Ultra-processed foods (UPFs) contribute a substantial proportion of daily intake across all age groups in the United States. Increased consumption has occurred alongside rising rates of cardiometabolic disease, mental health concerns, and all-cause mortality, drawing concern from health experts.^1-4 UPF

intake patterns are multifactorial, shaped by cost, convenience, food access, time constraints, cultural and socioeconomic status, and marketing practices, with higher intake often observed among children, adolescents, and underserved populations.⁵ These trends have heightened interest in understanding how UPFs influence health and how clinicians should address them in practice.

The UPF conversation is complex and nuanced. Inconsistencies in definitions and classification systems have created confusion among patients and providers alike.⁶ Based on the level of processing alone, foods that may contribute to health, like tofu, whole grain cereals, and canned beans, are rated as processed or highly processed, along with foods that may harm health when consumed regularly, such as packaged cookies, chips, and convenience meals. Some narratives frame UPFs as uniformly harmful, while scientific evidence reflects the need for greater consideration.^1-4,6 The purpose of this article is to support healthcare providers in interpreting the evolving literature on UPFs and translating it into practical, patient-centered guidance.

Defining Ultra-Processed Foods

The most widely used framework for classifying UPFs is the NOVA system, developed by researchers at the University of São Paulo in 2009, which classifies foods by the extent and purpose of processing.^7,8 The NOVA classification categorizes foods into four groups based on degree and purpose of processing: minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods.^7-10

Overview of the Nova Classification System¹⁰

Food Processing Category	Characteristics	Examples
Group 1 Unprocessed or Minimally Processed Foods	Whole foods are altered to preserve freshness or safety, without added fats, sugars, or salt. Minimal industrial processing and few additives.	Fresh or frozen fruits and vegetables, whole grains, legumes, eggs, plain milk and yogurt, fresh meat and fish, unsalted nuts
Group 2 Processed Culinary Ingredients	Substances extracted from foods in Group 1 (via pressing, refining, grinding, milling, or drying) and used in cooking; concentrated sources of fat, sugar, or salt; rarely consumed alone.	Vegetable oils, butter, sugar, honey, salt, vinegar
Group 3 Processed Foods	Foods made by adding culinary ingredients from Group 2 to whole foods in Group 1 using preservation methods.	Canned vegetables or beans, cheese, fresh bread, canned fish, fruit in syrup

Group 4 Ultra-Processed Foods

Industrial formulations containing multiple refined ingredients and additives, with minimal whole food content; designed for convenience and palatability.

Soft drinks/sugar-sweetened beverages, packaged snacks, sweetened cereals, frozen meals, processed meats, flavored yogurts

NOVA classification is based on processing characteristics rather than nutrient content or potential health outcomes. As a result, foods with similar nutrient profiles may fall into different categories, while nutritionally diverse products may be grouped together. For example, sugar-sweetened breakfast cereals and fortified whole-grain cereals with very different nutrient profiles may both be categorized as ultra-processed, despite meaningful differences in fiber, micronutrient content, and potential health effects (positive and negative).⁸ These limitations and complexities underscore the need for careful interpretation when discussing UPFs with patients or clients as a healthcare provider.

Several food classification systems based on processing have been developed internationally, including early frameworks from the National Institute of Public Health in Mexico and the International Agency for Research on Cancer in Europe, followed by NOVA in Brazil, and later systems from the International Food Policy Research Institute in Guatemala, the International Food Information Council, and the University of North Carolina, with NOVA emerging as the most widely applied globally.9 Though these systems differ in terminology and criteria, they generally take into consideration industrial formulation, added sugars, fats, and sodium, and reduced recognizable food structure.

Learn more about UPF classification and how to approach the conversation with your patients or clients in our recent Good Clean Nutrition Podcast with expert dietitian Elizabeth Ward.

