CONSIDERING ULTRA -PROCESSING IN THE
DEVELOPMENT OF POLICY INDICATORS TO
MONITOR FOOD SECURIT Y
Jean-Claude Moubarac, PhD
C e n t r e f o r E p i d e m i o l o g i c a l S t u d i e s i n H e a l t h a n d N u t r i t i o n , U n i ve r s i t y
of São Paulo, Brazil
M c G i l l I n st i t u te f o r G l o b a l Fo o d S e c u r i t y, C a n a d a
D ST- H S RC S c i e n ce S e m i n a r P r o g r a mm e
P o l i c y - r e l ev a n t I n d i c a to r s to M o n i tor H o u s e h o l d Fo o d S e c u r i t y S t a t u s
in South Africa
C a p e To w n , N ove m b e r 1 2 t h 2 013
Guiding principles
1.
2.
3.
4.
Public health mission
Interdisciplinary research
Transparency
Equity and justice
OUTLINE
1) Why discuss food processing at a seminar on food
security?
2) NOVA food classification
3) Trends in the consumption of ultra-processed products
and assocations to diet quality and obesity
4) Development of policy indicators to monitor household
food security status
WHY DISCUSS FOOD PROCESSING
AT A SEMINAR ON FOOD SECURIT Y?
Different views on the causes of food insecurity
 Lack of production: we need to double up production (FAO,
agro-business).
 The role of industrial food processing in food systems: how,
why and who transform food we produce?
 Lack of access, equity
AGRO-PROCESSING : A GROWING SECTOR OF FOOD SYSTEMS
•
•
•
•
Production
Processing
2nd industrial sector in Canada
Sales of 91 billions en 2011
Use 34% of agricultural production
Highly concentrated market power
Transport
Sales
Consumption
WHY DISCUSS FOOD PROCESSING
AT A SEMINAR ON FOOD SECURIT Y?
Measurement of diet quality
“Access to enough nutritious food is fundamental for human
health and is therefore a primary quality -of-life indicator”
“What policy interventions exist to help these households
access enough nutritious food for a healthy life?”
DST-HSRC Science Seminar program
 But how to define healthy foods and quality of diets?
HOW TO DEFINE HEALTHY FOODS
AND QUALIT Y OF DIETS?
 Nutrient-based approach is not working
 We need a contemporar y approach, one that account for the way we
produce, transform and eat food today...
 The world is moving towards an increasingly processed diet ( Sw i n burn
et a l . 2 01 1 ; St uc k l er et a l . 2 01 2 ; M o o di e et a l . 2 01 3 ; M o n te iro a n d C a n n on
2 01 2 ; M o n te iro et a l . 2 01 3 ; Po pk i n 2 0 0 5 ; H aw ke s 2 0 07 )
 We must consider the role of food processing in the quality of diets
Hydrogenation,
Pesticides
Fertilizers
OGM
Evolution of food technology
•
Core role in human evolution
•
Gradually changed during pre-industrial era
•
Revolutionary and rapid changes since
industrialization, and globalization
Rollerstills
wheels
Canning
Mass
Agriculture & Production of
Oil, Salt &
Husbandry:
Sugar
Pounding, grinding,
roasting,
wetting, boiling,
Large
fermenting of
granaries
seeds an acorns
Cooking
2M
Butchering,
smoking &
Drying of meats
300 000
30 000
12000
6500
3000
1780 1950
DEFINITION AND METHODS OF FOOD PROCESSING
 Food processing per se has received little attention in nutritional and
epidemiological analysis (nutrient -limited or product -limited).
 Terminology vague and multiple (highly -processed, convenience
products, fast -food, etc.).
 NOVA food classification system
 Based on the extent and purpose of industrial food processing
 First devised by Carlos Monteiro and colleagues at University of São Paulo,
Brazil.
 Trans-disciplinary conceptual model drawing from the sciences of public
health, nutrition and anthropology.
 Global research network: applied to more than 40 databases, from 30
countries.
Food processing in the food system
Food
production
(at farms)
Industrial
food
processing
(at factories)
NATURAL
RESOURCES
UNPROCESSED
FOODS
(sun, soil,
water,
seeds ...)
(roots, stems, leaves,
fruits, seeds, meat,
milk, eggs ...)
