The concept of ultra-processed foods (UPF)
Position statement April 2023
British Nutrition Foundation position statements set out our views on important areas in food and nutrition and provide guidance to researchers, regulatory agencies and policy makers, health professionals, the food industry and the media. Our position statements are produced by our team of expert nutrition scientists and reviewed by the Foundation’s Scientific Committee, a group of independent experts that advises on the interpretation and translation of scientific information as part of our governance.
A number of countries advise the reduction or avoidance of ‘ultra-processed foods’ (UPF), a category of foods described within the NOVA classification system by the ‘extent’, ‘purpose’ and ‘nature’ of food processing, within national dietary guidelines. This is based on evidence, largely from observational studies, linking high intakes of foods that would be classified as ultra-processed according to NOVA group 4 with poor health outcomes including heart disease, type 2 diabetes, obesity and cancer. Although such studies have shown consistent associations, it is difficult to untangle the impact of less healthy dietary patterns and lifestyles and they do not provide clear evidence of a causal association between processing per se and health. At present in the UK there is no agreed definition for UPF and they are not referred to in government dietary recommendations. Within this document, when reference is made to the concept of UPF the term refers to foods and drinks that would be classified as ‘ultra-processed’ according to the NOVA classification system.
The NOVA UPF definition is broad and captures many foods that have a poor nutritional profile, are energy dense and high in fat, sugars and salt. Understanding of other mechanisms to explain adverse effects of ‘ultra-processing’ on health is limited. As the links between excess consumption of saturated fat, sugars and salt and poorer health outcomes are well established, the British Nutrition Foundation supports approaches to reduce their consumption. Reformulation, with the potential of improving nutritional intakes without changing consumer behaviour, should continue to be part of a suite of strategies to improve the quality of our diets. Alongside dietary advice to consume foods such as fruit and vegetables, wholegrains, pulses and other good protein sources, consumers need to be supported to choose healthier versions of processed foods and this can include some nutrient-dense, affordable UPF. In countries such as the UK, UPF are currently reported to make a significant contribution to total dietary intake. Whilst support to reduce intakes of less healthy processed foods is important, blanket advice to avoid all foods that would be classified as UPF may have unintended consequences that have not been fully investigated for different groups within the population.
Discussions on the concept of UPF bring a welcome opportunity to highlight the importance of healthier dietary patterns. SACN’s recent review (July 2023) evaluated the classification and suitability of UPF as a dietary exposure. The Committee identified some concerns around the practical application of the NOVA classification in the UK. It suggested that it was not always possible to correctly classify foods to the NOVA categories based on current data from the National Diet and Nutrition Survey (NDNS). In particular, they raised concern about the classification of some foods not being consistent with existing UK dietary advice. SACN concluded that the observed associations between higher consumption of UPF and adverse health outcomes warrant further investigation. However, the limitations in the NOVA classification system, the potential for confounding, and the possibility that the observed adverse associations with UPF are covered by existing UK dietary recommendations as these foods can be energy dense and high in fat, sugar and salt mean that the evidence to date needs to be treated with caution.
At present, the British Nutrition Foundation believes that due to the lack of agreed definition, the need for better understanding of mechanisms involved and concern about its usefulness as a tool to identify healthier products, the concept of UPF does not warrant inclusion within policy (e.g. national dietary guidelines). Strong and comprehensive action to improve the food environment is critical to reduce the high prevalence of obesity and non-communicable diseases. In addition, research to improve our understanding of the mechanisms linking ‘ultra-processing’ with adverse health outcomes is warranted to provide translatable advice to manufacturers and retailers in relation to any other aspects of foods/drinks, beyond their nutritional composition, that may influence healthier dietary choices.
- There is good evidence that energy-dense, nutrient poor dietary patterns, with high intakes of foods high in saturated fat, sugars or salt (HFSS), are detrimental to health. Dietary patterns higher in fibre, vitamins and minerals, based on nutrient-rich foods such as wholegrains, fruits and vegetables, fish, pulses, nuts, seeds and dairy foods, are associated with better health outcomes. Such diets are the basis of national and international dietary guidelines.
