I was asked to write an editorial commenting on a study published a couple of weeks ago that looked at changes in weight among people participating in a comparison of ultra-processed vs. minimally processed diets.

The study: Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial. Nat Med (2025). https://doi.org/10.1038/s41591-025-03842-0.

The study has a long list of authors: Samuel J. Dicken, Friedrich C. Jassil, Adrian Brown, Monika Kalis, Chloe Stanley, Chaniqua Ranson, Tapiwa Ruwona, Sulmaaz Qamar, Caroline Buck, Ritwika Mallik, Nausheen Hamid, Jonathan M. Bird, Alanna Brown, Benjamin Norton, Claudia A. M. Gandini Wheeler-Kingshott, Mark Hamer, Chris van Tulleken, Kevin D. Hall, Abigail Fisher, Janine Makaronidis & Rachel L. Batterham .

It must have been a huge amount of work to conduct this trial.  I can’t even imagine.

The lead author, Sam Dicken, explained the trial and its results on X.

My editorial has just been published in Nature Medicine:  Ultra-processed diets promote excess calorie consumption (I have no idea why the editorial was not published at the same time as the study, but it is now out).

I fthought several things about the study to be especially interesting.

• Participants, all overweight or obese, lived at their homes while under study.
• They were fed ultra-processed meals for 8 weeks followed by minimally processed meals for 8 weeks, or vice versa.
• Both sets of meals were designed to meet British guidelines for healthy foods; the ultra-processed foods were all healthy.
• They were give about 4,000 calories a day and could eat as much as they wanted from that.
• Participants lost weight no matter which diet they were on.
• They lost twice as much weight on the minimally processed diet.
• They ate more calories on the ultra-processed diet in comparison to what they were eating on the minimally processed diet.

Here’s the summary from my editorial.

One of the co-authors on the study is Kevin Hall, who did a rigorously controlled clinical trial of ultra-processed v. minimally processed diets and reported participants to be unwittingly consuming 500 calories a day more on the ultra-processed.

His study has been criticized for being too short in duration: two weeks on each diet.

This study kept participants on one or the other diet for eight weeks, and got a smaller but similar result.

Dicken et al also addressed a frequent criticism of the concept of ultra-processed foods: that the category excludes healthy foods like whole wheat commercial bread, commercial yogurts, power bars, and the like.  That’s what these participants were fed when they were on the healthy ultra-processed diet.

Here’s how I concluded my editorial:

Overeating, overweight, and increased risks for chronic disease are rapidly increasing public health problems for global societies.  Dietary guidelines in the UK and the United States have had little effect on improving overall dietary intake. None of these guidelines considers the degree of processing; the findings from Dicken et al. suggest that they should.

Brazil’s dietary guidelines, issued in 2015, say “avoid ultra-processed foods.” Researchers in the United States have called for guidelines and regulatory approaches to reduce intake of ultra-processed foods.

Despite ongoing debates about their definition, classification, and effects on health, in the context of maintaining or losing weight the evidence points to a clear message: minimize intake of ultra-processed foods.

If nothing else, the study provided further evidence for this sensible dietary advice.

Dicken et al: press coverage

• New York Times
• The Guardian
• CNN  I’m quoted in this one

Here is yet another industry-funded study with a predictably favorable outcome, this one about a drink containing 6 grams of dietary fiber shown in this study to reduce blood glucose levels after consumption.

The study: Prebiotic soda lowers postprandial glucose compared to traditional soda pop: a randomized controlled trial.

Conclusion: a prebiotic soda is a favorable alternative to traditional soda formulations for managing postprandial blood glucose levels and maximal glucose excursion in generally healthy adults with overweight or obesity.

Competing interest statement: This study was funded by the manufacturer of the prebiotic soda beverage, OLIPOP, Inc. CFM, TB, EM, VK, and CC were employees of Biofortis, Inc., a Contract Research Organization that received funding from OLIPOP, Inc. to conduct the study. NV, MJM, and CM were employees of OLIPOP, Inc., the study sponsor company. AMV was a consultant of OLIPOP, Inc. for research support at the sponsor’s request.

