What are Ultra-Processed Foods?

The Nova System of Categorization

The term ultra-processed foods is primarily attributed to Brazilian epidemiologist Carlos Monteiro. Like many health professionals, Monteiro was concerned by the rising rates of diabetes and obesity within the population. He sought to understand why these health problems were escalating in Brazil while the country was experiencing an overall increase in prosperity and decline in poverty. Monteiro observed a shift in the purchasing habits of many lower-income households. Despite buying less sugar and salt, two staples known to have a negative health impact when consumed in excess, the rates of diabetes and obesity were increasing, particularly among the nation’s poorer citizens. So, if they were buying fewer food ingredients of concern, why were negative health issues associated with poor diet growing? Digging deeper, Monteiro discovered that the reason consumers were purchasing fewer staples like sugar was because they were increasingly opting for prepared foodstuffs, such as highly processed canned goods, dry goods such as easy-preparation mixes, and processed, ready-to-eat foods.

To better understand consumer eating habits, Monteiro aimed to create a new system for categorizing foods based on the extent of processing they underwent from raw agricultural ingredients. He presented his findings in an article entitled “A new classification of foods” or Uma nova classificação de alimento in Portuguese.[1] This classification system is now known as the “Nova” system, derived from the Portuguese word for “new”. The Nova system categorizes foods into four groups according to the level of processing they have undergone prior to consumption.

The four categories in the Nova system are:

1. Unprocessed or minimally processed foods
   This category does allow for minimal processing through physical methods such as grinding, drying, filtering, freezing, vacuum packing, and similar techniques. Heating methods used in pasteurizing are also classified as minimal processing. Essentially, foods that are either fresh or undergo non-chemical preservation processes are considered unprocessed or minimally processed, as they may be consumed as is or used as ingredients in home cooking.
2. Processed cooking ingredients
   These are foods that are not typically consumed on their own but are instead used as ingredients in cooking. The processing methods are similar to those in the first category but also include traditional processes such as fermentation. Common examples of processed cooking ingredients include cooking oils, butter, sugar, salt, spices, and flour.
3. Processed foods
   These are foods created from ingredients categorized in groups 1 and 2. Canned vegetables, fish, or meats fall into this category, as do bread, cheese, and similar foods.
4. Ultra-processed foods
   These are foods prepared using ingredients such as flavors, preservatives, and processing aids that are not typically found in traditional (home) cooking. They may also be prepared using methods that are not found in traditional food preparation, such as hydrogenation.

Armed with this Nova tool, health experts found that consumers with diets high in ultra-processed foods experienced higher rates of dietary-related health concerns than those whose diets primarily consisted of unprocessed foods Can we therefore confirm that UPFs are inherently unhealthy and should be avoided, or at least limited in an individual’s diet? The answer is not as clear-cut as it may seem. Critics have noted several shortcomings to the Nova system, particularly its reliance on somewhat arbitrary categorizations. As in the above example, processing yogurt to create a low-fat version and then adding preserved, unsweetened fruit blend results in a product typically viewed as healthy, but it still falls in the UPF category. Similarly, a diet high in sugars is generally considered detrimental, whether the sugar comes from high-fructose corn syrup (which would be categorized as ultra-processed) or honey (which is unprocessed/minimally processed). Thus, the degree of processing alone may not have a health impact on the food.

The Debate on Ultra-Processed Foods

Despite its limitations, Monteiro’s study generated considerable interest around the world. Epidemiologists and health authorities began to explore whether the extent to which food is processed could have health and nutrition impacts. Some studies have proposed alternatives to the NOVA system to better correlate the degree of processing with potential health impacts.[1] Although some alternate models sought to incorporate nutritional components into their definitions, such as subdividing ultra-processed foods according to their salt, sugar, and fat content, they still primarily focused on the level of processing, defining high processing through methods used industrially rather than those typical of home cooking.

While several studies support Monteiro’s initial supposition that a diet high in ultra-processed foods is linked to health issues, few have identified specific mechanistic drivers. Furthermore, most health experts agree that the largest contributors to dietary-related health concerns are diets high in saturated fats, sugars, and salt, coupled with low levels of beneficial nutritional ingredients such as fiber, vitamins and minerals, and proteins. Ironically, some methods that maximize the healthy components of processed foods while minimizing those associated with poor health may result in the food being characterized as ultra-processed. Therein remains one of the major criticisms surrounding the definition or labeling of ultra-processed foods, as such labels can misrepresent nutritional value and distract from established dietary concerns.

This is not to suggest that there are no concerns regarding a high degree of processing. A key theory in contemporary research suggests that the link between ultra-processed foods and health issues is related to their nutritional density. Foods characterized as UPFs often have a very high caloric and nutritional content, meaning that the same quantity of processed food may contain more calories, fats, salts, and/or sugars as compared to traditionally prepared foods. Consequently, by eating the same amount of processed foods, consumers could be inadvertently consuming more of the nutritional content that is best kept to a minimum.

Conclusion

The efforts to correlate the health impact of foods to their degree of processing are intriguing and warrant further investigation. A deeper understanding of how processing, and the specific types of processing, impacts nutritional density is essential for determining the potential health implications of highly processed foods. Such understanding could inform consumer guidelines aimed at reducing diet-related health concerns.

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