Introduction

Thoughts of food are a regular part of our cognitive processes. Every day, people think about where to get food, and which foods to eat. Sometimes people also think about food in terms of health, social expectations, and cultural norms [1]. Additionally, radical changes in the food environment of developed countries have led to people thinking about food more often. Food-related decisions have become more complex with increasing awareness about the relationship between food and health, new food labeling, increased exposure to food marketing, and increased food availability [2]. Food-related decisions may become particularly burdensome when using diet to manage a health condition such as obesity or diabetes. The idea that thinking about food may sometimes be persistent, tedious, or unpleasant has recently been a topic of public discourse, and has been referred to as food noise.

Because the term has become so popular, we hosted a formal discussion in order to characterize the current state of the science of food noise. We convened an expert panel at the American Society of Nutrition meeting in Chicago on June 28, 2024, on food noise. Our objective was to define food noise, characterize the boundaries of the construct, draft survey items for a food noise measurement tool, and discuss future research directions. Accordingly, this paper presents the proceedings of that panel discussion.

Defining food noise

Patient anecdotes

Though the original source is difficult to isolate, the phrase food noise appears to have originated from patient anecdotes that inspired a wider conversation in the media and amongst clinicians. It is not clear who first used the term, or in what context. However, most public and scientific discourse using the term food noise references patient experiences. Specifically, the dampening of food noise that is suddenly noticeable following treatment with a glucagon-like peptide1 receptor agonist (GLP-1 RA) for weight loss. Although it is unclear how long food noise has existed, it is unlikely to be a new construct. Rather, people have likely been experiencing food noise, and it has become more noticeable (e.g., isolated as a construct) through its sudden absence—and the relief from it that commonly occurs following treatment with a GLP-1 RA.

Anecdotal accounts of food noise suggest that food noise goes beyond everyday thoughts of food, and that the term likely refers to a distinct psychological construct. For example, one patient of a coauthor described her preoccupation with food as part of her weight management as follows: “I feel like it is always on my mind. Not in an obsessive, ‘ooo I want food’ type of way, but almost like, am I doing the right thing? Am I eating enough, or not enough? Was that the right amount of calories? Should that have been more protein?….. it’s this noise in my head all the time, it’s always there…. I’d say 80% of the time, it’s on my mind.” Interestingly, cravings for food items are not the sole topic of food-related mental chatter. Thoughts can also include whether a person is eating the “right” way at the “right” time in the “right” amounts, and whether they have these foods available.

Patient accounts also suggest that food noise can be unpleasant and unwanted, and that relief from food noise may be desirable. In a recent Scientific American piece on food noise, one patient described her relief from food noise after taking a glucagon-like peptide 1 (GLP-1) receptor agonist for weight loss: “All of a sudden it was like some part of my brain that was always there just went quiet. It felt almost surreal to put an injector against my leg and have happen in 48 h what decades of intervention could not accomplish. If I had lost almost no weight, just to have my brain working the way it’s working, I would stay on this medication forever” [3]. Additional anecdotes have similar themes, and can be found in Table 1.

Table 1 Definitions and key elements of food noise from selected media articles.
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While strongly worded personal testimonies do not constitute an evidence base in and of themselves, the volume and consistency of discussion on food noise lends itself to specific hypotheses. These are that (a) food noise is a distinct psychological construct, and relatedly, that (b) experiencing an excessive amount of food noise may significantly affect food choices, mental health, and quality of life.

Public discourse on food noise

The phrase was first googled in November of 2006, and in the fall of 2022, Google Search queries for the term noticeably increased. Interest peaked most recently in spring of 2024 and has remained fairly high since [4]. Food noise is a term being used by patients to describe “incessant mental chatter” and “constant rumination” about food. Discussion of food noise is primarly emerging from the United States.

Discussion of food noise has become sufficiently widespread that the concept has been featured in several high-profile media features. For example, Scientific American recently published an article about how GLP-1 receptor agonists quiet food noise [3]. Weight Watchers joined forces with the STOP Obesity Alliance to publish a consumer trend report about food noise [5]. Further examples of recent publicity and how food noise is described are listed in Table 1.