Funding Statement: This study was funded by OLIPOP, Inc.

Comment: I particularly wanted to include this one because it is so blatantly done for commercial purposes, funded by the maker of the soda and conducted by employees or consultants. It belongs in the Journal of Industry-Funded Research, if such a thing existed.  Adding fiber to sodas to feed your microbiome?  I’d rather get mine from vegetables, grains, beans, nuts, and fruits.

The Global Health Advocacy Incubator has issued an action guide to legal advocacy.

As GHAI puts it,

GHAI has launched a new Legal Advocacy Action Guide to show how legal professionals can advance public health objectives by identifying the most feasible legal strategies, drafting robust laws and regulation and using strategic litigation to promote and protect public health policy. Download it here, or read our sponsored Devex article summarizing how legal strategies can help advocates draft stronger laws and hold health-harming industries accountable. The new legal guide complements our Advocacy Action Guide.

This is a how-to manual for lawyers and advocates about how to use the legal system of a country to promote public health.  It’s divided into the 4 sections shown on the cover: Analyze, Draft, Assess, Litigate.

Each of these discussions comes with international case studies.

Here is an excerpt from the litigate section.

This guide is really useful.  Use it!

I thought I should say something about the new state bans on using SNAP benefit cards to buy sodas and other kinds of junk foods.

More states ban soda and ‘junk food’ purchases from SNAP benefits: Varying restrictions add more confusion for food companies already struggling with slowing sales.

This article, from Food Dive, says

• Twelve states have now received approval to restrict benefits, with bans set to commence next year. The Department of Health and Human Services said the waivers aim to end the “subsidization of popular types of junk food.”

It points out that the bans vary in what they cover, and define candy and soft drinks in different ways.

Iowa, which has one of the most restrictive set of SNAP rules, is banning sugar-sweetened beverages that contain less than 50% juice, including sodas, energy drinks and flavored waters. The state is also restricting drink concentrates and powdered mix-ins.

The USDA has a web page devoted to SNAP Waivers (of existing rules governing what SNAP participants are allowed to buy).

Comment: I have long been in favor of pilot projects for banning sugar-sweetened beverages on SNAP (I was a member of the SNAP to Health Commission which issued a report in 2012.

Sodas are composed of sugars and water and have calories but no other redeeming nutritional value.

Even though we sympathized with the arguments that restrictions on purchases are condescending, we recommended pilot projects—along with research to evaluate them.  Would the bans change purchasing habits?  How would SNAP recipients feel about them?

It’s pretty clear how retailers feel about them.  Ouch.  Reduced sales.

The USDA turned down all requests for researchable pilot projects, ostensibly for logistical reasons.  Whatever.

Times have changed.

USDA’s SNAP waivers do not require research, unfortunately. I hope somebody in those states does some before-and-after data collection.

I worry that the waivers will be used as wedges to further cut SNAP benefits.

This one is a wait-and-see.  Stay tuned.

The big news in my world last week was the leaking of drafts of the forthcoming MAHA strategy report.

At least four reporters sent me copies for comments.

• Leaked version dated August 6 (highlighted to indicate food issues)
• Leaked version dated August 11 (no highlights)

I did not do a careful comparison.  The main difference seems to be that the earlier version had this useful graphic about MAHA’s strategic intentions.

All of this may change when the final report is released, but here are my initial thoughts on its food sections.

First, the background: The first report, despite the hallucinated references, was a strong indictment of this country’s neglect of the health of our children. It stated the problems eloquently. It promised that the second report would state policies to address those problems.

As for this report: No such luck.

It states intentions, but when it comes to policy, it has one strong, overall message: more research needed.

Regulate?  Not a chance, except for the long overdue closure of the GRAS loophole (which lets corporations decide for themselves whether chemical additives are safe).

Everything else is waffle words: explore, coordinate, partner, prioritize, develop, or work toward.”

One good thing: the report mentions marketing to children, but only to “explore development of industry guidelines.”  Nothing about regulation.  This is too little too late.  We know what food marketing does to kids.  It’s way past time to stop it.

A few comments on specific issues mentioned.

