A new three-paper series in The Lancet reviewed the global rise in ultraprocessed foods (UPFs) and warned that this trend poses an urgent threat to health, calling for coordinated policy action.

The researchers noted the rising risks for populations exposed to these products and emphasized that meaningful improvements in diet quality require strong public policies. They call for a coordinated approach that curbs the production, advertising, and consumption of UPFs while expanding access to healthier options.

Diet Shift

“The growing consumption of UPFs is restructuring diets worldwide, replacing unprocessed and minimally processed foods,” said Carlos A. Monteiro, MD, professor from the Department of Nutrition at the School of Public Health and researcher at Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde (NUPENS), both in Sao Paulo, Brazil.

“This shift in how people eat is driven by large global corporations that obtained extraordinary profits by prioritizing ultraprocessed products, supported by powerful marketing and political lobbying that blocked public policies that promote adequate and healthy diets.”

Researchers from NUPENS introduced the term UPFs, which anchors the NOVA classification system. NOVA categorizes foods into four groups based on the processing level: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and UPFs.

UPFs are branded commercial formulations made from inexpensive ingredients with little or no whole food content and are often produced using chemically modified components and industrial techniques, such as extrusion, molding, and pre-frying.

UPFs often contain colorings, flavorings, emulsifiers, and other cosmetic additives used to enhance appearance, texture, sound, aroma, and taste, often making these products hyperpalatable.

“The Lancet Series on Ultra-Processed Foods and Human Health,” which compiles scientific reviews on the health impact of UPF consumption and analyses of national dietary surveys documenting rising intake across many regions, was led by Monteiro.

Health Risks

Over the past three decades, the contribution of UPFs to total household food purchases in Spain has increased from 11% to 31.7%. In Canada, this proportion has more than doubled over the past 80 years, from 24.4% to 54.9%.

In Brazil and Mexico, UPFs rose from approximately 10% to 23% of total purchases over four decades, while in Argentina, they increased from 19% to 29% over 30 years.

In China, where UPFs still represent a smaller share of the diet, their contribution increased from 3.5% to 10.4%. In the US and the UK, where UPFs have long supplied more than half of the dietary energy, only modest further increases were observed, suggesting that these dietary patterns were already well established.

Diets high in UPFs are associated with excess calorie intake and poorer nutritional quality — characterized by high free sugars, unhealthy fats, low fiber content, and low protein content — and greater exposure to food additives and other potentially harmful chemical substances.

A systematic review conducted for the series assessed 104 long-term prospective studies: 92 reported an increased risk for one or more chronic conditions, with significant associations for 12 outcomes, including obesity, type 2 diabetes, cardiovascular disease, depression, and premature all-cause mortality.

The article also addressed common scientific criticisms of the concept of UPFs, such as the lack of long-term randomized clinical trials and the heterogeneity of nutritional profiles across UPFs subgroups, and provided responses to these concerns.

While acknowledging the remaining gaps, the authors noted that many issues have already been addressed by the current evidence.

“Although scientific debate about UPFs is welcome, it is important to distinguish legitimate discussions from attempts by groups with economic interests to weaken the evidence,” said Mathilde Touvier, PhD, a professor at the French National Institute for Health and Medical Research.

“The growing body of research indicated that diets high in UPFs were damaging health on a global scale.”

Policy Response

The second paper in the series emphasized the need for public policies designed specifically to combat the spread of UPFs, complementing existing regulations targeting salt, sugar, and fat content of foods.

It outlines multiple strategies to reduce and regulate the production of UPFs, including stricter limits on advertising, particularly marketing aimed at children.

Researchers have urged the removal of UPFs from schools, hospitals, and other public institutions and recommended limiting their shelf space and visibility in supermarkets. They also called for stronger accountability measures for companies that shape unhealthy eating patterns, including major food manufacturers and fast-food chains that promote and make these products available.

