GLP-1 drugs: weight loss revolution and cultural backlash (Full Transcript)

[00:00:00] Speaker 1: In the span of just a few short years, weight loss jabs like Wigovi and Monjaro have become so prevalent in our culture, transforming the way we live, move, and eat.

[00:00:11] Speaker 2: Well, a lot of people have been wondering about my new fitness journey and what I've been doing, and I've been really open about me being on GLP1s, and I thought it was really important just to come out and say it.

[00:00:21] Speaker 3: You look great. Thank you. Skinny like this. Really. You look, I mean, like 20 years younger. How did you do that?

[00:00:27] Speaker 4: Through that injection that everybody takes.

[00:00:29] Speaker 3: You took the Olympic?

[00:00:30] Speaker 4: When you have a weight problem and you've tried everything, and then somebody says, take this injection, and you're going to be skinny.

[00:00:39] Speaker 1: From the BBC, I'm Asma Khalid in Washington, D.C., and today on our show, how weight loss drugs are changing our world. Welcome to The Global Story, where each weekday we dive deep into one story that tells us where the world and America intersect. And today I am joined by Giles Yeo, who has a job title that I will allow him to explain himself.

[00:01:06] Speaker 5: I am a professor of molecular neuroendocrinology, which sounds very complex. No, I study how the brain controls food intake and the genetics of body weight at the University of Cambridge.

[00:01:16] Speaker 1: These drugs have been around for a few years now, and they're rather popular here in the United States. I've seen some surveys that show about one in eight Americans are on a GLP-1. And we want to understand in our episode today how these drugs have changed our world. And so I want to begin there with you. I mean, you have been studying this all. What do you see as the most fundamental way these drugs have changed our lives?

[00:01:41] Speaker 5: I think the most fundamental way these drugs have changed our lives is that for the first time, we have broadly safe, we can discuss side effects in a second, but broadly safe, broadly affordable to a large number of people with huge efficacy with regards to weight loss and type 2 diabetes. I mean, the weight loss we're looking now at these drugs are anywhere between 15 and 25%, depending on which flavor of drug we're talking about, which would have been mind-boggling just six, seven years ago. And actually this class of drugs, these so-called GLP-1 drugs have actually been around for 20 years. So for a while, but for a large portion of their lifespan, they have been once daily injections. And the weight loss was in single digits. And so you sort of saw step changes, right? You go to the meetings, you meet with the scientists, either that have done the basic research or work within the companies. And so you saw these things, oh my goodness me, look, 8%, 9%, 10%. Oh, now it goes from once daily to once weekly. And so when it came out that there was a once weekly with this effect size, none of us were within the field were truly, I think, surprised. We were not surprised by the effect of the weight loss. We were surprised by the fact that the cultural uptake.

[00:03:08] Speaker 1: The cultural zeitgeist, you're saying? Yeah.

[00:03:09] Speaker 5: The cultural zeitgeist, the cultural uptake, because how many, okay, I work in the United Kingdom. We go to the doctor, the doctor gives us drugs. Okay. We don't know the name of most drugs, the vast majority of drugs, the only, Advil maybe. Okay. Tylenol. Okay. So you know those drugs, but suddenly this was a drug that everybody knew. And I think it was when I began to see TikTok videos, and this must have been in 2020, height of COVID. We were bored at home swiping on our phone. When I was looking at this, oh my God, this is a type two diabetes drugs. Why is there a hashtag that has to do with that? So for me, when it actually occurred to me, hmm, this is odd, was probably 2020 during that TikTok hashtag follow my obsempic journey phase of it.

[00:03:59] Speaker 1: Well, I want to talk more about the impacts of these drugs, the ways in which they are changing our world. But I think before we do that, Giles, it's worthwhile to, to actually understand what these drugs are. I mean, there's a range of them. You've mentioned Wagovi, Monjaro, Ozempic, so many people know that one. And before we talk about the cultural impact of them, can we talk about what they actually do? If you were taking a GLP-1, what will that do to your body?

