In this edition of Med Op-Ed: Why doesn’t food noise quiet for everyone on GLP-1s? How does the bias against GLP-1 use affect adherence? And what does long-term obesity management actually look like?

GLP-1s Don’t Always Quiet Food Noise

“Food noise” doesn’t quiet for everyone on a GLP-1 or following bariatric surgery. Clinicians don’t fully understand why. Writing in Diabetes, Obesity and Metabolism, Devika Umashanker, MD, and James Mitchell, MD, propose a more detailed way to classify food-related thoughts, building upon earlier definitions and screening tools from Daisuke Hayashi, Hanim E. Diktas, and colleagues. The goal: a framework that helps clinicians more consistently assess patients, track changes over time, and tell healthy food-related thoughts apart from ones requiring treatment.

The Context

• Patients with obesity or type 2 diabetes often report decreased food noise on GLP-1s, and some notice the same after bariatric surgery or newer medications, but responses vary widely, and it’s not yet clear why.
• A proposed definition: frequent, intrusive food-related thoughts that become problematic when they interfere with daily functioning or drive unhealthy eating. This is meant to be distinct from craving, rumination, binge eating, non-food-related intrusive thoughts, and compulsive eating. Sorting these thoughts by how often they occur, how intrusive they feel, their emotional tone, and the behaviors they trigger could help clinicians more precisely assess patients and tailor treatment.
• Two existing screening tools — the Food Noise Questionnaire and the Ro Allison Indiana Dhurandhar-Food Noise Inventory — capture different aspects of these thoughts, but both have limitations, especially in tracking how symptoms change with treatment. Assessing specific domains — food planning, food memories, encounters with food, worries about food, and food noise itself — may capture clinical significance that current tools miss.

In Their Own Words

“This approach could facilitate standardized assessment, longitudinal monitoring, and more individualized treatment selection based on symptom severity and overlap with other food-related types of thoughts, rather than the mere presence of food noise….Ultimately, this framework could inform the development of more comprehensive screening instruments capable of distinguishing adaptive food-related thoughts from maladaptive thoughts that warrant clinical intervention and may support more targeted assessment and treatment strategies.”

Read it: Food Noise Is a Type of Thinking

Stigma May Derail GLP-1 Adherence

Stigma around GLP-1 use is its own distinct problem, separate from general weight stigma; many question whether losing weight with medication is the easy way out. Writing in the International Journal of Obesity, Stacy M. Post, PhD, argues this stigma can pile onto existing weight bias and may discourage patients from starting or staying on medication. As GLP-1 use grows, Post calls for clearer definitions, validated measurement tools, and long-term research across diverse patient groups.

The Context

• In experimental studies, people who lose weight using GLP-1s are judged more harshly than those who lose weight through diet and exercise — their success is dismissed as a “shortcut.” They’re also sometimes viewed more negatively than people who don’t lose weight at all. In surveys, 76% of GLP-1 users report experiencing stigma about their medication use.
• This stigma could keep some patients from starting treatment out of anticipated shame, undermine adherence as it does with other stigmatized conditions, and encourage unhealthy eating patterns that it’s already linked to.
• About 25% of US adults have used a GLP-1, and more than 100 million are clinically eligible. Priorities going forward: a clear conceptual framework, validated tools to measure both external stigma and self-stigma, and more research, especially long-term studies across diverse patient groups.

In Their Own Words

“This compounded form of stigma may exacerbate negative physical and mental health impacts and GLP-1 treatment engagement beyond those associated with weight stigma alone, potentially creating new barriers to effective obesity care….A prominent theme of these criticisms centers on discipline, willpower, and personal responsibility, with GLP-1-assisted weight loss often portrayed as taking the easy way out compared to traditional lifestyle methods like diet and exercise.”

Read it: GLP-1 Receptor Agonists and the Emergence of Treatment-Related Stigma: A Call for Conceptual Clarity

Treat Now to Prevent Future Harm

BMI alone isn’t enough to guide obesity care for individual patients, write Priya Sumithran, MBBS, PhD, and Louise A. Baur, MBBS, in Obesity. Clinicians should confirm excess body fat, assess its health impact, stage any complications, and provide individualized, long-term care. Comparing recommendations from The Lancet Commission on Clinical Obesity, the European Association for the Study of Obesity (EASO), and the American Association of Clinical Endocrinology (AACE), the authors find broad agreement: Treatment is warranted both to address current illness and to prevent future harm.

The Context

• BMI still works well for tracking obesity at the population level, especially in low-resource settings, if ethnicity-specific cutoffs are used. But for individual patients, it should be paired with other measurements — such as waist circumference — to catch excess or abdominal fat, especially when BMI falls below the obesity threshold.
• A full evaluation — history, exam, and targeted testing — should document how obesity affects a patient’s health and well-being. Obesity raises the risk for noncommunicable diseases such as atherosclerotic disease and can impair health or function even before other conditions appear.
• EASO and AACE both recommend staging obesity by the presence and severity of complications. AACE uses a simple three-tier system. Other systems look at cardiometabolic, mechanical, psychological, and functional domains. The Lancet Commission doesn’t address staging. All three frameworks, AACE, EASO, and The Lancet Commission, call for individualized, holistic, long-term management. Treatment is appropriate both for existing illness and for prevention. AACE and EASO offer medication guidance that focuses on treating complications.

In Their Own Words

“All frameworks recommend thorough evaluation of obesity’s impact on health and well-being through history taking, physical examination, and investigations as relevant.”

Read it: Navigating the Numerous Frameworks for Obesity Care

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.