The New Science of Food Noise and Its Impact on Weight Loss

James Hill:
Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:
And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

James Hill:
Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:
Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

James Hill:
Ready for the “And” factor?

Holly Wyatt:
Let's dive in.

James Hill:
Here we go.

Holly Wyatt:
Jim, one of the most interesting things that I've heard from patients over the last few years wasn't about how much weight they lost. It was something that is much simpler. They'd tell me “I didn't realize how much I thought about food until I didn't anymore.” And that stopped me in my tracks because they weren't talking about hunger. They weren't talking about cravings. They weren't talking about things we talk about. They were talking and describing something that was completely different.

James Hill:
Yeah, and once enough people started describing the same experience, Holly, scientists actually began paying attention.

Holly Wyatt:
I'm proud of us, right?

James Hill:
Yeah, and researchers gave it a name, Food Noise, and started asking an important question. Can we actually measure what patients have been describing?

Holly Wyatt:
And for a long time, the answer was no. It was new, so we didn't know how to measure it. We didn't have tools to measure it. People were describing an experience, but we didn't have a way to define it scientifically or ways to measure it objectively. But that changed this year. Researchers published the first validated instruments (we have more than one), designed to measure food noise, turning something that patients have been describing into something science can finally study.

James Hill:
Yeah, Holly, and we did a previous episode about food noise, but we're revisiting that because we've progressed so much in understanding and measuring it and, maybe in thinking about its importance for weight management. So that's what today's episode is about. Not simply what food noise is (we've talked about that before), but how this observation from thousands of patients became one of the newest and maybe most important areas of obesity research.

Holly Wyatt:
Yeah, this matters, Jim, because once we can measure something (and now we're really going to talk about how do we measure it), we can stop arguing about whether it's real and start asking much better questions. Who experiences food noise? Who doesn't experience food noise? Why does it happen? Can we treat it? What could make it decrease? It can help us understand why maintaining weight loss is so difficult, potentially.

James Hill:
Those aren't just interesting questions. Actually, they have the potential to change how we think about obesity. For decades, we focused on what people eat and how much they eat appropriate, right?

Holly Wyatt:
Yeah, yeah.

James Hill:
But now we're beginning to understand that our relationship with food, how often we think about it, how much mental energy it occupies, that may also be an important part of the story.

Holly Wyatt:
Something we didn't think about before. That's what's so cool about this. And maybe that's the biggest takeaway. This isn't just about giving a name to something patients experience. It's about recognizing that the mental burden of managing weight may be every bit as important as the physical burden that we've been talking about for years.

James Hill:
Yeah, so Holly, today we're gonna explore what we've learned about food noise and what we still don't know and why this may become one of the most important new concepts in obesity medicine.

Holly Wyatt:
Yeah, I'm excited about this topic, Jim. So we've kind of organized some questions that go in a flow. And Jim, we're going to try to stick in order because you know I get anxiety when we start not staying in order.

James Hill:
I'm not good at staying in order.

Holly Wyatt:
I know. I'm telling you, though. I need to stay in order.

James Hill:
Keep me in line.

Holly Wyatt:
Yep, yep, yep. So let's start off by just talking about the first kind of segment was when patients noticed something new. How did food noise become part of the scientific conversation?

James Hill:
Well, back to the GLP-1 meds. One of the unexpected findings was that people reported food noise went away. Now, we didn't even know what food noise was. I think many people didn't even know what food noise was. But they suddenly realized something had changed.

Holly Wyatt:
They started talking about it on social media. They started saying, “I don't think about it. I don't hear it.”

James Hill:
This isn't coming out of the research labs or clinical practice. These are patients saying, “Hey, guys, I experienced something really interesting. Have you experienced it?” And what happened is people said, “Yeah, that happened to me too.”

Holly Wyatt:
Yeah. And even what I love about it is for a lot of people, they didn't realize it was happening until it was gone, until the GLP-1s took it away. And then suddenly they're like, wait a minute. They just thought it was normal. It wasn't anything different. Until it disappeared, they didn't even know it existed.

