Food Noise Cacophony, Part 2

Apparently, “food noise” is not a new phenomenon, but a new term for what used to be called “constant rumination about food,” which seems to spring from a combination of hereditary factors, environmental influences, and habit:

Some researchers associate the concept with “hedonic hunger,” an intense preoccupation with eating food for the purpose of pleasure, and noted that it could also be a component of binge eating disorder, which is common but often misunderstood.

For The New York Times, Dani Blum described an informant who habitually started thinking about the next meal as soon as the meal in front of her had been consumed, and whose urge to eat was persistent even when she was full. She started taking one of the -tide drugs and experienced “acid reflux, constipation, queasiness…” but her brain stopped producing food noise, and cravings disappeared.

And why not, with all that gastrointestinal distress going on? Seems like the same effect could be achieved much more economically by just eating some spoiled tuna fish or something.

Another interviewee revealed that food noise — aside from “What can I eat next?” — may include peripheral matters like “internal negotiations about whether to eat in front of other people, wondering if they’ll judge her for eating fried chicken, or if ordering a salad makes it look like she’s trying too hard.”

For Health.com, reporter Maggie O’Neill spoke with the director of the Cleveland Clinic’s Obesity Center, Marcio Griebeler, M.D., who warned that if a patient ceases taking one of the semaglutide-based medications, which affect both the gut and the brain, the food noise may come back, and, “Eventually, this could cause a person to gain weight they lost while taking the medication.”

Waffling, and another kind of noise

To some, that prediction might seem disingenuous, with “eventually” leaning quite toward the optimistic side. As we have seen, the consensus seems to be that when a person decides, or is forced by economic circumstances, to discontinue their -tide drug, the weight returns not “eventually,” but more likely, within a year — much more quickly than it was accumulated in the first place.

For example, healthcare columnist David Wainer wrote for The Wall Street Journal,

As social-media hype around drugs like Ozempic and Mounjaro explodes, patient testimonies have focused not only on the dramatic effect on their waistlines, but also on how quickly many seem to pack the pounds back on if they stop taking the injections.

And yes, there has been plenty of noise of another kind, as social media from old-fashioned newspapers to vanity blogs are full of exhortations from both lovers and haters of the -tide drugs. A health tech correspondent at STAT, Katie Palmer writes,

Dozens of accounts were suspended from TikTok in early July, many belonging to content creators who talk about their weight loss and monetize the platform via partnerships with telehealth companies that prescribe GLP-1s and other weight loss drugs.

That venue and others have become stricter about letting “influencers” proselytize about what are called imitable behaviors. It is of course too late. Everything is already out there. The notorious TikTok website, for instance, has allegedly been called upon to explain food noise to viewers 1.8 billion times.

Your responses and feedback are welcome!

Source: “People on Drugs Like Ozempic Say Their ‘Food Noise’ Has Disappeared,” NYTimes.com, 06/21/23
Source: “What Is ‘Food Noise’? How Drugs Like Ozempic and Wegovy Quiet Obsessive Thoughts About Food,” Health.com,” 07/03/23
Source: “Obesity Could Be Pharma’s Biggest Blockbuster Yet,” WSJ.com, 05/05/23
Source: “TikTok cracks down on users posting about popular weight loss drugs,” StatNews.com, 07/19/23
Image by Josh Davis/CC BY-ND 2.0

Food Noise Cacophony, Part 1

No, food noise isn’t just what you hear when chewing a hunk of celery or a mouthful of chips. Actually, according to Dominique Ruggieri, Ph.D., it is at least four different things, but the one to concentrate on right now is this:

Have you ever spent a good part of your mental energy worrying about the food you ate, the food you’re thinking of eating, the food you might eat at the next event you go to, or the food you should be eating?

This is a newsworthy subject right now because so many people are taking the new GLP-1 weight-loss drugs. A large number of them are delighted that their food noise is finally silenced, or at least muffled. Of course, a certain amount of mental energy should rightfully be directed toward these matters.

For instance, there is an appropriate time to think about future eating, and that is while composing the grocery shopping list. It is to be hoped that we give some thought to making wise choices. While preparing a meal is also a suitable time to have food on the brain. But nobody wants that channel playing 24/7.

