ppoor students as they head off to college, ready to survive until Christmas on instant noodles and breakfast cereal. The first doctor to raise the health alarm over ultra-processed foods believes it’s time to put a tax on those noodles – and he’s even got ice cream in his sights.
Professor Carlos Augusto Monteiro says that the strength of the evidence of the problems that such foods cause for “most body systems” leaves “no doubt” that governments need to act now.
“Strong policies, as soon as possible” on ultra-processed foods (UPF) are needed to reduce chronic diseases in countries around the globe, says Monteiro. If we wait another 10 years to act, “this will be a tragedy, because this has a cost.”
His team at the University of São Paulo in Brazil was with the New food classification system, first proposed in 2009 and now widely adopted. It groups them by their level of processing, which ranges from category one – unprocessed or slightly processed foods, such as whole fruits and vegetables – to four: ultra-processed.
This category consists of food products that have been industrial manufacturedoften using artificial flavors, emulsifiers and colorings. They include alcoholic beverages and packaged snacks, and tend to be extremely tasty and high in calories, but relatively low in nutrients.
Critics say UPF is an ill-defined category and existing health policies, such as those aimed at reducing sugar and salt consumption, are sufficient to address the potential threat.
Monteiro agrees that some foods fall between “ultra-processed” and “processed,” which pose a problem for regulators.
“A healthy bread that has emulsifiers, that has added fiber – it’s ultra-processed, technically, by definition, but clearly it’s not the worst product,” he says.
“I think the solution is: forget the technical definition of ultra-processed foods and target all food groups that are most likely ultra-processed,” says Monteiro.
Products that are clearly UPF, he says, include reconstituted meat products, instant noodles and soft drinks. He adds: “If you take, for example, ice cream. Probably 99% of ice cream in the UK market is ultra-processed. And maybe you have 1% that is not, which is probably very expensive. So, if do you tax all ice creams?
The hard sell of ultra-processed foods in developing countries, and among the poorest communities in particular, is causing a crisis of non-communicable diseases, say the militants.
Earlier this year, Monteiro addressed the International Obesity Congress in São Paulo, where research was presented that showed the rapid increase in obesity rates in the country. Brazil is on course for 68% of adults to be overweight or obese by 2030, up from 62% today.
He asked multinational food companies that manufacture UPF to be treated like tobacco companies, obliged to display warnings on the front of their packages and subject to taxes and public health campaigns.
Monteiro says he was surprised by the amount – and consistency – of evidence accumulated over the past five years. He recently counted 70 cohort studies that followed large groups of people for long periods to look at the impact of diet on their health, and says that 62 found UPF are linked to health problems.
The studies are observational – they cannot prove without a doubt that UPF causes health problems – but, Monteiro points out, it was the same type of evidence that linked smoking and lung cancer.
“It is really strong, and not only with obesity or diabetes, but cardiovascular diseases, mental diseases, kidney, liver, gastrointestinal diseases. So we are talking about an exposure (to UPF) that damages most of the body’s systems “.
He believes it is time for a global convention on ultra-processed foods, comparable to that imposed on the tobacco industry: an international treaty aimed at curbing demand and supply that prevents tobacco companies from lobbying the UN and the World Health Organization, and sponsoring scientific conferences.
There are obvious differences, he says, between UPF and tobacco, not least because the relationship between diet and health is more complex than that between smoking and disease. But, he says, both “increase the risk of many serious diseases” and are “produced by huge transnational corporations that have immense power”.
What do these foods contain?
Ultra-processed ingredients include fruit juice concentrates, maltodextrin, dextrose, golden syrup, hydrogenated oils, soy protein isolates, gluten, “mechanically separated meats,” organic dried egg whites, and even rice and cornstarch. potato and corn fiber. Additives such as monosodium glutamate, colorants, thickeners and glazing agents are also ultra-processed.
Why does it matter?