The definition of food noise

Hayashi and colleagues recently integrated the term food noise into a theoretical model of food cue reactivity called the Cue-Influencer-Reactivity-Outcome (CIRO) framework [6]. In this model, food noise is defined as, “heightened and/or persistent manifestations of food cue reactivity, often leading to food-related intrusive thoughts and maladaptive eating behaviors” [6]. They propose that food noise is propogated and reinforced by external food cues, and conflate food noise with food cue reactivity.

We conducted a detailed review of colloquial definitions (Table 1). Briefly, a Google search was performed for “food noise” in June 2024. Media articles and discussion forums were sorted by date, and were selected for review from newest to oldest until information in the articles or forums became redundant. The definition from each article was pulled verbatim, if given, for Table 1. In addition, co-authors Emily Dhurandhar and Xi (Rita) Wang reviewed each piece of media identified for key features of food noise that were mentioned by either the article author or the individuals featured in the article to characterize the experience of food noise, which are also listed in Table 1.

The review of colloquial definitions by the expert panel suggested that food noise has several key features that also resonate with their clinical experiences. Food noise does cause a significant cognitive burden, similar to preoccupation with food, but also has features, such as dysphoria, that are unique. Food noise exists to varying degrees and may not always be present at levels or contexts that cause dysphoria. Food noise also appears to cause anguish and self-recrimination that individuals feel towards themselves, and it therefore may cause self-stigma, and may be unwanted. There also seems to be an inability to control the frequency and intensity of food noise, and it is described as “incessant”.

Based on this review, the panel agreed on the following formal definition of food noise:

Persistent thoughts about food that are perceived by the individual as being unwanted and/or dysphoric and may cause harm to the individual, including social, mental, or physical problems.

The boundaries of food noise—what it is, and what it is not

Food noise is not characterized by thoughts about food alone. A more dysfunctional level of food noise is likely similar to rumination. Thoughts of food directed toward acquiring and eating food are natural. Rumination is defined according to the American Psychological Association Dictionary as “obsessional thinking involving excessive, repetitive thoughts or themes that interfere with other forms of mental activity” [7].

In the realm of psychopathology, rumination has a long-standing empirical base in the response styles theory of Nolen-Hoeksema, who defines rumination as a process of thinking perseveratively about one’s feelings and problems—independent of the content of the thoughts [8]. In the case of food noise, the ruminations center around food and food-related behaviors, such as eating, procuring food, preparing food, and even considering the next eating opportunity while still finishing a snack or meal. Thus, food noise may become clinically relevant when it transcends occasional thoughts or cravings and becomes rumination that interferes with normal cognitive functioning.

Various situations are purported to exacerbate food noise. Many examples of food noise are in the context of eating a specific diet for health-related purposes. Food noise may also be induced by environmental cues such as the presence of food or food marketing, but the causes of food noise do not appear to be exclusive to incoming external food cues. Similarly, food noise may be caused by physical hunger at times, but it is not limited to hunger-induced thoughts about food. On the contrary, food noise has been reported as intrusive, and often occurs in contexts unrelated to the physical presence of food, mealtimes, food cues, or hunger. Finally, we observed that anecdotes of food noise are reminiscent of how patients with eating disorders describe their experience. Although food noise is emerging in public discourse in the context of obesity and weight loss, food noise may also occur in patients with eating disorders.

It is unclear whether food noise is a trait (i.e., a stable feature of someone’s lived experience) or a state, which is an experience that is influenced by someone’s current environment or context. Although food noise has primarily been described as a trait, and something that some people “have”, it may also be problematic even when experienced temporarily as a “state” (e.g., only in specific situations or contexts). For example, it could be hazardous to experience food noise in situations requiring a person’s continuous full attention to their actions, such as while driving, during police and military operations, or while performing surgery. Therefore, theremay be time-dependent and context-dependent implications of food noise and its impact.

Food noise measurement

Establishing the existence of a psychological construct is a complex process. As adeptly explained in Uher’s recent review of quantitative psychology, it is important to conceptualize differences between signifier, referent, and meaning [9]. Here, the written phrase “food noise” is a signifier that represents what we suspect is a type of experience (the referent), which is the actual set of experiences that compose food noise. The meaning is what a person understands food noise to be. It is therefore our goal to capture the experience (the referent) of food noise, as we have defined it based on what anecdotes describe its meaning to be, using a survey.