Dr. Ruggieri recommends the definition put forth by chef Bethenny Frankel, who tagged it as an “inner food dialogue, commenting on and criticizing everything you eat, or think about eating, or don’t eat,” and goes on to say,

However, some of my clients have told me that just making them aware of their food noise has been a “game changer” for them. I think this is because once you can recognize food noise for what it is — just critical self-commentary that seeks to derail your happiness and your healthy living style — you can often start to notice when it’s happening and talk yourself down from it.

The first step toward that is to notice what circumstances bring on the food noise. Is it worse around holidays, or when you are hanging out with a certain crowd? Or when you’re not taking care of yourself in other ways, or what? This author recommends talking it out, in which case a group situation might be the way to go.

Health.com reporter Maggie O’Neill also wrote a food noise explainer. First, it is a survival mechanism that reminds the body to seek nutritious substances and consume them, to maintain life. But that basically elegant design can get out of hand for a number of reasons: stress, genetics, insufficient sleep, metabolic syndrome, polycystic ovary syndrome (PCOS), food addiction and other eating disorders, and even some medications, like beta-blockers, birth control pills, antidepressants, and antipsychotics, that are prescribed to manage various conditions.

Your responses and feedback are welcome!

Source: “Recognizing Food Noise,” BonVieHealth.com, 04/07/23
Source: “What Is ‘Food Noise’? How Drugs Like Ozempic and Wegovy Quiet Obsessive Thoughts About Food,” Health.com, 07/03/23
Image by David Long/CC BY 2.0

Do Drug Makers Tell It Like It Is? Part 3

Many articles about the GLP-1 drugs share a similar trait, namely the invention or use of verbiage that doesn’t quite mean what it seems to. Here is a sample. For Mother Jones, Jackie Flynn Mogensen wrote,

Researchers now know that childhood obesity is a result of genetic, socioeconomic, and environmental factors, not a personal choice. “It’s not a situation of gluttony,” says Mary Savoye, associate director of pediatric obesity at the Yale School of Medicine. “It’s actually a complex disease.”

Yet somehow, the American Academy of Pediatrics saw fit to give the nod to weight-loss drugs for kids as young as 12, a recommendation that Mogensen jokes “nearly broke the Internet.”

Just for starters, did the pharmaceutical companies involved divulge the staggering amount of accumulated evidence that, in order for their potions to be effective, the brand-new teenager will need to shoot up once a week for the rest of her or his life?

Slippery words

One of the guidelines’ authors, past AAP president Sandra Hassink, talks about lifestyle therapy, like conscious eating and a generous amount of exercise, as designed to “push back” against unhealthy environments. Then there are the “adjuncts”, drugs and surgery. Strictly speaking, that term doesn’t mean an alternative.

An adjunct is a thing added to something else, as a supplementary part, rather than an essential one. Another authority says an adjunct is something added or connected to something larger or more important. So, grammatically speaking, the implication here would be that changes in diet and exercise are the essential, larger, and more important factors. Another adjunct would be intensive behavioral counseling, which…

[…] typically takes place at an academic medical center. It often involves weekly sessions on exercise, nutrition education, support group sessions for parents, and conversations with kids about things like self-esteem and bullying.

Dr. Thomas Robinson, a professor of pediatrics and of medicine at Stanford University who leads a behavior change program for families, estimates there are fewer than one to two dozen lifestyle programs like his across the country, and almost all aren’t covered by public or private insurance.

In the eyes of some critics, rather than bestir itself to demand more of these highly effective behavioral change programs for families, the AAP appears all too ready to inject drugs into adolescent humans. In either case, the help is very expensive.

Most members of the Black and Latino populations find both family therapy and weight-control pharmaceuticals beyond their reach. They and others tend to have higher obesity rates and lower bank balances than Euro-Americans. When people who most need treatment for obesity are least able to afford it, this systemic flaw does not nurture the ideal of health equity.

Another treatment that almost nobody can afford is bariatric surgery. According to some reports, that route can involve a patient in bizarre scenarios, like being told they aren’t quite fat enough yet, so go ahead and pile on some more pounds in order to qualify.

Your responses and feedback are welcome!