James Hill:
Yeah, and the amazing thing is thousands of people at the same time were realizing this. And that's obviously what got scientists interested. It's like, yeah, one or two people, who knows? But this is happening all over. So, hey, guys, there is something here.

Holly Wyatt:
So, Jim, what does this teach us about how scientific discoveries happen? I mean, I know this is kind of a little bit off subject, but back up. This, to me, is the cool part of being a scientist and how we discover things.

James Hill:
Well, you've always talked about the pathway goes both ways. We study things in the lab or in the clinic and take it out to the patients. But we also see things that are happening out in the real world and say, “Hmm, maybe that's worth studying.” So an idea can start with a scientist and their work, or the idea could start in the clinic and the community where someone says, “That's an interesting observation. Thousands of people saying something is going away. Let's look and see what it is.”

Holly Wyatt:
Yeah. So good science often begins or can begin by listening to patients. That's what I love about this. Listen to your patients. And when you start hearing themes, that can translate the other direction into good science.

James Hill:
You got to be a little bit of a detective in the clinic.

Holly Wyatt:
Yeah. Yeah. So do you think that food noise is new? Do you think we've had it? How long do you think we've had food noise?

James Hill:
See, I really wonder about that. And it actually gets back to the concept of what is food noise. Now we've had hunger for periods of time and we've had people who experienced a lot of hunger thinking a lot about food. It was that food noise?

Holly Wyatt:
And we've measured that?

James Hill:
We've measured that. So I don't know, Holly. I don't know the answer to that question. I think the way it's perceived may be relatively new. That has accompanied what we call the period where the obesity epidemic arose. Whether it happened before then, maybe in a different form.

Holly Wyatt:
Yeah. Yeah. It's so interesting to think about. I think maybe it's not new, but the experience maybe has allowed us to think about it in a new way and maybe to define it in a new way. Because food noise and hunger are probably related, but that's not everything. Food noise isn't just hunger. Food noise may get higher, get increased when you're hungry. There may be a correlation, but it's not just hunger. So thinking about it a little bit differently than we have before.

James Hill:
Yeah, I think if you think overall about food intake, there are so many. We need so many terms to identify it: appetite, satiety, hunger, century-specific appetite. As we learn more, we're learning it's not all the same. But I don't know how I have this sense that food noise is going to turn out to be pretty important.

Holly Wyatt:
I do too. And I think it shows us that sometimes science names and measures something long after people have been living with it. It was there and we didn't know it.

James Hill:
Well, thinking about that, one of the studies that nutrition people really highlight, it's one of the more important studies of all time. It's the Minnesota Starvation Study. And again, you remember that study? Because what they were doing is they were trying to look at how to refeed prisoners of war after World War II, that they were very emaciated and underfed. And so they actually had people volunteer to undergo starvation to mimic those kinds of conditions so they could look at the best way to help people regain their weight and eating habits.

Holly Wyatt:
Wow, I did not know that. So people volunteered to do this.

James Hill:
Yeah, I think these were conscientious objectors, if I'm not mistaken. They may have gone through worse stuff than the people who actually volunteered. But they went through a huge period of starvation. And these were healthy men, okay? These were healthy men. And they reported tons of publications from this study. But they reported preoccupation with food after a time. Now, that's not shocking, is it? That if you don't get food for a period of time, you start thinking about food. Is that food noise? I don't know, Holly.

Holly Wyatt:
Yeah, yeah. I mean, it's different than what people are talking about now because they haven't. Well, I guess, yeah, I see what you're saying, actually, a little bit.

James Hill:
But they're not starved. They are eating plenty of food but they don't have the preoccupation with food.

Holly Wyatt:
Yeah.

James Hill:
This is tough to sort this out.

Holly Wyatt:
They're eating plenty of food, and they still have the preoccupation with food. Yeah.

James Hill:
So is food thoughts maybe a normal biological response to food restriction? But is that food noise? Is food noise something different? Is that something that's independent of energy deprivation?

Holly Wyatt:
Yeah, I think it is. I do think it is. But I think this is what, now that we can measure it, we can start to understand it better.