Several validated instruments that measure eating disorder-related constructs capture preoccupation with food, such as the Preoccupation with Food Scale [10], the General Food Craving Questionnaire [11], and the Eating Attitudes Test [12]. These existing scales offer a starting point for measuring food noise. For example, items from the General Food Craving Questionnaire- Trait and the Preoccupation with Food Scale were used to inform item development to understand if someone experiences food noise per se. But existing validated instruments do not measure all facets food noise that are described in anecdotes of food noise such as dysphoria, and additional item development is warranted.

We completed the initial stages of development of the Ro Allison Indiana Dhurandhar Food Noise Inventory (RAID-FN Inventory) to measure food noise. We developed items by referring to our working definition of food noise, and the 4 key features of food noise: cognitive burden, persistence, dysphoria, and self-stigma.

We also completed several exercises to establish content validity of a preliminary food noise questionnaire. Indiana University indicated that according to their policies, institutional review board approval was not required for these content validity checks. First, we explored content validity by circulating a survey with 34 draft items for the questionnaire to 10 experts (including authors NVD, TIAS, LJC, MH, SY, Dr. Amanda Fairchild and others). Each respondent rated the draft items on their relevance, clarity, and representativeness of food noise, as they understood it. Respondents were also invited to submit additional items, and to revise the items proposed. From this exercise, 27 items had a high level of agreement that they were likely to be relevant and representative of food noise. The panel then revised the items for clarity and further tested them through cognitive interviews to derive the final wording.

We took effort to ensure that the number of items was commensurate with how important we perceived the facets to be. To ensure representativeness of all potential features of food noise, we added 2 items for a final total of 29 draft items for future sample testing (see Table 2 for the full list of test items). We have completed data collection on an initial sample for item testing and reduction and factor analysis and are currently conducting an analysis on the survey’s validity, reliability, and responsivity.

Table 2 Draft items for RAID-FN Inventory.
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Future research directions

Once an instrument to measure food noise is well-validated, many research questions can be explored. By examining past literature and our clinical experiences, the panel identified several key areas and working hypotheses for future investigation related to food noise.

Epidemiology of food noise

Everyone thinks about food, but who experiences food noise more frequently, or more intensely, remains in question. Individuals with obesity frequently report experiences with food noise. In one recent report, 57% of interviewed individuals with obesity said they experienced food noise. Further, individuals with a variety of eating disorder pathologies often endorse a similar, though distinct, experience: preoccupation with food [10]. What often (but not always) overlaps between obesity and eating disorders is a desire or attempt at weight loss, which may explain why food noise has become a topic of particular interest in cultures that promote thinness as the ideal.

An important area of future research is how cultural norms influence food noise. Culture, religion, and personal ethics can all influence dietary choices daily. For example, a person with a food allergy may need to be more thoughtful in planning their grocery shopping, and someone who follows a vegan or kosher diet may need to read restaurant menus before making plans to ensure that their dietary needs can be accommodated, but these examples may not lead to food noise. Further, eating frequently, planning eating episodes frequently, or considering oneself a “foodie” by celebrating food or enjoying food is not necessarily harmful. Therefore, it is unclear how cultural norms may contribute to or interact with food noise.

The factors that determine when food noise becomes harmful, and when it is not, are also important to delineate. While we expect restriction and weight-loss goals to relate to the experience of food noise based on the anecdotes discussed previously, it is possible that motivation for restriction plays an important role in whether someone experiences food noise during or resulting from restriction. For example, individuals who restrict their diet in some way for moral or religious reasons often experience lower levels of eating disorder pathology than those who restrict for weight-loss reasons [13]. Food noise may be related to an overabundance of choice, and uncertainty. For example, the most effective diet to promote weight change is typically unclear. Restricting the diet for moral or religious reasons, on the other hand, provides a clear guideline for food choice. The influence of these differences in restriction practices on food noise would be interesting to examine in future research.

Outside of restriction, we are uncertain as to what sociodemographic features may influence the experience of food noise. White non-Hispanic women tend to more closely adhere to the thin ideal; so it is possible that they are more at risk for increasing restriction and thus for increasing chances of experiencing distressing food noise [14]. Other considerations, such as body shape, sex and gender, race and ethnicity, age, poverty/food security, family dynamics, and occupation should also be explored.

