Processing the News on Ultra-Processed Foods

Strawberry yogurt, potato chips, fortified water, soda, frozen meals, cookies, infant formula and sliced wheat bread.

What do these products have in common? According to a public health movement that’s sweeping the globe, they are all “ultra-processed.”[i] Some public health nutrition advocates are using this terminology to judge a food or beverage’s impact on health – arguing that it’s the processing aids and methods (versus nutrient composition) contributing to obesity and disease. What exactly makes a food “ultra-processed?” It’s complicated –  certain processes or ingredients that can’t be found in your grandmother’s kitchen intended to enhance the palatability and acceptability of foods (like carbonation or added whey protein, for example) land many common and even nutritious foods in this category, making it difficult to determine what foods meet this definition.[i]

We’ll tell you everything you need to know about this emerging trend, from the new policy realities it’s creating to why the food and beverage sector may need to rethink its approach to product reformulation, innovation and corporate social responsibility efforts.[i]^,[ii]

How Did We Get Here?

The notion of ultra-processed foods originated in Brazil in 2009, when Dr. Carlos Monteiro, Professor of Nutrition and Public Health at the University of Sao Paulo, Brazil, created the NOVA system.[iii] NOVA defines ultra-processed foods as “cheap industrial sources of energy and nutrients, plus additives, using a series of processes.”[i] Five years later, Brazil’s dietary guidelines adopted this idea, encouraging Brazilians to “avoid ultra-processed foods.”[iv] Since then, other countries like Uruguay, Canada and France have followed Brazil’s lead, with more to come. ^{[v],[vi],[vii],[viii]} Dietary guidelines recommendations like these lead to restrictions around ultra-processed foods and beverages through front-of-package warning labels, marketing restrictions and other policies.^{1, [ix],[x]} 

The science supporting recommendations to limit processed food consumption is still evolving and controversial. Studies in Brazil, Spain, New Zealand and the UK, largely observational in nature, have found associations between ultra-processed foods and obesity, metabolic syndrome, hypertension and cardiovascular disease.[i]  Very recently, the first randomized controlled trial on the subject was published by the U.S. National Institutes of Health (NIH)—it too found these foods may cause weight gain.[xi]^,[xii] Critics, however, have pointed out significant limitations in these studies, including small sample sizes, the inability to distinguish the effect of high caloric content versus that from processing, inconsistent definitions of processing and not controlling for affordability. Some contend the focus on processing is flawed because it fails to acknowledge the role processed foods can play to promote health and provide affordable, accessible and practical options.[xiii]^,[xiv]

5 Potential Impacts on the Global Food & Beverage Marketplace

1. “Ultra-processed” – but otherwise healthy – foods may be unfairly stigmatized, but today, consumer opinion is mixed. As food processing definitions gain ground, foods and beverages regarded as “ultra-processed,” but otherwise considered healthy – like wheat bread or peanut butter, by the U.S. Food and Drug Administration’s standards[xv]^,[xvi] – may be restricted or discouraged, potentially reducing consumer demand and sales. When we surveyed U.S. consumers in May 2019, most were unaware of the term “ultra-processed” and sentiment varied. Some consumers, males especially, perceived “ultra-processing” as a benefit. Intended behavior is also mixed – upon learning that a favorite food is “ultra-processed,” 39% of consumers reported they would reduce or completely stop eating that food while 34% wouldn’t change or would increase their consumption.[xvii]
   • Will public opinion on “ultra-processed” foods affect your brand? Develop communications strategies to educate consumers and key opinion leaders about processing and the role of processed foods in an overall healthy eating pattern.
2. Dietary guidelines that incorporate recommendations to limit consumption of processed foods may inform policy actions. Even though processing is not always an indicator of nutrition, it has been incorporated into dietary guidance. For example, the Pan American Health Organization (PAHO), a regional office of the World Health Organization, integrates processing into food and nutrition criteria that countries may choose to rely upon when implementing food and nutrition policies. Based on this advice, Brazil is now considering a proposal that would require processed and ultra-processed foods to use on-package warning labels.[i]^,[xviii]
   • Does your company have a presence across global markets? Educate policymakers about the difference between processing and nutrition, and monitor and contribute to regional and global dietary guidance development to anticipate changes and inform business strategies.
3. Industry nutrition strategies and reformulation targets may need to evolve. For some categories of foods and beverages, no amount of nutritional improvement (e.g., reducing sodium and sugar, adding calcium and fiber) will change a food’s processing categorization. For example, by NOVA’s definition, a sugar-sweetened beverage is considered an “ultra-processed” product, but a reformulated, sugar-free soda is also “ultra-processed” because of its use of low- and no-calorie sweeteners.[i]
   • Want to identify where to shift reformulation strategies? Conduct a portfolio audit to understand which products are currently defined as “ultra-processed” and what formulation or processing changes may shift its categorization, if any.
4. Encouraging consumers and manufacturers to focus on processing instead of nutrition has unclear implications for public health goals. Product reformulation, often achieved via processing innovations, has resulted in substantial improvements to the nutritional composition of the food supply. Many global food and beverage companies have introduced nutritious foods, such as nutrient-dense frozen meals, to consumers’ diets through reformulation or similar investments in science.[xix]
   • Are you working to improve the nutritional profile of your products? Demonstrate to key stakeholders how product reformulation has contributed to nutritional and dietary improvements, meeting global recommendations.
5. Labeling all processing as bad may conflict with evolving consumer tastes for nutritious and innovative products. Food and beverage processing reflects evolving demands. Products like sparkling water, ultra-filtered milk, low-calorie ice-cream, gluten-free bread, protein shakes, and plant-based foods are appealing because of food science and technology innovations.
   • Do you have in-demand products that may be considered “ultra-processed?” Identify how processing innovations support changing consumer expectations around nutrition and lifestyle benefits.