James Hill:
And we did not have a name for it before. Naming it is huge, food noise. You hear this term everywhere. But now there's so much legitimate study about food noise. We're going to learn a lot more about it, I think.

Holly Wyatt:
I know people tell me that they experience food noise even after eating what they would consider a satisfying meal. Like they'll finish one meal and they'll still be thinking about what's the next meal.

James Hill:
See, I think that's different than these people who were starved and they were just thinking about food because they were so hungry. So I think those are different, Holly.

Holly Wyatt:
I agree. I agree.

James Hill:
So hunger is a physiological signal that your body needs energy. In this kind of situation, that isn't why this is arising. Food noise doesn't arise to tell you your body needs energy.

Holly Wyatt:
Right.

James Hill:
Oftentimes, food noise is associated with cravings for a specific food, those cookies in the cabinet or the ice cream in the freezer.

Holly Wyatt:
But it's not always about cravings, right? Cravings are a little bit different too. So this is complex, but it's giving us another, something to measure, a name, and I think this all came out because of the GLP-1. So very, very interesting.

James Hill:
Makes you wonder what else we may learn over time.

Holly Wyatt:
Do you think that food noise could help explain like why maintaining weight loss is so difficult? Our favorite topic.

James Hill:
It is. I don't know. If you look, part of the problem, and we've talked and written about this, is when you lose weight, your body pushes back, right? There's a defense against losing weight. Well, that's not surprising. You want to hang on to energy. You don't want to starve to death. So the question, and we know there are lots of ways that happens. Your energy expenditure goes down, your hunger may go up, and food noise may be a part of that whole defense system. So food noise arises when the body tries to push back against losing weight. And in our current environment, people are maintaining this high weight. So having this constant food noise may be a resistance against actually losing weight.

Holly Wyatt:
It could be. I think that's something that we can definitely now study better. Things like does repeated dieting, maybe it's going on repeated diets and this is just a hypothesis, restricting intake over and over and over again, does that amplify food noise or make food noise part of what you experience because the body says “oh you go through these periods where you don't eat very much I'm going to make you think about food so that doesn't happen again” making that up but that's the type of thing we could study.

James Hill:
Well do you think that food noise is a biological phenomenon or related to willpower or behavior somehow?

Holly Wyatt:
Yeah, I think it's biological. And I don't think it's a failure of willpower, but I think it explains why people have to use a lot of willpower sometimes to be successful. So it kind of puts the two together. If you're thinking about food all the time, I like to think about willpower as a muscle. So you're thinking about food and you want to eat and you're thinking about food and you're thinking about it and you're trying, no, no, no, no, or trying to use energy, willpower, the muscle to not eat certain things you may be thinking about all the time or to restrict your intake to a certain level. That gets tired. You get tired. That's tiring. And then end of the day, something happens. You're out of willpower. And what do you typically do? You eat something, I order the pizza.

James Hill:
To heck with it. I'll go with the easy route. And again, I think that's what the GLP-1 meds have illustrated. There's some real biology here. And I think food noise is part of that biology. Whether it's existed, how it differs, those are questions I'd love to know the answer to. And I think there's a lot of research going on. But Holly, why is now measuring food noise a breakthrough?

Holly Wyatt:
Because now we can study it and we can take something that people are talking about and observing it and we can actually have data and scientific evidence and we can measure it and we can test hypothesis. I mean, we just threw up three or four hypotheses, Jim. We could design a study to test that now because we can measure it and look at who has it and how strong is it. And that's really what you need to be able to study something like food noise.

James Hill:
So it's kind of, we have a history of doing that, right? This occurred when researchers developed reliable ways to measure blood pressure, or even more important, pain. Everybody was talking about pain, but we didn't have good ways to measure it, or depression, or even quality of life. So measurement is critical to really understanding something. And so the question is, how did researchers begin to measure food noise?

Holly Wyatt:
And they did it pretty fast, if you think about it, because we now have at least two validated tools to measure food noise. Jim, would you know the first one, what do we call that one?

