Hey Team and welcome back to the Can I Have Another Snack? podcast. We’ve been on hiatus but we’re back with a new fortnightly pod. Today I’m talking to Dr. Asher Larmie, AKA The Fat Doctor. Asher is a transgender, non-binary GP who uses they/them pronouns. They are a fat activist and founder of the #NoWeigh campaign. Asher joined me on the Don’t Salt My Game Podcast back in May last year, and we had such a great conversation that I just had to have them back for the CIHAS pod.
This episode is in response to the news that the NHS/NICE in the UK are contemplating offering weight-loss injectables to kids. These drugs have already been approved in the US (which I discuss here) - it was only a matter of time before we started talking about it here too. In this episode, we talk about the evidence behind semaglutide, or lack thereof, potential side effects and unintended consequences, and of course, we talk about the company behind this drug, Novo Nordisk, who are set to make bank off of fat kids. So yeah, the first episode back is kind of a bummer - but I wanted to make sure we had a good grasp of the science before the media shitstorm kicks off.
We also have a new podcast editor - the lovely from - welcome Lucy! (see if you can find the Avery Easter eggs she planted in the new episode format).
Find out more about Asher’s work here.
Follow their work on Instagram here and Twitter here.
Listen to The Fat Doctor Podcast here.
Follow Laura on Instagram here.
Subscribe to my newsletter here.
Sign up to my upcoming webinar with - ‘Substack for Nutrition Professionals: Launching & Growing Your Email Newsletter’.
Here’s the transcript in full:
Asher Larmie: We had 180 teenagers for a year, and that's it. It's not enough time to understand what is going to happen to that teenager long term. We need studies that have looked back after 20 years. We need to know what's gonna happen to these kids when they become adults, when they become older adults, but not the first year. It's so dangerous. These drugs haven't existed for long enough. We've never used them in children before. It's terrifying to me. Absolutely terrifying.
Laura Thomas: Hey, welcome to the Can I Have Another Snack? podcast where we talk about food, bodies and identity, especially through the lens of parenting. I'm Laura Thomas. I'm an anti-diet registered nutritionist, and I also write the Can I Have Another Snack? newsletter. Today I'm talking to Dr. Asher Larmie. Asher, who uses they/them pronouns, is a transgender non-binary GP and fat activist who is campaigning for an end to medical weight stigma.
They're the founder of the #NoWeigh campaign and they have over 20 years of medical experience and have been fat for even longer than that
Laura Thomas: As the self-styled Fat Doctor, Asher started a blog in June 2020. They now also host a successful podcast and run a number of training courses, as well as monthly webinars for people who are interested in learning about weight inclusivity.
Today I'm gonna be talking to Asher about the news that came out of the UK that the National Institute for Clinical Excellence, or NICE, is considering approving the weight loss injectable Semaglutide for kids. Asher is here to explain to us why this is catastrophic for kids' sense of safety in their bodies and their wellbeing.
We talk about the evidence behind Semaglutide, or I suppose the lack thereof, the potential side effects and unintended consequences. And of course, we talk about the company behind this drug, Novo Nordisk, who are set to make bank off of fat kids.
Just before we get to Asher though, I wanna tell you real quick about the benefits of becoming a paid subscriber to the, Can I Have Another Snack newsletter community, whole universe.
Now, I know we're not used to having to pay for content on the internet, and why would you pay for something where 85% of the content is free? Well, that's a great question. I'd love to answer it for you. Well, because without paying supporters, this work just wouldn't be possible. As well as supporting me in the time it takes to research, interview contributors and write articles, your support goes towards paying guests for their time and their labour, as well as a podcast and newsletter editor. You also help keep this space ad and sponsor free so I don't have to sell out to advertisers or exploit my kid for freebies. Plus keeping the community closed to paying subscribers only means that we keep the trolls and the fatphobes out.
I recently asked the CIHAS community why they support the newsletter, and this is what they had to say:
“I am a mum of one, fairly adventurous, self-proclaimed vegetarian and one theoretical omnivore. The latter survives almost exclusively on added sugar and butter, but mostly sugar. I consumed all the picky eating advice, some of it really well-meaning, and pretty mellow. But by seven years in, I was more frustrated, confused, and full of self-doubt than ever. Enter CIHAS. The no-nonsense, cut through the bullshit, science-backed content is exceptional. The content about sugar is especially helpful to me, and the anti diet lens is an anecdote to my extremely anti-fat slash diet-culture conditioning. And as an American, the British references are just an added bonus to say your work is actively changing. My life is not an understatement. Thank you.”
Well, thank you to the reader who shared that lovely testimonial, and if that hasn't inspired you to become a paid subscriber, I don't know what will. It's just a fiver a month or £50 for the entire year, and you get loads of cool perks, as well as just my undying gratitude for supporting my work.
Head to laurathomas.substack.com to subscribe now. All right, team. Over to Asher.
Laura Thomas: So Asher, last month, the news broke that the Department of Health have recently asked the Medical Watchdog NICE. Which stands for the National Institute of Clinical Excellence to review the so-called benefits of using weight loss injectables for kids aged between 12 and 17 years old. Specifically, they're looking at the drug Semaglutide. Which has been in the news a lot recently, which I'm sure we'll get to. But I wondered if we could start by talking about what exactly Semaglutide is, how it works and what the evidence says about it.
