In the year 2010, Dr. Carlos Monteiro, a Brazilian epidemiologist who holds the position of scientific coordinator at the Nutritional Epidemiology Research Center at the University of São Paulo in Brazil, achieved worldwide attention for his contribution to the development of the NOVA classification. NOVA was notable on a global scale for its introduction of the notion of ultraprocessed foods, which brought about significant changes in nutrition and public health, as well as causing discomfort in the food business. This was despite the fact that it was initially not based on sound mathematical explanations or randomized experiments.
Monteiro presented the most recent research that supports his classification during the International Congress on Obesity, which took place in São Paulo, Brazil. He participated in the discussion alongside Dr. Kevin Hall, a researcher from Canada who is a senior scientist at the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland. Up until that point, the study that Hall had been conducting had been driven by doubt regarding Monteiro’s views.
What Is Ultraprocessed Food
During the beginning of the meeting, Monteiro provided an overview of the fundamental premise of the NOVA classification, which classifies foods according to the level of processing they have undergone. The categories include foods that have been minimally processed or not processed at all, such as bagged beans and pasteurized milk; processed culinary ingredients, such as butter, olive oil, and sugar; processed foods, such as canned grains and vegetables, jams, and tomato paste; and ultraprocessed foods, which are products that are the result of aggressive fractionation of unprocessed foods, such as sodas, cookies, and frozen pizzas.
“Ultraprocessed foods were developed to serve as a substitute for fresh meals; they were not developed to supply the required proportion of nutrients or to enhance the sensory properties of the food.” This is accomplished through a number of different industrial methods. Industrial processes such as frying are used to prepare [foods] by hydrolyzing, hydrogenating, extruding, and other types of processing. Various cosmetic additives, including tastes, emulsifiers, colorings, and flavorings, are added to the products in order to make them more edible and long-lasting. All of these processes are what give the meal its name, “ultraprocessed,” and they have an effect on the overall quality of the food as well as on the health of the consumer, as Monteiro said.
He offered information from the scientific community regarding the dangers that are associated with the widespread intake of these items. The data from more than nine million individuals was reviewed in a systematic review that was published in February 2024. The analysis was carried out by specialists from a variety of institutions, including the Johns Hopkins Bloomberg School of Public Health in Baltimore and the University of Sydney in Sydney, Australia. A total of 32 health indices, including mortality, cancer, and disorders linked to mental, respiratory, cardiovascular, gastrointestinal, and metabolic health, were found to have direct relationships with exposure to ultraprocessed food, according to the findings of the research.
Monteiro also presented a study that he had conducted himself, which is currently being evaluated by his peers. According to the findings, ultraprocessed foods are today responsible for providing close to or even more than half of the calories that are consumed in the diets of industrialized countries like the United States of America, Canada, and the government of the United Kingdom. Consumption is also considerable in countries with a middle income, albeit in smaller amounts, though it is growing (for example, consumption is about twenty percent in Brazil).
Data from 93 different nations were evaluated for this study, which focused on the consumption and sales of ultraprocessed food between the years 2007 and 2022. According to the findings, there has been a consistent rise in the consumption of these products, particularly in nations with countries with low and intermediate incomes. Comparatively, countries with high incomes have shown signs of stabilization. This is due to a decrease in the sales of sugary drinks, which has been counterbalanced by an increase in the sales of other ultraprocessed foods, as Monteiro explained. There was a threefold increase in the amount of ultraprocessed meals that were consumed in China. Similar to the previous example, countries such as Brazil, Mexico, Korea, and Spain have also demonstrated increases in consumption of these products that are twofold to triple higher than before.
Additionally, Monteiro brought attention to a study that shown that individuals whose diets are high in ultraprocessed foods consume a significantly higher number of calories, frequently exceeding 5000 per day, which leads to weight increase. After conducting a post hoc analysis, the researchers came to the conclusion that the hyperpalatability and high caloric density of these foods are the primary elements that are contributing to the excessive consumption of these foods. The loss of the nutritional quality of foods as a result of ultraprocessing, which diminishes the quantity of important phytochemicals like flavonoids, was another topic that was brought up.
It is Monteiro’s opinion that these features constitute “a recipe for diseases.” The manufacturing process additionally “creates chemical contaminants, such as acrylamide and bisphenol, which have proven harmful effects on health,” according to the researcher. Additionally, he addressed the issue of reliance on food that has been extremely processed. According to him, approximately fourteen percent of adults and twelve percent of youngsters in the United States exhibit symptoms of addiction to these foods. Addiction may be exacerbated by marketing strategies that are forceful.
Monteiro underlined the importance of conducting additional study, despite the abundance of data that was presented. “We are not even close to having a finished comprehension. More specifically, we do not have sufficient statistics on countries with low incomes, particularly those in Africa. In addition, we have a limited understanding of the entire exposure to chemicals that are typically included in ultraprocessed meals. This includes the quantities of emulsifiers and other components, which are measured in micrograms or milligrams. In spite of this, the data is already adequate to suggest that public health actions be taken in order to offset the adverse effects of ultraprocessed food, he stated.
Evidence of the Concept
On the other hand, Hall began his presentation by highlighting the fact that the research he conducted on ultraprocessed meals was first prompted by the critiques that were leveled against the notion. In the beginning, I was in agreement with the comments that were made, which were fairly severe. On the other hand, I came to the realization that those who were condemning were not attempting to test the notion but rather being opinionated. Additionally, as a scientist, one of the things that we are required to do is develop tests in order to demonstrate whether or not we are correct, and that is exactly what I did,” he explained.
