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Could ultra-processed food be the new smoking?

A global study of nearly ten million people has shown the physical and mental health risks of UPFs.

By Sarah Dawood

In the 1930s and 1940s, tobacco companies battled it out via advertising to be known as the “healthiest” cigarette brands. Adverts featured illustrations of smiling doctors clutching their favourite packets, with notorious campaigns reassuring the public that “More doctors smoke Camels”. Some of these ads even appeared in medical journals.

Now we know the catastrophic health implications of smoking, restrictions on tobacco products have increased dramatically over recent decades. It’s illegal to advertise cigarettes in the UK, and mandatory for packets to include health warnings (often accompanied by gruesome images). Smoking is banned indoors, the legal smoking age has risen from 16 to 18, and prices have steadily increased. Last year, Rishi Sunak went further by announcing the raising of the legal age every year – in effect, a gradual smoking ban – a measure also pledged by Keir Starmer.

A similar reckoning is now happening with unhealthy food – last week, a global study of nearly ten million participants published in the British Medical Journal found that ultra-processed food (UPF) is directly linked to 32 harmful health effects, including increasing the risk of heart disease, cancer, type-2 diabetes, obesity, depression and early death.

UPF is the most processed foods we can eat, but unfortunately, also often the most delicious. They typically contain industrial substances like additives, preservatives and sweeteners, which make food tasty, addictive and long-lasting. They include biscuits, crisps, sausages and fizzy drinks, but also more surprising culprits such as mass-produced bread, breakfast cereals and flavoured yoghurts. It’s deeply embedded within our diets – more than half of the average UK diet is made up of UPF, and this rises to a staggering 80 per cent for poorer people and children.

Opinions on UPF, and what constitutes “unhealthy food”, are divided. Tim Spector, a medical doctor and professor of epidemiology (but perhaps best known as the founder of the Zoe nutrition app), told parliament last week that UPF was making Britain the “sick man of Europe”, and called for mandatory black labels to be added to products to warn consumers. But health bodies like the Food Standards Agency have said that fear-mongering about UPF, which often includes less calorific alternatives like diet drinks or sugar-free yoghurt, could cause people to choose more fattening options. Eating disorder charities have also previously cautioned against excessive labelling as it can worsen restrictive eating habits, with the recent inclusion of calorie counts on restaurant menus being an example.

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Nobody is saying that eating a fruit yoghurt is as harmful as smoking a cigarette. But the main concern is about the levels of UPF we consume. We’re also undeniably influenced by what’s marketed to us. It’s almost impossible to scroll on your phone, stream a TV show, or walk down a street without being bombarded by fast-food adverts. As Greg Fell, England’s leading public health director, told Spotlight last year, “We are products of the environment in which we live… [If] our environment cues us to behave in a certain way, we’re going to do it.”

Stronger regulation around advertising could go some way towards encouraging healthier choices, especially among children. Research from the World Health Organisation has found that children under ten are particularly susceptible to fast-food ads, as they struggle to discern whether information is biased or not. The government has committed to a 9pm watershed ban on TV and online junk food advertising, though its implementation has been delayed until October 2025. Because of this, health campaigners have criticised them of bowing to big business. Meanwhile, libertarian political factions lambast the idea as indicative of a “nanny state”. But as Fell told us: “Advertisers spend millions of pounds influencing our choices – who’s the nanny in that context?”

However, curbing clever advertising still doesn’t get to the root of the issue; unhealthy eating is directly linked with poverty. The Food Foundation’s “Broken Plate 2023 report” found that the most deprived fifth of the population would need to spend 50 per cent of their disposable income on food to afford a healthy diet, while the least deprived needs to spend just 11 per cent. Free food education in schools for children and adults, subsidies for healthy food like fruit and vegetables, and reforming welfare rates are all more holistic policy solutions that could encourage people to make better choices.

The UK is essentially sleepwalking into a preventable health crisis – by 2040, one in five adults are expected to be living with serious illnesses such as cancer, diabetes and heart disease, many of which correlate directly with lifestyle factors like diet, smoking, alcohol consumption and exercise. This is dangerous for society as well as individuals, placing excessive strain on health and social care systems and the wider economy. It’s estimated that 40 per cent of the NHS’s costs go towards treating preventable conditions, while nearly 7 per cent of the UK working-age population (2.8 million people) are currently out of the workforce due to ill health. Meanwhile, both the Conservatives and Labour have pledged to focus on prevention, shifting the NHS from one that treats illness to one that stops people getting sick in the first place.

We should prioritise people’s health over conglomerates’ profits. Better policy around healthy eating doesn’t need to be a totalitarian ban on biscuits, demonising someone’s choice to get a takeaway, or stopping people from eating food they enjoy. It could just be promoting a more balanced diet through less targeted advertising, better food education and more affordable healthy alternatives. Medical research has always made policymakers (and doctors) to rethink what’s healthy, what’s harmful, and what’s appropriate to promote. Despite tighter regulation in recent decades, smoking still costs the NHS an estimated £2.6bn per year. So if politicians really want to focus on prevention, they should start tackling the next health crisis now.

[See also: What can history teach us about policymaking?]

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