As Ozempic, Wegovy and other medications that have gone viral for their ability to induce weight loss continue to spark conversation on social media, another side effect has come to light — the absence of "food noise."
On TikTok, the hashtag #foodnoise has garnered 10.6 million views, and the search term "what is food noise" has accrued over 2 million. Users who say they're on Ozempic or similar medications (that release synthetic hormones that mimic the effect of eating) are sharing how their days used to be riddled with intrusive thoughts about food. But since starting treatment, they find it easier to think about other things.
Both Dr. Ania Jastreboff, associate professor at Yale School of Medicine and obesity medicine physician-scientist, and Dr. W. Scott Butsch, director of Obesity Medicine with Cleveland Clinic’s Bariatric & Metabolic Institute, tell TODAY.com they've worked with patients who've reported a silencing of "food noise" after taking such medications. (Jastreboff is on the scientific advisory board for Novo Nordisk, which makes Ozempic and Wegovy, and is in charge of a semaglutide clinical trial at Yale funded by Novo Nordisk.)
Shea Murray, who has Type 2 diabetes and uses they/them pronouns, took Ozempic for two and half months in 2022 before going off it because of a change to their insurance. Ozempic is approved by the U.S. Food and Drug Administration to treat Type 2 diabetes, and Wegovy is approved for obesity, but they both contain the same active ingredient, semaglutide.
Murray tells TODAY.com they first noticed Ozempic was affecting their brain when, one afternoon, their cell phone alarm went off, signaling it was time to pick up their son from school, and they realized hadn't eaten lunch because it hadn't occurred to them.
Before they started Ozempic, "it's not like I was food-obsessed," Murray recalls. But they did experience food noise when their mind would wander to what they'd have for lunch while eating breakfast or they'd crave "just something to chew on" while working.
Taking the medication at first led to just subtle changes in their thoughts, until, after a few doses, they observed that "food didn't even come to mind," Murray, 48, of Matawan, New Jersey, says.
And when Murray did eat, for the first time in their memory, they had no interest in food once they felt full. "It was very easy to put your fork down and push the rest of it away because suddenly it was like you had a plate full of dirt," they explain.
"Even if like you like the taste of Doritos, once you've hit a limit, the taste does not bring you pleasure," they add.
Murray also says they felt more productive when taking Ozempic, a once-weekly injection: "I had a lot of time for other things. I didn't realize how much of my life centered around thinking about food."
But stopping Ozempic last August meant their food noise — a mental back-and-forth over what, how much and when to eat — returned. While Murray hasn't regained the 13 pounds on the drug, they say they've "been fighting tooth and nail" with themselves to maintain the diet changes that Ozempic kickstarted.
The guilt after snacking slip-ups, as well as the stress of not feeling in total control of their food choices — for Murray, it all came back.
Ozempic on the rise
Prescriptions for the blockbuster diabetes drug — a major side effect of which is weight loss — have skyrocketed recently. Prescription cost savings site SingleCare estimates filled prescriptions for Ozempic increased 251% between 2021 and 2022. Health care data and technology company Komodo Health reported that, over the past four years, prescriptions for Ozempic and Mounjaro (another diabetes medication that causes weight loss) have gone up 2,082%. Ozempic was first approved by the FDA in 2017, and Mounjaro was approved in May 2022.
The effects of Ozempic and Wegovy on patients' appearances are well-documented. According to Novo Nordisk, which manufactures both medications, Ozempic leads to an average weight loss of 9.3 to 14.1 pounds. The substantial and rapid weight loss that the drug may cause can also alter face shape, some patients and doctors have observed, a phenomenon dubbed Ozempic face.
But semaglutide can also impact thoughts about food, aka "food noise," and mental health, patients and doctors tell TODAY.com.
Ozempic works by producing a synthetic version of the hormone GLP-1, which is released into the intestine and pancreas during eating. When semaglutide hits GLP-1 receptors in the brain, it mimics the effect of eating so you have less appetite and feel full sooner. The drug also stimulates insulin production and slows down stomach emptying, keeping you full for longer.
