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A series of three new research papers, published in The Lancet, describe how the overconsumption of ultra-processed foods has created an ‘urgent health challenge’ and call on the food industry and governments to facilitate a shift toward healthier diets. FoodBev heard from the experts this week to delve into this call for action, and what it could mean for the sector and consumers.

The series of papers, authored by 43 global experts, highlight the health risks associated with diets high in ultra-processed foods (UPFs) – with high-UPF diets shown to be on the rise around the globe.

UPFs are categorised by the authors as food products made from inexpensive industrial ingredients, designed and marketed with the intention of cutting production costs and maximising corporate profits. This typically includes foods made with additives such as artificial dyes, sweeteners and emulsifiers, as well as hydrogenated oils and protein isolates.

The term UPF was first coined by Carlos Monteiro, professor emeritus of food nutrition and public health at the University of Sao Paulo in Brazil. Monteiro co-authored the new papers and developed the Nova system (a framework used to determine a food’s level of processing).

Paper one: The rise of the high-UPF diet

In the first paper, the researchers review the scientific evidence on UPFs and their impact on health, highlighting how these foods are ‘displacing long-established dietary patterns and worsening diet quality’.

The paper outlines the health impact associated with diets that primarily consist of UPFs. It shows how a systematic review, encompassing 104 long-term studies, found 92 reported greater risks of one or more chronic diseases. Meta-analyses showed significant associations for 12 health conditions, including obesity, diabetes, cardiovascular disease, depression and early death from all causes.

It also points to national surveys indicating that the portion of UPFs in diets is rising significantly worldwide. The estimated share of UPFs in household food purchasing or daily food intake tripled in Spain (from 11% to 32%) and more than doubled in China (4% to 10%) in the past three decades. It also increased from 10% to 23% in Mexico and Brazil over the past four decades, while in the UK and US, it increased slightly to maintain levels already above 50%.

Paper two: Developing coordinated policy

The second paper in the series focuses on developing coordinated policies to regulate and reduce UPF production, marketing and consumption.

To complement existing legislation that currently focuses on reducing foods high in fat, salt and sugar (HFSS), the authors believe specific UPF policies should be introduced – with the response varying across different regions globally depending on the context and each country’s unique situation.

Measures proposed by the research team include mandatory front-of-package labels highlighting ingredients that are typical markers of UPFs – such as synthetic colours, flavours and sweeteners – alongside HFSS labelling.

They also propose stronger marketing restrictions, on digital media and at brand level, as well as banning UPFs in public institutions like schools and hospitals.

Alongside the regulation of UPFs, the authors emphasise that policies must expand access to fresh foods to ensure that minimally processed foods are accessible and affordable. They suggest taxing certain UPFs to fund fresh food subsidies for low-income households.

Paper three: The ‘political playbook’ of UPF producers

In the third and final paper, the authors state that global food corporations are driving the rise in UPFs, calling for an urgent global health response – and for the big food players to change their tactics.

The paper highlights how, with global annual sales of $1.9 trillion, UPFs are the most profitable food category – with UPF manufacturers accounting for over half of $2.9 trillion in shareholder payouts by all publicly listed food companies since 1962.

The paper names the eight largest trans-national UPF manufacturers, all headquartered in America and Western Europe: Nestlé, PepsiCo, Unilever, Coca-Cola, Danone, Fomento Económico Mexicano (FEMSA), Mondelēz International and Kraft Heinz.

UPF companies employ ‘sophisticated tactics’ to protect profits, the authors state – such as blocking regulations, shaping scientific debates and influencing public opinion.

In order to tackle rising UPF consumption, the authors call for a public health response to ‘protect policymaking from industry interference, end industry ties with healthcare professionals and organisations, and build a global UPFs action advocacy network’.

They make comparisons to the tobacco industry, suggesting a similarly significant global response should be implemented to curb the power of the largest UPF-producing multinational corporations.

Key points from the authors

Reformulation is not a silver bullet

Over the last decade, reformulation has been a crucial component of the global food and beverage industry’s efforts to improve public health and curb dietary-related diseases, such as type 2 diabetes and cardiovascular disease.

This began with moves to reduce saturated fat, salt and sugar in line with tightening regulations, such as the sugar tax and the HFSS legislation in the UK.

But with growing awareness of UPFs and the potential health impacts of synthetic additives, the focus has recently shifted to reformulating for ‘cleaner labels’ more broadly – formulations made with ingredients perceived as more natural, as well as with reduced sugar, salt and fat.

A focus on artificial colours has been particularly prominent in the US in the last year, amid the Trump administration’s push to phase out petroleum-based dyes from the national food supply. This has led food giants including Kraft Heinz, General Mills, Hershey and Kellogg’s to announce reformulation plans, set to replace artificial colours across their portfolios with natural alternatives.

However, despite such initiatives, co-author Camila Corvalan – professor of the public nutrition unit at the University of Chile – believes reformulation is not the answer to the UPF problem.

“It’s just part of the solution,” she told reporters in a press briefing this week. “For instance, if you take Coca-Cola – you would have difficulty trying to reformulate Coca-Cola to make it non-ultra-processed. There are some UPFs that cannot be reformulated.”

“We would like, in the paper, to highlight that this is not a food-centred issue. This is really a dietary pattern transformation in which we have promoted the consumption of UPFs, displacing the consumption of minimally processed foods and fresh meals.”