Asher Larmie: You sort of put it in air quotations, or you said so-called benefits, didn't you? I like that, yeah. Cause that, that was a really good way to start. Yeah. So Semaglutide, it's a incretin mimetic. It mimics a hormone called inncretin or one of the hormones, GLP1, which is an incretin, and, and these hormones are released by the gut in everybody's body and in response to eating. So look, you have a meal, your gut releases these hormones and they impact several parts of the body. The main thing they do is they impact the insulin pathway. So they impact the pancreas, but they also have various other effects. And one of them is they sort of decrease appetite and increase a feeling of satiety, of fullness, which makes sense, right? Because when you start eating, after a while, your body sort of wants to tell you, okay, you've been eating now like it's time to stop eating cos you can't eat forever. And when we talk about intuitive eating, we're always talking about, like, picking up our hunger cues and picking up our fullness cues. Well, there's a reason we have hunger cues and fullness cues. It's nothing to do with the size of your stomach or anything like that. It's because of these hormones acting on the appetite sensors in the brain. So this drug Semaglutide was designed for diabetics because of the way that it works on the pancreas and the insulin pathway. But they found very quickly that it causes suppression. And so people were losing weight on this drug. Their diabetics were losing weight.
Laura Thomas: And to this point, just to clarify, you are talking about in adults, right?
Asher Larmie: Absolutely.
Laura Thomas: This research was initially done in diabetic adults?
Asher Larmie: In diabetic adults. And we're talking…when they probably started working on this drug, this would've been early 2000s, I think the first one of its…the first drug in this group - and it wasn't Semaglutide, by the way, it was a completely different drug - would've come out in the sort of early 2000s. Semaglutide for diabetics, which is Ozempic, Ozempic is the brand name for the drug. Semaglutide one milligram weekly subcutaneous injection. So it comes like a little pen and you inject it into your stomach, usually. One milligram is the maximum dose for diabetics and the brand is Ozempic. I can't remember, I don't wanna say for sure, but it was definitely after 2010, somewhere around that time that we started using it in diabetics or it was approved, and more recently we've been using it in diabetics more and more and more. It's a very expensive drug, it's the most expensive diabetic drug…I dunno how it compares to insulin, but certainly compared to all the other diabetic drugs.
Laura Thomas: Yeah, I saw that for like a month's supply of Wegovy, which is the, the weight loss version of Ozempic, that it costs something like $1,300 a month in the US. I don't know what it is in the UK, but in the US, $1,300 a month, that is an astounding amount of money.
Asher Larmie: Sure. And that's the private prescription. But when you look in the NHS, it's how much it costs the NHS per month, right? So that's always like then.. sale price, it's, you know, it's…
Laura Thomas: That's the wholesale.
Asher Larmie: The wholesale, the Costco price.
Laura Thomas: The Costco price!
Asher Larmie: And I can't remember what it is, but it's at least twice as much.
Laura Thomas: It's expensive.
Asher Larmie: It's expensive. Compared to Metformin, which is probably like £1 a month. You know, in terms of diabetic drugs, it's much more expensive. Anyway, so Novo Nordisk creates Semaglutide. It's a once weekly injection. Ozempic, people like it. And then, quickly they realized it was kind of like the Viagra story. I mean, if you know the story of Viagra, Sildenafil was supposed to be for blood pressure, was anti-hypertensive for blood pressure. But they soon realised it's not so much what it does to blood pressure - in fact, it wasn't very good with blood pressure. But look at the side effects. You think something was happening to men. And so they realised, well, we could definitely corner the market here because there's no other sort of medicine that has quite the same effects. And so Viagra was born. This is very similar. Ozempic was being used on diabetics. Diabetics were losing weight, and they thought, right, let's push this through. Let's, let's turn this into a weight loss drug. And so they started studies in 2017, 2018, they started the actual study. The results came out late 2020, maybe early 2021, depending on the studies. There’s been eight. And then the teenage one, so we're talking still adults only. Right. Literally within like six months, the FDA had approved it and NICE took a little bit longer. They sort of semi approved it in 2022 and fully approved it in 2023. With very, very little data. All we know is that this drug suppresses your appetite and therefore makes you lose weight. And it also does all the other things, like sort of acts on the insulin pathway and all the other things that it's known to do, but we have no idea how that impacts non-diabetics and how that will impact children, certainly. We have a zero idea.
Laura Thomas: Okay, so just to summarise, cuz you're a doctor. And not everybody else is! This drug is a GLP1 analog. So it mimics a hormone in the gut that is produced naturally in response to, in response to eating a meal. Our bodies, our guts pump out this hormone. And that is one of the ways, one of the pathways, one of the signals that tells our brain, okay, we can slow down now. We've, we've got enough here, we'll be good for a little while. Right.
Asher Larmie: That's it.
Laura Thomas: And so we have a fall in our appetite basically. What this drug is doing, it's an external version of that hormone that you are injecting into your stomach, that artificially suppresses your appetite. Right.
Asher Larmie: That's it.
Laura Thomas: So it's not…it's essentially tricking your body into thinking that you've had more food than you actually have. Now this might be helpful when you have a chronic condition such as Type 2 Diabetes, it might help manage blood glucose. However, what you're saying is that we don't know what the impacts are on people who have just been prescribed this for weight loss. And we also don't know the impact of this on children who are growing.
Asher Larmie: Mm-hmm.
Laura Thomas: Which is…I mean, all of it is a mess. All of it is concerning and upsetting to me, but it feels particularly upsetting and concerning to me when we're talking about children, when we don't know the full scale of the impact. So what evidence do we have on children? You know, why are we at a…I mean, this is a separate conversation, but if we could get into the minds of the DoH and the NICE people, why do they think that we should start prescribing this to children?
