The Health Impacts of Ultra-Processed Foods: A Special Report

A special issue of the American Journal of Public Health, published June 3, presents multiple studies examining the health impacts of ultra-processed foods (UPFs), public opinion on regulation, and historical parallels to the tobacco industry.

The research comes amid ongoing debate over how to define and regulate these products, which constitute over 50% of calories consumed by U.S. adults and approximately 60% by children.

Health and Cardiovascular Risk

Independent Health Risks Linked to Processing

For every 10% increase in calories from UPFs, participants showed higher body weight, worse blood sugar control, higher blood pressure, and higher prevalence of diabetes, metabolic syndrome, and cancer.

A study from the Food is Medicine Institute at Tufts University analyzed data from 10 cycles of the National Health and Nutrition Examination Survey (1999–2018). These associations remained after adjusting for overall diet quality and intake of saturated fat, added sugar, or sodium.

Senior author Dr. Dariush Mozaffarian stated that factors beyond nutrients—such as changes to cellular structure, additives, and chemical migration from packaging—may play an independent role.

Cardiac Event Risk

Participants consuming over nine servings of UPFs daily were 67% more likely to experience major cardiac events (heart attack, stroke, or fatal heart disease) compared to those consuming approximately one serving per day.

A separate study led by Dr. Amier Haidar of UTHealth Houston, published in the Journal of the American College of Cardiology, analyzed data from 6,814 adults aged 45–84 without pre-existing cardiovascular disease over 12 years. Each additional daily serving was linked to more than a 5% rise in cardiac event probability. The elevated risk persisted after controlling for calorie intake, overall diet quality, and existing health conditions.

Racial Disparity in Cardiac Risk

For Black participants, the chance of cardiac events associated with UPFs increased by 6.1% with each daily serving, compared to a 3.2% increase for other racial and ethnic groups.

Dr. Haidar attributed this disparity to socio-environmental factors, including limited access to healthy food options and unfavorable nutrition environments in predominantly Black neighborhoods.

Cognitive Health

Another study examined over 5,000 older Americans over 10 years and found a possible association between higher consumption of UPFs and increased risk of cognitive impairment and dementia, with caveats on recall accuracy and dementia assessment.

Public Opinion and Policy Support

National Survey (American Journal of Public Health)

Over 60% of Americans consider UPFs addictive and a major cause of obesity, Type 2 diabetes, and heart disease.

A survey of 2,000 U.S. adults conducted by Cornell University in June 2025 found:

• 58% have heard of UPFs, but only one-third feel confident explaining what they are.
• Nearly 70% believe these foods are addictive.
• Over 80% support government safety testing of lab-made chemicals before use in food.
• Roughly two-thirds support national education campaigns, advertising restrictions to children, banning dyes, and warning labels.
• A majority favor litigation or accountability measures against food companies.

Researchers noted strong cross-partisan support for interventions, contrasting with prior polarized debates on obesity and soda taxes.

PLOS One Survey

A separate study published in PLOS One surveyed nearly 1,000 Americans on support for six hypothetical policies targeting UPFs:

• Information-based policies (defining UPFs, dietary recommendations): Highest support.
• Restriction-based policies (in stores, schools, food assistance programs): Majority support, with highest support for school restrictions.
• Price-based taxation: Did not achieve majority support.

Support varied by political affiliation. However, support for school restrictions was equal across political affiliations.

Industry and Historical Context

Parallels to Tobacco Industry

Researchers including Laura Schmidt of UCSF reviewed tobacco company archives and found that in the 1980s, tobacco firms bought large food companies (Philip Morris owned Kraft General Foods; RJ Reynolds owned Nabisco) and applied marketing, flavor engineering, and processing technologies developed for cigarettes to food manufacturing.

A quote from a former Philip Morris CEO noted that UPFs and cigarettes were similar as low-cost consumer packaged goods with a large market.

Tobacco companies Reynolds and Altria did not respond to requests for comment. The Consumer Brands Association stated that member companies adhere to FDA safety standards and provide consumer information.

Policy Tools

An editorial by Kelly Brownell and Jennifer Pomeranz highlighted litigation by state and local attorneys general as a potential strategy, similar to tobacco lawsuits in the 1990s. The editorial warned against industry attempts to use federal preemption to block state and local measures.

Defining Ultra-Processed Foods: Expert Debate

The term "ultra-processed food" originated from the NOVA classification system developed by Brazilian researchers. The system categorizes foods by processing level:

• Unprocessed/minimally processed: e.g., an apple, frozen peas.
• Ultra-processed: Foods made from manufactured ingredients with additives such as artificial colors, flavors, emulsifiers, and preservatives (e.g., processed deli meats, packaged cookies, candies, sweetened beverages, frozen ready meals).

Focus on Processing vs. Nutrients

Experts disagree on whether policy should target processing methods or nutritional content.

Arguments for targeting processing:
Dr. Mozaffarian contends that "there's something about the processing itself that's important." He notes that high processing alters the physical and chemical structure of foods, leading to rapid digestion and quick absorption of sugars and starches, potentially increasing risk of insulin resistance and Type 2 diabetes. He cites evidence suggesting greater calorie absorption from UPFs compared to high-fiber whole foods.

Arguments for targeting nutrients:
Dr. David Ludwig of Harvard argues that the "ultra-processed" concept is too broad and may stigmatize healthy foods while promoting less healthy alternatives. He notes that some UPFs (e.g., whole-grain breads, plant-based milks, some yogurts) have been associated with health benefits in studies. The Institute of Food Technologists supports a definition prioritizing nutritional quality over degree of processing.

Consumer advice:
Julia Wolfson of Johns Hopkins advises that consumers can choose whole-grain options, reduce consumption of sugary beverages and processed meats, and read ingredient lists. She notes that finding non-UPF options is not always feasible and involves a "tradeoff" between nutrition and processing.

Current Policy Landscape

• Health Secretary Robert F. Kennedy Jr. has made statements linking UPFs to chronic disease and has promised a federal definition for UPFs.
• California has passed a ban on specific ultra-processed foods in school lunches.
• Some states have passed restrictions on synthetic dyes in foods.
• The Trump administration has initiated efforts to develop a federal definition for UPFs.

Key Expert Statements

Marion Nestle, food politics scholar, summarized the special issue's message to policymakers as "Do policy!" She described the system as "rigged in favor of profitable ultra-processed foods."

Dr. Haidar recommended that individuals evaluate their diets and consider replacing certain UPFs with whole foods, unprocessed meats, vegetables, and fruit. He suggested buying frozen options for cost-effectiveness.

Researchers proposed policies to make fruits and vegetables more affordable, including redirecting resources from food benefit restrictions on soda and candy to subsidizing local farmers. Several experts expressed support for redirecting corn subsidies to fruit production.

The special issue of the American Journal of Public Health was supported by a grant from Bloomberg Philanthropies.