The purpose of the research conducted by Hall was to determine whether or not diets that are high in ultraprocessed foods are associated with excessive intake and weight gain. At our clinical center, we carried out a study in which twenty individuals who had maintained a steady weight participated. For a period of one month, we observed their dietary environment by randomly assigning them to one of two groups. Both groups were given a meal that was nearly exclusively composed of ultraprocessed foods, which accounted for 83% of the total energy in the diet, as stated by Hall.
In his explanation of the experimental design, he stated that the participants were free to consume the diets that were specified for them whenever they pleased. The participants were able to consume amounts that they deemed to be satisfying according to our methodology, which did not impose any specific constraints on weight gain or reduction. Essential components such as fat, sugar, fiber, salt, energy density, and glycemic load composition were analyzed within the diets that were being studied. They followed a diet consisting solely of ultraprocessed foods for the first two weeks, and then switched to a different diet for the final two weeks,” he explained.
Hall came to the conclusion that those who were opposed to the idea of ultraprocessed food were incorrect as a result of the research that was conducted and published in Cell Metabolism. This research was considered to be one of the first randomized controlled trials on the subject. Although I was wrong, it wasn’t a terrible thing. “In point of fact, it is preferable to demonstrate for oneself rather than to delegate the task to another individual,” he stated. According to our findings, individuals who consumed ultraprocessed food had a difference in their daily energy intake of 500 calories when compared to those who followed a diet that was lightly processed. While following the diet that was extremely processed, they unexpectedly gained weight, while following the diet that was little processed, they lost weight.
In light of the findings of the study, the topic of which possible mechanisms are responsible for excessive consumption of ultraprocessed food was raised. One of the hypotheses, which Monteiro agrees with, proposes that these foods might be addictive and lead to dependence on them. Hall’s investigation into the addictive potential of ultraprocessed food was prompted by this notion, which is analogous to hypotheses that suggest that addiction to ice cream and potato chips is equivalent to addiction to heroin. When he and his team wanted to assess the dopamine response in humans after they had consumed an ultraprocessed milkshake, they used methods that are considered to be standard from the National Institutes of Health in the United States.
Despite the fact that the research, which utilized positron emission tomography (PET) to locate and observe the dopamine receptors in the brain, did not find evidence of a massive dopamine release comparable to that which is associated with drugs, Hall emphasized that this study represents an important step in understanding how particular foods can influence brain reward pathways.
“It is possible that the detection method that was employed in the research is not sensitive enough to capture a considerable release of dopamine comparable to that which is found with drugs of abuse. “We are planning a new comparative study that will include a wider range of diets, ranging from those with minimally processed foods to those with high ultraprocessed food content,” he explained. For the purpose of expanding these findings, we are going to conduct this study.
In the Fight Against Ultraprocessed Food
Monteiro believes that in order to effectively battle ultraprocessed food, a diverse and robust approach is required, similar to the techniques that were utilized in the fight against tobacco. He suggested, for instance, the establishment of public health campaigns that would educate people about the risks associated with the consumption of these foods. In the course of these campaigns, warnings would be prominently displayed on the package, drawing attention to the potential health hazards linked with consumption. In addition, Monteiro is an advocate for the prohibition or severe restriction of advertising for ultraprocessed foods, as well as the adoption of policies that would eliminate the sale of these items in educational institutions and healthcare facilities.
An additional action that the expert proposes is the implementation of a high tax on ultraprocessed food, with the proceeds from the levy being used to subsidize foods that are fresh and barely processed. Taking this strategy, he suggested, would not only discourage the use of an excessive amount of ultraprocessed foods, but it would also make healthy foods more financially available to everyone. In order to underline the urgent need for stringent laws to protect public health from the harm caused by these goods, Monteiro drew attention to the similarities that exist between the marketing and lobbying methods employed by the ultraprocessed food sector and those employed by the tobacco industry.
During an interview with Medscape Medical News, Monteiro was asked about his expectations, and he responded by saying that it is highly improbable that the sector will forsake items that create high consumption and profitability. In addition, he noted that the industry is opposed to the idea of ultraprocessed meals because it indicates criticisms of the techniques that they have established in order to maximize their profits, despite the fact that these practices have had significant impacts on public health, such as the pandemics of obesity and diabetes. The researcher believes that there will be a turning point, not so much because of the initiative of the industry, but more because of the pressure from regulatory authorities and the mounting costs to the healthcare system. This prediction is made despite the fact that the researcher anticipates challenges.
“At some time in the future, this will become so obvious and costly that the industry will be forced to make appropriate adjustments. One of the difficulties is estimating how much time it will take. The scenario is comparable to that of global warming. People will eventually come to the conclusion that there is a need for change. What we need to know is whether or not we will have sufficient time. If we are only able to find solutions to these issues in twenty or thirty years, the damage will be severe. The situation will, without a shadow of a doubt, be resolved. Monteiro came to the conclusion that the problem is that we want things to be resolved as quickly as feasible for us.
The organization Pallium Canada has provided Pereira with stipends, and he is one of the cofounders of the organization. In terms of their financial links, Seow and Gallagher were not relevant.
