E162: Ultra-processed Foods Need a Warning Label to Protect Consumers

Thursday, March 3, 2022
Related to: Addiction & Food | Food Industry Behavior & Marketing | Food Policy | Food Safety & Food Defense | Ultra-processed Food & Additives |

In today’s podcast, we’re talking about ultra-processed foods. Our guest today is Trish Cotter from the global public health organization Vital Strategies. She’s the author of a new commentary published in the BMJ Global Health calling for warning labels on ultra-processed foods.


Interview Summary

First I’d like you to tell us, what our ultra-processed foods? And how do you think they’re affecting health?

So as you mentioned in the introduction, I lead the food policy work for Vital Strategies. Our team supports partners and governments to introduce high-impact policies aimed at creating a healthier food environment. Now, these policies that we focus on are taxes on sugary drinks and junk food, restrictions on marketing of unhealthy food, especially to kids, and front of package labels on foods that are high in fat, salt, and sugar. The common denominator amongst all these policies is ultra-processed foods. So your question, what are ultra-processed foods? They’re foods that you can’t make at home in your home kitchen. In fact, as you said, this debate about whether they’re even foods at all, and you’ll find them on the supermarket shelf, packed full of them, soft drinks, breakfast cereals, ice creams, frozen prepared dishes. They’re products that go through many manufacturing steps which alter the food from its natural state, and they’re quite literally torn apart and put back together again with the addition of a cocktail of preservatives and flavors and colors. And what we get at the end of it are products that are packaged, ready to eat, hyper palatable. Some research is indicating that they’re addictive and ultimately leading to long-lasting consequences on a person’s health.

So you’re completely in agreement there with some of our other guests who have spoken about ultra-processed foods and noting the dangers of them. Why do you think the public has remained unaware of the risk of these foods?

One of the reasons is that the term itself is relatively new. It’s coined by Brazilian professor Carlos Monteiro in about 2009, and while the research community’s quite familiar with it and have been researching it over this period of time and increasingly so, there’s been limited data about the public’s understanding of ultra-processed products. So part of the Bloomberg Philanthropies Food Policy Program, Vital Strategies supported some studies in Brazil and Colombia in 2017 and ’18, which included several questions on public perceptions of ultra-processed foods or products. And what we found was clear evidence of the food and beverage industry’s success, really, at marketing these products where we saw a significant number of people associate them with satisfying cravings, being tasty, bringing happiness and joy, and you can all understand what those products are. Also, they associate them with family, social gatherings, children, ease, and even breakfast and physical activity. So the evidence also was really enlightening in that we found was that, while people aren’t really familiar with the term, they recognize the group of products as harmful. So it makes sense to them that this scary sounding word, ultra-processed products, could be harmful.

What are your thoughts on the food industry involvement in food environments and food policies?

So look – unhealthy products, unhealthy diets are responsible for an estimated 11 million preventable deaths each year, and with this at the forefront of our minds, we cannot forget that food and beverage companies’ first responsibility is to their shareholders, not our health. So let’s have no illusions about why they may seek to be involved in food policy. The industry also has a vested interest in maintaining the status quo of continuing to freely promote thousands of individual products that they have us believe are tasty and convenient, but in fact, as we’ve described, they’re full of nasties and harmful to our health. So while there are thousands of individual harmful products, they cannot be really targeted by public health policy. But the minute they become known as one, for example, ultra-processed foods or a collection of foods that are high in fat, salt, and sugar, governments will find ways to regulate them, and that’s when we’ll see large corporations flex their muscles. Letting the industry engage in policy solutions usually leads to ineffective or weakened policy at best. They’re part of the problem, and while they need to be part of implementing the solutions, they cannot be part of the policy making. Health policy is for health experts. That process can’t be muddied by commercial interests.

You’ve just answered this question, but it’s an interesting one to talk a little further about. When an industry feels under threat from litigation or regulation, legislation, one thing they typically do is say, “You don’t need the police us. We’ll police ourselves, and we’ll come up with these self-regulatory efforts, and we’ll abide by this, or we’ll create that standard.” They do a lot of that kind of thing. It doesn’t sound like you’re not optimistic.

Absolutely, and in fact, I’m less than optimistic. I’m convinced, and we’ve seen lots of examples worldwide, that voluntary agreements don’t work. And of course that’s what the industry will propose because that’s what they can live with, and that’s how they will continue to go on the path of least resistance. But it’s incumbent on governments and public health practitioners to respond decisively and to implement strong mandatory policies so that we can advance the public’s right to healthy and nutritious food because the fact that over 50% of the calories that they’re consumed in US, for instance, ultra-processed means that these companies have just gone ahead and managed to take over our food environment without any opposition, and it’s time they were held to account.

