Reviewed by Neha Pathak, MD on February 21, 2020
From the WebMD Archives

Feb. 21, 2020 -- At his heaviest, Steve Konzelman weighed 503 pounds. His blood pressure had reached 180/140. (Normal is 120/80 or lower). His doctor told him he could have a stroke at any moment.

He was in his 20s at the time. “Even then, I still didn’t take my medication,” he says.

Konzelman, whose mother, brother, and late father struggled with obesity, too, had looked into weight loss surgery several times. But, he says, “I just always felt like I could still do it on my own.”

As he neared 30, though, he knew he needed help. So he finally moved forward 4 years ago at age 29. Doctors had warned him that gastric bypass surgery, which reduces how much the stomach can hold and the amount of calories and nutrients the body absorbs, had a very high fail rate.

“It doesn’t fix your life. It’s only a tool. I had to go into it fully committed,” says Konzelman, an operations analyst at Bank of America in Atlanta. He knew he’d lose weight rapidly over the first 6 months. But in order to keep the weight off, he’d have to change everything. That meant giving up the calorie-rich and nutrient-poor ultra-processed foods that were a staple of his diet.

“I was the stereotypical fat American,” he says. “I’d hit up a fast-food drive-thru in the morning and get two breakfast sandwiches and two hash browns and a 40-ounce soda. Then, after having all my calories for the day in one meal. I might do it again at lunch and dinner.”

Those kinds of ultra-processed foods -- which include ready-made snacks, drinks, and meals that contain additives, artificial colors, preservatives, and plenty of sugar, salt, and fat but very little nutrition -- account for up to 60% of some people’s diets. Recently, this subset of processed foods has become the focus of blame for ailments including heart disease, diabetes, obesity, some cancers, and an overall shorter life.

What is Ultra-Processed Food?

Unless you make all your food at home from scratch -- and even then -- processed food is practically unavoidable. But there are degrees of processing.

Minimal processing cleans food, preserves it, or removes inedible parts -- like the outer skin of a coffee bean as it’s ground. Besides grinding, these processes include refrigerating, freezing, fermenting, pasteurizing, and vacuum-packaging. The key to keeping it minimal is that the nutrition content of the food is still pretty much the same. Whole-grain flours and pastas are also minimally processed foods, as well as some cooking ingredients. Think oils pressed from nuts, olives, or seeds.

Once you add sugar, salt, or fats to the mix, processing is no longer “minimal.” Canned fruits and vegetables that include added salt or sugar are processed. So are fresh-baked bread, some cheeses, and canned fish. Still, they’re not ultra-processed. Their ingredient lists are limited to two to three items, but they are typically ready to eat (or at least edible) right out of the package.

Ultra-processing includes multiple steps -- not just, for example, adding salt and canning. The process also brings in ingredients -- usually with unrecognizable names -- that you wouldn’t find in a crop or on a farm. They include artificial colors and flavors, preservatives, and ingredients, such as emulsifiers, meant to make the look or texture of the food more appealing.

Sodas, luncheon meats, sugary cereals, and chips are ultra-processed, along with many other packaged snacks and baked goods, some frozen meals, and some crackers.

“You’re introducing ingredients that shouldn’t be there in the first place, that don’t naturally exist in food and instead are brought in purely by human preparation,” says Qi Sun, MD, ScD, an associate professor of nutrition at Harvard University. “You basically destroy the structure of the food and reorganize it -- introducing a new food matrix.”

Food matrix? That’s a food’s structure. It’s not only a food’s components -- say, vitamin C and fiber -- that make it nutritious. It’s also the food’s structure. That means that even if an ultra-processed food contains certain vitamins and nutrients, it still wouldn’t be as nutritious as a whole food. That’s why, for example, a high-fiber whole food is better for you than, say, a fiber pill.

What’s the Harm in Ultra-Processed Foods?

Research links ultra-processed foods to a number of health problems. People who eat more of the stuff are more likely to be obese, and have diabetes, heart disease, and vascular disease (that includes stroke), too.

One recent study even tied the convenience foods to cancer risk. Researchers tracked the eating habits and health records of 104,980 adults for 5 years. Those who ate the most ultra-processed foods were most likely to get some form of cancer over the study period. The researchers then looked at cancer risk based on average number of servings per day over the 5 years. For each 10% increase in ultra-processed food intake, there was a 12% increase in overall cancer risk. That’s the difference between someone who eats one whole Twinkie per week for 5 years and someone who eats one whole Twinkie plus one bite of another one per week over the same time period.

Maybe it’s because of the risk for these diseases that studies also show eating more ultra-processed foods equals living a shorter life.

Experts can’t say for sure whether the harm in ultra-processed foods is in what these foods contain or what they lack. “It’s probably both,” says Sun. “Certain chemicals, preservatives, sweeteners -- even the ones that don’t have any calories -- may potentially interfere with metabolism. We know these foods are not good for us, but there’s also a lot we still don’t know.”

And if you’re snacking on processed foods, you’re doing that instead of eating, say, an apple.

