Ultra-processed foods a leading cause of ‘chronic disease pandemic’, experts say

Ultra-processed foods (UPFs) are a leading cause of the “chronic disease pandemic” linked to diet, with food firms putting profit above all else, global experts have warned.

Writing in The Lancet medical journal, 43 scientists and researchers joined forces to argue that UPFs are “displacing” fresh foods and meals, worsening diet quality, and are linked to multiple chronic diseases.

They said: “The key driver of the global rise in UPFs is the growing economic and political power of the UPF industry, and its restructuring of food systems for profitability above all else.

“The industry comprises UPF manufacturers at its core, but also a broader network of co-dependent actors who collectively drive the production, marketing and consumption of UPFs.”

UPFs have been linked to poor health, including an increased risk of obesity, heart disease, cancer and early death.

Examples of UPFs include ice cream, processed meats, crisps, mass-produced bread, some breakfast cereals, biscuits, many ready meals and fizzy drinks.

UPFs often contain high levels of saturated fat, salt, sugar and additives, which experts say leaves less room in people’s diets for more nutritious foods.

UPFs also tend to include additives and ingredients that are not used when people cook from scratch, such as preservatives, emulsifiers and artificial colours and flavours.

Writing in The Lancet, the global team said that, although some countries have brought in rules to reformulate foods and control UPFs, “the global public health response is still nascent, akin to where the tobacco control movement was decades ago”.

They said government policy, including in high income countries like the UK, has done little to change the “commercial and structural determinants of the problem”, instead focusing on consumer responsibility, industry partnerships, and voluntary self-regulation in industry, such as when companies replace sugar in some foods with sweeteners, or reduce fat.

“This policy inertia reflects the co-ordinated efforts of the industry to skew decision making, frame policy debates in their interest, and manufacture the appearance of scientific doubt,” they said.

They argue that the main barrier to policies to protect health is “industry’s corporate political activities, coordinated transnationally through a global network of front groups, multi-stakeholder initiatives, and research partners, to counter opposition and block regulation.”

These activities include direct lobbying, “infiltrating government agencies”, and filing lawsuits, they added.

The experts argue that the “continuing rise of UPFs in human diets is not inevitable” and, while research into their effects continues, this should not delay policies aimed at promoting diets based on whole foods.

The dietary share of UPFs remains below 25% in countries such as Italy, Cyprus, Greece, Portugal and across Asia, but it is 50% in the US and UK, the research said.

Action is needed now to tackle UPFs directly rather than relying on current measures, it added.

Professor Chris Van Tulleken, from University College London, one of the authors, told a press briefing there had been a “three-decade history of reformulation by the food industry”.

He added: “We took the fat out first, then we took the sugar out. We replaced the sugar with the sweeteners, the fats with gums. These products have been extensively reformulated and we have seen obesity, particularly obesity in childhood and other rates of diet-related disease persistently go up in line with reformulation.

“This is not a product level discussion. The entire diet is being ultra-processed.

“And remember that built into the definition of ultra-processed food is its purpose. Its purpose is for profit. And so as long as you’re reformulating, if your purpose is still profit, you’re unlikely to cause positive health outcomes.”

Several experts commenting on the Lancet papers called for more, better quality research into the impact of UPFs, adding that current studies have shown a link with poor health but not a direct cause.

Kevin McConway, emeritus professor of applied statistics at the Open University, said “it seems to me likely that at least some UPFs could cause increases in the risk of some chronic diseases (certainly not all – there’s little evidence of an increase in cancer risk, for instance).

“But this certainly doesn’t establish that all UPFs increase disease risk.

“There’s still room for doubt and for clarification from further research.”

He said he was not advocating that no public health action about UPFs is taken until all the research gaps have been filled but said there was a need for “transparency” about “what we have good evidence for and what we don’t.”

Professor Jules Griffin, from the University of Aberdeen, said the authors had shown “a wide range of chronic diseases are associated with increased consumption of ultra-processed foods” but “association may not be causation, as the authors freely admit”.

Kate Halliwell, chief scientific officer at the Food and Drink Federation (FDF), which represents industry, said: “Food and drink manufacturers make a wide range of products, all of which can form part of a balanced diet – from everyday food and drink, like frozen peas, wholemeal bread and breakfast cereals, to treats like puddings and confectionary.

“Companies have been making a series of changes over many years to make the food and drink we all buy healthier, in line with government guidelines.

“As a result, FDF-member products on sale across shops and supermarkets now contain a third less salt and sugar and a quarter fewer calories than they did in 2015.”

She said the UK’s current dietary advice to eat more fruits, vegetables and fibre and less sugars and salt, is “based on decades of scientific evidence”, adding the FDF agreed there is a need for “better quality research to be able to understand if there’s an additional link between food processing and health”.