in the trials is because there are real-world studies of semaglutide and they don't find the same results.

00:39:04 Speaker_00
So there's a study in the US that followed like people who went to weight loss clinics and got these drugs for one year. If you remember in the trials of these drugs the average weight loss was around 15%.

00:39:17 Speaker_00
In the real world trial people are losing 7.5% of their body weight.

00:39:21 Speaker_00
And there are other real world trials, it's quite remarkable actually, that find almost the same thing that like the weight loss, you know, 80% of people lose 5% of their body weight or more. In the real world that tends to be around 40%.

00:39:34 Speaker_00
So almost all of the numbers that we're seeing in these randomized control trials are half once we get to the real world. They're not zero, right?

00:39:41 Speaker_00
So this still is going to be, again, a big deal, but we're not seeing in the real world those results continue to show up. It's not totally clear why this is happening.

00:39:53 Speaker_00
One of them appears to be that in the randomized controlled trials, people aren't just taking the drug, they're also getting like dietary counseling.

00:40:03 Speaker_00
So one of the trials is like super intensive behavioral therapy where they're like meeting with dietitians once a week, but in all of the other trials, they're doing monthly check-ins with counselors and they're having all of these, you know, biomarkers taken

00:40:18 Speaker_00
I think there's something about like people just being in a study, like you really want to finish because you're like, oh, I'm part of this like project, it's like experimental and super cool.

00:40:26 Speaker_00
And like the adherence rates for these randomized controlled trials are like significantly higher than we have in the real world.

00:40:34 Speaker_00
When you look at the real world trials, even among people who have type 2 diabetes and who like really need these drugs, a lot of them are finding like 50% dropout rates. after two years. And one of them finds 70% dropout rate.

00:40:48 Speaker_01
You can already see as we're sort of like walking through this research the gap between the popular claims that are being made about these drugs and what the research actually says. That's where we got to with FenFen. That's where we got to with Ally.

00:41:04 Speaker_01
That's where we got to with like, this is sort of a pattern with weight loss drugs, is that we get out over our skis culturally with like this kind of magical thinking excitement stuff.

00:41:16 Speaker_01
We then make a bunch of policy decisions based on the excitement and not the data. And then we're kind of stuck with these sort of adjusted systems that were, again, changed based on what we thought was possible, not what we were actually seeing.

00:41:34 Speaker_01
Exactly.

00:41:34 Speaker_00
And the other thing that, again, we have very good data on is that people tend to regain all of the weight the second they stop taking these drugs. So one of the studies switched people from semaglutide to a placebo at 20 weeks.

00:41:52 Speaker_00
There's also a trial of another GLP-1, tirzepatide, these fucking tides, that did the same thing.

00:41:59 Speaker_00
After 36 weeks they switched people to a placebo and basically it's like people start regaining the weight very quickly and like within a year they've regained almost all of the weight.

00:42:10 Speaker_00
These drugs seem to put people in the same cycle as fad diets but just with more dramatic and longer results.

00:42:18 Speaker_01
And the people that I have heard talk about taking these drugs are like, I'm just going to take it until I get down to X weight and then I'm going to stop. And that is people's plan for how this is going to happen and that's not how these drugs work.

00:42:31 Speaker_00
I'm seeing this discourse among like weight loss clinicians too, where they're like, well ultimately it comes down to diet and exercise and so we need to get people on these drugs and then teach them the diet and exercise stuff.

00:42:42 Speaker_00
And then once they know that, we can take them off the drugs. But this trial of carzepatide, the other drug, had people on an intensive behavioral therapy program when they went off the drug.

00:42:55 Speaker_00
So people took it for a while, then they switched to a placebo while still doing like exercise and like cooking classes and all this stuff that everybody says is so fucking effective. And they gained all the weight back.

00:43:06 Speaker_01
This is another case of pump the brakes and ask a fat person. Has anybody tried to teach you how to cook? Has anybody offered you a gym membership? Has anybody told you that your form was wrong while you were working out? Right. This is every day.

00:43:19 Speaker_01
The reason that people think that, in part, is that it reinforces our existing beliefs about fat people. Right? Right. Which is just that they're too lazy or they're too unintelligent or they're too uninformed to just do it for themselves.

00:43:33 Speaker_01
So they need a thin person to teach them how.

00:43:36 Speaker_00
This is going on my Aubrey Gordon soundboard. Yeah, step back, ask a fat person. I mean, genuinely, that's going to be my advice.

00:43:43 Speaker_01
Like 80% of the time it's like, have you even talked to a fat person about this?

