Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing

Document Type : Original Article


1 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

2 Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia

3 Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia


As evidence grows about negative health impacts of ultra-processed foods (UPFs), nutrient-centred advice is contested, and food-based dietary guidelines are increasingly utilised. Previous analyses of dietary guidelines evaluated their potential impact on health and sustainability, but little research has been conducted to examine how the concept of UPFs is reflected in dietary advice for consumers. This paper systematically analyses whether and how UPFs are represented in dietary guidelines internationally.

Based on a systematic online search, the consumer-targeted key messages of 106 dietary guidelines were identified and a qualitative content analysis was conducted. A coding framework was developed to classify messages as ‘eat more’ or ‘eat less’ according to the language used (eg, ‘choose’ vs ‘avoid’) and to differentiate between a focus on nutrients or food processing. Specific foods mentioned in ‘eat less’ guidelines were classified according to their level of processing using the NOVA framework.

99% of guidelines utilised some type of nutrient-based message, either promoting ‘positive’ nutrients (eg, vitamins) or discouraging the consumption of ‘negative’ nutrients (mainly salt, sugar and fat). Explicit references to food processing were present in 45% of ‘eat less’ guidelines and 5% of ‘eat more’ guidelines. Implicit references (eg, promoting ‘raw’ or discouraging ‘packaged’ foods) were found in 43% of ‘eat less’ and 75% of ‘eat more’ guidelines. 53% of the specific foods referred to in ‘eat less’ advice were UPFs.

Overall, nutrient-based messages were more common than messages about processing levels. The majority of discouraged foods were UPFs, however some minimally processed foods were discouraged, which points to tensions and contradictions between nutrient- and processing-based dietary advice. As dietary guidelines begin to include advice about food processing, it is important to consider both consumer understanding of the terms used and their capacity to act on the advice.


