What is food noise and what do GLP-1 medications actually do to it?

Food noise refers to persistent, intrusive, unwanted thoughts about food — the kind that loop constantly, create anxiety around eating, and make it hard to focus on anything else. While it became a widely-used term around 2023-2024, largely driven by people describing their experience on GLP-1 medications like semaglutide, it is not a clinical diagnosis. As of 2025, only two published research papers address it directly, and no validated measurement tool exists to quantify it.

From a clinical standpoint, food noise is best understood as a natural consequence of restriction. When someone physically or mentally limits food — whether through dieting, food rules, or moralizing eating choices — the brain responds by increasing preoccupation with food. This is not a willpower failure or a brain disorder. It is an adaptive biological response: the more you restrict, the louder food thoughts become. This pattern is well-established in eating disorder research and was first documented systematically in Ancel Keys’ Minnesota Starvation Study, which showed that semi-starvation produces profound food preoccupation that can persist for years.

GLP-1 receptor agonists quiet food noise primarily by slowing gut motility. When the gastrointestinal tract slows down, it signals to the brain that no additional food input is needed, which reduces hunger cues and the mental preoccupation that follows them. For many people, this feels like dramatic relief. However, this mechanism does not address the underlying restriction cycle that generated the food noise in the first place. The medication interrupts the signal; it does not resolve the patterns of restriction, shame, or disordered eating behavior that are the root cause.

The clinical concern is that food noise relief from a GLP-1 can mask the development of disordered eating or eating disorders, particularly in people who are already restricting. Research shows that 35% of people who pursue intentional weight loss will develop disordered eating, and 20-25% of those will meet criteria for a clinical eating disorder. Without screening for this risk before and during GLP-1 use, these outcomes go undetected. A weight-neutral, behavior-focused approach that addresses the restriction cycle directly is the most sustainable path to reducing food preoccupation without the risks associated with pharmacological suppression of hunger.

Transcript 

[00:00:00] Stephanie: Welcome to the podcast, Erin

[00:00:04] Erin Knopf, MD: Hey, thanks for having me

[00:00:06] Stephanie: I’m gonna quickly read your bio, and we’re gonna get right into the topic because we have a lot to talk about with food noise. So today we have Dr. Erin Knopf, a triple board certified physician in pediatric, adult psychiatry, and children and adolescent psychiatry, and she’s a certified eating disorder specialist, and she’s the co-founder of VERI, Virtual Eating Recovery for You.

[00:00:32] Stephanie: I love this acronym, by the way.

[00:00:35] Erin Knopf, MD: Thank you.

[00:00:36] Stephanie: multidisciplinary outpatient eating disorder practice. And obviously, our topic today is gonna be everything about the brain, right? So we’re gonna go in the depth and the troughs of food noise. But I’m gonna ask you this question because that’s what I asked everyone when we started this series. From your seat, in your triple board certified specialty, what would you say we’re missing when we think about GLP-1 in 2026?

[00:01:07] Erin Knopf, MD: Oh, how much time do we have, truly? Um, what are we missing? I think we are missing everything about holistic healthcare. I think GLP-1 prescriptions and, you know, provisions is really just looking at one outcome, is there weight loss? And then people are either responders or non-responders. They’re not actually looking at the whole person.

[00:01:29] Erin Knopf, MD: Um, when people talk about GLP-1s will improve quality of life, they’re really talking about just giving in to weight stigma and, uh, reducing discrimination by being in a smaller body. We’re not really talking about how much discrimination truly exists for individuals in larger bodies. It really is as ubiquitous as racism, but at least racism is something people know they shouldn’t really admit out loud.

[00:01:55] Erin Knopf, MD: But when it comes to healthcare and weight stigma, no, it’s normalized, and the degree of harm is minimized tremendously.

[00:02:05] Stephanie: I love this analogy because that’s what I say as a fat person. I say to people like I’m a victim of oppression in the same way of color are, but the difference is in today’s world, it’s acceptable for people to treat me because I’m fat versus discrimination of other groups of people.