00:43:47 Speaker_00
This is another like super fucking familiar pattern where it's like, okay, everyone should go on Atkins because low fat diets work and then like, or low carb diets work.

00:43:56 Speaker_00
And then of course, after like six months, everyone gains the weight, you know, and then it's like, it's like, well, if you stayed on it, you would have cut the weight off, which Which is true, fine, if you can stay on it.

00:44:04 Speaker_00
But no one can fucking stay on it. We know, in the real world, no one can stay on these extreme low-carb diets for very long. So let's move forward on that basis that no one can fucking stay on them. And with this, it's going to be the same thing.

00:44:15 Speaker_00
Well, Ozempic does work if you can stay on it. But people aren't staying on it. We know from real-world data that even when it's fucking free, people are not staying on it.

00:44:22 Speaker_01
Well, and if you do stay on it, people characterize it as the easy way out. Yeah. And then you have this bullshit, right? Like Oprah was just saying the other day, like, it's the easy way out. So I'm not going to do it.

00:44:32 Speaker_01
And I'm like, Oprah, you were in your sixties. How hard do you think you need to have appeared to have tried?

00:44:39 Speaker_01
And then like, listen, the discourse makes it worse because in the discourse is like a bunch of the reporting is like, we really need to tamp down on the stigma facing people who take Ozempic. And I'm like, yeah. The stigma!

00:44:54 Speaker_01
that we need to clamp down on.

00:44:55 Speaker_00
What's so fucking annoying to me about this discourse, you have like successfully radicalized me on this in like the last 72 hours. As I've been reading this, it's like this shows up everywhere, like what about the stigma of taking the drugs?

00:45:08 Speaker_00
But the stigma of taking Ozempic is fat phobia. It's the same fucking stigma that fat people are facing. But just like, oh, you're taking the easy way out by using a weight loss drug. That's the connection between fatness and virtue.

00:45:21 Speaker_00
You should lose weight in the virtuous way. Take the stairs. Yeah, take the fucking stairs. It's like, well, you might look thin, but you're really a fat person.

00:45:30 Speaker_00
You cannot muster any fucking gumption from anybody to give a shit about stigma against fat people. But they're super chill to invoke fat phobia against people who stop being fat.

00:45:42 Speaker_01
And they still do the fucking stigma against fat people. And they still do it. It's also been fascinating, I'll say, on the discourse end,

00:45:49 Speaker_01
that there have been all of these bizarre hand-wringing pieces from thin people being like, was body positivity for nothing? I know, it was all a lie. The vast majority of fat people were under no illusions about broader social acceptance.

00:46:06 Speaker_01
At best, people said fewer unwanted things about our bodies. It never stopped. We were never lifted up. We were never centered. We got one Lizzo out of it. And we don't even have that anymore. And we don't even have that anymore.

00:46:25 Speaker_01
The degree to which this discourse is thin people telling themselves stories that they want to hear.

00:46:33 Speaker_00
It's funny to me that we meticulously outline this and plan it out, but neither one of us can resist talking about the discourse. I hate it so much. Like fast forwarding. I hate it.

00:46:46 Speaker_01
Okay, Michael, we've talked about the drug. Let's talk about the manufacturer of the drug.

00:46:53 Speaker_00
Yeah.

00:46:53 Speaker_01
Ozempic and Wegovy are both made by Novo Nordisk. It's a big pharmaceutical company from Denmark. From Denmark. And their marketing practices have really set the template for all the discourse we've been seeing since.

00:47:07 Speaker_00
Okay, wait, are there ads for Wegovy and Ozempic? You haven't seen the, oh, oh, oh, Ozempic. That's like the cover songs that are in all the fucking trailers now.

00:47:15 Speaker_01
The very slow brooding cover of like, I whip my hair back and forth.

00:47:23 Speaker_00
I'm blue, ba-doo-dee-da-doo-die, but it's like super dark. Yeah. No, as we've discussed many times, we're on very different, like, Instagram experiences and, like, algorithms and, like, I've never seen an ad for weight loss, anything.

00:47:38 Speaker_01
I'll tell you what, Mike, I might give you homework at one point and be like, go watch a half an hour of TV and tell me what you notice about the ads. Dude, no!

00:47:46 Speaker_00
Absolutely not. I watch terrestrial TV, like, once a fucking year when I'm, like, visiting my grandma and I'm like, this is, like, this is, like, actively making me stupider. It's, like, shocking how bad it is.

