What doctors wish patients knew about ultraprocessed foods

For people on the run, ultraprocessed food may become their go-to diet, sacrificing nutrition for convenience. While it may be convenient, consuming ultraprocessed foods on a regular basis increases a person’s risk of health complications including cardiovascular disease, certain cancers, obesity and type 2 diabetes. But it can be hard to tell when these foods are on your plate.

Research has shown that diets high in ultraprocessed foods are linked to more than 30 health conditions, according to an umbrella review of meta-analyses that was published in The BMJ. Meanwhile, more exposure to ultraprocessed foods was associated with a higher risk of dying from any cause. There were also strong ties with higher consumption and cardiovascular disease-related deaths, mental health disorders and type 2 diabetes.

The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.

In this installment, two physicians took time to discuss what patients need to know about ultraprocessed foods and healthier steps to take. These AMA members are:

• Stephen Devries, MD, a preventive cardiologist and executive director of the educational nonprofit Gaples Institute in Chicago.
• Neha Sachdev, MD, MS, a family physician who is the director of clinical engagement and equitable care at the AMA.

“Ultraprocessed foods are industrial creations made with little—if any—whole foods that often contain large amounts of added sugar and salt,” Dr. Devries explained, noting ultraprocessed foods “are typically infused with artificial colors and additives.”

“Foods that are ultraprocessed are altered from their natural forms. This can be done to make foods appear a certain way or preserve foods for longer,” said Dr. Sachdev. “Compare a carton of eggs that you purchase with a frozen egg patty. Even though both of these items contain eggs, these are very different foods that have gone through very different journeys to get to the store shelves.”

Some other examples of ultraprocessed foods include:

• Fatty, sweet, savory or salty packaged snacks.
• Ice creams and frozen desserts.
• Cola, soda and other carbonated soft drinks.
• Energy and sports drinks. 
• Canned, packaged, dehydrated and other instant soups.
• Packaged meat, fish, vegetables, breads and buns. 
• Breakfast cereals and bars.
• Sweetened juices.
• Margarines and spreads.
• Infant formulas and drinks.
• Meal replacement shakes such as Slim Fast.

Processed and ultraprocessed doesn’t just apply to the food you eat. It can also be the beverages you drink.

For example, “tap water is not processed, whereas energy drinks and sodas are processed,” noted Dr. Sachdev. “The beverages you drink are just as important to pay attention to as the foods you eat.” 

“Ultraprocessed foods are clever manipulations of mostly unhealthy ingredients titrated to appeal to common cravings—tasty by design, but it’s all a trick,” said Dr. Devries. “For example, our bodies are naturally drawn by evolution to the sweetness of fruit because of its associated nutritional value.”

That’s why “ultraprocessed foods draw on the craving for sweetness but are largely devoid of the nutritional value historically associated with that taste,” he explained. “Compounding the problem with ultraprocessed foods are the ingredients added to enhance shelf life, including unhealthy fats and preservative chemicals that may have negative health outcomes.”

As a result, “ultraprocessed foods are better at preserving shelf life than human life,” Dr. Devries emphasized.

“Processed foods are more nutrient-dense than ultraprocessed and usually are less refined and have few or no additives,” said Dr. Devries, noting “they are generally healthier than their ultraprocessed counterparts.

“Examples of processed foods are whole wheat bread, extra-virgin olive oil and tofu,” he added.

“Health consequences of ultraprocessed foods are dire. A large study conducted over 19 years showed a 31% higher mortality for the highest versus lowest consumers of ultraprocessed foods,” Dr. Devries explained. “The concerns include recent documentation of an increased risk of type 2 diabetes, cardiovascular disease and dementia.”

“The stakes are high because ultraprocessed foods are so widely consumed. Recent data shows that 57% of caloric intake in adults comes from ultraprocessed foods,” he said. “For children it’s sadly even higher, with 67% of children’s daily calories from relatively empty ultraprocessed foods.

