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Research has shown that actions to reduce ultra-processed food consumption could lead to substantial public health benefits such as reducing obesity, type 2 diabetes, dental problems and several other health issues, including cardiovascular disease.
Ultra-processed food is generally rich in free sugars; these are what we call any sugar added to a food or drink, or the sugar that is already in honey, syrup and fruit juice. These are free because they are not inside the cells of the food we eat. The sugars naturally found in fruit, vegetables and milk don’t seem to have a negative effect on our health, and they come with extra nutrients, such as fibre.
An article in the British Medical Journal (BMJ) found that ultra-processed foods account for 56.8% of total energy intake and 64.7% of total free sugars in the UK diet. Free sugars represent 12.4% of total energy intake, and 61.3% of the sample exceeded the recommended limit of 10% energy from free sugars.
This percentage was higher among children (74.9%) and adolescents (82.9%). Prevalence of excessive free sugar intake increased linearly across the five age groups of ultra-processed food consumption for all age groups, except among the elderly. Eliminating ultra-processed foods could potentially reduce the prevalence of excessive free sugar intake by 47%.
What is ultra-processed food?
Ultra-processed foods are foods that have been manufactured from ingredients that are already highly refined, such as cheap vegetable oils, flours, whey proteins, sugars and emulsifiers. Whilst that does not sound particularly appetising, the foods that are produced in this way are often cheap, attractive, convenient and often very tasty.
Ultra-processed foods now account for more than half of all the calories eaten in the UK and US, although the term ultra-processed is not necessarily instantly recognised by consumers. These foods are in fact among some of the most available and highly marketed.
A number of these ultra-processed foods might be thought of as “junk food” – think “Turkey Twizzlers”. However, although so-called “junk foods” do make up a percentage of ultra-processed foods, other food that we might consider nutritious and even healthy can also be classified as ultra-processed foods.
Foods such as margarine, long-life almond milk, vitamin-fortified breakfast cereals and, surprisingly, many vegan and plant-based foods also fall into the category of ultra-processed foods.
Ultra-processed foods tend to be low in essential nutrients, high in sugar, oil and salt, and liable to be overconsumed. However, these foods make up a majority of most people’s daily diet.
For example, if you:
- Start the day with a bowl of cereal and a sweetened fruit drink.
- Have a biscuit with your mid-morning tea or coffee.
- Eat a ham or vegan “meat” sandwich, perhaps with a “cuppa soup” or packet of crisps and a fizzy drink at lunchtime.
- Have a shop-bought cake with your tea or coffee mid-afternoon.
- For your evening meal, pop a ready-made roast dinner or plant-based alternative in the microwave, followed by an ice cream.
- End the day with a bedtime hot chocolate drink.
…you have consumed nothing but ultra-processed foods throughout the day. As these items are so readily available in supermarkets, where the majority of us do our food shopping, you can see how these ultra-processed foods have become prevalent in our daily diets.
What is the difference between processed and ultra-processed food?
The British Nutrition Foundation (BNF) suggests that people find it difficult to distinguish between foods classed as ultra-processed and other processed foods. Put simply, a processed food means any food that has undergone a change before it is ready to be sold and/or consumed.
Processed food is food that has been changed in any way from its natural state and that includes canning, bottling, freezing, or adding ingredients to it. A majority of processed foods are healthy to eat such as tinned tuna or salmon in water, frozen fruit and vegetables, cottage cheese, and bagged vegetables such as lettuce and spinach.
Some of these processed foods may contain additives such as fibre or vitamins, but they can be part of a healthy diet if eaten in moderate amounts. Baking, cooking or preparing food counts as processing, too.
Ultra-processed food takes this process one step further by incorporating additives such as added salt, sugar, preservatives, artificial flavours and colourants, often to make the food more appealing to consumers or to give the food a longer “shelf life”. Because they are often high in sugar, salt, colourants and flavourings, ultra-processed foods are generally nutritionally poor compared with unprocessed or processed foods.
What is classed as ultra-processed food?
There is a widely used food classification system called NOVA that was developed by an international panel of food scientists and researchers.
It splits foods into four categories:
Unprocessed or minimally processed foods such as vegetables, grains, pulses, fruits, nuts, meats, seafood, herbs, spices, garlic, eggs and milk.
Processed culinary ingredients – these are substances obtained directly from nature or from processed or minimally processed foods by pressing, refining, grinding, milling or spray drying. Salt, sugar, treacle and vegetable oil would be examples.
Processed foods are made by adding processed culinary ingredients to unprocessed or minimally processed foods.
These include but are not limited to:
- Tinned or bottled vegetables.
