Ezra Klein

Why?

So I want to start on the part of this that people actually don't talk about that much, which is diabetes, which is what these drugs are originally approved for.

As you say, a huge number of Americans have diabetes and have terrible health consequences often from it, including limb amputation and blindness.

What do these drugs do for diabetics?

Okay, so you have the recognition, which is just something people begin observing, that diabetics on these drugs begin to lose weight and they don't feel hungry.

Right.

And as researchers begin testing, you know, the first generation of this, Ozempic, what we now in that context call Wegovy, how big is the effect size?

What do we actually know about what Wegovy does for weight loss?

There's another one which is slightly more advanced.

It has more mechanisms of action to its appetite, which is also goes by ZepBound.

How much weight do people lose on these?

You've written or co-written a whole book about the metabolism.

And one of the arguments of that book, one of the arguments of books in this space that I think people don't appreciate is that hunger is a function of the brain.

And it's a function of the brain's reaction and predictions about the world around it.

We always have this idea that people just feel hungry and then, you know, you should use your brain to decide if you want to eat, but your brain is deciding if you feel hungry and you're sort of fighting its own instincts.

So I'd like to spend a minute on this idea that hunger is a function of the stomach versus hunger is a function of the brain and sort of how research has moved from one to the other.

Like what you would get during food poisoning or something?

So the wonder drug we've invented is we've made your brain slightly think it's being poisoned all the time?

One of the things that I find interesting about the GLP-1s is we basically created this food environment that does not exist in nature of hyper-sugary, hyper-fatty, hyper-salty, hyper-calorie-dense foods.

Our brains are evolved over very, very long periods of time to treat those as getting three cherries on the salt machine.