What The Ultra-Processed Foods Debate Still Gets Wrong

Consumers Don’t Eat Classifications. They Eat Diets.

Today, the American Journal of Public Health released one of the most comprehensive collections of research and commentary on ultra-processed foods (UPFs) published to date. The special issue links UPFs to chronic disease, examines their potential addictive properties, explores the role of food-industry practices in shaping modern diets, and calls for stronger government intervention.

The publication arrives at a moment when ultra-processed foods have moved from a largely academic discussion into the center of public policy debates, fueled in part by the growing influence of the Make America Healthy Again (MAHA) movement and its criticism of modern food systems.

For all the attention being paid to how foods are formulated, marketed and processed, far less attention is being paid to an equally important question: how consumers actually purchase and consume them.

How Consumers Actually Eat

Much of today’s UPF debate implicitly treats foods within the category as if they are consumed similarly and produce equivalent outcomes. Chips, sugar-sweetened yogurt, protein bars, frozen meals, cookies, candy and sweetened beverages are often grouped together despite substantial differences in how consumers use them.

That distinction matters because health outcomes are shaped not only by what foods contain, but also by how much is consumed, how often, and within what broader dietary pattern.

An occasional dessert within an otherwise high-quality diet is not equivalent to a pattern of frequent consumption accompanied by caloric excess and poor overall nutrition. Yet public discussions increasingly blur these distinctions.

As a result, the UPF debate focuses heavily on how foods are made while paying far less attention to how they are actually consumed. That may be the most important unanswered question in the entire conversation.

The importance of consumer behavior becomes particularly clear when examining indulgent foods.

Chocolate and candy are frequently cited as emblematic “unhealthy” foods because they are high in sugar and fat. Yet consumption patterns tell a more complicated story. According to Georgetown University’s consumer research on indulgent foods, candy accounts for less than 2% of calories in the American diet and only 6.4% of added sugars. More importantly, purchasing patterns illustratd that consumers with obesity bought candy at approximately the same rate as some of the healthiest consumer segments.

That does not make candy a health food.

But it does illustrate an important principle: foods cannot be understood solely by examining their composition. They must also be understood through the lens of how consumers actually use them.

Consider the much-discussed “ice cream paradox.” In several large observational studies, researchers found that ice cream consumption was not associated with the negative outcomes many expected and, in some cases, appeared linked with unexpectedly favorable health measures. Most researchers caution against interpreting these findings as evidence that ice cream improves health. More likely, they reflect the challenges of isolating individual foods from the broader dietary and behavioral patterns in which they are consumed.

But the episode illustrates an important lesson. Nutrition science is often far more effective at identifying broad dietary risks than predicting the effects of individual foods in isolation. Sometimes the assumptions we bring to foods are more certain than the evidence itself.

The Danger Of Oversimplification

Simplistic frameworks often produce overly simplified policies.

Nutrition history is filled with examples of well-intentioned efforts that focused on the wrong variable. We demonized fat, only to accelerate an era of low-fat, high-sugar reformulations. We focused narrowly on nutrients while often overlooking broader dietary patterns and consumer behavior.

There is a risk of making the same mistake if processing itself becomes the next nutritional villain.

None of this means ultra-processed foods deserve a free pass. Nor does it mean industry should dismiss legitimate public health concerns.

It does mean that the next scientific frontier should move beyond broad food classifications and spend far more time understanding how foods are actually consumed. Frequency, quantity, dietary quality, consumer differences, physical activity and broader eating patterns may ultimately prove just as important as processing itself in determining health outcomes.

What Works In The Real World?

If the objective is improving public health, the more important question is not simply what is wrong with the food system. It is which interventions are most likely to work.

More than a decade ago, the McKinsey Global Institute evaluated dozens of obesity interventions and concluded that portion control and product reformulation ranked among the most cost-effective approaches for improving health outcomes. That finding remains highly relevant today.

Rather than treating public health and industry as adversaries, policymakers and manufacturers should focus on practical improvements that better align with how consumers actually behave. Smaller portions, continued reformulation, clearer consumption guidance, and products designed around evolving consumer needs for healthier fare may ultimately deliver more impact than another round of labels, warnings, restrictions, or litigation.

Examples already exist. The confectionery industry’s “Always A Treat” initiative emphasizes occasion, portion awareness and mindful enjoyment rather than encouraging unrestricted consumption. More importantly, the industry backed its messaging with measurable action. Through its commitments to the Partnership for a Healthier America, confectionery companies achieved a goal that at least 50% of their individually wrapped products would contain 200 calories or less, demonstrating that portion architecture can help align consumer preferences with public-health objectives without requiring consumers to abandon products they enjoy.

Other industries have taken similar approaches. In another sector facing intense public health scrutiny, Anheuser-Busch InBev invested more than $1 billion over a decade in initiatives aimed at reducing harmful alcohol use. The effort reflected an important recognition: industries do not strengthen their long-term credibility by ignoring legitimate public health concerns. They strengthen it by helping to address them.

As I have argued previously, food manufacturers facing growing public-health scrutiny may ultimately strengthen their credibility by leading change rather than resistance. The companies most likely to thrive in a more health-conscious marketplace will be those that help consumers achieve better outcomes while continuing to deliver the taste, convenience and affordability consumers value.

From UPF Debate To Results

Consumers will continue making tradeoffs among health, cost, convenience and enjoyment. Effective policy should recognize those realities rather than assume they can be regulated away.

For years, nutrition policy has focused on nutrients, ingredients, labels and now processing. Yet obesity rates continue to rise, even in countries that have adopted increasingly aggressive interventions. That does not mean public health concerns are misplaced. It means the next generation of solutions must become more sophisticated.

The next phase of the UPF debate should not be about finding the next nutritional villain. It should be about understanding how real people actually eat, and identifying which interventions are most likely to improve health outcomes in the real world.

Consumers don’t eat classifications. They eat diets.

That means paying as much attention to consumer behavior as product formulation. It means studying not only what foods contain, but how often they are consumed, in what quantities, by whom, and within what broader dietary patterns. And it means recognizing that lasting progress will come not from winning an argument about food, but from helping people build healthier lives.

Because if the objective is improving public health, the most important question is not who wins the debate.

The question is what works.