Ultra-processed foods and drinks (UPFs) have now been linked by a “mountain of epidemiological data” to at least 32 harmful health outcomes, including type 2 diabetes, obesity, depression, anxiety, cardiovascular disease and cancer. The evidence is so strong that American lawyers are “rubbing their hands [together]” in anticipation of class action lawsuits against big food manufacturers, says Ultra-Processed People author Chris van Tulleken, “just like we did with tobacco”.
Yet the UK has been slow to regulate UPFs. The highly effective sugar tax on soft drinks introduced by the Conservatives in 2018 covered only a small subset of ultra-processed food and drinks. Labour’s policy offering – banning junk food advertising to children, and the sale of high caffeine energy drinks to under-16s – looks anaemic in comparison to the revolution in nutritional advice, labelling and, increasingly, taxation that has taken place in Latin America over the last decade.
Proven efficacy.
These new policies are beginning to bear fruit. Brazil, which in 2014 overhauled its nutritional guidelines to recommend avoiding all ultra-processed products altogether, has seen a halving in the rate of increase in both adult obesity and UPF purchases.
Front-of-packaging warning labels used in Chile indicating that foods are high in calories, sugars, salt and saturated fat. Chilean Ministry of Health/Researchgate
The most widely-adopted policy in the Latin American toolkit – front-of-package warning labels – has proven much more effective than the UK’s own, traffic lights-style nutrition labelling system. Chile’s 2016 introduction of stop-style warning labels on foods high in sugar, salt, saturated fat or calories led consumers to purchase 24% fewer calories, 37% less salt and 27% less saturated fat from these foods, as well as 10% less sugar overall. Mexico’s own warning labels are expected to prevent 1.3 million cases of obesity, a reduction of 15%, saving $1.8bn in direct and indirect costs over five years.
By contrast, the UK’s traffic lights system has little effect on purchases, as multiple colours send mixed signals and the colour red elicits cravings when associated with food.
Decolonising food.
Part of the reason Latin American countries have moved fast to regulate UPF, public health nutritionist Vanessa Couto told Novara Media, is that the muscling in by western firms evokes memories of colonialism. While high-income countries still represent the largest volume of overall UPF sales, in recent decades emerging markets in the global south have accounted for the most growth. In 2000, sales of carbonated soft drinks across Latin America were worth about 60% of those in North America; by 2013, they had overtaken them.
The rapid erosion of traditional diets in favour of increasingly cheap UPFs has contributed to the perceived urgency of action. Across Latin America, ultra-processed foods and drinks account for around 20-30% of calories consumed, much less than the 50-60% they make up in the US and UK. Policymakers see this as the last chance to preserve rich traditional food cultures, which centre on sustainable local smallholder produce increasingly threatened by globalised agribusinesses. Latin America has also benefited from a home-field advantage, in that the paradigm shift from a focus on individual nutrients to a holistic view of how foods are processed, marketed and consumed originated in Brazil.
Carlos Monteiro, professor of nutrition and public health at the University of Sao Paulo, Brazil, came up with the term “ultra-processed food” in 2009 in response to an apparent paradox: rising obesity rates coinciding with falling raw sugar and oil purchases. He explained this via the growing consumption of UPF, defined in the Nova framework Monteiro helped devise as “industrially manufactured food products made up of several ingredients … and food substances of no or rare culinary use”. A wealth of evidence has since supported Monteiro’s conclusions. Ultra-processed food is formulated to be as cheap, long-lasting and palatable as possible, bypassing our body’s satiety mechanisms, disrupting the microbiome, and displacing more nutritious alternatives.
In 2014, Brazil overhauled its conventional food pyramid-based nutritional guidelines in favour of an injunction to “always prefer natural or minimally processed foods and freshly made dishes and meals to ultra-processed products”. The UK’s Eatwell Guide – created by Public Health England in 2016 to help people make healthy food choices – still centres around 1950s-style drawings representing food categories (starchy foods, fruit and vegetables, proteins) hard to map onto the ready meals and sandwiches that form much of our diet (though PHE does provide some variation on the guide for specific food cultures, eg Bengali). Brazil’s guidelines, by contrast, include real photos of suggested meals. They also frame food in the context of social lives, with recommendations to eat in company where possible; to make food an important part of your life; and to develop and share cooking skills.