James Hill:
Yeah, it's called the RAID-FN. These are from our friends and colleagues who we know very well who are outstanding. Emily Dhurandhar and David Allison led this, but they involved a lot of other colleagues. And they formally defined food noise and described the development of the Ro, Allison Indiana Dhurandhar Food Noise Inventory.

Holly Wyatt:
All right, that's what RAID stands for. Okay.

James Hill:
Yeah, RAID-FN. And so this is a multidimensional instrument designed to measure the experience of food noise.

Holly Wyatt:
Yeah, and I think that's going to become important. I think this tool allows you to kind of dig in a little bit deeper and talk about different aspects of it. But there's another tool that also measures food noise. And that came from Corby Martin, Dr. Corby Martin and some colleagues. We had him on, I think. He may have talked briefly about it.

James Hill:
Yeah, Corby's a great colleague and a really, really superior behavioral researcher. He and his colleagues at Pennington Biomedical Research Center published the Food Noise Questionnaire. And so this was the first brief. It's just simple five-item validated questionnaire used to determine whether people have food noise in clinical practice and research.

Holly Wyatt:
Yeah, so it's really quick, five questions, validated, which is important in a questionnaire. I know a lot of people are starting to use this in clinical practice, but also in research. And so I think together, these tools are starting to transform what we can learn about food noise. So this is exciting.

James Hill:
It's not which one is the best because they measure different things. And I'd be shocked if we don't get other tools that measure aspect of food noise. So just one isn't necessarily the total answer, but we have two good ones that measure a little bit different things, but begin to allow us to study food noise. So I think scientifically, this is a huge step forward.

Holly Wyatt:
Yeah. The food noise questionnaire, that brief one, I think they call that the FNQ. It's really simple. So it makes it practical that you can use it in clinical care easily. The RAID-FN, I think, is more comprehensive and explores more about how a person experienced the food noise. And it measures several different things. I think it measures, I have them written down here, cognitive burden, which is how much mental space the food occupies during the day. Persistence, how difficult it is to stop thinking about food once those thoughts begin. Dysphoria, how upsetting or frustrating or emotionally distressing those thoughts are. And self-stigma; feelings of guilt, shame, or self-blame associated with experiencing food noise. So it gets a little deeper into those different dimensions. So you can look at some of the different factors. I mean, someone may have a lot of dysphoria and not a lot of cognitive burden, for example.

James Hill:
Yeah, and if I'm not mistaken, both of these are free to use, and you can just search for them online and be able to use them. If you're a clinician or a researcher, I think they're both available for you to use. So you can do an internet search and find the food noise questionnaire or the RAID-FN.

Holly Wyatt:
Yeah, so very, very exciting there. The other thing I wrote down is there is a model that has been developed to look at this.

James Hill:
CIRO model, Holly. C-I-R-O.

Holly Wyatt:
C-I-R-O stands for cue, influencer, reactivity, and outcome.

James Hill:
And this was developed by Hayashi-Masterson and colleagues and it was published in 2023, And it was really, I think, one of the first, if not the first scientific framework to explain food noise. So it's not measuring it in the way the other two were, but it's sort of beginning to lay out, let's look scientifically at how we might develop a framework to help us understand food noise.

Holly Wyatt:
Yeah, how does food noise, how it might develop. So starting to think about that. And so that's exciting too. So we have some tools now to really get in and study this.

James Hill:
Yeah. The CIRO model proposes that food cues, like seeing, smelling, thinking are filtered through a variety of influencers, including biology and hormones, sleep, stress, previous experience, surrounding environment. So it begins to capture the complexity. You see this?

Holly Wyatt:
Yeah.

James Hill:
So cues come in from different ways, but they're perceived by this whole integration of systems. And somehow this organ we call the brain puts that all together and boom, food noise comes out.

Holly Wyatt:
Yeah. So this is good. I'm really glad that we have these now. And I think we're going to be seeing studies use them. And we're going to have now data to look at different groups and be able to look at food noise in different ways, which we've never had.

James Hill:
So what kinds of things do you think these tools allow us to study that are interesting, Holly?

Holly Wyatt:
Oh my gosh. So, so many. You can think back to all the studies we've done, Jim, and I would love to have had this, these tools to be able to measure.

