Public health journal issues rallying cry on ultra-processed foods

The all-star lineup of ultra-processed food researchers who teamed up on a new special edition of the American Journal of Public Health have an overarching message for policymakers: “Do policy!”

That directive, offered by food politics scholar Marion Nestle during a press call ahead of the issue’s release, is accompanied by new polling that shows broad cross-partisan concerns over the health harms associated with ultra-processed foods. 

A survey of 2,000 U.S. adults included in the new issue found that the overwhelming majority of Democrats, Republicans, and independents agreed that ultra-processed foods are addictive and a major cause of obesity, type 2 diabetes, and cardiovascular disease. The survey also found majority support in all parties for government interventions including testing additives for safety before they can be included in food products, banning artificial dyes, requiring warning labels, and ordering companies to reduce the amount of sugar and salt in their foods.

“In this polarized era where Americans disagree on so much, this is actually something where we’re seeing a lot of agreement and public support, which should be a catalyst for policymakers,” said Lindsey Smith Taillie, a nutrition epidemiologist at UNC Gillings School of Public Health, who co-authored a paper on the environmental toll of the single-use plastics that package many ultra-processed foods for the new issue. 

But despite both public support and Robert F. Kennedy Jr.’s focus on ultra-processed foods as a major health issue during his current tenure as U.S. health secretary, experts said that the federal government is not doing enough to take action against the food industry. Top of mind was Kennedy’s promise that the Food and Drug Administration will soon release a formal definition of ultra-processed foods, which Taillie said was crucial to get right. “What’s at risk here is … you only capture a small fracture of the ultra-processed foods on the food supply, which will also have minimal health impact,” she said. (The assembled experts voiced support for the widely used Nova classification system.)

Kennedy’s Make America Healthy Again is “not a science-based movement, they’re a feelings-based movement, and they believe personal experience is much more important than what the science says,” said Nestle. In her paper for the special issue, she writes that the government’s new dietary guidelines attempt to shift responsibility for avoiding highly processed foods to individuals rather than focusing on industry regulation. However, she said, the MAHA movement is doing some things right, such as working hard to get certain additives, artificial dyes, and glyphosate out of the food supply. “There have been advocates trying to get those things out of the food supply for decades,” she said. “I just wish the government would act on it.”

The 17 articles in the special issue also include new research on topics including how tobacco giant Philip Morris Companies drew from its cigarette playbook to develop Lunchables in the 1980s and 1990s during the period when it owned Kraft General Foods, applying the flavor-enhancing technologies that had helped the company make lower-nicotine cigarettes to create more palatable fat-free cheeses and processed meats. Another striking study found a possible association between ultra-processed food consumption and dementia in older adults. (The study has several important caveats, including the fact that surveys that ask people to recall what and how much they eat are notoriously imprecise, and that dementia was assessed based on a test rather than a clinical diagnosis.) 

The special issue also lays out strategies to combat the dominance of ultra-processed foods in the American diet. In an editorial, Duke University obesity expert Kelly Brownell points to  litigation from attorneys general at the state, city, and county levels as an important tool in the fight against the food industry. 

“One of the greatest threats to making progress in this area will be attempts by the food industry to do pre-emption laws, where the federal government pre-empts state or local governments from doing their own things,” Brownell said. There are already signs that the food industry is trying to do just that by protesting patchwork requirements in the wake of states across the U.S. passing bills cracking down on ultra-processed foods.

The assembled group of researchers also had a number of ideas about policies that could make fruits and vegetables more affordable and easily accessible. For example, the 22 states that have stopped allowing low-income people to purchase foods like soda and candy with food benefits could redirect resources to subsidize local farmers, said Laura Schmidt, a professor at the University of California, San Francisco, who focuses on the root causes of chronic disease. “There are some real missed opportunities,” she said.

In answer to a question about whether corn subsidies should also be redirected to growing fruit, several of the experts called out “yes!” while others nodded and gave the thumbs-up.

The researchers were also unanimous in their belief that simply educating people about healthier eating habits will not be enough to move the needle on ultra-processed food consumption and associated chronic diseases. 

“These are among the most profitable products in the supermarket; the system is rigged,” said Nestle. “If you go into a supermarket wanting to eat healthfully, you’re fighting the entire system on your own.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.