How Much Junk Is in Junk Food? AHA Statement Aims for Clarity

Not all junk food is created equal, but much of it can and should be avoided for the sake of a heart-healthy diet, according to a new science advisory from the American Heart Association (AHA). Yet, there is some wiggle-room for ultraprocessed foods (UPFs) that still manage to serve up an acceptable amount of nutrition.

“Often the term ‘ultraprocessed’ is confused with any kind of packaged food, because it’s described so many different ways in the media,” said writing group chair Maya K. Vadiveloo, PhD, RD, (University of Rhode Island, Kingston).  “The American Heart Association wanted to gather as much evidence as we could to help orient the public around where science currently is on this topic and how to understand ultraprocessed foods.”

While it’s easy to assume that most people know what UPFs are, the paper, published online this week in Circulation, focuses on the importance of limiting the intake of those with high saturated fat, sugar, and sodium levels.

The writing committee says that although many UPFs are both inexpensive and nutritionally poor, others like low-sugar yogurt and bread containing whole grains are nutrient dense enough that they can be a part of a healthy diet, with some even having been shown to be inversely associated with CVD risk despite being categorized as ultraprocessed.

“The way that we currently define whether something is ultraprocessed versus not is the inclusion of a single additive ingredient that falls into certain classes,” Vadiveloo said. “So, if it’s a nonnutritive sweetener, if it’s an emulsifier, you could have the exact same yogurt and then just add that single ingredient, and it’s now ultraprocessed.”

Recently, the US Department of Health and Human Services (HHS) announced that it, along with the Department of Agriculture and the Food and Drug Administration, has begun efforts to establish a federally recognized uniform definition for UPFs.

Categories and Policy Recommendations

The AHA’s science advisory explains food-processing classification systems, focusing on the widely used Nova framework, which categorizes foods into four groups: unprocessed or minimally processed, processed culinary ingredients, processed foods, and UPFs. In this system, the processing of UPFs can include “industrial techniques such as extrusion, molding, and prefrying; application of additives, including those that function to make the final product palatable or hyperpalatable such as flavors, colorants, nonsugar sweeteners and emulsifiers; and sophisticated packaging, usually with synthetic materials.”

Looking at that rubric alone, however, leaves out information such as how certain types of industrial food processing are beneficial for food preservation and safety; can lower cost and extend shelf life; control microbial growth; mitigate chemical toxicants; preserve functional, nutritional and sensory qualities; and reduce food loss and waste.

Essentially, it harkens back to the example of yogurt, according to Vadiveloo.

“This statement emphasizes that we really need to focus our efforts on reducing intake of things like sugar-sweetened beverages, which are ultraprocessed and particularly problematic because of their nutrient composition, as well as ultraprocessed meats, refined grains, candies, and baked goods and other snacks,” she added.

Often the term ‘ultraprocessed’ is confused with any kind of packaged food, because it’s described so many different ways in the media. Maya K. Vadiveloo

Beyond just avoiding or cutting down on these foods, the committee says there is need for research and public policy changes that balance multiple priorities rather than simply banning certain foods.

As reported by TCTMD, several US cities have already instituted taxes on sugar-sweetened beverages, resulting shifts in how much people not only buy but also consume. Some data have shown an association between living in those cities and lower body mass index. Also, as part of ongoing reform to the Supplemental Nutrition Assistance Program (SNAP), which provides aid to low-income individuals and families, the HHS has begun allowing individual states to prohibit SNAP recipients from using the food allowance to purchase “junk food.”

Vadiveloo said while shifts in the consumption of UPFs are needed at the population level, “when you only ban certain foods and you don’t offer affordable, convenient, tasty replacements, you create other problems.”

For that reason, the committee recommends enacting multipronged policy approaches that curb consumption while also educating the public on how to identify high-risk UPFs and choose healthier options. They note the need to retain access to some UPFs, including bread and milk with emulsifiers, that can represent nutritional security for low-income and low-access communities.

“Effective strategies include a mix of educational initiatives (eg, nutrition labeling and public awareness) and regulatory measures (eg, procurement standards, marketing restrictions, taxation, and subsidies for healthier alternatives),” they add.

The paper also addresses ways in which the food industry hinders efforts to better understand the health implications of UPFs and the gaps in research that make it difficult to accurately assess their effects on human health as well as their impact on sustainable environments and food systems.

Moreover, Vadiveloo and colleagues suggest that increased research funding is necessary to tease out mechanistic relationships between UPFs and cardiometabolic health.

“Further research is needed to differentiate UPF subgroups and to assess how factors such as geography, additives, processing techniques, and population characteristics influence health outcomes,” they added.

Specifically, Vadiveloo stressed the importance of conducting controlled studies that provide food to participants and test the differences and the nutritional equivalents between UPFs. These might “look at multiple types of intermediate markers, including things like the gut microbiome, different blood-lipid risk factors, and try to extrapolate from there, along with epidemiological studies, to see what are the mechanisms of action that might link certain food additives or processing methods with adverse health apart from the nutritional composition,” she noted.