It has been estimated that one in five deaths globally are due to poor diets, or diets characterized by inadequate intake of fresh fruit and vegetables, whole grains, nuts and seeds, and excess intake of foods high in sodium, saturated/trans fats and added sugars 1. Rather than reflect our collective inability to exercise restraint and adhere to national healthy eating guidelines, it reflects the growing consensus of “the inability of food systems to deliver healthy diets”. This is apparent to anyone setting foot in a supermarket or convenience store, where what dominates the scene is food we are told to consume in only limited amounts, not those we should be eating to promote health and wellbeing. While the NOVA food classification system does not promise to overcome the systemic problems of the food system, its adoption and implementation will make it easier for consumers to make informed dietary choices, and harder for manufactures to disguise unhealthy food as something worthy of our consideration.
Rather than framing foods in terms of its nutrient content e.g. amount of protein, carbohydrate etc., the NOVA system classifies foods according to the amount of processing. Under the NOVA system, foods are classified as either (1) unprocessed or minimally processed e.g. fresh fruit and vegetables, packaged grains, (2) processed culinary ingredients e.g. salt, butter, sugar, (3) processed foods e.g. canned fruit in syrup, canned vegetables in brine and (4) ultra-processed, defined as “..industrial food and drink formulations made of food derived substances and additives, often containing little or no whole foods”2 These ultra-processed foods typically provide excessive amounts of energy, fat, sugar, and/or sodium; intake of which is associated with an increased risk of diet related disease, including obesity, type 2 diabetes, hypertension and cardiovascular disease3. As these foods are usually cheaper than less processed, healthier foods and perfectly “designed” to be hyper-palatable, when combined with sophisticated and aggressive marketing, it’s not surprising that in many countries intake of ultra-processed foods constitutes over 50% of peoples total energy intake. While this represents a boon in profit for multi- and transnational food and beverage corporations, it spells a disaster for health care budgets around the world.
The appeal of the NOVA classification is that it makes it harder for food manufacturers to deceive consumers with questionable nutrient and health claims made on ultra-processed foods that existing nutrient guidelines can encourage. Examples abound. Sugar-laden granola bars that are “high in protein”, chocolate nut spread that is “low GI”, cereals processed to within an inch of their lives fortified with “essential vitamins and minerals”, and one of my favorites, candy that is “99% fat free”. Manufacturers also manipulate the portion and serving sizes of these foods so as they fit within certain nutrient criteria e.g. less than 5g of added sugar, creating the impression that they are a healthy choice, rather than a wolf dressed up in sheep’s clothing. Such practices also allow many of these products to be made available in institutions that have implemented nutrition policies aimed at improving the quality of the food provided in these environments. Under the NOVA classification, these foods are less likely to make it into the school or hospital cafeteria.
Like the tobacco and alcohol industry before them, “Big Food” typically frames the problem of diet related disease solely as one of individual responsibility, rather than that of a food system unable to deliver healthy diets. That is, they will forever argue that it’s not the excess amounts of saturated and trans fats, sodium and added sugars in ultra-processed foods that is the problem, rather it’s our inability as consumers to exercise self-restraint. However, as we learnt from the successful campaign to reduce smoking rates in most developed countries, reduced exposure to harmful substances (which ultra-processed foods are) doesn’t solely come about through the implementation of some novel, ground breaking behavior change techniques or clever “nudges”, but through a broad range of demand and supply measures e.g. restrictions on advertising, large increases in taxes, or graphic front of pack warning labels. The main argument made against imposing similar measures on ultra-processed foods is “that people need to eat”. Granted, we do need to eat food to survive and thrive, but we definitely don’t need these “edible food like substances”, a term coined by Michael Pollan to describe ultra-processed foods and beverages, that are more likely to make us sick.
The inconvenient truth is that none of us really “need” any of all the ultra-processed foods so ubiquitous in our food environments. However we may rationalize our “need” for that chocolate bar (“it’s a good source of anti-oxidants”) or rice crispies (“it’s a good source of iron”) or kale chips (“it’s a good source of folate and Vitamin A), we will always be better off obtaining those same nutrients through un- or minimally processed foods. Most, if not all, ultra-processed foods are “discretionary” i.e. we don’t need them to support healthy growth and development. A cursory glance at the list of ingredients of many ultra-processed foods used to make them resemble “real food” rather than the outcome of a scientific experiment, such as colors, emulsifiers, emulsifying salts, artificial sweeteners, thickeners, and foaming, anti-foaming, bulking, carbonating, gelling and glazing agents3, should be enough to inspire most to reach for the fruit bowl, rather than for the fruit flavored candy.
Positive change in the area of diet-related disease will only occur when there is a fundamental change in the food system, whereby the foods associated with improved health outcomes, as articulated in most national food guidelines, are easier to access, cheaper, and as promoted as ultra-processed foods and beverages. Measures needed to bring about these changes include strict regulation of advertising of ultra-processed foods, international trade agreements that put the health of the public before the profit margins of transnational corporations, increased taxes on ultra-processed foods and concomitant increase in subsidies for un- and minimally processed foods. At the individual level, you can support and promote the many groups advocating for positive changes in our food systems, recognize some of your food “needs” as “wants”, and ask your elected officials at every available opportunity “why is it that Pepsi cheaper than milk?”
While the adoption of the NOVA classification is only a small part of a much bigger picture, it will make it easier to identify foods and beverages that are consistent with improved health outcomes, and easier for us to leave those that are not on the supermarket shelf.
Extra reading and resources
Ultra-processed foods, diet quality, and health using the NOVA classification system. Excellent resource if you want to take a deep dive into the research looking at the impact of ultra-processed foods on health
INFORMAS (International Network for Food and Obesity / Non-communicable Diseases (NCDs) Research, Monitoring and Action Support). “A global network of public-interest organisations and researchers that aims to monitor, benchmark and support public and private sector actions to increase healthy food environments and reduce obesity and NCDs and their related inequalities”
Stop Marketing to Kids Coalition. One of a number non-profit organisations globally that are advocating for strict regulation of advertising of unhealthy foods and beverages to children.