GLP-1 receptor agonists: a case study of food noise and possible physiological mechanism

The GLP-1 receptor agonists used for obesity management may provide insight into the food noise experienced by some individuals with overweight or obesity. Semaglutide for obesity management has demonstrated a significantly higher percentage of weight loss compared to placebo (10–12% placebo-corrected) when administered at a dose of 2.4 mg by weekly subcutaneous injection, even when both groups receive a background lifestyle intervention [15, 16]. The substantial improvements in weight loss with semaglutides may be related to appetite suppression.

People who use semaglutide for obesity management experience a decrease in appetite and food cravings [17]. Results from a 20-week clinical trial of 72 participants support these reports [18]. The participants who received 2.4 mg semaglutide consumed 35% fewer calories than did the placebo group when offered an ad libitum lunch at week 20. The participants in the semaglutide group also reported significantly less hunger and prospective food consumption, and significantly more fullness and satiety, compared with the placebo group. Additionally, participants receiving semaglutide reported significantly better control of eating and fewer and weaker food cravings [18]. Similar results were found in a smaller (n = 30) 12-week trial with a lower dose of semaglutide (1 mg) [19]. Therefore, GLP-1 receptor agonists may promote weight loss by influencing pathways in the brain, both directly and indirectly, that influence appetite, such as in the hypothalamus and hindbrain [15, 16]. Bariatric surgery also increases postprandial secretion of GLP-1 and other substances, thereby promoting satiety through gut-brain signaling and resulting in reduced appetite [20], along with fewer and less intense cravings for food [21].

The relationship between weight fluctuations and food noise

It is plausible that food noise contributes to weight regain following weight loss. Several physiological metabolic adaptations occur after weight loss that make it harder for a person to maintain their new body weight. Concentrations of hormones that promote hunger (e.g., ghrelin) increase and concentrations of hormones that promote satiety (e.g., GLP-1, peptide YY) decrease after weight loss [22]. Changes in concentrations of the hormones that regulate hunger and appetite likely contribute to the increased hunger, food cravings, and preoccupation with food that often occur following weight loss [22, 23]. Future research should investigate whether food noise is impacted by these changes in appetite hormones and whether food noise mediates or moderates weight regain following weight loss.

The Minnesota Starvation Experiment provides some insight into the psychological changes that occur following calorie restriction and weight loss. The purpose of the Minnesota Starvation Experiment was to characterize the physical and mental effects of starvation on healthy men (n = 36) [24]. The participants were fed a baseline diet of ~3200 kcal/d for 33 months followed by a semistarvation diet of ~1800 kcal/d for 6 months, with a goal of a 25% reduction in body weight. Following the weight-loss phase of the study, the participants completed a 3-month nutritional rehabilitation phase. The participants were also required to walk 22 miles/wk for the duration of the study [24].

During the semistarvation phase of the study, the participants experienced psychological changes, such as irritability, impatience, and loss of interest in other activities such as dating. Additionally, the participants became obsessed with food and food-related activities, including collecting cookbooks and fantasizing about food-related careers [24]. Not surprisingly, the participants experienced physical and psychological changes during the semistarvation phase that were most likely related to conserving energy expenditure (e.g., loss of sex drive). During the nutritional rehabilitation phase, the participants continued to experience psychological and physiological effects that favored overeating. Many of the participants experienced insatiable hunger and increased food cravings. Interestingly, some of the participants described that they did not feel any relief from feelings of hunger, even following episodes of overeating [24]. The results of the Minnesota Starvation Experiment provide insight into the psychological influences that occur after weight loss that may involve food noise.

The biological basis for food noise: a working hypothesis

To manage food noise effectively, it may be worthwhile to question why food noise exists. Could it be a normal feature of human physiology before it becomes pathological? What physiological purpose does it serve, if any? It is unknown if food noise is simply a pathological reaction to a problematic situation, or if it is actually functional. One hypothesis could be that food noise may serve to remind an organism to seek food, the third pillar of survival after air and water. Thirst reminds us to drink water. Similarly, food noise may have developed as a biological alarm, particularly when food consumption is often preceded by a significant investment in food-seeking.