James Hill:
Let's go back and do them all over again, Holly

Holly Wyatt:
Right, exactly. I mean, does food noise predict weight regain? Just that. Like we're always looking for predictors.

James Hill:
Does anybody know the answer to that?

Holly Wyatt:
I don't think so yet. But I mean, that's a good question, right? I mean, if your score is higher for the food noise or if you're using the RAID, if certain areas are higher and you have a high food noise, does that, me and you tend to, the people with those kind of have a harder time, therefore they tend to regain more weight. I mean, basic question, but I love it.

James Hill:
Wow. Can we reduce food noise without GLP-1s, Holly?

Holly Wyatt:
Yeah, I've thought about this.

James Hill:
Yeah? What's your answer?

Holly Wyatt:
I mean, I don't have data, right? I've got to study this to show that. But I think that's what we're trying to do sometimes, which I think you potentially might can do that by what you eat. I think physical activity, Jim, physical activity may impact food noise. We don't know.

James Hill:
That may be the answer, I hope.

Holly Wyatt:
Yep. Mind state, that could influence food noise. So we may be able to modify food noise with things other than GLP-1s. That's what we can study. That's what's really cool about this. We don't know, but I think that's something we will find out pretty soon. We're going to see more about this.

James Hill:
So behavioral treatment programs have always focused on helping people change what they eat, how they eat, patterns, and everything else. So do you think that hitting food noise is something that's going to become a standard part of behavioral treatment?

Holly Wyatt:
I do. And you know why?

James Hill:
Why?

Holly Wyatt:
Because people tell me the food noise going away is super important. People who even don't lose that much weight will say, having the food noise turned down makes a huge difference in my life. So I do think it's something we're going to measure and we're potentially going to say we want to impact because it's affecting quality of life, even independent sometimes of the weight. Although I think it will correlate with weight when you turn down the food noise. I do think that helps you lose weight. But I know people whose food noise is low, at least they say it is, we need to measure it, is low that they don't necessarily lose that much weight. But they say this is a really good outcome for them.

James Hill:
Now, I want to be clear, not everyone who's overweight experiences food noise, correct?

Holly Wyatt:
I don't know.

James Hill:
Oh, you don't know.

Holly Wyatt:
Well, do you know?

James Hill:
Maybe.

Holly Wyatt:
Maybe they don't.

James Hill:
I'm asking you. You're the expert.

Holly Wyatt:
I would think there would be some people who don't have food noise or don't have it as much.

James Hill:
We don't even know some basic questions like that.

Holly Wyatt:
Well, do you know? Because I don't.

James Hill:
I don't. I'm going to guess and say, I don't think everybody's going to have it. But that's just a guess. Maybe they do.

Holly Wyatt:
Well, I would think that when people get, if you don't eat and hunger comes, then, you know, once again…

James Hill:
But that may not be food noise.

Holly Wyatt:
Right. But this constant preoccupation, even when you're full, even after you've just had a meal, I think maybe some people don't have it. And that's maybe one reason why it's easier for them to lose weight or to maintain a lower body weight is that's just not dialed in for them.

James Hill:
Fascinating questions that we need to answer. I wonder, you know, everything in weight and nutrition now is personalized approaches. You think we could have personalized approaches based on whether people have food noise or not?

Holly Wyatt:
Yeah, that's what we want. I mean, I know, I know. I just think this is so exciting because...

James Hill:
We've got work to do, Holly.

Holly Wyatt:
Well, for the first time, but instead of just thinking about what they're eating and how much they're moving, we have something else to look at. And I like that.

James Hill:
So in a way, you're saying reducing food noise might actually be a treatment goal.

Holly Wyatt:
Oh, for sure. I think for sure.

James Hill:
Wow.

Holly Wyatt:
I'll go on the record. I'll go on the record for that one.

James Hill:
And you're also, I'm interpreting what you're saying here, Holly, you know. You're also saying that maybe reducing food noise might have some positive outcomes that are weight independent.

Holly Wyatt:
Yes. Yes.

