By Damian Reynolds, Reducing Inequalities Manager at Bradford District and Craven Health and Care Partnership.
Earlier this summer, I attended an Inequalities Action Workshop, hosted by the Reducing Inequalities Alliance in Bradford City centre. Delegates were asked to plan for the event by thinking about the question: “What inequality really matters to you, that you want to do something about?”
Following some initial introductory comments, delegates were given the opportunity to raise an inequality that mattered to them, and then lead a conversation about the inequality at a table where other interested delegates could join. I chose to raise the subject “food deserts and Ultra Processed Food (UPF).” I was encouraged to see a number of representatives from various backgrounds at the table, including Public Health, the NHS, Social Prescribing and Voluntary and Community Sector organisations, all of whom had concerns about the consumption of UPF and the lack of access to good quality, nutritious food in our district.
However, while UPF is a term we are increasingly beginning to pay attention to within the health and care sector, in general many people have never heard of it.
What are Ultra Processed Foods (UPF)?
Ultra-processed foods include packaged baked goods and snacks, fizzy drinks, sugary cereals, ready meals containing food additives, dehydrated vegetable soups, and reconstituted meat and fish products. These products often contain high levels of added sugar, processed fat, and/or salt, but are low in nutritional value, vitamins and fibre.
A food classification system called NOVA separates foods into the following four categories based on the amount of processing involved:
- Group 1: Unprocessed or minimally processed foods such as fresh, squeezed, chilled, frozen or dried fruits and vegetables; pasteurised milk; grains; legumes; and fresh or frozen meat and fish.
- Group 2: Processed ingredients such as sugars, oils, honey, butter and lard.
- Group 3: Processed foods such as jam, tinned or bottled fruit, vegetables and legumes; salted and smoked meats; tinned fish; unpackaged bread; cheese; and salted or sugared nuts.
- Group 4: Ultra-high processed foods (mostly low in protein and fibre, and high in salt, sugar and fat). These foods are made with five or more ingredients not commonly used in food preparation at home. Examples are mass-produced bread, biscuits and cakes; some breakfast cereals; fizzy drinks; ready-made pizzas, pies, pastries and pastas; instant noodles and soups; nuggets, sausages and burgers.
Ultra-processed foods have been described not as foods, but as “edible industrial substances.” They are heavily marketed and designed to be cheap, convenient, durable, extremely tasty and attractively packaged.
How much UPF are we consuming?
It is reported that the daily calorie intake of adults in the UK is made up of 55 percent ultra processed food and drinks– which is higher than across the rest of Europe.
What is even more concerning is that children consume even more UPF. A recent 17-year prospective study of the diets of over 9,000 UK children and young people aged 7 to 24 years old found that one in five were consuming over 78 per cent of their daily calories from ultra-processed food and drinks. Research has also found that nearly a third of baby foods sold in the UK are ultra-processed.
Should we be concerned about the level of UPF consumption?
The subject of UPF has been given more attention in recent media reports, and in research studies. While these have presented some differing views, most information available points to the high possibility of a link between the high consumption of UPF and poorer health outcomes. In particular, studies have suggested that high consumption of UPF may increase the risk of conditions such as obesity, diabetes, heart disease, cancer and depression. While more robust research would be helpful to demonstrate whether there is a direct causal link between high consumption of UPF and these serious health conditions, it is generally accepted that there is a causal link between nutrition and health outcomes.
Since the consumption of UPF appears to be increasing at a time when we are also witnessing a major increase in these health conditions, would it not make sense to give more attention to whether there is a direct link?
Have you heard of food deserts?
A food desert has been defined as an urban area in which it is difficult to buy affordable or good quality fresh food. This links to health inequalities across our district because in areas of high deprivation such as Bradford and in pockets of Craven, many people live in food deserts where there may be plenty of food available, but not much of it healthy. High streets are full of food outlets offering processed and ultra-processed low nutrition foods at relatively low cost. While there may be a greater choice in supermarkets, the lower costs of UPF when compared with other healthier options may leave many low-income households with little choice than to consume large amounts of this type of food.
The speed with which UPF can be prepared in the home may also lead many working parents to choose these options for mealtimes. There may also be a lack of understanding as to what type of foods are “healthy” given that items regularly consumed such as mass-produced bread, most breakfast cereals, many pre-packed pasta dishes, and flavoured yogurts are actually UPF.
Taking action to reduce food inequalities
When I first heard of UPF, I personally took some action to reduce my intake, and I have experienced benefits from doing so. I felt concerned over the lack of awareness over UPF and their possible effects – even among clinicians and leaders.
Santander recently said that “the food industry is the largest manufacturing sector in the country, employing 4 million people and generating around £121 billion annually.” This enables the food industry to exert a great influence on what we eat in the UK. In an area of high deprivation such as Bradford, this influence may well be even greater. The primary goal of the food industry is to make a profit rather than improve nutrition. Do we not owe it to our population to ensure there is a greater awareness of the possible risks from high consumption of UPF and empower people to make healthier choices?
I was very encouraged when eight people from various influential backgrounds joined me at the above-mentioned table discussion during the Inequalities Action Workshop. We discussed how we could take action and one of the recommendations made was to try to form a “UPF movement” to identify what more could be done. While ours may be a very small voice, we must do what we can to raise awareness and keep the subject on the inequality agenda as a possible way of preventing poor health outcomes.
Photo by Jack Lee on Unsplash