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 [9]. 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 [12]. 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 [13]. 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 [14, 15]. 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 [16]. Results from a 20-week clinical trial of 72 participants support these reports [17]. 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 [17]. Similar results were found in a smaller (n = 30) 12-week trial with a lower dose of semaglutide (1 mg) [18]. 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 [14, 15]. Bariatric surgery also increases postprandial secretion of GLP-1 and other substances, thereby promoting satiety through gut-brain signaling and resulting in reduced appetite [19], along with fewer and less intense cravings for food [20].

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 [21]. 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 [21, 22]. 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) [23]. 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 [23].

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 [23]. 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 [23]. 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 [24], 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 [25, 26] 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 [27]. 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 [28]. 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 [29]. 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 [30]. 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 [31, 32]. 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 [33].

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 [34]. These and similar efforts have produced short-term changes in some targeted behaviors but no lasting improvements in health or obesity prevalence [34]. 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 [35].

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 [36]. 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 [37].