“We proposed including ingredients that characterize UPFs foods such as colorings, flavorings, and sweeteners on front-of-pack labels alongside markers of excess saturated fat, sugar, and salt,” said Barry M. Popkin, PhD, a professor from the Department of Nutrition at the University of North Carolina at Chapel Hill. “This measure would help prevent substitution with equally harmful ingredients and enable more effective regulation.”

The authors also called for holding major corporations, including multinational food manufacturers and fast-food chains, accounting for their role in promoting unhealthy diets.

“We recommend the use of warning labels on menus in fast-food restaurants and added taxation on fast-food products that are UPFs. Also deserving of consideration are policy options in food service and retail settings to regulate UPF sales at the corporate level by restricting or applying penalties based on the proportion of total sales of UPF products,” wrote the authors.

Scientists have emphasized that regulating UPFs must go hand in hand with efforts to expand access to fresh, unprocessed options. Taxes on ultraprocessed products are outlined as a way to raise revenue to support these measures. 

Among successful examples, the authors cited Brazil’s national school feeding program, which has eliminated most UPFs, with 90% of the food required to be whole or minimally processed by 2026.

Corporate Influence

The third paper in the series examined how major corporations have driven the global spread of UPFs, which are now among the most profitable sectors of the food industry. “Large corporations not individual choices were behind the global expansion of ultraprocessed foods,” said Simón Barquera, PhD, from the National Institute of Public Health in Cuernavaca, Mexico.

“Through interest groups, these companies often presented themselves as part of the solution, but their actions told a different story one focused on protecting profits and resisting effective regulation.”

Manufacturers have relied on inexpensive ingredients and industrial processing methods to reduce costs; combined with aggressive marketing and appealing product design, this model has made UPFs the most lucrative food sector, with global annual sales exceeding US$1.9 trillion.

According to the authors, “The higher profitability of producing UPFs, compared with other types of food, is key to understanding the industry’s expansion — in capitalist economies, where resources and investment accumulate in the most profitable firms and sectors, this drives a structural transformation of entire food systems towards ultraprocessed diets.”

In recent decades, as major corporations in the sector have expanded and globalized, they have widened their markets for UPFs, particularly in low- and middle-income countries.

The authors indicated that political strategies are routinely used to block government regulatory initiatives, thereby enabling continued commercial growth.

This political activity in support of UPFs is described as being coordinated internationally through a global network of interest groups.

This article reports that these companies use sophisticated tactics to protect their profits, including influencing scientific debates and shaping public opinion.

The authors added that large corporations coordinate hundreds of interest groups worldwide, lobby policymakers, make electoral donations, and use judicial action to delay public policies.

In light of this, researchers have called for a global effort to deliver a coordinated response that protects public policymaking from industry interference.

Karen Hofman, MD, professor, SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS SA, School of Public Health, University of Witwatersrand, Johannesburg, South Africa, compared the model with the global alliance against cigarettes. “Just as we have confronted the tobacco industry for decades, we now need a bold and coordinated global response to curb the disproportionate power of UPFs corporations and build food systems that prioritize people’s health and wellbeing,” she said.

Clinical Implications

Several organizations, including the World Health Organization (WHO) and the UNICEF, have issued statements supporting the series and emphasizing its policy relevance.

In a social media post, director general of the WHO, Tedros Adhanom Ghebreyesus, MD, highlighted new analysis in The Lancet that details the health dangers linked to UPFs and outlines WHO led efforts to make healthy food choices more accessible.

He noted that a higher intake of UPFs raises the risk for obesity, type 2 diabetes, cardiovascular disease, and other noncommunicable conditions.

“The rise of UPFs in human diets is harming global public health. However, policy responses are still emerging, much like tobacco control efforts decades ago, indicating the need to understand the root causes and accelerate global action. This paper, the third in a three-part Lancet Series, takes several steps to advance knowledge of these causes and to inform a global public health response,” wrote the authors.

Giuliana Miranda, who holds a master’s degree in science communication from Unicamp in Brazil, has covered health and science since 2010. Her experience includes more than a decade at Folha de S Paulo and work for Superinteressante, Galileu, and The Telegraph in the UK. 

This story was translated from Medscape’s Portuguese edition.