Why Your Brain Won't Stop Thinking About Food with Emily Dhurandhar

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:
Today, we're diving into something so many people deal with every day, but never really had a name for. They really never knew what they were dealing with. It's not hunger. It's not cravings. It's not emotional eating, but that constant mental chatter about food, the noise you can't shut off.

James Hill:
Now, Holly, and for some people, that seems to be just relentless. For others, it ramps up the moment they start dieting. And a lot of people starting the new GLP-1-based medications say that it's the first thing that suddenly gets quiet.

Holly Wyatt:
And for years, people were told this was a willpower issue. It never was.

James Hill:
Yeah, and that's why we're really excited about today's guest. She helped take this lived experience, food noise, and turn it into something we can actually measure and study. We're joined by Dr. Emily Dhurandhar, who's Director of Research for Special Projects at Texas Tech University Health Sciences Center, and she's the lead author of the RAID-FN Inventory. Holly, we're going to talk about that more, but this is the first validated tool to measure food noise.

Holly Wyatt:
Emily, we're thrilled to have you here. Welcome to the show.

Emily Dhurandhar:
Thank you. I really love your podcast and I'm excited. Yeah, excited to chat with you all. Thanks for having me.

James Hill:
Okay, I got to ask you because Holly and I talk about this. When was the first time you heard the term food noise?

Emily Dhurandhar:
I probably heard it in a patient forum, actually, that I followed. I've been doing a lot of work with different communication, outreach, education type stuff. And I believe it was in, yeah, a patient forum where I heard the term first.

James Hill:
Wow.

Holly Wyatt:
Yeah, I think it originated from patients, not clinicians is what I think I'm hearing. And that's kind of unusual in science for the patients to create a term that we're now looking at, studying.

Emily Dhurandhar:
Yeah, I think it is a little unique in that way. You're right. And I always have found it very interesting, you know, when phenomena like this come from the patients themselves. I think it presents an opportunity for us to listen and to study that and bring some science to the topic.

Holly Wyatt:
Exactly.

Emily Dhurandhar:
So we were excited to do that.

James Hill:
You know, I'll have to admit, when I first heard the term, I was sort of baffled. I thought, I don't really understand that. And then I started talking to people, Emily, and people got it. They said, oh my God, yes, I get it. I understand it. And then one of the amazing things, and I think this is partly why you're interested in this, how quickly it often gets turned off when people take these medications.

Emily Dhurandhar:
Yeah. So you're referring to the new GLP-1 receptor agonist weight loss medications?

James Hill:
Yeah.

Emily Dhurandhar:
I think for a lot of people, they say that their food noise goes down or disappears when they take those medications and that it's pretty life changing for some people at least. And it's as if, you know, maybe if you have, I don't know if you ever cook with the fan on, you know, when you're cooking something that's maybe smoking a bit on the stove and you've got that fan on and it's going for a while and you kind of, everybody gets used to it. But then when you're done cooking and you turn it off and you kind of go, oh, thank goodness, that sound is gone. And so that's kind of the same phenomenon that people experience is like they didn't realize how irritating it was necessarily until it's gone. And then they they really appreciate the peace that they experience.

Holly Wyatt:
Right. I agree. I think it's the GLP-1s that allowed people to suddenly understand and realize what was going on in their head. The absence of it allowed them to identify what it really was. So what is the formal definition? What is food noise and what is it not? Let's do both ways.

Emily Dhurandhar:
Sure. Yeah. So food noise, we've described it formally, I guess, as a team when we worked on this together with clinicians who've worked in obesity for a long time, with scientists who have studied obesity, experts in eating disorders and the psychology around eating and obesity and weight loss. And we came to the definition that it's basically persistent thoughts about food that are both unwanted and unpleasant. We're still trying to understand exactly where there's maybe a threshold at which it becomes particularly problematic. And so that's part of the reason we decided to try to measure it and put some more quantitative data to the study of the topic. Basically, your brain just won't stop thinking about food and it bugs you.

Holly Wyatt:
How is it different from maybe normal related thoughts? I mean, we all have thoughts about food. I think we think about, I would like to go eat, or, you know, this would taste good, or, oh, I have those cookies in the cabinet. I'm going to go get one. So we all have thoughts. How is it different from, I mean, normal thoughts many people have?