Asher Larmie: Well, first of all, we've been lied to about this drug, although I think the Department of Health and the National Institute of Clinical Excellence should be smart enough to figure out that they've been lied to about this drug. I can understand why the average person doesn't, but if you've read studies, which I have in detail, all eight of them, well, seven of them, one wasn't published, and the one on teens, it's very obvious. Because the first thing is, in order for them to achieve weight loss, the participants in this trial had to go on a diet 500 calories deficit, plus exercising for 150 minutes a week, plus an hour of counselling every month.
Laura Thomas: Right, We don't know if the impact is coming from the diet and lifestyle modifications versus the drug in and of itself.
Asher Larmie: We do to a degree because everybody was on the diet. Only some people were on the Wegovy. And others were on placebo, just a water injection. And so what we saw was a) that diets don't work. Which you've been saying this whole time! The diet-only group only lost about 2.5% of their body weights over a period of a year, and then regained it all. So diets don't work. What a surprise. The people who took the Wegovy definitely lost much more weight. There was a significant difference. So in the first 16 weeks, that's when you lose the most amount of weight. We know this. This is the physiological response to calorie deficits or energy deficits.
It then slows down and between sort of week 16, week 20 until about month 10, it sort of slowed down, but was still going. And then at month 10 in the first study, we reached the nadir, which is the peak, and then people started regaining weight. If you look at the study over two years, people regained something like 15% of the weight that they lost within eight months. You carry that forwards….I mean, it's not particularly scientific to carry it forwards, but if you were to assume that every eight months you'd gain about 15% of the weight that you'd lost. Within five years, you've regained the weight. And that's if you are on the medication. If you stop the medication, which in the UK you only are entitled to have it for two years, the moment you stop that medication, you will start regaining the weight.There is absolutely no way you can maintain it because nobody could. Nobody could maintain it, even when they stayed on the diet. They could not maintain that weight loss. They immediately start gaining the weight back and at a rate that is almost unprecedented. We've never seen such dramatic weight loss followed by weight regain with any other weight loss drug.
Laura Thomas: Well, shit, you're gonna be hungry! As soon as you stop taking that drug, like, you're gonna be fucking hungry!
Asher Larmie: Sure. Although I think it's more than that. Like I don't even think that explains it. There's something else that's happening in the body and we just don't know what it is, right, to know how it's working
Laura Thomas: And this is it, like, when you go in and you start messing with hormone pathways. It's not just gonna be one individual pathway in isolation, there are gonna be knock on effects and that is what we've seen in historic weight loss medications, right? We're, we're giving people something for weight loss, but it turns out, oh, actually we're burning them alive from the inside. Right? That's what has happened with other, with other drugs…or where we've, we've tried to suppress people's appetites, but we've also suppressed their libido because again, you can't isolate out individual pathways within the human body cos everything is interconnected.
Asher Larmie: That's exactly right. And actually what we know is that this drug primarily works on the insulin pathway. And the insulin pathway is extremely important for so many different reasons. We know that the insulin pathway, insulin sensitivity, insulin resistance, for example, leads to weight gains. So we could, you know, make an argument that actually once you stop messing with the insulin pathway, perhaps there is a weight regain and perhaps you are making permanent changes to the body because you are messing with the pathway you shouldn't be messing with.
I, you know, I often say don't play about with a healthy organ if you can avoid it. And so in a diabetic, the pancreas is already exhausted. The pancreas is already struggling, so okay, you're gonna mess with pancreas, but it needs help anyway. Benefits outweigh the risks, but in this case, this people with a healthy pancreas, especially children, The last thing you wanna do is mess with organs that are still growing. You know that that's massively worrying. So the first thing I will say is that we have been lied to about this medication. We have been told that this medication will help you to lose weight and keep it off. Wrong. Even NICE said with the adults’ guidelines, you will not be able to maintain the weight loss.
So that's one thing…
Laura Thomas: And can I ask you…sorry, cos I know you're like desperate to tell me your second point! But I'm just curious, like, what is the reason that NICE are giving for people only being able to stay on the drug for two years?
Asher Larmie: Because that's all the evidence we have. We don't have anything beyond two years. If we had evidence for five years, they probably would've said five, but they've said, look, all you've got is two years, so that's all we can allow. Now, remember with NICE, it’s the UK, this is a Nationalised Health Services, there’s only a certain amount of money, so when NICE is approving a drug, they're not just worried about the drug safety, efficacy, you know, and all of that stuff. They're also worried about…is this a cost effective…yeah, it's money. Is it cost effective? So Novo Nordisk had to prove to NICE that there was a cost benefit. So helping people lose weight for two years and then regain it, which they admitted would happen because that's what their studies show.
And so that's the problem if you look into that calculation, that calculation is materially flawed. The fact that NICE accepted it makes me very sceptical of the whole thing, but we can cross that bridge later. The point is that in the UK you can only have it for two years. But even if you continued it for five years, you will have regained most of the weight back by that point in time.
And then they talk about maintenance doses. What maintenance dose? If the treatment dose doesn't work, then what's the maintenance dose gonna do? What does that say to me? They can only keep going up, up and up, right? At what point in time are we gonna accept that we really shouldn't be messing around with the body like that? Just for temporary weight loss. That's all it's doing. It's not improving your health. There's no evidence that it does anything for your health. It just makes you lose weight. They didn't even bother to measure the impact on your health, even your like, blood pressure, blood sugar, cholesterol. They didn't even bother to do like a statistical analysis of that, I think because they knew that they wouldn't be able to find anything.