Future research is warranted regarding the practical role food noise may play in regulating energy stores. For example, when a significant investment is required to obtain food, and food availability is high, food noise may be a critical and routine signal to seek and eat food while it is available. Alternatively, during times of low energy availability, food noise would not result in procuring food. In this case, the intensity of food noise may reduce, instead of continually nagging to no avail.

While this theory is speculative, a coauthor of this manuscript (NVD) has observed a related construct for decades in his patients treated for obesity management with diet therapy. He observed that initiation of a reduced energy diet for weight loss is followed by a huge increase in food noise for a few days (usually 3–4 days). The food noise subsides as patients get used to eating a reduced energy diet. If the person experiences a lapse in a weight-loss regimen, say a brief vacation that involves high-calorie food, food noise returns strongly, making it difficult for the person to get back to the routine diet (and thus the lapse in diet leads to relapse and finally collapse of the weight-loss effort).

These theories merit further testing. Does food noise serve an important function but need to be addressed when it reaches pathological levels? Also, is food noise in a person dynamic, changing in intensity based on circumstances or the energy balance status of an organism?

Food noise and stigma

It is important to consider the potential for stigma among those who experience food noise. Additionally, it is important to consider how emergent conceptualizations of food noise may be related to the stigmatization of related disorders, such as obesity.

According to current stigma conceptualization [25], the stigma of food noise would occur when (a) the experience of food noise is labeled as a difference among people (e.g., people with high food noise vs. those with low or none), (b) this labeled difference is marked as negative or undesirable in some manner, (c) others seek distance and separation from the labeled person, and (d) this “othering” and separation lead to discrimination and status loss and (e) ultimately systemic power differentials. Stigmatization can be experienced from others or be internalized (i.e., self-stigma), meaning that those with food noise could experience others’ devaluation due to their thinking patterns regarding foods and also devalue themselves. While no explicit scales currently exist to ascertain whether people experience self or other stigma due to food noise, related constructs of weight/obesity stigma or the stigma of food or other substance addictions [26, 27] suggest that having greater food noise may not be perceived as a desirable trait given its associations with a lack of control, poor decision-making, or inability to perform other life tasks given the heightened focus on a particular stimulus (food-related) and behavior pattern (eating-related).

As in the obesity and substance use literature, if food noise is determined to be an undesirable or stigmatized trait, people may blame themselves, or others may blame them, for experiencing food noise if they feel that it should be under their control. People may feel shame or inadequacy if they believe that one can choose to experience food noise or not, and that experiencing food noise is a choice made due to weakness or lack of willpower. If food noise is a potentially stigmatized process with corresponding shame, it may be useful to determine whether individuals feel pressured to exhibit, or actually engage in, masking behaviors [28]. Masking is the process of intentionally, or unintentionally, hiding aspects of oneself to avoid harm (i.e., stigma). Masking is common in other stigmatized conditions like autism. With masking (or camouflaging, adaptive morphing), individuals with a potentially concealable stigmatized trait attempt to do exactly that: hide it.

The language used to describe food noise and those who have it should be carefully considered. When the language of addiction was applied to food, for example, complex findings arose in which a food addiction explanation for eating behaviors sometimes appeared to reduce self-stigma and stigma from others but with concerns that it may also reduce eating self-efficacy and other health behaviors [29]. Might these findings be relevant to food noise as well? Specifically, the concept of food noise could provide biopsychological explanations for maladaptive eating. Those explanations may move the focus away from “willpower” as a causal factor and toward biological drives, but they could also reduce perceptions of controllability of food noise and its downstream impacts without biologically active interventions, such as GLP-1 medications.

All the above points suggest several future stigma-relevant research topics that will likely deserve empirical attention. For instance, who will get “the blame” for food noise, or how will causal attribution be applied as research determines how much of food noise is personal choice vs. caused by internal biological or external sociocultural pressures [30]. Additional points of consideration in future research topics concerning food noise stigma could include the following: (a) to determine how food noise might fit into current models of food addiction and weight/obesity stigma models; (b) to avoid conflating food noise with obesity c) to learn how food noise is experienced across different body sizes or intersecting identities that have their own stigmatized statuses; and (c) to apply lessons on stigma reduction techniques from other fields to develop stigma reduction [31]. Being cognizant of the importance of language and labels as we define food noise and its potential research, clinical, and public health impacts will be important throughout all of the above efforts.