“These alarming statistics go a long way to explain the record-breaking prevalence of obesity, type 2 diabetes, and all of the adverse health consequences that follow,” he added. “Ultraprocessed foods are the perfect storm to promote overconsumption and weight gain: They are laboratory engineered to maximize appeal, are calorie-dense, and have little or no fiber or other healthful nutrients.”

“The problems are even more acute for individuals who are food insecure, as constraints of limited access and affordability of nutritious food lead to especially high consumption of ultraprocessed foods,” Dr. Devries said.

“The food label tells the story. Ultraprocessed foods typically contain a long list of ingredients, most of which are not used in home cooking and would be more familiar in a chemistry lab,” said Dr. Devries. “Examples are many types of packaged snacks, breakfast cereal, prepared meals and sugary beverages.”

“Looking at a nutrition label will give you an idea if a food is ultraprocessed,” said Dr. Sachdev. “If you don’t recognize many of the ingredients listed, that can be a sign that there was a lot of processing involved.”

“High amounts of added fat and sugar added to ultraprocessed creations make them considerably more calorie-dense than most whole foods,” said Dr. Devries.

“It is important to highlight that calories are not all created equal,” said Dr. Sachdev. “So the same calories that you might get from eating an apple, for example, are very different than the calories you might get from eating an apple fruit bar.

“These might be equivalent in number, but what ultraprocessed calories represent and the nutrition that they provide your body is different,” she added.

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“There are a lot of foods that may be marketed or thought of as healthy, but have actually been processed quite a bit,” said Dr. Sachdev. That means “it’s important to be aware of the foods you’re eating on a regular basis and how processed these foods are.”

“The best choices are meals made from whole foods, often more easily put together in a single skillet dish,” said Dr. Devries. “While on the run, a salad with a healthy protein is a great choice. And for snacks, it’s hard to beat fresh fruit and nuts.”

“Having home-cooked meals where you’re using whole foods is key,” said Dr. Sachdev. “That means you’re buying things like fresh fruits and vegetables, then preparing them at home.”

“The best advice is to choose foods that don’t have and don’t need labels: fresh vegetables, fruit, dried beans and intact whole grains,” said Dr. Devries. “Among packaged foods, focus on those in which a whole food predominates with as few added ingredients as possible, like frozen vegetables and fruit, canned beans and canned fish.”

“Many grocery stores are set up with fresh items on the outer ring and then the center aisles are where you find a lot of the processed and ultraprocessed items,” said Dr. Sachdev. “Shop the perimeter of the grocery store to find those whole, fresh fruits and vegetables, and healthy proteins.”

Additionally, “the supermarket perimeter generally includes the produce section, and that’s a great place to load up,” said Dr. Devries. “But other parts of the perimeter are not necessarily preferred destinations, including the deli counter and bakery.

“It is best to focus predominantly on purchasing whole foods that don’t have labels and a few carefully selected packaged foods that contain mostly single whole food ingredients,” he added.

“It’s probably not practical to eliminate every processed food or ultraprocessed food. Everyone is different, so think about where you can start making changes. Talk with your doctor or health care team about what changes would be most beneficial for your health,” Dr. Sachdev said, noting the value in ‘being pragmatic about what works for you.”

“What you eat is very personal and the best diet is the one you can follow,” she said.

“Ask yourself: What are some small steps you can take to change your habits and follow a healthier diet with less ultraprocessed and processed foods?” Dr. Sachdev said. “Small changes add up and once you’ve established one habit, you can work on changing another.”

“The best plan is to make ultraprocessed foods an infrequent exception rather than the rule,” said Dr. Devries. “There are a lot of forces at work that encourage us to make less healthy choices, including product placement.

“It’s no wonder why candy bars are placed near checkout counters and even, unfortunately, in some hospital cafeterias,” he added. “But we’re starting to see some positive changes, including some vending machines—traditionally bastions of junk food—that now offer gourmet salads.”

When it comes to ultraprocessed food, “talk with your doctor and health care team. Together, you can come up with some specific and actionable goals,” said Dr. Sachdev. “Your doctor may also be able to refer you to resources that can help you make and sustain lifestyle changes.”