Currently browsing posts about: Ultraprocessed

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

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.

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.

The American Heart Association (AHA) has issued its long-awaited advisory on ultra-processed foods and heart health (and the CDC, just in time, says just about everyone consumes more than half their calories as UPFs).

The AHA advisory is complicated, somewhat schizophrenic in my view.

It says UPFs are bad for you but makes a big deal over how some UPFs are good for you.

It does not seem helpful to make a big fuss over the few UPF foods that are nutritious.

I say this for two reasons: The number of foods in that category is small, and a study of the effects of “healthy” UPFs still finds that people eat more calories from them than they would from minimally processed foods (I will write about this study when Nature Medicine publishes it and my accompanying editorial).

The key statement in the AHA report:

A small number of UPF products such as whole-wheat breads and unsweetened soy milk with emulsifiers can support nutrition security in low-income and low-access communities by offering convenient, affordable, and palatable options. However, the strong evidence linking HFSS {high fat, sugar, salt] UPFs to increased cardiovascular risk underscores the need for targeted policy interventions to regulate their availability, marketing, and accessibility in disproportionately affected communities.

The operative word here is “small.” This is a trivial issue, not worth fussing about.

Obviously the AHA committee thought so too.

Here is my translation of the report’s recommendations.

1. Replace most UPFs with real foods.
2. Enact policies to reduce UPFs, like front-of-package labels and taxation.
3. Increase research funding on UPFs and heart health.
4. Get the FDA to do a better job of assessing and regulating food additives.

I can’t argue with that.  Good job!

Resources

• The CNN article on this report (I’m quoted)
• The AHA press release
• The report’s supplemental tables

The California Assembly has passed a bipartisan bill banning harmful ultra-processed food in schools

California is one step closer to becoming the first state in the nation to ban unhealthy ultra-processed foods in public schools under bipartisan legislation approved today by the state Assembly. AB 1264, introduced by Assemblymember Jesse Gabriel, directs the California Office of Environmental Health Hazard Assessment (OEHHA) to define ultra-processed foods and identify particularly harmful ones to be phased out of schools by 2032. The legislation is co-sponsored by Consumer Reports and the Environmental Working Group.

Whether this will go any further remains to be seen.  The bill sets an ambitious agenda:

The bill defines ultra-processed foods as those that contain one or more certain functional ingredients, including colors, flavors, sweeteners, emulsifiers, and thickening agents. OEHHA would be required to identify ultra-processed foods considered particularly harmful based on whether peer-reviewed evidence has linked the substance to cancer, cardiovascular disease, metabolic disease, developmental harms, reproductive harms, obesity, Type 2 diabetes; whether the substance is hyper-palatable or may contribute to food addiction; and whether the food has been modified to be high in fat, sugar and salt.

I assume this has to go to the Senate and be signed by the governor, so at the moment this is still wishful thinking.

I hope it passes, not least because I can’t wait to find out how its authors think the state will go about identifying the specific foods blocked from schools.

In the meantime, it will be fun to watch the lobbying.

________________

Published this week!  Information is here.

The FDA is an agency within the Department of Health and Human Services, now headed by Robert F. Kennedy, Jr.  It is getting busy on carrying out Secretary Kennedy’s stated agenda.  It took four actions of interest last week.  Check out #3; it requires action.

I.  Approved Three Food Colors from Natural Sources

Since the HHS and FDA announcement last month during a press conference at HHS on petroleum-based food dyes, more U.S. food manufacturers have committed to removing them within the FDA’s set time frame of the end of next year.

“On April 22, I said the FDA would soon approve several new color additives and would accelerate our review of others. I’m pleased to report that promises made, have been promises kept,” said FDA Commissioner Martin A. Makary, M.D., M.P.H. “FDA staff have been moving quickly to expedite the publication of these decisions, underscoring our serious intent to transition away from petroleum-based dyes in the food supply and provide new colors from natural sources.”