- Salted, sugared or roasted nuts and seeds.
- Salted, cured or smoked meats.
- Tinned fish.
- Fruits in syrup.
- Unpackaged freshly made breads and cakes.
Processed foods may contain additives used to preserve their original properties or to resist microbial contamination such as meats preserved with nitrites.
Ultra-processed food and drink products typically have five or more ingredients and contain industrial substances such as preservatives, emulsifiers, sweeteners, and artificial colours and flavours.
Examples of ultra-processed foods include but are not limited to:
- Sweet or savoury packaged snacks including crisps.
- Pre-prepared pasta and pizza dishes.
- Many ready meals.
- Pre-prepared pies and pasties.
- Energy bars.
- Energy drinks.
- Ice cream.
- Confectionery including chocolate.
- Margarine and spreads.
- Sausages, burgers, hot dogs, and other reconstituted meat products.
- Poultry and fish nuggets, sticks and fingers.
- Vegan “meat” and plant-based foods.
- Mass-produced bread.
- Breakfast cereals.
- Cakes, and cake mixes.
- Carbonated drinks.
- Fruit drinks.
- Fruit-flavoured yoghurts.
- Cocoa drinks.
- Meat and chicken extracts and instant sauces.
- Packaged instant soups, noodles and desserts.
- Health and slimming products such as powdered or fortified meal and dish substitutes.
- Baby formulas, follow-on milks and other baby products.
and some alcoholic drinks including:
How can you eat less ultra-processed food?
One of the main reasons that we all eat far more ultra-processed foods than is good for us is that they are often cheap, so convenient and, let’s be honest, they usually taste good, as the industrial additives such as emulsifiers can make something more appetising.
These foods are also aggressively marketed to us; just contrast the number of adverts on any normal evening’s TV viewing for vegetables, grains, and pulses compared to the number of adverts for ready meals, snacks, pizza, fizzy drinks and breakfast cereals. Also, some of the most enticing offers in supermarkets such as buy one get one free and half price, tend to be for these ultra-processed foods.
Limiting the number of ultra-processed foods that we consume has to begin with our buying habits. This is not always an easy task. Obviously, if we buy fresh fruit and vegetables, fresh uncooked meat and fish, milk and eggs then we are sure that these are not ultra-processed foods. But just eating these would make our diet quite limited and lacking in the little treats.
To enable us to limit the number of ultra-processed foods we buy and eat, we need to examine all other foods to know whether or not they belong to the ultra-processed food group.
It is not, however, always immediately clear whether some specific food products are ultra-processed or not, even when we examine the labels to establish their contents. Ingredients labels must by law be included on pre-packaged food and drink products; however, knowing which ingredients take a food from the processed foods category to the ultra-processed foods category can be difficult.
For example, packaged bread may fall into the processed foods category if it is only made from wheat flour, water, salt and yeast; however, if emulsifiers or colours have been added the bread then falls into the ultra-processed foods category.
All food additives, including artificial colours, have an “E number” so checking for these can help limit purchasing and eating ultra-processed foods.
Other ingredients listed on food labels that denote ultra-processed foods include, but are not limited to:
- Hydrolysed proteins.
- Soya protein isolate.
- Whey protein.
- Mechanically separated meat.
- High-fructose corn syrup.
- Fruit juice concentrate.
- Invert sugar.
- Soluble or insoluble fibre.
- Hydrogenated or interesterified oil.
- Monosodium glutamate.
- Caramel colour.
- Soya lecithin.
The UN Codex Alimentarius provides a regularly updated list of additives with their functional classes. There are also apps available to check food labels before you buy the foods. These apps can often offer healthier alternatives to ultra-processed foods.
How does ultra-processed food affect health?
Evidence suggests that diets heavy in ultra-processed foods can cause overeating and obesity. Researchers at Imperial College London found that not only do ultra-processed foods make up a considerably high proportion of children’s diets, more than 40% of intake in grams and more than 60% of calories on average, but that the higher the proportion of ultra-processed foods they consume, the greater the risk of becoming overweight or obese.
In addition, they highlight that “eating patterns established in childhood extend into adulthood, potentially setting children on a lifelong trajectory for obesity and a range of negative physical and mental health outcomes”.
When eaten in large amounts, ultra-processed foods have also been linked to a whole host of health conditions such as:
- Cardiovascular disease.
- Heart disease.
- High cholesterol.
- Gastrointestinal disorders.
- High blood pressure.
- Type 2 diabetes.
Two studies on ultra-processed foods were published in the British Medical Journal; one followed 105,159 people in France, and another followed 19,899 university graduates in Spain.
