Ultraprocessed foods: A majority of the American diet, and a majority bad for health

Ultra-processed foods (UPFs) that make up more than half of the American diet are dragging down the health of the nation, according to two new analyses.

For two years starting in August 2021, UPFs made up 55% of the calories consumed by Americans aged 1 year and older — and 61.9% of the calories consumed by youths aged 1 to 18 years. Four of the top five sources of calories were sandwiches including hamburgers, sweet bakery products, savory snacks and sweetened drinks, according to a new report by the U.S. Centers for Disease Control and Prevention (CDC).

Meanwhile, Americans need to relearn how to avoid “junk” foods low on nutritional quality, but loaded with saturated fats, added sugars and sodium, while differentiating the limited number of healthy UPFs, such as whole grain breads, low-sugar yogurts, and tomato sauces. In a larger sense, rethinking and research would benefit the nation’s food industry, according to the American Heart Association (AHA).

In two days starting Aug. 7, CDC and AHA published their latest analyses that could resonate with Health and Human Services Secretary Robert F. Kennedy, Jr., who has promoted a re-examination of the nation’s eating habits as part of the campaign to Make America Healthy Again (MAHA). Earlier this year, the White House’s MAHA Report took aim at food nutritional values, calorie count and additives, which all are addressed in the AHA science advisory.

Confusing the issue

UPF consumption has grown rapidly since the 1990s, and now it is estimated up to 70% of grocery store products in the United States contain at least one ultraprocessed ingredient, the AHA announcement said. Many of those are bad for health, but not all are, and for some food ingredients and additives, no one knows. That leads to confusion among physicians, other clinicians and the public, the AHA announcement said.

“The relationship between UPFs and health is complex and multifaceted,” said Maya K. Vadiveloo, PhD, RD, FAHA, who served as volunteer chair of the writing group for the science advisory.

“We know that eating foods with too much saturated fat, added sugars and salt is unhealthy,” Vadiveloo said in the announcement. “What we don’t know is if certain ingredients or processing techniques make a food unhealthy above and beyond their poor nutritional composition. And if certain additives and processing steps used to make healthier food like commercial whole grain breads have any health impact.”

Some healthy advice

AHA published “Ultraprocessed Foods and Their Association With Cardiometabolic Health: Evidence, Gaps, and Opportunities: A Science Advisory From the American Heart Association,” a roundup of research and unanswered questions about the state of the nation’s diet.

AHA’s announcement about it included straightforward advice:

• Reduce the intake of most UPFs, especially those high in saturated fat, added sugars and sodium, and those that contribute to excessive calories; and
• Replace UPF consumption with healthier options like vegetables, fruits, whole grains, beans, nuts, seeds and lean proteins.

Actions needed

AHA called for at least four actions improve public health and reduce health risks of UPFs.

• Introduce approaches for people, food manufacturers and retailers to shift eating patterns away from UPFs and replace those with vegetables, fruits, nuts, seeds, legumes, whole grains, nontropical liquid plant oils, fish and seafood, low-fat-low-sugar dairy, and, if personally desired, lean poultry and meats.
• Use policy and systems-change strategies, such as front of package labels, to reduce consumption of saturated fats, added sugars and sodium.
• Boost research funding to explore critical questions about UPFs, including the difference between health effects of ultraprocessing and of added ingredients.
• Improve food additive science with streamlined and efficient study and regulations.

“More research is needed to better understand the mechanisms of how UPFs impact health,” Vadiveloo said. “In the meantime, the association continues to urge people to cut back on the most harmful UPFs that are high in saturated fats, added sugars and sodium, and excessive calories and instead follow a diet rich in vegetables, fruits, nuts, seeds and whole grains, low-fat-low-sugar dairy, and lean proteins like fish, seafood or poultry — for better short- and long-term health.”

How to classify foods

The AHA paper noted additional factors affecting the American diet, and how people choose foods to eat, how people talk about them, and how scientists research them.

The Nova classification system categorizes foods into four groups, from unprocessed or minimally processed (Nova 1) to ultraprocessed (Nova 4). But it does not consider nutritional values of foods, and it is not the only classification systems for analyzing foods.

Meanwhile, not all industrially processed foods are considered ultraprocessed. There are benefits to some methods of handling or treating foods: safety, longer shelf life, lower costs, and preservation of nutrition, and convenience.

Considering human health, “overall UPF intake is consistently associated with harm,” but some UPFs have shown neutral or protective effects.

A great unknown

AHA specifically mentioned the U.S. Food and Drug Administration and the 1958 Food Additives Amendment that grants its authority to regulate food additives. A list of ingredients “generally recognized as safe” started with 800 chemicals and has grown to more than 10,000. Most of those “remain unevaluated, and the cumulative effects of exposure to multiple additives are poorly understood,” the AHA paper said.

Who’s eating what

The CDC report did not dive deep into nutritional value, but it quantified eating patterns of American children and adults.

With growing concern about negative health effects of food, the nation appeared to be trending away from UPFs, albeit slowly, according to the CDC figures. In the period 2017-2018, UPFs made up 65.6% of mean percentage of total calories consumed by youths, but that decreased to 61.9% in the August 2021-August 2023 period.

For adults, UPF mean percentage of total calories declined from 56% to 53% for those respective time periods. The two-year period ending August 2023 also was lower than that 55.8% of 2013-2014.

Good food for young people?

Youths aged 6 to 11 were the top UPF eaters, at 64.8% of total calories, and youths aged 12 to 18 years were at 65%. Children aged 1 to 5 years were at 56.1%, according to the CDC figures.

For adults, UPFs made up caloric intake at the levels:

• 54.4% for people aged 19 to 39 years
• 52.6% for those aged 40 to 59 years
• 51.7% for those aged 60 years and older

Spending and appetite

There was a noticeable, if not dramatic, difference in diet based on family income, according to the CDC figures. For adults, total calories from UPFs were:

• 54.7% for families at less than 130% of the federal poverty level (FPL)
• 55.3% for families at 130% to 349% of FPL
• 50.4% for families at 350% or more of FPL

For youths, the total calories from UPFs were:

• 61.2% for families at less than 130% of FPL
• 63/5% for families at 130% to 349% of FPL
• 61.6% for families at 350% or more of FPL

CDC published “Ultra-processed Food Consumption in Youth and Adults: United States, August 2021–August 2023,” by Anne M. Williams, PhD, MPH, Catharine A. Couch, PhD, RD, Samuel D. Emmerich, DVM, and Damon F. Ogburn, PhD, MSPH.