[00:02:27] Erin Knopf, MD: Correct. And exactly, and this has been something that has been building up for, you know, truly we can at least say the last 100 years, but we can go back even further. We know that there are racist origins into why there’s so much fatphobia and weight stigma. But at least, you know, in American history, we know it began in the early 1900s.

[00:02:47] Erin Knopf, MD: And it all began when MetLife wanted to create a certain standard of what is ideal health and ideal body size. And that was the first time human beings were actually compared to some standard metric. And then unfortunately, it just ran from there. Now you have the Society of Obesity Physicians, and we overly clinicalize the larger body physique.

[00:03:09] Erin Knopf, MD: And then you have Ancel Keys, who I have a love-hate relationship with, since he provided so much data for us to better understand how starvation affects the brain and body and long-term issues beyond. He is also the one who said, “Oh, BMI, great. This equation can absolutely work across cultures and genders and children and adults,” when absolutely not.

[00:03:33] Erin Knopf, MD: It was a bogus mathematical equation created by a Belgian, a mathematician and astronomer who was just on a kick to find an equation to describe the ideal European man. So what? That’s the metric that our modern medical society and world, and we are forced to comply with understanding health through this small narrowed equation.

[00:04:03] Erin Knopf, MD: I also find it amazing that somehow correlation and causation has been completely blurred, completely blurred. When I was in medical school, it was always very clear it’s correlated, and yet at the same time, we were clearly taught a very stigmatized perspective. You know, it was the assumption that you were implicitly and explicitly taught that someone in a larger body was unhealthy, and your job was to help them be healthier, weight loss being one of those mechanisms.

[00:04:39] Erin Knopf, MD: And so this is where I look to my fellow physicians out there. This is not just social justice, and please don’t roll your eyes about what’s, you know, hip and cool at the moment. No, this is so much more than that. This is about actually taking a critical eye to our education, to our practice of medicine, to our oaths of do no harm, and really rethinking what are we doing here.

[00:05:03] Erin Knopf, MD: If all we can tell someone is, “Oh, lose weight and you’ll get better,” first of all, you’re not actually reading the literature, you’re not actually reading the outcome studies, and you’re certainly not reading about all of the harm that happens when you try to interfere with adaptive physiology. That ultimately is the issue here.

[00:05:21] Erin Knopf, MD: Weight cycling is harming people more. It is actually probably what is causing high blood pressure type 2 diabetes, atherosclerosis. You know, this concept of fatty liver disease being something only in a larger body is also bullshit, pardon my French. It actually occurs in thinner people too. So this is all based in rhetoric and narrative, not actual facts.

[00:05:46] Erin Knopf, MD: And so you can tell, I’m on my soapbox. But really, you know, the GLP-1 craze is so scary to watch. It feels like one more example of snake oil promises.

[00:06:10] Erin Knopf, MD: This is a metabolic molecule being given to change how the body responds to hunger and satiety, and most importantly, through slowing of gut motility. So we already know what happens with gastroparesis for those that are more clinically minded out there, and we already know the problems with it, and yet it’s being normalized.

[00:06:50] Erin Knopf, MD: These side effects, I’m putting that in air quotes, of nausea and vomiting and constipation, those aren’t side effects. That is what happens with gastroparesis, period. So if you are supposed to be consenting someone to a treatment and you don’t tell them that these symptoms will occur because of how this molecule will work in your body, you are absolutely causing harm and not providing ethical informed consent.

[00:07:22] Stephanie: This is one angle that we didn’t see coming. A year and a half ago, nobody was talking about food noise. It wasn’t marketed with food noise, but that’s what patients started to express. It’s not making me lose weight, but it’s making me lose that constant narrative and preoccupation with food. And the marketing term is now called food noise. In my world of intuitive eating back 10 years ago, that was called diet mentality, but it’s now being rebranded as food noise.

[00:07:57] Erin Knopf, MD: Cute, right? And also more marketable than diet mentality.

[00:08:05] Stephanie: What do we know about food noise? What is it clinically? Is there any science behind it?