00:47:57 Speaker_01
So, We're going to talk a little bit about the marketing practices at Novo Nordisk. OK, there is a lot here that leaves me feeling icky. A very good example of this is a campaign called It's Bigger Than Me. Have you seen this campaign at all?

00:48:13 Speaker_00
It's like billboards.

00:48:14 Speaker_01
There are ads, there are billboards, there are branded segments on TV shows, there are so many things. The slogan is, obesity, it's bigger than me.

00:48:24 Speaker_01
The idea behind the campaign is, it's not your fault you're fat, followed immediately by, it's because you have a disease and that disease requires medical treatment. And that medical treatment can only be provided by one company.

00:48:38 Speaker_00
It's bigger than me, it's $15,000 per year. Yeah, that's right.

00:48:42 Speaker_01
That's right. As part of this campaign, Novo Nordisk has specifically courted black public figures and particularly black women as spokespeople. Their first spokesperson was Queen Latifah. Their next was Yvette Nicole Brown, who was on Community.

00:49:00 Speaker_01
Their third was Roland Martin from CNN. Okay. who ran an hour-long segment on fatness in black communities that was listed as quote-unquote, powered by Novo Nordisk.

00:49:14 Speaker_00
That's like when influencers say like, I've partnered with Nike or whatever. It's like, it's just them paying you to say words.

00:49:21 Speaker_01
Well, and on top of that, the reporting around the quote unquote, it's bigger than me campaign is just rife with like the most garbage messages about fatness and body positivity and all kinds of stuff. So.

00:49:37 Speaker_01
I read an interview with Yvette Nicole Brown with The Griot. In that interview, she said, quote, being focused on your health does not mean that you're not body positive.

00:49:48 Speaker_01
I think it's actually the most exemplary way that you can be body positive because you need your body to continue to live.

00:49:54 Speaker_00
Aubrey, were you just like losing your mind? You hate this body positivity stuff already.

00:50:00 Speaker_00
This is like, this is reifying everything you've said about the whole body positivity thing that it's all just like they're repackaging the same shit and selling it back to you.

00:50:09 Speaker_01
The article goes on to say that quote, In my notes, I wrote in all caps, who is saying this?

00:50:25 Speaker_00
Who fucking said this?

00:50:26 Speaker_01
Who is saying this? And it's like trolls, right? It's seeding a bad faith argument to be like, we don't think that's true. Look at what all those nutty people are saying. They're wrong.

00:50:39 Speaker_00
This is like when conservatives are like, feminists don't even want you to get married and have kids.

00:50:44 Speaker_01
It's the phenomenon that has built Michael Hobbs' Twitter feed. Hey! Hey! You're familiar with my work. So, our third section, Michael Discord. Is the part that I have realized is most troubling to me and that is the discourse.

00:51:02 Speaker_00
There's been a lot of like garbage media about this in the last like year.

00:51:06 Speaker_01
Here are three actual fucking headlines from coverage of this. Ooh. Will Ozempic change how we think of being fat and thin, question mark?

00:51:18 Speaker_00
Okay.

00:51:18 Speaker_01
Life after food, question mark?

00:51:21 Speaker_00
Yeah.

00:51:22 Speaker_01
And Ozempic settles the obesity debate.

00:51:26 Speaker_00
Oh. That one's annoying.

00:51:28 Speaker_01
It is just bad faith proclamations and bullshit question mark headlines, like as far as the eye can see. Yeah, yeah. What I am worried about is that

00:51:38 Speaker_01
When we see a wave of media like we have seen around Ozempic, we also tend to see a wave of increased anti-fat bias, right? And the reporting that I have seen so far, the think pieces that I have seen so far, none of them are grappling with that.

00:51:55 Speaker_01
Right. Very few people are asking fat people what they need in this moment. And nobody is asking diabetic people what they need in this moment.

00:52:04 Speaker_01
Like a thing that I experientially know in every bone in my body is that when people I know start to lose weight, the vast majority of them start to see themselves

00:52:18 Speaker_01
as more virtuous, whether they want to or not, whether they mean to or not, whether or not they would say it out loud. It's very common for people to expect social reinforcement for weight loss.

00:52:31 Speaker_01
And I would say now, as I have said for years now, which is you have got to get people's consent to do that. The best case scenario is that you're sending a message that you're, like, not a very good friend to a fat person, right?

00:52:47 Speaker_01
And the worst case scenario is that you're increasing the stigma that they face and potentially also, like, triggering people's eating disorders. Like, this shit is not unthorny.

00:52:57 Speaker_01
And the fact that you're hearing it everywhere doesn't make it less urgent. I would argue it makes it more urgent. to double up on those boundaries. You have got to give fat people an out for this conversation.