Source: “Should Insurers Cover Kids’ Obesity Drugs?,” MotherJones.com, May 2023
Image by poppet with a camera/CC BY 2.0

Do Drug Makers Tell It Like It Is? Part 2

The GLP-1 drugs (the -tide drugs) are not the sort of medicine that a person takes until the cough goes away. All the known facts, so far, suggest that signing up for one of them is a lifelong commitment. As the healthcare reporter Josh Nathan-Kazis phrased it for Barron’s, “[B]ecause these medicines aren’t curative, patients will probably need to take them for a long time, expanding the drugs’ earnings potential.”

For The Wall Street Journal, columnist David Wainer wrote,

To find a true parallel to the bonanza now getting started, one probably has to look back to the cholesterol-drug revolution starting in the 1990s. Statins… created a new category of medicine and generated billions of dollars for their manufacturers because the market was huge… and millions of people have been on them for decades.

The only reason this is not a bigger problem is that, after a certain number of years, a drug’s developer loses the patent and competitors can then sell a generic equivalent. However, every new drug that is approved is entitled to the same protection of their ability to make back the research and development costs, and a whole lot more.

The vetting process has plenty of fancy wrinkles, including a prize unofficially called the golden ticket, which is explained at length by author Robert Cyran for Reuters, but the main point is: “Cutting just several months off the approval process could yield $30 billion in additional value.”

How does this happen? The granting of exceptions started off with good intentions:

Almost two decades ago, some Duke University economists noticed pharmaceutical companies avoided developing drugs to cure tropical diseases because the market is small, but the cost and uncertainty of producing them is high…. The program was implemented and expanded to cover rare pediatric diseases and biological warfare threats.

There is a lot more to it, of course, but according to one point of view, with all things considered, giving a break to the weight-loss drug makers is not the most effective incentive, and is not conducive to real progress. There is also the separate matter of granting exclusivity to patent holders for a number of years, which apparently is also negotiable.

Mention of the approval process is a reminder of another example of how language can hide more than it reveals. One headline, for instance, read “Analysis of New Drug Approvals Suggests Reliance on Less Rigorous Standards.” Some people will interpret that as meaning, “Finally the government will loosen its grip on the reins of power, and make it easier for people to get the meds they need.” Others will read it as “The government just wants to help the corporations rush their products to market so they can make millions.”

Thrashing out the differences between various viewpoints is one reason why bureaucracy thrives. In any given situation, it can be our best friend or worst enemy.

Your responses and feedback are welcome!

Source: “Weight-Loss Drugs Will Be Blockbusters. Here’s the Stock to Buy,” Barrons.com, 05/04/23
Source: “Obesity Could Be Pharma’s Biggest Blockbuster Yet,” WSJ.com, 05/05/23
Source: “Eli Lilly’s golden ticket is a regrettable winner,” Reuters.com, 05/03/23
Image by Paul O’Rear/CC BY-SA 2.0

Do Drug Makers Tell It Like It Is?

As we have seen, the manufacture and promotion of new weight-loss drugs have done a few funny things to the English language, intentionally or not. Some of the results are funny just for being dumb, like the prediction that a change in the drugs’ cost may improve affordability. Sure; or it may make affordability even more impossible. A change will be either positive or negative, and “may” is a weasel word that leaves the field wide open.

A mildly amusing linguistic trick is to mention how, if patients who are prescribed the -tide drugs want the results to last, they will have to stay on them “indefinitely.” Apparently, the word is easier to digest than “forever,” or even the classy phrase “in perpetuity.”

Another thing a manufacturer can do, which has been done, is to announce that severe, painful side effects are normal. Perhaps so, but after exposure to certain natural substances radiation burns are also “normal.” That does not mean it’s acceptable to nuke a city. Invoking the word “normal” does not magically make everything okay.

Unwarranted optimism

There are ways of expressing an idea that, while not pointedly deceptive, can still shed a more rosy light on the matter than is actually deserved. Here is an example:

Dr. Devika Umashanker […] says a significant number of patients gain back weight when they come off the drug, especially if they haven’t made real changes to their diet and exercise routine. Dr. Priya Jaisinghani […] tells her patients that stopping the drug is a bit like no longer going to the gym after having a three-times-weekly exercise routine.