[00:08:12] Erin Knopf, MD: Food noise is hunger. It is legitimate hunger. What happens when you physically and mentally restrict, you are now more likely to desire it. If I told you “Don’t think about pink elephants,” you are now thinking about pink elephants whether you want to or not. So when someone says they can’t control themselves with chips, all they want is chips.

[00:09:00] Erin Knopf, MD: And then they have this cyclic paradigm that starts to build up through repetitive behaviors and interactions with chips, where they’re avoiding it, avoiding it, it’s around them. They have a concept of “This is the last time I’m going to allow myself to enjoy this, so I’m just going to go for it.” And then having one serving turns into a binge, and now you’ve activated the guilt and shame cycle on top of it.

[00:09:59] Erin Knopf, MD: Food noise is a result of literal and mental restriction. Nothing else, really.

[00:10:20] Erin Knopf, MD: The body doesn’t do well if you live just on broccoli either. You need all the things. But we have health guidance and health advice that gets distilled to very narrow recommendations, and certainly are not individualized.

[00:12:05] Stephanie: In my preparation for this podcast, there were literally two articles talking about food noise. They were dating from 2023 and 2025, because before that it was nonexistent, and there is no clinical diagnosis for food noise. It’s just observational thoughts that people are having about food.

[00:12:52] Erin Knopf, MD: If anyone were to get into a true history of whichever individual is coming in front of them, there’s very clear evidence of why that matters. Maybe it was the model of what their parents did in the household they grew up in. Maybe it’s genetic, where they have a family history of eating disorders. Maybe it was weight stigma, where they were bullied and sent to fat camp in the nineties.

[00:13:34] Erin Knopf, MD: That’s really the underlying foundation of why they are so obsessed and preoccupied with thinking about food. We normalize this in our Hollywood productions, in our social groups, in our family conversations around the Thanksgiving table. “I didn’t eat all day so I could have plenty of space for Thanksgiving dinner.” That is all disordered, period.

[00:14:42] Erin Knopf, MD: Ancel Keys, when he did the Minnesota semi-starvation study and had completely healthy participants subject themselves voluntarily to starvation, so they lost 25% of their body weight, these were the psychological outcomes: food preoccupation, food hoarding, more isolation, more distrust. And even after they were weight restored, a lot of the participants continued to have symptoms even 20 years later. This is not benign. Weight loss is not benign.

[00:15:50] Stephanie: How, as we think of food noise as this hunger, as almost the fear system engaging, the body is afraid not enough food is coming in — what is the mechanism that when GLP enters the body, the food noise shuts down literally overnight?

[00:16:20] Erin Knopf, MD: When you don’t have your hunger cues, because again, you’ve slowed down gut motility, the gut is telling the brain, “Hey, don’t allow any food to come in. We’re not really moving things through. We need to slow down.” Kinda like traffic control. You’re not gonna have that same push, and you’re not going to fall into a pattern of obsessing over things you actually love.

[00:17:12] Erin Knopf, MD: So when you take out that emotional relationship with food and how it transcends to other people in interpersonal relationships, you are fundamentally interrupting what creates safety for the human organism, and you are triggering so much more fight or flight, sympathetic nervous system responses.

[00:17:57] Erin Knopf, MD: When people have a GLP-1, it does provide relief from that mental noise, mental chatter that they think is the problem. They’re just really misattributing what is bothering them. They make it a problem with their brain and their willpower when that’s not it at all.

[00:18:41] Stephanie: I also mentor a lot of professionals who’ve evolved from dieting to now it’s about health. They still have the food noise, but the language has changed from “I wanna lose weight” to now “I need to be healthy.”

[00:19:00] Erin Knopf, MD: We talk about this all the time — it’s co-opting terminology that had very clear understanding and definitions and then blurring the lines. If someone says “I just wanna be healthier,” we have accepted that as a good statement for far too long, when really underneath it, there is so much more being lost in that pursuit.

[00:25:00] Stephanie: I wanna bring another parallel to the food noise thing and talk about another trend I’m seeing coming up — body noise. The constant obsession with the body that people are having because of fatphobia, social media fatphobia. And that is also tuned out when people are taking GLP-1. But body noise is just the constant obsession about your look. That’s not a disease or diagnosis.