I agree with you entirely. All you have to do is read about how other industries have responded under these circumstances to know what the food industry was likely to do. And yet we still let them do it. For example, marketing foods to children – they created a self-regulatory effort that then the field has to spend a lot of time proving doesn’t work. But now those things have been proven, and so the time to expect industry to change on its own seems to have long passed. So I agree with you that coming up with better regulations makes perfect sense. Let me ask you about obesity rates during COVID. Then I’d like to come back and ask about ultra-processed foods in particular. So the rates have risen in some parts of the world during COVID, obesity rates, that is, including the United States. What’s your take on this?

I think that COVID-19 really exposed the vulnerabilities in our food system. And what it did was accelerate an already alarming trend in our global weight status, I guess, is the way to describe it. But also what happened is that, throughout the pandemic, many people were faced with food insecurity for the first time in their lives, and almost all of us have seen shifts in availability and supply. So when there’s no food available, hardly any food available, any food is better than no food, and one of the things that the industry did so well during the pandemic is capitalize on it. They used that opportunity to really lift their corporate social responsibility profile. One of the things we must do is not blame the individual who often have very little control over their food environment. We think we’re making our own decisions when we are purchasing food, but really, someone else is pulling the strings. Many times, a large food or beverage company has made that decision for us before we even get to the supermarket by setting prices, designing products that are easy and convenient and that look good, look tasty and nutritious, but in reality, they’re something quite different. And even before the pandemic, worldwide palates and brains have been trained to crave these unhealthy foods, and we know that the industry has invested millions upon millions in formulating and marketing them to be highly desirable. So the person who’s the consumer is very much like a puppet.

It’s an interesting way of thinking about it and deadly combination of vulnerable biology, industry exploiting that biology, and the heavy marketing of foods makes for a pretty powerful picture. So what are some of the possible solutions? What do you think that public health community and policy makers and advocates and others can do to raise awareness?

Well, I think we really have a responsibility to warn consumers about the harms of ultra-processed foods. At the moment, they’re in the dark. So what could we do really is the question. What could we do to warn them? The first thing in our favor is that the term ultra-processed food, as I said earlier, is really unfriendly, and people can conceive that these products as being unhealthy, and most recognize them in our research as being harmful. So we can use this to our advantage to fight against industry marketing efforts. Just like the marketing industry builds a brand around a product, the public health community needs to build meaning around this term ultra-processed to alert consumers about its harms. We can also look at past movements like tobacco control and see where the public health community has achieved huge policy wins in strong public understanding of the consequences of consuming a dangerous product. Raising awareness is incredibly important. We’ve spent over 50 years educating the public on the harms of tobacco. We’re going to need to do that for this category of products. We can also add information about the level of processing to food packages and warn about the products that are ultra-processed. Evidence shown that and our own consumers to make healthy decisions through clear front of package labeling really has a positive effect. We know that most shoppers spend 10 seconds or less selecting each food and beverage item. They need quick and easy ways to select the healthiest foods to avoid unhealthy foods. A number of countries, particularly Chile, Mexico, have introduced front of package warning labels in an effort to address poor diets. If in these examples we could further strengthen the warning labels by adding the descriptor, “This food is ultra-processed,” we would be further educating the community about which foods are safe to consume and which aren’t.

That raises a very interesting point that I know these warning label systems that you’re talking about tend to score foods according to being high or low in particular nutrients. So foods high in sugar, for example, would get a poor score. And I think the point that you’re making, that’s very well taken and others have made as well, is that there’s something about these ultra-processed foods that is damaging beyond the fact that they carry lots of bad nutrients with them. It’s the processing itself that is part of the reason our human biology is being thrown off. So if that’s the case, then labeling these would be very interesting. It might be pretty simple to take these existing labeling systems and just add an additional criteria for giving a food a poor score. It sounds like you’re optimistic that this could occur given that it’s occurring in some countries already.

Yes, I do agree with that. The opportunity here is that when industry reformulate their product as they do in some countries if they’re able to reduce the levels of fat, salt, and sugar in their products to avoid with the label, it doesn’t stop the product from being ultra-processed. So what we are trying to avoid is the situation where we see no labels on ultra-processed products, so no warning labels for fat, salt, and sugar, but the product remains ultra-processed and, therefore, it’s still harmful. So this is one proposal that might help mitigate that. It might help the public continue to understand that it’s not just the fact of these single nutrients that are harmful, but it’s the whole product that can be dangerous to people’s health.

Trish Cotter is the global lead for the Food Policy Program at Vital Strategies. She has extensive experience aligning strategic communications to achieve policy and behavior change outcomes across several areas of public health including food policy, tobacco control and cancer prevention and screening. Trish is the lead author of a new commentary published in BMJ Global Health: ‘Warning: ultra-processed’ — A call for warnings on foods that aren’t really foods. She holds a master’s degree in public health from Monash University in Melbourne, Australia


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