Ep. 34 - Food Noise, GLP-1 Medications, and the Set Point: Why Weight Comes Back

Dr. Tim Sayed walks through a recent New York Times article on food noise — the persistent mental chatter about eating that many people with obesity describe as relentless — and what GLP-1 medications like semaglutide and tirzepatide appear to do to quiet it. Drawing on both his clinical experience prescribing these medications and his own personal use of them, Sayed unpacks the concept of the set point: the weight a body seems to naturally gravitate toward, which researchers believe may be dysregulated in obesity. The piece raises a question Sayed finds genuinely unresolved — if GLP-1s are suppressing food noise by resetting the set point, what exactly is being reset, and where in the brain is that happening?

Patient accounts from the article illustrate how dramatic the shift can feel — and how quickly food noise returns when the medications stop. Sayed doesn't frame this as a failure of the drugs. He's more interested in what it reveals about the underlying biology, and whether behavioral changes adopted during treatment can outlast the medication itself. He also touches on the broader compulsion research emerging around GLP-1s — gambling, alcohol, smoking — and what it might mean that a single drug class appears to quiet such different urges. The honest takeaway here isn't a clean answer but a more precise version of the question: the drugs work, the biology is real, and the mechanisms still aren't fully understood.

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Transcript

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Welcome back, listeners to The Scalpel's Edge. I'm your host, Tim SyedMD, board-certified plastic surgeon in Southern California with a practice that focuses on holistic health and wellness, medically supervised weight loss, breast implant illness, explant surgery, and overall wellness. Uh on our podcast, The Scalpel's Edge, we'd like to talk about all those various factors that help optimize our ability to perform. And that includes optimizing our physical, mental, spiritual, and emotional health. I like to call that being on the bleeding edge or the scalpel's edge of life. And so on the scalpel's edge today, we're going to talk about GLP1 medications as we do on uh many of our episodes. Um today I'm going to talk about a recent New York Times article uh talking about what they call food noise. And um, as we've mentioned on the podcast before, the concept of food noise is essentially this idea that your brain is getting cues to telling you do you need to eat or you want to eat, but sometimes it's telling you you want to eat when you don't actually need to eat. And food noise is a big part of kind of compulsive eating, recreational eating, uh, eating when you're bored, uh, eating late at night when the TV is on and you feel like you should have something in your hand, feeling the need to eat something when you go to the movies. Um, some of these are just sort of social cues and and learned social um behaviors and group uh settings. Obviously, food plays a big role. You know, who wants to go to a party when there's no food or uh to a wedding reception where there's, you know, the food isn't any good. Um so but food noise is this uh concept that may be sitting in the background in your brain and may play a role in overeating and obesity. And one of the things that has been learned about the GLP1 medications is that in addition to working to directly slow down the gut by actually acting on the gastric pacemaker or the part of the stomach organ that tells the stomach when to start emptying its contents into the small intestine to begin the digestion process. Um the gastric pacemaker is slowed down by uh glucagon-like peptides, um, as it is by glucagon, the hormone that it's mimicking that comes from the pancreas, and is kind of like the opposite uh peptide to insulin or the antidote to insulin. Um but you know, the GLP1s act also on the brain, on kind of cortical brain centers, and contribute to our sense of uh of compulsion and urge to act on the compulsion. And for that reason, the GLP1s are being studied and often prescribed off label, not for the FDA's approved purposes, but for other clinical value in the um, you know, at the discretion of providing you know, physicians basically. Uh it's being used for things like gambling addiction and alcoholism and smoking addiction, you know, uh to help people uh with smoking cessation, even sex addiction and other compulsions. So I'm gonna go through this article kind of in real time here. I just came across it, and I thought it'd be fun to kind of dissect what they have to say about the food noise. So without further ado, we're gonna go through an article from the New York Times entitled The Day the Food Noise Died. And uh the uh byline is Gina Colata, April 27, 2026 is the date of publication. And the subheading under the um headline is before the rise of GLP1s, obesity