A Bengali variation on the UK government’s Eatwell Guide. Public Health England/Gov.uk
Two years later, Chile pioneered black, octagonal warning labels on UPFs high in salt, sugar, or fat. Laws on versions of this system have now been introduced in 30 countries across Latin America and adopted in 11, typically in combination with a set of policies restricting their promotion and sale. Ultra-processed products “cannot be advertised, and they cannot be present in schools, and they can’t be purchased with public money”, says Fabio da Silva Gomes, a nutrition advisor at the World Health Organization, having a “huge effect on the diets and the food systems of these countries.”
Colombia went further this year by introducing a broad tax on ultra-processed foods, starting at 10% immediately and rising to 20% in 2025 – a global first which will be watched closely by the industry as well as policymakers worldwide.
Snakes and ladders.
The experience of Latin American countries in rolling out these policies offers several lessons on best practices, as well as pitfalls to avoid – chief among them navigating Big Food’s efforts to “weaken, delay, and impede these policies to keep their market as deregulated or weakly regulated as possible,” according to Gomes.
“Industry interference is huge in every political space,” public health professor Ana Paula Martins told Novara Media, and includes contact “directly with decision-makers”. Martins said that industry bodies such as the Brazilian Association of the Food Industry (Abia), the Brazilian Association of the Beverage Industry (Abir) and the Brazilian Association of Animal Protein (ABPA) have directly lobbied the country’s national congress against taxes on UPFs and urged the Brazilian Agency for Health Surveillance against approving front-of-packaging warning labels in 2019.
The best current system for regulating UPFs can be found in Argentina, where large warnings must be at the top and front of packages and cannot be accompanied by any health claims (such as “contains vitamins”). In Brazil, industry lobbying has meant that stop sign-like octagons were replaced by much less effective magnifying glasses that suggest additional information rather than offer warnings, and which can be located on the back of products rather than on the front. In Chile, manufacturers have discretion over placing labels at the bottom of packages. In Uruguay, the industry succeeded at raising the threshold for requiring warnings by 20% for sodium, 30% for sugars, 45% for saturated fats, and 50% for total fats. They also lobbied to substitute octagonal labels with traffic lights there, and successfully amended regulation in this direction in Ecuador.
“Having a very strong civil society and academia without conflicts of interest providing data for the government is essential,” added Martins, echoing Chris van Tulleken’s call to “disentangle all the charities that influence policy from the companies that make the food that is harming us.”
Another “very important barrier” to the success of anti-UPF measures, Martins said, comes from an older generation of academics “used to considering nutrients rather than processing”. Critics of the concept will sometimes point out that “ultra-processed food” is a capacious category, encompassing some products – like wholemeal sliced bread – associated with better health outcomes.
Moreover, it can be hard to categorise some margin cases among the thousands of industrial products on offer. At a recent World Heart Summit, King’s College nutritionist Dr Tom Sanders dismissed “airy fairy ultra-processed foods”, preferring to restrict foods high in salt, fat and sugar, especially crisps and confectionaries.
In at least one regard, the debate over language is unnecessary. Almost everyone agrees that the nutrients targeted by warning labels (salt, sugar, fat) cause harm, and – precisely because of ambiguities over categorisation – they are formulated without reference to the Nova processing framework. Yet when the thresholds for nutrient warnings are not watered down by industry lobbying, according to Fabio Gomes, they capture over 95% of ultra-processed foods.
Early days.
It’s too soon to tell whether the Latin American policy set will be enough to halt the rise in adult obesity, much less reverse it. Advocates point to the long lag time before regulations around tobacco cut lung cancer cases.
Still, other countries are beginning to take note. From 2026, Canadian products will feature “high in” warning labels, which are also being considered in the United States and multiple African and east Asian countries. France, Belgium, Portugal, Finland and Israel’s nutritional guidelines now recommend avoiding or reducing UPF consumption. Singapore and South Korea have restricted marketing of unhealthy foods that target children.
The UK’s reliance on UPFs, which make up as much as 80% of some groups’ diets, creates additional challenges for its regulation. New taxes would need to be balanced by subsidies on healthy alternatives to avoid regressive impacts. The food industry has greater clout and investment in a system in which it supplies a majority of our calories.
Still, insiders are rattled: the former head of the UK’s Food and Drink Federation recently warned that the “coming wave of campaigning for draconian action on ultra-processed food … would strike at the very heart of the industry’s mass production model.”
NGOs, activists and academics across Latin America have shown that the case for improving public health can succeed despite intensive industry lobbying. Given that obesity overtook tobacco as the leading cause of preventable death in the UK a decade ago, and costs us £100bn a year, including £19bn paid directly by the NHS – a tenth of its budget – the price of failure could be high.
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Publish date : 2024-10-14 00:01:00
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