Currently browsing posts about: Ultraprocessed

I’ve been interviewed a lot lately about ultraprocessed foods.  See, for example:

• New York Times Well Challenge: Day 4: Grocery shop like a nutrition scientist
• New York Times 10 Ways to Eat Better 
• The New Yorker:  Why is the American Diet So Deadly?

And Gary Ruskin of US Right to Know sent me this collection of fact sheets.

• Overview: Ultra-processed foods tied to cancer, diabetes, dementia, depression, early death, and more
• Ultra-processed foods and early death
• Ultra-processed foods: increased risk of cancer
• Ultra-processed foods: obesity and weight gain
• Ultra-processed foods linked to increased risk of Type 2 diabetes
• Ultra-processed foods: increased risk of dementia, Alzheimer’s disease
• Ultra-processed foods: increased risk of depression and anxiety
• Ultra-processed foods increase risk of cardiovascular disease
• Some ultra-processed foods are as addictive as cigarettes and cocaine

I’m hearing an awful lot of fuss about difficulties defining ultra-processed foods and how some conditionally ultra-processed foods (e.g., whole wheat bread and yogurt) are healthy.  Maybe so, but the overall concept makes a lot of sense to me, especially with research demonstrating that ultra-processed foods encourage greater calorie intake.  That alone is reason to minimize intake.

How did a nice girl like me end up in New York Magazine’s MAHA issue?  I was amazed to find myself in this.

MAHA is the Trump Administration’s Make America Healthy Again campaign.

For the record: I’m totally for making America healthy, and especially for doing everything possible to reduce risks from chronic disease.  I’m for some of what RFK, Jr wants to do (reduce intake of ultra-processed foods, get toxins out of the food supply, reduce conflicts of interest) but by no means all.

Oh well, I didn’t want you to miss this. Enjoy (?).

The Dietary Guidelines Advisory Committee may not think there is much to ultra-processed foods (UPF), but companies making them have just been served with a lawuit.

I learned about this from a tweet (x) from Carlos Monteiro, the Brazilian public health professor who coined the UPF term.

CMonteiro_USP (@Carlos A. Monteiro) posted: A first-of-its-kind lawsuit against 11 UPF industries alleging they engineer their UPF products to be addictive with details on the actions taken to target children including internal memos, meetings & the research conducted to create addictive substances.

The lawsuit, filed by several law firms, is aimed at Big Food: Kraft, Mondelez, Post, Coca-Cola, PepsiCo, General Mills, Nestle, Kellanova, WK Kellogg, Mars, and Conagra.

The suit charges that these firms, through their deliberate marketing, are making people sick.

Due to Defendants’ conduct, Plaintiff regularly, frequently, and chronically ingested their UPF, which caused him to contract Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease Plaintiff is now suffering from these devastating diseases, and will continue to suffer for the rest of his life.

The suit makes interesting reading.

Some examples:

• Big Tobacco companies intentionally designed UPF to hack the physiological structures of our brains.  These formulation strategies were quickly adopted throughout the UPF industry, with the goal of driving consumption, and defendants’ profits, at all costs.
• The same MRI machines used by scientific researchers to study potential cures for addiction are used by UPF companies to engineer their products to be ever more addictive.
• Big Tobacco repurposed marketing strategies designed to sell cigarettes to children and minorities, and aggressively marketed UPF to these groups.
• The UPF industry now spends about $2 billion each year marketing UPF to children.
• UPF increase the risks of disease because they are ultra-processed, not because of how many grams of certain nutrients they contain or how much weight gain they cause. Therefore, even attempts to eat healthfully are undermined by the ultra-processed nature of UPF. One cannot evade the risks caused by UPF simply by selecting UPF with lower calories, fat, salt, sugar, carbohydrates, or other nutrients.
• The UPF industry is well aware of the harms they are causing and has known it for decades. But they continue to inflict massive harm on society in a reckless pursuit of profits.

Can’t wait to see what happens with this one.  Stay tuned.

Resources

Consumer Federation of America: “Ultra-processed Foods: Why They Matter and What to Do About It.”

With government officials reluctant to issue advice on ultra-processed foods (UPFs), Consumer Federation of America aims to raise awareness about research on UPFs, explain the leading theories of how they harm health, and build support for public policies to reduce harms from UPFs in our diet.

The report pushes back on arguments that researchers have not consistently defined UPFs, or that the categorization lacks scientific rigor. In fact, researchers have operationalized the “Nova classification” system behind UPFs in a largely consistent manner, defining foods based on whether they contain ingredients that are “industrial formulations” or “rarely used in home kitchens,” with little serious disagreement about which ingredients should be considered “ultra processed.” Consumers can take CFA’s online quiz to test their knowledge of which ingredients are markers of “ultra processing.”

