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What are ultra-processed foods and can they help dietary guidance in Australia?

The idea of ultra-processed foods (UPFs) as defined by the Nova classification system is gaining traction with more research showing associations between their consumption and poor health outcomes.

With the review of the Australian Dietary Guidelines currently underway, there is a temptation to include advice to limit or avoid UPFs, as have some other countries such as Brazil and Malaysia. But there are critics who question the validity, reliability and usefulness of the Nova classification system to identify unhealthy foods. The question remains whether this system is worth using in Australia and New Zealand.

What are UPFs?

Ultra-Processed Foods (UPFs) are defined as part of the Nova classification system developed by Carlos Monteiro and colleagues in Brazil and divides foods into four categories: unprocessed or minimally processed, ingredients, processed and ultra-processed foods. Essentially, UPFs are foods produced in a factory by processing and contain additives such as thickeners, colours, emulsifiers, sweeteners; put simply, they contain ingredients never or rarely used in kitchens. The definition includes a large number of foods in the Australasian food supply, however the definition is imprecise and subjective so there is variability in how the classification is applied, even by food and nutrition experts. A survey conducted by the British Nutrition Foundation found consumers cannot reliably identify them either.

Discretionary foods are ultra-processed.

It is true that most nutrient-poor, discretionary foods are ultra-processed such as sugary drinks, confectionary, ice-cream, cakes, biscuits and salty packet snacks. There is no argument these should be limited for good health. But the key question is, are they less healthy because of their nutrient profile or because they are made in a factory? The Nova system discounts nutrient profile in classifying UPFs. For example, a butter cake made in a factory is a UPF, but a butter cake made in your kitchen is not and, by inference, home-made is healthier. 

Not all UPF are unhealthy

The definition of UPF is very broad, which makes drawing meaningful associations between intake and health status problematic. Nova cites foods made in a factory as nutritionally worse than foods made in the home or in a restaurant. For example, a frozen ready-meal of brown rice, chicken and vegetables is classified as a UPF by Nova but a butter shortbread biscuit made at home or a restaurant-prepared chocolate mousse is not. Flavoured yoghurt (a core food) is considered a UPF but making whipped cream with sugar and vanilla in a home kitchen is not. This is nutritionally counter-intuitive.

Many ‘core’ foods are ultra-processed

There are many core foods recommended in the Australian Dietary Guidelines classified as UPF by Nova, suggesting a shortcoming in its usability in the Australian context. For example, packaged breads and most breakfast cereals are UPF no matter what their nutrient profile or how many Health Stars they have. Flavoured yoghurts and milks are also classified as UPF, despite being nutrient-rich. A key method of improving the nutritional attributes of packaged foods- reformulation- is criticised by Monteiro and colleagues despite being recommended by the WHO (see News item 1) and actively pursued as a public health nutrition strategy.

There are many healthy and affordable food choices that would be classified as UPF. Australian research found 33% of the most nutrient-dense and low-cost foods in the Australian food supply were classified as UPF. Avoiding these so-called UPFs is problematic for households on limited income and would worsen, not improve, their diet.

Does Nova add anything useful?

We already have systems that help to identify healthier and less healthy choices. We have the ‘core’ and ‘discretionary’ foods described in the Australian Dietary Guidelines and the front-of-pack Health Star Rating (HSR) system. While the presence of food additives used in mass produced food automatically classify foods as UPFs due to suspect safety, the additives in foods in Australasia are subject to rigorous safety checking by Food Standards Australia and New Zealand (FSANZ) before they are permitted for use. 

The need to reduce discretionary foods for better public health and environmental sustainability is well established, casting doubt on the need for another classification system, especially one with such an untidy fit with a modern, complex and sophisticated food supply. In Monteiro’s published argument for incorporating UPFs into dietary guidelines, the term ‘discretionary foods’ could be used in place of ‘UPFs’  and reach similar conclusions.

Ideology or science?

Applying Monteiro’s Nova classification, you could infer that the solution to chronic disease and environmental degradation is simply to shun industrially produced foods and go back to cooking everything from scratch. This is idealistic, not realistic, in modern Australasia. Due to a range of social, economic, cultural and political factors, we are reliant on convenience foods. We have become attached to the variety, enjoyment -and healthy options- available in our food supply. 

There is much demonising of the food industry in the UPF debate, which ignores the consumer research and advances in food technology behind much modern food innovation that delivers what people need and want. Moreover, shunning food processing is incompatible with feeding an increasing global population with dwindling and degraded planetary resources. We must work harder with the food sector to make processed foods healthier and more sustainable. This work is happening.

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