Emily Dhurandhar:
Yeah, that's a very good question. So one of the words we really zoned in on when we were talking about this concept of food noise was rumination. So rumination has a long standing history in the field of psychology as very unproductive thoughts. And so I think back to, for example, like the movie Groundhog Day, where, you know, he keeps living through the same day over and over, keeps making the same mistakes and having the same experiences over and over. And it's not for quite a bit of time there in the beginning, at least. It's really not productive. It just doesn't go anywhere. And so there's a sense of futility and a sense of frustration because, you know, you keep living the same experience over and over.

Emily Dhurandhar:
You don't want to be doing something, but you find yourself doing it anyway. And so that's, I think, what people often describe with food noise. They keep thinking about food, but they would really rather not be thinking about food all the time. I think the other part of it that makes it a little bit different than usual food thoughts is simply the feelings you have about it. So it could be that, you know, there are times where thinking about food is very joyful, like maybe thinking about what you're going to make for upcoming holiday meals and what you're going to bring to this potluck. And you hope this other person brings what they always bring because you love that dish. And so all of that can be very fun and joyful. But I think food noise, it becomes noise. The very definition of noise is something that's unpleasant and unwanted.

Emily Dhurandhar:
And so I think that's the distinction where it's your emotional reaction to it, the emotional valence that the thoughts hold.

James Hill:
You know, I think a lot of people feel like, you know, finally someone has recognized what's going on. They put a name to it. They validated that this is something that's important for me. And Holly has suggested that what we need is a drug that helps people who don't feel food noise to feel it so that they actually understand it. Because again, not everybody experiences food noise. And I think we have to recognize that it's real and it's an important part of what's driving behavior for a lot of people.

Emily Dhurandhar:
Absolutely. I think that's an important point. You know, I actually, it was the forum where I first learned about food noise is someone posted something saying, you know, I just heard about this term food noise and I've never experienced that. And it just blows my mind that people have this problem you know I've never had this problem so it was someone who was very empathetic who started the thread where i first learned about it yeah it's one of those things where you have to be a pretty empathetic person if you don't experience food noise to understand exactly what it is and so I really hope that as people learn about this, they just speak out about their own experiences with it, and hopefully people will come to understand that it's a real issue for some people.

James Hill:
It really is.

Holly Wyatt:
Right, and I think that the tool that you've developed, tell us a little bit about the tool that can help measure it, because some people may have more food noise than someone else, and you don't know. You only have the kind of experience of what the amount of food noise you have or don't have. So I like the idea of a tool that can kind of go in there and measure it. So tell us a little bit about that, the new tool.

Emily Dhurandhar:
Sure. Yeah, absolutely. So it's called the RAID-FN, and it's basically like a questionnaire that you would take. I don't know if you, you know, when you go into the doctor's office and they maybe have you fill out some questionnaires in the beginning. Maybe if you go to see a therapist, they'll have you fill out some information and questionnaires, most likely, where you're just answering some questions. And based on how strongly you agree with the statements or the items that we've come up with, that's going to signify how strong your food noise is.

James Hill:
So tell us a little bit more about how you did that process. People take these surveys all the time, but this was systematic. How did you go about coming up with something that you felt like could really measure this phenomenon?

Emily Dhurandhar:
Yeah, I can tell you a little bit about the story. I think that some of us when we heard the term, and we've been working in obesity for a long time, we recognize it right away as something that we've all been studying tangentially, but never really put a name to as well. And so we got together a group of people and went through kind of one of those formal agreement processes where we all talk about what we think it is, what you think it is. We all write down items that we feel someone would endorse if they had food noise. So we came up with a bunch of items and then we had some other folks look at them and say, oh, yeah, I also think that if someone had food noise, they would endorse this item. And the thing about that process is that we also wanted to make sure that that particular statement for the questionnaire item was really someone only with food noise would endorse, right?

Emily Dhurandhar:
That it wasn't a common experience to potentially to other people. So it needed to be accurate and kind of specific to the experience of food noise. And so a lot of clinicians who were working with us, Dr. Larry Cheskin, he's been working with patients for decades. So has Dr. Nikhil Dhurandhar.