• “USDA will prioritize precision nutrition research…”  USDA?  NIH is already doing that, and it is the antithesis of public health research, the kind that really will make Americans healthier.
• The report emphasizes color and other chemical additives (we knew it would), a definition (not regulation) of ultra-processed foods, and a potential front-of-pack label (unspecified).
• It says it will modernize infant formula (really? how?), and will work to increase breastfeeding (again, how?).

And then there are the contradictions:

• Improve hospital food, but the administration is taking money away from hospitals.
• Teach doctors about nutrition (how?)
• Prioritize “whole healthy foods” in nutrition assistance programs (but cut SNAP and WIC)
• Expand EFNEP (but eliminate SNAP-ED)
• Promote healthy meals in child care settings (also defunded)
• Encourage grocery stores in low-income areas (how?)

How are they going to do this?  It doesn’t say.

Are there any teeth behind it?  It doesn’t look like this is anything more than voluntary (and we know how voluntary works with the food industry; it doesn’t).  None of this says how or has any teeth behind it.

And oh no!  MAHA boxes.  I’m guessing these are like what got given out—badly—during the pandemic. 

Resources

• Politico: it published the first leak.  Its current headline: “quite industry friendly”
• Stat News (I’m quoted): This covers the entire report and emphasizes the reneging on trying to reduce pesticides in response to industry lobbying
• New York Times (I’m quoted): also a much longer story emphasizing the pesticide problem
• Washington Post: also emphasizing ag issues
• CNN (I’m quoted): lots on processed foods, as well
• Civil Eats: Should Regenerative Farmers Pin Hopes on RFK Jr.’s MAHA?
• Center for Science in the Public Interest: 

It is striking that the leaked Make America Healthy Again (MAHA) Strategy Report, like its AI-assisted predecessor, embodies much of the idiosyncratic beliefs about food and drugs of one person: Robert F. Kennedy, Jr. He might be right about food dyes, but the report’s recommendations to alter our vaccine framework, restructure government agencies, and promote meat and whole milk are going to promote disease, not health…

The report…seems to twist itself into knots to make it clear that it will not be infringing upon food companies….But we also need to judge the administration by what it does, not what it says. And the administration’s attacks on SNAP, Medicaid, the health insurance exchanges, and the FDA and USDA workforces are poised to make America sicker, hungrier, and more at risk from unsafe food.

• John Oliver on the MAHA movement’s lack of genuine policy initiatives (I’m quoted!)  Do not miss this one.

Ultra-processed foods (UPFs) are a big issue in nutritiion these days, because we eat so much of them, observational studies link them to poor health, and controlled clinical trials show they cause people to eat more calories from them than from minimally processed foods.

The implication of current evidence is clear: avoid eating a lot of ultra-processed foods.

These, unfortunately, are among the most convenient, least expensive, and most profitable foods in supermarkets.

Consequently, they have triggered enormous pushback from:

• Big Food companies, which want you to eat more of their ultra-processed foods, not less
• Some nutrition scientists, who don’t like the idea of excluding the small number of ultra-processed foods that have better-than-average nutritional value
• Smaller “healthy” food companies making products that meet the definition of ultra-processed (industrially produced, full of additives, etc)

Phil Baker, an Australian scientist who is the lead author on a paper in a forthcoming Lancet series on ultra-processed foods (I’m a minor co-author on a couple of them), sent me this example of critics in the smaller “healthy” category.

The critics wrote in The Conversation: Ultra-processed foods might not be the real villain in our diets – here’s what our research found 

Some UPFs do deserve concern. They’re calorie dense, aggressively marketed and often sold in oversized portions. But they’re not a smoking gun.  Labelling entire categories of food as bad based purely on their processing misses the complexity of eating behaviour.

The study:  Food-level predictors of self-reported liking and hedonic overeating: Putting ultra-processed foods in context.  Appetite Volume 213, 1 September 2025, 108029

Conclusion: “This research demonstrates how nutritional characteristics of foods contribute to self-reported liking and hedonic overeating. Considering people’s beliefs about nutrient and sensory attributes can explain more than nutrients alone, and there are negligible additive contributions from CFR [carbohydrate to fat ratio] or UPFs on food reward.”