[00:04:29] Speaker 5: So these, first of all, what is GLP-1? Why do we call them a GLP-1, right? And so GLP-1 is actually the name of a natural hormone in our body that is produced from our gut, from our intestines. So our intestines produce 20 different hormones, these gut hormones, two of which are relevant to our conversation today. The first is GLP-1 and the second is GIP, G-I-P. Okay. Now, these drugs are modified versions of one or both of these hormones. These hormones are called encretin hormones. They're called encretin hormones because what they do is they enhance insulin secretion when you eat food. And so when you eat food and it passes through your gut, these hormones signal to the pancreas and enhance insulin secretion, helping you maintain blood glucose, which is why they were primarily originally used as a type 2 diabetes drug. But most gut hormones, 18 of the 20 gut hormones, make you feel fuller. Okay. So as you eat and food goes through your gastrointestinal tract, these hormones are produced, which let your brain know how much you're eating, what you're eating, and they tend to make you feel full. So GLP-1 and GIP, in its natural native form, that is their role. Now, the magic power that comes, that the drug companies have done to these drugs, is to produce a version of these that stay in your blood for longer, because a natural version of these hormones that are produced from the gut only have a half-life of two minutes, because they're designed to be volatile. Okay. They're designed to reflect what you're currently eating. And once that bolus of food has kind of passed through, it's then designed to go back down again. It's designed to kind of pulse your insulin. And once it's taken up the glucose to go away again, right? But what the drug companies, all the drug companies have done is sort of put molecular decorations on versions of these hormones. And so what you do is when you take them, they stick around the blood for longer. The half-life of these drugs are a week to 10 days, which is why- A week to 10 days, compared to two minutes. Two minutes, exactly. And so they stick around the blood for longer, which means that you're able to use them as a type two diabetes drugs, because for every given gram of food you eat, there's more insulin sorting out your blood sugar. And because they stick around the blood for longer, they go to the brain, your brain feels fuller. Your brain thinks you have eaten more food than you actually have.

[00:06:55] Speaker 1: That's what I guess in reference to, I always hear people refer to this idea of silencing food noise.

[00:07:00] Speaker 6: One of the things that I realized the very first time I took a GLP-1 was that all these years, I thought that thin people, those people had more willpower. They ate better foods. They were able to stick to it longer. They never had a potato chip. And then I realized the very first time I took the GLP-1 that, oh, they're not even thinking about it.

[00:07:25] Speaker 1: So Giles, since these GLP-1s have been introduced and really taken off in our culture, we have seen them radically reshape our world in so many ways. And I want to talk through some of these ripple effects with you. Perhaps we could begin with one of the most obvious effects, and that is their impact on diet and weight loss culture. How have you seen these drugs change the conversation as it relates to diet and weight loss culture?

[00:07:56] Speaker 5: So at the moment, the vast majority of these drugs are taken privately, which means that you've got to be able to afford the drugs. So diet culture is still there, okay? But diet culture tended always to be something that was discussed by the middle-class people anyway, and it has definitely taken over. In fact, Weight Watchers is a classic example. Now, Weight Watchers are obviously a sort of group support way of actually trying to lose weight. Their key spokesperson was Oprah Winfrey. But Oprah then famously, on one of her programs, declared that she was actually on these drugs. I don't know if that was the tipping factor, but in effect, they then declared bankruptcy. So I guess the effect on the diet industry is that it has slightly polarized people, because there's still a substantial proportion of the world population that considers these drugs as cheating, okay? There are a lot of people who agree that these drugs are wonderful. I think even more people at the moment who think these drugs are cheating, and people should do it the natural way. And this is a widely held opinion, I want to point out, in many different countries.

[00:09:04] Speaker 1: Jos, I know you've done a lot of research over the years on the food industry. How are we watching restaurants or grocery stores, nutrition change as a result of this GLP-1 culture?

[00:09:17] Speaker 5: I know that, and I can speak for the UK, because this is where I work. There's a company called, there's a sort of bakery called Gregg's. And they're one of the biggest in the UK, sort of like it, they're found in every corner shop. And they sell something called sausage rolls. It's just sausage wrapped in pastry, okay? And you know, it's delicious, but not great for you if you eat it every day, okay? And this is something where you go, everyone, you know, can afford something that's cheap. They've had to reduce the size of their sausage rolls, and use higher quality meat to actually make some more protein, smaller size, to cater to GLP-1 users. On the completely the other end of the spectrum, there's someone here called Heston Blumenthal, famous celebrity chef, okay, in the UK, on one of these GLP-1 drugs as well. And he has a three Michelin star restaurant called The Fat Duck. Now, what he's done is he's, you know, one of these 13, 17 course tasting menus that cost you an arm and a leg. He's realized that so many people, and these are rich people going to eat at his restaurants, he realized he has to cater to them. And so there was a joke article in The Guardian, one of the newspapers here, called The Thin Duck, The Fat Duck has become The Thin Duck, where he now offers exactly the same tasting menu, but two thirds portion size, to cater for people on it. So you have on one end of the spectrum, the mass market sausage roll, to your three star Michelin restaurant, changing the way they market their food. And then now all the supermarkets here now have aisles of food that cater for people on these drugs, either supplements, nutritionally dense foods, smaller portions, it's beginning to change the way we are shopping.

[00:10:58] Speaker 1: But does that then filter down to everybody? I mean, you mentioned a restaurant serving a tasting menu with a portion that's about two thirds of the size that they normally would. I mean, here in the United States, we are famous for some of our restaurants having very, very large portions, right. And I think that a lot of folks who have tried to prioritize a healthier lifestyle have for a long time argued that, you know, our portions here in the United States are sort of out of control, this needs to be changed. And so if these GLP-1 drugs are driving that change, are you seeing signs that it's filtering down and changing our relationship more broadly with food, whether or not you're on these drugs?