[00:25:35] Erin Knopf, MD: There’s body dysmorphia, which is when you see yourself differently than how you actually are in the world, and that has to do with a biological issue in the parietal lobe. It’s not a problem with the eyeballs, the optic nerves, or the occipital lobe. It’s where the vision is given meaning.

[00:26:43] Erin Knopf, MD: In eating disorder populations, body dysmorphia is huge. Unfortunately, it’s also one of the last symptoms to heal because it becomes this driving pattern that keeps relapses so profoundly present. You have to tell yourself, “I need to remember that I don’t see myself accurately. What I see is actually a projection of emotion and even self-rejection.”

[00:28:05] Erin Knopf, MD: With social media and the interconnection of human beings on such a level that has never been seen in human history, of course people are scrutinizing their bodies more. Of course people are fearing having any trait that is not the ideal most desired trait.

[00:29:00] Erin Knopf, MD: For body dysmorphia, the data around the gold standard modality is more gray than just CBT. The best approach is what is the patient grabbing onto? CBT is one, but also exposure and response prevention. ERP can be really helpful here.

[00:30:01] Erin Knopf, MD: What helps a lot of people move away from their obsession with body features is actually acceptance and commitment. So you’re looking at both radical acceptance of what is, but also really looking at how does my life align with my values? And that’s when you realize, “Oh, this was so much more superficial than I ever gave it credit for.”

[00:31:14] Erin Knopf, MD: The root of binge eating is restriction. That has been proven over and over again. So yes, there might be a paper that says GLP-1 works to treat binge eating, but why would we not still be trying to treat the initial start of a binge eating issue? And it’s restriction.

[00:33:21] Erin Knopf, MD: Eating disorders are actually a manifestation of psychological state more than being something existing independently. You have to cure the foundation, the soil where the eating disorder behaviors grew from, and understand more of why the patterns are there to begin with.

[00:33:55] Erin Knopf, MD: For those that don’t know, you are actually likely experiencing malnutrition if you lose 10% or more of your body weight in less than three months. The brain shifts into starvation mode and protection of the body to try to prolong life as much as it can when it experiences rapid weight loss.

[00:34:42] Erin Knopf, MD: 35% of people who pursue intentional weight loss will develop disordered eating. 20 to 25% of those individuals will develop clinical eating disorders. The prevalence and incidence metrics we have are not actually indicative of what’s happening in real life. And especially with GLP-1s on the market now and as rampant as they are, I know this is just gonna keep going up.

[00:36:40] Stephanie: Since you’re a pediatrician, I’d love to have your thoughts on children and GLP-1. What are your thoughts on the prescription of GLP-1 to children and adolescents?

[00:36:40] Erin Knopf, MD: When the American Academy of Pediatrics came out with their new clinical guidelines in 2023, honestly, I was appalled. They did a nod to weight stigma, a nod to eating disorder screening, but ultimately saying this is a viable and clear option to help children in larger bodies, sometimes down to age 10. And that includes bariatric surgeries, by the way.

[00:37:34] Erin Knopf, MD: Kids are not little adults. They are growing and developing at completely different rates and have completely different needs. And weight loss at their age is not only problematic from a development of identity and self — you’ve now told them there’s something wrong with their body — you’re setting them up to have a medical treatment that will interfere with their engagement with life.

[00:38:40] Erin Knopf, MD: Kids need those reserves for their height potential. So if you start making them lose weight, they’re not gonna grow the same way they would have before. You are literally causing height suppression. When kids are growing, they’re like Play-Doh. If you want to roll out a long snake, the first thing you’re gonna do is roll a ball.

[00:39:43] Erin Knopf, MD: Even if the AAP issues some sort of recanting of this article, the damage is already done. Clinicians in more rural areas rely on AAP treatment guidelines to keep them current. It’s gonna take years, if not longer, to completely undo this.

