What happens when a diet targets ultra-processed foods?

Most dietary programs are designed to help people achieve weight loss or adhere to U.S. nutrition guidelines, which currently make no mention of ultra-processed foods (UPFs). UPFs – like chips or candy – are the mass-produced, packaged products that contain little or no naturally occurring foods. Eating UPFs is strongly associated with increased risk of diseases and early death.

Because almost no existing programs focus specifically on reducing UPF intake, researchers from Drexel University’s College of Arts and Sciences designed an intervention that included a variety of tactics to target the uniquely problematic aspects of UPFs, including being engineered to be addictive. In addition to providing education about UPFs, the program integrated mindfulness and acceptance-based strategies, to help participants cope with cravings; one-on-one meal planning; a focus on improving the home food environment by involving a household member in the intervention; and financial support to help participants purchase healthy foods, such as fresh fruits and vegetables which can be more expensive.

Recently published in Obesity and Science Practice, the researchers tested a two-month intervention with 14 adults with overweight or obesity, who regularly ate UPFs (two UPF items per day). On average, participants successfully reduced their UPF intake by almost half.

“Reducing UPF intake can be extremely difficult, because the food industry wants us to be hooked on UPFs,” said lead author Charlotte Hagerman, PhD, an assistant research professor in the College. “The industry designs UPFs to be ultra-delicious, convenient, cheap, and constantly present in the U.S. — even if not directly in front of us, then on our TVs, phones, and roadside signs.”

Hagerman noted that although the sample was small, the results of this intervention were very promising. By the end of the program, participants had reduced their UPF intake by almost half – both when measured as calories from UPFs and as the total number of UPFs consumed. Participants also reduced their calorie intake, on average by over 600 calories per day. Further, sugar consumption declined by 50%, saturated fat consumption declined by 37%, and sodium consumption declined by 28%. Participants also self-reported losing an average of 7.7 pounds.

“Interestingly, participants did not have meaningful increases in their fruit and vegetable consumption, suggesting that if we want to improve dietary intake more wholistically, we may need to more strongly encourage people to eat these foods,” said Hagerman.

The research team highlighted that participants had highly positive feedback about the intervention and were enthusiastic about the benefits they noticed. During interviews, many reported that they experienced improvements in their mood and energy.

During the two-month intervention, the 14 participants worked with coaches with expertise in health behavior change at weekly group sessions that included one-on-one meetings, discussion and activities. Participants received education about identifying UPFs and their harmful effects, learned acceptance-based strategies for coping with the cravings and withdrawal of reducing UPFs and learned the importance of the household food environment for reducing UPF intake. Participants also had individual meal-planning sessions and financial support in the form of a $100 grocery store gift card.

To assess their dietary intake, participants completed the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA-24) to ask participants to report everything they ate over the past 24 hours. Before and after the intervention, participants reported everything they ate during two weekdays and one weekend day (since eating behavior tends to be different during the weekend). The assessment tool automatically reported servings of specific food groups (e.g., fruits), macronutrient intake, and calorie intake, to help the team and participants identify consumption patterns.

A member of the research team categorized each entry as UPF or not and consulted with a UPF expert for a second opinion on ambiguous cases. Researchers were not aware of whether each entry was from before or after the intervention, to avoid biasing their coding.

The data allowed the team to determine whether participants had significant changes in their UPF intake, sodium, added sugar, saturated fat, weight, and fruit/vegetable intake.

“The findings suggest that people can reduce their ultra-processed food intake, if given the proper tools, and that they will be enthusiastic about interventions designed for this purpose,” said Hagerman. “The results also suggest that reducing UPF intake will lead to meaningful health improvements – such as weight loss and better mood – in as short as eight weeks.”

The research team plans to continue testing the intervention – on a larger sample, testing efficacy of the specific components of the intervention and testing on different populations.

The full study can be read here: https://onlinelibrary.wiley.com/doi/10.1002/osp4.70029.