[00:11:37] Speaker 5: Wouldn't it be ironic, okay, that we have spent the last 25 years trying to fight obesity by reducing, you know, reducing portion sizes and getting fight back from the food lobby and things, but actually there are these drugs which are going to force the change. Now, we haven't, let's see, I think 2026, 2027 is going to be very informative. But with my ear to the ground, just looking at the changing landscape, it is all now about reducing the portion size, but within that portion, increasing the nutritional density, charging still the same, I want to point out, I don't think anyone's trying to charge less. But I just get the feeling that a sector of our food is going to be better for us, because it's going to be smaller, but better. It's going to have more protein, it's going to have more nutrients. Let's see if it does indeed seep through.

[00:12:31] Speaker 1: Jos, we've been talking a lot about the positive side effects or the positive outcomes of these drugs. I have also heard though, quite a bit about some of the side effects of these drugs. Can you walk us through what are the side effects from these drugs? And are there concerns about them being overused or abused by people who don't need to be on them?

[00:12:56] Speaker 5: So I think the most common side effects are going to involve your gastrointestinal tract. So the most common side effect that were picked up in all of the main trials is nausea. The second one affects the other end of the tube, okay? Either stuff is moving through your tube a little too quickly, so diarrhea, or constipation a little too slowly. So many people are charting their journey on these drugs. And I'm talking probably 20% of people will have some of these side effects. But my major concern is actually less about the side effects, but about the wrong people getting ahold of these drugs. And what do I mean by this? So I mean by this, where these drugs do not have a weight limit in which they start working. If you're a 300-pound man looking to lose 50 pounds, this drug's probably for you, all right? That's fine. The problem is, these drugs will also work if you're a 16-year-old girl weighing 70 pounds. That's the problem, all right? It doesn't say, oh, you're skinny. It's not going to work now. They will do what the biology of these hormones will do. They'll still stop you from eating. That is the real danger. So we need to make sure that these drugs are regulated so that only the right people get it, because there's no weight limit to which they start. That's my biggest fear, because if you've got an eating disorder, you are only 70 pounds, you'll kill yourself. And then that is when we'll get into serious problems. So that is my biggest concern, the wrong people getting ahold of these drugs.

[00:14:31] Speaker 1: You mentioned that there's no weight limit at which point these drugs will start being effective. Is there an age limit? I mean, and I ask because GLP-1s are now being prescribed to children with obesity as young as 12 years old. What does the research suggest about how useful these drugs might be in treating children with obesity? And is it the same process as treating an adult?

[00:14:56] Speaker 5: It isn't. And the reason is because obviously children are growing. My view is that there is a cost-benefit analysis. Now, the problem with obesity, and we know that childhood obesity is a hugely growing problem, the main problem is unhealthy children and unhealthy adults. And the reality is if you end up with obesity, particularly severe obesity as a child, it's very, very difficult, not impossible, but very, very difficult to become unobese as an adult. So you do need to take a cost-benefit, a far, far greater cost-benefit analysis than you do with an adult if you're dealing with 12-year-olds and above. Below 12 still can't be treated with these drugs, rightly so. They are drugs. Okay, I know they make you or make you perceive yourself to look better, but they're not a cosmetic tool. They're designed to treat obesity and their related illnesses. The side effect might be you might look better. So when you're treating a child, you're not trying to make the child look better, you're trying to make the child healthier. If the cost-benefit analysis means the child, the adult, anyone taking the thing becomes healthier, fine, okay, in consultation with your doctor. But if it's simply to look better, because I don't want to be teased or anything like that, okay, this is not the drug for you, shouldn't be used as a cosmetic tool.

[00:16:12] Speaker 1: Giles, you've referenced a few times that, you know, we have to wait and see what will happen with these drugs. And it strikes me that the story of GLP-1s is in some ways only just beginning in our culture. And one of the big recent developments is that you can now take this drug in pill form. Novo Nordisk has this version of a pill, and there's been a lot of buzz over Eli Lilly also working to get approval for a pill version of these drugs. Do I have that right, that Novo Nordisk, I mean, Wigovi is available in pill form, is that correct?

[00:16:42] Speaker 5: It is, yeah. FDA approved in December 2025, and we are waiting for approval in this country.

[00:16:49] Speaker 1: Yeah. So I was just going to ask, why, just for my own understanding, why has there been all the buzz over this Lilly one that's coming out in March?

