Food noise—the relentless, intrusive, uncontrollable mental rumination about food—is a common experience reported by people struggling to manage their weight. The surge in use of GLP-1 inhibiting drugs has spotlighted this phenomenon because many patients report that GLP-1 treatments quell the intensity of food-related thoughts.
But until recently, clinicians and researchers have been at a loss on how to objectively quantify the prevalence and severity of food noise.
Enter Hanim Diktas, PhD, an obesity researcher at the Pennington Biomedical Research Center, Baton Rouge, LA, who headed a multi-disciplinary research team that took on the task of developing the first scientifically validated food noise assessment tool.
Like all subjective experiences, food noise is challenging to frame in standardized, objective terms. Dr. Diktas and colleagues spent a lot of time reviewing all that has been so far published about food noise, and also interviewing patients. They then developed a tentative list of questionnaire items, and sent them to independent survey development experts for review and revision.
The final form of their Food Noise Questionnaire (FNQ) uses a five-point Likert scale format, by which patients rate their level of agreement or disagreement with the following five statements:
1. I find myself constantly thinking about food throughout the day.
2. My thoughts about food feel uncontrollable.
3. I spend too much time thinking about food.
4. My thoughts about food have negative effects on me and/or my life.
5. My thoughts about food distract me from what I need to do.
For each statement, a “strongly disagree” rating was assigned a score of 0, while a “strongly agree” gets a score of 5. The individual item scores are then summed to give a total score (maximum = 20), with higher scores indicating higher levels of perceived food noise.
The researchers subjected the questionnaire to an array of statistical analyses to test and retest its reliability and validity. The study involved a nationally representative general population sample of 409 individuals (67% female, mean age 51.5 years, 72% White, mean BMI 31 kg/m2). Close to one-third of the sample population (28.5%) were dieting for weight loss, but none were taking GLP meds at the time. A total of 396 completed the full test and retest study protocol.
“The FNQ provides a psychometrically reliable and valid measure of food noise, although further research is needed to evaluate its clinical utility, reported Diktas and colleagues in their paper published in the journal Obesity.
The questionnaire showed “excellent internal consistent reliability (Cronbach α = 0.93) and high test–retest reliability (r = 0.79; p < 0.001; mean [SD]= 7.4 [1.0] days between administration),” they note, adding that it also performed well on measures of convergent and discriminant validity.
Dr. Diktas and her group acknowledge that there are several tentative definitions of food noise in the medical (and consumer-facing) literature. But one factor common to nearly all of them is the intrusive and persistent nature of the food-related trains of thought. For their research purposes, they defined the phenomenon as: “persistent, intrusive thoughts about food that are disruptive to daily life and make healthy behaviors difficult.”
These thoughts include intense concern about what to eat, when to eat, and how much to eat.
Dr. Diktas said that the ruminations may sometimes be triggered by, or intensified by actual, external food cues of one sort or another, this is not always the case. Many patients experience food noise independent of any external triggers.
She and her colleagues stress that the current iteration of the FNQ is merely a starting point, albeit a strong one, in establishing a standardized way of quantifying a highly subjective experience. They call for further research to determine, among other things, whether food noise scores change in response to GLP-1 drug therapies and dietary interventions, and whether the reported validity of the questionnaire holds up across a wider range of ethnic, racial, and age groups.
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