James Hill:
Right?

Holly Wyatt:
Yes.

James Hill:
So even, oh boy, Holly, this opens up. So people who don't need to lose weight, but experience food noise could be treated to reduce food noise and that might improve their quality of life.

Holly Wyatt:
Yes. I'm running into those people who are saying that it didn't move the scale very much for me, but I don't want to, I want to continue on the GLP-1s. And if you talk about it, it's about quality of life. They were fighting the food noise for so long, and maybe they were successful at fighting it, meaning not eating, but not having it or having it turned down. I think to get rid of it completely, I don't know if that's going to be our goal either. But to turn it down, they say, “Yeah, this is a big deal for me.

James Hill:
Do we have any idea other than GLP-1 meds about what works to reduce food noise? Sleep, stress, exercise? We know anything there?

Holly Wyatt:
I don't know any studies that have, you know, I think we can make a lot of guesses here that are things that could, but I don't have the data.

James Hill:
Wow.

Holly Wyatt:
So this is a great area, man. And it started with the patient saying something's different.

James Hill:
So listen to your patients, Holly.

Holly Wyatt:
Yeah, absolutely. Oh, I know. Here's a question. Should people be worried if they have food noise?

James Hill:
That's a tough one. My initial response is no. I think everyone experiences some thoughts about food and it's probably a continuum. I think about food but I'm not sure I have food noise. I don't think right now you should worry about it. But I think, if you experience food noise, there's a hopefulness that we're going to actually have treatments that reduce food noise.

Holly Wyatt:
I think it comes down to how intrusive or distressing the food noise is for you. It's just like a lot of things in psychology. If it becomes something that's interrupting your daily life, affecting the quality of your life, that's when it becomes a problem that you might want to take some action for, this may end up being something like that. So I would also say, I don't think you have to be worried if you have food noise, but if it's frequent and if it's distressing, it may be something that is treatable.

James Hill:
But again, it's okay to think about you would like to reduce food noise. That's an okay thing to say, I have food noise and I'd love to lessen it. That's a reasonable strategy to think about. It's okay to want to get rid of your food noise.

Holly Wyatt:
And I already know one of our listeners, because she emails me all the time. She is at a healthy BMI, but she has food noise. It distresses her, and she wants to be on a GLP-1 so bad.

James Hill:
Not to lose weight.

Holly Wyatt:
Not to lose weight. And it's not, and it's FDA, it's not indicated, right? Just for food noise.

James Hill:
Yeah, but, oh my gosh, this could lead to a whole nother hour of conversations about treating people with GLP-1s that don't need to lose weight for other things, anti-aging and cardiovascular disease and so on.

Holly Wyatt:
She's maintaining a huge weight loss. So she's been, and she feels like she works really, really, really hard to maintain this lower body weight. So then it's like someone who's never been obese or someone who was obese and now is a reduced obese, are you able to treat them? That's not how the drug is currently indicated. Let's be really clear about that. But who knows?

James Hill:
Well, before we take some listener questions, tell our listeners why this episode is of interest to them. What's the takeaway and why should they want to know more about food noise?

Holly Wyatt:
Well, I think it's cool because it's an emerging area, right? It's new stuff. And people like to know that new stuff. Scientists are starting to explain it, measure it, define it. I think it could improve both our understanding of body weight regulation and patient care. And you know I like both. I like those things to be connected. And I think it's nice that we can start to understand how those thoughts about food could be burdensome. I think that also helps people maybe who don't have them realize, oh, things aren't the same. It can help people who experience these food noise kind of be validated out there that this is what's going on.

James Hill:
Wow. All right. You want to take some listener questions?

Holly Wyatt:
Let's take a couple. You start with one.

James Hill:
All right. Here's one, very common. I never thought about food noise until I started at GLP-1. Was it there all along? Oh my gosh, I wish I knew the answer to that. So very common that people don't recognize food noise until it becomes quieter. So the GLP-1 meds have revealed this thing that we didn't even realized was there. That is fascinating, Holly. We didn't even realize it was there. And now scientists are out there trying to figure out what it is, what it does, how to reduce it. It's going to be fascinating over the next few years.