Emily Dhurandhar:
We also worked with some folks who work in eating disorders, like Sydney, your cow, She's at Yale, and she practices with eating disorder patients. And then we also had, Misty Hawkins, who's an expert also in disordered eating, weight loss, weight management. So, there are people in the room who have heard in detail, patients describing their experience with food noise. And so that allowed us to capture these kind of common threads that they were hearing across all these different anecdotes that we had to work with from these experts and the patient anecdotes that they had. We also did a review of all the literature and the media, all the media articles on this, all the patient anecdotes that were published online in different blogs and forums. And so, based on all of that, that's how we came up with our list of items.

James Hill:
Cool.

Emily Dhurandhar:
Yeah. So it was a pretty extensive, intense process.

James Hill:
So why is it important to be able to measure food noise? What does having an instrument then allow us to do?

Emily Dhurandhar:
Yeah, so I think one of the most important things that measuring does is that you can't really understand something well until you can measure it. It's like when you're going to make a cake or something, you have to measure the flour, so that you know how much flour you put in when the cake turns out a certain way. It's really no different with any psychological construct. We can't understand who has it, how badly do they have it, how do we treat it until we can measure it. And, like, if we give a treatment, we see that their amount of food noise in somebody decreases. And so it just helps us to actually study so we can help people.

Holly Wyatt:
Yeah. So that kind of brings to a question. How does food noise, people who score high on this questionnaire, does it correlate to their body mass index? Does it correlate to maybe how well they lose weight? Have we been able to look at that at all?

Emily Dhurandhar:
Yeah, so we do see that in a couple of different samples, it's associated with your frequency of dieting for weight loss. And so that might play a role if you're dieting frequently, it might increase your food noise, for example. Or it could be the inverse, we really don't know. Of course, it could be that you have more food noise, you diet because you have more food noise, right? And so you just have a higher weight because of that. So we don't really know how that works. But we also see that, surprisingly, it is somewhat associated with BMI, such that it's like higher with people with very high BMI, and it's a little bit higher in people with very low BMI. It's really not a huge effect. Really, we see that the bottom line is people all across the BMI spectrum are experiencing food noise. And so that's something we need to look into more. It could be that people in the mid-range of BMI are still having food noise because of the context that they live in, maybe because they're trying to control their weight and trying to keep it down. So there's a whole bunch to study there as far as why do we see high food noise really all across the BMI spectrum.

Holly Wyatt:
Yeah, that's really interesting to understand that a little bit more. It may be that people do have a lot of food noise, but they're able to push back. It just may be more difficult, but they're still able to manage their weight or keep their weight in a healthier range or something. But it is interesting that it's not, we don't see that correlation yet and understand that with BMI.

Emily Dhurandhar:
Yeah, yeah, I think, and if you look at what exactly we're measuring, if you look at the different factors of the questionnaire, it's about you're preoccupied with food. And the thoughts are very persistent, meaning they don't go away and they're kind of inescapable. And then they cause dysphoria or they cause distress. And so you could think of maybe many different situations where you're preoccupied with food, the thoughts just won't go away, and it's distressing. That could be because you're trying to lose weight, because you have a high weight, but it could be for many other reasons. Like, for example, someone with type 1 diabetes who is constantly having to think about their food because, you know, someone with type 1 diabetes can be very serious, right? If they don't manage their food, it can be life-threatening. And so that could be a huge burden for them to manage their food noise.

Holly Wyatt:
I think we just don't understand it yet. Jim, this reminds me of when we first started measuring resting metabolic rate and, you know, everybody thought that those who struggled with their weight should have a low resting metabolic rate. And they didn't. And we were like, well, why is that? But then we untangled it. We understand why. And I think this is kind of the same thing. We'll untangle how this all works together in the future. And having a tool to be able to measure it really is key to being able to understand it better.

Emily Dhurandhar:
Exactly. Yeah, that was already a big surprise that we learned, maybe this isn't specific to people with obesity.

