How One Doctor Quiets Some of the City's Most Intrusive Noise;
An Interview with Dr. Thomas Moth M.D.
Earlier this morning as I grabbed my hat not knowing what odd weather this freaky-November NYC day had in store, I debated whether or not I had time to pick up breakfast. Scooped out, double toasted, wheat bagel with cream cheese, and a small black tea. Maybe this New Year's Eve I will resolve to be more economically breakfast savvy, but for now, I’ll enjoy the perfect crunch and gift-like wax paper wrap.
Some of you get this.
The subject of food popped up many more times throughout the day. At around 11, I went to find Sam who has been bringing delicious treats to the office, made by his wife who is stuck at home on maternity leave. Lunchtime deliberations landed with pizza. Just before my scheduled interview with Dr. Thomas Moth, I called a friend to sync up dinner plans, while fueling up with three chocolate kisses still in my jacket pocket from my lobby’s Halloween bowl.
It’s a wonder how this is the first time I have ever heard the term ‘food noise’.
On what turned out to be an abnormally cold NYC evening, I was happy to get the corner table at St. Ambrose Cafe in the lobby of Sotheby's, three blocks away from the Comprehensive Weight Control Center on York Avenue where Dr. Moth is an internist specializing in weight management and nutrition. While waiting and looking over the menu, I regretted asking the doctor to choose the place. Luckily I had plans to meet my friend for dinner, so I passed on the $36 spaghetti and opted for the fruit salad. Dr. Moth ordered a tea and cookie plate for himself, earnestly apologizing for being late. I smiled and thanked him for taking the time to meet me, but he still wanted to explain how he was late because he had been waiting to hear back from the surgeon who had performed a procedure on one of his patients who had not stopped hiccupping for 12 days post-surgery. I assumed that I heard him wrong and that it was some medical term that I was unfamiliar with. Surely he recognized my quizzical expression. “I know it’s very odd, one for the books.” Not to seem too unprofessional, I took a sip of water to cover up my smirk.
Dr. Moth is board-certified in Internal Medicine and Clinical Nutrition. He has been working in weight management and metabolic clinical research for over 20 years. Dr. Moth is everything that I had expected - youthful looking, middle-aged, patient, soft-spoken, and deliberately kind. I imagine that he assumed that a skinny, fit, young man like me would be pretty unfamiliar with the medical intricacies of weight loss and obesity. Full disclosure: I didn't realize just how little I knew.
Dr. Moth came by weight management easily, his dad was a gastroenterologist and ironically his mom’s law firm represented a few over-the-counter diet products in the 80s. His family growing up in NYC was very health conscious, sort of ahead of their time. He thinks that their health habits came from his mother who was raised in Europe where they ate everything fresh from the market every day. I grew up in Northern California so I get it. Dr. Moth recounts how several of his parents' friends' homes were filled with strange diet shakes and one friend's house always had the horrible smell of cabbage soup because his mom was a diet coach of sorts. During his residency in internal medicine, he saw many overweight patients struggling with high blood pressure, diabetes, and heart disease, and became very interested in the health risks of being obese. He speaks very highly of his mentor and colleague, Dr. Louis Aronne.
More than 65% of U.S. adults are considered overweight. According to the most recent Gallup poll, 55% of U.S. adults want to lose weight (three in five women, one in two men). Dr. Moth has agreed to talk with me about the popular weight loss drug Ozempic. Dr Moth’s office is on the Upper East Side which has been deemed as the zip code with the highest percentage of Ozempic prescriptions in the United States.
In 1948, the World Health Organization recognized obesity as a disease, but the medical community paid little attention. In the ‘90s matters of weight caught national attention, in 1998 The National Institute of Health proclaimed obesity a disease, and eventually, in 2013, the American Medical Association voted to acknowledge obesity as a disease inspiring prevention, destigmatization, and treatment efforts. It is important to note that Ozempic was approved in 2017 by the FDA to treat adults with type 2 diabetes, as the drug helps the pancreas make more insulin, and while it is not currently approved for weight loss, many physicians prescribe it to help their patients. The same ingredient semaglutide is approved for weight loss under the name Wegovy.
Dr. Moth happily recommends Ozempic to many of his patients and seems dismayed by the negativity he often hears about this extraordinary drug. “The mistake is thinking of obesity as a lifestyle choice, as opposed to a medical disease. If we think about weight or obesity, like we think about blood pressure or cholesterol, it'll be far healthier for everybody.” Dr. Moth seems impressed by the degree to which Ozempic reduces the ‘food noise’ that so many people who struggle with their weight share.