experts didn't study the internal buzz that compels people to eat. Now that food noise is being switched off, they want to understand it. So um the article starts out by pointing out that before the GLP 1 revolution and the obesity drugs kind of exploded, nobody ever used this term food noise. This is certainly not a term that we learned in medical school. It's not a term that would typically appear in a textbook or in journal articles talking about compulsions. Um and um it kind of developed as the researchers developing the drugs were analyzing side effects and clinical efficacy at different dosing strategies and what things it was improving. And um, you know, at the time they weren't really looking at this idea of these thoughts that are kind of, you know, kind of incessantly going through people's heads about what to eat, what not to eat, when to eat, you know, um how to kind of curb your eating, uh, all the things that people grapple with when they're attempting to lose weight. Um, you know, these were all things that were uh really not kind of on the research agenda at the time, uh, but have come to be in the common understanding of what these drugs can do. So um, you know, people in the community of patients taking these meds were beginning to talk about this issue. And um they basically felt like this food noise was suddenly being silenced despite being something that was always there previous, previously. And for a lot of people who deal with obesity, type 2 diabetes, you know, compulsive eating, and so on, uh, there is this idea of this kind of like, uh I need to eat because I'm bored if I'm not eating. Uh, I need to eat because I'm doing some other activity that seems to be enhanced by eating. There are a lot of people who do this with smoking, of course, where they're not normally smokers who, let's say, will, you know, take a 15-minute work break and want to go outside to smoke or vape because they are doing it all the time. But they're people who, when they go and have a drink with their girlfriends, go to a bar, you know, go out clubbing, once they're one or two drinks in, then they're like, yeah, I want a cigarette. But they otherwise wouldn't be smoking daily or or spending their money on cigarettes. Um, so it's kind of like that that tobacco smoking, social pressure, social proof, noise, but kind of present more commonly because eating is considered generally a more benign activity. So um, so you know, this goes through a few testimonials of of uh people who were interviewed, and one of them um who's 53 years old says that she struggled with kind of having relentless thoughts of food. She was having plagued by internal voices. This is quoting the article, urging her to eat and shaming her for eating. So at the same time, it's sort of like the devil, you know, on the left shoulder and the angel on the right, and like, you know, you don't need to eat that, don't eat that, it's not good. Oh, you need to eat that. You know, it's it's this kind of push-pull. Uh, you know, there's cake in the kitchen. Hey, there's cake in the kitchen. Don't you want the cake in the kitchen? Um, so she said, like, that was like a relentless auctioneer, one of the voices. And then another voice was like a really bad used car salesman. You don't want the salad, you don't want the carrots, you want the cake. And then there was a bully, you know, uh voice in her brain saying, You're so fat, I can't stand you. And then there's the advanced planner. Can I get to the store next Tuesday to get the special cupcakes so I can eat them in the car before I get home? So um, the article asked, What would make people have these thoughts? What is it that drives that? And the researchers say that they suspect that the answer lies in what we call the set point. Um, so this kind of uh came out of research on animals, on behavior and uh, you know, uh compulsive behaviors, eating, training animals like lab rats to kind of behave the way you want them to. And one of the things they noticed is that if um they got uh rodents to gain or lose weight, that once the study ended, these rodents would typically return back to their original weight. Um so there wasn't like a sustained effect. And uh the same thing seems to happen with people. And we know from recent literature that when people go off the GLP1 drugs, they may have lost 20% of their body weight, and now they're off the medications for a year and they're almost right back up to where they started. Um and so, and I've experienced this a little bit in the sense that I went for a period of time where I was trying to kind of wean off the GLP1, see how long I could go between shots uh without gaining weight. And then I found that I had crept up by like eight pounds over the course of maybe three months of regained weight. And then I'm like, okay, I need to get back on the wagon. Maybe I should go back to a weekly dose for a while and maybe sort of do this titration kind of um spurts, and then almost like