Why ultra-processed foods need tobacco-style warnings

Ultra-processed foods (UPFs) get a bad press but their increasing dominance on supermarket shelves and overwhelming evidence they are responsible for a range of health problems across whole populations has heightened concerns.

It culminated this week with nutritionist Carlos Monteiro, who coined the term UPF 15 years ago, calling for tobacco-style warnings and a ban on their sale in schools and health facilities.

What are UPFs?

UPFs include cereals, industrially produced breads, protein bars, fizzy drinks, crisps, ready meals and fast food.

In the UK and US, more than half the average diet consists of ultra-processed food. For some, especially people who are younger, poorer or from disadvantaged areas, a diet comprising as much as 80 per cent UPF is typical. There is evidence that Irish diets are trending in that direction. In February, the world’s largest review of its kind found they were linked to 32 harmful effects, including a higher risk of heart disease, cancer, type 2 diabetes, adverse mental health and early death.

Determining what is a UPF is complicated as a growing number of foods for sale in shops, even ones that appear healthy, fall into this category. This includes fruit-flavoured yoghurts full of sugars, flavourings and thickeners like guar and carob bean gum, or packaged bread with ingredients like soy lecithin and monoglycerides slipped in alongside flour and water. These industrially formulated products are often high in fats, starches, sugars and additives.

“UPFs are increasing their share in, and domination of, global diets, despite the risk they represent to health in terms of increasing the risk of multiple chronic diseases,” Monteiro told the Guardian in advance of addressing an obesity conference in Brazil. “UPFs are displacing healthier, less processed foods, and also causing a deterioration in diet quality due to their several harmful attributes. Together, these foods are driving the pandemic of obesity and other diet-related chronic diseases.”

The Nova system, which he helped design in 2009, assesses not only nutritional content but also the extent of processing. It places food and drink into four groups: minimally processed food; processed culinary ingredients, processed food and ultra-processed food.

What is the best approach to highlighting UPF risk?

Monteiro believes health research is no longer sufficient to warn the public of the consequences. “Public health campaigns are needed like those against tobacco to curb the dangers of UPFs. Advertisements for UPFs should also be banned or heavily restricted, and front-of-pack warnings should be introduced similar to those used for cigarette packs.”

There should be heavy taxation of UPFs, with the revenue generated used to subsidise fresh foods, he says.

Food giants marketing UPFs know that, to be competitive, their products must be more convenient, more affordable and tastier than freshly prepared meals, he believes. “To maximise profits, these UPFs must have lower cost of production and be overconsumed.”

Is associating UPF producers with tobacco companies justified?

Tobacco and UPFs cause numerous serious illnesses and premature mortality, he says. Both are produced by transnational corporations using their attractive/addictive products in aggressive marketing strategies, and lobbying against regulation — “and both are pathogenic [dangerous] by design, so reformulation is not a solution”.

Are there dissenting views on how to highlight UPF risk?

Nutrition specialist Dr Hilda Mulrooney of London Metropolitan University says comparing UPF to tobacco is simplistic. “There is no such thing as a safe cigarette, even second-hand, so banning them is relatively straightforward in that the health case is very clear. However, we need a range of nutrients including fat, sugar and salt, and they have multiple functions in foods — structural, shelf-life — not just taste and flavour and hedonic properties.”

The controversy confirms, however, that issues around the modern diet are not just about ingredients and nutrients; they are just as much about processing.