James Hill:
Yeah, that's really important. Going back to the GLP-1-based medications, we know that they reduce food intake substantially, maybe 25-30%, and that kind of reduction in food intake leads to weight loss. I think we still don't understand mechanistically how that works. And I guess my question is, do you think this reduction in food noise is a big part of the mechanism that leads people to eat less?

Emily Dhurandhar:
I think it is related. It seems to me that the parts of the brain that regulate your hunger and your appetite and your energy expenditure, and then the parts of your brain that regulate reward, they're all interconnected with the parts of your brain that make decisions, right? Like your executive functioning. And we are seeing that there are receptors for GLP-1, so parts of the brain that are getting in the hippocampus, like where your memories are formed, where your decisions are made. We are now understanding that there are GLP-1 receptors in those parts of the brain too. And there's interconnectedness there. And so, it could be that the way hunger or the lack of hunger manifests itself is just simply less planning around food. So, someone described it was very striking to me that when she was on these medications, it used to be that the kitchen was always catching her attention. She worked from home. She worked in like an open concept house. And she'd be sitting at her kitchen table in her living room working and her mind was just always halfway on the kitchen, thinking, what's there? Did I put that food away?

Emily Dhurandhar:
Am I going to have that later? That kind of thinking. And she said, and it's as if someone put a wall up and I no longer realize there's a kitchen there anymore. The fact that our really more primitive parts of the brain are no longer driving these thought processes, it seems very, very plausible, right?

James Hill:
It does. It does.

Emily Dhurandhar:
Kind of obvious, actually. Not that I'm saying it out loud.

James Hill:
And the other thing we know, and Holly and I are very interested in this, is when you stop the medications, most people gain back the weight fairly quickly. And I just wonder, because probably when you stop the medication, the food noise comes back. And I wonder if food noise isn't one of the factors that's driving those people to regain weight after they stop the GLP-1 meds.

Emily Dhurandhar:
Yeah, we are interested in that too, is it a good kind of clinical marker of, oh, here it comes, the appetite is fired back up. Yeah, for sure.

Holly Wyatt:
Yeah. And then there's probably a role for food noise. So, the GLP-1’s may put that wall up. Is it a good thing to have the wall up? Like how much food noise do we need and how much food noise is maybe too much? And can we start to draw a line to be able to look at that? Because I think we are wired to think about food sometimes for us to realize it's time to go eat and there's food in the kitchen and it's there and not to wait to the end of the day to say, oh, where's the food? So this is always a slippery slope for me. What do you think about that?

Emily Dhurandhar:
I think that's a really important point, Holly. And I am working with patients on GLP-1 medications. Some of them do say I have to set a timer so that I remember to eat.

James Hill:
We've heard that.

Emily Dhurandhar:
They have to write it down. Otherwise, at the end of the day, they don't even remember how much did I eat, right? So it's so not on their minds that it could maybe be a little dangerous. And you're absolutely right that I think when I describe food noise and we talk about it in our lab meetings and our research group, we call it, I think of it as almost like the foraging, right? Like we, of course, you know, we need to have some gauge of what is the energy availability around us. Right? How much food do I have? Is it food I like? Do I need to go get some food that I actually want to eat? Because then that'll be more fun. And so all of that is very normal. I think where it becomes problematic and maybe in some sense why this is a newer phenomenon is like, at what point does that become problematic? And maybe it's just being uncomfortable in a comfortable world. I think that's what I'm seeing. Is that it's almost the dysphoria of it. It's almost like people have a meta-awareness of the irony of the fact that they're thinking about food and there's so much right there that it's ridiculous, right? It's like, oh, my gosh, again, I'm being assaulted by food. Like, again, I have to think about this.

Holly Wyatt:
Yeah. Well, this brings up that that maybe, maybe in our current environment, it's different. Like when as our environments changed, what level of food noise is helpful changes with that environment?

Emily Dhurandhar:
Exactly. Yes. I think a lot of food noise could be very natural and good and healthy and normal for someone who is part of the Hadza tribe in Tanzania, right? Like that could be very healthy, normal, even a source of happiness. Whereas if you're trying to work in an office and manage your family, and there's just food everywhere all the time, it's like, why am I thinking about this? Right? It's like, why is this necessary anymore?

