Abstract
All over the world, long-established dietary patterns based on a variety of unprocessed or minimally processed foods and freshly prepared meals made with these foods using processed culinary ingredients and some processed foods, are being displaced by ultra-processed foods. There is mounting consistent evidence from large cohort studies, and now by a randomised controlled trial, that displacement of unprocessed or minimally processed foods and freshly prepared meals by ultra-processed foods induces passive dietary energy overconsumption and increases the risk of obesity and other chronic non-communicable diseases, and of all-cause mortality. These studies also show that the ill-effects of ultra-processed foods do not depend only on the use of high amounts of fat, sugar or salt in their manufacture. Other likely mechanisms are due to ultra-processing itself such as the destruction of the food matrix and the loss of the synergy existing in the original foods between nutrients and other bioactive compounds. Or the presence of harmful substances created by high temperatures and compression or released by synthetic packaging material. Ultra-processing also depends on the use of a myriad of additives whose effects on health, cumulatively and in combination, are unknown. This is why ultra-processed foods reformulated with less salt, sugar or fat remain harmful to health. Official international and national dietary guidelines should all emphasize a great diversity of unprocessed or minimally processed foods, mostly plants, and freshly prepared meals, and clearly state that ultra-processed foods should be avoided. National dietary guidelines already do so in Brazil and a few other countries. This will benefit human health and well-being. It will also have social, cultural, economic and environmental benefits, including the support of local cooperative and family farming, retailing and catering businesses, and protection of non-renewable resources and biodiversity. Statutory policies and programmes should now be put in place, approximating to those now used to limit smoking and use of tobacco. They should also support, protect and encourage the production, distribution and consumption of unprocessed and minimally processed foods, and the preparation and enjoyment of fresh meals at home, schools, workplaces, hospitals, community facilities, and in modestly priced restaurants.