Culinary
food
processing
(at kitchens)
MINIMALLY
PROCESSED FOODS
CULINARY
INGREDIENTS
MULTI-FOOD
FRESHLY
PREPARED
DISHES
PROCESSED &
ULTRA-PROCESSED
FOOD PRODUCTS
DIET
GROUP 1
UNPROCESSED AND MINIMALLY PROCESSED FOODS













Grains (cereals)
Legumes (pulses)
Roots and tubers (starchy)
Vegetables (green, salad, non -starchy roots
Fruits
Nuts and seeds
Meat
Fish
Seafood
Milk
Eggs
Water
other
GROUP 2
PROCESSED SUBSTANCES





Oils
Animal fats
Sugars
Salt
other
Food and substances are turned into freshly prepared
dishes and meals by domestic/artisanal processing
+
=
GROUP 3
READY-TO-CONSUME PRODUCTS
P ro c es s ed fo o d p ro d uc t s :
 Bo t tl e d, c a n ne d p ro d u cts
 S a l te d , s a l t - p ick le d , c u re d , s m o ke d p ro d ucts
 Cheese
 o t he r
U l t ra -p ro c es s ed p ro d uc t s :
 I n d us tri al b re a d s
 S we ete n e d b re a k fa s t c e re a l s
 S we et b a ke d p ro d ucts
 S we et s n a c k s, p re s e r ve s
 S a l t y fri e d o r ba ke d p ro d u cts
 C a rb o n ate d s o f t d ri n k s
 S we et j u i c e s a n d d ri n k s
 Re c o n s ti tute d m e a t a n d f i s h p ro d u cts
 C h e e s e p ro d ucts
 S p re a d s a n d s a u c e s
 Ba by fo o d p ro d u cts
 ‘ H e a l t h ’ a n d ‘ s l i m m i ng’ p ro d u cts
 P re - p re p a re d re a d y - to -h e a t d i s h e s , p ro d u cts
 other
‘Ultra-processed products are assemblages
of industrial ingredients obtained from the
extraction, refinement, and transformation
of constituents of raw foods with usually
little or no whole food.’
Moodie R, Stuckler D, Monteiro C et al (2013) Profits and pandemics:
prevention of harmful effects of tobacco, alcohol, and ultra-processed food and
drink industries. The Lancet, Feb 12.
Ultra-processing
Oils, fats,
flours, sugar, salt
starches, plant
proteins, milk
whey, remnants
of meat
UNPROCESSED
FOODS
Hydrogenated oils,
starch-modified sugars,
hydrolyzed proteins, extruded meat extracts
ULTRAPROCESSED
PRODUCTS
Preservatives, stabilisers,
emulsifiers, solvents,
binders, bulkers,
sweeteners, sensory
enhancers, flavours,
colours, other additives,
synthetic micronutrients.
Little or no
preparation
Snacks, soft drinks,
sweets, sausages,
frozen dishes
Ultra-processing
Oils, fats,
flours, sugar, salt
starches, plant
proteins, milk
whey, remnants
of meat
UNPROCESSED
FOODS
Hydrogenated oils,
starch-modified sugars,
hydrolyzed proteins, extruded meat extracts
ULTRAPROCESSED
PRODUCTS
Preservatives, stabilisers,
emulsifiers, solvents,
binders, bulkers,
sweeteners, sensory
enhancers, flavours,
colours, other additives,
synthetic micronutrients.
Little
or no
preparation
Snacks, soft drinks,
sweets, sausages,
frozen dishes
Ultra-processing
Oils, fats,
flours, sugar, salt
starches, plant
proteins, milk
whey, remnants
of meat
UNPROCESSED
FOODS
Hydrogenated oils,
starch-modified sugars,
hydrolyzed proteins, extruded meat extracts
ULTRAPROCESSED
PRODUCTS
Preservatives, stabilisers,
emulsifiers, solvents,
binders, bulkers,
sweeteners, sensory
enhancers, flavours,
colours, other additives,
synthetic micronutrients.
