Ultra-processed Foods: Are They Addictive?
A recent media headline
suggests that consuming ultra-processed foods (UPFs) initiates a response similar to consuming addictive substances like alcohol and drugs, in response to a publication in the British Medical Journal (1). The published analysis* suggests that UPFs high in refined carbohydrates and added fats may be addictive and identifies policy approaches (including taxes, warning labels, reformatting the food supply) to lower their overall consumption and improve population health (1). The PEN Team has previously addressed UPFs before in a variety of Trending Topics, related to cancer, mortality risks and overall consumption trends.
UPFs have been defined previously,
but generally refer to foods and drinks that contribute excess sodium, sugar or saturated fat to the diet (2) and foods that contain ingredients not typically available in home kitchens (1). UPFs are considered highly rewarding, appealing and can be consumed compulsively (1). Globally, research on UPF intake is growing, with the highest level of consumption of UPFs observed in the United States and the United Kingdom (3), and increasing energy contributions of UPFs to the diets of Canadian (4) and Australian (5) populations.
What does this mean?
The authors of the published article suggest that consuming UPFs may be addictive because behaviours around these foods meet the criteria for the diagnosis of substance use disorder in some people (1). Foods high in refined carbohydrates or fats lead to increased levels of extracellular dopamine in the brain. It is suggested that the ability of UPFs to deliver bioavailable rewarding substances to the brain rapidly increases their addictive potential. This also includes food additives, which increase sweet and savoury tastes and mouthfeel. Flavour-enhancing additives are also found in commonly addictive substances. The authors are clear that while all foods do not trigger addictive behaviours, the characteristics of UPFs most strongly influence addictive eating patterns, which are associated with an increased likelihood of poorer physical and mental health as well as a lower overall quality of life. The authors also note that no specific chemicals have been identified for foods, unlike nicotine for tobacco addiction.
The authors use the validated 11-symptom assessment Yale Food Addiction Scale (YFAS) (1), which was developed to measure food addiction compared with substance-use disorder classifications in the DSM-5 (6). By understanding UPFs as addictive, there is better capacity to mobilize novel approaches for social justice, clinical care and policy to promote the health of the public (1). This can look like the following:
- At the population level, reformulating foods to reduce saturated fat, sugar and salt is one strategy to mitigate public health risks associated with dietary patterns that rely heavily on UPFs (1,7).
- At the individual level, the authors suggest a UPF addiction diagnosis can improve access to clinical care, support and treatment (1).
- With respect to policy, appropriate classification of UPFs as addictive can help support regulatory and policy efforts to reduce overall consumption (1,8).
Criticisms of UPF classification remain. The criticisms have implications for advancing the framing of these foods as addictive and therefore, harmful.
- As pointed out in reviews of other studies on UPF consumption (4), the data largely relies on food frequency questionnaires not validated for foods classified as UPFs and use observational data (4,9). This limits the ability to prove the cause and effect of consuming UPFs and may be restricted to potential confounding behaviours, including factors related to income, physical activity and smoking habits, which differ from people who consume more UPFs than those who cook from scratch.
- Secondly, the nutritional value offered by UPFs is not necessarily represented. A recent study suggests UPFs can still be included in healthy dietary patterns, given they contain adequate amounts of most macro- and micronutrients (10). Thus, eliminating UPFs may not be necessary and may result in poor nutrition.
- Lastly, as pointed out by the authors, messaging related to decreasing the intake of UPFs can contribute to stigma (1), particularly within groups and communities who already experience stigma and bias due to their weight, race and socioeconomic status (11). Such messaging should be framed appropriately within the context of food consumption patterns, food insecurity and diet quality when making recommendations that benefit the population more broadly.
- Dietitians should continue to promote national healthy eating guideline recommendations to limit the consumption of highly processed foods and drinks while emphasizing whole grains, vegetables and legumes, lean meats, poultry, fish and plant-based alternatives. Water is the beverage of choice.
