Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing

Abstract

Background: As evidence grows about negative health impacts of ultra-processed foods, nutrient-centred advice is contested, and food-based dietary guidelines are increasingly utilised. Previous analyses of dietary guidelines evaluated their potential impact on health and sustainability, but little research has been conducted to examine how the concept of ultra-processed foods is reflected in dietary advice for consumers. This paper systematically analyses whether and how ultra-processed foods are represented in dietary guidelines internationally. Methods: Based on a systematic online search, the consumer-targeted key messages of 106 dietary guidelines were identified and a qualitative content analysis was conducted. A coding framework was developed to classify messages as ‘eat more’ or ‘eat less’ according to the language used (e.g. ‘choose’ vs ‘avoid’) and to differentiate between a focus on nutrients or food processing. Specific foods mentioned in ‘eat less’ guidelines were classified according to their level of processing using the NOVA framework. Results: 99% of guidelines utilised some type of nutrient-based message, either promoting ‘positive’ nutrients (e.g. vitamins) or discouraging the consumption of ‘negative’ nutrients (mainly salt, sugar and fat). Explicit references to food processing were present in 45% of ‘eat less’ guidelines and 5% of ‘eat more’ guidelines. Implicit references (e.g. promoting ‘raw’ or discouraging ‘packaged’ foods) were found in 43% of ‘eat less’ and 75% of ‘eat more’ guidelines. 53% of the specific foods referred to in ‘eat less’ advice were ultra-processed foods. Conclusion: Overall, nutrient-based messages were more common than messages about processing levels. The majority of discouraged foods were ultra-processed foods, however some minimally processed foods were discouraged, which points to tensions and contradictions between nutrient- and processing-based dietary advice. As dietary guidelines begin to include advice about food processing, it is important to consider both consumer understanding of the terms used and their capacity to act on the advice.

A systematic assessment of the revised Nutri‐Score algorithm: Potentials for the implementation of front‐of‐package nutrition labeling across Europe

“…In recent years, UPFs have been extensively investigated, and some studies have suggested that increased intake of UPFs can be linked to increased risk of NCDs (Food and Agriculture Organization of United Nations, 2019; Lane et al., 2021; Rauber et al., 2018). In this regard, UPFs have also become a part of many FBDGs that discourage their excessive consumption (Koios et al., 2022). Even though the main challenge of UPFs is commonly unfavorable nutritional composition, some studies suggest other negative impacts (Bonaccio et al., 2022).…”

How do we differentiate not demonise – Is there a role for healthier processed foods in an age of food insecurity? Proceedings of a roundtable event

“…The concept of UPF has been incorporated into advice of authoritative health bodies (Karlsen et al, 2022;Koios et al, 2022;Lichtenstein et al, 2021;Monteiro, Cannon, Lawrence, et al, 2019;WHO, 2021). However, the discussions that took place during the roundtable concluded that the concept of using processing solely to indicate the healthiness of food was not accepted by a group of diverse stakeholders or believed to be a useful tool at present in helping consumers to eat healthier diets.…”

Interdisciplinary insights on the future of food systems research: perspectives from the next generation of research leaders

“…National dietary guidelines are one important lever to promote healthy and sustainable food systems and diets, yet research suggests that few dietary guidelines present straight-forward advice regarding ultra-processed foods, instead reverting to euphemisms that can be exploited by food companies for marketing (17) . Understanding the gap between evidence and policy is a political question.…”