Laura Thomas: It's just so transparent, isn't it? When you say that? Like it's just, we don't actually give a shit about your health. We don't care about any other parameter of your wellbeing. We just wanna make money off of you.
Asher Larmie: And so you asked, you said, well, why? Why are we trying to get this available for children? And the answer is simple: for more money. Novo Nordisk is a, you know, a traded company. They have a, a group of shareholders and they're constantly trying to improve their, you know, profit margin.
And, and the thing is, when you look at all of the, if the last 15 years or so, there's been this huge push, hasn't there to -quote unquote- tackle the -quote unquote- ob*sity epidemic. And, you know, we have a -quote unquote- war on ob*sity and all these, you know, like really kind of like highly charged words.
Novo Nordisk has had their hands in all of this. Novo Nordisk has fingerprints on every single article that you read in the paper. Every single PR campaign for the last 10 years. Whenever you hear the word childhood ob*sity in the, in the papers…whenever you hear that word, if you look carefully enough, you will find Novo Nordisk.
They have wanted to sell this drug to teenagers for a really long time. So much so that the American Academy of Pediatrics, when they brought out their guidelines, they actually held off and waited for Novo Nordisk to be able to put their study into the, into the guidelines. Literally they were like, this is the cutoff date. And then they went, oh, hang on, hang on, hang on. Novo's not ready. Alright, let's just wait. Let's just wait. Let's just wait. Novo's ready now. Okay. We can proceed. That's how much influence Novo Nordisk has. And so it's simply about making money. The risk, the potential risk to children is really mind boggling.
Laura Thomas: Yeah. So let's talk about this because there's, as far as I know, there's one study in adolescence. Is that right?
Asher Larmie: That's it, yeah.
Laura Thomas: Should we talk about that single study that they are basing this recommendation or this, you know, it hasn't gone through yet, but this, I mean, I mean, come on. The writing is on the wall, right. They're gonna do everything that they can to push this through.
Asher Larmie: They will.
Laura Thomas: First of all, let's talk about the study, and then let's talk about the implication for children, for adolescents
Asher Larmie: 180 12-17 year olds are involved in the study. There's only 180. Bearing in mind that the one for adults, the first one was 2000. 180 is actually a very low number of people. And basically it was your typical randomised controlled trials. Some got placebo, some got Wegovy. You know, they did it for 68 weeks. And then they were interested in change in body mass index. That's all they were interested in. They didn't look at anything else, and they found exactly what all of the other studies found: that in the first year, children lost weight and they lost much more when they took this drug than they did when they had placebo, just water.
It's not surprising. That is what always happens. You know, when you have a drug that's going to suppress appetite, it's going to be more effective than just, you know, trying to suppress your own appetite, if that makes sense. Right. So of course it was effective, but it was only effective for the first year. That's all we've got and that's all the data. We had 180 teenagers for a year, and that's it.
It's not enough time to understand what is going to happen to that teenager long term. We need studies that have looked back after 20 years. We need to know what's gonna happen to these kids when they become adults, when they become older adults, but not the first year. It's so dangerous. These drugs haven't existed for long enough. We've never used them in children before. It's terrifying to me. Absolutely terrifying.
Laura Thomas: Something that I found really interesting…so shout out to Reagan Chastain, who did a really great deep dive on this, on her, Weight and Healthcare Substack, I'll link to it. But one of the things that, that she pointed out were all of the side effects that were reported in this study. A lot of them were related to gastrointestinal side effects, so a lot of nausea, vomiting, diarrhoea and abdominal pain. And so again, of course if you've got a kid who is nauseous, who has diarrhoea, if they've got that for an entire year, they're going to lose weight. But at what cost to that child? To their quality of life? To like think about if you feel sick, like even for a couple of hours during the day, let alone for an entire year. And these are kids who are presumably going to school, trying to learn, trying to have a social life, trying to navigate the headfuck that is puberty, right? All of that stuff. And we think it's a good idea to subject them to this kind of…like for why? Why?
Asher Larmie: Yeah. So for me, weight loss and children is absolutely unacceptable. Always. Okay. If I see a child who is accidentally losing weight…
Laura Thomas: Huge red flag, huge red flag.
Asher Larmie: Massive red flag like that, that's like panic stations. Figure it out immediately. The second thing that I will say about children is that we know that dieting of any kind is going to predispose them to eating disorders, especially at that stage in life, especially at this…
Laura Thomas: It is the most vulnerable point in a child's development...
Asher Larmie: Absolutely.
Laura Thomas: For, yeah. Yeah. The onset of an eating disorder.
Asher Larmie: And we know that the more extreme their sort of dieting behaviour is, the more likely they are to develop an eating disorder. So that's the second thing. It's not just that dieting creates eating, but the more extreme…now, taking drugs is one of the most extreme form of dieting out there.
So what we are doing is we are essentially prescribing eating disorders to adolescents. It is no wonder that over the last 20 years, certainly over the last few years, where we've become more and more obsessed with weight in children, where we keep sending them to these -quote unquote- weight management clinics, and we keep singling them out at school and policing what they eat and all this stuff. If you're a fat kid nowadays, like, you know, you can't even bring in a packet of crisps in your lunchbox without getting told off by your teachers.
Laura Thomas: You can’t even have a snack that's over a hundred calories. It's something I'm writing about at the moment and it's fucking horrendous, because we're literally policing the amount of food that a child, a growing child can have.
