Long-established diets centered on whole foods (and their culinary preparation as dishes and meals) is being displaced across the planet by diets based on ultra-processed foods.
In fact, the intake of UPFs in the US and UK already make up more than 50% of the energy contribution to people’s diets.
But in lower income countries, UPFs do not yet have the same dominance in people’s diets: meaning it’s time to act now before they take over, say researchers.
The problem with UPFs
A deterioration of diet (a move away from fresh, whole foods and towards UPFs) increases the risk of chronic disease. That’s because UPFs often lack essential nutrients and health protective phytochemicals; yet have high energy density and may contain toxic compounds, endocrine disruptors and potentially harmful classes and mixtures of food additives.
Industrial food processing can help extend the shelf life of whole foods and preserve their sensory properties, and it can make food easier to prepare at home.
But the focus of food processing, write the authors of the series in The Lancet, ‘has become increasingly aimed at creating substitutes for whole foods and their preparation as dishes and meals’.
And – furthermore – this has been ‘in pursuit of greater profits’: with new technologies chemically modifying food components and combining them with additives to make ready-to-eat, long-lasting and highly palatable foods.
This shift, which started in high-income countries after WW2, accelerated in the 1980s with the globalization of the corporate food industry and has continues to spread around the world.
UPF categories
UPFs include all carbonated soft drinks; reconstituted fruit juices and fruit drinks; cocoa, other modified dairy drinks, and energy drinks; flavoured yoghurt; confectionery; margarines; cured meat or fish with added nitrites or nitrates; poultry and fish nuggets and sticks, sausages, hot dogs, luncheon meats, and other reconstituted meat products; powdered instant soups, noodles, and desserts; infant formulas and follow-on products; and health-related and slimming-related products, such as meal-replacement shakes and powders.
Soda sales drive UPFs up – or down
UPFs are on the rise. In fact, in the US and the UK, UPFs make up more than 50% of energy contribution to total daily food intake. In Spain, it has tripled from 11% to 32% over the last 30 years. In Mexico and Brazil, the figure is now around 23%.
In the period 2007–2022, annual per capita overall sales and sales of UPFs increased across south Asia, southeast Asia, and sub-Saharan Africa, as well as in central Europe, eastern Europe, Latin America and the Caribbean, central Asia, eastern Asia, north Africa, and the Middle East.
However, UPF sales declined in North America, Australasia, and western Europe, where sales already exceeded 200 kg in 2007.
That’s partly because UPF sales were already high: but also because of a shift in sweetened carbonated drinks sales in these regions.
Soda is a large contributor to UPF energy intake. In high income countries, sweetened drinks (both carbonated and non-carbonated), make up around half of UPF sales.
In lower income countries, sales of sweetened drinks are much lower overall. Proportionally, however, their overall contribution to UPF sales is much higher (that’s because the proliferation of other UPF categories such as ready meals is much lower).
But public experts are concerned that - as consumers in higher-income countries become more savvy about what they eat and drink - food giants are targeting unhealthy food at poorer countries.
High-income country reformulation
In high income countries, soda has long been in the firing line over its sugar content and artificial ingredients: and that’s already led to a backlash from consumers. Manufacturers, meanwhile, have reformulated products and focused on innovation in ‘better-for-you’ categories.
But another factor is the impact of government policies – notably sugar taxes – and that’s an area that The Lancet authors focus on.
To date, almost all food tax policies have targeted sugar-sweetened beverages. That’s because soda and sugary drinks are often products with ‘empty calories’ – products containing calories for no nutritional gain. And in many countries, they represent a top contributor of sugar in diets.
It’s important, say the authors of the studies in The Lancet, to appreciate that different countries are at different stages in the UPF transition.
UPF consumption tends to be highest in high-income countries (in the US, Australia and UK, UPFs have come to form a central part of dietary patterns for most of the population).
Since the 1990s, UPFs have also risen rapidly in middle-income countries such as Chile, where almost a third of calories are derived from UPFs.
Finally, UPF consumption is now ‘rapidly rising’ in low income countries in Africa and Asia.
Policies and strategies need to be adopted to each local market. That might mean whether selectively prioritizing some subgroups (such as soda) or excluding others (which still offer some nutritional value or affordable option) in lower income countries.
“Countries with the highest UPF consumptions have continually prioritised reformulation-oriented policies, as has been the case in the UK and Australia, and the EU,” note the authors in The Lancet.
“However, reduced UPF consumption should be their aim. The dominance of UPF products and UPF corporations means that the availability and affordability of non-UPF versions of some categories of foods can be rare, such as non-UPF bread products in the UK.
“In this situation, some UPF subgroups, such as packaged breads, could initially be exempted from regulations that target their price and availability to avoid detrimentally affecting people on low incomes, while discretionary subgroups (eg, sugar-sweetened beverages) can more readily be targeted, as has been the case in the UK.”
Countries at the ‘intermediate stage’ of the UPF dietary transition need strategies that directly target UPFs. Countries such as Chile, Mexico and Brazil have targeted availability and affordability of UPFs.
“The recent introduction by Colombia of a tax on UPFs— primarily targeting products high in fats, sugars, and salt—represents an extension of these food environment policies.
“In these countries, UPF consumption is still mostly based on drinks and snacks, so targeting all or some major UPF subgroups is possible. Nevertheless, for more vulnerable, lower income groups, strong governmental support is still needed to promote minimally processed food consumption.”
And in countries where UPFs aren’t yet as common, it’s important to act now.
“Countries at the early stages of the ultra-processed dietary transition need strategies that aim to prevent the rise in UPFs, rather than acting when they already dominate local food systems and dietary patterns,” notes the study.
“A review assessing the implementation of food environment policies in four south Asian countries concluded that, compared with global benchmarks, implementation of food environment policies was generally weak and mostly related to food safety, rather than to UPFs and diet quality.”
Countries such as Kenya, Ghana, and India are now considering front-of-package warning labels and other food policies.