FDA approved color additive petitions for:

• Galdieria extract blue, a blue color derived from the unicellular red algae Galdieria sulphuraria (by petition from Fermentalg).
• Butterfly pea flower extract, a blue color that can be used to achieve a range of shades including bright blues, intense purple, and natural greens (Sensient Colors LLC)
• Calcium phosphate, a white color approved for use in ready-to-eat chicken products, white candy melts, doughnut sugar, and sugar for coated candies (Innophos Inc).

II.  Announced top priorities for the Human Foods Program

FoodNavigator-USA report that Mark Hartman, who directs the new Office of Food Chemical Safety, Dietary Supplements, and Innovation, says the FDA soon will:

• Reveal how it will deal with the safety of chemicals in the food supply
• Create a new Office of Post Market Review to conduct risk reviews of chemical additives
• Increase transparency and stakeholder engagement in the review process
• Work through 70,000 comments on the FDA’s proposal for reviewing the safety of chemical additives
• Partner with the NIH to research how food additives affect children’s health
• Work with the food industry to phase out synthetic color additives
• Work through comments on sodium guidance
• Think about ways of addressing added sugars
• Identify ultra-processed foods as an “area of emerging study”

III.  Extended the comment period for front-of-package labeling until July 15

We are taking this action in response to requests to extend the comment period to allow interested parties additional time to submit comments. Comments should be submitted to Regulations.gov and identified with the docket number FDA-2024-N-2910.

Recall: This is what the Biden FDA proposed.  Here’s what I said about it (basically, we need something better).

Here’s a real opportunity.  If you want a front-of-package warning label like those in Latin America, here’s your chance to weigh in.

RFK Jr says he wants to Make America Healthy Again.  One way to do that is to discourage sales of food products high in saturated fat, sodium, and added sugars, but also discourage sales of ultra-processed foods.  Identifying foods as ultra-processed, on the basis of their chemical additives as well as their fat, sugar, and salt, would be an excellent step forward.

If you like the warning labels used in Latin American countries, send a note to the FDA Docket.  You have until July 15 to do that.

IV.  Announced a joint research initiative with NIH to address, among other unspecified questions,

• How and why can ultra-processed foods harm people’s health?
• How might certain food additives affect metabolic health and possibly contribute to chronic disease?
• What is the role of maternal and infant dietary exposures on health outcomes across the lifespan, including autoimmune diseases?

Comment

OK.  This represents action or proposed action.  My question: What will the FDA actually do?  I’m particularly interested in the joint NIH research initiative on ultra-processed foods.  Will NIH reverse its stance on Kevin Hall, whose research aimed to answer precisely that question?  I will be watching all this with much curiosity.

If you have any doubts about the value of the concept of ultra-processed, the breadth and extent of industry pushback against the idea is excellent evidence.  The concept is an existential threat to the processed food industry, and it is fighting back.  The Italian food industry is especially concerned because it also has the Nutri-Score front-of-pack labeling system to contend with; the letter grades on ultra-processed products tend to be C’s, D’s, and E’s—as bad as they come.

Here’s an example of the pushback.

The opinion piece: Visioli, F., Del Rio, D., Fogliano, V., Marangoni F, Ricci C, Poli A.  Ultra-processed foods and health: are we correctly interpreting the available evidence?. Eur J Clin Nutr 79, 177–180 (2025). https://doi.org/10.1038/s41430-024-01515-8

Competing interests: AP and FM are the Chairman and Scientific Director, respectively, of NFI—Nutrition Foundation of Italy, a non-profit organisation partially supported by Italian and non-Italian Food Companies. All other authors declare no conflict of interest associated with this publication.

Comment: The senior (last) author and one other run the Italian Nutrition Foundation, an organization sponsored by food companies, Italan and international.  This makes the Foundation an industry front group, pretending to be independent, but not.  Its job is to further the commercial interests of its corporate sponsors, which is what it is doing here.  It is using the tobacco industry playbook: cast doubt on the research, suggest alternatives, argue against regulation.  The foundation’s authors are joined by academic and government authors, who have their own, not necessarily commercial, reasons for unhappiness with the UPF concept, which focuses on degree of processing, not nutrient content.  Yes, nutrients matter, but there are better ways of getting them than through UPFs.

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.