Asher Larmie: Yeah, it's despicable. But what are we doing? More importantly, we are literally prescribing an eating disorder to them. We are saying to them, this is what's gonna happen. And are we surprised that nowadays eating disorder rates have gone up dramatically?
Laura Thomas: Escalated.
Asher Larmie: They're escalating in boys, they're escalating in people with like, you know, multiple marginalised identities. You know, it's not just a really thin, sort of, like, fragile teenage girl anymore that we need to be worried about. We have to be really concerned about all of these young. boys, for example, who were trying to build up muscle. It's actually quite terrifying what's happening to young people.
Their mental health is really poor anyway at the moment, and what we're adding to, with this weight management, is just awful. So this isn't even about the drug. This is just about the fact that you should never mess with weights in a child. You should never, ever mess with growing organs, just let the child grow up.
Laura Thomas: I wanted to ask you about, like, what are the implications of putting a child on a calorie restricted diet? Messing with their energy intake while they are growing and developing, like, what are the implications there for…around their physical development, around puberty, around sexual development, all of those things? Do we know or do we just not know?
Asher Larmie: I was gonna say, first of all, it's amazing how much we don't know. No one is interested in researching this. No one ever says, what are the risks of putting a child on this medication? You know, they look at the side effects of the medication, but no one's actually said, what happens to children if you put them on diet after diet, after diet when they're young?
We know the answer to this question because we are, and we are of the generation. I'm 43 years old. I was on a diet when I was a kid. I know exactly what that did to me. I weight cycled and weight cycled and weight cycled and weight cycled. It messed with me mentally. It messed with my self-esteem, my self-worth, my confidence. Instead of helping me to trust my body, it did the opposite, it took away my relationship with my body, my relationship with food, all of these things, like, it completely messed with that. So that's from a kind of like psychological point of view.
But from a, from a physical point of view with these particular drugs, we don't know. We're not just worried about malabsorption. You're not getting enough nutrients if you're not eating enough food. That's, that's hugely problematic. Right?
Laura Thomas: Yeah. And I know you, you say we don't know, but I think. We have a good sense, right? Like we can infer. What we would imagine would probably happen, like you say, if, if you don't have enough nutrition, if you have deficiencies. What I'm thinking about in particular is bone health and how can, you know, while you're still trying to achieve peak bone mass? You are then putting people at risk, children at risk for falls and fractures and you know, osteoporosis as they get older.
Asher Larmie: Osteoporosis, anemia, you know, all sorts of things. Also gastrointestinal problems. So we are looking at things like, you know, irritable bowel syndrome and stuff that, you know, you, you mess around with the gut cos this drug, like I said…
Laura Thomas: That's what you're doing.
Asher Larmie: This drug impacts your appetite centres, but it also impacts your gut itself. So you're gonna mess, you know, we're talking sort of gut function and motility issues. And this is the thing that like, you know, most concerns me out of everything is, you are messing with a healthy pancreas. Now if you understand the insulin pathway, what happens with insulin is that when we ate food, sugar, insulin is released because of this incretin, right? The incretin from the gut, the GLP1 comes along, tells the pancreas: Hey, there's food here.
Laura Thomas: You need to process it.
Asher Larmie: And, and it goes, woo, I'm gonna release lots of insulin. So that's the pancreas and insulin. Insulin is like a key. If you put the key into the lock and you turn the lock that you open the door. Sugar can go from the blood where it's, you know, currently sitting, into the cell, which can then be used as energy for the cell, or can be stored to be used later. So you need the sugar to go from the blood, where it's useless, into the cell, where it's needed and insulin is the key.
Now over time some people develop something called insulin resistance. Because you're overproducing insulin, and that's one of the first things that happen is we start overproducing insulin. Nobody knows why. It's probably genetic. You start overproducing insulin. So now there's lots and lots and lots of keys, constantly trying to turn locks and eventually the, the locks become a bit faulty, right? You keep messing around with the locks after a while, locks, you know, stop working as well. So now you can't open the door to get into the cell so there's more sugar in the blood. And eventually when you have enough sugar in the blood, you develop a condition called Diabetes, Type 2 Diabetes.
At the same time, because of all this stuff that's happening, the pancreas is panicking. I keep releasing insulin, but there's still loads of sugar in the blood. What's going on? So the pancreas does what, like, you know, like what Jewish mothers do, you know? It's like, let's just keep going. It doesn't stop to think. Mm. I wonder what's going on. No, no, no. Just, let's just keep doing the same thing and let's just…
Laura Thomas: It overworks itself.
Asher Larmie: Yeah. It becomes exhausted. As any organ would. After a while it becomes knackered. We call it pancreatic exhaustion. At that point in time, you are also going to, it's also gonna have implications and you'll develop Type 2 Diabetes.
So here's my thing. This drug is making you secrete lots and lots of insulin. Because like you said, it's fake incretin, so you're injecting it into your skin. All of a sudden you have lots more of this, you know, a mimic of this hormone in your blood at all times. So your body starts producing more and more insulin. Now as it produces more and more insulin. If you're a diabetic, this is great cos you need the insulin. But if you are not a diabetic, you're producing all of this insulin. Keep producing it, keep producing, keep producing. Isn't it possible, theoretically, that you could actually be speeding up the process of insulin resistance? And so what you could be doing is you could be speeding up the process of developing Type 2 Diabetes. So isn’t it possible - and it's just the theory cos there's no evidence. But isn’t it possible that, if we give a 12 year old this drug and they take it for say, five years, because by that point in time they'll be allowed to take for five years, they’ve taken it five years and then they start to develop insulin resistance, and maybe by the time they're in their twenties they've got quite profound insulin resistance and then they get diabetes at 26 say, and people think, gosh, diabetes at 26, that's quite young, but you know, they are fat, so it's their fault they've been fat, so they were kids, so it's their fault.