- In UK policy, HFSS foods and drinks are defined using the FSA nutrient profile model which also considers beneficial nutrients/food components (e.g. fibre, protein, fruit, vegetables and nuts). Many foods that would be classified as UPF have poor nutrient profiles, are high in ingredients widely recommended to be limited and low in ingredients we want to encourage (e.g. some biscuits, confectionary, cakes and fried/salty snacks). However, the definition of UPF can also include foods such as sliced wholemeal bread and lower sugar wholegrain breakfast cereals which can contribute to an affordable healthy, balanced diet.
- Classification systems that categorise foods based on the ‘extent of processing’, are not universally accepted. The most widely used and applied UPF definition is from the NOVA food classification system but this has been criticised for being too broad across and within categories. For example, a lower sugar wholegrain breakfast cereal with chicory inulin isolate, a high sugar refined breakfast cereal, a multi-seed sliced wholemeal loaf and a white sliced loaf would all be classified as UPF. It has been suggested by critics that NOVA is difficult to interpret, challenging to apply robustly to dietary data (e.g. food frequency questionnaires are usually not validated to assess UPF intake) and its scientific rationale has been questioned. As it can imply that expensive artisanal products are superior for health, the health equity of advice to limit intake of UPF in the current backdrop of rising food insecurity and the cost-of-living crisis is also an important consideration. The UPF NOVA 4 definition also includes foods and drinks needed for medical or nutritional purposes (e.g. gluten free products, fortified plant-based milk alternatives), for which there is often no accessible or convenient alternative.
- Research has linked high intakes of UPF with a range of adverse health conditions including obesity, cancer, type 2 diabetes and cardiovascular diseases, irritable bowel syndrome, depression and frailty conditions and all-cause mortality. However, this is largely based on observational studies that, by design, cannot demonstrate cause and effect. As much of the research is observational, good quality studies on possible mechanisms by which particular risk factors (e.g. aspects of processing, specific ingredients or packaging types) may cause ill health are needed. Understanding why research has indicated diets high in UPF are linked with poor health is crucial, particularly as food processing encompasses a broad spectrum of processing techniques. For example, the impact of food texture and food matrix integrity on health could have relevance to healthier food innovation.
- The food environment is a key driver of diet-related poor health, facilitating the easy accessibility of unhealthy dietary patterns. There is an urgent need to increase the availability, affordability and desirability of healthier diets. Processing can play an important role here, as well as in food safety and in extending shelf life, a consideration in terms of access to affordable nutrition and reducing food waste.
- It has been estimated that over 50% of the calories we consume in the UK are from foods that would be classified as UPF. Whilst industry has a responsibility to develop, market and promote healthier options, blanket messaging to consumers, via policy tools or nutrition communications, to avoid or reduce UPF may have unintended consequences. Demonising all processed foods could foster feelings of guilt and stigma around food choices, adversely impacting intake of more affordable sources of nutrients. Increasing cooking skills is undoubtedly to be encouraged, but negative messaging could imply we have to spend more money on unprocessed foods and more time in the kitchen to prepare healthier meals completely from scratch, when this is not the case. Some foods that would be classified as UPF such as vegetable-based sauces can aid the preparation of low-cost nutritious home-cooked meals, by combining these with basic ingredients such as a protein source (e.g. canned fish/pulses), wholegrain or higher fibre starchy foods and vegetables. Alongside improvement to the food environment, we would like to see innovative, inclusive and actionable support to help consumers identify and prepare nutrient-dense, healthier meals and snacks, which can include healthier processed foods.
- It is useful to consider whether messaging to avoid UPF might discourage industry from reformulation to improve the nutritional profile of products.
- As food processing plays a relevant role in food system sustainability and ensuring food security, consideration also needs to be given to the environmental impact of different UPF to support advice on healthier and more sustainable dietary choices.
Our position statement along with background information can be found as a pdf file at the bottom of this page.
The British Nutrition Foundation receives no direct financial contribution towards its Position Statements, and the final content reflects the views of the authors alone.
The British Nutrition Foundation’s funding comes from: membership subscriptions; donations and project grants from food producers and manufacturers, retailers and food service companies; contracts with government departments; conferences, publications and training; overseas projects; funding from grant providing bodies, trusts and other charities. For a list of our current members please see https://www.nutrition.org.uk/our-work/support-what-we-do/corporate-membership/current-members/.
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