intermittent fasting, but sort of intermittent GLP1ing, you know, intermittently taking these meds and then having holidays. And maybe that confusion in the way we talk about like muscle confusion with working out, where you don't want to do the same workout every time because otherwise the muscles habituate to a certain level of load and tension and energy expenditure. So you're not actually getting the most out of your muscles and therefore you're not pushing them, and you won't actually build more muscle mass. Um, and so people have talked about muscle confusion with circuit training and um and various other, you know, P90X and various other exercise regimens over the years uh to try to um, you know, trigger the brain and the body to think differently and and to kind of uh be constantly um not knowing where the next move is. So um uh this concept known as the set point was kind of developed, and it was basically the idea that with each person they have a weight that the body naturally gravitates toward, or the set point that you're basically it's like a black hole that you're kind of being uh uh directed towards the center of gravity of where your weight wants to be. And it can change as you get older, and typically the set point, of course, goes up as we get older for most people, because most people become um poorer at metabolizing food, also become more sedentary and not exercising as much, not burning calories as efficiently, or spending as much time trying to burn calories, um, which is why some of the efforts at the quantified self and wearables, uh whoop bands, uh aura rings, um, you know, sleep monitors, Apple Watch, all these different products that you can monitor yourself and kind of quantify your activity levels. Fitbit, of course, being one of the early most popular of such devices. Basically, the idea there is, you know, really kind of monitoring and quantifying how much you're doing of these things, like counting calories, but also counting steps. So the set point, though, as we get older, um, probably you know goes up uh and we oscillate around a higher weight, um, which is not necessarily healthier for us. Um and they say that for some people, the set point may actually go into some form of dysfunction or malfunction, and then it reaches such a high level that the person's health is affected by the excess weight because they their body just can't seem to push them down below that that set point. And then they start having cardiovascular issues, obstructive sleep apnea, all the various other health ailments, type 2 diabetes that can arise as a consequence of weight gain. So let's learn a little bit more about the set point. But before we do that, a quick check-in. We are on the scalpel's edge. I am your host, Dr. Tim Sayed, MD, double board certified plastic surgeon in Southern California with a practice that focuses on holistic health and wellness. Uh, one of the hallmarks of our practice uh in the last several years has been GLP1 compounded medications as part of the weight loss revolution with medically supervised weight loss. And we're talking and we're talking about the idea of food noise and a uh fresh off, hot off the presses New York Times article talking about food noise as it relates to the GLP1s. So we were talking about this idea of the set point. The set point is whatever kind of weight your body kind of seems to naturally gravitate towards for metabolic and genetic reasons, and that that point may fluctuate in time, may malfunction. Um, and so obesity, basically, according to Dr. Lee Kaplan, who's the director of the Obesity and Metabolism Institute in Boston, he says obesity returns from the initial elevation of the set point to an abnormal level. And um, anytime that somebody tries to get their weight much below the set point, food noise kicks in. And this has been observed in various studies. So this may be part of a physiologic process because the idea is that if you've lost the weight, your metabolism slows, so you need less food than would be expected to maintain your weight. But then the food noise kicks in, compelling you to eat more calories than the body can handle without storing some of it as fat. And that's basically why the diets fail. So, you know, you've lost weight, you don't need as much metabolism because you don't need to consume as many calories. Um, but the food noise kicks in, you are now eating more than you actually need, and your body is not able to metabolize that uh because of the new uh point where it's at, and uh you end up storing that extra energy as fat. And and that is one of these sort of ping-pong rebound problems that you have a lot with a lot of diets, which is that they're not sustainable behavioral changes, and the set point may play a role in that. So, food noise, by the way, um, isn't just restricted, it says to people who with obesity, um, you can have it if your weight falls below your preferred set point. Um so another uh set of colleagues at