  • epublished Author Accepted Version: January 16, 2022
  • epublished Final Version: February 16, 2022
  1. Elizabeth L, Machado P, Zinöcker M, Baker P, Lawrence M. Ultra-processed foods and health outcomes: a narrative review. Nutrients. 2020;12(7):1955. doi:3390/nu12071955
  2. Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21(1):5-17. doi:1017/s1368980017000234
  3. Monteiro CA, Levy RB, Claro RM, Castro IR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 2010;26(11):2039-2049. doi:1590/s0102-311x2010001100005
  4. Gibney MJ. Ultra-processed foods: definitions and policy issues. Curr Dev Nutr. 2019;3(2):nzy077. doi:1093/cdn/nzy077
  5. Dwyer JT. Trailblazer lecture: why are processed foods so controversial? J Acad Nutr Diet. 2015;115(11):1871-1876. doi:1016/j.jand.2015.09.002
  6. Botelho R, Araújo W, Pineli L. Food formulation and not processing level: conceptual divergences between public health and food science and technology sectors. Crit Rev Food Sci Nutr. 2018;58(4):639-650. doi:1080/10408398.2016.1209159
  7. Baker P, Machado P, Santos T, et al. Ultra-processed foods and the nutrition transition: global, regional and national trends, food systems transformations and political economy drivers. Obes Rev. 2020;21(12):e13126. doi:1111/obr.13126
  8. Herforth A, Arimond M, Álvarez-Sánchez C, Coates J, Christianson K, Muehlhoff E. A global review of food-based dietary guidelines. Adv Nutr. 2019;10(4):590-605. doi:1093/advances/nmy130
  9. Mozaffarian D, Rosenberg I, Uauy R. History of modern nutrition science-implications for current research, dietary guidelines, and food policy. BMJ. 2018;361:k2392. doi:1136/bmj.k2392
  10. Ridgway E, Baker P, Woods J, Lawrence M. Historical developments and paradigm shifts in public health nutrition science, guidance and policy actions: a narrative review. Nutrients. 2019;11(3):531. doi:3390/nu11030531
  11. Nestle M. Food Politics: How the Food Industry Influences Nutrition and Health. 1st ed. Berkeley, Los Angeles, London: University of California Press; 2013. Accessed May 30, 2021.
  12. Scrinis G. Nutritionism: The Science and Politics of Dietary Advice. New York: Columbia University Press; 2013. doi:7312/scri15656
  13. Popkin BM. Relationship between shifts in food system dynamics and acceleration of the global nutrition transition. Nutr Rev. 2017;75(2):73-82. doi:1093/nutrit/nuw064
  14. Scrinis G. On the ideology of nutritionism. Gastronomica. 2008;8(1):39-48. doi:1525/gfc.2008.8.1.39
  15. Dixon J. From the imperial to the empty calorie: how nutrition relations underpin food regime transitions. Agric Human Values. 2009;26(4):321. doi:1007/s10460-009-9217-6
  16. Tapsell LC, Neale EP, Satija A, Hu FB. Foods, nutrients, and dietary patterns: interconnections and implications for dietary guidelines. Adv Nutr. 2016;7(3):445-454. doi:3945/an.115.011718
  17. Mozaffarian D. Dietary and policy priorities to reduce the global crises of obesity and diabetes. Nat Food. 2020;1(1):38-50. doi:1038/s43016-019-0013-1
  18. Monteiro CA, Cannon G, Lawrence M, da Costa Louzada M, Pereira Machado P. Ultra-Processed Foods, Diet Quality, and Health Using the NOVA Classification System. Rome: FAO; 2019. Accessed May 25, 2021.
  19. Moubarac JC, Parra DC, Cannon G, Monteiro CA. Food classification systems based on food processing: significance and implications for policies and actions: a systematic literature review and assessment. Curr Obes Rep. 2014;3(2):256-272. doi:1007/s13679-014-0092-0
  20. Chen X, Zhang Z, Yang H, et al. Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies. Nutr J. 2020;19(1):86. doi:1186/s12937-020-00604-1
  21. Pagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, Sofi F. Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr. 2021;125(3):308-318. doi:1017/s0007114520002688
  22. McClements DJ, Vega C, McBride AE, Decker EA. In defense of food science. Gastronomica. 2011;11(2):76-84. doi:1525/gfc.2011.11.2.76
  23. Reardon T, Tschirley D, Liverpool-Tasie LSO, et al. The processed food revolution in African food systems and the double burden of malnutrition. Glob Food Sec. 2021;28:100466. doi:1016/j.gfs.2020.100466
  24. Monteiro CA, Cannon G, Levy RB, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936-941. doi:1017/s1368980018003762
