What is 'food noise' and how does it impact weight loss?

Sade assumed constant and consuming thoughts about food were normal. It wasn’t until the 32-year-old from Christchurch tried the weight loss drugs Saxenda and now Wegovy (the weight loss version of the diabetes drug Ozempic) that she experienced life without what has become known as “food noise.”

“It's just not there at that capacity. Before, I would be tempted [to overindulge in food], but now there's just no temptation there for me. I could take it or leave it.”

Wegovy, part of the GLP-1 class of drugs, adds to a feeling of fullness. It gave Sade room to make better food choices. So far, she has lost 12 kilos in five months. The reduced food noise had a bonus impact on her mental health, which often plays a role in the complex causes of obesity.

“I have also noticed that it has stabilised my moods hugely to the point where we could look at dropping down on anti-anxiety medication.”

“So the results from that went hand in hand as well. To reduce food noise meant more efficient day-to-day living for better mental health and better weight loss results.”

The idea of food noise isn’t entirely new. Weight loss practitioners and researchers in the obesity space have been referring to some version of it for decades, with names such as “rumination” or “obsessive thoughts.” It wasn’t until the weight-loss benefits of Ozempic, a diabetes management drug launched in the US in 2017, were noticed and promoted by celebrity culture that the concept of food noise became a recognised term in news headlines and everyday language.

Ozempic was repackaged as Wegovy for weight loss in 2021. After years of success and fascination overseas, Wegovy became available to New Zealanders last month. The weekly injectable drug is not publicly funded. It comes at an ongoing cost of about $500 a month.

“[Food noise] wasn’t so easily identified, and it’s so interesting that when you say it and people know exactly what you mean by that,” says Catherine Kissel, a psychologist who works with patients of MacMurray Centre, which has four medical weight-loss clinics in New Zealand.

“It’s distressing for people, and it tends to drive behaviours that we don’t like. Eating behaviours or making food choices that we don’t specifically want.”

Kissel described food noise as “complex” and “sticky” thoughts about food.

“You could start to feel hungry even though you don't need food at that moment.”

Food noise is not a term that appears in medical literature, says Kylie Russell, a dietician with Rfynd, another medical weight-loss clinic.

“It's more of an anecdotal term that patients or clients use with us when they're talking to us as clinicians.”

The closest medical term Russell has seen is “food cue reactivity” which refers to the brain’s response to internal and external food-related cues. It is tied up with reward, motivation and executive control in our brains. This impacts sensory, emotional and cognitive information about food, she says.

"For some people, the brain is especially sensitive to food cues, like seeing or smelling food, which can overpower the natural signals that tell us when we’re truly hungry or full.”

Almost everyone has some level of food noise, and it has proved very useful to the survival of the species, says Russell.

“Food noise, if you want to call it that, allowed us in times of scarcity to respond to opportunity, to meet our nutritional needs, whether we actually physiologically needed them at that point in time or not. So it allowed us to store energy for the future...”

However, fast forward to now, and those evolutionary cues have a different effect. Modern life serves up a constant bombardment of food messaging, according to Helen Gibbs, a Dunedin-based dietitian who works with patients on weight-loss drugs. It’s not necessarily healthy foods either, but calorie-dense, ultra-processed foods.

“If you walk down the street, there’s so much more food available. If you’re on the Internet, you are exposed to food messaging all the time.”

Gibbs puts a patient's volume of food noise down to a mix of genetics, environment, socialisation and food availability. Too little food, noise can also be a problem, with reports from overseas indicating some on the GLP-1 weight loss drugs are experiencing malnutrition.

Yes, you can, but it isn’t easy. The weight-loss drugs hush the food noise and give patients space to develop new behaviours and strategies, says Kissel, the weight-loss psychologist.

“What we need to do is break the chain of events.”

That might mean recognising food cue triggers like stress, and having a self-talk response to sift through what is genuine hunger and what isn’t.

“It’s not real hunger, so I don’t need to respond to it.’ They’re saying things like ‘It’s just a craving, so it will pass.’”

One of the issues with the GLP-1 drugs is the food noise and often the lost weight returns when patients discontinue taking them. Preparing patients to manage their weight without weight-loss drugs is part of Kissel’s role at the MacMurray Centre.

“Comprehensive, wraparound support makes a huge difference in terms of results with both the optimisation of achieving the goals, but also sustaining them long term.”

The anticipation of food is part of the joy of food for some people. That might mean peeking at a restaurant menu ahead of time or mapping out a food-focused tour of a foodie paradise like Japan or France.

Claire Murphy, host of the Mamamia women's health podcast Well, takes Wegovy. She went to Japan last year. Her lack of food noise did not impact her trip.

“I just ate less of it instead of gorging myself and then feeling like shit afterwards,” she says, adding that the smaller portions of food in Japan were adequate for her.

She was speaking from Cairns in Australia's tropical north while on a working holiday, where food would previously have been an all-consuming focus. What cafe to eat brunch at? What snacks to buy? Even when she was eating, she would be thinking about her next meal.

In the morning, she went for a walk around the harbour and she didn’t ruminate on food. Instead, she finds time and brain space to enjoy other features of a new place.

“I stopped in at [Woolworths] and got a bottle of water, but I didn't stop and get snacks or anything sugary. It's so unusual for me.”

“I went for a walk around the Esplanade, around the harbour, but I didn't stop and get snacks or anything sugary. It's so unusual for me.”

The one enjoyment Wegovy has dampened for Murphy is her desire for wine. She grew up in Adelaide, a food city in Australia, surrounded by vineyards where enjoying wine is part of the culture. She simply doesn’t want it and feels queasy when she does.

“That has been something harder to deal with because we're a very alcohol-driven culture, and it's how we socialise. I've had to be okay in social situations without drinking.”