Obesity is rampant in the U.S., dragging along a trail of chronic illnesses, hospital bills, and premature funerals. The root cause is unequivocally the consumption of a greater number of calories than are utilized. But a fundamental question is why is there such an imbalance? Certainly, lifestyle in the U.S. has become more sedentary. But then why hasn't our caloric intake adjusted accordingly?
Though we’ve long moved past blaming it solely on willpower, as it turns out, our biology has a starring role. Research has unearthed the hormonal and neurological underpinnings of appetite, satiety, and body weight. Enter stage left: semaglutide, tirzepatide, and now the new arrivals, CagriSema (a GLP-1 agonist/Amylin analog combination) and Retatrutide (a triple agonist acting on GLP-1, GIP, and glucagon receptors). These medications boost the neurohormonal signals among the gut, pancreas, and brain, causing a myriad of desirable outcomes, including appetite suppression and weight loss. This undoubtedly represents some of the most efficacious medications in the arsenal of metabolic drugs ever encountered in clinical medicine. Prescribing these medications and witnessing the metabolic outcomes has been one of the most fulfilling experiences of my clinical practice. Moreover, if patients couple these medications with meaningful changes in their dietary and exercise habits — that’s cherry on the top.
These medications do more than shrink waistlines. They actually quiet the “food noise” — that relentless mental hum of cravings and hunger. Patients often report that they just stop thinking about food. It’s not magic — it’s pharmacology. These drugs regulate hormones that, in turn, regulate appetite, and since their receptors are distributed throughout the body, the effects are widespread and profound.
But here’s the uncomfortable question: Why is this “food noise” so loud in the first place? Is the static a natural glitch in human biology — or is someone, somewhere, turning up the volume?
Spoiler alert: It’s not just human nature. Nurture plays a vital role.
If this were truly just a matter of biology, we’d see the same obesity patterns throughout human history and across the world. But we don’t. The American brand of food obsession is very much a human-made phenomenon. We engineered the environment to make eating not just constant, but compulsive. Three ingredients make this recipe perfectly disastrous: Food processing, marketing, and snacking.
Let’s start with processed food. Thanks to our evolution from agrarian fields to digital screens, fewer people grow food, and more companies tweak it. Consumption of ultraprocessed food has steadily been rising in the U.S. From super-sizing portions to controlling salt, sugar, and fat content, the goal is longer shelf lives, cheaper production, and, let’s be honest, irresistible flavors. It’s this bliss point (a stunning manipulation of the ingredients by the food industry) that causes the dysregulation of the brain reward center via dopamine pathways that eventually leads to food addiction. Hence, more cravings and more caloric consumption with ultraprocessed foods as elegantly demonstrated by a study in Nature Medicine. It’s food, but upgraded with a chemical engineering degree. It is depressing, to say the least, to witness such exploitation of human biology by the for-profit food industry.
Add marketing to the mix. According to a study, nearly half of television commercials targeted at children are food-related. And not just food — hyper-stylized, slow motion cheese-pulling, crunch-amplified, ASMR-laced fantasies of food. It’s not just on television; it’s in schools, workplaces, social media, grocery stores, and gas station checkout lines. Marketing wizards have honed this art down to a precise science.
From targeted advertisement, to bright and flashy packaging, strategic shelf placement to maximize visual exposure, and enhanced sensory stimulation, it’s almost impossible to spend a day without seeing, smelling, touching, and hearing about food. Food, specifically processed ones, has become both sustenance and spectacle.
Then there’s snacking. Once considered borderline pathological, snacking is now a lifestyle — practically a constitutional right. Our bodies, biologically designed to fast for most of the day, have been hijacked into grazing around the clock. To give one example of its effect on metabolism, fasting, among many other benefits, promotes ketosis that becomes the preferential source of fuel for the brain and heart. However, the idea of ketosis via fasting has been seized by the food industry, which now promotes the emerging trend of keto diets and snacks. Studies have demonstrated a higher risk of cardiovascular disease with keto diets. It is important to differentiate between natural ketosis, which is induced by fasting, and diet-induced ketosis. The pervasive snacking culture reduces the opportunities for the body to attain this natural state of ketosis and accrue its concomitant advantages.
So what now?
The answer isn’t to live on injections forever. The solution starts with awareness — and action. We can’t dismantle the food-industrial complex overnight, but we can mute the food noise in our own lives and try to educate not only our patients, but also family members, children, coworkers, and others.
We can try to create microecosystems purposefully devoid of food noise, which hopefully can coalesce into a larger macroecosystem. We can start by focusing on our homes. One strategy that has worked reasonably well for my “motivated” patients is not to keep processed food and snacks at home, and if possible, at their workplaces. I have advised them not to go to those aisles at their grocery stores, and if temptation is irresistible (it's all dopamine-induced), they should consider changing grocery stores. The “out of sight, out of mind” strategy does work.
Another strategy which I have observed work reasonably well, but admittedly is easier said than done, is de-stressing interventions. Be it exercise, meditation, yoga, adopting a hobby, or any creative outlet. Chronic stress leads to cortisol mediated increase in quantity as well as higher carbohydrates and fat consumption.
Moreover, having buy-in from family members and colleagues goes a long way. It takes a village to make a long-lasting and meaningful impact. When patients say that they buy ultraprocessed foods and snacks not for themselves but for their family members, then in all likelihood, they are eating them too. My pitch to them is that poison is poison for everyone –– their bodies just don’t know it yet.
To put it simply, when it comes to food, 1) keep the ultraprocessed food out of sight, 2) learn to de-stress (it is astounding that how in this society we forget to slow down and relax, and 3) remember it takes a village to live a healthy life.
It's not uncommon when patients share that at times the food noise does become distracting enough that they can’t focus on work or live a life. In that scenario, discussion usually revolves around trying to tune it down with protein and plant-based, portion-controlled, fresh, and not processed options – such that if they are to have food within their visual fields most of the time, then let’s surround them with these options. The human body is resilient. It will adapt, but it needs to be readapted before irreversible damage sets in. Small steps, big impact.
The food industry is there to make a profit. It is upon us, health care professionals, patients, families, and all consumers, to send a message that the current food climate needs a transformative overhaul.
Food noise doesn’t have to be our background music. Maybe it’s time we changed the station.
What has been your experience with “food noise”? Share in the comments.
Dr. Ameer Khowaja is an endocrinologist based in San Antonio, TX. In addition to his clinical practice, he enjoys participating in population research, teaching internal medicine residents, community volunteer work, reading, writing, and spending time with his family. Dr. Khowaja was a 2024–2025 Doximity Op-Med Fellow.
Illustration by Jennifer Bogartz
