CW: discussion of eating, processed food, weight, health outcomes

Five years ago, I wrote on this blog about then-new studies on ultra-processed foods. You can check it out here:

The newest processed food nutrition studies: more to chew on

What was the verdict? Ultra-processed food diets were associated with weight gain (compared with minimally processed food diets) as well as increased mortality risk.

Just FYI: ultra-processed foods are pretty much what you think they are. But here’s a definition from the NOVA classification system for foods:

[Ultra-processed foods are] ready-to-eat industrially formulated products that are “made mostly or entirely from substances derived from foods and additives, with little if any [minimally processed plant or animal] foods.

It’s now time for an update.

In a recent scientific advisory, the American Heart Association clarified the messaging around ultra-processed food (UPF) consumption. On the one hand, they advise us to:

• Reduce the intake of most UPFs, especially junk foods, and
• Replace most UPFs with healthier options such as vegetables, fruits, whole grains, beans, nuts, seeds, healthy oils, and lean proteins.

However, they also said this:

… not all UPFs are harmful. Certain whole grain breads, low-sugar yogurts, tomato sauces, and nut or bean-based spreads are of better diet quality, have been associated with improved health outcomes, and are affordable, allowing possible inclusion in diets. These food products should be monitored and reformulated if future data show harm to overall health.

The focus should be on cutting back the most harmful UPFs that are already high in unhealthy fats, added sugars, and salt while allowing a small number of select, affordable UPFs of better diet quality to be consumed as part of a healthy dietary pattern.

So what’s the more nuanced message here, and why does it seem like nutrition scientists are pulling their punches on processed foods? These are complicated questions. But, here’s my attempt as a first pass.

We know that a lot of people consume ultra-processed foods for a majority of their daily diets.

Recent data from the US Centers for Disease Control and Prevention (CDC) show that from 2021 to 2023, people in the US aged 1 year or older consumed an average of 55% of their calories from ultraprocessed foods. For youth aged 1 to 18 years, ultraprocessed foods made up about 62% of their diets.

Just telling people they’re eating a lot of junky food and to stop it forthwith isn’t an effective public health policy. Instead, we can focus on a few more specific strategies.

Not all food additives are created equal, or equally harmful, or equally regulated. Through a combination of closing some regulatory loopholes on “generally regarded as safe” food additives,, adding front-of-package nutrition labeling for foods, and focusing on specific foods and beverages, nutrition experts argue that a more incremental and nuanced approach holds more promise for improving the public’s health. For instance,

“When we’re shifting the 55% to 60% of calories from ultraprocessed foods,” [nutrition professor Maya Vadiveloo] said, “we really need to be reducing sugar-sweetened beverages, processed meat, candies, baked goods.”

Still, she noted the considerable challenges ahead. It’s difficult for people to make wholesale changes to eating behaviors, especially when there are barriers to accessing and affording more healthful foods. Plus, preparing whole foods often takes longer—time that many households may not have.

“We want people to make healthier choices most of the time, and we need to set up the food environment in a way that allows that, which involves changing so many different things, including the marketing of different foods; the cost of raw ingredients used to make different foods; the availability of adequate fruits and vegetables and whole grains and things that people need to consume more of; and the skills that they need to have to prepare them,” she said.

What does this mean?

Focusing on particular ultra-processed foods–paying more attention to them as individual consumers, community members, voters, and policymakers– can pay off in terms of incremental and sustainable changes in diet patterns, and hopefully public health in the long term.

Also, we need to work towards building a food environment with better access to good-for-us and yummy-tasting fruits, vegetables, whole grains and proteins, which includes pricing and easy consumability (I made up that word, but I mean not having to cook for five hours to make it edible).

How do nutrition experts and medical organizations propose to do this?

They don’t know exactly. But they think it’s important, and need our help. So I though I’d put this in bold letters too.

Personally, I love pictures to help illustrate complicated and often technical messaging. So in summary, even though we often eat like this::

We should apply principles of nuance to our eating, which will help, like this:

Sometimes a thousand words are better than pictures, eh?