In the Spanish study, the group eating the fewest ultra-processed foods ate less than two servings per day, and the group eating the most ate more than four servings per day. People in the group eating the most ultra-processed foods were 62% more likely to have died after an average of 10.4 years than people in the low consumption group.
In the French study, participants were classed according to the percentage of their daily diet that came from ultra-processed foods. This ranged from an average of 7.5% for the lowest consumers to 30.8% for the highest. After an average of 5.2 years, each 10% increase in the intake of ultra-processed foods was linked to a 12% increase in cases of heart and circulatory disease.
How to avoid ultra-processed foods
Many countries are looking for strategies to help to combat obesity in their populations. According to the Food and Agriculture Organization of the United Nations (FAO), in 2014 the Brazilian government took the radical step of advising its citizens to avoid ultra-processed foods outright.
Their radical new guidelines urged Brazilians to avoid snacking, and to make time for wholesome food in their lives, to eat regular meals in company when possible, to learn how to cook and to teach children to be “wary of all forms of food advertising”. One of the first rules in the Brazilian guidelines was to “avoid consumption of ultra-processed products”.
However, it is hard to avoid ultra-processed foods altogether, as they have been designed to taste and look attractive, they are generally convenient, require little preparation and are readily available. Many people choose ready to eat or ready to heat ultra-processed foods over foods that are healthier but that require more preparation.
As a consequence of our reliance on ultra-processed foods, we are in danger of losing the knowledge, skills and interest to be able to prepare healthy dishes from scratch, leading to a situation where we become increasingly dependent on ultra-processed foods.
One way to avoid or limit our intake of ultra-processed foods is to look for healthier alternatives.
If we take the earlier daily diet example, healthier alternatives might include:
- Instead of starting the day with a bowl of cereal and a sweetened fruit drink, try substituting them for a bowl of porridge or muesli and either unsweetened fruit juice or squeeze your own fruit juice.
- Instead of having a biscuit with your mid-morning tea or coffee, have a banana.
- Instead of eating a ham or vegan “meat” sandwich, perhaps with a “cuppa soup” or packet of crisps and a fizzy drink at lunchtime, swap for a tuna salad, or a chicken breast, egg or salad sandwich, homemade soup, nuts and water.
- Instead of having a shop-bought cake with your tea or coffee mid-afternoon, bake your own, and not with a shop-bought cake mix.
- For your evening meal, instead of popping a ready-made roast dinner or plant-based alternative in the microwave, cook from scratch, with fresh vegetables, and instead of the ice cream, try plain yoghurt and fresh fruit salad.
- At the end of the day swap your bedtime hot chocolate drink for hot milk.
These swaps are fairly easy to make and there are many others you can do to help avoid or limit ultra-processed foods in your diet, including swapping:
- Ready-made pasta sauce for homemade. It’s easy, just fry a chopped onion gently in olive oil until it has softened. Add a tin of chopped tomatoes and a splash of vinegar. Season with salt and pepper. Bring to the boil and simmer for 15 minutes.
- Shop-bought salad dressings for homemade, as they’re easy too. Crush a garlic clove with some salt. Add a teaspoon of mustard to form a paste. Stir in olive oil and add cider vinegar to taste. Put the mix in a clean jam jar and top up with oil and vinegar to your taste. Shake the jar each time to mix the oil and vinegar before using on salad.
- Pre-grated cheese for freshly grated cheese, as there is potato starch in pre-grated cheese to stop clumping.
- Ready meals for batch cooking and freezing so you have homemade ready meals available whenever you want them.
- Shop-bought or fast-food burgers for homemade.
- White pasta for wholewheat pasta or spiralised courgette.
- Fruit juice for the fruit itself.
- Crisps for plain popcorn or nuts.
- Shop-bought meat and vegetable stock for homemade.
The list of swaps is endless – They’re much easier to do than you think and, generally, they taste better too.
If you are considering making lifestyle changes to help eliminate ultra-processed foods from your diet, you will probably be more successful if you make the changes slowly rather than all at once.
Making small changes and building upon them will help form long-lasting habits rather than rushing in to change everything at once, which will make the change appear far more difficult. Next time you think about reaching for that pop in the microwave meal, or ordering that takeaway delivery, think about what alternatives you could have instead.
Making these changes doesn’t mean giving up ultra-processed foods altogether – we all enjoy a chocolate cake or packet of crisps from time to time, and eating out can be a trial if you are forever checking the food content.
A tip is to try to apply the 80:20 rule; eat healthier non-ultra-processed food 80% of the time and you can have treats such as ultra-processed foods 20% of the time, whether that’s the occasional sausage, or burger or chocolate chip cookie.