00:53:09 Speaker_01
And we've got to stop presuming that this is a good and exciting conversation for everybody.

00:53:15 Speaker_00
I am not all that invested in the drugs themselves. The drugs are the drugs. I don't know. Same, same. Maybe they'll be effective weight loss drugs. Maybe they won't. I don't know.

00:53:25 Speaker_00
But given what we know now, the most likely scenario is that they're going to be prescribed to millions, potentially tens of millions of people.

00:53:35 Speaker_00
And what you said to me the other day is that you can see the number of people who lost 15 fucking pounds and then all of a sudden are really mean to fat people just exponentially increasing.

00:53:47 Speaker_01
The other thing that I will say about the discourse around this is that every like celebratory story about Ozempic that comes out now, that's all going to be mirrored by future panicky think pieces on the rising costs of obesity and how fat people are bankrupting us once again, right?

00:54:07 Speaker_01
This is an unbelievably expensive medication and all of that is going to come back to scapegoating fat people once again. Right? That like, right now we're saying it's frivolous housewives and whatever.

00:54:20 Speaker_01
When we get into the insurance conversations, we're not going to be scapegoating rich people. We generally don't do that. We scapegoat poor people, BIPOC, fat people, queer people. You know what I mean? Like, we've got a list of people we scapegoat.

00:54:32 Speaker_00
We're also setting ourselves up for another round of excruciating discourse in another couple years when people look around and they're like, wait a minute, there's still fat people.

00:54:40 Speaker_00
All the magazines told me a couple years ago that this was the end of obesity, and yet people are still fat.

00:54:47 Speaker_01
We should also say, like, listen, you will face serious, serious fucking stigma as a person who stays fat. Trust me, a person who has stayed fat through all the interventions, right? Like, I've already, like, sort of started shifting

00:55:04 Speaker_01
Uh, socially, you know, I'm already a very homebody indoorsy kind of lady and I'm already restricting who I socialize with pretty dramatically because of this kind of talk and because I'm unwilling to be in spaces where this shit will come up. Right.

00:55:21 Speaker_01
And for me that means functionally like a vast majority of people I know who are not fat and some people I know who are right. So I just want people to understand the stakes of this as a fat person are, I feel like I don't belong in the world.

00:55:35 Speaker_01
When people talk about how great it's going to be when I'm not around, that's not me being too sensitive. That's not fat people taking it too hard. That's you saying plainly, everything will be better when you're gone.

00:55:48 Speaker_01
And then fat people like taking that message.

00:55:51 Speaker_00
horrible. The fact that you have been through so many rounds of this, it's like, why aren't you on fen-phen? Why aren't you on bariatric surgery? Why aren't you clean eating?

00:55:59 Speaker_00
Why aren't, like, all this is is just new packaging for, like, why aren't you thin? Yeah. And, like, that is worth listening to. This isn't, like, a paranoid fantasy on the part of fat people.

00:56:10 Speaker_00
This is something that they've been through numerous times over the course of their lifetimes now. We're just doing the same thing again even when the data does not remotely indicate that we're not going to have fat people anymore.

00:56:22 Speaker_00
It never has, we're always going to have fat people and there's always going to be people, whatever the medical intervention is, that can't use it or it doesn't work for them or they've tried it already. That's always going to be the case.

00:56:35 Speaker_00
The fact that people are so obsessed with asking the question, is this the end of obesity, like really early. Like, oh, is this going to be the reason we don't have fat people around anymore? It's like, it's so fucking telling.

00:56:45 Speaker_01
So moving forward, we're going to continue to get these drugs. We're going to continue to get this sort of, quote unquote, gold rush.

00:56:53 Speaker_01
And in that time, I think it is worth being extra skeptical and returning to the voices of fat people and diabetic people when media isn't doing that for us, right?

00:57:08 Speaker_01
to actually return to the people who are most impacted by this debate and to spend way the fuck less time speculating about Elon Musk and Kourtney Kardashian and making celebrities defend themselves and trying to think through, how do we get these drugs to people who need them?

00:57:27 Speaker_01
How do we design a better discourse that isn't so wildly dehumanizing to fat people and, again, to diabetic people?

00:57:36 Speaker_01
And like, how do we just show up for people a little bit more around this stuff and interrupt some of this like dancing in the street kind of energy that is like really upsetting to see as a fat person? Okay, we've done enough table setting.

00:57:50 Speaker_00
Let's start the episode. Are you ready? It's been two hours and 45 minutes.