Are ultra-processed foods a public health hazard?

Ultra-processed foods are front-page health news — I'll scan the latest evidence on whether they amount to a public health hazard.

Based on current evidence, ultra-processed foods (UPFs) are widely considered an emerging public health hazard, though the degree and mechanism of harm is still debated.

What are ultra-processed foods?

Ultra-processed foods commonly are defined by the NOVA classification as foods which are made through industrial processes, composed of ingredients extracted from whole foods, combined with additives, and containing few ingredients commonly found in home kitchens.

The formal NOVA Group 4 definition refers to "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"

Examples include packaged baked goods and snacks, fizzy drinks, sugary cereals, and ready-to-eat or heat products, which undergo multiple industrial processes and often contain colours, emulsifiers, flavours, and other additives. They are typically energy-dense and high in sugar and salt but low in dietary fiber, protein, vitamins and minerals

The World Health Organization (WHO) is in the process of developing a definition, as is the US Food and Drug Administration (FDA), and the FDA has identified ultra-processed foods as a 2026 priority and is working on a formal definition

A proposed operational definition is a food is ultra-processed if it contains cosmetic additives like colors, flavors, or emulsifiers, or non-culinary ingredients like high-fructose corn syrup or protein isolates

Why considered a hazard: scale of exposure

•They can account for up to 58% of total daily energy intake in some high income countries

•According to the FDA, around 70 percent of packaged food products in the United States are considered ultra-processed, and 60 percent of calories consumed by children are from these foods

•It is estimated that 70% of the U.S. food supply is comprised of foods commonly considered ultra-processed, and that children get over 60% of their calories from such foods

The American Journal of Public Health published a special issue with 17 studies building a case that these products are a public health crisis on the same scale as tobacco

Evidence linking UPFs to adverse health outcomes

Researchers have found links between the consumption ultra-processed foods and a range of negative health outcomes, including obesity, cancer, heart disease, type 2 diabetes, and mental disorders, as well as an increased risk of death

The FDA notes that "dozens" of studies have shown links between foods considered ultra-processed and adverse health outcomes such as cardiovascular disease, type 2 diabetes, cancer, obesity, and neurological disorders.

The largest synthesis to date:

•Findings published Feb 28, 2024 by The BMJ come from a review of 45 analyses published in the last three years, involving about 10 million people in total

•Researchers carried out an umbrella review of 45 distinct pooled meta-analyses from 14 review articles associating ultra-processed foods with adverse health outcomes involving almost 10 million participants

•Consistent evidence shows that higher exposure to ultra-processed foods is associated with an increased risk of 32 damaging health outcomes including cancer, major heart and lung conditions, mental health disorders, and early death

Graded evidence:

•The most convincing or highly suggestive evidence linked diets rich in ultra-processed foods with increased risks for premature death, cardiovascular disease, mental health disorders, diabetes, obesity, and sleep problems

•Convincing evidence showed that higher ultra-processed food intake was associated with around a 50% increased risk of cardiovascular disease related death, a 48-53% higher risk of anxiety and common mental disorders, and a 12% greater risk of type 2 diabetes

•Highly suggestive evidence also indicated that higher ultra-processed food intake was associated with a 21% greater risk of death from any cause, a 40-66% increased risk of heart disease related death, obesity, type 2 diabetes, and sleep problems, and a 22% increased risk of depression

Other studies cited:

•A study followed more than 5,000 Americans over 50 for nearly a decade. Those who ate the most ultra-processed foods had a 58% higher risk of developing dementia and a 46% higher risk of cognitive impairment

•Epidemiological studies have linked UPF consumption to increased risk of cardiometabolic diseases, including diabetes and obesity, as well as mental health disorders and cognitive decline

Authors conclude: "These findings support urgent mechanistic research and public health actions that seek to target and minimise ultra-processed food consumption for improved population health"

Editorialists argued reformulation does not eliminate harm, and profitability discourages manufacturers from switching to make nutritious foods, so public policies and action on ultra-processed foods are essential. Proposed measures include front-of-pack labels, restricting advertising and prohibiting sales in or near schools and hospitals, and fiscal measures that make unprocessed foods cheaper than ultra-processed foods, with calls for a framework convention on ultra-processed foods similar to the framework on tobacco.