[00:16:55] Speaker 5: The Wigovi pill is simply that, right? So Novo managed to take the injectable version of it and sort of package it into a pill, so they still have to make the drug. And these drugs are not cheap to make, so they're still modified hormones, and they're still difficult to make, okay? Lilly is about to make what we call a small molecule drug. A small molecule is chemically made, it's chemically made rather than synthesized, it's a white powder. Now a white powder can be made at higher volumes far cheaper, because you don't have to try and mimic a hormone. Mimicking a hormone is just, it requires a specialist set of skills. A white powder can be made by anybody with a knowledge of chemistry, okay? And at scale, you still have to make it safe, which means that when those drugs come off patent, you're going to end up with Tylenol, broadly speaking, okay? Because Tylenol is a white powder, okay? Statins are a white powder. And so the moment you have a white powder, it's scalability, deliverability, and cost. Lilly will still charge what Lilly will charge, because they'll have to make back their R&D costs. Once it goes off patent, then we get population penetrance that we won't see today, because now the drugs will go down to single-digit, maybe double-digit costs, probably, but single-digit costs, something like that.

[00:18:18] Speaker 1: And that could dramatically change our culture.

[00:18:21] Speaker 5: Yeah, but that won't be for 15 years, right?

[00:18:23] Speaker 1: What does it mean for these drugs to be available in pill form? Does it increase access, affordability? Broadly, I just want to understand, what does it mean?

[00:18:33] Speaker 5: Yeah. Both, both. I think it will increase access, because it'll be cheaper, because there's no delivery system that you have to create, the needles and things like that, so automatically it'll be cheaper. And crucially, they don't have to be refrigerated, because all the current injectables need to be in the fridge, which means that in order to deliver them, in order to store them, you need to have a cold chain, which is fine in the United States and Northern Europe and what have you, but it means accessibility to places which don't have refrigeration, for example, is nearly impossible. In pill form, they're easy to transport and don't have a cold chain. So accessibility, equitable accessibility, that suddenly, suddenly opens up. The downside goes back to the right people getting it, right? As an injectable, it's more difficult to sort of get a black market version of it. As a pill, it's going to be a lot easier. So as we increase access, rightly so, right, to drive down prices so that more people who suffer can get the drug, then we need to make sure we tighten up on black market versions of these drugs, illicit version of these drugs, getting to the wrong people.

[00:19:41] Speaker 1: We have talked throughout this conversation about ways in which these drugs are changing our culture. And I'm struck by the fact that on the one hand, these are drugs that are lifesaving for some people, and that they are radically reshaping the lives of people who have been on diabetes, who may be obese. And on the other hand, I'm thinking about how we've seen this recent wave of culture articles, at least here in the United States, about the return of so-called heroin chic. I don't know if you're familiar with this, but the idea that there's this resurgence of culture, right, that prioritizes extreme thinness. And I can't help but wonder if these phenomena are perhaps related. And I wonder from your perspective, is the existence of drugs that make it so easy to lose weight, further entrenching our culture of extreme thinness? And it just strikes me as being really different than some of the focus we saw over the last, you know, several prior years, where there's this idea around body positivity and different types of shapes and models of different sizes. And now we see a real cultural focus, at least here in the US, it feels, on extreme thinness.

[00:20:52] Speaker 5: I think that we got to hold these two thoughts in our head, right, that this is said that these are powerful drugs that will help a lot of people. And I think that's going to be true. But we're humans. Okay. And so we like beautiful things. At the moment, beautiful is thin, sadly. And now we have a tool, which could make us thin, if you want to use it as a cosmetic drug. I'm not encouraging anything. But this is just this is just the truth.

[00:21:17] Speaker 1: The fact is, you're saying it can be used that way.

[00:21:20] Speaker 5: It can be used that way. And the reality is, these drug companies do not want these drugs in the wrong hands, either. Because if something bad happens, it reflects bad. It's bad for business. Okay, just from a purely mercenary perspective. But I am already seeing, just on social media, when you go swipe, swipe, swipe, of people saying, why does this person look like that? He or she can afford the new drugs, when they're just choosing to look like how they're looking. So it is, I think it's a true fear that you're saying, the only way that we're going to fight back against this are probably two ways. First of all, legislating who gets these drugs. But, and this, and then the second one, more of a pipe dream. Maybe we need to reconsider what our standards of beauty mean. What does beauty mean? And disconnecting beauty from weight, but reconnecting weight to health.

[00:22:12] Speaker 1: Yeah, those are conversations that it feels like we've been going through every few years. And there's different cycles that kind of ebbs and flows where the conversation goes in a given year. Well, Charles, thank you so much for taking the time to join us. I really appreciate it.

[00:22:28] Speaker 5: Thank you so much.

[00:22:29] Speaker 1: That's it for today's show. If you enjoyed our episode, I cannot let you go without sharing that our show, The Global Story, is also available every weekday as an audio podcast. You can find us on bbc.com or wherever you listen to your favorite shows.