Dora Romaguera (ISGlobal): “One of the main problems with ultra-processed foods is that they displace the consumption of healthy foods”

A scientific team from the Barcelona Institute for Global Health (ISGlobal) has carried out a study in which they have analyzed the relationship between the consumption of ultra-processed foods and colorectal cancer.

The study, based on data from a one-year dietary monitoring of 7,843 people with validated questionnaires, is the first carried out in Spain with these characteristics, and has concluded that 10% more intake of ultra-processed foods and sugary drinks increases 11% the risk of developing colorectal cancer.

We have talked with Dora Romaguera, first author of the study, and she has explained us the present and the future of ultra-processed foods in our lives.

What do you mean when you talk about ultra-processed foods?

Ultra-processed foods have very little to do with the fresh food they try to simulate. Industrial confectionery (including cookies), sugary drinks, pre-cooked foods, fast-food, snacks, sweets, some processed meats, some dairy products such as smoothies, highly alcoholic beverages, etc. are included in this group. Ultra-processed foods share the following characteristics:

• They are industrial formulations (they are produced in factories), with more than five ingredients, many of which are substances or additives that we never find in a kitchen: emulsifiers, colorants, preservatives, etc.
• They have a lot of added sugar, salt, or fat.
• Their packaging is also of industrial origin, they are usually cheap, durable over time (long expiration dates) and very palatable, almost addictive.
• They are very helpful in the food industry, but usually unhealthy.

Why should we avoid consuming this type of food? Can you counteract its consumption with healthier foods?

The problem with these foods is that they displace the consumption of healthy foods such as fruits and vegetables. We have seen that part of the harmful effect of ultra-processed foods is precisely due to consuming less healthy food and having a diet of poorer nutritional quality. But this does not explain the whole effect; the processing itself can also be harmful to health.

Therefore, there are two dimensions that must be taken into account when planning a healthy diet: a diet full of natural foods such as fruits, vegetables, nuts, legumes, and in turn, poor in ultra-processed foods.

Looking at the results of the study, what actions should the authorities implement to reduce the consumption of this type of food?

Currently there are some measures underway, such as putting a tax on sugary drinks, which is an example of ultra-processed food. This is a measure that can work and it has been seen that it can lead to a reduction in the consumption of these types of ultra-processed products. But at the same time, healthy, fresh and less processed foods would have to be promoted more and they would have to be more accessible to the population.

“A healthy diet full of fresh foods is generally more expensive than a diet full of ultra-processed foods.”

That is why it would be good if the money raised with the tax on sugary drinks was used to lower the cost of healthy foods, such as fruits and vegetables.

In other countries, such as France or Chile, the labels incorporate food classifications… Is a similar action foreseen in Spain? What is the validity of the Nutriscore that some supermarkets have incorporated?

Nutriscore is a front-end food labeling system that has already been applied in some European countries, such as France, and is expected to be applied in Spain on a mandatory basis. It is a food ‘traffic light’ that includes colored letters to indicate whether a food is healthier (green, letter A) or less healthy (red, letter E). Or rather, less unhealthy (A) or more unhealthy (E).

It takes into account the amounts of salt, sugar, saturated fat, calories, protein, fiber, as well as vegetable oil (olive), fruit, vegetables or legumes on food. It is a system that has been developed and validated by serious researchers in very important epidemiological studies and without conflict of interest from the industry. That said, the main problem with Nutriscore is that it can only be applied to industrial products, which are mostly ultra-processed, since by definition Nutriscore can only be calculated from the nutritional information that appears on the packaging.

Therefore, fresh foods that should be consumed the most (fruit, vegetables, fish) will never have a Nutriscore. On the other hand, it classifies with a low score some foods that are healthy, such as olive oil (it is given a letter C) and that is why this product has been excluded from carrying this frontal labeling in Spain.

“Fresh foods, which are the ones we should consume the most (fruit, vegetables, fish) will never have a Nutriscore”

Therefore, it must be made clear to the population that the preferred foods are those that do not have a Nutriscore. But if you have to consume a processed food, for example a yogurt, the Nutriscore allows you to compare foods within the same category to choose the least unhealthy.

The study also talks about smoking… Is there a relationship between this habit and the consumption of ultra-processed foods?

In general, unhealthy lifestyles tend to group in the same people. Therefore it is possible that people who eat more ultra-processed food, do less physical exercise or smoke tobacco.

In our study we have seen that there is a significant interaction between smoking and the consumption of this type of food and the risk of breast cancer. In other studies, these two lifestyles have shown detrimental synergistic effects on health. But our results are very exploratory, there is very little evidence, and these findings would need to be replicated.

And speaking of smoking, do you think that at some point we will have such restrictive measures against ultra-processed products (campaigns, labelling, restricted sale, etc.)?

Years ago it was decided that the measures to improve the diet of the population had to involve the food industry, contrary to what had been done with the tobacco industry.

Thus, it was thought that it would be possible to work together with the industry by reformulating food, limiting its advertising in certain population groups, etc. But in the long run it has been seen that this strategy does not work, since food has not improved much and nutrition problems at the population level continue to exist.

“Years ago it was decided to involve the food industry to work together, but in the long run it has been seen that this strategy does not work”

So now the strategy is different, even though it is still not as restrictive as with tobacco. Even so, some taxes have already been imposed (sugary drinks), as has front labelling to indicate whether the food is more or less healthy.