All the harmful effects of ultra-processed foods are not captured by nutrient profiling

Madam

In reacting to my commentary on food processing and health⁽Reference Monteiro¹⁾, Nicole Darmon⁽Reference Darmon²⁾ advocates nutrient profiling systems as an expression of food category-based recommendations. In so doing, she regrets the adoption by the European Community of a version of such systems that ‘will likely induce the development of products that, in order to “pass” the system, will be moderately loaded with fat, sugar and/or salt, and in order to have something to claim, may be artificially fortified with vitamins, minerals or other ingredients considered as positive’. The EU decision makes one of my points. It illustrates the limitation of reducing the relationship between food and health to nutrient profiles, while ignoring other features and effects of food processing.

As I said in my commentary, diets largely made up from ultra-processed foods – such as breads, sausages, cookies, cereal bars, chips, ice creams, confectionery, savoury and sweet snacks in general, and soft drinks and other sugared beverages – are intrinsically harmful to human health. The reason is not only the nutrient profile of these foods.

Again as I said, other features of ultra-processed foods, unrelated to their nutrient composition and so not detected by nutrient profiling systems, make both ‘regular’ and ‘premium’ products intrinsically harmful to health. Ultra-processed foods, whether ‘regular’ or ‘premium’, are not perishable (as vegetables and fruits are) and do not require preparation or cooking (as grains and meat do). This is why they are correctly termed ‘convenience foods’ or ‘fast foods’. But the convenience and the rapidity cause eating patterns which are known to harm the human ability to regulate energy balance, and therefore increase the likelihood of excess eating and obesity. Such unhealthy eating patterns, which include snacking instead of having regular meals, eating while watching television and consuming a lot of energy in liquid form⁽Reference De Graaf^3–Reference Mattes⁵⁾, are all reinforced by the typically very heavy and aggressive advertising and marketing of such foods.

Also, both ‘regular’ and ‘premium’ ultra-processed foods are branded, packaged and marketed to give the impression to consumers that they are unique. This, plus the incredibly low cost of the main ingredients used in the production of ultra-processed foods (vegetable oils and fats, starches, sugars and salt), and the limitless opportunities to invent ‘new’ products and market them all over the world, explain why transnational food and drink manufacturers have a colossal investment in this sector. This, plus sophisticated marketing techniques targeted particularly at children and adolescents, and the general failure of national governments to establish effective regulations to limit unethical marketing strategies, also explain the explosive increase of production and consumption of ultra-processed foods, and the displacement of unprocessed or minimally processed foods, now evident everywhere.

The best recommendation on all ultra-processed foods, irrespective of their nutrient profiles, is to avoid them, or at least to minimise their consumption.

Further, as well stated by Mark Lawrence⁽Reference Lawrence⁶⁾: ‘…as the degree of food processing increases, often so does the requirement for energy inputs – directly in the processing itself, and indirectly in packaging…’. This is another reason to avoid all types of ultra-processed foods. The weakening of traditional food cultures, and the loss of culinary diversity, are also not captured by nutrient profile systems.

Ultra-processed foods and drinks, in the amounts now produced and consumed, are a menace to public health all over the world. Regulations are needed that will restrict their advertising and marketing. So are fiscal policies that will stop them being artificially cheap and that will make unprocessed and minimally processed foods more affordable as well as more accessible.