Joey Wahler (Host): It can be a major obstacle when fighting weight issues. So, we're discussing food noise. Our guests are Dr. Rhonda Mough, an internist specializing in obesity medicine, and joined by Jamie Hamm, a family nurse practitioner. This is Meaningful Medicine, a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Thanks so much for joining us. I'm Joey Wahler. Hi there, Doctor, Jamie. Welcome to you both.

Rhonda Mough, MD: Hello, thanks for having us today.

Host: Absolutely. Appreciate the time. So first, for you, Doctor, what do we mean by the term food noise? Because I know in preparing to speak to you both, this is a new one on me.

Rhonda Mough, MD: Yes. So, it's a relatively new term that has come about since really the advent of GLP-1 medications. And there really isn't a clear scientific definition for food noise. But typically, what it is referring to is this food chatter. So, repetitive thoughts about food that are really unwanted and can be distressing for patients. And it can kind of become a beast of its own where it's difficult for patients to focus on other aspects of their life because they're having these repetitive thoughts about food and cravings and really strong urges to consume certain types of foods.

Host: And so, really in a sense, right, Doctor, when we say food noise, we're talking literally about noise or a voice, if you will, in our heads that says, "It's time to eat. It's time to eat X, Y, and Z. It's time to eat such and such an aMough," right? Something that kind of is this inner voice urging us what to do, yes?

Rhonda Mough, MD: Yes.

Jamie Hamm: Right.

Host: And so Jamie, how do we know we're experiencing food noise and too much of it, and that it's not just looking forward to a good meal and doing what we should be doing? Where's that line, would you say?

Jamie Hamm: It's for the patients, they can't cut off the thoughts. Whether they've just eaten, whether they're full, they're still thinking, you know, I want to eat more. What am I going to eat next?" And I mean, it can interrupt their workday. It can interrupt their thought process, their time with friends, because they're just constantly thinking, "What am I going to eat? When can I get, you know, that next snack?"

Host: So, Doctor, as the two of you well know, there's that old saying, don't grocery shop while you're hungry or you may end up buying a lot of stuff that you don't need if you weren't, right? So if you are full, can you still experience food noise? Tell us a little bit please about that link between hunger and noise. What's the connection there?

Rhonda Mough, MD: Yeah, absolutely. And oftentimes that is exactly the case. So, you know, hunger is something that we need to have, right? We need food. There's a reason why we eat. And so, not all food thought is food noise. So, thinking about what your next meal is going to consist of, making sure you're having good nutritious meals is fine.

The difference between hunger and food noise, hunger typically is more of a gradual onset. So, you know, it's getting to be time for a meal, so you start to feel hungry, you get that growling in your stomach, as opposed to food noise, which is more of a kind of out of the blue, sudden urge, craving for a specific type of food. It's another big difference between hunger and food noise. Hunger typically is satisfied by with whatever you eat, right? It doesn't really matter what it is, it'll satisfy the growling in the stomach and you'll feel better. With food noise, it's very specific, and typically the only thing that will satisfy the food noise is that specific food, whether it's chocolate or chips or whatever it is, pizza, it's that specific type of food that's going to satisfy.

Host: And when you say that, Doctor, that there's only a certain thing that'll satisfy that craving, is that typically more mental, more physical, or maybe a combination of both?

Rhonda Mough, MD: I mean, it can be a combination of both. What we believe is that there's part of the brain that's involved with reward and cravings. And when that gets activated by a particular food, oftentimes it's something that's higher in sugar or fat or salt. Those are the foods that we tend to crave or some combination of those, that once that gets activated and we feel some reward from eating that food, we're going to tend to do it again. We tend to repeat rewarding activities. And so, that's why we engage in those types of behaviors.

Host: I'm not saying, Doctor, that this works for everyone. I'm sure it certainly doesn't. But I know for me, one trick that I use doesn't always work, but it works I think more often than not, is sometimes I'll get a craving for something and usually if it's something unhealthy, I'll first try to wait. Like, I'll think, "Let me grab some candy." But then, I'll think, "How about if you don't grab some candy? Give it five minutes." And I find usually that'll at least put it off for now, right? Which is better than nothing. So, how much of this is impulsiveness, where as soon as we have that food noise in our head, we try to react to it? Is there something to be said for trying to back off and give it a little time, a little space?