Evidence Linking Ultra-Processed Foods to Adverse Health Outcomes

A growing body of observational research has linked higher UPF consumption to adverse health outcomes, including increased risk of obesity, type 2 diabetes, hypertension, cardiovascular disease, and all-cause mortality, as well as depression, anxiety, and other common mental health conditions.^3,11,12

A recent systematic review and meta-analysis of prospective cohort studies (N=25 studies) consistently demonstrated positive associations between high UPF intake and increased risk of diabetes (37%), hypertension (32%), hypertriglyceridemia (47%), low HDL cholesterol (43%), and obesity (32%).¹¹ Another recent systematic review (N=17 observational studies with 385,000 participants) found that higher UPF consumption was associated with increased odds of depressive and anxiety symptoms and a 22% higher risk of subsequent depression in prospective analyses.¹²

To learn more about the connection between UPFs and mental health, check out our interview with expert dietitian and researcher Dr David Wiss on the Good Clean Nutrition podcast.

Several mechanisms may contribute to the observed associations between UPF intake and adverse health outcomes. Many UPFs are energy-dense and high in added sugars, refined carbohydrates,

sodium, and saturated fats, with lower amounts of fiber, protein, and micronutrients.^1-4 These characteristics may drive glycemic dysregulation, dyslipidemia, reduced satiety, and excess energy intake, leading to the negative health outcomes seen in research. Certain additives and processing byproducts may influence inflammation, endocrine function, and the gut microbiome. UPF palatability and convenience may further encourage overconsumption and displace nutrient-dense foods.^1-4

It is important to note that much of the available evidence remains observational, and causality cannot be assumed.¹¹ Personalization for each patient, their goals, barriers, access, preferences, and health status should be taken into consideration when discussing dietary changes.

UPFs Within Overall Dietary Patterns

Higher UPF intake tends to cluster with lower overall diet quality, including lower intake of fruits, vegetables, whole grains, and legumes. In contrast, health-protective dietary patterns emphasize minimally processed foods, plant-forward eating, and adequate fiber and protein intake.8 Recommended dietary patterns, including the Healthy Eating Index (based on the dietary guidelines), Mediterranean Diet, DASH diet, and MIND diet, if followed correctly, are low in UPFs and provide options for patients to follow based on their preferences.^13-16

Overly simplistic categorizing of foods, based on processing, as “good” or “bad” may be counterproductive. Not all UPFs are detrimental to health; some (such as fortified products) may support nutrient adequacy and accessibility, particularly among vulnerable populations. Focusing on dietary patterns rather than individual foods often provides a more clinically meaningful framework.

For example, protein powder, bars, or other fortified products may land in a highly or ultra-processed category but could provide meaningful health benefits to certain populations. Some athletes rely on prepackaged ingredients for endurance performance or protein powders to meet their increased protein needs. Studies indicate that up to 2.8g/kg protein may be needed for strength training, which is difficult to maintain with whole foods alone.¹⁷ Some people with cancer or other chronic diseases have increased protein needs, with some studies estimating needs up to 2g/kg/day or more.¹⁸ Though highly processed, fortified liquid products are often more easily tolerated and can help patients meet their increased needs.

There are many examples of the role some UPFs can play for certain populations, so health care providers should keep an open mind and help each patient assess UPFs in their diet, keeping overarching health goals and dietary patterns in mind.

Practical Counseling Strategies and Key Takeaways for Providers

Effective counseling on UPFs may emphasize reduction rather than elimination and an overall dietary pattern rather than an intense focus on individual foods. Lowering the proportion of calories derived

from UPFs is often a more achievable and sustainable approach for patients and can improve their long- term health outcomes.

Providers can support behavior change by emphasizing replacement and addition strategies. This includes replacing ultra-processed items with minimally processed alternatives when feasible and adding fiber-rich foods, adequate protein, and regular meals to promote satiety and metabolic stability. Easy swaps include eggs on whole-wheat toast at home instead of a fast-food or pre-made breakfast sandwich to start the day. Consider roasted chickpeas, or veggies and hummus for a crunchy snack over chips or crackers. Teaching patients meal-prepping skills for easy batch-cooking dishes, like making soups, stews, or sheet-pan meals at home, can replace frozen, packaged, or instant meals or fast-food stops.

