The guidelines could change the way Americans view nutrition by focusing on how their food is made and what happens to it before they bring it home.
By Anahad O'Connor November 7, 2023 at 6:00 a.m. EST
For decades, the federal government's dietary guidelines have urged people to eat plenty of foods rich in vitamins, minerals, fiber, and protein — while warning us to steer clear of foods high in sodium, sugar, and saturated fat.
But now, the scientific experts who shape the way we eat might start warning consumers against eating too many ultra-processed foods.
For the first time, the guidelines committee is examining the science on obesity and ultra-processed foods — industrially manufactured foods that have unusual combinations of flavors, additives, and ingredients, many of which are not found in nature. These include things like chicken nuggets, sweetened breakfast cereals, boxed mac & cheese, frozen dinners, potato chips and fast food.
The committee's conclusions could lead to a seminal change in how Americans view nutrition, forcing them to think beyond the basic nutrients in a food, and instead consider how their food is made and what happens to it before it reaches their table.
A big change to the country's diet
In recent years, dozens of studies have found that people who consume a lot of ultra-processed foods have higher rates of weight gain, obesity, cardiovascular disease, cancer, diabetes, and other chronic diseases.
Nutrition experts say that highlighting ultra-processed foods in the upcoming guidelines could have a significant effect on the country's diet and national food programs. The dietary guidelines help determine which foods can be served to the approximately 30 million American children who participate in the National School Lunch Program. The guidelines influence the food industry, food assistance programs, and agricultural production. They affect the types of meals served in government buildings and on military bases.
Critics have long argued that current health guidelines wrongly focus on individual nutrients and ignore the effects of processing and additives. This essentially allows food companies to meet basic nutrition requirements while engineering ultra-processed junk foods that carry marketing claims that sound healthy — such as "fat free," "less sugar," "high in vitamins" and "reduced sodium."
The National School Lunch Program, for example, allows schools to serve children meals consisting of Domino's pizza, Lunchables, Cheez-Its, and other ultra-processed foods that have been formulated to meet government standards for fat, protein, sodium, and whole grains. Yet many of these processed foods are loaded with additives. For example, the turkey in a box of Lunchables served in schools contains 14 different ingredients, including additives for texture, flavor and shelf life.
"It's important for the dietary guidelines to start talking about this," said Barry M. Popkin, a professor of nutrition at the University of North Carolina at Chapel Hill. "I hate the fact that kids are getting ultra-processed junk foods in schools when they should be eating healthy food. We're making them fat and unhealthy."
Pushback from the food industry
The dietary guidelines are updated every five years by the departments of Agriculture and Health and Human Services. The next edition won't be published until 2025, but an advisory committee is expected to issue its scientific report next year. One question the committee is examining is whether eating ultra-processed foods influences "growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance."
The lobbying campaign by the food industry has already started. At least a half dozen food industry trade and lobbying groups have written letters to HHS urging the government to be cautious about issuing a recommendation on ultra-processed foods. They say that industrial processing makes food safe, convenient, and affordable, and they argue that there's no accepted scientific definition for what exactly constitutes an ultra-processed food.
One group, the Institute of Food Technologists, wrote a letter addressed to HHS in September. Anna Rosales, the senior director of government affairs and nutrition for IFT, wrote that food processing helps "preserve food for longer and improve shelf life, which minimizes food waste, is more affordable for consumers since they waste less, and ensures food and nutrition security when fresh foods may not be available or accessible."
In another letter addressed to HHS in September, the American Frozen Food Institute, an industry group, was blunt: "The DGAC should not proceed with recommendations about level of food processing as part of dietary recommendations."
The letter was written by Jennifer Norka, the group's director of regulatory and scientific affairs. She said that the dietary guidelines advisory committee should recognize "that all foods can fit into a nutritious dietary pattern within moderation."
A passive intake of calories
Deirdre K. Tobias, a member of the guidelines advisory committee, said she could not comment on the guidelines while the committee's work is underway. But she said that the evidence from large epidemiologic studies showing that people who eat more ultra-processed foods have a higher risk of many diseases is "as compelling as it can be."
"I think there's clearly a critical mass of observational evidence that's been reached," said Tobias, an obesity and nutritional epidemiologist at the Brigham and Women's Hospital and Harvard Medical School.
Tobias said that more research was needed to understand the biological mechanisms behind ultra-processed foods and poor health. But she pointed to a landmark 2019 clinical trial carried out at the National Institutes of Health, which found that when people were fed a diet of ultra-processed foods, they consumed roughly 500 extra calories a day and quickly gained weight compared to when they ate a diet of mostly unprocessed foods.
Tobias said that ultra-processed foods appear to induce higher "passive intake" of calories beyond our energy needs, and that this leads to gradual weight gain and a higher risk of obesity-related diseases. She said the research indicates that it's something "inherent to these foods, which is a little bit scary but also a little reassuring because it might be easier to reformulate these foods than to change our overall food environment."
Lagging behind other countries
In a study published in July, a group of public health experts concluded that the United States lags behind other countries in addressing ultra-processed foods in its food policies. Jennifer Pomeranz, an author of the study, said it was "great news" that the guidelines advisory committee was considering a recommendation on ultra-processed foods.
"It would be a huge step forward," said Pomeranz, an associate professor of public health policy and management at the NYU School of Global Public Health.
At least a half dozen other countries have issued dietary guidelines in recent years explicitly urging people to cut back on ultra-processed foods. Mexico's dietary guidelines for example, which were published in May, warn people to "avoid ultra-processed foods such as processed meats and sausages, chips, crackers, cookies, sweet bread, and boxed cereals."
"I think there's sufficient evidence to recommend a reduction in calories from ultra-processed foods," said Marion Nestle, an emeritus professor of nutrition, food studies and public health at NYU. "I wouldn't say don't eat them at all — that makes no sense. But ultra-processed foods belong in a category of, ‘Don't eat too much of them.' "
Ultra-processed foods typically contain things like artificial sweeteners, synthetic colors, flavors, emulsifiers, and other ingredients that people don't cook with at home, Nestle said.
"If you can make it at home in your kitchen, then it's not ultra-processed," Nestle said. "When I give lectures on this, I find that people understand the concept right away. There's not much problem defining it."