Ultra-processed foods should come with a black box warning' - Dr. Eric Berg

Ultra-processed foods — dangerous enough to require a black box warning?

The American Heart Association (AHA) would like Americans to start preparing their own meals and sit at the table with family members to eat at home. 

In an American Heart Association News article titled “Too much of a food thing: A century of change in how we eat,” author Michael Merschel related how changes in food production and purchasing have taken Americans out of the kitchen and into the supermarkets and fast food restaurants. As a result, today ultra-processed food (UPF) constitutes a large percentage of the American diet.  Merschel quoted New York University professor emerita of nutrition, food studies, and public health, Dr. Marion Nestle, who defined UPF as “food that can't be made at home because of the processes and additives involved.” 

The consequences of eating UPFs, research has shown, is “a higher risk of heart conditions and numerous other health problems.”

Considering the serious heart conditions and other illnesses caused by UPFs, Dr. Eric Berg, in the tweet below, says that ultra-processed foods should have a black-box warning, as some medications do. 

“Food” our ancestors wouldn't recognize

The ultra-processed, store-bought foods we are eating today, Merschel said, would not be recognized by anyone living 100 years ago when people were still eating fresh, locally grown, unprocessed foods. He quoted food historian Ken Albala who explained that supermarkets have changed the way Americans shop and eat.

Before supermarkets, Albala said, shoppers would have had a personal connection with the grocer at a local market, who would have fetched the items customers asked for based on what he had chosen to stock. The supermarket let people select their own items, which put a premium on branding as manufacturers sought to make their products stand out.

That led to "incredible diversity, because now there's 18 different kinds of ketchup and there's 20 brands of frozen this or that," Albala said.

But supermarkets also began distancing people from the source of what they were eating, he said. Before that era, a family might have gotten produce from a stand, which would have sold local harvests in season. The new system favored mass-grown varieties that were bred for color, durability or other factors.

Fast non-nutritious food affordable for everyone 

Worse than the supermarkets were the fast-food chains which enabled everyone, not just wealthy people, to eat out, Merschel continued:

Attitudes about eating out changed. In the 19th century, usually only the wealthiest families would have eaten for pleasure at restaurants. Chain restaurants started popping up in the 1920s, and the 1950s brought widespread fast food – meals that emphasized speed far above nutrition. Spending on meals eaten away from home eclipsed at-home eating in 2010, according to the U.S. Department of Agriculture.

Consequently, the amount of time people spent preparing their food had decreased from several hours to under 45 minutes.

A homemaker could have spent several hours a day cooking in the 1920s. As of 2022, according to the U.S. Bureau of Labor Statistics, the average American spent an estimated 39 minutes a day on food preparation and cleanup.

The cost of food also decreased and people were able to purchase much more than previously.

Technology and transportation improvements mean someone in Kansas can pick up pineapples from the tropics and farmed salmon from the Atlantic on the same mid-winter grocery trip. And it wouldn't eat up as much of their money as food did a century ago: In 2022, families spent about 11% of their disposable income on food, federal data shows. In 1919, they spent more than three times that percentage, according to historical data.

Expanding waistlines 

Cheaper and more abundant food provides more calories for people to consume.

And food is more abundant than ever. One analysis, published in Frontiers in Nutrition in 2022, estimated that available calories grew 18% from 1909 through the following century.

More calories have led to expanded waistlines; most Americans are overweight today.

It shows in our waistlines: More than 70% of U.S. adults are overweight, according to the Centers for Disease Control and Prevention.

“People without a lot of money eat what they can get”

Nestle, Merschel writes, is unsure how these trends can change, particularly for less well-off families who may be unable to afford the education needed to learn how to make the necessary changes, or even have the funds to do so.

For people trying to stay healthy, fighting all that history can be an uphill battle. "I don't have a crystal ball," Nestle said. "But I see the trends going in the same direction unless there's a big change."

Understanding how we got here can help. But that requires education, Nestle said. And that favors wealthier people, who can afford healthier dining options. People without a lot of money "eat what they can get," she said, and in low-income areas, healthier food often is not easily accessible.

“Value in sharing and preparing foods”

Albala, related Merschel, suggests that although historical trends are hard to fight, people who can enjoy preparing, serving, sharing, and eating their food will find some balance.

For people interested in bucking historical trends, Albala suggests a thoughtful approach. "Get as much pleasure as you can out of preparing it and cooking and serving it and sharing it and eating it. And that way, I think you will necessarily be more balanced."

While raising his children, Albala emphasized home-cooked meals that were eaten as a family. That's hard sometimes, he said. But "there's a value in sharing and preparing foods. It's much more than just feeding."

Health begins at home

British doctor Rangan Chatterjee encourages his patients to do as Albala suggested. In the episode of "Dr. in the House" below, Chatterjee, who is prepared to help Dotti D’Arcy reverse her type 2 diabetes, explains that her disease results from lifestyle choices. He recommends the family make significant dietary changes, helping them remove highly processed foods from their diet and encouraging them to purchase fresh foods and prepare their meals at home. An important part of his plan is to have them move away from the sofa and TV at dinner time, sit at the table together, and eat as a family.

As he helps the family clear the UPFs out of their pantry, he explains one way to make decisions about which foods to eliminate:

“A good rule is,  if it's got more than five ingredients, don’t eat it.”