- Some available consumer resources include:
- At the same time, it is essential to acknowledge the socioeconomic implications of limiting access to ultra-processed foods. As acknowledged by the publication authors, UPFs are an important source of calories for many people worldwide (1). A wider reach and broader response are needed to address inequitable food environments globally (5,11).
- The PEN Team continues to review the latest evidence, including future directions in the science of UPFs.
Dietetic-related Position Statements
*The Food for thought 2023 analysis is part of a special collection of articles on the science and politics of nutrition to provide thoughtful perspectives and expertise on current knowledge and the quality of evidence. For more information: see: https://www.bmj.com/food4thought23
- Gearhardt AN, Bueno NB, DiFeliceantonio AG, Roberto CA, Jiménez-Murcia S, Fernandez-Aranda F. Social, clinical, and policy implications of ultra-processed food addiction. BMJ. 2023 Oct 9;383:e075354. doi: 10.1136/bmj-2023-075354. PMID: 37813420; PMCID: PMC10561019. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/37813420/
- Shared Services Canada. Canada’s Food Guide. 2019. Available from: www.canada.ca/FoodGuide.
- Marino M, Puppo F, Del Bo' C, Vinelli V, Riso P, Porrini M, Martini D. A Systematic Review of Worldwide Consumption of Ultra-Processed Foods: Findings and Criticisms. Nutrients. 2021 Aug 13;13(8):2778. doi: 10.3390/nu13082778. PMID: 34444936; PMCID: PMC8398521. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8398521/
- Statistics Canada. Health Reports. Consumption of ultra-processed foods in Canada. 2020 Nov 18. Available from: https://www.doi.org/10.25318/82-003-x202001100001-eng
- Coyle DH, Huang L, Shahid M, Gaines A, Di Tanna GL, Louie JCY, Pan X, Marklund M, Neal B, Wu JHY. Socio-economic difference in purchases of ultra-processed foods in Australia: an analysis of a nationally representative household grocery purchasing panel. Int J Behav Nutr Phys Act. 2022 Dec 12;19(1):148. doi: 10.1186/s12966-022-01389-8. PMID: 36503612; PMCID: PMC9742014. Available from: https://pubmed.ncbi.nlm.nih.gov/36503612/
- University of Michigan. Yale Food Addiction Scale. [cited 2023 Oct 31]. Available from: https://sites.lsa.umich.edu/fastlab/yale-food-addiction-scale/
- Campbell N, Browne S, Claudy M, Reilly K, Finucane FM. Ultra-Processed Food: The Tragedy of the Biological Commons. Int J Health Policy Manag. 2023;12:7557. doi: 10.34172/ijhpm.2022.7557. Epub 2022 Dec 26. PMID: 37579452; PMCID: PMC10125221. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10125221/
- Popkin BM, Barquera S, Corvalan C, Hofman KJ, Monteiro C, Ng SW, Swart EC, Taillie LS. Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating. Lancet Diabetes Endocrinol. 2021 Jul;9(7):462-470. doi: 10.1016/S2213-8587(21)00078-4. Epub 2021 Apr 15. PMID: 33865500; PMCID: PMC8217149. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217149/
- Dietitians of Canada. Trending Topics. Ultra-Processed Foods and Early Death. In: Practice-based Evidence in Nutrition ® [PEN]. 2019 Jun 6. Available from: https://www.pennutrition.com/TrendingTopic.aspx?id=27753
- Hess JM, Comeau ME, Casperson S, Slavin JL, Johnson GH, Messina M, Raatz S, Scheett AJ, Bodensteiner A, Palmer DG. Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods. J Nutr. 2023 Aug;153(8):2472-2481. doi: 10.1016/j.tjnut.2023.06.028. Epub 2023 Jun 24. PMID: 37356502. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/37356502/
- Earnshaw VA, Karpyn A. Understanding stigma and food inequity: a conceptual framework to inform research, intervention, and policy. Transl Behav Med. 2020 Dec 31;10(6):1350-1357. doi: 10.1093/tbm/ibaa087. PMID: 33421077; PMCID: PMC8218858. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218858/