The catch? To continue to get these effects, you need to keep taking Ozempic. Studies show that people who stop taking semaglutide regain about two-thirds of what they lost. Current data show semaglutide is safe to take long-term, experts previously told TODAY.com.
Not all patients respond to Ozempic, and many experience uncomfortable side effects, Butsch. says. He stresses that doctors should address this with patients in the very first appointment.
While many people are taking Ozempic off-label for weight loss, Novo Nordisk told NBC News in a statement that it doesn't promote, suggest or encourage off-label use of Ozempic, and that it hasn't studied weight changes after stopping Ozempic, as it's only FDA-approved as a diabetes drug.
How Ozempic quiets 'food noise' in the brain
Jastreboff explains that "food noise" exists usually because "somebody is trying to lose weight, but the mechanisms (causing them to have obesity or be overweight) aren't being targeted."
But, she says, semaglutide is able to target these mechanisms, and its effects start in the brain.
When the body releases GLP-1 when we eat, it activates neurons in the brain called POMC CART neurons, which, when activated, decrease food intake and increase energy expenditure, Jastreboff explains. GLP-1 also indirectly inhibits AgRP neurons, which, when activated, increase food intake and decrease energy expenditure. Ozempic releases synthetic GLP-1 in the body, so it triggers these neurons to reduce food intake.
POMC CART and AgRP neurons are located in the hypothalamus, which controls hunger and satiety, or feeling full. But, Jastreboff says, semaglutide may also affect the other parts of the brain that control eating for pleasure and executive function, as all three of these brain regions affect food intake.
It's in this way that semaglutide and Ozempic address the disease mechanism — or the cause of a disease down to the molecular level — of obesity or being overweight.
For example, someone who has obesity and is trying to control their weight by eating less might tell themselves, "I've eaten X amount, and that's enough," Jastreboff says, but overnight they may wake up hungry. For people who respond to semaglutide, the body resets how much fat it wants to carry, and feeling hungry is less common.
"With obesity, we cannot expect our patients to control every morsel of food they eat for the rest of their lives. It would be akin to asking someone who has diabetes to concentrate really hard to make their blood sugar normal," she adds. "Patients who have obesity spend so much of their mental energy ... anticipating and planning (around food), so taking medications that actually target disease mechanisms enables them to devote (space) to other things."
Butsch explains that for a long time obesity treatments have focused on patients changing their behavior and placed blame on them. But now, more doctors realize that eating behaviors can be tied to a patient's physiology.
"We're understanding to a larger degree ... there's communication between the gut and the brain so powerful that some of these behaviors are hardwired," he explains.
For individuals who've been preoccupied with food noise, taking semaglutide can cause "a light switch going off, where all of a sudden they have some freedom in their brain and relief from constant signals around food," Butsch adds.
Ozempic patients on 'food noise' and mental health
Michael Pearson, 30, of Phoenix, Arizona, noticed his relationship with food shift after starting semaglutide for his prediabetes. He takes Rybelsus, also made by Novo Nordisk, but it's taken orally. The drug isn't covered by his insurance since it's approved for Type 2 diabetes, so he took samples from his doctor and then switched to paying out of pocket. After a month, he lost 7 pounds.
Before Rybelsus, "I would eat so fast. ... I was eating like somebody who hasn't eaten for days, but I just had my last meal a couple hours before," Person tells TODAY.com. "I never really understood why I was so ravenous every single meal, and it's helped temper that bit of desperation I feel when it comes to eating."
He still "desperately" craves candy bars and the like, but, more than anything else he's tried to lose weight, semaglutide helps him stop and think, "I should probably go eat something that's more nutritious ... so that's been very positive," he says.
That "desperation mindset" toward food, as Pearson calls it, has made him struggle to focus in the past. But now, he has less food noise and prepares more simple meals for himself, his wife and daughter. He feels he's lost some, but not all, enjoyment from eating because he doesn't anticipate and look forward to meals as much.