Ultra-processed food contains higher levels of salt, sugar, fat and additives that are associated with obesity, cancer, type 2 diabetes and cardiovascular disease. They also tend to have lower levels of protein, zinc, magnesium, vitamins A, C, D, E, B12 and niacin needed for optimal child growth and development. It is also thought that other mechanisms are at play in UPF that are associated with worse health outcomes, including negative effects on the development of the intestinal microbiota.
By Anna Bawden
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Quick guide
What is ultra-processed food?
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Ultra-processed food involves extremely high levels of manufacturing to produce. It includes all formula milks, many commercially produced baby and toddler foods, fizzy and sweet drinks, fast food, snacks, biscuits and cakes, as well as mass breakfast breads and cereals, ready meals and desserts.
What do these foods contain?
Ultra-processed ingredients include fruit juice concentrates, maltodextrin, dextrose, golden syrup, hydrogenated oils, soy protein isolates, gluten, “mechanically separated meats,” organic dried egg whites, and even rice and cornstarch. potato and corn fiber. Additives such as monosodium glutamate, colorants, thickeners and glazing agents are also ultra-processed.
Why does it matter?
Ultra-processed food contains higher levels of salt, sugar, fat and additives that are associated with obesity, cancer, type 2 diabetes and cardiovascular disease. They also tend to have lower levels of protein, zinc, magnesium, vitamins A, C, D, E, B12 and niacin needed for optimal child growth and development. It is also thought that other mechanisms are at play in UPF that are associated with worse health outcomes, including negative effects on the development of the intestinal microbiota.
By Anna Bawden
The national dietary guidelines should tell people to avoid UPF as much as possible, says Monteiro, pointing out the evidence shows that even a diet of relatively high quality can be derailed by an increase in such foods.
“You lose protection,” he argues. “That means you can’t say, ‘Well, I’ve already eaten fruit and vegetables today, I can (drink) three cans of Coke’. No, you can’t.”
The policy changes should be followed by taxes and marketing restrictions, Monteiro adds. In Brazil, he recommended tax reforms leading to zero or low taxes on minimally processed foods and high taxes on UPF.
He takes issue with the idea that some ultra-processing can make foods healthier, arguing that reformulation too often just means making food more palatable, so consumers buy and eat more of it.
“UPF are manufactured to replace non-ultra-processed foods, so they are new products: new breads, new yogurts, new soups, new pizzas that replace traditional pizzas, traditional yogurts, traditional cheeses, traditional breads, etc.
They are made “extremely tasty, to really get to our brain very quickly and produce enormous pleasure.”
While flavored yogurt (an example of the UPF) is “better than a soft drink, of course – you get some calcium, you get some protein – and if you compare ultra-processed flavored yogurt with yogurt plan and fruit?”
Moreira has little time for the argument that the extra tax hits the poorest the hardest, since UPFs tend to be cheaper. This can be combated by targeted policies and social support, he says.
This could mean working to improve the supply of fresh fruit and vegetables in “food deserts” like Brazil’s slums, he says. But it is “ridiculous” to use this as “a reason not to promote healthy food or healthy diets”.
“No one is saying ultra-processed food should be banned,” he says, adding, “Don’t ban tobacco or alcohol.”
Countries find themselves in one of two situations, he says. In Western countries such as the United States, Great Britain, Australia and Canada, traditional food crops have been “destroyed” and UPF already constitutes the majority of the population’s energy intake (about 66% for teenagers in the UK), a figure that I believe is stabilizing.
In others, particularly “low- and middle-income countries,” UPF consumption is lower, but “increasing very rapidly.”
In less affluent countries, chronic diseases related to UPF can mean decades of suffering for patients, and health care costs “that are simply not affordable,” he says.
For himself, eating UPF is “an exception”. On a recent trip to Europe, he couldn’t find chocolate in a supermarket without emulsifiers or flavorings or colorings, he says, adding, “I bought what I found.”