James Hill:
You know, we've heard people tell us that the relief from food noise is maybe more meaningful than even the weight loss for them. Do you think it's common that people feel this kind of, I guess, relief and pleasure from getting rid of the food noise?

Emily Dhurandhar:
I would actually love to get some and that's part of the reason we developed this measurement tool is to measure how many people feel that way. I think the fact that if you look at like the rise in Google searches over the last about four years, it's it's grown just exponentially. And I think it's because it resonates with people. And I think, yeah, one of the reasons everyone's talking about it is because it's real and it resonates and it's important to people. So to me, that's the best sign.

James Hill:
Clearly is. We know that these GLP-1 medications reduce food noise. Do you think as we learn more about food noise, we may come up with techniques to address the food noise without the medication, through lifestyle, etc.?

Emily Dhurandhar:
Yeah, we are actually discussing that and trying to put together some ideas around that as far as what it would look like. So there are common cognitive behavioral therapies for rumination type behaviors around OCD, for example, obsessive compulsive disorder, around anxiety and excessive worrying. And so I do think there's probably a lot of capacity to develop some behavioral therapies for people with food noise. Absolutely.

Holly Wyatt:
Yeah. So if someone's listening and they think they may have food noise, this resonates with them, what would you like them to know? What could they take away from this that might be important for them?

Emily Dhurandhar:
I think a lot of people just find a lot of comfort in just knowing that it's a common experience, that it's not necessarily something that you can control, right? So it's not an issue of willpower. so if you start with with accepting that it's kind of an automatic automated thing that's happening and you can become more aware of that that's the first step right to managing that better and to managing the impact it has on your life and the distress that it might cause and so if you're listening I would say like this is step one and there's there's more to come now that we can research this right we can develop therapies for it so there's hope for sure yeah for managing it better.

James Hill:
You know, the concept of food noise developed largely in the U.S. Do we know if this is common across different cultures, different subgroups of people? Have we studied that at all?

Emily Dhurandhar:
That's a great question, too. So we have translated the RAID-FN to Spanish, working on translating it to Turkish, to Hindi, getting some studies going in different places so that we can study that. A lot of folks think that it might be wrapped up in sort of the thin ideal in trying to achieve that, and that might be why thinking about food is so dysphoric and self-stigmatizing, self-incriminating. And then others have said, well, it also could be social. It could be related to the food environment and food queues. Like, so, you know, in the United States, for example, our portion sizes are much bigger than they are in Europe. And so how does that influence food noise? So, interestingly, when I went to Europe, it influenced my food noise because I was traveling with two very tall men. And I myself at the time was very active and younger. And I remember being fed a small portion size and it actually aggravated my food noise. I remember thinking, I was thinking about food all the time, like, am I going to get enough to eat? We were skiing, right? And that helps, and I'm so hungry all the time. And so, like, you know, how does this even, and that's an example of, like, a cross-cultural dynamic there, too. So, it's so many fascinating research questions.

Holly Wyatt:
So, culture could be playing a thing in an environment. Jim, I think this is, it's working somehow or another with environment, so we may see it different in different places.

James Hill:
Absolutely. So I'll ask Emily the question you and I argue over. Emily, was food noise prevalent in the 1940s in the U.S., do you think?

Emily Dhurandhar:
That's a good question. Was it as prevalent as it is today?

James Hill:
Or did it exist? I don't know.

Emily Dhurandhar:
Did it even exist?

James Hill:
Again, we can't answer this, but I think it's interesting to see, is food noise always there and it was uncovered? Or is the environment somehow triggered this that didn't exist before? And obviously there's no answer, but it's fun to think about those things.

Emily Dhurandhar:
I agree. I would say it was probably, I think it's aggravated by the environment. And it kind of comes back to that trying to be comfortable in an overly comfortable world. It's almost, in the 1940s, I'd imagine it was a different type of environment where you appreciated food more in a different way. What you had to eat is what you had to eat. And you couldn't necessarily go to the store and have endless options of what to eat. So it probably was less dysphoric, for sure. Like, you might have had food noise, you might have thought about food, but it was probably like a rewarding, pleasurable thing, rather than a nuisance, like it is today.

