In the current issue of the online Journal of the World Public Health Nutrition Association (of which I am a charter member), Carlos Monteiro, a professor at the University of São Paulo writes The big issue is ultra-processing. Because his Commentary is so lengthy, I am taking the liberty of extracting pieces from it, not always in the order presented.
The most important factor now, when considering food, nutrition and public health, is not nutrients, and is not foods, so much as what is done to foodstuffs and the nutrients originally contained in them, before they are purchased and consumed. That is to say, the big issue is food processing or, to be more precise, the nature, extent and purpose of processing, and what happens to food and to us as a result of processing.
Monteiro makes it clear that all foods and drinks are processed to some extent. Fresh apples are washed and, sometimes, waxed. Drinking water is filtered. Instead, he distinguishes three types of processing, depending on their nature, extent, and purpose:
The purpose of Type 3 ultra-processing is to create:
durable, accessible, convenient, attractive, ready-to-eat or ready-to-heat products. Such ultra-processed products are formulated to reduce microbial deterioration (long shelf life), to be transportable for long distances, to be extremely palatable (high organoleptic quality) and often to be habit-forming. Typically they are designed to be consumed anywhere in fast-food establishments, at home in place of domestically prepared and cooked food, and while watching television, at a desk or elsewhere at work, in the street, and while driving.
Monteiro argues: the rapid rise in consumption of ultra-processed food and drink products, especially since the 1980s, is the main dietary cause of the concurrent rapid rise in obesity and related diseases throughout the world.
As evidence, he notes that ultra-processed products as a group are:
Overall, he says:
Their high energy density, hyper-palatability, their marketing in large and super-sizes, and aggressive and sophisticated advertising, all undermine the normal processes of appetite control, cause over-consumption, and therefore cause obesity, and diseases associated with obesity.
His groups the main points of his argument in three theses:
Lest there be any confusion about the significance of this proposal for public health nutrition, an accompanying editorial (unsigned but assumed to be by Geoffrey Cannon) poses a serious challenge: Nutrition science: time to start again.
This editorial is about the significance of food processing, and in particular of ultra-processed food and drink products. It is also about the nature, purpose, scope and value of nutrition science, which as conventionally taught and practiced, is now widely perceived to have run into the buffers or, to change metaphor, to have painted itself into a corner.
The editorial argues that nutritionists focus on nutrients, rather than foods, has led to the assumption that if foods contain the same nutrients, they are the sameeven though it is never possible to replicate the nutritional content of foods because too much about their chemical composition is still unknown.
This notion is an exquisite combination of stupidity and arrogance, or else of intelligence and cunning. For a start, similar results can only be of those chemical constituents that are at the time known, and actually measured.
These are important ideas, well worth consideration and debate. I am struck by their relevance to the latest survey of soft drink availability in American elementary schools. Despite the efforts of the Clinton Foundation and the voluntary actions of Coca-Cola and Pepsi-Cola, the availability of soft drinks to young school children increased from 49.% to 61% just in the year from 2006-07 to 2008-09. Soft drinks, in Monteiros terms, are ultra-processed. Doing something about them requires statutory regulation.
Consideration of the effects of ultra-processing might help us look at what we feed our kids in a more constructive way. This is important work.
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