Bottom Line: While controversial, efforts to denigrate ultra-processed foods are gaining steam and changing the global public health landscape through communications and policy actions. The food and beverage sector should keep close watch on global developments and develop nutrition affairs strategies to productively contribute to the dialogue.

 

This post was written by FoodMinds’ Global Food & Nutrition Affairs team, in consultation with our sister agencies AXON and Hanover. Please email Sarah Levy ([email protected]) for more information.

 

[i]Monteiro CA, et a. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018; 21: 5-17. doi: 10.1017/S1368980017000234.

[ii] Recent guidance from Santé publique France included advice to minimize consumption of “ultra-processed foods.” (Santé publique France présente les nouvelles recommendations sur l’alimentation, l’activité physique et la sédentarité. Santé publique France. 2019. Accessed at: https://www.santepubliquefrance.fr/Accueil-Presse/Tous-les-communiques/Sante-publique-France-presente-les-nouvelles-recommandations-sur-l-alimentation-l-activite-physique-et-la-sedentarite.)

[iii] Monteiro CA, et al. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 2010; 26(11):2039-2049. doi: 10.1590/S0102-311X2010001100005.

[iv] Dietary Guidelines for the Brazilian Population. 2015. Accessed at: http://bvsms.saude.gov.br/bvs/publicacoes/dietary_guidelines_brazilian_population.pdf

[v] The new Canada Food Guide includes recommendations to limit intake of “highly processed” foods and beverages. (Canada’s food guide. Government of Canada. 2019. Accessed at: https://food-guide.canada.ca/en/.)

[vi] Recent guidance from Santé publique France included advice to minimize consumption of “ultra-processed foods.” (Santé publique France présente les nouvelles recommendations sur l’alimentation, l’activité physique et la sédentarité. Santé publique France. 2019. Accessed at: https://www.santepubliquefrance.fr/Accueil-Presse/Tous-les-communiques/Sante-publique-France-presente-les-nouvelles-recommandations-sur-l-alimentation-l-activite-physique-et-la-sedentarite.)

[vii] Food-based dietary guidelines for the population of Uruguay. 2016. Access at: http://www.fao.org/nutrition/education/food-based-dietary-guidelines/regions/countries/uruguay/en/

[viii] Pan-American Health Organization Nutrient Profile Model. 2016. Accessed at: https://www.paho.org/hq/index.php?option=com_content&view=article&id=11662:paho-nutrient-profile-model&Itemid=41739&lang=en

[ix] Decree no. 272/2018. Uruguay Ministry of Health. 2018. Accessed at: https://medios.presidencia.gub.uy/legal/2018/decretos/08/cons_min_705.pdf.

[x] Allemandi L, et al. Food advertising on Argentinean television: are ultra-processed foods in the lead? Public Health Nutr. 2018; 21:238-246. doi: 10.1017/S1368980017001446.

[xi] Gallagher J. Ultra-processed foods ‘make you eat more.’ BBC News. 2019. Accessed at: https://www.bbc.com/news/health-48280772.

[xii] Researchers found the consumption of “ultra-processed” foods causes increased calorie intake and weight gain. (Hall KD, et al. Ultra-processed diets cause excess calorie intake and weight gain: An inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 2019. doi: 10.1016/j.cmet.2019.05.008.)

[xiii] Gibney MJ. Ultra-processed foods: Definitions and policy issues. Curr Dev Nutr. 2018; 3(2). doi: 10.1093/cdn/nzy077

[xiv] Miller Jones J. Food processing: criteria for dietary guidance and public health? Proc Nutr Soc. 2019; 78(1): 4-18. doi: 10.1017/S0029665118002513.

[xv] U.S. Department of Health and Human Services. Food and Drug Administration. Code of Federal Regulations Title 21. 2018. Accessed at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.65.

[xvi] U.S. Department of Health and Human Services. Food and Drug Administration. Use of the term “healthy” in the labeling of human food products: Guidance for industry. 2016. Accessed at: https://www.fda.gov/media/100520/download.

[xvii] This survey was designed by FoodMinds Strategic Insights and fielded by SMS Research Advisors, a division of Padilla, in 2019.

[xviii] Federal University of Paraná warning label proposal to Anvisa. 2017. Accessed at: https://idec.org.br/noticia/idec-apresenta-novo-modelo-de-rotulagem-nutricional-anvisa

[xix] Access to Nutrition Index. Global index 2018. 2018. Accessed at: https://www.accesstonutrition.org/sites/gl18.atnindex.org/files/resources/atni_report_global_index_2018.pdf.