Sure, if people stop doing whatever led to the weight loss, there’s a chance that the weight will be regained. The article goes on to say that “it is possible to be weaned off the medications while avoiding a rebound, but it requires a lifelong commitment to lifestyle and dietary modifications.” This turns out to be not quite the case. It seems pretty clear, by this time, that if a person were capable of a particular lifelong commitment, they would have already exercised that capability, and not be in this situation in the first place.

This brings up another word that perhaps doesn’t sound so serious when it is in Latin — “caveat” — which means warning. An authority issues a caveat about the GLP-1 drugs, namely, “When users stop the treatment all the weight lost is regained!” Yes, all, and with an exclamation mark — which is not so much a warning, as the prediction of an absolute certainty.

People want a cure to be a cure. If someone has an infection and takes antibiotics and the infection goes away, they don’t expect to have to keep taking antibiotics for the rest of their life, and that would indeed be pretty destructive. Another authority says,

And when people stop taking it, there’s often rebound weight gain that’s hard to control. In fact, a study found that most people gain back most of the weight within a year of stopping the medicine.

Not some, but most. And within a year — much more quickly than they put it on the first time. And there’s this: Journalist Allison Aubrey explains how a patient whose insurance company, going forward, will not pay for her weight-loss drug. She will have to get back on what she used to take for control of her blood pressure and blood sugar. “She is at risk of having these conditions worsen with regain of weight.” So, having been able to access her -tide drug for a short time, this woman will now be in a worse condition than before.

Your responses and feedback are welcome!

Source: “Obesity Could Be Pharma’s Biggest Blockbuster Yet,” WSJ.com, 05/05/23
Source: “Mounjaro Weight Loss UK,” OutlookIndia.com, 08/25/23
Source: “Wegovy works. But here’s what happens if you can’t afford to keep taking the drug,” NPR.org, 01/30/23
Image by Mike Steele/CC BY 2.0

Personality, Behavior, and the New Weight-loss Drugs, Part 3

Extremely disturbed people do not care how full they feel; they will carry on eating anyway. Which may be a clue as to how much compulsive eating is accounted for by behavioral addiction. Some folks who eat are not looking to experience satiation; they are looking to shove things into their mouths, and chew.

The thrill is in the endless indulgence of a deviant behavior where the satisfaction is in the process, gained through repetitive actions, to which they are apparently addicted. Among other rewards, there is the sensual enjoyment of swallowing. There are all kinds of peripheral rewards that have nothing to do with nutrition, or even with food quality or flavor. It’s more about the mouth feel and gullet feel.

Would one stick oneself weekly with a needle and then sabotage that effort in such a way? More than likely, yes. After all, there are people who go through the huge ordeal of bariatric surgery, and then keep eating until their stomachs stretch back out. Likewise, just as a certain number of patients make it impossible for their bariatric surgery to work, some percentage will intentionally circumvent any benefit provided by the drug, and get themselves in real trouble. That is a danger inherent in approving weight-loss drugs.

Not training wheels

Originally, there was some hope that these meds could allow a patient to experience a grace period during which old behaviors could be abandoned and new ones learned. Then, according to this attractive myth, the patient could quit taking the stuff, and sail forth into life retrained and refurbished, and equipped to cling staunchly to a new set of behaviors throughout a new, slimmer life.

But no. Journalist Tara Haelle consulted Canadian weight management physician Ali Zentner, and wrote:

These obesity medications “are still viewed as a ‘training camp’ for teaching you how to eat, which is not how they work,” Zentner said. Just as people with chronic conditions, such as depression or diabetes, need to keep taking a medication to keep their symptoms at bay, so do people who have obesity.

[T]hese “medications are a compensation for what the body’s not doing in the first place, not an education for the body. If it’s not a behavior, then there’s nothing to learn.”

This discussion calls forth echoes reminiscent of the set-point theory. It’s as if a -tide drug is capable of overcoming the set point as long as it is used, but once it is discontinued, the body will spring with agility right back to its inescapable set point.