James Hill:
So like many other things, there's probably an interaction between our biology and our environment.

Emily Dhurandhar:
Yeah, I think so.

Holly Wyatt:
Yeah, I agree. I think it's really interesting to think of it that way, though.

James Hill:
So quick question, the RAID-FN measurement device, is that largely intended for other health professionals? Is it intended for the public? How do you see that being optimally used?

Emily Dhurandhar:
I would say at the moment, it's created for researchers and clinicians. That was our intent. And we developed it, the longer version of it, that's 23 items, that might be better for research, as we try to better understand. There's more nuance with the additional items in there that you can get from the data and so that can help us answer more questions. But the seven item version, We developed that specifically for clinicians to use. And as we develop those more informative cutoffs of, you know, when this score is very high and when you have a treatment, what's a meaningful difference or what's a meaningful decrease? And so once we kind of work out those numbers, I think clinicians will be able to use it more. At the moment, we don't have a lot of data-informed interpretation for clinicians, but we are rapidly working on that so that they can use it in that way.

James Hill:
So looking at maybe how food noise might interact with public health and public policy, you know, we talk a lot about food marketing. We talk about policies to sort of counter the food marketing that we see as negative. How might the two interact? How might recognition and maybe even treatment of food noise interact with some of our public health policies to help people eat better?

Emily Dhurandhar:
Yeah, I think that as the awareness of food noise increases in our social and policy forums and discussions, I do hope that it could help us to think about how we structure our food environment maybe differently. It might influence the way we talk about food and how we build our environment around food. I do think that there is something to be learned from the fact that people feel and often describe food noise as being assaulted by food, right? Food is supposed to be a source of nutrition, it's supposed to be a source of joy. And so when we're feeling like we're being assaulted by it, and that's the kind of word people are using, if that's related to this experience of food noise, I think we should hear that.

Holly Wyatt:
So now that you have this tool, and I understand you're collecting more data, where do you want to go? Where do you want to take it? What's next?

Emily Dhurandhar:
I am very keen on better understanding, you know, which clinical populations have this high food noise. And I'm very interested in testing and developing therapeutic approaches for it. And so we are currently partnering with lots of different people in order who have ongoing trials to add this into their trials. And I'm particularly interested in, of course, my area being obesity. I'm really interested in how it influences long-term weight management, especially, and how it influences weight loss outcomes and then weight regain. And yeah, so there's many studies to do.

Holly Wyatt:
Yeah, so I'm shocked Jim hasn't asked this question. So I've been waiting, but I'm going to ask it.

James Hill:
Oh, what did I miss?

Holly Wyatt:
Do we know how does activity, physical activity, exercise impact food noise? Do we have any data on that?

James Hill:
Good question, Holly.

Holly Wyatt:
I know.

Emily Dhurandhar:
That is a great question. Yeah. So, interestingly, one of the studies that we're working on getting started is the food noise in bodybuilders. And I have a feeling that the food noise that people experience, that athletes and folks who exercise experience, might really depend on their level of competitiveness, right? So you can see that, for example, someone who's a bodybuilder and who's counting every single gram of protein and down to the, you know, within a 20-minute window, they have to consume this much or that much. I can see how that person would have a lot of food noise. I've also heard endurance athletes say, like, gripe about how much food they have to eat and they have to plan so much around it, think so much about it, so that they have enough energy to get through their training. And so I think that, yeah, it might be very specific to the type of athlete and the level of activity.

James Hill:
You know, that's very interesting. The endurance athletes. I know when we were in Colorado, one of our colleagues worked with the Tour de France. And these cyclists were just struggling to get enough energy in. And that's a different kind of food noise it seems like, than someone who's dieting. So I wonder, Emily, as we learn more about food noise, maybe not all food noise is the same. We might be able to look at different ways of categorizing food noise.

Emily Dhurandhar:
Yeah, that's right. It's like as far as the root cause or the source of it. And similarly, folks who have really high food noise on that lower end of the BMI spectrum, it could be people who are struggling to keep their weight up, right? And they also see food as kind of a nuisance.

James Hill:
Interesting. I hadn't thought of it that way. That's a different way of thinking about it. Emily, is your survey available for other researchers to use?