Rockefeller University and Columbia University saw the this same effect many years ago, decades ago. They were studying metabolic and behavioral changes occurring when people lost weight, and their subjects stayed at a hospital on a low-calorie diet until they lost at least 10% of their body weight. Um, and some of these were people who were at normal weight, and some people were obese, so it wasn't just limited to people with obesity. And um their weights were lower when they left the hospital because, of course, that was the condition of the study was you need to lose 10% of your body weight, then we'll let you leave the hospital. But then they had the physiologic signs, it says, of starving people. The metabolisms were low, they dreamt and fantasized about food, and they binged when they were no longer subjected to the enforced diet. Um, they called this extent condition something so extreme that they uh named it semi-starvation neurosis. So that ends up leading to weight gain. So um uh so this idea of you know food noise does everybody have the food noise. Um so this patient that they're talking about, the 53-year-old, in the article, goes to a weight loss clinic at Yale, uh, running by a doctor who enrolled her in a clinical trial of trusepatide, which is the active ingredient in uh Zeppound and Munjaro and in the compounded versions of trusepatide that are offered by a lot of compounding pharmacies. And suddenly for her, this food noise was gone. And then when the study ended, she didn't have access to the drug because it was still in clinical trials. It was not yet FDA approved, so she had to go off the drug. And according to Ms. Smith Parker, the patient quoted in this, she says, the food noise came roaring back with a vengeance. I gained back 40 pounds pretty much by eating spaghetti nonstop and chocolate chocolate cupcakes, which sounds just delicious. But um then when um Wagovi, that had been approved, um uh was prescribed to the patient because they were waiting for Zeppound to come on the market, uh, the voices stopped talking to her in her head. The food noise went away. And she was like, wait, my brain is empty. So um, you know, basically the idea is that the obesity drugs may be setting that set point at a lower level so that the brain becomes accustomed to the weight that it's at and is okay with that weight and isn't feeling the need to drive that compulsion with these thoughts of of uh food obsession. Um so um, you know, but uh what uh is limiting about this is that it it only changes the set point while people are taking the drugs. So it seems to return when they stop taking the drugs, so does the food noise, followed by increased eating and regained weight. Um so they're talking about how this might be similar to the effects of aspirin or Tylenol, you know, on a fever, which is that it suppresses the fever, but it doesn't cure the underlying cause. Um and so the the real challenge, I think, you know, from my own personal experience, both prescribing and also taking these medications, I think the challenge is to be able to ingrain and adopt the behavioral changes that make you, you know, hopefully suppress that food noise or maybe just not succumb to it, um, which is the willpower. And the willpower issue has obviously been a big challenge in weight loss management for decades because so many people say, you know, I just can't maintain this diet or this, you know, regimen or intermittent fasting schedule. I just lose the will. I just can't, you know, compel myself. When I fast, say during Ramadan, um, you know, there comes a point in days and it's harder when the sun sets later as it does in the summer, uh, when it happens during summer months. It's on a lunar calendar, so it's not the same time every year. It moves up by about 11 days every year. So we're now in a time frame for the next several years where it's occurring mostly on the easy side of daylight savings. And so the sun sets at like five o'clock. And, you know, fasting from five in the morning or six in the morning to five p.m. to me is tantamount to just skipping lunch and you know, of course, not drinking water during the day, much easier than if the sun is setting at 8:30 p.m., 8.45 p.m. So, anyway, you know, during those times of fasting, I find myself, you know, at times two, three in the afternoon, it's just like, God, how much longer do I need to get, you know, to you know, I'm starting to count the T minus hours and then in the last two hours, T minus minutes to when I can finally eat, and you know, that food noise increases. And that's of course because I am starving at that point, and it is my brain telling me that I actually really need to eat, and it's because I do need to eat. Uh uh, you know, I'm needing the calories at that point. And so, how do you maintain that willpower though when you're hearing that? Of course, it's easier when you know that the sun is setting at five and not setting at 8:30. So, you know, the amount of time