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"How the hell did we get here?"
It's a simple question about one of the most complex issues of our time: an obesity crisis that's crippling the world, physically, mentally and financially.
It's also a question that has been driving writer Johann Hari, as obesity overtakes hunger as the top threat to global health.
The bestselling British author has spent years investigating a new style of weight loss drugs, including Ozempic, that some say could help end "globesity".
"I now know much more, but I don't know the answer," he tells triple j Hack of his investigation.
"But this is a new drug working in a completely different way, that has extraordinary effects."
Magic solution or magic illusion?
Approved for use in Australia for treating type 2 diabetes, Ozempic and Mounjaro have become a global phenomenon.
They help to control blood sugar levels in the body, in part, by mimicking a digestive hormone called GLP-1.
But it's their weight-loss effects that have everyone from Hollywood A-listers to bodybuilders lauding them as wonder drugs.
They have many wondering if they could be the world's obesity panacea.
But while open to the possibility the drugs could up-end the world, Hari also warns there remain big risks and even bigger unknowns.
"Pretty much every 20 years, going back to World War I, a new diet drug is announced," he told Hack.
"We're told it's a miracle drug, we're told it's going to save us all.
"Loads of people take it, and then they always discover some horrendous effect that it has on your health, and it gets yanked from the market, leaving a wave of devastated people behind it."
Loading...'It's absolutely massive'
There is no denying the world's appetite for an effective weight loss drug. According to the World Health Organization, global obesity has almost tripled since 1975, while two-thirds of Australians are now considered overweight or obese.
Indeed, the success of Ozempic — and its higher dose version, Wegovy — has made its manufacturer, Novo Nordisk, headquartered in Denmark, Europe's most valuable company.
This week Novo Nordisk and its American competitor Eli Lilly announced they were injecting billions of dollars into ramping up production of the drugs, as they strive to keep up with skyrocketing demand around the world.
It's a global market some analysts predict will be worth more than $US100 billion ($152 billion) by the end of the decade – a possibility food manufacturers like Krispy Kreme and Nestlé are already preparing for.
Hari says they're not the only ones.
"A big report by Jefferies Financial for the American airlines said: Prepare for the fact that you're going to save loads of money on fuel. The population's going to be much thinner and as a result, it's going to cost a lot less to fly them around.
"I think there are huge changes that we could see."
'I wasn't hungry'
For Hari, it's been a personal journey.
An Ozempic user himself, he says he lost 20 kilograms in just a couple of years, greatly reducing his risk of heart disease, diabetes and other chronic conditions.
He says he felt the effects almost immediately.
"Two days after I first injected myself with it, I was lying in bed, and I thought, 'I feel something really strange.'
"It took me a good five minutes to realise I had woken up and I wasn't hungry.
"I don't remember that ever happening to me before."
But while Hari was shedding weight quickly, he wasn't feeling as good as he had expected.
He experienced nausea, vomiting and fatigue – all well-documented side effects.
But mentally, he says he felt differently as well.
"One of the ways I had always coped was by stuffing myself, by over-eating," he told Hack.
"And I just couldn't do that.
"For a while, I felt quite a lot worse — it was like my drug had been taken away from me."
The risk debate
Novo Nordisk does warn that Ozempic's serious side effects may include pancreatitis, kidney problems and gastrointestinal issues.
It also warns of possible thyroid tumours, including cancer, after studies in rodents showed an increase in risk.
Hari says it poses a dilemma.
"You have to realistically weigh it against what are the risks from just remaining obese.
"Given my risk profile, I'll choose the risk of the drugs over the risk of the ongoing obesity."
The alternative way
In his book, Hari writes:
"Ozempic and the drugs that follow represent a moment of madness. We build a food system that poisons us and then to keep us away from the avalanche of bad food, we decided to inject ourselves with a different potential poison, one that puts us off all food."
But there was one place that changed his perspective on everything.
"We can learn from Japan," he told Hack.
"Japan is the third-richest country in the world, and there's almost no obesity there.
"There's no market for Ozempic there because there's almost no obese people."
In the book, Hari explores why, in his view, the West has lost its way with food knowledge and appreciation, touring schools in Japan where students surprise him by admitting their favourite foods are broccoli and white fish, rather than chocolate bars or cheeseburgers.
He wonders why schools in Western countries, including Australia, rarely have access to nutritionists who advise on healthy lunch options provided to their students.
"This is what you get when you get the obesity crisis right: you get more years of happiness, more years of joy, more years of dancing," Hari said.
"That's why it's so important that we think through both the science of these drugs but also how we see them in the wider context of this obesity crisis."
Australia's Ozempic future
Ozempic's use for weight loss in Australia is considered "off-label", meaning a doctor can prescribe it for a purpose outside of what is approved.
One of those doctors is obesity expert Kathryn Williams, who told Hack these new medications are game changers.
"These drugs are amazing, and we need them," she said.
"But I think we can't be giving them to 30 per cent of the population.
"I hope we actually start to look at the drivers for weight gain in our society, but definitely the medications are needed in people who are having a significant impact from their obesity."
Dr Williams says one of the biggest issues so far has been a shortage of the drugs that has left people needing them in desperate situations.
"It's terrible. I've had a lot of people with very severe diabetes suddenly unable to get supply and they can get quite sick, quite quickly.
"You shouldn't be using them for a quick benefit.
"They're not a drug for looking good for a wedding."
How it ends
Hari ends his book by spelling out how these new weight loss drugs may ultimately change our world.
He spells out three hypotheses, from worst to best.
"The most pessimistic scenario is this: that this is like the diet drug in the 90s called Fen-phen, and it was marketed exactly as Ozempic is being marketed.
"And then it was discovered it caused an horrific lung disorder and was pulled," he told Hack.
"I don't think it's likely that's going to happen, but I can't rule it out."
Hari goes on to explain his "middle" scenario: that the drugs work, but only a tiny minority of people get to use them.
"The Real Housewives of New Jersey get to be super skinny while the real school kids of New Jersey get to get diabetes at the age of 12."
Hari's most optimistic scenario: that the drugs do turn out to be highly effective with little risk and are accessible to all.
But even then, he thinks such success would come with a warning.
"Crucially, they also wake us up to go, 'How the hell did we get to this situation?'
"We don't have to tolerate our kids' appetites being hijacked [by processed foods] and their bodies being altered and them being made sick.
"We can do what we did with smoking to get out of this stupid trap that we should never have got into in the first place."
Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs by Johann Hari is published by Bloomsbury.