Chris van Tulleken, professor of infection and global health at UCL and author of the book Ultra Processed People, commented: “I would suggest in some countries, we have a three-decade history of reformulation by the food industry. We took the fat out first, then we took the sugar out. We replaced the sugar with the sweeteners, the fats with gums. These products have been extensively reformulated and we have seen obesity – particularly obesity in childhood and other rates of diet-related disease – persistently go up in line with reformulation.”

He added: “This is not a product-level discussion…As long as you’re reformulating, if your purpose is still profit, you’re unlikely to cause positive health outcomes.”

Holding major players accountable

The authors argue that to combat the problem, the food industry needs to rebalance the power currently held by the world’s largest producers of UPFs and coordinate a policy response independent of their influence.

Author Phillip Baker, from the University of Sydney’s School of Public Health, discussed the power imbalance: “The higher profitability of ultra-processed food corporations, relative to other types of food producers, provides these corporations with surplus resources that they can use to continue to expand and grow,” he said. “It also encourages investment in these corporations.”

“Higher profitability translates into very large marketing budgets, much larger than other types of food producers, and much larger than even governments have available to promote healthy food. More resources also translate into more political influence, because these companies can fund lobbyists, front groups and lawyers to do the litigation. And they can invest a lot into corporate social responsibility and public relations, conveying a favourable image. The result is that UPFs are spreading everywhere around the world.”

The third paper from the authors makes recommendations for UN agencies to develop technical guidance and a policy framework for governments and advocacy groups, highlighting examples of successful policies in Latin American countries.

Corvalan said: “Our colleagues from Mexico have not only marked foods based on the nutrients, but also added warnings for caffeine, for non-nutritive sweeteners. And in Colombia, they are taxing some of these ultra-processed food categories…[Policy] also needs to include the provision of minimally processed and fresh meals to vulnerable populations, and [an] example is Brazil, who have been doing this in their procurement programme.”

One size does not fit all

Though the authors are clear on their stance – that we need more regulation around UPFs, more responsibility placed on large corporations, and more minimally processed food made accessible and affordable – they acknowledge that the situation is nuanced and will vary depending on the context in each region around the world. They also acknowledge the validity of various scientific critiques of the Nova system and UPF definition – including the existence of sub-groups with different nutritional values.

Speaking to FoodBev during the press briefing, Monteiro addressed this point by discussing the example of meat alternatives like veggie burgers and sausages.

This is one sub-group that, according to the Nova system, is typically defined as UPF due to the common presence of additives such as emulsifiers, oils, stabilisers and thickeners, flavourings and highly processed proteins. Though often containing additives, these products often offer a more balanced nutritional profile than their processed meat counterparts – they provide fibre, don’t contain cholesterol and often contain lower amounts of saturated fat.

Monteiro noted that plant-based burgers, for example, correspond to less than 1% of total energy intake in the UK. And in the UK, they can help reduce red meat consumption, which is important for the environment too.

“So, if you start to have a tax policy here on UPFs in the UK, I wouldn’t tax these plant-based burgers, because they are irrelevant and maybe they have some positive value. But this is what each country has to define.”

Speaking about this tailored approach, Corvalan said: “Probably in some countries, such as the UK, Canada and the US…the taxes, for example, would have to be targeted at some specific categories first. At the same time, other policies at other levels will [need to] promote the access, affordability and convenience of minimally processed foods for vulnerable populations. What we are calling for in this series is not to abandon vulnerable people…We need governments to take responsibility for this by acting and promoting actions that will ensure those foods are convenient.”

The authors also addressed fortification, with some critics of the Nova system having raised the point that adding certain nutrients, vitamins and minerals to a food product could mean it is classed as a UPF, despite the fortification being done for health benefit.

Van Tulleken said: “We take no position against food fortification more broadly, which is a public health solution used by many governments around the world, [such as] fortification of flour with folate or the addition of iodine to salt. Nova is not against this. But that's much different to putting micronutrients into ultra-processed foods…to create [health] claims.”

He also pointed to a lack of understanding of the Nova system and what constitutes a UPF under the framework.

“Nova is not against food processing. The first three groups of Nova – minimally processed foods, culinary ingredients and processed foods – are still processed in some particular way,” van Tulleken continued. “Food processing is essential to the provisioning of healthy and sustainable diets. And we know this because…we've researched these diets and we know they're healthy. The Mediterranean diet, for example, combines some minimally processed foods, some culinary ingredients and some processed foods.”

“Food processing contributes to not just to healthy diets, it also contributes to food culture, to cuisines and culinary, to gastronomy. It also provides a critical role in the economy, providing jobs and supporting people's livelihoods. Where Nova differentiates UPFs is that these are foods produced for the purpose of profitability, for selling more food. And they do this by minimising the cost of producing the food…. They use cheap commodity ingredients, they use processing technologies, and they use additives to reduce the cost of production. They add the cosmetic additives to make these foods hyperpalatable, to drive repeat consumption.”

Mathilde Touvier, head of the nutritional epidemiology research team at the French National Institute for Health and Medical Research (Inserm), concluded: “While healthy debate about UPFs within the scientific community is welcomed, this should be distinguished from attempts by vested interests to undermine the current evidence. The growing body of research suggests diets high in ultra-processed foods are harming health globally, and justifies the need for policy action.”