you have left once you hit that point in the day where, you know, that afternoon lull, um, it's just easier. And the willpower is easier to, I don't know how to say it, you know, it's just easier to kind of maintain it uh because the end is in sight uh and it's closer. So that's psychology and and it plays a role in a lot of things that we do. They're resisting the urge to buy to impulse shop, to buy things on sale, to buy new gear when your old gear works just fine, but just because it's familiar to you now and now it's boring, um, we all deal with this in our personal spending habits, um, I think to different degrees, but it it affects most people. So um we're talking today on the scalpel's edge um uh about GLP1 drugs and the uh set point and food noise and how that um changes when you're on the drugs and then when you go off the drugs. You're listening to the scalpel's edge with your host today. I am Tim Side MD, double board certified plastic surgeon in Southern California. My practice uh uh in plastic surgery is mostly explant surgery for breast implant illness patients, but I also do medically supervised weight loss management with GLP1 drugs, and I've been on drugs like this now myself to lose weight and maintain my weight loss in the last two years. And this article in the New York Times that was recently published is talking about food noise and this um communication to your brain that happens when you're um grappling with obesity and how we have a set point potentially where our maybe it's our hypothalamus, our pituitary gland, our um pineal gland, whatever it is, you know, different parts of our brain that govern compulsion, our frontal lobe, um uh, but govern sort of what our body feels like it's in balance and equilibrium at. And and for some people, they're fortunate that that um set point seems to be one where they stay very fit and stay very lean. Uh and for other people, unfortunately, it seems like no matter what they try, they have a set point that's just very high. And I think some of that is genetic. So if no the new obesity drugs reset the set point, this article asks, how do they do it? What's the thing that's set and what's reading that as set, asks Daniel, uh Dr. Daniel Drucker, who's at the University of Toronto. And he helped develop these new obesity drugs many decades ago. So understanding this mechanism um uh may help explain why obesity is this disease where that set point is just way too high and help people find ways to lower that set point, maybe without drugs. Um uh this quotes talks about uh Oprah uh Oprah Winfrey and uh her life without food noise in a book that she published and co-wrote with one of the doctors who is quoted in the article. And she said that until her food noise was silenced by one of the obesity drugs, she thought everyone had food noise and that it was normal. And she said the single biggest surprise of taking the medications was waking up and not thinking about the very first thing I wanted to eat or the healthier thing I should have wanted, or the bargain I could make with myself so I could eat first thing. This is Oprah writing. And we know Oprah has famously shared her weight loss struggles. Whatever you think of Oprah, you know, um one thing you have to say is that she's been very candid with that, uh, brought out the big wheelbarrow of fat when she had massive weight loss. It was a famous sort of viral moment before social media. Um and uh when she's you know gained weight again and talking about those struggles and and being on stage with people like Michelle Obama and talking about you know self-esteem and and so on. So um uh Dr. Drucker, quoted in this article, says there's a lesson here about food noise for those who don't experience it. And the people who are not struggling with their weight can be very judgmental because they never had their brains driving this food noise behavior. And um I think that's really key. So, you know, the challenge and the article does not answer this, which is you know, what what uh is really being set? What exactly is the physiology of the set point? And how is this food noise being manifest? What part of the brain exactly is being triggered? What part of the brain is responding properly to this to help suppress those urges? There's a lot of talk about the amygdala, which is a center of emotion in the brain, pineal gland, which helps regulate our circadian rhythms. But this hasn't been really teased out and really researched adequately, I think, to have the answers. So it raises a lot of questions, but you know, this is something that we talk to patients about when we're prescribing these meds, which is that this is going to work on your brain and on your GI tract, and hopefully in a way that working in concert while you're on it. But there's no question in my mind that when you go off these drugs, yes, food noise does return. Maybe it doesn't return immediately, maybe it doesn't return as severely as it was in the beginning, or