Andrene Chung | Ultra-processed foods and their effects on health

Living in today’s fast-paced world, convenience has become a priority for many, especially in food choices. Processed and ultra-processed foods have gained popularity due to the minimal preparation required, their palatability, and not to mention, their low costs.

Ultra-processed foods (UPFs) are products made predominantly from industrial ingredients and processes, which have little or no resemblance to the original foods from which they are derived. These foods are designed to be convenient, hyper-palatable, and ready-to-consume, often containing high levels of added sugars, unhealthy fats, salts/sodium, artificial flavours, colours and preservatives.

Examples of UPFs include sugary cereals, sodas, packaged snacks, reconstituted meat products, and some ready-to-eat meals. In fact, these ‘foods’ are better referred to as “ultra processed products” (UPP) since they are not foods in the real sense! The growing consumption of ultra-processed foods has been linked to various adverse health outcomes, which are increasingly evident across different age groups.

IMPACT ON CHILDREN AND ADOLESCENTS

Children and adolescents are particularly vulnerable to the effects of UPFs due to their nutritional needs for growth. A 2021 study by Juul et al highlights that a high intake of UPFs is associated with poor dietary quality among children and adolescents, leading to insufficient intake of essential nutrients such as fibre, vitamins, and minerals. This nutritional imbalance can result in delayed growth and development, increased risk of obesity, and the early onset of metabolic disorders such as type 2 diabetes.

Subsequent studies have corroborated this data, such as a recent literature scope review of the association between the consumption of ultra-processed foods and health outcomes, which emphasises that the aggressive marketing of UPFs towards younger populations exacerbates the problem. Pervasive food marketing has made these foods a staple in many children’s diets. This, combined with a sedentary lifestyle, significantly increases the risk of obesity, which, in turn, can lead to psychological issues such as low self-esteem and social stigmatization.

HEALTH CONSEQUENCES IN ADULTS

In adults, the consumption of UPFs is strongly linked to an increased risk of chronic diseases. A 2024 systematic review of meta-analyses in the British Medical Journal (BMJ) outlines that UPFs contribute to the development of cardiovascular diseases, obesity, and certain cancers. The high calorie density and low nutrient content of UPFs promote weight gain and fat accumulation, particularly around the abdomen, which is a significant risk factor for heart disease.

Other studies have also highlighted how UPFs can disrupt metabolic processes, leading to insulin resistance and chronic inflammation, both of which are precursors to a wide range of chronic illnesses, including type 2 diabetes and hypertension. These data suggest that the frequent consumption of UPFs might alter gut microbiota composition, promoting dysbiosis, which further contributes to these conditions.

MECHANISTIC INSIGHTS

The mechanistic insights into how UPFs affect health are becoming clearer. UPFs often contain additives and substances like emulsifiers, sweeteners, and preservatives, which are not only poor in nutrients, but can also induce physiological changes. These additives may trigger inflammation and oxidative stress, which are pathways involved in the development of chronic diseases.

Moreover, research data has shown how UPFs can alter hormonal responses related to hunger and satiety. The lack of fibre and protein in these foods means that they do not promote the same level of satiety as whole foods, leading to overeating. This disruption in appetite regulation is a critical factor in the increasing rates of obesity and metabolic disorders observed globally.

SOCIOECONOMIC AND PSYCHOLOGICAL EFFECTS

The consumption of UPFs is not just a health issue, but also a socioeconomic one. Zhang & Giovannucci (2022) suggest that lower-income populations are more likely to consume UPFs due to their affordability and accessibility. This creates a cycle of poor health outcomes that are harder to break due to limited access to healthier food options. Recent research also indicates that the stress associated with low socioeconomic status can drive people to choose these convenient but unhealthy food options, further exacerbating the health divide.

Psychologically, the high sugar and fat content of UPFs can create a dopamine-driven reward loop, similar to addictive substances, making it difficult for individuals to reduce their intake. This addiction-like behaviour is particularly concerning among vulnerable populations, such as children and those with mental health disorders, leading to long-term dependency and further health complications.

MITIGATING EFFECTS

The Caribbean has some of the highest adult obesity rates in the world, and an emerging crisis of overweight and obesity is facing up to one in three children in the region. Children from this region consume more sugar-sweetened beverages than anywhere in the world and more than triple the global average. Like many other small-island developing states (SIDS), Jamaica has experienced a nutritional transition driven by globalisation and trade liberalisation, resulting in a culture of diets characterised by excess consumption of UPFs high in fat, salt, and sugar, fuelling increasing rates of obesity and diet-related NCDs.

In response, there is an increasing momentum across the region towards the implementation of policies that empower locals and our Caribbean neighbours to make healthier food choices and to restrict, or altogether ban, the availability of unhealthy foods and beverages in schools. At a public health lecture at the University of Technology, Jamaica in November 2023, concerns were raised by Minister of Health and Wellness Christopher Tufton about the rise in the consumption of UPFs by Jamaicans, including children. Dr Tufton urged Jamaicans to be more mindful of their diets as “the cost of sickness is not worth the price of ultra-processed food consumption in excess”. Notably, research shows that an approximate 66 per cent of Jamaican adolescents aged 15 to 19 years consume fast food most days of the week.

MULTIFACETED APPROACH

Given the widespread consumption of UPFs, mitigating their health impacts requires a multifaceted approach. Public-health policies that regulate the marketing and availability of UPFs, especially to children, are crucial. Educational campaigns that promote the benefits of whole foods and the dangers of UPFs can also help shift dietary patterns. Global-health authorities such as WHO encourages action in a range of policy areas through a whole-of-government, health-in-all-policies approach. The goal is to improve food-system governance and overall quality of the populational diet and nutrition to ultimately promote health and well-being by creating healthy food and drink environments, promoting the gains of a healthy diet throughout life, especially for the most vulnerable groups and reinforcing health systems to promote healthy diets.

Regulating the availability and marketing of foods in school settings is one of a package of evidence-informed policy recommendations (including taxation of sugar-sweetened beverages (SSBs) and front-of-package nutrition-warning labelling) promoted by PAHO/WHO, the CARPHA (6 Point policy package, 6PPP) and the Healthy Caribbean Coalition’s Civil Society Action Plan 2017-2021, to tackle obesogenic environments. As suggested by Monteiro et al, there is need for clearer food labelling that helps consumers make informed choices. Governments can also incentivise the production and consumption of minimally processed foods by making them more affordable and accessible, particularly in low-income communities.

While UPFs offer convenience, their long-term effects on health are profound and alarming. The evidence from multiple studies underscores the urgent need to address this public-health issue through education, policy changes, and a societal shift towards healthier eating habits. Without such interventions, the burden of chronic diseases related to UPF consumption will continue to rise, affecting individuals and healthcare systems worldwide.

Dr Andrene Chung is a consultant cardiologist and chair of the Heart Foundation of Jamaica. Send feedback to ghapjm@gmail.com.