Holly Wyatt:
I agree. I agree. Here's another one. Is food noise the same as cravings?

James Hill:
Ooh.

Holly Wyatt:
And once again, this is a little hard. There's probably some overlap, but I think hunger, cravings, and food noise are related, but different. I think hunger is more to a biological need. Cravings, usually I think about a specific food or type of food. And food noise, I think it's more about that persistent, intrusive thought about food. There's probably a normal thought about food. But food noise is when it's persistent, and intrusive that it's getting in your way. It's becoming distressing to you. So I kind of think of them that way, although I think they're related, and there's probably some overlap.

James Hill:
Yeah. Okay, here's a good one, Holly. If my food noise comes back after stopping a GLP-1 med, does that mean the medication failed? Oh my gosh, there's so much in this question. So first of all, the medication only works if you take it. So the idea that if you stop and things go back to where they were, the medication isn't working wrong because the medication isn't solving your problem. The problem that's manifest as your obesity is still there after you stop the meds. And in fact, I think you can almost guarantee that if you stop the meds, the food noise is gonna come back to some extent. Does not mean the meds didn't work. And it does not mean that you can't keep the weight off without the meds. You and I talk about that and have plans to do that. It's one of those things that you should expect. When you stop the meds, your hunger is going to come back and your food noise is going to come back. That's totally expected. But there are ways to deal with that.

Holly Wyatt:
We think. We hope, right? We hope. But I think one thing I was just thinking about, the food noise, I think, precedes the weight regain. So it may be kind of a clue that I've stopped the medication, my food noise may come back. Here's a question we don't know. And people, I've heard this out on social media. Does the food noise come back stronger than it was before?

James Hill:
Oh, now that's a good question.

Holly Wyatt:
Yeah. Is there any difference?

James Hill:
We don't know, do we?

Holly Wyatt:
No, we don't. You would need to measure it before someone goes on a GLP-1, get their level, lose weight on a GLP-1. measure it, you know, measure it right after. And then, you know, as they potentially stop the GLP-1 and regain. I don't think we know that. But this gives us an idea of how to maybe look at it.

James Hill:
Here's another question for you. So we're talking about many people taking these medications for decades. Does the food noise come back over time? Does it stay reduced? What happens if you're taking a GLP-1 med for 30 years? Same?

Holly Wyatt:
Do we see tolerance? Meaning it comes back. The data we have thus far don't show weight regain while on the drug.

James Hill:
Right.

Holly Wyatt:
So wouldn't point to that because you would think if it came back that we would start to see weight regain associated with it. But we don't know 30 years. We don't know about that. So once again, yeah, really good question.

James Hill:
Wow.

Holly Wyatt:
All right, Jim, what time is it?

James Hill:
Vulnerability?

Holly Wyatt:
Yes. You think it's time for some vulnerability questions?

James Hill:
Okay.

Holly Wyatt:
All right. So I'll start you off. I mean, we can both answer these. Have you ever experienced food noise yourself or do you know? Have you, do you think you have food noise?

James Hill:
I have thought about that, Holly, and I don't know the answer. I think I have not. I clearly think about, I've thought about food when I'm hungry, but I can't tell you that during the day, thoughts of food is something that bothers me. I might think if I'm going out to dinner, wow, I get to go out, I'm going to have a nice dinner or a nice glass of wine. So I don't know. I've experienced hunger. I've experienced cravings occasionally. I don't think I've experienced food noise, but the interesting thing is I'm not 100% sure.

Holly Wyatt:
Yeah. And it would be interesting to see if you did go on a GLP-1.

James Hill:
Right.

Holly Wyatt:
You're not on a GLP-1.

James Hill:
Maybe I should do it just to see if something changes.

Holly Wyatt:
Well, I can't. I'm not recommending that.

James Hill:
What about you? Have you experienced food noise?

Holly Wyatt:
I have food noise without 100%. I've lived my life with food noise. I think I've even told you, we didn't call it food noise, but back many years ago when I was on Fen-phen, because I've struggled with my weight my whole life, I noticed, I didn't call it food noise, but one of the things I loved even about Fen-phen was I didn't think about food as much.