maybe it takes months to get back to baseline the longer you're off the drugs. This article really seems to have resonated because as of my reading of the article, there are already 908 comments, and the article is only a couple days old. And, you know, uh the uh reporter, Gina Colotta, is responding to some of the content uh uh comments. One question was that um, you know, from somebody who lost 42 pounds over the year, she's staying at her target weight. Um and she has not taken GLP drugs to do this. She weighs herself every day and allows herself to have treats three times a week. Can you reset your set point naturally? She asks, as almost turns into like ask Eloise or you know, dear Abby. Um but um the reporter says set points are still sort of mysterious. The obesity experts that Gina Colotta spoke to in uh writing this article said that the set points can change through the course of a lifetime, which makes sense. We all know people who were skinny until middle age and then they gained weight, and in your case, maybe you did reset it naturally, which is great news. Um another person says Um GLP helped with food noise, but more importantly, it took the raging all-day, everyday hunger away, that sort of hangry feeling. And it says, before I could eat a perfectly healthy, high fiber, high-protein meal and be ravenous one hour later. Everywhere I went and everything I did, I had to try to ignore the screaming hunger I carried, and now it's gone. This started from uh when I was a young child for all my schooling, I sat there with screaming hunger, making it hard to concentrate on the lesson because my only focus was telling myself to simply be patient for the next meal. If I could have lived without being hungry all the time, I wonder what I could have accomplished. What an interesting philosophical question. And um, you know, the article's author again, she says, I think many who never struggled with their weight have no idea that others would have never-ending thoughts of food. Uh, and nobody would have thought that those thoughts would vanish from being on the GLP ones. But yeah, you know, I think that's true. For a lot of people end up with compulsions, the alcoholics, uh, smokers. Um, some of them will have measurable health problems, um, liver failure, needed liver transplant, uh, you know, lung cancer, throat cancer, end up speaking with uh, you know, uh an electrolynx because you have to have part of your windpipe taken out, um, losing relationships over these compulsions, um, uh people not wanting to kiss you because your mouth tastes like an ashtray, you know, the things we hear uh people talk about. Um compulsive gamblers who've lost their fortunes, who've lost relationships uh people who don't want to stay with somebody who's gambling the money away, uh sex addicts, uh, the role that you know online adult content has played potentially in damaging relationships. Um I think this food noise compulsion issue needs to really be studied in detail. And maybe there will be FDA-approved on-label indications with enough clinical trials to support approval of these drugs for other types of compulsions. The real question would be: what if you don't want to lose any weight, but you want to stop gambling? Uh, is there a way that they can formulate these drugs to only tweak the urge for gambling and not and make you end up skinnier than you need to be because it's resetting your set point and taking your food, you know, a little bit of food noise away when really it was, you know, um casino noise that you were dealing with? Um so I think this opens up so many questions. Um I'd love to engage listeners in dialogue on this, see what people have thought if they've been on these drugs. You know, share your thoughts with us in the comments, reach out to us. Um, you know, are you noticing food noise being suppressed when you're on these drugs? Have you noticed it come back if you went off these drugs? Uh, what do you do to cope with that? How what are your other strategies to try to suppress it? Um, I think that this article is really um uh thought-provoking, and I look forward to reading more about food noise as it becomes even more uh um in the public eye and hopefully becomes better understood. So, with that, I'm gonna wrap up this uh little talk about um food noise in the article in the New York Times. Um, this is Tim Sayat MD. You've been listening to The Scalpel's Edge, our podcast where we look at the various aspects of um our health and wellness that can impact our physical, emotional, mental, and spiritual well-being, and how to optimize those things so we can live on the bleeding edge or what I like to call the scalpel's edge of life. So please do listen to, rate, and review all episodes of the scalpel's edge wherever you get your podcast content. And please reach out with suggestions for uh topics and uh guests on the podcast. And until we meet again, this is Tim SightMD signing off. And stay well and keep on keeping on.