MARCO ISLAND, FLA. — As debate ramps up over processed and ultra-processed foods (UPFs) — the nebulous dietary categories that include products such as infant formula, ice cream and shakes — rhetoric is not always linked to science-backed claims.

Erin Ball, executive director of the Grain Foods Foundation (GFF), during the North American Millers’ Association spring conference listed examples of the debate that have popped up not only in social media, but also in mainstream newspapers with national audiences. 

“It’s a fight, a wrestling match, and I think it’s interesting the debate is everywhere,” Ball said, pulling up a screenshot of an article posted to LinkedIn, complete with a photo illustration contrasting fresh fruits with waffles, donuts, croissants and chips. “The graphic is building this argument against this murky category of food, alongside the copy saying these foods are sneaky, that they’re not only bad for our bodies, but they’re messing with the planet.”

Another LinkedIn screenshot depicted hands holding prison bars made of pepperoni pizza, soft tacos, fried chicken and curly fries.

“The graphic is dramatic with the prison of ultra processed foods, the headline ‘Unveiling the Addictive Power of Ultra-Processed Foods,’” Ball said. “So, not only are they sneaky, they’re killing us, they’re killing the planet, they’re also addictive.”

UPF rhetoric has made it into the non-fiction shelves at booksellers, as well. Ball highlighted “Ultra-processed People,” by Chris Van Tulleken — a British physician who ate about 80% of his calories each day from UPFs for 30 days, tracking his health at his own clinic. Bell said it “really captured the passion and the conviction and that anger around ultra-processed foods. This and his other articles put forward a compelling argument, if you were looking for a compelling argument, because it’s a great example of the passion against this category of food.”

She broke down the history of the debate and the attempt to define some foods as processed and ultra-processed.

The sparks of the debate were fanned into flames by Carlos Monteiro’s 2018 article “The UN Decade of Nutrition, the Nova food classification and the trouble with ultra-processing,” Ball said, noting Nova, not an acronym, attempts to put the foods of the American diet into four categories:

• Green: unprocessed or minimally processed foods such as legumes, vegetables, fruits, starchy roots and tubers, grains, nuts, beef, eggs, chicken, and milk.

• Orange: processed foods such as bottled/canned vegetables or meat in salt solution, fruits in syrup or candied, bread, cheeses, and purees or pastes.

• Red: ultra-processed foods such as breast milk substitutes, infant formulas, cookies, ice cream, shakes, ready-to-eat meals, soft drinks, other sugary drinks, hamburgers, and nuggets.

Nova classification, first proposed in 2009 by Monteiro and other researchers at the University of São Paulo, Brazil, places 96% of grain-based foods eaten in the United States in the processed foods and ultra-processed foods categories, Ball said.

“From green, eat with almost reckless abandon, to red, foods that should come with a warning,” Ball said.

A study published in the June 2023 Journal of Nutrition was led by USDA scientist Julie Hess. She built a modeling study on a diet where 91% of energy is derived from ultra-processed foods, a premise Ball said fails to reflect American eating habits.

“No one eats that way, no one eats that many ultra-processed foods,” she said. “The average in America right now is 61% of energy, maybe a little less, so she adopted an extreme version of an ultra-processed foods diet and then held it up against USDA’s own measure of diet quality called the healthy eating index, which measures macronutrients, micronutrients, as well as nutrients to avoid, such as powdered sugar. She found a consumer could eat a better diet than the current average American diet by eating 91% of energy from ultra-processed foods. Which says to us that it really isn’t this category of ultra-processed, it’s choosing nutrient-dense foods wherever they land on that processing continuum. Her diets scored 86/100, a strong B-plus, while the average American diet was a 59/100.”

The USDA Advisory Committee, which maintains dietary guidelines updated in five-year cycles, has processed and ultra-processed foods under discussion. The group intends to examine consumers’ eating patterns, focusing on the impacts on growth, body composition and risk of obesity in the heaviest users of foods from the processed and ultra-processed categories.

Ball was skeptical the committee was well prepared to make recommendations on UPFs in American diets without more peer-reviewed research.

The issue of UPFs and potentially discouraging them has ethical implications.

“If you picture giving the whole population advice to stay away from those orange and particularly red column foods and picking through the best choices among those processed and ultra processed foods, that puts a lot of consumers at a real disadvantage nutritionally,” Ball said. “This is really bubbling up among academics and it’s the conversation that we and the group industry pushed forward as well.”

The classification and narrative around UPFs have proven confusing to consumers, according to a survey by the International Food Information Council, Washington, which found one in five consumers reported trying to eat fewer processed foods for health purposes, but also reported being conflicted about what UPFs are.

The food industry has opened a communication campaign on UPFs, Ball said, which has included registered dietitians writing on LinkedIn, on their own websites and other social platforms, usually on behalf of and in a relationship with the food industry.

A workshop on UPFs was convened in March 2023 by the USDA and included 16 representatives from academia, 10 representatives from the US government and six representatives of the private sector. The meeting yielded six pillars to complete to move toward science-based recommendations around UPFs.

“This is a long list and a deep list, this work needs to be done, and it is going to take years and decades really,” Ball said. “The way forward must be both research and communications. It’s going to be more powerful if public health folks and the food industry are working together on these efforts.”