  25. Pan American Health Organization of the World Health Organization (PAHO). Ultra-Processed Food and Drink Products in Latin America: Trends, Impact on Obesity, Policy Implications. Accessed May 25, 2020. Published 2015.
  26. Baker P, Friel S. Food systems transformations, ultra-processed food markets and the nutrition transition in Asia. Global Health. 2016;12(1):80. doi:1186/s12992-016-0223-3
  27. Lane MM, Davis JA, Beattie S, et al. Ultraprocessed food and chronic noncommunicable diseases: a systematic review and meta-analysis of 43 observational studies. Obes Rev. 2021;22(3):e13146. doi:1111/obr.13146
  28. Askari M, Heshmati J, Shahinfar H, Tripathi N, Daneshzad E. Ultra-processed food and the risk of overweight and obesity: a systematic review and meta-analysis of observational studies. Int J Obes (Lond). 2020;44(10):2080-2091. doi:1038/s41366-020-00650-z
  29. Silva Meneguelli T, Viana Hinkelmann J, Hermsdorff HHM, Zulet M, Martínez JA, Bressan J. Food consumption by degree of processing and cardiometabolic risk: a systematic review. Int J Food Sci Nutr. 2020;71(6):678-692. doi:1080/09637486.2020.1725961
  30. Dos Santos FS, da Silva Dias M, Mintem GC, de Oliveira IO, Gigante DP. Food processing and cardiometabolic risk factors: a systematic review. Rev Saude Publica. 2020;54:70. doi:11606/s1518-8787.2020054001704
  31. Lawrence M. Ultraprocessed foods and cardiovascular health: it's not just about the nutrients. Am J Clin Nutr. 2021;113(2):257-258. doi:1093/ajcn/nqaa333
  32. Stuckler D, Nestle M. Big food, food systems, and global health. PLoS Med. 2012;9(6):e1001242. doi:1371/journal.pmed.1001242
  33. Albritton R. Let Them Eat Junk: How Capitalism Creates Hunger and Obesity. London: Pluto Press; 2009.
  34. Moss M. Salt Sugar Fat: How the Food Giants Hooked Us. London: WH Allen; 2013.
  35. Avena NM, Gold MS. Food and addiction - sugars, fats and hedonic overeating. Addiction. 2011;106(7):1214-1215; discussion 1219-1220. doi:1111/j.1360-0443.2011.03373.x
  36. Sbraccia P, Finer N. Obesity: Pathogenesis, Diagnosis, and Treatment. Springer; 2019. Accessed May 25, 2021.
  37. World Health Organization. Obesity and Overweight. 2018. Accessed May 25, 2021.
  38. Keller I, Lang T. Food-based dietary guidelines and implementation: lessons from four countries--Chile, Germany, New Zealand and South Africa. Public Health Nutr. 2008;11(8):867-874. doi:1017/s1368980007001115
  39. Bragg M, Nestle M. The politics of government dietary advice: the influence of Big Food. In: Germov J, Williams L, eds. A Sociology of Food and Nutrition: The Social Appetite. Melbourne, Australia: Oxford University Press; 2016. p. 75-90.
  40. World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO). Preparation and Use of Food-Based Dietary Guidelines. Geneva: WHO; 1998.
  41. Brown KA, Timotijevic L, Barnett J, Shepherd R, Lähteenmäki L, Raats MM. A review of consumer awareness, understanding and use of food-based dietary guidelines. Br J Nutr. 2011;106(1):15-26. doi:1017/s0007114511000250
  42. Mozaffarian D, Ludwig DS. Dietary guidelines in the 21st century--a time for food. JAMA. 2010;304(6):681-682. doi:1001/jama.2010.1116
  43. Scrinis G, Parker C. Front-of-pack food labeling and the politics of nutritional nudges. Law Policy. 2016;38(3):234-249. doi:1111/lapo.12058
  44. Monteiro CA, Jaime PC. Brazilian Food Guide attacked. Now, overwhelming support for the Guide in Brazil and worldwide. World Nutr. 2020;11(4):94-9. doi:26596/wn.202011494-99
  45. Springmann M, Spajic L, Clark MA, et al. The healthiness and sustainability of national and global food based dietary guidelines: modelling study. BMJ. 2020;370:m2322. doi:1136/bmj.m2322
  46. Gonzalez Fischer C, Garnett T. Plates, Pyramids, Planet: Developments in National Healthy and Sustainable Dietary Guidelines: A State of Play Assessment. Rome, Italy: Food and Agriculture Organization of the United Nations (FAO); 2016.
  47. Coats L, Bernstein J, Dodge E, Bechard L, Aboul-Enein BH. Food-based dietary guidelines of Arabic-speaking countries: a culturally congruent profile. Public Health Nutr. 2019;22(6):1129-1137. doi:1017/s1368980018004093
  48. Fuster M. Comparative analysis of dietary guidelines in the Spanish-Speaking Caribbean. Public Health Nutr. 2016;19(4):607-615. doi:1017/s1368980015002153
