Food fussing — the relentless, uncontrollable mental rumination about food — is a common experience reported by people struggling to control their weight. The surge in the use of GLP-1 inhibitor medications has highlighted this phenomenon because many patients report that GLP-1 treatments alleviate food-related thoughts.
But until recently, doctors and researchers were at a loss as to how to objectively determine the prevalence and severity of food noise.
Enter Hanim Diktas, Ph.D., an obesity researcher at the Pennington Biomedical Research Center, Baton Rouge, LA, who led a multidisciplinary research team tasked with developing the first scientifically validated nutritional noise assessment tool.
As with all personal experiences, food hype is challenging to frame in uniform, objective terms. Dr. Diktas and his colleagues spent a lot of time reviewing everything published to date about food noise, as well as interviewing patients. They then prepared a tentative list of survey items and sent them to independent experts in survey development for review and refinement.
The final form of the Food Noise Questionnaire (FNQ) uses a five-point Likert scale format, on 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 are uncontrollable.
3. I spend a lot of 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 should be doing.
For each statement, “strongly agree” was given a score of 0, while “strongly agree” was given a score of 5. The individual item scores are then summed to give an overall score (maximum = 20), with higher scores indicating higher levels of perceived food noise.
The researchers subjected the questionnaire to a set of statistical analyzes to test and re-test its stability and validity. The study included a nationally representative general population sample of 409 individuals (67% female, mean age 51.5 years, 72% white, mean BMI 31 kg/m2).2). Nearly one-third of the sample population (28.5%) was on a weight-loss diet, but none were taking GLP medications at the time. A total of 396 subjects completed the full test-retest study protocol.
“The FNQ provides a reliable and psychometrically valid measure of food noise, although more research is needed to evaluate its clinical utility,” Diktas and colleagues report in their paper. Paper published in the journal obesity.
The questionnaire demonstrated “excellent internal consistency 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),” adding that it also performed well on measures of convergent and discriminant validity.
Dr. Diktas and her group acknowledge that there are many preliminary definitions of food noise in the medical (and consumer-facing) literature. But one factor that almost all of these thoughts have in common is the intrusive and persistent nature of thoughts about food. For the purposes of their research, they defined the phenomenon as: “persistent, intrusive thoughts about food that disrupt daily life and make healthy behaviors difficult.”
These thoughts include intense worry about what to eat, when to eat it, and how much to eat.
Rumination can sometimes be triggered by actual external food cues of one kind or another, or intensified, but that’s not always the case, Dr. Diktas said. Many patients experience food noise independent of any external stimuli.
She and her colleagues stress that the current iteration of the FNQ is just a starting point, albeit a powerful one, in creating a standardized way to measure a highly subjective experience. They call for further research to determine, among other things, whether dietary noise scores change in response to GLP-1 drug treatments and nutritional interventions, and whether the questionnaire’s reported validity applies to a broader range of ethnic, racial, and age groups.
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