MARCO ISLAND, FLA. — As debate ramps up over processed and ultra-processed foods — the nebulous dietary categories that include grain-based foods such as bread, cereals, crackers, cookies and pasta —rhetoric is not always linked to science-backed claims.

It behooves milling and baking industry leaders to take an active role supporting science-based peer-reviewed research and partnering with public health officials and influencers to relay the facts to consumers, said Erin Ball, executive director of the Grain Foods Foundation (GFF).

“The milling industry has a great story to tell about processing’s role in delivering delicious, nutritious and safe ingredients to manufacturers and consumers,” Ball told attendees of the North American Millers’ Association spring conference in Florida in mid-March. “It's important to take our passion and conviction to a larger audience.”

In her comments delivered to an audience of millers and grain-adjacent professionals, Ball listed examples of the debate over ultra-processed foods (UPFs) that have popped up in social media and in mainstream newspapers with national audiences.  

“A ‘debate’ about UPFs is a bit of an understatement,” she said, pulling up a screenshot of an article posted to LinkedIn with a photo illustration contrasting fresh fruits with waffles, donuts, croissants and chips. “It’s a fight, a wrestling match, and I think it’s interesting the debate is everywhere. The graphic is building this argument against this murky category of food, alongside the copy saying these foods are sneaky, that they’re not only bad for our bodies, but they’re messing with the planet.”

Another LinkedIn screenshot depicted hands holding prison bars made of pepperoni pizza, soft tacos, fried chicken and curly fries.

“The graphic is dramatic with the prison of ultra processed foods, the headline ‘Unveiling the Addictive Power of Ultra-Processed Foods,’” Ball said. “So, not only are they sneaky, they’re killing us, they’re killing the planet, they’re also addictive.”

UPF rhetoric has made it into the non-fiction shelves at booksellers as well, Ball said, spotlighting “Ultra-processed People” by Chris Van Tulleken — a British physician who ate about 80% of his calories in each day from UPFs for 30 days, tracking his health at his own clinic — as an example that “really captured the passion and the conviction and that anger around ultra-processed foods. This and his other articles put forward a compelling argument, if you were looking for a compelling argument, because it’s a great example of the passion against this category of food.”

Ball broke down for the audience the history of the debate and the attempt to define some foods as processed and ultra-processed.

The sparks of the debate were fanned into flames by Carlos Monteiro’s 2018 article “The UN Decade of Nutrition, the Nova food classification and the trouble with ultra-processing,” Ball said, noting Nova, not an acronym, attempts to put the foods of the American diet into four categories:

• Green: unprocessed or minimally processed foods such as legumes, vegetables, fruits, starchy roots and tubers, grains, nuts, beef, eggs, chicken and milk.
• Yellow: processed culinary ingredients such as salt, sugar, vegetable oils, butter and other fats.
• Orange: processed foods such as bottled/canned vegetables or meat in salt solution, fruits in syrup or candied, bread, cheeses, purees or pastes.
•  Red: ultra-processed foods such as breast milk substitutes, infant formulas, cookies, ice cream, shakes, ready-to-eat meals, soft drinks, other sugary drinks, hamburgers and nuggets.

Nova classification, first proposed in 2009 by Monteiro and other researchers at the University of São Paulo, Brazil, places 96% of grain-based foods eaten in the United States in the processed foods and ultra-processed foods categories, Ball said. Whole kernels and whole oats fall under the minimally processed category while pasta, flours and meals fall under the processed culinary ingredients category.

“From green, eat with almost reckless abandon, to red, foods that should come with a warning,” Ball said. “What about enriched flour which, according to the rules, wouldn’t be a processed culinary ingredient? No one knows what to do with enriched flour. This scale doesn’t really provide for talking about culinary ingredients that have been enriched with vitamins, for example.”

Narratives that spread quickly online, some without sound scientific backing, and a lack of definition and clarity for the Nova system and its implications on consumer choices are headwinds for the grain and grain-based foods industries. But Ball’s update wasn’t without prominent examples of news bullish for bread and its brethren.

A peer-reviewed study published in The Lancet measured the consumption of UPFs against the risk of multimorbidities — two or more long-term health conditions, in this case cancer, cardiovascular disease and type 2 diabetes. The study’s many conclusions include the determination that “consumption of ultra-processed breads and cereals was associated with lower risk (of multimorbidity).”