Nuance and debate

Not all research supports viewing all UPFs as equally harmful:

•The American Heart Association (AHA) suggests that not all ultra-processed foods (UPFs) are bad for you and argued in an August 8 advisory in Circulation that some UPFs appear to have better nutritional profiles and can fit into an overall healthy diet

•That advisory noted “certain types of industrial food processing are beneficial for preservation and safety, and/or lowering cost, such as techniques that extend shelf life, control microbial growth, mitigate chemical toxicants, preserve functional, nutritional and sensory qualities, and reduce food loss and waste”

•This paper underscores that not all ultra-processed foods (UPFs) are created equal, and grouping them together as universally detrimental is overly simplistic

•“While many ultra-processed foods tend to be of poor nutritional quality and should generally be limited or avoided, processing itself is not inherently harmful,”

Examples of healthier UPFs cited include whole grain breads, high-fiber breakfast cereals, certain dairy products, fortified plant-based milks, canned beans, and Greek-style yogurts. Research has shown that sugary and artificially sweetened drinks and processed meats increased the risk of heart disease, but that bread, cold cereals, even some savory snacks, had beneficial effects.

Similarly, other reviews found ultra-processed breads and cereals showed a negative association with the risk of disease (i.e., protective), while for sweets and desserts, savoury snacks - no relationship was found, suggesting a more nuanced analysis is needed.

Limitations

The umbrella review authors acknowledge that umbrella reviews can only provide high-level overviews and they can’t rule out the possibility that other unmeasured factors and variations in assessing ultra-processed food intake may have influenced their results. The dementia study noted this is observational. It cannot prove cause and effect.

Conclusion

The consensus among major health authorities and recent large reviews is that high consumption of ultra-processed foods — particularly those high in saturated fats, added sugars, and sodium— is associated with convincing to highly suggestive risks for cardiovascular mortality, type 2 diabetes, anxiety, depression, obesity and overall mortality, supporting classification as a public health hazard warranting policy action. However, expert bodies including the AHA emphasize that UPFs are a heterogeneous category, and that nutrient profile and ingredient quality matter more than processing alone, so not every food classified as ultra-processed should be considered equally hazardous.

Citations (4)

1bmjgroup.comAcademic
Consistent evidence links ultra-processed food to over 30 damaging health outcomes - BMJ Group
Backs: “The formal NOVA Group 4 definition refers to "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". Examples include packaged baked goods…”
2celinegounder.comNot yet classified
The Companies That Made Marlboro Made Your Food
Backs: “They are typically energy-dense and high in sugar and salt but low in dietary fiber, protein, vitamins and minerals. The World Health Organization (WHO) is in the process of developing a definition, as is the US Food and Drug Administration (FDA), and the FDA has identified ultra-processed foods as a 2026 priority and…”
3harvard.eduAcademic
More evidence that ultra-processed foods harm health - Harvard Health
Backs: “The FDA notes that "dozens" of studies have shown links between foods considered ultra-processed and adverse health outcomes such as cardiovascular disease, type 2 diabetes, cancer, obesity, and neurological disorders. The largest synthesis to date: Findings published Feb 28, 2024 by The BMJ come from a review of 45…”
4healthline.comCommercial contentquality 0.81
Not All Ultra-Processed Foods Are 'Bad,' Experts Say. Here's Why
Backs: “Proposed measures include front-of-pack labels, restricting advertising and prohibiting sales in or near schools and hospitals, and fiscal measures that make unprocessed foods cheaper than ultra-processed foods, with calls for a framework convention on ultra-processed foods similar to the framework on tobacco. Nuance…”