New research: Trends in Adults’ Intake of Un-processed/Minimally Processed, and Ultra-processed foods at Home and Away from Home in the United States from 2003–2018.  J Nutr 2024, https://doi.org/10.1016/j.tjnut.2024.10.048.  The data show that 50% or more of calories are consumed from UPF at home, away from home, and by pretty much everyone.

New research: Hagerman CJ, Hong AE, Jennings E, Butryn ML. A Pilot Study of a Novel Dietary Intervention Targeting Ultra-Processed Food Intake. Obes Sci Pract. 2024 Dec 8;10(6):e70029. doi: 10.1002/osp4.70029.  Behavioral interventions to reduce UPF intake cut calories by about 600 calories per day.

My post summarizing the three studies demonstrating that diets high in UPF induce intake of an excess of 500, 800, and 1000 calories per day.

Two previous short-term studies demonstrated that if you eat a diet based largely on ultra-processed foods, you are likely to consume far more calories than you would eating less processed diets–and not notice that you are overeating.

The big question: why.

Study #1:  Hall K, et al.  Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake .  Cell Metabolism 2019; 30:67–77.

When study subjects ate the ultra-processed diet, they consumed 500 calories a day more than when they were eating the unprocessed diet.  This is a staggering difference.  They seemed to eat the ultra-processed diet faster.

Study #2: Hamano S, Sawada M, Aihara M, Sakurai Y, Sekine R, Usami S, Kubota N, Yamauchi T. Ultra-processed foods cause weight gain and increased energy intake associated with reduced chewing frequency: A randomized, open-label, crossover study. Diabetes Obes Metab. 2024 Nov;26(11):5431-5443. doi: 10.1111/dom.15922.

These investigators reported a difference of 813 calories.  They attributed it to less chewing.

Study #3 (as yet unpublished): Its results appeared as a Tweet (X) from Dr. Hall describing a presentation he gave at a meeting in London (Apparently, X is where science gets discussed these days).  The recording of the entire meeting is now available.  Dr Hall’s presentation begins at minute 38.

The latest result: a difference of 1000 calories a day!

Dr. Hall was kind enough to send me the slides from his presentation.

My translation:

• Blue bar: Minimally processed diet, low in energy density (calories per gram) and low in irresistably delicious (hyper-palatable) foods.
• Red bar: Ultra-processed diet high in energy density and high in hyper-palatable foods.

The big result: Difference between blue (unprocessed) and red (ultra-processed): 1000 calories a day.

• Purple bar: Ultra-processed high in energy density, low in hyper-palatable.
• Green bar: Ultra-processed low in energy density, low in hyper-palatable.

Difference between purple (high, low) and red: 200 calories a day.

Difference between green (low, low) and red: 630 calories a day.

Participants reported no differences in appetite or pleasantness of the meals on the various diets.  There also were no observable differences in eating rate.

Obviously, participants who ate more calories gained more weight.

Comment

My summary: We love and cannot stop eating yummy high-calorie foods.

All of this reminds me of the work of Barbara Rolls, who for years has argued for diets low in energy density, and whose low-energy-dense Volumetrics diet is consistently ranked at the top of diet plans.

It’s great to see all this research coming together.  Whatever the reasons—energy density, hyper-palatability, less chewing—the take-home-message seems utterly obvious: reduce intake of ultra-processed foods.

As Jerry Mande summarized the significance of this study, also in a Tweet (X) :

BREAKING..@KevinH_PhD  presents preliminary data from long awaited (6yrs!) follow-up study. Confirm initial findings. Energy dense, hyper-palatable UPF foods result in 1000 kcal/day greater intake than minimally processed food. Time to regulate UPF #MAHA

Indeed, yes.

Charlotte Bilekoff.  Real Food, Real Facts: Processed Food and the Politics of Knowledge.  University of California Press, 2024.  267 pages.

Food processing is a big issue these days (witness RFK Jr’s pledge to get ultra-processed foods out of school meals) and I was interested to see what food studies scholar Charlotte Biltekoff had to say about it.

Her thesis: When people say they want to eat “real food” rather than highly processed food, the food industry responds with “real facts,” science-based discussions of the benefits of food processing (“food scientism”).

The industry’s response is based on the idea that if you could only correct public ignorance and misperceptions, you could sell your products more easily.

But public concerns are about politics, not science.  And food scientism is a form of antipolitics.

She cites as an example, the FDA’s ongoing inability to define the term “natural.”