“We’re walking a line here of finding the threads of good news in science that may not be the highest quality research actually, but we’ve got to still hang our hats where good news is while also pushing for better science,” Ball said.

A study published in the June 2023 Journal of Nutrition was led by USDA scientist Julie Hess. She built a modeling study on a diet where 91% of energy is derived from ultra-processed foods, a premise Ball said fails to reflect American eating habits.

“No one eats that way, no one eats that many ultra-processed foods,” she said. “The average in America right now is 61% of energy, maybe a little less, so she adopted an extreme version of an ultra-processed foods diet and then held it up against USDA’s own measure of diet quality called the healthy eating index, which measures macronutrients, micronutrients as well as nutrients to avoid, such as added sugar. She found a consumer could eat a better diet than the current average American diet by eating 91% of energy from ultra-processed foods. Which says to us that it really isn’t this category of ultra-processed, it’s choosing nutrient-dense foods wherever they land on that processing continuum. Her diets scored 86/100, a strong B-plus, while the average American diet was a 59/100.”

The USDA Advisory Committee, which maintains dietary guidelines updated in five-year cycles, has processed and ultra-processed foods under discussion. The group intends to examine consumers’ eating patterns, focusing on the impacts on growth, body composition and risk of obesity in the heaviest users of foods from the processed and ultra-processed categories.

Ball was skeptical the Committee was well prepared to make recommendations on UPFs in American diets without more peer-reviewed research. A GFF partner’s survey indicated UPFs might be a minor concern among the guidelines being addressed this cycle. Of the public comments on the Committee’s guidelines update considerations — open to academicians, the food industry and consumers — only 3.6% addressed UPFs. Those that did brought forward three concerns to be addressed, Ball said.

“One, the lack of clarity on definition and classification and enriched flour is a great example of that,” she said. “People don't know how to classify that up against Nova. Second, the conflicting viewpoints on UPFs contributing important nutrients to the diet. Lastly, there are questions about the application of Nova, which came out of a very particular context in Brazil, as US-based dietary guidance.”

Ball recommended those along the grain value chain in attendance at NAMA’s spring conference strive to bring the conversation into the public sphere. One approach is to explain the benefits of processing, a list that includes increased food diversity, ensuring food safety, increasing convenience, improving texture and flavor, expanding food access, reducing food waste and adding value to agrifood waste, preserving nutritional quality and produce sustainable alternatives.

Also, the ability to fortify and enrich products with needed nutrients.

“This is really important,” Ball said, “If a group like the dietary guidelines committee wanted to make a recommendation to move people away from UPFs, there would be unintended consequences of nutrient deficiency. Lowered intakes of important nutrients like folic acid for women of child-bearing age, iron for other populations and, of course, B vitamins.

The issue of UPFs and potentially discouraging them has ethical implications.

“If you picture giving the whole population advice to stay away from those orange and particularly red column foods and picking through the best choices among those processed and ultra processed foods, that puts a lot of consumers at a real disadvantage nutritionally,” Ball said. “This is really bubbling up among academics and it’s the conversation that we and the group industry pushed forward as well.”

The classification and narrative around UPFs have proven confusing to consumers, according to a survey by the International Food Information Council, Washington, which found one in five consumers reported trying to eat fewer processed foods for health purposes, but also reported being conflicted about what UPFs are.

The food industry has opened a communication campaign on UPFs, Ball said, which has included registered dietitians writing on LinkedIn, on their own websites and other social platforms, usually on behalf of and in a relationship with the food industry. The GFF has worked with Liz Ward, the author of “I’m a Dietitian and I Eat Processed Foods Every Day.” Ball suggested the grain industry would be a powerful voice in defense of its own processing and ingredients. Her recommended readings include a European website called Processed With Purpose and the Consumer Brands Association website, where a suite of processing educational materials could be repurposed for individual audiences.  

A workshop on UPFs was convened in March 2023 by the USDA and included 16 representatives from academia, 10 representatives from the US government and 6 representatives of the private sector. The meeting yielded six pillars to complete to move toward science-based recommendations around UPFs.

“This is a long list and a deep list, this work needs to be done, and it is going to take years and decades really,” Ball said. “The way forward must be both research and communications. It’s going to be more powerful if public health folks and the food industry are working together on these efforts.”