James Hill:
So Fen-phen was probably reducing food noise.

Holly Wyatt:
It did for me because I just, you know, I don't think we had as many people on it and maybe it didn't do it to the same extent. So it didn't get out there in the social media and people talking about it as much. But for me, it definitely did. And so I know I do think about food a lot. I mean, I jokingly talk about if there's chips in my cupboard. They call my name, you know, even when I'm not hungry. The chips, I know exactly where they are. I think about when can I eat them? How much can I eat? Should I eat one serving? Can I eat five servings? So the constant thought about when I'm going to eat the chips, how I can eat the chips, what else could I eat with the chips is constantly in the background of my mind. So I do think I have food noise. I need to take one of these questionnaires, I guess, and see what my score is. But I do.

James Hill:
All right. What's next?

Holly Wyatt:
Let's do another vulnerability.

James Hill:
Uh-oh.

Holly Wyatt:
This is a good one. Okay. We may have different answers for this.

Holly Wyatt:
Do you think that we'll look back 10 years from now and realize food noise changed the way we think about obesity? I mean, is it going to have that big an impact? It's going to change the way we think about obesity 10 years from now.

James Hill:
I think the answer is almost certainly yes. And I wonder, here's what I think, Holly. I think this concept may be so important that the pharmaceutical companies may develop specific interventions just for food noise.

Holly Wyatt:
Wow.

James Hill:
Without worrying about weight. So again, if a large part of the population who isn't overweight experiences food noise, and if a reduction in food noise increases quality of life, then why wouldn't we go after a specific treatment for food noise without worrying about weight?

Holly Wyatt:
Yeah.

James Hill:
So I think it is going to change things. What do you think?

Holly Wyatt:
I think, yeah, I think it is. I think it already has. I think it's already changed it because what I really like about it right now, and in 10 years, I agree with you, there may be a lot more out there. It gives us a way to talk about, one of the invisible parts of obesity that we haven't talked about. It's giving us a way to talk about an important piece that helps people understand that obesity isn't just about making better choices, that there's biology happening, that there's different ways that we've been thinking about it. And I think that's such a meaningful shift. So I think just the idea of people are having these different levels of noise in their brain, and we can measure it, and it's something different, changes everything right now.

James Hill:
And you know, Holly, it fits with a lot of what we say that success isn't just number on the scale.

Holly Wyatt:
Yeah.

James Hill:
And reducing food noise may be a big part of success independent of losing weight. And if so, that's a wonderful thing to realize. And hopefully 10 years from now, we're gonna have treatments, not just GLP-1s, but behavioral treatments and other kinds of treatments.

Holly Wyatt:
And we'll know a lot more about food noise.

James Hill:
Wow. So, Holly, this episode wasn't really about a new questionnaire or a new scientific term. It's about what happens when thousands of patients begin describing the same thing and scientists listen.

Holly Wyatt:
Yeah. So, we've measured, I think for years, we've measured obesity by looking at things we could measure, we could easily see. You know, body weight, BMI, blood sugar, cholesterol, blood pressure. But now I think this says that obesity is also inside the mind.

James Hill:
And reducing this food noise seems to be one of the most powerful positive outcomes reported by people on the GLP-1 meds.

Holly Wyatt:
Yeah.

James Hill:
And so we have an experience. We're beginning to measure that experience. We're beginning to define food noise, develop tools to measure it, and build models to better understand why it happens. We're still very early in that journey, Holly.

Holly Wyatt:
Yep.

James Hill:
But we don't know everything yet, but I think this is something that research in this area is going to lead to something very, very powerful.

Holly Wyatt:
Yeah, I agree. All right, guys, send us questions about food noise we'll continue to keep you updated. We've done food noise before but this is something that's changing rapidly so let us know what you think.

James Hill:
Yep it's an important concept. See you next time on Weight Loss And.

Holly Wyatt:
Bye, everybody.

James Hill:
And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:
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James Hill:
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Holly Wyatt:
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