Addressing misinformation and food-related fear is also essential. Patients may interpret long ingredient lists or unfamiliar additives as indicators of harm or processing, when, instead, label reading and critical thinking skills should be used to analyze food options. Open-ended questions and collaboration can help facilitate communication and support patient empowerment. These approaches allow providers to identify potential misunderstandings or health literacy gaps while reinforcing evidence-based guidance within a personalized approach.

Resources:

1. Dicken SJ, Batterham RL. The role of diet quality in mediating the association between ultra- processed food intake, obesity and health-related outcomes: a review of prospective cohort studies. Nutrients. 2021;14(1):23.
2. Lane MM, Gamage E, Du S, et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. bmj. 2024;384.
3. Barbaresko J, Broeder J, Conrad J, Szczerba E, Lang A, Schlesinger S. Ultra-processed food consumption and human health: an umbrella review of systematic reviews with meta-analyses. Critical reviews in food science and nutrition. 2025;65(11):1999-2007.
4. Monteiro CA, Louzada ML, Steele-Martinez E, et al. Ultra-processed foods and human health: the main thesis and the evidence. The Lancet. 2025;406(10520):2667-84.
5. Juul F, Parekh N, Martinez-Steele E, Monteiro CA, Chang VW. Ultra-processed food consumption among US adults from 2001 to 2018. The American journal of clinical nutrition. 2022;115(1):211- 21.
6. Louie JC. Are all ultra-processed foods bad? A critical review of the NOVA classification system. Proceedings of the Nutrition Society. 2025:1-9
7. Crino M, Barakat T, Trevena H, Neal B. Systematic review and comparison of classification frameworks describing the degree of food processing. Nutr Food Technol Open Access. 2017;3.
8. Monteiro CA, Cannon G, Levy RB, et al. NOVA. A estrela brilha. Classificação dos alimentos. Saúde Pública. World Nutr. 2016;7:28–40.
9. de Araújo TP, de Moraes MM, Afonso C, Santos C, Rodrigues SS. Food processing: comparison of different food classification systems. Nutrients. 2022;14(4):729.
10. Martinez-Steele E, Khandpur N, Batis C, et al. Best practices for applying the Nova food classification system. Nature Food. 2023;4(6):445-8.
11. Vitale M, Costabile G, Testa R, et al. Ultra-processed foods and human health: a systematic review and meta-analysis of prospective cohort studies. Advances in Nutrition. 2024;15(1):100121.
12. Lane MM, Gamage E, Travica N, et al. Ultra-processed food consumption and mental health: a systematic review and meta-analysis of observational studies. Nutrients. 2022;14(13):2568.
13. Shams-White MM, Pannucci TE, Lerman JL, et al. Healthy eating index-2020: review and update process to reflect the dietary guidelines for Americans, 2020-2025. JAND. 2023;123(9):1280-8.
14. Liu J, Yang R, Ma P, Zhu X. Association Between DASH Diet and Metabolic Syndrome in US adults: A Cross-Sectional Study. Frontiers in Public Health. 2025;13:1524399.
15. Hareer LW, Lau YY, Mole F, et al. The effectiveness of the Mediterranean Diet for primary and secondary prevention of cardiovascular disease: An umbrella review. Nutrition & Dietetics. 2025;82(1):8-41.
16. Aderinto N, Abraham IC, Olatunji G, et al. The role of Mediterranean and MIND diets in stroke incidence, severity, and recovery. Nutrire. 2025;50(1):40.
17. Amawi A, AlKasasbeh W, Jaradat M, et al. Athletes’ nutritional demands: a narrative review of nutritional requirements. Frontiers in Nutrition. 2024;10:1331854.
18. Ravasco P. Nutrition in Cancer Patients. J Clin Med. 2019;8(8):1211.

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