[00:40:41] Erin Knopf, MD: Weight loss is not appropriate for any developing child, period. Adults have their own prerogative, their own ability to consent. But anyone else, no, they cannot truly assent to that treatment, nor should parents be guilted into consenting to it themselves.

[00:42:18] Erin Knopf, MD: We’re talking about imprinting on a new soul, a new human at such a young age. No wonder this is a constant obsession for them because they were taught to obsess about it. A child has new wiring that is getting put into place, and if the wiring is guided around rejecting their body, rejecting the size that it exists in, and constantly looking for an external influence to control their body, how can they have an appropriate relationship with their own existence?

[00:45:21] Stephanie: I want people to listen to that even if you’re not a professional. Those people have been trained for 10 to 12 years in science, and the fatphobia and weight stigma is so strong that it overrides their 12 years of scientific training. This is powerful.

[00:50:00] Erin Knopf, MD: Here’s the thing that worries me the most. We have nothing longer than five years of data on GLP-1s. But if we know that rapid weight loss causes starvation in the body, and we know that people on GLP-1s are suffering with sarcopenia, meaning loss of skeletal muscle, there is a point in the human lifespan where you don’t build muscle back. That happens around the seventies and eighties.

[00:50:21] Erin Knopf, MD: If fall risks in your eighties and nineties and a broken hip is the number one risk for death, what do we expect to happen to the lifespan of people who have signed up for GLP-1s who now have loss of skeletal muscle? Their bones are more brittle because malnutrition causes osteopenia and then osteoporosis. You’re gonna have a whole lot more devastating outcomes as people fall more and die earlier. And unfortunately, we’re not gonna have data on that until 20 years from now.

[00:51:20] Stephanie: Looking forward 5 to 10 years, when you think about the field of weight-neutral health, what is your prediction or what is your outlook?

[00:51:36] Erin Knopf, MD: I think it’s very clear there’s so much concern for why are people more unhealthy now. I actually think it is the mental toll and the mental load of being a human in today’s world. We are stretched beyond our capacity. We really weren’t supposed to be in such a global, huge data reception existence.

[00:52:44] Erin Knopf, MD: Knowing what the outcomes were of weight cycling research, what I see every day in clinical practice for people dealing with eating disorders, and how at first it offers relief from intolerable emotions, but ultimately increases just how intense they all are — we are unfortunately at a level where I wonder how can we actually protect our humanity and our interconnection and our sanity when the noise of everything else that’s demanded of us just keeps getting louder?

[00:54:23] Erin Knopf, MD: Every single person who has ever been subjected to intentional weight loss has a pattern of regain because the body doesn’t know that was self-afflicted. The body thought there was a famine. So it prepares. If everyone is saying fat people are the problem, what if we actually called out that your body size at this moment was never your natural set point?

[00:55:00] Stephanie: My outlook is that I think we’ve optimized the body as much as we can from a health perspective. I believe that the future is weight-neutral health because the solution is going to be weight-neutral health where we talk about health without talking about weight.

[00:55:18] Erin Knopf, MD: Yes. I love that you’re bringing it back to that. Weight-neutral approaches actually have the same outcomes as far as improvement of blood pressure, improvement of hemoglobin A1C, improvement of energy and function and participation in life. Why are we downplaying that?

[00:56:02] Stephanie: Before we end this conversation, I want you to talk to us about the Food Noise Reality Roadmap, because I think everybody listening should go and grab it from your website.

[00:56:12] Erin Knopf, MD: That actually was my attempt at catching people that I know are looking at their health from one paradigm and need to be re-educated. It’s a free resource that allows people to really explore the questions we talked about here — where did this come from, why is it here, and it better explains the neurobiology behind it and really asks those questions. Is this really a problem that you need to address, or is there something else worth addressing?

[00:56:36] Erin Knopf, MD: It’s a five-day free email course. You get emails from me, you can reply directly to me. And then truly, if you need more support, happy to offer options. VERY is one option I’d love for someone to consider, but we also are here to collaborate with other providers, and we absolutely refer to anyone and everyone that we’ve already verified is a good person to guide someone’s health journey.