“A diet that contains more ultra-processed foods may contain fewer whole foods, so it may be the lack of those foods that’s most harmful,” says Katherine Zeratsky, a registered dietitian nutritionist at Mayo Clinic in Rochester, MN.

Ultra-processed foods, though not all of them, tend to be low in fiber and other essential nutrients. If these snacks take the place of whole foods in your diet, you’ll miss out on those nutrients and could see the health consequences that go with that. Protein and fiber, for their part, help you feel full, which means foods that contain these nutrients may help you control calorie intake throughout the day.

Some studies find that ultra-processed foods, regardless of their nutrient content, don’t satisfy as well as whole foods do.

That could explain the results of a recent experiment. In the study, 20 healthy adults stayed in a lab under close surveillance for 28 days. Ten of them received a diet of mostly ultra-processed foods, including white bread, lunch meats, cheese slices, chips, and artificially sweetened diet drinks. The other 10 received the exact same amount of calories, sugars, fiber, fat, and carbohydrates per meal, but only in the form of unprocessed and minimally processed foods. They ate things like beef tips with broccoli, brown rice, apples and salad. (Note: It takes a lot of broccoli and apples to match the calories in a bowl of potato chips). The study participants could eat only the food that was provided, but they didn’t have to clean their plates. At the end of the 4 weeks, those in the ultra-processed group had eaten about 500 calories per day more than the others. And they had gained 2 pounds, while the others had lost 2.

Were the processed foods not as filling? Or were they just tastier, making it harder to stop? The researchers don’t know for sure why people ate substantially more of the processed stuff. But, either way, the ultra-processed foods led to overeating and weight gain.

As for Konzelman, he always found that processed foods were more satisfying. “I liked to cook and had a taste for vegetables and homecooked meals. I just didn’t do it very much because those foods didn’t fulfill and satisfy me as much as take-out fast food.”

How Do You Quit?

On his extreme weight loss journey, which got him from 503 to 218 pounds, Konzelman transformed from a guy who’d eat a whole pizza and a 2-liter soda for dinner to one who brings his own homemade salad dressing when he goes out to eat in restaurants.

“I wanted a salad dressing that wasn’t filled with sugar and all kinds of artificial ingredients,” he says.

And, with his stomach’s restricted capacity for food and his body’s limited ability to absorb it, there was no room for empty calories. “Now that I was only eating a small amount of food, I had to make sure that it was filled with the nutrients that I needed.”

Konzelman emphasizes that he didn’t go from whole pizza to make-your-own salad dressing overnight. When he first started preparing small, healthier meals at home, he’d cook vegetables, but he’d still throw in an ultra-processed sauce or marinade. Little by little, he learned about healthier ingredients he could swap in to replace the less healthy ones.

And that’s the right idea, Zeratsky says. Look for the low-hanging fruit. Are there a couple of ultra-processed foods in your regular diet that you could swap out for something else? “You could start by cutting back on ultra-processed foods at snack times,” she says. “Cut some of the chips or cookies and replace them with apples and peanut butter or vegetables with hummus.”

Dietitians and food industry professionals alike warn that it’s not about replacing one junk food with another seemingly better one. Don’t be swayed by labels on ready-to-eat convenience foods, like chips and cookies, that read “natural” or “organic.” You’re still likely to find unrecognizable words among the ingredients.

“It’s not always that much different -- the so-called cleaner versions,” says David Foerstner, a food product development consultant.

Even buzzwords like “plant-based” don’t mean it’s as healthy as a whole food. “All this stuff they’ve got in plant-based protein would still fall under ultra-processed foods,” says Michael Sigmundsson, a food and beverage product developer and consultant.

The ideal choice is whole, unprocessed, or minimally processed foods. Any movement toward more of those and less of the other is a positive change. It doesn’t mean you suddenly have to make everything from scratch.

“If you need a convenient meal, can you get a bagged salad? Or pick up a whole cooked chicken or frozen vegetables that you can heat up?” Zeratsky says. “Because I don’t think we are ever going to have a lifestyle that isn’t time-crunched and that doesn’t demand convenient foods.”

Show Sources

Steve Konzelman, Atlanta.

Qi Sun, MD, ScD, associate professor, Department of Nutrition, Harvard T.H. Chan School of Public Health.

Katherine Zeratsky, registered dietitian nutritionist, Mayo Clinic, Rochester, MN.

David Foerstner, consultant, Food Forward Consulting, Los Angeles.

Michael Sigmundsson, consultant, Epicurean Wizardry, Post Falls, ID.

Harvard T.H. Chan School of Public Health: “Processed Foods and Health.”

Harvard Health Publishing: “Eating more ultra-processed foods may shorten life span.”

Critical Reviews in Food Science and Nutrition: “The food matrix: implications in processing, nutrition and health.”

BMJ: “Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé),” “Ultra-processed foods and health outcomes,” “Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort.”

Current Developments in Nutrition: “Effect of a High-Protein, High-Fiber Beverage Preload on Subjective Appetite Ratings and Subsequent Ad Libitum Energy Intake in Overweight Men and Women: A Randomized, Double-Blind Placebo-Controlled, Crossover Study.”

NIH Research Matters: “Eating highly processed foods linked to weight gain.”


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