Rhonda Mough, MD: I mean, I think that does work for some people. You know, a lot of times these thoughts are very distressing though. It's almost like the itch you have to scratch, right? And so, people have a hard time sometimes not giving in just because it's such an uncomfortable feeling. But to your point, yes, if we can just hold off and maybe engage our thinking brain and think, you know, start an assessment of when did we last eat? Are we really physically hungry? That if we slow down and start thinking through those things, sometimes that can allow us to hold off on, you know, moving forward with that food.

Host: Jamie, how about some strategies for tackling this food noise? For example, choosing healthy snacks and any other tips you can give people for how they can combat this.

Jamie Hamm: Teaching our patients to kind of what Dr. Mough said, assess, "Did I just eat? Am I really hungry?" Making sure that they are getting protein throughout their day to keep them full. Making sure they're well-hydrated. Making sure that they are getting good sleep so that they have hopefully less of those hunger cues. And then, also, distraction. You know, when you have that cue, can you go do something else? Can you do something to give your body that five minutes to say like, "Wait, maybe I don't really need that food"?

Host: You said something there, Jamie, that really got my attention, which was ask yourself, "Am I really hungry?" How often are people hearing food noise when in fact they're not even hungry? How much does that exacerbate the problem here?

Rhonda Mough, MD: Yeah. So, I mean, I think that happens often, honestly, that patients are experiencing food noise. You know, it's like you finish a meal and you know that there's a pint of your favorite ice cream in the freezer, and you're not physically hungry, but that ice cream's there and it's a cue, right? You know it's there. Or, you know, it's walking around work and seeing the bowl of candy and knowing that, you know, you just had lunch, you're not really hungry, but that candy looks really good. So,, a lot of times we're just cued by things in our environment, whether it's something we're physically seeing. It could be an ad on TV for a fast food while we're watching TV at night that makes us start thinking about that food. So, I mean, that is fairly common.

I'll add one more thing to what Jamie had mentioned, and that's stress. Stress makes stress hormones go up, like cortisol. When our cortisol increases, we crave sugar because our brains prefer sugar as a fuel. And our brains feel the need to figure out how to manage the stress, right? We have to solve the problem. And so, that is also a strategy that can help people manage food noise, is dealing with stress and finding some healthy coping strategies.

Host: And speaking of which, Doctor, hence the term comfort food, right? Eating makes us feel comfortable. It's something we can control. It's something that tastes good. It's something that can literally make us feel good, at least for the moment, but it also makes us ignore the consequences oftentimes, right?

Rhonda Mough, MD: Right. And, you know, sometimes food can be a distraction. You know, if there's something that we need to do that's stressful or that we're kind of procrastinating and don't want to do, it can kind of be an escape from a situation as well. So, food can serve a lot of purposes in our lives. You know, we have complex brains. And so, we find a lot of ways to cope with those types of situations.

Host: And, Doctor, GLP-1 medications were briefly mentioned earlier in our conversation. So, meds like Ozempic and such that have become all the rave in recent years. They can quiet food noise, so to speak. So, how does that work exactly?

Rhonda Mough, MD: So, one of the major ways would be through affecting that reward center in the brain that I had mentioned earlier. So, kind of quieting some of the reward that comes from eating and reducing cravings. There are a couple of other things as well that GLP-1s do. They do promote a feeling of satisfaction.

So, I mean, part of the issue with food noise is people don't feel satisfied despite being physically full, right? They're still not satisfied. And so, it can help with that by reducing some of that reward from food as well as promoting that feeling of satisfaction. And then, finally, they help stabilize blood sugar. And blood sugar fluctuations throughout the day can definitely lead to more and more cravings. So, we want more stability in our blood sugar, which can come from dietary changes and also from taking medications like GLP-1s, and that can help reduce cravings and food noise.

Host: And picking up on that point, Jamie, how would you say food noise contributes to struggles with weight? If you look from the experience that you and yours have with people that have difficulty maintaining a proper weight, how much of a factor, if we were drawing a pie chart, for instance, how much of a factor is food noise in adding to those difficulties, would you say?

