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The UK consumes more ultra-processed foods (UPFs) than anywhere else in Europe. Figures from The Soil Association show UPFs make up 65 per cent of our children’s diets, and over 50 per cent of our shopping baskets, and new research from the universities of Cambridge and Bristol found UK teenagers get two-thirds of their calories from ultra-processed foods.
What are ultra-processed foods?
People have been fermenting, canning and pickling foods for centuries as a way of preserving them, and these are all forms of ‘processing’. However, a food becomes ultra-processed when it has undergone larger scale industrialised processing that often strips it of its original ingredients and adds in chemicals to make it last longer and taste more appetising.
This means the term covers a huge variety of foods, some of which are unhealthy, but others that may have good nutritional value. For example, bags of crisps or a ready meal that is very high in fat, salt or sugar would be UPFs, but so would a shop-bought loaf of wholegrain bread, or a low-fat yogurt.
Health impacts
Unsurprisingly, UPFs have created a lot of public debate – especially as some research has shown a correlation between consuming a lot of UPFs and heart, kidney and liver disease, obesity, cancer, depression and even early death.
However, since not all ultra-processed foods are high in fat, sugar and salt, it’s hard to establish whether this is the sole reason why consuming lots of them can lead to poorer health. Researchers are still unsure whether there are additional negative health impacts from other factors such as palatability (which might lead us to eat more), or energy density (the number of calories per bite), or how some UPFs are made.
Reviewing the current evidence, the Government’s Scientific Advisory Committee on Nutrition (SACN) has said that more research is needed before it can draw any firm conclusions about whether UPFs cause poor health.
On the other side of the debate, some organisations believe there is a direct link between the national availability of ultra-processed foods and chronic diseases.
- UPFs and obesity
According to The Soil Association, since UPFs are not just commonly high in salt, fat and sugar, but are very frequently less satiating than unprocessed foods, they are causing us to overeat. Citing a randomised control trial in 2019 that presented participants with a diet containing greater quantities of ultra-processed foods, The Soil Association says the results showed overall calorie intake was higher, and participants put on weight
- UPFs and diabetes
Speaking at the recent launch of the Health Supplements Information Service’s (HSIS) British dietary habits and declining nutrients intakes research review, dietitian Dr Carrie Ruxton said that researchers had found that a 10 per cent increase in reliance on ultra-processed foods can lead to a 17 per cent increase in type 2 diabetes
- UPFs and heart health
The British Heart Foundation says several studies have shown that eating higher amounts of ultra-processed foods is linked to a greater risk of high blood pressure, cardiovascular disease, heart attacks and strokes, and early death.
One study tracked 10,000 Australian women for 15 years. Those with the highest amounts of UPFs in their diet were 39 per cent more likely to develop high blood pressure than those with the lowest. Another larger analysis looked at 10 studies involving more than 325,000 men and women and showed those who ate the most ultra-processed food were 24 per cent more likely to experience serious heart and circulatory events including heart attacks, strokes and angina. A study from 2019, which followed 19,899 university graduates in Spain, also showed a connection between UPFs and risk of early death.
However, British Health Foundation senior dietitian, Victoria Taylor, stresses: “It’s important to remember that observational studies like these can only show an association. They cannot tell us what is behind this. The classification of UPFs used by the researchers is very broad and so there could be a number of reasons why these foods are being linked to increased risk to our health – for example nutritional content, additives in food or other factors in a person’s life.”
The NOVA food classification system
The NOVA food classification system was developed by Brazilian physician, Carlos Monteiro, and his team at the University of São Paulo, who devised a categorisation system to divide commercially available foods into four groups:
- Group 1: Unprocessed or minimally processed ‘whole foods’
This group includes anything from a tomato to a bunch of mint, a pork chop to a walnut. These foods are obtained directly from plants or animals and go through minimal processing (such as cleaning or freezing) before reaching our kitchens.
- Group 2: Processed culinary ingredients
This includes things like butter, sugar and honey which only undergo simple processes such as pressing, grinding, crushing, or refining. These foods are often used sparingly to make other foods taste delicious.
