Choosing real versus ultra-processed foods matters as it has a life-long impact on your health.
This is for the general public to be aware how to identify unhealthy foods based on processing and calls for action from policymakers of India to protect the health of its citizens.
The World Health Organisation recommends “healthy diet” for individuals. For infants, they should be breastfed exclusively during the first six months of life, continue breastfeeding for two years and beyond, complimented with a variety of adequate, safe and nutrient-dense foods after six months of age. Salt and sugars are avoided. For adults, it includes fruits, vegetables, legumes (e.g. lentils and beans), nuts and whole grains (e.g. unprocessed maize, millet, oats, wheat and brown rice) raw chicken/meat and eggs. WHO also recommends less than 5% of the daily diet as free sugar (added sugar or naturally present sugar in foods), less than 10% of saturated fats, less than 1%, trans fats, less than 5gms /day of salt (one teaspoon).
Processed foods have replaced real foods substantially in the west. India is fast catching up. Professor Carlos Monteiro from University of Sao Paulo, Brazil, and his team researched dietary patterns in Brazil. Obesity in adults went up from 7.5% in 2002 to 17.5% in 2013. They found that consumption of processed foods made people eat more and led to increased obesity and type-2 diabetes. This was happening despite the fact that people were buying less sugar and oil. They noted that consumption of highly processed, ready to eat; sugary and packaged food products had gone up. With this, they proposed a NOVA food classification and developed a guide to identify types of foods according to the extent and purpose of food processing rather than in terms of nutrients.
NOVA Classification of Foods
There are four types: unprocessed or minimally processed foods, the culinary ingredient foods, processed foods and the ultra-processed or highly processed foods (UPFs) briefly described here
Group 1-Unprocessed or minimally processed foods
These are real foods like edible parts of plants (e.g. seeds, fruits, leaves, stems, roots) or of animals (e.g. muscle, eggs, milk). Other examples are carrots, potato, onion, banana, and grains (wheat, rice, oats, barley, millets, ragi, corn), raw chicken or nuts. These are eaten as boiled, cooled, pasteurized, roasted, crushed, ground, fermented, fried or frozen. For example, fermenting milk makes curd/yoghurt. Cooked rice pulao, chapaati, lentils, veggies, idli, dosa, and herbs like mint belong here. These are prepared domestically not industrially processed.
Group 2-Processed culinary ingredients
These are obtained directly from group 1 or from nature by processes such as pressing, refining, grinding, milling, and spray drying. These are used in cooking and seasoning to make foods delicious. Examples are salt, sugar, oil and butter from milk, ground spices, salted butter, iodised salt, and vinegar figure in this group.
Group-3-Processed foods
These are usually prepared from Group 1 foods by adding sugar, oil, or salt. They are preserved, pickled, salted or fermented. Processing of food increases its durability or modifies its taste. Some examples are: fruits preserved in sugar syrup (murabba), vegetables preserved in salt water/oil (pickles), simple cheese made from milk, canned fruits or veggies etc. Indian sweets/mithai, traditional salted snacks, e.g. mathadi, and fresh home preapred breads belong here. Alcoholic drinks like beer and wine falls in this group. Sugar or salt content determines whether these are unhealthy.
Ultra-processed foods (UPFs)
These are produced in the factories and mostly sold as “packaged food”, “ready to eat” anytime anywhere foods. The UPFs are usually advertised with the aim to replace real foods. Real foods are a very small proportion of or are even absent from the UPFs.
The processing includes carbonating, firming, whipping, bulking and anti-bulking, de-foaming etc. They have typically five or even more ingredients.They contain at least one additive that we don’t ever use in the kitchen.These ingredients may be sugar, oils, fats, salt, anti-oxidants, stabilisers, and preservatives.Casein, lactose, whey, and gluten, hydrogenated oils, hydrolysed proteins, soy protein isolate, maltodextrin, invert sugar and high fructose corn syrup are only found in UPFs. Additives also include dyes and other colours, colour stabilisers, emulsifiers, flavours, and non-sugar sweeteners. These make foods intensely palatable.
Examples for infants and young children include: Infant formulas, follow-on formula and packaged baby milk/cereal/food products. For adults there are so many examples: Packaged “instant” soups, noodles, packaged breads with added emulsifiers, poultry and fish “nuggets” and “sticks”, sausages, burgers, and other reconstituted meat products, carbonated drinks, packaged fruit juices, health or energy drinks, sweet or savoury packaged snacks, ice-creams, yoghurt with added artificial sweeteners chocolates, candies, mass-produced packaged breads and buns, margarines and spreads, biscuits, cakes, breakfast cereals, energy bar/protein bars, processed meats (bacon, ham and salami), instant sauces, ready to heat products including pre-prepared pies, pasta and pizza dishes.
Health Risks of Consuming UPFs
Now you may ask what’s the harm in consuming such UPFs in our fast-paced lives when we can always study the calorie count per serving? Well, here’s the catch! Scientific research has revealed consuming UPF causes over eating and weight gain regardless of the sugar content. Negative health impacts include obesity, asthma and wheezing in children. And in adults increased obesity, Type -2 diabetes, adverse cardio-vascular health impacts, breast cancer, depression, irritable bowel syndrome, dyspepsia and frailty (exhaustion, muscle weakness,) have been documented.
What can you do?
UPFs are aggressively marketed, which increases its consumption. Food companies trick these foods as healthy. Several tactics are used for marketing like targeting gulliblechildren and adolescents, use of celebrities to advertise, use of health claims e.g. “made with whole grains” “high protein”, “ no added sugar” and “high fibre”. Projecting UPFs equivalent to real foods e.g. “noodles’ being advertised in the backdrop of chapatti.
As a consumer, you can make a choice of being aware to identify the food before you buy and not misled by what the food company says. Check the label for sugar or salt content, and how many ingredients the food contains.For your benefit, simple recommendations:
Real foods or minimally processed should form the basis of your or your child’s diet.
Consumption of group 3 foods should be limited. Take a careful look on the sugar and salt content.
If it’s UPF, avoid it. If you or your children are already consuming a lot of UPFs, it may not be easy to get rid of the attraction and pleasure. But slowly you can make healthier choices like opting for fruits and salads for snacking. Quick to make recipes like poha, makhane, roasted chana—you can begin it sooner than later.
Task for the Government to Regulate Marketing and Educate about Unhealthy UPFs:
The Government of India could adopt NOVA classification of foods as a policy. Ensuring appropriate labelling and end of promotion for UPFs could be done through a legal framework. Brazil has much to offer.They have begun to fix the food system and in 2014, they issued guidance to people: Avoid consumption of ultra processed foods, avoid smacking, and teach children to be “wary of all forms of food advertising”. There is a need to begin a new campaign on “junk the unhealthy foods”.
Covid-19 provides an excellent opportunity for you to transform your diet patterns by making healthier food choices and rejecting the unhealthy UPFs. And the Government of India should demonstrate its will and reform the food system for positive life-long impact on people’s health.
Dr Arun Gupta is MD FIAP Central Coordinator, BPNI https://www.bpni.org/; MD, World Breastfeeding Trends Initiative (WBTi) https://www.worldbreastfeedingtrends.org/;
Regional Coordinator-IBFAN South Asia, Advisor, IBFAN Global Council, Convener
Alliance Against Conflict of Interest (AACI) http://www.aaci-india.org/ &
Nutrition Advocacy in Public Interest (NAPi) http://www.napiindia.in/