Understanding Food Noise and New Obesity Drugs

Before the recent wave of obesity medications, the term “food noise” was hardly recognized. Researchers focused on drugs like Ozempic, Wegovy, Mounjaro, and Zepbound, examining their dosages, side effects, and benefits for conditions like diabetes and heart disease. Yet, they overlooked the mental chatter about food—the constant thoughts of what, when, or whether to eat—despite users of these drugs discussing it extensively.

Many users claimed that food noise had been a persistent background hum in their lives, something they assumed was universal. It wasn’t until they started taking these new medications that they experienced a profound silence regarding food thoughts.

This phenomenon has sparked new inquiries into the workings of these drugs. If researchers can grasp where this inner dialogue originates and why it fades, it may shed light on the root causes of obesity itself.

Voices in Our Heads

Individuals dealing with weight issues often describe an ongoing internal dialogue about food.

Lena Smith Parker, a 53-year-old from Hamden, Connecticut, spent years battling weight gain after various diets. She spoke about how relentless voices in her mind pressured her to indulge while criticizing her eating habits.

One voice resembled a persistent auctioneer, pushing the idea of cake, while another, akin to a sleazy used-car salesman, would dismiss healthier options: “You don’t want the salad; you want the cake.” Then there was the more brutal voice, insulting her weight, and another that plotted future indulgences, asking if she could sneak off for treats.

Why do thoughts like these exist? Researchers believe it connects to a concept known as the “set point.”

This idea dates back to studies from the 1940s when scientists noted that when rodents were made to gain or lose weight, they often reverted to their original weight after the study concluded. A similar pattern appeared to occur in humans.

This led to the notion that everyone has a “set point,” an ideal weight their body naturally seeks. Over a lifetime, this can shift, but for some individuals, their set point may become so elevated that it contributes to health-related issues linked with excessive weight.

Dr. Lee Kaplan, from the Obesity and Metabolism Institute in Boston, suggests that if the set point is raised significantly, obesity can ensue. Each time someone attempts to lose weight significantly below their set point, food noise seems to amplify, possibly as a physiological response. Weight loss can slow metabolism, leading the body to demand more calories than it can handle without converting some into fat. This explains why many diets tend to fail over time.

Researchers emphasize that food noise isn’t exclusive to those categorized as obese; anyone whose weight falls below their body’s preferred set point can experience it.

Experts like Dr. Jules Hirsch at Rockefeller University, along with his colleagues, tracked metabolic and behavioral responses in individuals who lost weight over the years.

Participants in their studies followed a low-calorie diet until they shed at least ten percent of their body weight. They observed that although these individuals left with lower weights, they exhibited physiological signs resembling starvation, such as low metabolism and food fantasies. This led to binge-eating once they returned to regular eating habits, a result so extreme it was termed “semi-starvation neurosis.”

Discovering a New Normal

Initially, Ms. Smith Parker viewed food noise as a normal aspect of existence. However, after participating in a clinical trial for the drug tirzepatide, also known as Zepbound, the noise vanished.

When the trial ended and she lost access to the medication—still awaiting FDA approval—she found her old food noise returning with a vengeance, leading her to regain 40 pounds through unfettered eating of spaghetti and cupcakes.

Dr. Jastreboff, who leads weight-loss initiatives at Yale, ultimately prescribed Wegovy for her, which eliminated her food-related thoughts. She recalled, “My brain is empty,” reflecting her surprise.

Dr. Jastreboff believes the new medications may effectively reset an individual’s set point to a lower level, allowing for hunger without the overwhelming inner dialogue pushing for constant eating. However, she and other experts clarify that this adjustment seems temporary—once treatment ceases, the original set point—and food noise—often returns, leading to increased eating and weight regain.

Dr. Leibel likens the impact of these drugs on food noise to how aspirin lowers a fever without addressing the underlying issue.

The question then becomes: how do these new obesity drugs achieve this reset?

Dr. Daniel Drucker, a researcher involved in developing these medications, questions what exactly establishes this set point and how GLP-1s influence it. This inquiry holds significant potential; understanding the mechanics could illuminate why obesity often correlates with elevated set points and lead to new strategies for lowering them.

People like Oprah Winfrey have noted the significance of living without food noise. In her recent book, she mentions that prior to the medication, she assumed constant food concerns were typical—until they disappeared.

“The biggest surprise was not waking up thinking about what I wanted to eat,” she explained.

Dr. Drucker shared an important observation about judgment from those who don’t grapple with these issues, noting that they often don’t understand the mental struggle faced by others.