The Food and Drug Administration (FDA) is exploring several initiatives to end hunger, and increase healthy eating to combat diet-related diseases like Type 2 diabetes, obesity and hypertension. One initiative we could see in grocery and convenience stores this fall is new “front-of-package” (FOP) labeling for ultra-processed foods (UPF) and beverages.
According to the FDA, “FOP labeling would complement the Nutrition Facts label that is required on food packages by displaying simplified, at-a-glance nutrition information that gives consumers additional context to help them quickly and easily make more informed food selections.” Similar FOP labeling initiatives have been incorporated in other countries, like Chile and Mexico.
Registered Dietitian Jennifer Nasser, PhD, an associate professor in Drexel University’s College of Nursing and Health Professions, shared her insight on the American diet, ultra-processed foods, FOP labeling and other public health dietary initiatives.
What are ultra-processed foods?
Ultra-processed foods are foods classified by a system called “NOVA” developed by Carlos Monteiro, PhD, a nutritionist in Brazil. The NOVA system gives this definition of ultra-processed food:
“Ultra-processed foods are industrial formulations made entirely or mostly from substances extracted from foods (oils, fats, sugar, starch and proteins), derived from food constituents (hydrogenated fats and modified starch), or synthesized in laboratories from food substrates or other organic sources (flavor enhancers, colors and several food additives used to make the product hyper-palatable). Manufacturing techniques include extrusion, molding and preprocessing by frying. Beverages may be ultra-processed. Group 1 foods (foods as found in nature) are a small proportion of, or are even absent from, ultra-processed products.”
How are ultra-processed foods impacting American’s health?
Epidemiological studies show an association (as opposed to a cause-and-effect relationship) between consumption of ultra-processed food and increased risk (about 1-1.5 times) for developing obesity, Type 2 diabetes, heart disease and cancer among other complex disorders.
One short-term, randomized clinical trial (four weeks total time) conducted at the National Institutes of Health (NIH) showed that individuals fed a diet of greater than 80% of calories coming from ultra processed food gained about 2.2 pounds in two weeks, where the same individuals fed a diet with greater than 80% of calories coming from unprocessed food lost about 2.2 pounds in two weeks.
However, a study published by the United States Department of Agriculture (USDA) showed that it is possible to assemble a diet that has 91% of calories from ultra-processed food and still have the nutritional quality of that diet (Healthy Eating Index score) be 86, which is 1.5 times more than the score for the average American diet (Healthy Eating Index of 59).
Ultra-processed foods are estimated to make up about 60% of the calories in the American diet. The diversity of results seen across these studies suggests that the NOVA category for ultra-processed food is not yet precise enough to be used to judge ultimate health effects.
Do you think the proposed FDA FOP warning labels will achieve the intended goal – making consumers rethink purchases of ultra-processed foods and beverages?
UPF have a number of consumer advantages, such as reduced price, increased shelf-life and decreased microbial contamination. I think the warning labels may be useful for letting everyone know what they’re eating, but purchasing habits are mainly driven by taste and price. If someone can afford to eat a diet containing a lot of unprocessed, whole foods they may try to adopt that option. However, for many Americans, food insecurity is high, and whole food availability tends to be limited in low-income neighborhoods. So, the chance to choose a diet of whole foods is limited.
Are there other options at the national level for addressing increasing rates of diet-related diseases?
As mentioned above, some UPF can possibly be part of a healthy diet. At the national level, the Center for Disease Control and Prevention (CDC) provides guidance and information on healthy eating and lifestyle. The Dietary Guidelines for America is a joint project of the USDA and the NIH which publishes recommendations every five years for healthy eating and physical activity.
What else should we know about UPF?
The NOVA system for categorizing food was developed in response to the dietary situation of processed food replacing native foods in Brazil. As such, it may not yet be the best method of categorizing food with respect to the American food supply and the American lifestyle. Foods like yogurt and whole grain breads are classified as UPF. In a culture where people were still preparing their own yogurt or bread from scratch, introduction of UPF could be seen as detrimental to health.
However, in a culture where “home-cooking” is less the norm, ready-prepared foods (many of which are classified as UPF) are a necessity of modern life. The challenge then is to have a common set of dietary health goals, categorize food based on those goals, and very importantly, have a system for making access of food meeting those health goals readily available to all Americans.
Another issue surrounding UPF is whether they are made to be hyperpalatable and thereby “drive” their own overconsumption. I think this is an important question, but I don’t think the available data can answer it. I think this topic needs to be addressed in dedicated clinical trials. Some have suggested that, for example, commercially made UPF dessert type foods are more hyperpalatable than home-made versions of similar foods. I think that’s an easy study to conduct in a number of different ways, but I haven’t seen any such data published yet.
Media interested in speaking with Nasser should contact Annie Korp, news manager, at 215-571-4244 or amk522@drexel.edu.