‘Food noise’ or internal obsessive chatter refers to obsessive or intrusive thoughts about food, which can affect people’s everyday lives. Dr. Moth explains how many of his patients walk around all day thinking about food. “They think about food all day – I want to have this, but I really shouldn't have it, they have this internal debate and noise in the background all day. This medication takes away that noise. And it's very freeing for them that they're not a slave to this all the time.” Food noise has a similar profile to the intrusive thoughts, urges, or mental images associated with OCD; they cause anxiety and provoke unhealthy compulsions. Ozempic helps quiet this noise.
The complex mechanism of food noise is associated with an imbalance in the communication between the brain and the gut. While the factors leading to food noise may be obvious to anyone observing a person stress eating or binging to fight off exhaustion, other factors including metabolic disease, certain medications, and genetics are also linked to food noise and obesity.
It is very hard to turn down the volume, especially in a culture where food is everywhere – in sports arenas, you no longer have to wait for a break to go to the food hall, theaters have a menu board of options, dashers will dash you a 5-course meal in under 30 minutes, there are coffee stations at the doctor’s office, and yesterday I saw my neighbor’s baby eating a full breakfast laid out on her stroller’s divided food tray fit with a suction cup holder. Food is everywhere! How much more evident is this problem than on a three-hour flight to Florida where I was offered several snacks and a choice between two different sandwiches? Even if we didn't generate our personal food noise soundtrack, there is a fortissimo accompaniment to living in our food-focused world.
Reducing the food noise is not as simple as turning the dial on your car radio or hitting the mute on the TV. Ozempic contains semaglutide which works the brain-gut pathways to effectively slow down digestion, increase the feeling of satiety, reduce food-focused thoughts, and act on dopamine pathways to make food less rewarding. Of course, when one stops the meds the noise and the weight return.
Dr. Moth’s enthusiasm for this miracle drug is contagious, but I had to ask – could a great drug like Ozempic have a bad outcome? Words like dangerous, abuse, addicts, ‘pill mills’, congressional hearings, class actions, depression, anorexia, and death all come to mind. How and where is Ozempic going, where are we heading with this? Should we learn to be OK with the uncomfortable noise and the tight jeans?
Dr. Moth thinks that the potential for abuse is overplayed. “I think that honestly, this medicine is under-prescribed, not over-prescribed. I think it's under-prescribed to the people who should be getting it. People who are really struggling with weight and health by virtue of their weight.” He assures me that he and any responsible doctor will only prescribe this medication where it is medically just to those meeting the published criteria of a body mass index over 30, or a body mass index over 27 with comorbidities like high blood pressure, high cholesterol, sleep apnea, or diabetes. His patients are monitored regularly to keep a close eye on how they're doing and to properly adjust the medication as necessary, discuss side effects, diet, and lifestyle. While Dr. Moth believes that the medication alone can be helpful, he prefers his patients to incorporate lifestyle changes for a better outcome. Dr. Moth explains that “Ozempic is associated with approximately 18% loss of body weight, and that if the prescribing criteria are properly considered there is no reason for people to get too thin.” Dr. Moth recognizes that treating patients in NYC means there are other obstacles to overcome. “New York is a very goal-oriented and aggressive kind of environment and Ozempic isn't like taking Tylenol, this is a prescription medication, and whoever's prescribing it has to use their head and their medical degree. Do no harm, right? It's part of being a doctor. And I take that seriously.”
What do you like to do when you’re not treating patients, educating the next generation of weight management doctors, staying current on treatments that seem to be advancing by the minute, parenting, keeping fit, or investigating unstoppable hiccups? Dr. Moth loves to cook! ‘Foodieweightdoc’ has a curious ring, I suggest. “My wife and I are both physicians and we try to stay close to home with our four young daughters so we don't eat out much,” Dr. Moth tells me. “Also, I do enjoy cooking, and except for my youngest daughter who pretty much hates everything, I have a great audience.” I asked Dr. Moth if he worries about his four daughters when it comes to body image, social media pressures, and the intensity of weight obsession among young women. I explained how I noticed a huge discrepancy in attitudes about weight in my family. I think that being a young woman in this country and for sure in this city is very hard when it comes to weight and appearance. As I brought up the recent viral post about the staggering difference in Instagram attention model Kendall Jenner, in a swimsuit received compared to Alyssa Carson, the youngest person in history to overcome all NASA’s aerospace tests, Dr. Moth nodded in agreement. He understands societal influence and has a front seat to the show. It's clear that Dr. Moth tries hard and cares a lot! “All I can do is educate my patients and set good examples for my family.”
I went into this interview skeptical about Ozempic but left realizing that while the drug can be dangerous if taken advantage of, the potential of the medication to help people who struggle with weight issues and are looking to mute their food noise is remarkable. As Dr. Moth noted between bites of his cookie, “Ozempic has been life-changing for many of my patients.”