Concerned about health, sustainability, and risk and wanting change in the food system, the public sought to act on its values and aspirations in the marketplace.  Narrowly reframing those concerns as demands that could be met through product reformulations and new approaches to marketing—but without serious, systemic engagement with the broader issues they reflected—the food industry produced products that appeared to be more natural, less processed, and therefore better…articles in the industry press and comments to the FDA show that many perceived the consumers of “real food” as irrational and misinformed.  Seen through the lens of food scientism of the Real Facts frame, consumer perceptions of processing and what “natural” meant, or should mean, were further proof that the public lacked the skills and understanding to meaningfully participate in the regulatory processess, let alone act as knowledgeable participants in the governance of technology and the shaping of the food system. (p. 143)

What Biltekoff has done here is to translate the classic two-culture risk communication problem to food.

Her book made me go back and look at what I wrote about the two-culture problem in Safe Food: The Politics of Food Safety.  The book contrasts the differing perceptions of industry and the public about the potential harm of microbial foodborne illness versus GMOs.

These differences in approaching questions of risk were understood long before anyone invented the techniques for genetically modifying foods. In 1959, for example, the scientist and writer C. P. Snow characterized the ways in which people trained in science tend to think about the world—as opposed to those without such training—as representing two distinct cultures separated from one another by a “gulf of mutual incomprehension” [1]. Much more recently, the anthropologist Clifford Geertz wrote, “The ways in which we try to understand and deal with the physical world and those in which we try to understand and deal with the social one are not altogether the same. The methods of research, the aims of inquiry, and the standards of judgment all differ, and nothing but confusion, scorn, and accusation—relativism! Platonism! reductionism! verbalism!—results from failing to see this” [2].  [1. Snow CP. Two Cultures and the Scientific Revolution: The Rede Lecture. London: Cambridge University Press, 1959; 2. Geertz C. Empowering Aristotle (book review). Science 2001;293:53].

Science-based approaches to food safety, I pointed out, count cases and estimate costs, whereas what I called “value-based” approaches, are about feelings of dread and outrage.

Biltekoff’s analysis applies the two-culture framework to public responses to food processing and to the ways the food industry deals with those responses.

Her analysis explains much about the current pushback against the concept of ultra-processed foods from the food industry and some nutritionists.  If you want to understand why the Dietary Guidelines Advisory Committee has chosen not to recommend reducing intake of ulra-processed foods, read this book.

And, amazingly, the book is available as open source.  Read the book online here.

Read Charlotte Biltekoff’s interview with UC Press here.

Ashley N. Gearhardt, Kelly D. Brownell, Mark S. Gold, and Marc N. Potenza, editors.  Food & Addiction: A Comprehensive Handbook, Second Edition.  Oxford University Press, 2024.  570 pages.

This is the second edition of a book I wrote about in 2012.

At the time, I said:

Brownell and Gold have produced an instant classic.  Food and Addiction presents a comprehensive, authoritative, and compelling case for considering whether food is addictive.  Its chapters raise serious questions about our current laissez-faire attitude toward food marketing, especially to children.  This book is a must read for everyone who cares about the causes and consequences of obesity and the need for food policies that better promote health.  It is a game changer.  Readers will never look at food the same way again.

Much has happened since then to focus greater attention on the ways food triggers addictive-like eating behavior.

• Michael Moss’s books, Salt, Sugar, Fat, and Hooked.  These document how food companies deliberately formulate products to make them irresistible (“you can’t eat just one”).
• The emergence of the concept of ultra-processed foods as a researchable category.
• Kevin Hall et al’s demonstration that ultra-processed foods encourage people to eat more calories but not realize it.
• The increase in research using the Yale Food Addiction Scale, and
• The research described and reviewed in this book.

All of this makes an increasingly convincing case that the word “addiction” applies to food as well as to other addictive substances, and that similar proportions of people (10% to 15%) meet criteria for addiction; everyone eats, but not everyone meets those criteria.

The editors’ introductory and concluding chapters lay out the diagnostic and policy issues.

The short chapters address biological, behavioral, clinical, and legal correlates of food addiction.

They are written by a authors who address these issues from enormously different , but highly critical, perspectives ranging from the exceedingly personal to the big-picture political.

Is anything missing here?  As with any multi-authored book, this one undoubtedly took years to produce.  That makes it a few years out of date in fast-moving areas.  It does not cover recent research on ultra-processed foods, Kevin Hall’s experiment, the concept of food “noise,” or the way the new GLP-1 drugs might interact with addictive behavior.

But, this is the resource of food addiction, a great gift to the addiction-perplexed and an enormous public service at a time when it is badly needed.

The FDA has announced its 2025  Priority Deliverables for the Human Food Program.

These cover the microbial and chemical safety of foods, but I am especially interested in what the FDA is and is not doing about nutrition and chronic disease prevention—something mentioned by FDA Commissioner Robert Califf as a priority for American public health.