Speaking of behavior, in relation to these drugs, in the U.K., a medical regulatory agency is looking into the prevalence of suicidal thoughts among users. Elsewhere “The European Medicines Agency is now evaluating about 150 reports of possible cases of self-injury and suicidal thoughts…” What behavior could be more definitive than ending one’s own life?

Your responses and feedback are welcome!

Source: “Is Mounjaro the weight-loss drug we’ve been waiting for?,” NationalGeographic.com, 05/02/23
Source: “European regulator expands investigation into risks of suicidal thoughts in users of popular weight-loss medications,” CNN.com, 07/12/23
Image by Nikk/CC BY 2.0

Personality, Behavior, and the New Weight Loss Drugs, Part 2

The mission of the newly available or soon-available substances is elegantly expressed in this AP article:

The obesity drugs lower blood sugar and slow down digestion, so people feel full longer. They also affect signals in the brain linked to feelings of fullness and satisfaction, tamping down appetite, food-related thoughts and cravings.

Because people feel full longer, they eat less and lose weight.

That is one reason why neither tirzepatide nor its semaglutide rivals can work for everybody. People are just wired differently, and some of them act on beliefs and motives that others find bizarre. Behavior is multi-factorial, and one of the possible factors is patient non-compliance, a subject that Childhood Obesity News has examined at length.

No matter what, a certain amount of non-adherence will always be with us. Imagine the frustration of a doctor who helps a patient gain access to -tide injections at a steep cost or, worse yet, at a discount — and then the patient doesn’t use the stuff.

Different demographics

People with diabetes do want to not suffer the consequences of the disease. They don’t want to pass out in public, or lose a foot, so they might be more diligent rule followers. But when the same drugs are injected or swallowed for weight loss, that crowd might justify a fear that has already been expressed.

It is both sad and likely that, once embarked on a course of -tide drugs, many overweight and obese people would take a deep dive into fat-logic. “I’m covered, let the drug worry about doing the work,” such a person might think, and go on to fool herself or himself into believing that now, they can eat more than ever, because the drug will fend off further weight gain.

Even more serious is the problem of people who don’t even bother to rationalize what they basically want to do in any case. These meds work by persuading the body that hunger has been assuaged. The stomach is filled to capacity, and there is no actual need to add any more food. That is a rational conclusion, but rationality has nothing to do with this kind of hunger.

If the person is simply into “eatertainment” or “recreational eating,” what then? Someone who enjoys a video game can sit there and play it for 10 hours at a stretch. Someone who enjoys chewing and swallowing can do that for half a day, too. If the hunger is not physical but emotional, a distended belly can’t fool the emptiness inside.

Ambition

The persuasive information (aka advertising) aimed at people who are curious about the -tide drugs has quite a lot to say about things like neurotransmitters that need boosting, and about cravings and hunger. But hunger does not all come from the same place.

A popular media platform published an article whose title suggested that the new class of weight-loss drugs could end obesity. That is quite an ambition, and an impossible one. Like many other things in life, obesity is multifactorial. One factor is, some folks are not reachable by logic, or even by an appeal to their own self-interest. Somehow they forget the other attractive features of life, narrowing self-interest down to “I’m interested in eating more. And I’m interested in it now.”

Your responses and feedback are welcome!

Source: “How do Ozempic, Wegovy and Mounjaro work? What to know about drugs promising weight loss,” APNews.com, 04/27/23
Image by Sam Nabi/CC BY-SA 2.0

Personality, Behavior, and the New Weight Loss Drugs

After researchers scoured eight databases and came up with seven suitable English language studies published as recently as last month, they undertook a brand new multi-author meta-analysis of information on personality traits associated with childhood obesity.

Despite multifaceted ongoing attempts to prevent and impact the problem, “the overall progress of childhood obesity interventions has been far from satisfactory.” Childhood obesity continues to rise in countries with low, middle, and high-income levels. Meanwhile, adult studies show that the influence of personality traits on obesity counts more than socioeconomic factors or even the highly suspect FTO gene.

About the lack of success thus far in controlling childhood obesity the authors say,

One critical reason is that most of the existing interventions only focused on the proximal factors of obesity such as behaviors, but paid little attention to the rooted drivers motivating behavioral changes such as personality traits.

