Food noise: integrating experience and evidence

Nutrition & Diabetes CORRESPONDENCE www.nature.com/nutd OPEN Food noise: integrating experience and evidence © The Author(s) 2026 1234567890();,: Nutrition and Diabetes (2026)16:10 ; doi.org/10.1038/s41387-026-00419-9 https:// Dear Editor, The Obesity Medicine Association defines obesity as a “chronic relapsing, multifactorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical and psychosocial health consequences” [1]. Hereby, Dhurandhar et al. offer a timely definition and measurement of “food noise,” a neurobehavioral aspect of obesity, through the Ro Allison Indiana Dhurandhar Food Noise Inventory (RAID-FN) [2]. The authors give structure to the widely reported cognitive phenomenon of persistent, intrusive mental chatter around food, thus integrating lived experience into obesity science. The cue-reactivity framework proposed by Hayashi et al. largely implicates reactivity to environmental food cues in perpetrating food noise [3]. Dhurandhar et al., however, note that food noise occurs even in the absence of food-related stimuli, and the RAIDFN items reflect this broader view. The authors also discuss the significant roles of food-related sociocultural, dietary, and moral contexts [2]. The authors acknowledge the uncertainty of whether food noise represents a fluctuating state or an enduring trait. If food noise varies with metabolic states like hunger or illness, it may behave as a state, whereas it may reflect a neurobehavioral trait if stable across contexts [4]. Clarifying this distinction with RAID-FN would require explicit recall periods, frequency scales (e.g., never to always), and longitudinal trends. Like other cognitive and affective phenomena, it may exist on a trait-state continuum, depending on physiology and environment [4]. The authors note that item testing and factor analysis are ongoing, which could determine whether the four conceptual domains, i.e., cognitive burden, persistence, dysphoria, and selfstigma, could be distinguished empirically within the broader construct of food noise. Further, while the authors note that food noise may reflect both metabolic and cognitive mechanisms, future studies could validate this distinction by pairing the RAIDFN with brief hunger/satiety ratings or cue-neutral versus cueexposure conditions [5]. These could clarify whether variations in food noise track predominantly with homeostatic signals or with neurobehavioral intrusions within an individual, and how interventions differentially modulate each pathway. We would also note that mental “noise” seems to be a shared phenomenon underlying several conditions other than obesity and eating disorders, like substance abuse, gambling, and anxiety. This leads us to believe that food noise could provide a window to better understand the brain–gut axis in both psychiatry [6] and metabolism and understand why incretin-based therapies like semaglutide have shown benefit in both these areas [7]. While many lose weight on incretin-based therapies, a small percentage fail to show a clinically significant response [8]. Possibly, measuring food noise in these individuals could better identify ideal candidates for incretin-based therapy. Further, phenotypic classifications of obesity, a topic that has been garnering more attention, could be supplemented by neurobehavioral phenotyping with the use of food noise inventories like RAID-FN [9]. We would conclude this letter by emphasizing that, perhaps, the most significant contribution of this work lies in the integration of patient-derived language into the scientific discourse of obesity. Translating this lexicon into a measurable construct exemplifies a broader paradigm shift focused on qualitative, patient-centered measures of disease and its outcomes while maintaining scientific rigor [10]. ✉ Rashmi Prakash 1 and Arif Khan2 Northwest Clinical Research Center, Bellevue, WA, USA. 2Department of Clinical Medicine, Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, WA, USA. ✉email: 1 REFERENCES 1. Bays HE, McCarthy W, Burridge K, Tondt J, Karjoo S, Christensen S, et al. Obesity algorithm eBook. Denver (CO): Obesity Medicine Association; 2021. 2. Dhurandhar EJ, Maki KC, Dhurandhar NV, Kyle TK, Yurkow S, Hawkins MAW, et al. Food noise: definition, measurement, and future research directions. Nutr Diabetes. 2025;15:30. 3. Hayashi D, Edwards C, Emond JA, Gilbert-Diamond D, Butt M, Rigby A, et al. What is food noise? A conceptual model of food cue reactivity. Nutrients. 2023;15:4809. 4. Nijs IMT, Franken IHA, Muris P. The modified Trait and State Food-Cravings Questionnaires: development and validation of a general index of food craving. Appetite. 2007;49:38–46. 5. Chao AM, Fogelman N, Hart R, Grilo CM, Sinha R. A Laboratory-based study of the priming effects of food cues and stress on hunger and food intake in individuals with obesity. Obesity. 2020;28:2090–7. 6. Toader C, Dobrin N, Costea D, Glavan LA, Covache-Busuioc RA, Dumitrascu DI, et al. Mind, mood and microbiota–gut–brain axis in psychiatric disorders. Int J Mol Sci. 2024;25:3340. 7. Moiz A, Filion KB, Tsoukas MA, Yu OHY, Peters TM, Eisenberg MJ. The expanding role of GLP-1 receptor agonists: a narrative review of current evidence and future directions. eClinicalMedicine. 2025;86:103363. 8. Squire P, Naude J, Zentner A, Bittman J, Khan N. Factors associated with weight loss response to GLP-1 analogues for obesity treatment: a retrospective cohort analysis. BMJ Open. 2025;15:e089477. 9. Rubino F, Cummings DE, Eckel RH, Cohen RV, Wilding JPH, Brown WA, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol. 2025. https://doi.org/10.1016/s2213-8587(24)00316-4. 10. Perez A, Ball GDC. Are we overlooking the qualitative ‘look’ of obesity? Nutr Diabetes. 2015;5:e174. AUTHOR CONTRIBUTIONS RP performed literature review, analysis, writing, and manuscript preparation. AK conceptualized and supervised the project. Both authors have reviewed and approved the final manuscript. Received: 21 October 2025 Revised: 27 February 2026 Accepted: 18 March 2026 Correspondence 2 COMPETING INTERESTS The authors declare no competing interests. ADDITIONAL INFORMATION Correspondence and requests for materials should be addressed to Rashmi Prakash. 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