Ultra-processed foods: Have we forgotten the biggest problem?
Amid the debate over whole-grain bread and tinned fish, researchers say something crucial is being overlooked: We now have a food system that is designed to make us overeat unhealthy food.
It is profitable for the food industry that we eat more than we need.(Photo: Shutterstock / NTB)
Ingrid SpildeIngridSpildeIngrid Spildejournalist
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The debate about what ultra-processed foods actually is is intense.
It contains refined and powdered nutrients and many additives, such as emulsifiers, thickeners, sweeteners, and preservatives.
But what about store-bought whole-grain bread and yoghurt with toppings, or cooked ham containing a preservative? Are these foods truly harmful to health?
There is also another side to ultra-processed foods:
The intention behind the processing.
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Profit before health
Food manufacturers use additives and processing for many reasons, for example to make food safer, to prevent food waste, or to secure the food supply.
But there's also another consideration: profit.
A significant share of the food in stores is created by large – often multinational – food companies that prioritise profit over health, according to an editorial recently published in The Lancet.
These companies want to create products that sells as much as possible. This has led to the rise of a very special type of product:
"Foods made from cheap raw materials – such as refined wheat, corn, sugar, and oil – are combined with a range of additives that give them an especially appealing taste and texture," says Simon Dankel, a professor at the University of Bergen.
The result is a targeted development and marketing of increasingly tempting ultra-processed foods that are difficult to stop eating.
Food designed for overeating
Professor Simon Dankel at the University of Bergen believes we know more than enough to take action to slow the sale of unhealthy ultra-processed food.(Photo: Synnøve Ygre Hauge / University of Bergen)
These products are often very easy to chew and digest because the original structure of the raw ingredients has been completely broken down.
They typically contain little water and have preservatives added so that they keep for a long time during transport and on store shelves.
"This is extremely profitable for the companies," says Dankel.
The problem is that this profitability depends on people consuming more food than they need.
"Processing has become a means to make money and win the battle for customers, but it also leads people to consume too much energy and too few essential nutrients," says Dankel.
"The brain has not kept up"
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Tine Sundfør, a clinical dietitian with a PhD in nutrition, considers this a serious issue.
"Market capitalism has one goal: to sell more products, especially a company's own goods. This strongly fuels overconsumption," she says.
The food industry invests heavily in developing and marketing ever more irresistible products.
And the responsibility for resisting them falls on each and every one of us – with nature working against us.
"The brain has not kept up with the times," says Sundfør.
"Tempts the brain"
Clinical dietitian Tine Sundfør believes a market-capitalist food system is an extreme driver of overconsumption.(Photo: Anita Sælø)
When humans evolved, it was an advantage to find energy-dense food. Strong biological forces within us make us crave fast carbohydrates, especially when they're combined with added fat. Eating this kind of food triggers a powerful reward response in the brain, releasing feel-good chemicals.
"It's so easy to communicate this to the brain and tempt it," says Sundfør. "So even though seven out of ten of us say we want to eat healthier, we still leave the store with unhealthy food."
This is where the greatest potential for increased sales lies.
"People don't overbuy healthy food. You're not tempted to pick up an extra apple," says Sundfør.
"Can override the body's regulatory systems"
Dankel also believes it's possible that this new type of food confuses the body's regulatory systems.
The body relies on complex mechanisms to control how much we eat. Chewing, swallowing speed, digestion, and nutrient absorption all influence how the brain interprets hunger and fullness.
"But we're designed to handle whole foods," says Dankel. "With the scale that processing has reached today, we can override the body's regulatory systems."
Wanted to find the effect of industrial food processing
This was precisely the starting point for the NOVA system, developed by Brazilian researchers. They wanted to investigate what happens to health when industrial food takes over.
Senior researcher Paula Varela-Tomasco at Nofima believes it's important to include nuances in the debate about ultra-processed food.(Photo: Jon-Are Berg-Jacobsen / Nofima)
However, this may not be the best system for identifying problematic industrial food, says senior researcher Paula Varela-Tomasco at Nofima, who researches ultra-processed foods herself.
May need a new system
"Not all ultra-processed products are unhealthy, but most unhealthy products are ultra-processed," Varela-Tomasco writes in an email to Science Norway.
A system that includes both the degree of processing and nutritional content would likely be better able to distinguish between such products, she believes.
"Not all categories of ultra-processed foods have equally strong associations with health outcomes. More research is needed to better understand these differences and to identify the underlying causes, mechanisms, and the most important products, especially in the Norwegian diet," she writes.
Still, despite existing knowledge gaps, both Dankel and Sundfør agree that there is already sufficient evidence to conclude that diets high in ultra-processed foods are harmful to health.