Based on FDA’s Nutrition Initiatives, the deliverables begin with:

FDA’s Role in Empowering Consumers to Build Nutritious Diets that Support Health and Wellness

Using a risk management approach, we focus our efforts in FY 2025 on labeling and other initiatives to help consumers make more informed choices about the food they eat, and, for those who rely on certain critical foods, such as infant formula, as their sole source of nutrition, we work to make sure those products are safe, properly labeled, and nutritionally sound.

As for the Human Food Program’s priority policy initiatives:

• Update FDA’s Nutrient Content Claim “Healthy”
• Propose Front-of-Package Nutrition Labeling:
• Support Reductions in Sodium in the Food Supply
• Increase the Resiliency of the U.S Infant Formula Market

The deliverables do mention diet-related chronic disease in the contexts of sodium and research.

• We will also collaborate with our federal partners and engage with key stakeholders to enhance sodium-related data sharing and learnings, as part of these efforts to help reduce diet-related chronic diseases and deaths associated with high sodium intake, such as hypertension and stroke.
• We will continue to collaborate with other federal agencies on developing and advancing a nutrition research agenda, including accelerating high-quality research to better understand the mechanisms between ultra-processed foods and poor health outcomes.

Despite Commissioner Califf’s statements, it looks like the Human Food Program is not particularly interested in chronic disease prevention or policy approaches to improving the environment of food choice.

Instead, its policies put the burden of responsibility on you as an individual to make healthier choices—not to find ways to counter the food industry’s marketing imperatives.

The FDA’s Human Food Program is all about empowering consumers.  Good luck with that.

Yes, the FDA is grossly underfunded and handicapped in what it can do, and yes, addressing environmental determinants of chronic disease would encounter opposition from vested interests.

But the FDA is an agency of the Public Health Service.  It needs to do better.

The Human Food Program should be taking the lead in addressing Commissioner Califf’s stated concerns

• The big issue is chronic disease, on which we are “doing terribly.”
• We have to deal with the marketing of ultra-processed foods designed to make you hungry for more.

These issues are consistent with the new administration’s Make America Healthy Again campaign.  Let’s hope that works.

The current Dietary Guidelines Advisory Committee has produced its draft recommendations.  These, as I discuss tomorrow, are mostly banal, much the same as all guidelines since 1980.

But this year there are two rather shocking exceptions, both having to do with what is not recommended.

Incredible non-recommendation #1.  Reduce the focus of the Dietary Guidelines on reduction of chronic disease risk.

What???  The entire purpose of the Dietary Guidelines is to reduce the risk of diet-related disease.  Chronic diseases—obesity, type-2 diabetes, heart disease, cancer, etc—are the leading causes of death and disability among U.S. adults.

Maybe this was a typo?  Surely this committee means to say “Recommend increasing the focus of the Dietary Guidelines on chronic disease risk reduction.

The current wording is a travesty.  I’m not the only one who thinks so.  See Jerry Mande’s Tweet (X).

Update: I gather the uproar over this did some good and the committee is changing the wording.

Incredible non-recommendation #2.  Say nothing about ultra-processed foods.

The committee made it clear that they were not going to say a word about ultra-processed foods.  At least not now.  Why not?

Scientific experts tasked with advising federal officials drafting the 2025-2030 Dietary Guidelines for Americans said the data were far too limited to draw conclusions…Ultra-processed foods don’t have a recognized definition or a robust body of scientific literature that has studied them, they said, so guidelines would be premature.

Another travesty.  An overwhelming body of observational research suggests harm from diets high in ultra-processed foods.  OK, these studies only demonstrate association, not causation.

But—not one, but two well-controlled clinical trials demonstrate that ultra-processed foods induce people to consume more calories than they would otherwise: 500 more in one trial and more than 800 in the second.  These are enormous differences.

Yes, it would be great to know why, exactly.  And yes, the definition of ultra-processed can be fuzzy with respect to a few—remarkably few—foods.

But what more do you need to know?  Isn’t this enough to tell people that if they want to keep caloric intake under control, a good way to do that would be to limit consumption of ultra-processed foods?

But this committee chose to ignore the controlled trials because they didn’t last long enough.

As I explain in that link, the committee’s hands are tied by having to make “science-based” recommendations.  But in nutrition, most of the science is observational, which is why those controlled trials, short in duration as they are, matter so much.

The committee needs to revisit this decision.  If the guidelines do not include a recommendation to limit intake of ultra-processed foods, they will be ignoring the science and will be behind the times.

Worse, the guidelines will not help Americans reduce their risks for chronic disease.

See: Stat News:  5 questions about the next U.S. dietary guidelines, and the ‘impossible restriction’ on them: Difficulty of nutrition research leaves problems like ultra-processed foods largely unaddressed. 

Tomorrow: the banality of the latest recommendations.