Little or no
preparation
Snacks, soft drinks,
sweets, sausages,
frozen dishes
Ultra-processing
Oils, fats,
flours, sugar, salt
starches, plant
proteins, milk
whey, remnants
of meat
UNPROCESSED
FOODS
Hydrogenated oils,
starch-modified sugars,
hydrolyzed proteins, extruded meat extracts
ULTRAPROCESSED
PRODUCTS
Preservatives, stabilisers,
emulsifiers, solvents,
binders, bulkers,
sweeteners, sensory
enhancers, flavours,
colours, other additives,
synthetic micronutrients.
Little or no
preparation
Snacks, soft drinks,
sweets, sausages,
frozen dishes
Ready-to-consume ultra-processed products: replaces
home cooking
Per capita retail sales of selected ultra-processed products in highincome countries (1998-2012)
Frozen products
Snacks
Soft drinks
40
40
140
30
30
130
20
20
120
10
10
110
0
0
100
Monteiro, Moubarac, Ng, Cannon & Popkin, 2013. Obesity Rev
Per capita retail sales of selected ultra-processed products in lowermiddle-income and upper-middle-income and countries
(1998-2012)
Frozen products
Snacks
Soft drinks
8
8
80
6
6
60
4
4
40
2
2
20
0
0
0
▲ Upper-middle-income countries; ■ Lower-middle-income countries.
Per capita retail sales of selected ultra-processed products in South Africa
and upper-middle-income and countries (1998-2012)
Frozen products
Snacks
Soft drinks
8
8
80
6
6
60
4
4
40
2
2
20
0
0
0
▲ Upper-middle-income countries; ■ South Africa
Time trend changes in household purchases
of food groups in canada, 1938-2001
% available kcal at household level
60
Ultra-processed products
54.9
50
42.1
40
30
20
Unprocessed/minimally processed foods
29.2
29
24.4
Processed ingredients
9.3
10
6.8 Processed products
4.3
0
1938
1953
1969
1984
2001
Dietary shifts in the global food systems
What kind of
power and
control people
loose when
they stop to
cook?
Diets based on freshly prepared meals and
dishes made from foods
Diets based on ready-to-consume
products that require little or no
preparation
Food processing and quality of diets
Compared to foods and culinar y ingredients, ready -toconsume products (most are ultra -processed) have:







less protein
less dietar y fiber
more free sugar
more total, saturated and trans fats
more sodium
less potassium, less vitamins
higher energy density
Sources: Monteiro et al Public Health Nutrition 2011
Moubarac et al. Public Health Nutrition 2012
Higher proportion of ultra-processed products is associated to
lower diet quality
Indicator
<33
34-54
55-64
65-72
>73
Goal
Protein
(% of calories)
14.9
14.1
13.8
13.4
11.6
*
10-15
Fiber
(g/1,000 kcal)
11.2
10.1
9.7
9.1
8.0*
> 12.5
Free sugars
(% of calories)
9.2*
11.6
12.0
13.5
15.1
*
< 10
Sodium
(mg/1,000 kcal)
1.1
1.4
1.5
1.6
1.6*
<1
Energy density
(kcal/g)
1.8
2.0
2.1
2.1
2.3*
Source: Moubarac J-C et al PHN 2012. * p < .001 for linear trend
FOODS A N D I N GRE DI ENT S VS RE A DY-TO- C ONSUME P RODUC T S
E NE RGY D E NSI T Y ( KCA L/ G )
Country
Food +
Ingredients
Ready-to-consume
products
CANADA 2001
1.3
2.8
BELGIUM 1999
1.6
3.0
AUSTRIA 1999
1.7
3.1
FINLAND 1998
1.4
2.7
SPAIN 1999
1.9
2.7
GERMANY 1998
1.6
2,9
UK 2008
1.4
2.8
BRAZIL 2008
1.9
2.9
COLOMBIA 2007
1.8
2.7
1.3 - 1.9
2.6 - 3.1
ALL
UNIQUE CHARACTERISTICS OF ULTRA -PROCESSED
PRODUCT S
 Affordable, accessible and highly marketed products
 Liquid calories (all sugared drinks)
Vartanian et al (2007) Am J Public Health 97: 667-75
 Hyper-palatability (all products)
Kessler (2009) The End of Overeating. New York, Rodale.