This would be…it wouldn't surprise me and we wouldn't be able to do anything about it by then. So I'm not saying that this drug is going to cause diabetes. I'm just saying that it is theoretically possible that it could cause diabetes because excess of insulin is the first step of insulin resistance and diabetes progression.
So this is really worrying and nobody is addressing this. It also interferes with the cholesterol pathway and all sorts of other things. So my worry is that it's actually making things worse rather than better.
Laura Thomas: And it sounds as though Novo Nordisk are not asking those questions.
Asher Larmie: There's no mention of this anywhere in their literature, I have to say. Nobody's asking, and this is what I can't understand. right. I'm a GP. I am not an expert. There must be people out there who understand the process of insulin resistance and they're thinking, Hmm, logically this makes sense. I wonder if we need to look into it. But I never hear anyone talk about it.
And I remember the first time. I brought it up with Greg Dodell, who is an endocrinologist. I remember the first time I said, are we not worried about this? And he was like, no, of course not. Because you know it, it reduces insulin resistance. And I was like, no, no, no. It, it reduces insulin resistance in diabetics, but what about in healthy people long term? Shouldn't we be worried about this? And I remember at one point in time Greg going, oh. No one, no one said this before. I was like, why is no one talking about this? But nobody is, and that's just one of my many concerns. It also causes pancreatitis, acute pancreatitis. Which is a life-threatening condition.
There's no evidence that causes pancreatic cancer. I just wanna point out, but we also don't have enough long-term data to say whether it does or it doesn't. So that is an absolute, we couldn't say, you know, we couldn't possibly comment.
Laura Thomas: Even, you know, regardless of what the long term implications are, which..obviously there is not enough research going on to establish that, but even the short term impacts on children, you know, again, some of those side effects that were reported in the study we were talking about were gallbladder problems, gallstones, low blood pressure, itching, rash, like all kinds of side effects on top of the nausea, vomiting, diarrhoea, headache, abdominal pain, all these other things. And I just… there is no rationale that I think you could convince me of where that is a good idea, to subject children to that. And you know, and that's without knowing the answers to…what about their growth? What impact is this gonna have on their development? Without knowing any of that.
Asher Larmie: When we are making a recommendation, right, there's two things we look at. Number one is the quality of the evidence. The quality of the evidence here is shit. The second thing we have to understand is, are the benefits, do the benefits far outweigh the risks?
If the benefits don't outweigh the risks, or if the benefits are sort of similar to the risks then we shouldn't be recommending this, this, any medication. Not only is the evidence shit, but there are no proven benefits apart from temporary weight loss. And there are so many risks. Some of them hypothetical, but as you say, some of them very real and very immediate.
So if that's the case, there is never a reason to give this drug to a child, never, ever, ever, especially because, yes, they are able to consent, but only if they're given all of the information and aren't being pressured into it by external, external people and, and unfortunately they just won't have that ability. They won't have the agency over their body to say, no, I know I'm fat, but I'm not taking this medication. Most of them won't feel that way. So no, I don't think…we have a consent issue here. We have all sorts of issues.
Laura Thomas: I think it's an important point is that kids are gonna feel pressured into it, both from medical anti-fat bias, as well as just anti-fat bias that is everywhere, that they're gonna feel from their peers, that they're gonna feel from their parents, that they're gonna feel from teachers. Yeah. Like, I can also understand why this drug is so attractive to so many people if it reduces the stigma that they're experiencing. Even if it is temporary and even if it has a really high price tag associated with it.
Speaking of price tags, The Guardian reported earlier this month that Novo Nordisk, so the company that makes Wegovy, paid more than £21.7 million to UK health experts and organisations in just three years, according to Disclosure UK records. And then several of those experts and organizations went on to make submissions to NICE, supporting the drug's approval for use in adults. It just, again, shows you that enormous conflict of interest within Novo Nordisk. But like we said before, the, the writing's kind of on the wall in terms of this getting pushed through NICE. And, you know, being incorporated into NICE guidelines.
What does that process look like from here? Like what happens between now and then? And you know, how can we intercept, you know, where do we submit evidence and submit concerns and ask these questions? Can we even do that? Or is this just gonna go through?
Asher Larmie: The can we is tricky actually. It's not the kind of process where you can get involved as as easy as you'd like to.
Laura Thomas: It's not like a public consultation, basically.
Asher Larmie: It's not. What will happen is that NICE has to make a decision about whether they're going to look into it first. And then they will form a guidelines committee. NICE will have a group of…it doesn't have to be doctors. It'll be, uh, experts. And some of them will be more interested in data and some of them will be interested in finances and some of them will be doctors and not necessarily pediatricians or endocrinologists. They could be psychiatrists, they could be anything. And they're just members of the panel. So you get this little guideline committee and then you've got your stakeholders. And so there will be certain groups that will be invited to partake. Obviously Novo Nordisk is gonna be…
Laura Thomas: At the table.
Asher Larmie: …doing the big presentation. In the adult one we had Ob*sity UK, a charity that is funded by Novo Nordisk. We had another ob*sity charity, whose name I can't quite remember, but again, is funded by Novo Nordisk. We had Professor John Wilding, who is the lead author of the Step 1 trial, the Wegovy Trial who has been paid countless times…
Laura Thomas: Handsomely.