Food noise and health outcomes

Another area of future research is the potential impact of food noise on health outcomes. According to anecdotal accounts, it is plausible that food noise may have a negative impact on health at a certain threshold. Food noise may affect quality of life, eating behaviors, adherence to dietary therapeutics, or other medical outcomes.

Quality of life has not yet been quantified with particular attention to food noise as a contributor, but anecdotally, many patients cite unanticipated relief from food noise from taking a weight-loss medication, and some individuals report a profound positive impact on their sense of well-being. Prominent levels of food noise may also increase cognitive burden and impair focus on other aspects of life (productivity, family responsibilities, and social relationships, etc.), as well as cause overall distress. The degree to which food noise has this influence needs to be quantified so that the clinical relevance of food noise is clear.

With respect to its impact on eating behaviors, food noise may heighten food cue reactivity or vice versa. It may also be associated with binge eating, as well as food cravings, independent of food cues. An area of interest for future exploration is whether food noise impacts the potential of nutrition to be therapeutic for food-related health conditions. For example, does amelioration of food noise improve adherence to dietary advice and thus reduce patient burden in implementing effective long-term preventive health strategies?

Finally, what are potential therapeutic approaches to manage food noise and its impact on health? Understanding the limitations of GLP-1 receptor agonists and other anorexigenic pharmacotherapy for food noise reduction will be important. The role of specific dietary or other lifestyle strategies for weight management in managing food noise may also become more relevant. Quantification of food noise will allow us to measure improvements in food noise in response to various therapeutic approaches. Being able to measure food noise will also make it possible to gauge whether there are any differential effects on specific health outcomes (long-term weight management and cardiometabolic risks, for example) from a given magnitude of food noise reduction.

Food noise, public health, and food policy

Much of the effort to reduce the harm of obesity has centered on primordial and primary prevention of obesity. Until recently, treatment of people with obesity has been viewed as being daunting and futile and, thus, health advocates have long focused more on prevention. Those prevention efforts have increasingly relied on an assumption that the food environment is the primary driver of rising obesity prevalence [32, 33]. In recent years, food policy advocates have focused on cues generated by food marketers and targeted at vulnerable populations, including children and persons with lower social and economic status who are thought to be more susceptible to obesity and to experience more harm from it [34].

Thus, policies in various jurisdictions have sought to regulate food marketing. For example, Chile implemented restrictions on food marketing to restrict activities that would serve as cues to overconsume unhealthy foods [35]. These and similar efforts have produced short-term changes in some targeted behaviors but no lasting improvements in health or obesity prevalence [35]. Therefore, one target for future research is to determine whether policies regulating environmental food cues may be most effective when paired with interventions that also target food noise, which has a physiological basis within individuals [36].

This effect has been noticeable enough to prompt food companies to adapt their product offerings to meet the needs they anticipate from a population seeking more modest portions and more healthful products [37]. The extent to which a reduction in food noise may be a factor in these market phenomena may also be a target for future research. In this way, it is possible that the reduction of food noise could lead to the evolution of a healthier food environment by increasing demand for it. Some food business analysts have suggested that the industry is moving toward a business growth model that relies on offering higher value products rather than prompting consumers to consume ever larger quantities of food [38].

Conclusion

Food noise is a psychological construct that may be important for those managing obesity and other food-related conditions. The emergence of consistent and frequent patient experiences, as described herein, indicates the potential of food noise to be profoundly clinically relevant. The clear definition of food noise provided herein can be a foundation to build on for further refinement and characterization.

Our preliminary work on the RAID-FN Inventory, designed to measure food noise, provides a basis for further testing and validation. Measuring food noise will enable research to characterize the correlates, causes, and consequences of food noise, and responsiveness of food noise to treatments. Very little is known about food noise thus far, and rigorous experimental tests are warranted.

Many questions about food noise remain, and we feel that food noise merits further investigation. The role of food noise in weight management and mental health, the role of anorexigenic medications in modulating food noise, and the social and cultural implications of food noise all require further exploration. Just as the characterization of binge eating disorder propelled the treatment of binge eating, we wish to call attention to the potential of further characterization of food noise to impact the health and well-being of people who experience it.