 Habituation/addiction
Brownell and Gold (2012) Food and addiction. New York, Oxford University
Press; Garber and Lustig (2012). Current Drug Abuse Reviews 4(3): 146162
 Super size servings (many products)
Report of the DGAC on the Dietary Guidelines for Americans 2010
 Mindless eating (all products)
Cohen & Farley (2008) Prev Chronic Dis 2008;5:1-7
Estimates for the dietary share of ultra-processed
products in 27 countries (1991-2010)
70
62
60
58
52.8 53.5
49.6 50.2
50
% of total energy
54.9
38.7
40
33
30
25.4
41.4
40.1 40.3 41
43.3
45
46.4
35.2 35.5 36
28.4
27.2 27.5
18.6
20
12.7
10
USA 2010
UK 2008
CANADA 2001
GERMANY 1998
CHILE 2007
IRELAND 1999
BELGIUM 1999
FINLAND 1998
MALTA 2000
NORWAY 1998
SLOVAKIA 2003
AUSTRIA 1999
CROATIA 2004
MEXICO 2010
LATVIA 2004
URUGUAY 2006
SPAIN 1999
CYPRUS 2003
GREECE 2002
FRANCE 1991
ITALY 1996
PORTUGAL 2000
BRAZIL 2008
COLOMBIA 2006
PERU 2009
0
Estimated from national household food expenditure surveys for Brazil (HBS), Canada (FOODEX), Chile (EPF),
Colombia (ENIG), Peru (ENAPREF) Mexico (ENIGH), Uruguay (EGIH), and the Data Food Networking (DAFNE) for all
European countries, except UK (LCF), and from 24 h recall survey for USA ((HANES)
S H A R E O F U LT R A - P R O C E S S E D P R O D U C T S I N N AT I O N A L FO O D
B A S K E T S A N D O B E S I T Y I N 1 9 E U R O P E A N C O U N T R I E S ( 1 9 91 - 2 0 0 8 )
40
y = 0.2812x + 12.207
R² = 0.5619
Obesity in adults (%)
35
USA
Mexico
30
Chile
Canada
25
20
Uruguay
Peru
Colombia
Brazil
15
10
5
0
0
10
20
30
40
50
60
70
Ultra-processed products (% of total energy)
Source: National household food expenditure surveys and national health surveys in the same year or period and NHANES for USA
S H A R E O F U LT R A - P R O C E S S E D P R O D U C T S I N N AT I O N A L FO O D
B A S K E T S A N D O B E S I T Y I N 1 9 E U R O P E A N C O U N T R I E S ( 1 9 91 - 2 0 0 8 )
30
y = 0.3514x + 1.0513
R² = 0.4141
Obesity in adults (%)
25
UK
Germany
20
Hungary
Croatia
Norway
Lithuania
Greece Spain Latvia
Portugal
15
Cyprus
10
Malta
Ireland
Slovakia
Austria
Belgium
Finland
France
Italy
5
0
20
30
40
50
Ultra-processed products (% of total energy)
Source: National household food expenditure surveys and national health surveys in the same year or period
60
P R E D I C T I V E VA L U E S FO R O B E S I T Y I N D I C AT O R S AC C O R D I N G T O T H E
H O U S E H O L D AVA I L A B I L I T Y O F U LT R A - P R O C E S S E D FO O D P R O D U C T S
( KC A L / P E R S O N / DAY ) . B R A Z I L , 2 0 0 8 - 2 0 0 9
Availability of ultra-
Obesity indicator
processed products
Mean BMI
Prevalence of
Prevalence of
(mean values
(Z score)
excess weight
obesity (%)
according to quartiles)
(%)
1st (220.0 kcal)
0.56
35.6
9.9
2nd (345.6 kcal)
0.66
38.7
12.0
3rd (422.0 kcal)
0.69
39.6
12.3
4th (564.3 kcal)
0.75
41.7
13.6
Values are adjusted by log of income, proportion of women in stratum, proportion of elderly in stratum, proportion
of children in stratum, setting, region, percentage of expenditure on eating out of home, and for complementary
calories, including calories of processed food products), set for the mean value of the confounding variables.
Source: Canela et al. 2013 (in review)
RESEARCH PROGRAM 2014MCGILL INSTITUTE FOR GLOBAL FOOD SECURIT Y
U N I V E R S I T Y O F S Ã O PA U L O
 Food insecurity is associated to higher prevalence of obesity; this
relation is thought to be mediated by diet quality, but diet quality is
related to the types of processing.