Asher Larmie: Handsomely by Novo Nordisk. And that was basically it. There was nobody not representing, Novo Nordisk. And so they go through like you know, the beginning and people were asked to submit evidence and then you know, there are questions and then they have to submit more evidence and then they have the draft guidelines.
And there is probably a time when you can get involved and register your concerns. But I don't think it's open to the public. I don't believe, to my knowledge, that it's open to the public. I think that if this does happen, we are going to have to consciously, and by we, I mean the kind of people who are, you know, advocating against this drug being used in children are going to have to consciously get together and find a way to get involved in this process.
I wasn't with it enough when NICE was looking at Wegovy, it was too early on. It wasn't far enough into my sort of, I guess, deliverance…
Laura Thomas: Activism.
Asher Larmie: Deliverance, I would say more! From, from diet culture and weight stigma, but certainly this time around we're gonna have to do something about it. It's absolutely unacceptable, but to be honest, I would like it not to get that far.
The Guardian, the Observer, have been writing a few political pieces about the politics of Novo Nordisk. And they have in the UK had a bit of a slap on the wrist. I don't think they're taking it very seriously. I don't think they're worried about it, but they have been caught doing some very unethical things. We're not surprised. They are very aggressive in their marketing campaign. And you know the, how much did you say it was? 20 million.
Laura Thomas: Yeah, 21.7 million.
Asher Larmie: It's nothing compared to how much they spent in America. That was 150 million or something. Like, it's nothing. I'm not going to, for one second defend my colleagues cos I don't have time for that. But I do think a lot of them will have been going to weight management courses, conferences, and conferences, whatever. And not realised that because, because Novo Nordisk was not outspoken. They weren't like, we are Novo Nordisk and we are presenting this data to you. They ran these courses without telling them yeah, that they were running these courses.
And so a lot of my colleagues are fanatical about this drug and also, again, most of my colleagues learn a lot of medicine from reading the Sun and the Daily Mail, and maybe not the Sun or the Daily Mail. Maybe my colleagues are too high brow for that. You know? They're far too snobby to read the Sun or the Daily Mail. But they're reading it in the paper. They're reading their stuff in the paper. They're not reading.
Laura Thomas: They're reading, like, Henry Dimbleby talk about ultra processed food. Like yeah, he knows what the fuck he's talking about.
Asher Larmie: How many, how many fat people have gone to see a doctor and they've been recommended, oh, you should try keto because, you know, that worked for my uncle, or something stupid like that.
Like, you know, doctors really have no clue when it comes to nutrition, when it comes to -quote unquote- weight. Um, what do they call it?
Laura Thomas: Weight management.
Asher Larmie: Weight Management, right? So they just say stuff, they repeat stuff they've read in the papers. So they've all got it in this head that this is a miracle drug because of this beautiful PR campaign.
Now, if I worked in public relations, I would be massively impressed. But as a doctor who is conscious of the fact that this drug is going to massively harm children and is already massively harming adults, I am horrified that this is the society that we live in. So we have to do something about this. We really do. But all we can do is educate at the moment, because I don't know how much more political power we have.
Laura Thomas: I'm counting on you, basically Asher, to send up the bat signal and when it’s time for us to fuck shit up, just let me know
Asher Larmie: We’re keeping a close eye. Again, shout out to Reagan. She's amazing and she has been keeping on top of what's happening in the UK, and the politics with no, because obviously, Reagan, I, I learn a lot of, I learned most of my stuff from Reagan, but there are a group of us around the world that are doing whatever we can to, to shed some light on the very dark, underhanded dealings of this company.
And because she's keeping abreast of what's happening in the UK, the one good thing I can say about it's the UK is that it's a lot more out in the open. Yes. You know, the FDA, it's all done behind closed doors and there's, there's no legislation, there's no, there's no legal requirements to do things a certain way.
But if you've noticed the ABPI, which stands for something to do with pharmaceutical industry and their main organisation, has kicked Novo Nordisk out and given them a really, you know, has given them a telling off because of the ethics, because of what they've done and how unethical it's been.
So this is my point. I think we also need to be exposing them for the fraudsters that they are. And anyone and everyone can do that. My friend Jeanette, who is The Mindset Nutritionist, she just wrote a Substack newsletter where there was an article, uh, that was in the papers last week about how, how much fat people are costing the NHS.
Laura Thomas: I saw this..
Asher Larmie: Yeah And Jeanette basically is like, she talked about it and at the end she was like, oh, by the way, this person's funded by Novo Nordisk. And it's like, oh, there you go. You can find Novo's name anytime you try and look into it. So, you know, if you're sitting at home thinking, what can I do about this? Feel free to do a little bit of sleuthing, like Googling by yourself and try, just try and find the name, Novo Nordisk. Google the name of the doctor that's quoted in the article, and then Google Novo Nordisk and see where you can find the connections. Cause I think the more we bring attention to this, the, the more we expose these fraudsters for who they are.
Laura Thomas: Right? Any investigative journalists listening. You know, hit Asher up.
Asher Larmie: Yeah. I'm totally on board. That's it. I'll give you my number.
Laura Thomas: What you're saying is that we, we need to kind of make a noise about how unethical and dubious all of this is. And, and how devastating this could be if it, if it goes through, so yes.
Okay, well, we'll see how this all plays out. If you haven't signed up to Reagan's newsletter and Jeanette's newsletter, I'll make sure that I've linked to both of those in the show notes so that you, you know, we can watch out for developments. And of course I'll link to Asher's social media and everything so you can, you can follow his work as well.