Emily Dhurandhar:
Yes, we actually just developed like the manual for it. And so it's currently the publication in Appetite, which has just come out. You can get all the information from that. But I'm very much a steward of this tool. I want people to, you know, it's a baby still. We're still trying to understand how it behaves and in different populations. And so we're very eager to collaborate and help in any way that we can.

Emily Dhurandhar:
So, if someone wants the more detailed manual, and if they want our help with the analysis or anything, they can reach out to me directly, or they can reach out to David Allison, who is the other co-corresponding author on the paper, and we're happy to help. Yeah.

James Hill:
That's great that you make it readily available to other people. So, those of you who are listening who are researchers, go to it. We need to learn much more information about food noise.

Emily Dhurandhar:
Absolutely.

James Hill:
All right, Holly, you want to do some rapid fire questions to put Emily on the spot?

Holly Wyatt:
Oh, not to put her on the spot. These are fun.

James Hill:
Oh, why not? Come on.

Holly Wyatt:
Oh, no, no, no. She's been too good.

James Hill:
She can handle it. I guarantee you.

Holly Wyatt:
Oh, I know she can handle it. All right. So these are just quick questions off the top of your head. Easy. No right or wrong. Okay. First one. One misconception about food noise you wish would disappear tomorrow.

Emily Dhurandhar:
Got it. It's only in people with obesity.

James Hill:
Ah, good.

Holly Wyatt:
One thing clinicians misunderstand about food noise or intrusive food thoughts.

Emily Dhurandhar:
It is not always related to the patient's environment or their eating habits. I think a lot of clinicians automatically assume it's about what's in the fridge or it's about the fast food restaurants they go to. It's more deeply rooted in biology than that.

Holly Wyatt:
Nice. The most surprising finding from your research?

Emily Dhurandhar:
I actually thought that women would have a lot more food noise than men. And they do have a little bit more, but it's not as stark as I thought. And men also seem to have quite a bit of food noise.

James Hill:
I would have thought women would have had more, too.

Emily Dhurandhar:
Yeah. And they do, but the difference is very small. It's not as big as I thought. Yeah.

Holly Wyatt:
Is there one habit that maybe could help reduce food noise? Do we have any info on that?

Emily Dhurandhar:
We don't have any, like, data other than, there is some data about the GLP-1s, reducing food noise, from Novo Nordisk did a study. So there's, it was just a pre-post, not a strong study, but there is a study out there. As far as non-data informed suggestions, I don't know, I would be a little bit cautious about, you can try things, but there's a lot of stuff out there on the internet that, I don't know, I'm not so sure is helpful.

Holly Wyatt:
They've already jumped on that. They've already started to use that. Yeah, I agree that. All right. Last rapid fire question. Why does food noise matter?

Emily Dhurandhar:
Because it's bugging a whole lot of people. It's just, I think it really reduces people's quality of life. It gets in their way of reaching their full potential, right? If you're just bogged down by this. It's up there with anxiety and, you know, other things that we take seriously that we treat.

James Hill:
Okay.

Holly Wyatt:
Love it.

James Hill:
All right, Holly, time for some listener questions.

Holly Wyatt:
Yeah, you do those, Jim.

James Hill:
Okay. Here's one, Emily. How do I know if I'm experiencing normal dieting thoughts or actual food noise?

Emily Dhurandhar:
I think it's the level of distress that you experience. And so if you find that thinking about food is becoming upsetting, that's probably a good sign. You know, that could be a sign of food noise for sure. That's probably the clearest indicator, I would say.

James Hill:
Okay, here's another one. How do I talk to my doctor about food noise when they may not even know the term?

Emily Dhurandhar:
I think, I don't know, everyone has a different approach of talking to their doctor. A lot of times, if it's an obesity specialist, they probably have heard of it before. And they probably are, you know, kind of at least somewhat up to date, and you can probably just talk about it. But with other doctors, there might be a little bit of, you know, there's this new area of research and providing them with my contact information. I've done a lot of outreach and education with physicians. The Obesity Action Coalition actually is another great resource, and they also are developing some materials around food noise. So sharing those with your doctor, just advocating for yourself. And, you know, that that's something you really feel is getting in your way with some concrete examples, too. You know, like, because I have food noise, I can't do this. I can't take care of this aspect of my health. I can't enjoy this or that. You know, your doctor wants you to be well. So if you give them concrete examples of what food noise is doing, that helps, too.