  49. van 't Erve I, Tulen CB, Jansen J, et al. Overview of elements within national food-based dietary guidelines. Eur J Nutr Food Saf. 2017;7(1):1-56. doi:9734/ejnfs/2016/32645
  50. World Bank. World Bank list of economies (June 2020). 2020. Accessed May 25, 2021.
  51. Food and Agriculture Organization of the United Nations (FAO). Food-Based Dietary Guidelines. 2020. Accessed May 25, 2021.
  52. Food and Agriculture Organization of the United Nations (FAO). Food Groups and Sub-Groups. 2020. Accessed May 25, 2021.
  53. Kellogg's. What’s New on Shelf? 2018. Accessed May 25, 2021.
  54. Scarborough P, Adhikari V, Harrington RA, et al. Impact of the announcement and implementation of the UK Soft Drinks Industry Levy on sugar content, price, product size and number of available soft drinks in the UK, 2015-19: A controlled interrupted time series analysis. PLoS Med. 2020;17(2):e1003025. doi:1371/journal.pmed.1003025
  55. Oostenbach LH, Slits E, Robinson E, Sacks G. Systematic review of the impact of nutrition claims related to fat, sugar and energy content on food choices and energy intake. BMC Public Health. 2019;19(1):1296. doi:1186/s12889-019-7622-3
  56. Taillie LS, Ng SW, Xue Y, Busey E, Harding M. No fat, no sugar, no salt... no problem? prevalence of “low-content” nutrient claims and their associations with the nutritional profile of food and beverage purchases in the United States. J Acad Nutr Diet. 2017;117(9):1366-1374.e6. doi:1016/j.jand.2017.01.011
  57. Scrinis G, Monteiro CA. Ultra-processed foods and the limits of product reformulation. Public Health Nutr. 2018;21(1):247-252. doi:1017/s1368980017001392
  58. Lacy-Nichols J, Scrinis G, Carey R. The evolution of Coca-Cola Australia’s soft drink reformulation strategy 2003-2017: a thematic analysis of corporate documents. Food Policy. 2020;90:101793. doi:1016/j.foodpol.2019.101793
  59. Russell C, Grimes C, Baker P, Sievert K, Lawrence MA. The drivers, trends and dietary impacts of non-nutritive sweeteners in the food supply: a narrative review. Nutr Res Rev. 2021;34(2):185-208. doi:1017/s0954422420000268
  60. Cespedes EM, Hu FB. Dietary patterns: from nutritional epidemiologic analysis to national guidelines. Am J Clin Nutr. 2015;101(5):899-900. doi:3945/ajcn.115.110213
  61. Wingrove K, Lawrence MA, McNaughton SA. Dietary patterns, foods and nutrients: a descriptive analysis of the systematic reviews conducted to inform the Australian Dietary Guidelines. Nutr Res Rev. 2021;34(1):117-124. doi:1017/s0954422420000190
  62. Kurzer P, Cooper A. Biased or not? organized interests and the case of EU food information labeling. J Eur Public Policy. 2013;20(5):722-740. doi:1080/13501763.2012.751703
  63. Tselengidis A, Östergren PO. Lobbying against sugar taxation in the European Union: analysing the lobbying arguments and tactics of stakeholders in the food and drink industries. Scand J Public Health. 2019;47(5):565-575. doi:1177/1403494818787102
  64. Ares G, Vidal L, Allegue G, et al. Consumers' conceptualization of ultra-processed foods. Appetite. 2016;105:611-617. doi:1016/j.appet.2016.06.028
  65. Aguirre A, Borneo MT, El Khori S, Borneo R. Exploring the understanding of the term "ultra-processed foods" by young consumers. Food Res Int. 2019;115:535-540. doi:1016/j.foodres.2018.09.059
  66. Menegassi B, de Morais Sato P, Scagliusi FB, Moubarac JC. Comparing the ways a sample of Brazilian adults classify food with the NOVA food classification: an exploratory insight. Appetite. 2019;137:226-235. doi:1016/j.appet.2019.03.010
  67. Khandpur N, de Morais Sato P, Neto JRG, Scagliusi F, Jaime PC. Developing and refining behaviour-change messages based on the Brazilian dietary guidelines: use of a sequential, mixed-methods approach. Nutr J. 2020;19(1):66. doi:1186/s12937-020-00585-1
  68. Quinn M, Jordan H, Lacy-Nichols J. Upstream and downstream explanations of the harms of ultra-processed foods in national dietary guidelines. Public Health Nutr. 2021;24(16):5426-5435. doi:1017/s1368980021003505
  69. Popkin BM, Barquera S, Corvalan C, et al. Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating. Lancet Diabetes Endocrinol. 2021;9(7):462-470. doi:1016/s2213-8587(21)00078-4
Volume 11, Issue 11
November 2022
Pages 2588-2599
  • Receive Date: 04 June 2021
  • Revise Date: 09 October 2021
  • Accept Date: 15 January 2022
  • First Publish Date: 16 January 2022