Asher Larmie: I am in the process of bringing out a book about this. So if you're interested in finding out a little bit more, it's a little ebook, everything that we've talked about, but in much more detail. So, yeah, keep your eye out.
Laura Thomas: All right, Asher, to wrap up at the end of every episode, we share what we have been snacking on.
So it can be an actual, literal snack if you want, or just something that you've been really vibing on, something you're really interested in and you wanna share with the audience, a book, a podcast, whatever. What do you have for us?
Asher Larmie: Mine's a book. It's called, It Was Always Ours by Jessica Wilson.
Laura Thomas: Oh, yeah. We had Jessica on the podcast talking about her book.
Asher Larmie: Oh, oh. Well then I'm not bringing any new revelation. I dunno what she said, but I absolutely love this book.
Laura Thomas: You can give it a plug and I'll link, I'll link to the episode as well.
Asher Larmie: It's such a good book. It's great. I found it a very easy book to read. You know like sometimes when you read non-fiction books, it feels heavy
Laura Thomas: There's so many like pop culture references, that I think it just make it feel really like relatable and understandable. She digs into Goop. That's brilliant.
Asher Larmie: And it’s funny! Really funny. Really funny. Like it keep, it keeps you laughing until the end.
There was like one chapter at the end where she's talking about goop, where I was literally rolling around giggling. It's a really insightful book when it comes to just how anti-fatness has played out, especially within the black community. Cause it's a, it's a book written by a black woman for black people, for black women.
But I think there's so much to learn from reading this book, so cannot plug this book enough. Love it, love it, love it, love it, love it. And I think I've read it three times now. .
Laura Thomas: Oh wow. Okay. So you’re a Stan.
Asher Larmie: Re-snacking. Re-snacking on it.
Laura Thomas: I love it. Yeah, no, Jessica is great. And I'll link to the episode that we had her on cos it was a really good conversation.
All right, so my thing, little less high brow than Jessica's book. I was telling you before we started recording that tomorrow is my kid's third birthday. And so over the weekend we put up his birthday tree. A birthday tree - for people who have not been following my Instagram stories over the past couple of years - is a Christmas tree. Except it's pink and covered in fake snow that I put up for my birthday, my husband's birthday and Avery's birthday. And I just think it's the most fun tradition, we have, like all his little birthday presents underneath it, and it kind of gets you in like the birthday spirit. And I'll put probably some like little lights and stuff on it. So yeah, I have this giant fucking pink Christmas tree in my living room and it's so festive and cheery. Do you wanna see it? Should I show?
Asher Larmie: Yeah. No, but is it like a…oh my gosh. It's like a full size. I was thinking like a little mini one.
Laura Thomas: No, no, it’s like…yeah
Asher Larmie: And look at all those presents.
Laura Thomas: I know.
Asher Larmie: How did you manage to keep those unwrapped, like, you know, they're sitting under the tree not being messed with, I don't think my kids would've been that sensible.
Laura Thomas: Well…Yeah. I don't know. Actually, I think that next year we'll probably have a bigger problem. He's like, he's pretty chill. Like he'll..I think.. he does ask can we open them? And, and we're like, no. Well, it's your, it's, it's not quite your birthday yet, but yeah. If it was me, I'd be in, I'd be like pushing… like, what's this? What's this?
Asher Larmie: Little tear in the wrapping.
Laura Thomas: Peeking in between the wrapping paper. My snack, what I'm snacking on is birthday trees and I think everyone should get involved in this tradition.
Asher, can you let everybody know where they can find you and your work online?
Asher Larmie: Yes, head to fatdoctor.co.uk and there you will find not only my socials, but all of the classes that I'm running, all of the courses that I'm running. I do one-to-one consulting. If and when the book…the book will come out and when it comes out, you'll be able to see it all on my website. So I think that's probably the central place. I'm also on Instagram, but like I said, if you go to fatdoctor.co.uk, you'll be able to find me on all my socials as well.
Laura Thomas: We are gonna link to all of your places on the internet in the show notes anyway, so people will be able to, to find you. Thank you so much for coming and having what I think is a really important conversation.
You know, I think the media are presenting one side of the story. Like you said, there's a couple of journalists who are doing some sleuthing and that's really good work, but it's not going far enough. And I think we need to alert parents, teachers, other doctors, medical people to the really concerning dark underbelly of, you know, the Novo Nordisk, Wegovy Industrial complex, whatever you wanna call it.
Asher Larmie: Yeah. Well said.
Laura Thomas: So thank you. Thank you so much, Asher.
Asher Larmie: Thank you.
Laura Thomas: Thanks so much for listening to the Can I Have Another Snack? podcast. You can support the show by subscribing in your podcast player and leaving a rating and review. And if you want to support the show further and get full access to the Can I Have Another Snack? universe, you can become a paid subscriber.
It's just £5 a month or £50 for the year. As well as getting tons of cool perks you help make this work sustainable and we couldn't do it without the support of paying subscribers. Head to laurathomas.substack.com to learn more and sign up today.
Can I Have Another Snack? is hosted by me, Laura Thomas. Our sound engineer is Lucy Dearlove. Fiona Bray formats and schedules all of our posts and makes sure that they're out on time every week. Our funky artwork is by Caitlin Preyser, and the music is by Jason Barkhouse. Thanks so much for listening.
ICYMI this week: Fundamentals: Helping Kids build a Good Relationship with Sugar - Part 2