Initial studies
 In Canada, since people living in food insecure households tend to
be of lower income and buy ready -to-consume products that are
cheap, but energy dense and nutritionally imbalanced (McLaughlin
2003; Engler-Stringer et al. 2011)
 In the US, higher frequency and complexity of home food
preparation and cooking, more structure meal patterns and eating
with other s, are associated with higher dietar y quality ( Laska et al.
2012; Lar son et al. 2006, 2007, 2009)
RESEARCH PROGRAM 2014MCGILL INSTITUTE FOR GLOBAL FOOD SECURIT Y
U N I V E R S I T Y O F S Ã O PA U L O
The research program is centered on three related hypotheses:
1) Industrial food processing and cooking activity are among the main
determinants of diet quality;
2) Obesity is related to the consumption level of ultra -processed products
and the frequency, complexity and diver sity of cooking
3) The relationship between food security and obesity is mediated by the role
of industrial food processi ng in the diet.
Food
security
Food
processing
Quality of
diet
Obesity
DEVELOPMENT OF NEW POLICY INDICATORS TO
MONITOR HOUSEHOLD FOOD SECURIT Y STATUS
 Trends in sales and availability of ultra-processed products in the
food system
 Household availability and consumption of ultra -processed
products (linked to quality of diets)
 Measures that grasp household’s cooking capacities and abilities
 Access, price, and marketing of ultra-processed products in local
food systems.
 Quality of diets: Start with food categories; and then use nutrient
profiling models to assess quality diversity within ultra processed products
NATIONAL DEVELOPMENT PLAN 2030-CHALLENGES
Human security inter ventions in the region should focus on improving
livelihoods in countries that are dependent on agriculture and agro processing by suppor ting ef for ts to improve productivity and include an
increasing propor tion of Africa producers in global value chains.
Centralized power
 “In South Africa, however, a highly centralised, ver tically integrated
agro-processing sector already exists for staple foods. The scope for
small-scale manufacturing and agro -processing targeting local
consumers in poor communities is limited”.
Invasion of su permarkets ( Hawkes 2007)
South African agro-food fystem and the dualistic nature of the
agriculture and deep penetration of supermarkets (taken from
the seminar program)
NATIONAL DEVELOPMENT PLAN 2030
Recommendations :
 Expand and diversify trade in agriculture and agro-processing - which
should include a purposeful strategy on food security. (p.246)
 International bargaining must include securing investment,
diversification and continued progressive development in agriculture
and agro-processing (p.243)
 Provide innovative market linkages, by: linking farmers to markets will
also require infrastructure for processing and value addition and new
forms of intermediaries, such as cooperatives, to help small producers
achieve economies of scale in processing (p.229).
 Links between agriculture and nutrition can be strengthened,
par ticularly regarding producing and processing nutrient -rich foods
such as legumes and other vegetables (p.235)  MINIMAL PROCESSING
PUBLIC ACTIONS TO INCENTIVE, SUPPORT, AND
PROTECT TRADITIONAL FOOD SYSTEMS AND DIETS:
LEARNING FROM BREAST-FEEDING!
ACTION
Incentive
Support
Protection
HUMAN MILK
MINIMALLY PROCESSED
FOODS
Information/education
Information/education
(health, environment,
and culture arguments)
Maternal leave, babySubsidies and taxes,
friendly hospitals, human family agriculture
milk banks
support, government
food procurement
Code to regulate the
Code to regulate the
marketing of infant
marketing of ultraformulas
processed products
CONCLUSION
Industrial food processing is a important determinant
of quality of diets and of the risk of obesity.
This role need to be considered in the development of
indicators to monitor food security at the household,
local and national level.
Food processing is (one of) the missing links between
Agriculture and Nutrition
jcmoubarac@gmail.com
Carlos Augusto Monteiro, Geoffrey Cannon
Centre for Epidemiological Studies in Health and Nutrition (NUPENS)
School of Public Heath,University of Säo Paulo. Brazil
Hugo Melgar Quinonez
McGill Institute for Global Food Security
Fundação de Amparo à Pesquisa do Estado de São Paulo