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The Public Health Impacts of “Addiction” to “Ultra-Processed Foods” - Recent Updates & Reflections

By Melissa Southwick posted 07-11-2022 15:22

  

Since my previous Public Health COI blog posts about food addiction (on January 13, 2020 and February 3, 2020) I’ve been incorporating information from the scientific literature (obtained via ongoing PubMed Alerts on this topic) into multiple professional presentations. Below are some brief summaries of newer points along with my personal musings from ongoing scientific and popular readings.

 

  1. The ongoing debate about alternative names for “food addiction” continued with someone suggesting “food use disorder”, while someone else complained that this term failed to capture the differentiation of highly processed foods being most implicated in the phenotype. Recently someone nailed a better diagnostic term which I hope achieves more common usage: "Instead of Food Addiction, the proposed disorder could be called 'hedonic hunger disorder' to encompass the notion of eating for pleasure, rather than to maintain homeostasis, which is the root of food addiction". (1)
  2. In a public health blog post in September of 2021 I commented on Herman Pontzer’s book about metabolism (Burn), which did a wonderful job explaining why addictive-like eating represents a mismatch between adaptive hedonic processes and today’s over-abundant food environments. In March of 2020 chef/writer Mark Bittman teamed up with David Katz, MD to coauthor a book titled “How to Eat” which further explained that “You don’t stop having Stone Age impulses just because they no longer serve you well in a modern world.” (2)
  3. An article outlined the conflicting goals of the commercial food system (for short term profits) and public health policy (for population health) listed here (3):
  • Commercial Food System Current Actions
    • Highly processed food production
    • Unhealthy fast food
    • Aggressive marketing of unhealthy foods
    • Defensive and offensive challenges to public interest
  • Public Health Policy Current Actions
    • Regulation - taxation, advertising restrictions
    • Mandatory nutritional back of pack labeling
    • Advisory front of pack labeling
    • Education - social marketing
  • Potential for Closer Alignment (although I have big doubts about this possibly happening)
    • More profitable retailing of minimally processed foods?
    • Reduced reliance on profits from highly processed foods?
    • Restaurants selling more wholesome foods
    • Voluntary policies restricting unhealthy food sales and promoting healthier sales?
    • Supportive public health regulation and frameworks for healthier, sustainable food systems?
  1. Another article explained that a higher consumption of ultra-processed foods (greater than 4 servings daily) was independently associated with a 62% relatively increased hazard for all-cause mortality. Each additional serving of ultra-processed food daily increased the mortality hazard by 18% (4). Until I see more published information about recommended limits for daily consumption of ultra-processed foods, knowing that highly processed foods make up at least 60 percent of the foods Americans buy I’m guessing that it is prudent to suggest limiting daily consumption of these products to less than or equal to only 3 servings per day.
  2. I believe we need to educate people about minimally processed foods, which have healthful benefits, versus ultra-processed foods for reduced consumption. We are currently not doing an adequate job helping people to avoid over consuming ultra-processed foods that increase risks for health problems. I’m hoping that we soon begin to see more health education resources driving consumption of less processed, more healthful food. Here’s one online from EatingWell Magazine (which has recently stopped publishing): https://www.eatingwell.com/article/281308/3-ways-to-limit-processed-foods-the-ones-you-should-keep-in-your-diet/ I have reached out to colleagues at CDC and NACDD to inquire about consumer literature currently available or planned for future development. I’ve shared this publication with them. It has a good summary of the four NOVA food groups regarding degrees of processing and health concerns (5).
  3. The gut’s nervous system, also called the enteric nervous system, is so extensive in function and communication with the central nervous system that some have referred to the gut as a second brain. A recent term you see in the literature is the “gut-microbiota-brain axis”. We’ve long known that the enteric nervous system plays a crucial role in homeostasis, but the newer evidence is that the gut microbiota are playing a critical role in the brain’s hedonic or mesolimbic systems (6).
  4. A recent popular book, Stolen Focus (7) had comments about how diet affects our metabolic health. The book makes the point that our “eating habits” and our “thinking habits” have connections, which many of us have not appreciated to date. For me, this book goes even deeper by hinting about the cultural problems imposed by ultra-processed foods. Not only have they impacted our physical health; these foods have also altered our taste preferences and robbed us of appreciation for subtle complex natural flavors and textures from plant-based foods that our ancestors appreciated and that now a shrinking minority of people with limited access to wholesome foods enjoy.

 

 

References:

  1. Takgbajouah M et al. Applying the developmental model of use disorders to hedonic hunger: a narrative review. J of Addictive Diseases. 2021; 40:47-55.​
  2. Bittman M. and Katz D. How to Eat - All Your Food and Diet Questions Answered. New York, New York: Houghton Mifflin Harcourt; 2020.
  3. White M et al. What role should the commercial food system play in promoting health through better diet? BMJ 2020;368:m545.
  4. Rico-Campa et al. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study.  BMJ 2019; 365.
  5. Monteiro, C et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019. Apr;22(5):936-941. doi: 10.1017/S1368980018003762.
  6. Novelle MG. Decoding the Role of Gut-Microbiome in the Food Addiction Paradigm. Int J Environ Res Public Health. 2021 Jun 25;18(13):6825.​
  7. Hari, J. Stolen Focus: Why you can’t pay attention - and how to think deeply again. New York, New York: Random House; 2022.
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8 days ago

Hi Brenda, 
Thank you for reaching out, and for your interest in sharing our blog. I have checked with Robin and she would be happy to have you share it. Please let me know if there is anything I can do to help you with that. I will be attending ADCES and am looking forward to meeting you! 
Kindly,
Melissa

8 days ago

Robin,
Thank you for sharing articles that address the controversies regarding ultra-processed foods
I am interested to hear more about the presentation you were preparing for your state Health department!
Will you be attending ADCES22?
Warmest regards,
Brenda

8 days ago

Melissa,

What an AWESOME blog!!! With your permission, I would love to post your blog in the Plant Based Nutrition COI.

When discussing a whole food plant-based pattern of eating, it is not simply eating more fruit, vegetables, grains & legumes and reducing intake of animal products ... it is eating more whole foods and less processed foods.

Will you be attending ADCES22?
I look forward to hearing back from you!

Warmest regards,
Brenda Jagatic BScN, RN, CDCES
Chair, Plant Based Nutrition COI

07-13-2022 11:25

Earlier this week I came across three excellent articles that address the controversies regarding ultra-processed foods: their health effects and the needs/challenges regarding public health policies. I'm in the process of extracting key takeaways for a presentation I'm doing at my state's Health Department next week, but here are the references for these timely informative articles:

Quinn, M et al. Upstream and downstream explanations of the harms of ultra-processed foods in national dietary guidelines. Pub Health Nutr 2021 24(16):5426.

Astrup A and CA Monteiro. Does the concept of "ultra-processed foods" help iniform dietary guidelines, beyond conventional classifications systems? NO
Am J Clin Nutr June 2022 https://doi.org/10.1093/ajcn/nqac123

Monteiro CA and A Astrup. Does the concept of "ultra-processed foods" help iniform dietary guidelines, beyond conventional classifications systems? YES
Am J Clin Nutr June 2022  https://doi-org.ezproxy.uvm.edu/10.1093/ajcn/nqac122