Funding: “This study was funded by Slimming World, UK, and the School of Psychology, University of Leeds.”

Comment: And what might Slimming World be?   Oh.  It’s a subscription meal plan.

Slimming World’s Food Optimising plan is a flexible, hunger-busting way to eat real food that fits in with every taste, lifestyle, family and budget – so it’s easy to stick to and even easier to enjoy. Based on tasty, healthy foods that everyone will love, Food Optimising helps slimmers cut calories without counting them, and get real results that last.

Of needing to avoid UPFs, Slimming World says

We also feel clear guidance on the difference between what constitutes a UPF and what is a processed food but can be consumed as part of a healthy, nutritionally balanced diet is essential, to avoid misinterpretation and confusion.

This company must make “healthy” UPF meals.  As we know from a recent clinical trial, people still eat more calories from UPFs, even when they are healthy (I will write about that trial as soon as Nature Medicine publishes my accompanying editorial).

In the meantime, I still think it’s a good idea to minimize intake of UPFs and eat minimally processed foods as much as possible.

My former NYU colleague, Corinna Hawkes, who now directs the Agrifood Systems and Food Safety Division at FAO in Rome, sent a link to its new publication, Transforming Food and Agriculture through a Systems Approach.

This publication provides an organizing framework for applying a systems approach to the transformation of food and agriculture. Building on evidence from systems science and practical real-world examples from countries, it identifies six core elements of a systems approach and specifies key practices and shifts needed to implement in practice. It includes examples from across the world of how systems-based practices are already being taken forward at different scales.

This publication is about food systems, why they matter, and how to use a food systems approach to improve food quality and access.

It is beautifully illustrated.  The definition:

And here’s how it works.

There is much more in this report.  I view it as a how-to manual. Use it!

Resources

• Download the publication: https://doi.org/10.4060/cd6071en
• Dr. Hawkes’ Tweet and Post about the report
• Register for briefing sessions: 12 September (11-12 CEST) or 15 September (15-16 CEST)

David Kessler, a physician, lawyer, and former FDA Commissioner, has done a great service for the Make America Healthy Again movement.  He has written a letter to RFK Jr presenting a Citizen’s Petition to the FDA: “Petition to Limit the Exposure of Refined
Carbohydrates used in Industrial Processing in order to Prevent Obesity, Diabetes, and Cardiovascular Disease in Children and Adults.”

His petition argues that processed refined carbohydrates should no longer be considered Generally Recognized As Safe (GRAS).

These are:

1) refined sweeteners, including corn syrup, corn solids, glucose syrups, dextrose, invert sugar, xylose, maltose, and high fructose corn syrups; and maltodextrin

2) refined flour and starches that are subjected to food extrusion technology, including wheat, corn, tapioca, oat and potato  flour, and starches that are processed by extraction or similar technology, and

3) sucrose, refined flours, or starches that are used with emulsifiers (e.g. mono- and diglycerides of fatty acids, DATEM, sodium stearoyl lactylate, polysorbates); dough conditioners and strengtheners (e.g. azodicarbonamide, L-cysteine, calcium peroxide); humectants (e.g. propylene glycol); stabilizers and gums (e.g. carboxymethylcellulose, methylcellulose); or modified starches and fillers (e.g. regelatinized starch, modified food starch, dextrins).

The carefully argued and lengthy petition makes a strong case for the unhealthy nature of processed refined carbohydrates.

Wow.

If the FDA agrees—and it has to deal with the petition within 180 days—these ingredients would no longer be GRAS and foods containing them would be considered adulterated and illegal to sell.

Here’s what I said to the press:

• This would cover an extraordinarily large percentage of foods that are ultraprocessed…an extraordinarily impressive document” (New York Times).
• Kessler has given the FDA a way to define the vast majority of ultra-processed foods. In doing so, he has handed RFK Jr a huge gift on the path to regulating these products. It’s just what MAHA has asked for. I hope they take it seriously (CNN).

Can’t wait to see how RFK Jr and the FDA handle this.