The Five-Factor model posits five dimensions of personality traits, namely extraversion,
agreeableness, neuroticism, openness, and conscientiousness. Together, these are said to
“reflect a person’s inherent patterns of cognition, attitude, emotion, self-regulation or coping strategies and have been shown to be related to multiple health-related behaviors.”

As it turns out, the only trait that merited attention in this context was conscientiousness, “the tendency to be self-controlled, perseverant, and disciplined to social norms” and the association is a negative one. In other words, children who score low on that quality have more of a tendency to be obese. And, “No consistent patterns were found in the associations between the other 4 dimensions of personality traits and BMI/obesity in children.”

According to the study results, the conclusion is:

Low conscientiousness has been found to be consistently associated with childhood obesity. Causal associations of personality traits with the risk of childhood obesity remain to be clarified in future studies.

“A growing body of evidence has revealed an association between personality traits and obesity, but the findings regarding this association among children remain mixed.” Not much there yet, but this is definitely the sort of thing that needs to be looked into before blithely authorizing the prescription of the -tide drugs to kids. How do the drugs’ known side effects mix with the five dimensions of personality delineated by the Five-Factor model?

And what about the one that stands out, the negative association between obesity and conscientiousness, “the tendency to be self-controlled, perseverant, and disciplined to social norms.” Those traits definitely show up in a child’s behavior, and many behaviors can be taught and cultivated, especially at a young age.

Is it possible that training designed to teach children to pick up after themselves, keep quiet in class, and persist in trying even after they fail at a task — is it possible that this kind of upbringing could also help them avoid obesity? And avoid the necessity for weekly injections of the latest weight-loss drugs?

Your responses and feedback are welcome!

Source: “The association of personality traits with childhood obesity: A systematic review and meta-analysis,” ScienceDirect.com, August 2023
Image by FolsomNatural/CC BY 2.0

Behavior, a Big Word

One problem with people is: Often it is not that difficult to put a finger on What Is Wrong, but sometimes people want to take a deep dive into the cesspit and spend a monumental amount of energy, endlessly elaborating on what is wrong.

Another way to do things would be like Abraham Maslow. Study the people who are doing well, and figure out which of their traits might be transmissible. Traits are expressed by behavior, so concentrate on behaviors that can be taught and learned. Then, devise a way to get people to want to learn them.

It covers a lot of ground

Just as our diet basically means everything we eat, our behavior basically means anything we do. It encompasses all of human nature. There has been a lot of talk, probably ever since people could talk, about how much anyone ought to take it upon themselves, or be empowered, to interfere with other people’s behavior.

Imagine a very basic society, confronted by a member who will neither hunt nor gather. Life was rough for everyone, and a person who refused to fulfill the most obvious societal obligations might very well be ostracized. Snubbed, shunned, excluded, avoided, rejected, shut out, expelled. Even though they did not possess the brains we have today, early humans probably thought, “When this perfectly capable person refuses to help himself, the rest of us suffer for it. We don’t need the aggro. We’re letting him go.”

The pain of largeness

And what does ostracize itself mean? To leave a person out of conversations, friendships, groups, privileges, rights, comfort… which is what, in our society, often happens to obese people. The younger ones are especially vulnerable to ostracism, not having other means to compensate for the social handicap of being too big. They get left out and pushed out. It is a variation of the ancient scenario in the previous paragraph. Even though we are now very advanced, it inspires a similar thought. “If someone with excessive fat does not care enough to help himself, it weakens and endangers all of us.”

Then, we rationalize our distaste by listing all the different ways in which uncontrolled obesity statistics will mean the end of civilization, or an equally dire outcome. One expert sees things differently. In the pages of his book, Overweight: What Kids Say, Dr. Pretlow refers again and again to the depression, unhappiness and misery of children and teens who are stuck in a bad situation and don’t know how to get out. His personal empathy and compassion are obvious. The work leaves the reader feeling that helping obese young people to thrive is an ambition both worthy and doable. If we take care of these kids, civilization will have an easier time taking care of itself.

Your responses and feedback are welcome!

Source: “Abraham Maslow, His Theory & Contribution to Psychology,” PositivePsychology.com/ 09/29/17
Image by Sandra Cohen-Rose and Colin Rose/CC BY 2.0