On Nutrition

Ultra-processed foods have been blamed for all manner of health ills. But what are these foods, exactly? Are they all lacking in nutrition? Should we avoid them? It’s complicated.

Identifying ultra-processed foods should be easy, thanks to the “clear and simple” NOVA classification system. However, a recent study found that even food and nutrition experts find it challenging to identify ultra-processed foods. These experts were asked to assign 231 foods to these four NOVA groups.

  • Minimally processed foods. “Single-ingredient” foods such as broccoli, salmon or spices that — at most — have been squeezed, chilled, frozen, dried, pasteurized, ground or precut. Also includes pasta and plain yogurt.
  • Processed culinary ingredients. Includes oils, butter, honey, maple syrup, sugar and salt.
  • Processed foods. Includes salted nuts, fruits in syrup, and smoked meats — as well as foods that have been canned or bottled. Also includes fermented foods such as artisan breads, many cheeses and sauerkraut.
  • Ultra-processed foods. Made from ingredients and processes not available for the home kitchen. Examples include carbonated soft drinks, packaged snack foods, candy, ice cream, mass-produced breads, breakfast cereal, chicken nuggets, hot dogs, frozen pizza, and “instant” soups and noodles.

More than half the foods were branded packaged products with a complete list of ingredients. The rest were “generic” food items with no specific list of ingredients provided. Only three packaged foods and one generic food were consistently assigned the same group. Most foods were assigned to two or three different groups — or even to all four. In other words, ask a different expert how processed a food is and you will probably get a different answer.

So what about nutrition and health? A recent systemic review and meta-analysis published in the American Journal of Epidemiology found that the highest consumption of ultra-processed foods was associated with a higher risk of death compared with the lowest intake. However, high consumption of breakfast cereal was associated with a lower risk of death. That suggests that all ultra-processed foods are not created equal. More importantly, given that association is not causation, studies like this raise questions about who is eating the highest levels of ultra-processed foods — and how does that coexist with other factors that contribute more significantly to poor health? For example, income, food access and housing status. Is it the ultra-processed food that’s the problem, or is it the constant stress of living a life where ultra-processed foods are your only realistic option? Stress damages every organ system.

When I used to volunteer at food banks, when someone came in who was unhoused, we would pick out foods that were nonperishable, didn’t have to be cooked, and didn’t require a can opener. Ultra-processed foods were a lifeline. For those of us fortunate enough to have a home and a kitchen with a working refrigerator and stove, adopting a zero-tolerance policy for ultra-processed foods can feed an unhealthy relationship to food, contributing to food obsession and possibly what feels like out-of-control eating if we do find ourselves dipping into a bag of chips.

Logically, an exclusive diet of frozen pizza and soda is going to lack important nutrients and contain excessive sodium and added sugar. But many rigid “healthy” diets can also lack some key nutrients and may trigger an eating disorder. And those “healthy” faux meat burgers that are so popular? Yep, ultra-processed. If you have the privilege of an adequate food budget and good food access, a varied, nutritious, enjoyable diet can absolutely include favorite foods that, yes, might rank high on the processing scale.