Ultra Processed Foods: a global public-health threat?

A new three-paper Series published in The Lancet reviews evidence that ultra-processed foods are displacing fresh and minimally processed foods and meals, worsening diet quality, and are associated with an increased risk of multiple chronic diseases. 

Ultra-processed foods (UPFs), as defined by the Nova classification, are novel branded products made from inexpensive industrial ingredients such as hydrogenated oils, protein isolates or glucose/fructose syrup, and cosmetic food additives (e.g. dyes, artificial sweeteners, emulsifiers).

While most tomato products would not be classified as UPFs, some sauces, pizzas, ketchup are included in this category or eaten as part of meals which are largely classified as such.

According to the National Academy of Medecine in the USA, the fact that a product is a UPF should not dictate whether it is viewed as a healthy option. Stanford University professor Christopher Gardner explained that “a pasta dish with tomato sauce, defined as a UPF because it contains high fructose corn syrup, may be a healthier option than what is otherwise available. Foods categorized as UPFs but with healthy nutritional profiles will also likely be more affordable than organic or less processed options, allowing families and schools to make healthy choices within established budgets.” 

While UPFs account for only 10% of calorie intake in China, it is around 30% to 40% in many countries in Europe and up to 60% in the United States.

As part of his “Make America Healthy Again” campaign, Secretary of Health and Human Services, Robert F. Kennedy Jr., has often described UPFs as a major contributor to the country’s chronic-disease epidemic and federal agencies are working to develop a clearer definition of those while stressing that there are no plans to ban them across the board.

Studies from around the world show that consumption of these products is associated with an increase in certain chronic diseases such as cardiovascular disease and type 2 diabetes. Limiting consumption of these products is a public health challenge that requires coordinated policies and action at the international level, according to a The Lancet series of three articles written by 43 global experts. The authors present a roadmap for moving towards effective regulation and healthier, more accessible and affordable diets.

Evidence of the harmful effects of ultra-processed foods is mounting

The data examined in the first article in the series show that diets rich in ultra-processed foods are associated with overall overeating, poor nutritional quality (too much sugar and unhealthy fats, too little fibre and protein) and higher exposure to chemicals and additives that may be harmful to health. 

In addition, a systematic review of the scientific literature, covering 104 long-term studies, found that 92 of them reported a higher incidence of one or more chronic diseases associated with the consumption of ultra-processed foods, with meta-analyses showing significant associations for 12 health problems, including obesity, type 2 diabetes, cardiovascular disease, depression and premature mortality from all causes. 

According to Mathilde Touvier, Inserm research director in France, who contributed to the first article in the series: “More and more studies show that a diet rich in ultra-processed foods is harmful to health. While a debate on ultra-processed foods within the scientific community is welcome in order to strengthen the level of available evidence, particularly on the mechanisms and factors involved, it should be distinguished from attempts by special interest groups to discredit current scientific evidence and slow down public health policies.”

Policies to combat ultra-processed foods while improving access to healthy alternatives

The second article in the series presents solutions aimed at regulating and reducing the production, marketing and consumption of UFPs, in order to make manufacturers accountable for their role in promoting ultra-processed foods.

The article explains how improving nutrition globally requires specific policies to complement existing legislation to reduce the saturated fat, salt and added sugar content of foods. Although measures need to be put in place at the consumer level (labelling, education, recommendations), the main focus is on fundamentally transforming the ultra-processed food system. In terms of labelling, for example, this would involve indicating the ultra-processed nature of products so that consumers can easily identify them, as has been proposed and tested with an advanced version of the Nutri-Score that incorporates the dimension of ultra-processing.

The authors also propose stricter trade restrictions, particularly for advertising aimed at children, in digital media and at brand level, as well as a ban on ultra-processed foods in public institutions such as schools and hospitals, and restrictions on their sale and shelf space in supermarkets, as is already the case in several countries.

Associate Professor Gyorgy Scrinis, University of Melbourne, Australia, adds, “Importantly, policies must ensure that fresh and minimally processed foods are accessible and affordable – not just for those with time to cook, but for busy families and individuals who rely on convenient options. Only by combining stricter regulation on poor quality food products with realistic support for more nutritious choices can we truly promote better diets for all.”

A coordinated global response to combat the lobbying strategies of the ultra-processed food industry

The authors of the third and final article in the series explain the relationship between the strategies of the agri-food industry and the rise of ultra-processed food products: the use of cheap ingredients, industrial methods to reduce costs, intensive marketing and attractive designs to stimulate consumption. With annual global sales of USD 1.9 trillion, ultra-processed foods are the most profitable food sector.

The series examines the mechanisms that contribute to avoiding regulation, steering scientific research and influencing public opinion despite knowledge of the health impacts.

The authors call for a coordinated global public health response and argue that ‘there is now a need for a bold and coordinated global response to establish food systems that prioritise the health and well-being of populations.’

Professor Karen Hoffman, University of the Witwatersrand, South Africa, adds “Just as we confronted the tobacco industry decades ago, we need a bold, coordinated global response now to curb the overproportionate power of UPF corporations and build food systems that prioritise people’s health and wellbeing.”

While the articles have been widely cited in the general and specialised press since their publication, they have been criticised by many food industry groups and trade-associations, including FoodDrinkEurope which outlined the limitations of ‘ultra-processed food’ terminology while providing alternative solutions to meet our collective goals (see HERE).

Full articles at:  https://www.thelancet.com/series-do/ultra-processed-food  (free upon registration)
Summary infographics from The Lancet HERE

 Sources: The Lancet, Inserm, National Academy of Medecine, FoodDrinkEurope
All images from The Lancet article