Intended for healthcare professionals

CCBYNC Open access
Analysis Food for Thought 2020

Public health response to ultra-processed food and drinks

BMJ 2020; 369 doi: (Published 26 June 2020) Cite this as: BMJ 2020;369:m2391

Read our Food for Thought 2020 collection

  1. Jean Adams, senior university lecturer1,
  2. Karen Hofman, director2,
  3. Jean-Claude Moubarac, assistant professor3,
  4. Anne Marie Thow, associate professor4
  1. 1Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
  2. 2South Africa MRC/Wits Centre for Health Economics and Decision Science, University of the Witwatersrand, Johannesburg, South Africa
  3. 3Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, Canada
  4. 4Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney Australia
  1. Correspondence to: J Adams Jma79{at}

Growing evidence confirms a link between consumption of ultra-processed food and drinks and non-communicable diseases. Jean Adams and colleagues explore the implications for public health action

People have used food processing to make food safe, palatable, and longer lasting since prehistoric times.1 Common modern food processing to achieve similar safety, palatability, and preservation goals includes pasteurisation of milk to reduce harmful microbes, milling of wheat to remove indigestible components, and canning fruit to increase its shelf life. However, in the past 100 years industrial techniques have been increasingly used to produce novel ultra-processed food and drink products.

Ultra-processed foods (a term which we use to include ultra-processed drinks in this article) tend to be highly palatable, convenient, shelf stable, and affordable, and are often marketed in ways that appeal to children.23 These characteristics may explain why, in high income and, increasingly, in middle-income countries, ultra-processed foods consistently account for more than 50% of dietary energy.456 However, evidence is growing that consumption of ultra-processed foods is associated with increased risk of non-communicable disease, presenting a public health challenge.

Several definitions and classifications of food processing exist, but in this article we use the Nova system (table 1). Despite some debate,89 Nova is emerging as the most conceptually coherent, operationally useful, and widely used in dietary public health research and policy.10

View this table:
Table 1

Nova classification of foods based on the extent and purpose of processing7

Global changes in eating patterns

Consumption of ultra-processed foods varies globally. In 2016, 271 kg of ultra-processed foods were sold per capita in the North America and Australasia region compared with only 52 kg per capita in Africa.11 However, whereas sales were falling or stagnant in the regions with the highest consumption (Western Europe and North America and Australasia) sales of ultra-processed foods …

View Full Text