- Group 3: Processed foods
These contain elements from groups one or two that have been processed by manufacturers by being, for example, salted, fermented or pickled. These foods include bacon, cheeses, canned fruit and vegetables, smoked salmon, and traditionally made bread.
- Group 4: Ultra-processed foods
Sugars, oils and starches tend to make up the bulk of these foods, which include most shop-bought snacks, biscuits and cakes, mass-produced bread and breakfast cereals, reconstituted meat products, mass-produced desserts, infant formula and some baby foods, sweetened yogurts and ready meals. UPFs also contain ingredients with unfamiliar names such as soy protein isolates, as well as colourings, emulsifiers, flavourings and other additives.
Exacerbating health risks
So, is there any evidence that consuming UPFs can worsen health conditions?
“What we do know is that certain less healthy foods with high sugar, fat, and salt, and which tend to be lacking in vitamins and minerals, can exacerbate health conditions,” says Dr Ruxton. “So, if you're somebody with type 2 diabetes and you have lots of sugary sweets and drinks, and eat lots of white processed bread and cakes and biscuits that are devoid of fibre and nutrients, you will make your condition worse. And the same with cardiovascular disease.”
Another risk is addiction to UPFs. Researchers in the USA, Brazil and Spain estimated that ultra-processed food addiction occurs in 14 per cent of adults and 12 per cent of children. While not all UPFs have addictive potential, the researchers said the risk comes with UPFs which are high in refined carbohydrates and added fats such as sweets and salty snacks, since these are “highly rewarding, appealing, and consumed compulsively”.
Considering Government advice
The Government’s general nutritional advice is for people to try follow a healthy diet, cutting down on saturated fat, sugar and salt and eating more vegetables and fibre. NHS England’s Eatwell Guide shows how much of what we eat overall should come from each food group to achieve a healthy, balanced diet, with a reminder that it’s not necessary to achieve this balance with every meal, but to try get the balance right over a day or even a week.
In a further bid to tackle growing rates of childhood obesity and improve public health in the UK, in September, public health minister Andrew Gwynne, announced that a ban on junk food adverts being shown on TV before the 9pm watershed will come into play on 1 October 2025, alongside a ban on online ads for foods which are high in fat, salt and sugar.
Professor Christina Vogel from the Centre for Food Policy says restricting exposure to adverts that promote unhealthy food is “a welcome step forward in the Government’s commitment to improving public health”, but further steps are needed. “It’s critical that the Government now sets a clear timeline for implementing the revised Nutrient Profile Model”, she adds, “which accounts for updates to our national dietary guidelines, particularly on reducing free sugars and increasing fibre intake”.
Looking to cut down UPFs
In the meantime, there is plenty of advice that pharmacy teams can give customers who want to learn more about ulta-processed foods, and how to eat less of them.
The Soil Association says there are some key indicators to look out for to identify if a food is ultra-processed. These include:
- A long list of ingredients
- Unrecognisable ingredients with “chemical-sounding” names such as monosodium glutamate, acesulfame K, aspartame and disodium ribonucleotide
- Fresh food with a long shelf life, like sausage rolls, as these will contain preservatives.
Victoria says the British Health Foundation recommends people adopt a Mediterranean-style diet, which includes plenty of minimally or unprocessed foods such as fruit, vegetables, fish, nuts and seeds, beans, lentils and wholegrains: “This, along with exercising regularly and not smoking, has been shown to be beneficial for lowering risk of heart and circulatory disease.”
“Chronic illness is preventable, and diet is a major part of that,” agrees Dr Ruxton. “For example, cardiovascular disease is still the biggest killer in the UK, killing 480 people a day and costing the UK £16 billion a year. The number of strokes is going up amongst younger people because they tend to have more obesity. Unhealthy diets are a key driver for all cardiovascular disease, and diets that are bad for our heart are going to increase our risk of dementia as well. If you can get in early with prevention, then you're not looking at huge costs in terms of treating and dealing with the social consequences of cardiovascular disease. So that's well worth keeping in mind: if we self care better, we are also helping the NHS.”