James Hill:
Okay, here's a great follow-up. I'm a clinician. If my patient tells me they have food noise, how can I help them?

Emily Dhurandhar:
That is a great question. So we don't have a lot of, you know, evidence-based interventions right now. I would say one of the best places you could start is referring them to a therapist who has experience with eating disorders. I think, yes, I do think a lot of eating disorder therapists specialize in that. I think they are very well equipped to help.

James Hill:
Fantastic. All right, Holly, you know what time it is now.

Holly Wyatt:
Yes. Vulnerability, Emily. You thought that was difficult. Now we're just going to go a little bit deeper.

James Hill:
Oh, you want to go first?

Holly Wyatt:
I do because I have the, I know what question I want. For sure. So this question is, have you experienced food nose personally? Have you taken this survey? How do you, how does your food noise kind of come out when you do the questionnaire you created?

Emily Dhurandhar:
Yeah, that's a really good question. I think a lot of actually, a lot of us in the group kind of had that realization as we were working on this, that, oh, maybe I have this too. And I think there have been, you know, times in my life, you know, where I'm working on my diet for health, where it does really get aggravating. I think my awareness of it is very helpful, right? I can catch it. And so I think I'm okay, but I definitely think I've had times where I have experienced food noise.

James Hill:
All right, here's one. Emily, what does it mean to you when patients thank you for giving language to something that they've lived with silently.

Emily Dhurandhar:
Well, it's probably one of the reasons I got into this field. You know, I watched my family members struggle with their weight growing up, and it never added up, you know, seeing what they were going through and the results they were getting and the way they would place that blame on themselves. And so just like a lot of different ways of thinking about obesity over the last few decades, coming to understand how chronic it is, coming to understand some of the strong genetic and environmental contributors that really no one can stand up to. It's like all of these kind of revelations are the reason I got into this field, the reason I get up and go to work every day. So it feels really good.

Holly Wyatt:
Yeah.

James Hill:
I love that.

Holly Wyatt:
This is going to make a big difference. This is going to, I think, this is something we're going to be looking at, measuring, looking at interventions for. I mean, we've just, you've just started, but this is going to open a whole new area. And I would say it goes both ways. I have a lot of food noise. And when my food noise is quiet and I'm not having it, I think this is how people who don't understand why it's difficult to eat healthy, the people who don't have it. So it kind of goes both ways, but the kind of the empathy and the awareness and the insight it gives, I think is so helpful for the field in general.

James Hill:
All right, Holly, let's sum it up here. This has been fantastic. We've learned a lot about food noise. Food noise is real. And I think many people feel like it's given a name to what they've experienced and what they struggle with. One of the really great things here is that Emily and her colleagues have actually developed a way to measure food noise. And if we can measure it, then we can learn about it. We can learn how to address it. And I think within the next one to two years, we're going to see a ton of research around food noise. And it's real, and it is something that makes a difference in people's lives. We know that it's often silenced when people go on the new GLP-1-based medications, but when they come off, the food noise comes back, and it may be one of the contributors both to the success on the medications and the weight regain following the medications. So I think we're going to see, we're going to learn so much in the next few years about food noise and the work that Emily and her colleagues have done is going to play a big role in helping that research move forward. So, Emily, thank you so much. This has been a really informative issue, and I'm sure we're going to talk much more in the future about food noise.

Emily Dhurandhar:
Yes, I'm sure we're all going to learn a lot now that we can measure it.

James Hill:
That's great.

Emily Dhurandhar:
Yep, there will be more to talk about.

Holly Wyatt:
Thank you for being on the show.

Emily Dhurandhar:
Thank you.

Holly Wyatt:
This is wonderful.

James Hill:
Yeah, thank you, and we'll see you next time on Weight Loss And.

Holly Wyatt:
Bye, everybody.

James Hill:
Bye. 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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