What we know about ultra-processed foods – and what we still don't
In recent years, large amounts of research have pointed in the same direction: People who eat a lot of ultra-processed foods have a higher risk of obesity and a wide range of diseases.
What researchers do not yet fully understand is which products are harmful and how they affect the body.
In studies, many different foods can be grouped under the category of ultra-processed food – ranging from energy drinks and cakes on one end of the spectrum to whole-grain bread and fish cakes on the other.
The study found that ultra-processed animal products and soft drinks, both with and without sugar, were associated with disease. Ultra-processed breads and cereal products, on the other hand, were linked to a lower risk of disease.
Not just sugar and fat
Many ultra-processed products contain ingredients that have long been considered unhealthy, such as sugar, refined starch, and added fat.
But a handful of experiments – so-called randomised controlled trials – suggest that these factors alone do not fully explain the negative health effects.
A study published this summer, for example, examined what happened when participants followed either a minimally processed diet or an ultra-processed diet, both in line with dietary guidelines in the UK.
Although participants could eat as much as they wanted, both diets led to some weight loss. But those who ate ultra-processed food consumed more calories. On average, they lost one kilogram over eight weeks, compared with two kilograms among those eating minimally processed food.
"This suggests that processing itself matters, beyond nutritional content," says Simon Dankel at the University of Bergen.
Research has also linked certain additives – including some emulsifiers and sweeteners – to negative health effects. Additives may also contribute to flavours and textures that make us overeat.
European health authorities conduct thorough assessments of each additive to ensure they are not harmful. But such evaluations do not consider whether foods become easier to overconsume, writes Paula Varela-Tomasco at Nofima.
This also applies to other possible effects, such as disruptions to gut bacteria or the hormonal system. Researchers also lack an overview of what happens when we consume a cocktail of different additives from a diet high in ultra-processed food.
There is also only limited research on individual products. Researchers do not know whether ultra-processed fish cakes or cinnamon buns affect the body differently than homemade ones.
This uncertainty makes it difficult for many to relate to the concept of ultra-processed food.
Cannot wait
"Naturally, we would prefer to have insight into all the mechanisms," says Dankel.
Studies could, for example, compare how individual products with different levels of processing affect health, digestion, and how quickly and how much we eat.
But waiting for such definitive knowledge is not necessarily an option, Dankel believes.
Resources for nutrition research are quite limited, and given the sheer number of ingredients, processes, and products involved today, it would take an extremely long time to test everything in randomised controlled trials.
Such studies also do not necessarily capture the effects of an entire diet, says Dankel.
"You might find small differences between individual ultra-processed and minimally processed foods. But when the effects of many ultra-processed products accumulate over years, the impact could be substantial," he says.
The Mediterranean diet is also vague
Dankel understands why the concept of ultra-processed foods has faced scepticism.
"One key definition focuses not on nutrients, but on the purpose of processing. I think many researchers are reluctant to accept that, because they want to study the details," he says.
Still, he argues that vague definitions are not unique to ultra-processed foods.
"Health authorities advise limiting red meat, for example, even though there's no research on the health effects of game meat or liver pâté," says Dankel.
They also promote the Mediterranean diet, despite the lack of clear boundaries defining exactly what it includes or excludes, or how every ingredient affects the body.
State Secretary in the Ministry of Health and Care Services, Usman Ahmad Mushtaq, believes we need more knowledge about system approaches.(Foto: Helse- og omsorgsdepartementet)
Yet most people accept that overall dietary patterns matter, and that such patterns are generally beneficial.
Keep two ideas in mind at once
Usman Ahmad Mushtaq, state secretary at the Ministry of Health and Care Services, welcomes more research on ultra-processed foods.
"We currently have a society that seems to promote obesity for many people. There's a need for more knowledge about a systems-based approach to these challenges, rather than only studying individual factors," he writes to Science Norway.
At the same time, he believes we must be able to keep two ideas in mind at once. Not all ultra-processed food is unhealthy.
"The World Health Organization is working on reviewing the definition of ultra-processed foods. We have had meetings with WHO, and the Norwegian Directorate of Health is closely following this work," he writes.
We know enough to act
"I believe there's more than enough knowledge to take action," says Dankel.
Both he and Sundfør believe that professionals are actually much more in agreement than the heated debates might suggest.
"Those working in nutrition should unite around common ground," says Sundfør. "Namely, reducing the consumption of sweets, snacks, soft drinks and other sweet drinks, store-bought cakes and biscuits, and processed meats like sausages, burgers, and bacon."
All of these foods are already singled out in dietary guidelines as items to cut back on. The priority, she says, should be to follow those recommendations.
Both researchers believe action is long overdue.
"Food directly affects our health, and that alone justifies strict regulation of how it is produced," says Dankel.
