There has been a lot of discussion about the public health impact of ultra-processed foods in recent times. First Chris Van Tulleken’s bestseller Ultra-Processed People, and more recently the pre-eminent medical journal The Lancet published three papers on why UPFs are harmful to human health. It summarised the results of more than 100 studies that showed associations between ultra-processed food and an increased risk of 12 chronic diseases, including obesity, type 2 diabetes, heart disease, kidney disease, Crohn’s disease, depression and dementia. It also zeroed in on what we can do to reduce the harm: not more consumer education, but rather to clamp down on the “corporate political activity” of the food industry which blocks the development of policies to limit the production and mass normalisation of UPFs.
Dramatic changes in how we produce food have been driven by an understandable preoccupation with food security and the avoidance of famine after the second World War. Norman Borlaug won the Nobel Peace Prize in 1970 for inventing a strain of wheat with a shorter stem that made it easier to grow and harvest. It saved a billion people from starvation. This and numerous other developments in food production and processing have been good for humanity. Nobody is saying that extending shelf life and reducing cost and scarcity by freezing, tinning or pasteurising foods is bad. Nobody who is worried about chocolate breakfast cereals for six-year-olds has a problem with pickling gherkins. That’s because processing is not the same as ultra-processing.
Three things put the “ultra” in ultra-processing. Firstly, when bulk commodities such as maize, wheat, sugar cane and fat are extracted from their whole sources and chemically modified by processes such as industrial heating, fractionation and extrusion, the resulting product has a substantially degraded food matrix. So, if you eat an orange, you are getting a lot of things from that whole – the cell structure, the fibre, the pith that’s full of bioactive compounds. That “matrix” is lost in an orange cordial, even if it is fortified with zinc and Vitamin C.
Second, the bulk is enhanced with flavours (usually to disguise the unpleasant taste from the first process) and texturised to improve the feeling in your mouth with bulking, gelling or foaming agents. You know you’re eating UPF when that crunchy, moreish feeling turns quite suddenly to a gluey string.
Third, ingredients such as fibre and water that usually slow down the absorption of sugar and fat are often removed during the processing – the resulting “food” overwhelms our internal control of appetite and fullness. You end up staring at the cereal bowl or the wrapper, wondering if you’ve eaten at all.
So, there’s a world of difference between food processing for preservation, safety and food security, and ultra-processing for sensory enhancement and the stimulation of repeated over-consumption, which is really, really profitable.
Why? First, it’s cheap. Cheese flavouring costs less than buying actual cheese as an input to a food product. Second, ultra-processing seems to uniquely bypass appetite and satiety control systems in the brain, and makes us consume larger portions. A famous experiment by Kevin Hall in 2019 showed that people eat 500 calories more a day on an ultra-processed diet, compared to a less processed one, even when the sugar, salt, fat and calorie content of the diet is the same. Third, UPF producers invest heavily in branding and public relations. If your child insists on cheese strings for lunch, it’s not because of your bad parenting skills. It’s the cumulative and inevitable result of UPF producers with targets for cheese string sales.
[ Ultraprocessed foods: Do they affect gut health?Opens in new window ]
The biggest criticisms of the science of ultra-processed food are that there’s no food that is “good” or “bad” – moderation and balance are what count. That is 100 per cent correct, and it misses the point entirely. The point is that the nutritional science model and the business model exist together. You cannot separate them. So a UPF firm and its scientists of course say to eat in moderation, that balance is important, that fortified food is good for you and so on. But its business model is laser-focused on making sure we eat more of that food, year-on-year.
This drive to grow displaces less processed food, and that is the entire point. In 2018 it was estimated that UPF food accounted for 45.9 per cent of all food we ate in Ireland.
Critics will often revert to the age-old advice of “energy-in-energy-out”; one of the many problems with this advice is that UPFs affect the entire body; the strongest evidence in UPF research is the link between UPF and anxiety and depression. Eating this food is not making us happy.
We ourselves recently researched the business model of supermarket baked goods over a 30-year time span. Why did we choose baked goods? They are a key “boundary food” in the global debate on UPFs – sliced bread is an affordable staple in most of our diets. Supermarket bread is certainly not the worst UPF. The point is that most supermarkets producing bread also produce cakes and tarts, doughnuts and muffins, savoury pies and Viennoiserie (croissants, pastries and brioche), categories that have grown the most in Ireland’s UPF consumption. It’s a key strategy known as “led by bread” where bread acts as an initial draw and casts a halo over the category.
The reality of baked-goods production is far from the imagined connotation of a traditional homely kitchen. We found that the lurch to ultra-processing by producers of ultra-processed baked goods has been driven by a growth imperative and a need to return a greater profit for investors than the previous year, every year. It is no wonder that the raw materials must get cheaper, the products must get even more hyperpalatable, and the lifestyle claims must get more sophisticated.
As Kevin Hall discovered, the problem is in the processing, as much as in the ingredients. In the old days we characterised problem foods as those with “high fat salt sugar” or “nutrients of concern”, and countries all over the world sought to cajole producers to reformulate: please pretty, please decrease the salt, sugar and saturated fat in your foods, but at your own pace of course.
Ironically this led to more processing to square the circle of making food salty without salt, or sweet without sugar. The problem is there is no such thing as a healthy reformulated food. With reformulation, “bad” ingredients are just replaced with more intensive processing and new types of ingredients, rather than with whole or minimally processed foods. We’ve seen the pitfalls of reformulation in the past: trans-fats, now known to be harmful, were intended to be a healthier replacement for saturated fats in the 1960s. That didn’t go well.
[ Bread, cereals and yoghurts: 11 foods you might not realise are ultra-processedOpens in new window ]
Reformulation will be about as effective as low-tar cigarettes or guns with fewer bullets – an inadequate public health strategy that suits commercial interests and distracts legislators and the public from more decisive, effective public action.
This is the part where it is necessary to say what consumers should do. Of course the answer is to eat less processed food, but doing that is not a lifestyle hack. It will require shifting subsidies to make organic fruit and veg cheaper, widening the sugar tax to encompass other food, giving citizens time to prepare, cook and eat food.
Consumers cannot shift subsidies, tax and so on. For this to happen, we have to think of ourselves less as consumers gazing at labels and working out lifestyle hacks from Instagram, and more as citizens who ask the politicians who come to our door what their proposals are to make cheap, healthy food a dedicated part of our daily lives.
Francis Finucane is an honorary full professor in medicine at the University of Galway.Norah Campbell is an associate professor in Trinity Business School, Trinity College Dublin.