Ultra-Processed Food: What is it and is it Really That Worrisome?

Goodbye ice cream. Goodbye bread that stays fresh for weeks. Goodbye easy mid-week frozen pizzas and “healthy” frozen rice and veggie bowls. Goodbye easy on-the-go kids Clif bars? Goodbye everything that comes in a box or a bag whether it’s organic or not? Goodbye protein bars that are finally palatable?

In 2018, a report in the British Medical Journal (BMJ) suggested a link between ultra-processed foods and an increased risk for cancer. More recently, a study from JAMA Internal Medicine (published April 1, 2019) revealed that French adults 45 years or older who consumed 10% more ultra-processed food had a 14% higher risk of all-cause mortality. Another study in younger adults showed an even greater risk of death from ultra-processed foods. (According to published research studies, other ways to die an earlier death include sitting too much, eating fried chicken or seafood daily and smoking.)

“Ultra-processed” is not just a media buzz word or a new food avoidance trend. It is a term (and now commonly accepted food classification system) coined by Carlos Monteiro, a Professor of Nutrition and Public Health in Brazil. In 2009, Monteiro and colleagues suggested a link between the global surge in obesity and chronic disease to increasingly popular food production practices. Rather than just studying the effect food has on health by fat, carbohydrates, sugar, salt, protein, organic/non-organic for example, Monteiro created a classification system called NOVA that groups foods by their degree of processing: unprocessed (or minimally processed), processed and ultra-processed.

The NOVA system classifies foods this way:

Unprocessed foods have not been refined and do not have any added ingredients. Examples include fresh produce, dairy, whole grains, meat and fish. Think “farmer’s market”.

Processed foods have been altered in some way from their original state. Minimally processed foods include canned vegetables, canned broth, salted nuts, canned fish, plain yogurt, bran cereals, whole grain breads, tofu, cheese and smoked meats. These foods contain minimal additives and therefore have short ingredient lists. Pasta sauce and flavored yogurts are slightly more processed with added flavors and texturizers.

Ultra-processed foods, according to BMJ, are defined as “…formulations of food substances often modified by chemical processes and then assembled into ready-to-consume hyper-palatable food and drink products using flavors, colors, emulsifiers and . . . other cosmetic additives.” The formulation and the ingredients of ultra-processed foods make them highly convenient (packaged, ready-to-eat), highly palatable and highly profitable (due to low-cost ingredients). Because they are tasty, cheap and easy to eat, these products are consumed by people in ever-increasing proportions over natural/whole foods and freshly prepared meals. Examples include frozen meals, soft drinks, chips, candy, store-bought ice cream and ice pops, instant noodles, infant formula, energy bars and reconstituted meat products.

Ultra-processed foods are often high in sodium, sugar and fat. They usually have a low fiber content. They tend to be associated with a high glycemic response and become substitutes for unprocessed or minimally processed foods. Ultra-processed foods may contain additives like sulfites, be changed during the production process (e.g. high heat), or be packaged in materials that may be associated with adverse health effects like bisphenol A.

We all eat ultra-processed food. Fruits and vegetables have a short shelf life, but packaged mandarin oranges, for example, have a long shelf life. It takes time to make homemade granola but it’s easy and inexpensive to buy it in a box. Something labeled organic or natural that is in a box, bag or frozen is often ultra-processed. The “Healthy Choice” brand may not be so healthy after all. So how do we navigate this without getting overwhelmed?

Elizabeth DeRobertis, MS, RD, CDN, CDE, is Director of the Nutrition Center at Scarsdale Medical Group and has some suggestions for how to realistically decrease the amount of ultra-processed food in our lives. “I think it is unrealistic to avoid this completely,” she admits. “I think in moderation it is okay despite the headlines that are designed to scare us.” Elizabeth warns that we don’t want to instill the fear of eating anything unhealthy in our kids (called orthorexia), but that there are ways to buy, prepare and consume more conscientiously.

For breakfast, she suggests an omelet with fresh veggies. “For someone with less time, you can make ‘egg muffins’ (eggs and veggies baked in a muffin tray) in advance and just heat them up in the mornings. Hard-boiled eggs are another great option and you can purchase them already boiled and peeled at the grocery store.”

For lunch, she suggests trying to avoid the packaged breads with long lists of ingredients. “Instead, try to buy freshly baked bread or a brand like Dave’s Killer Bread that has minimal ingredients. And instead of ultra-processed bologna, salami or pepperoni, try fresh sliced turkey that only has salt and turkey on the ingredient list,” she says.

For snacks, Elizabeth agrees that whereas it would be great to always snack on fresh fruits and veggies, it’s generally unrealistic. “Sometimes the nutritional benefit outweighs things like a little bit of salt,” she says. “Some packaging also helps with portion size. Just because it’s packaged does not mean it’s ultra-processed.” Some healthier snack examples include 100-calorie bags of almonds, 100-calorie cups of guacamole with veggies, freeze-dried fruit packages and yogurt with fruit. As far as yogurt, Elizabeth recommends Siggi’s because even though there is added sugar, the total carbohydrate count is only 13 grams which is about the amount of sugar in a small piece of fruit. It also has 15 grams of protein and 150mg of calcium so it’s packed full of nutrients. Rx Bars offers bars for kids and have a very short, healthy ingredient list. (I personally always find these to be very sticky on the teeth.)

For dinner, Elizabeth recommends investing in an air fryer if your family likes the taste and consistency of fried or crispy food. “They have become very popular,” she said. “You can make the much beloved chicken fingers and chicken nuggets. You can make healthier versions of French fries, too.” For some healthier air fryer recipes, click here. For hot dogs, she suggests switching to a brand like Applegate Farms as they have far less ingredients than others, all of which can be identified. Another quick dinner suggestion is chicken lime burgers from Trader Joe’s. The ingredient list is a great example of the type to look for (short with things you can pronounce): ground chicken, onions, bell peppers, garlic, cilantro, natural flavor, salt, lime juice concentrate, red pepper flakes. Inspired by Elizabeth, I grilled these last night and they are rather delicious on a bun. (Of course, I then realized that my bun had about 104 ingredients.)

The bottom line is that though we cannot eliminate ultra-processed foods from our diets completely, if we understand the definition of ultra-processed versus minimally processed versus unprocessed, we can try to make more informed decisions when food shopping, cooking, packing lunches and snacks for school, getting take-out and eating at restaurants without going overboard.

Elizabeth recommends starting small with some healthier snacks. Please comment below if you have suggestions to share for less-processed meals or snacks that work for you and your family.