Jamie Hamm: For some patients, it's really the major thing that keeps them from staying on track. You know, we can have the whole team, we can have the diet plan, the exercise plan, they're doing great. But if you just constantly have this record over and over again, even the best, you know, laid out plans can be very hard for a patient to follow.

Rhonda Mough, MD: Yeah, 100%. And the other thing I would add to that is that when weight loss does happen, particularly patients who are really trying their best with diet and exercise, our bodies respond to weight loss by increasing our appetite. And of course, because our body wants to go back to our previous weight. Like, we have a set point, and that's where our body wants to go. And so, we're going to crave higher calorie foods if our body is trying to regain the weight we lost. And so, that is part of the reason why it's so tough to lose weight and keep it off.

Host: Well, Jamie mentioned a moment ago that we're talking here about trying to stick with a plan, right? It's not a one-size-fits-all. These things have to be tailored to individual patients based on their lifestyle, their particular obstacles, et cetera. And so, Doctor, your clinic of course has a registered dietician, bariatric surgeons as well. How about the resources that you and yours can offer to support people in this journey? Because you need that support to say the very least, right?

Rhonda Mough, MD: Yes, absolutely. And so, we have a team here of professionals who are very passionate about helping patients achieve better health and manage their weight. And, you know, as we've been alluding to, there are a lot of different components in terms of what can affect weight and the ability to manage weight long term.

So yes, we do have a dietician who can definitely help with some of the macrodistribution. We've been talking about protein, fiber, healthy fats, those sorts of things that can help you with that satisfaction and managing blood sugars and avoiding cravings. We have a social worker on our team as well, which is important for, of course, the mental health piece of this because there is a large part of it there.

So, she can help too with some alternative coping strategies. You know, if, you know, stress is a trigger, for example, for food noise or eating certain foods, just helping with some alternative strategies there as well. And of course, we have Jamie and myself as the medical side of weight management, and we do have a number of bariatric surgeons as well for patients who are looking for a surgical route for long-term weight management. So, we aim to offer all of those needs here in one place.

Host: And so, to kind of put a bow on this here, in summary, Jamie, what advice would you offer to someone joining us, struggling a long time with all this, feeling like they've already tried a lot of diets as so many have, and who knows what else in terms of solutions that haven't worked long-term? What do you want to say to them about taking that first step to try to take advantage of these great resources that you and yours can offer? What can you tell them about what they can expect when they come to that first visit and try to go down the right road, whereas they've gone down the wrong one so far?

Jamie Hamm: The biggest thing is, you know, of course, we're going to talk to them about, you know, their diet and their exercise, you know, and a lot of times patients will say, like, "I've done that, I've heard that." But we have the benefit of having more time to really go through, get to know them, like, what is your eating style? Where are you struggling? Is it the food noise? Is it simply a knowledge deficit? Do we need to bring a dietician in? Is it that you have untreated anxiety or an eating disorder? Do we need a social worker? Do we need, you know, a special counselor? And we can meet with them, you know, as frequently as needed. And then, we can also implement medication to help.

So, I think the difference is with us, it's building a team around a patient that is not just going to see them occasionally, but is going to, you know, see them throughout their journey while also working with their primary care and their other specialists.

Rhonda Mough, MD: Absolutely. Yeah, I agree 100%. And then, the other thing is to not be afraid to ask for help. You know, this is a chronic medical condition that we're talking about, and it's no different than asking for help with management of any other chronic medical condition. And so, this just happens to be what our passion is and we're here to support them. They don't have to walk this alone. There's so much conflicting information out there. Come see us. You know, we'll get you pointed in the right direction.

Host: Great point to emphasize there, Doctor. And I think it's important as well that you've both touched on the fact that oftentimes in these situations there is a mental health component. And you, of course, can offer that help there as well if needed. Well, we hope that you're now more familiar with food noise. Doctor, Jamie, keep up all your great work and thanks so much again.

Jamie Hamm: Thanks.

Rhonda Mough, MD: Thank you so much. Goodbye.

Host: Absolutely. And to find a physician, please visit novanthealth.org. For more health and wellness information from our experts, please visit healthyheadlines.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of Meaningful Medicine, a Novant Health podcast.