"I have more self-control," Pearson says. "The feelings I had in the past, I don’t hate myself for it. I understand I was just listening to what my body was telling me, but for whatever reason, my body has been misunderstanding how much food I actually need."
His goal for the medication is to leave his "vicious cycle" with food and lose enough weight so he can exercise without hurting himself, especially his joints, he says. But since he's paying out of pocket, he might not be able to spring for another three-month supply. He's worried his intrusive, self-hating thoughts about food will return.
"It's scary to think about where that would put me," Pearson says.
Danielle Baker, 34, of Beaufort, South Carolina, took Ozempic for three months in 2021. She was prescribed it after years of being overweight and struggling with chronic health problems, including thyroid disease and rheumatoid arthritis. At one point, because of her weight, it was painful for her to walk from her car to her house.
Ozempic did eliminate her food noise and cravings, helping her lose between 5 and 10 pounds, but she says it did so by making her nauseous constantly. She didn't vomit but tells TODAY.com she felt "just kind of green from the minute I woke up to the minute I went to bed."
Nausea is the most common side effect of Ozempic, followed by vomiting, diarrhea and abdominal pain, per clinical trial data.
"While the primary goal was weight loss, it was (also) to do it in a way that felt healthy," Baker says. "There was this constant blanket over everything that I did, feeling a little more sick than I did before. It was definitely a letdown and discouraging, to say the least."
She says she would under-eat because of the nausea and wasn't able to meal prep healthy meals because she felt so ill. Then, she'd revert to unhealthy foods, which harmed her mental health. She and her provider decided she should stop the medication.
"My appetite came rushing back," Baker recalls, adding that she gave in because she was so exhausted mentally. "I felt overwhelmed by the food cravings. It was almost like my body was trying to compensate for the awful diet that I had on Ozempic."
"It was just kind of depressing," Baker continues. "There’s all these advertisements for ways to fix (your weight) and it’s easy, and I’m like, what am I missing? Because I’m trying and obviously I’m not successful. ... I definitely felt like it was a negative experience."
Baker has since had bariatric surgery, suffered no complications and lost 95 pounds.
For Wynter Mitchell-Rohrbaugh, taking Ozempic helped reduce her food noise. The Los Angeles-based 43-year-old tells TODAY.com she spent decades fixating on her body after coming of age in the ‘80s, when diet culture was everywhere.
More recently, she started to focus less on her weight and more on eating healthy and exercising, but when she started pursuing IVF, she says doctors would tell her she had to lose 35 to 40 pounds. She'd suffered multiple second-trimester pregnancy losses, which contributed to the weight, and was diagnosed with polycystic ovary syndrome as a teen, which made losing weight more complicated.
While searching for diet pills, Mitchell-Rohrbaugh found out about Ozempic, and her doctor said it was worth trying. Her approach was to go with what her body was telling her. She started losing weight, in part because she thought about food much less.
She says her experience taking Ozempic confirmed that, before starting the drug, "my body was doing what it wanted to do in spite of what I've been trying to do to help it, and there was just something that I couldn't control about that. ... This medicine helps you right that ship."
'Food noise' and going off Ozempic
The extent to which food noise and thoughts about food come back after stopping the medication depends on how much weight the patient lost on semaglutide, Jastreboff says.
"If they lost a significant amount of weight, then the hunger, the craving, the desire to eat ... definitely is very strong," she explains, adding that controlling cravings after stopping Ozempic "becomes that much more difficult because your biology is driving the increased food intake."
Butsch says that he's studying how often people on semaglutide experience decreased food noise, noting that feeling full faster and for longer and less hungry overall are the most common mental responses he sees. But he believes it's important for providers to talk to their patients about what may happen to their relationship to food when they stop the medication.
Since going off Ozempic in August, Murray has maintained the weight loss, despite the cravings returning, and wants people to know the medication isn't a "magic bullet," mentally or physically.
"You don't take it and then it fixes everything and you go on with your life," they stress. "You have to take that opportunity to make changes so if you do go off the drug, you can maintain those changes."