Time for a noodle tax?: Doctor who raised alarm over ultra-processed foods urges tougher measures

Pthe poor students heading off to university, ready to survive on instant noodles and cereal until Christmas. The first doctor to sound the health alarm about ultra-processed foods thinks it’s time to tax those noodles – and he’s even got ice cream in his sights.

According to Professor Carlos Augusto Monteiro, the weight of the evidence about the problems such foods cause to “most body systems” leaves “no doubt” that governments must act now.

“Strong policies, as soon as possible” on ultra-processed foods (UPFs) are needed to reduce chronic diseases in countries around the world, Monteiro said. If we wait another 10 years to take action, “it will be a tragedy, because it has a price.”

His team at the University of São Paulo in Brazil came up with the following idea: New classification system for foods, first proposed in 2009 and now widely adopted. It groups them based on their level of processing, ranging from category one – unprocessed or minimally processed foods, such as whole fruits and vegetables – to four: ultra-processed.

This category consists of food products that have been industrially produced. manufacturedoften with artificial flavors, emulsifiers and colors. They include soft drinks and packaged snacks, and are generally extremely palatable and high in calories, but relatively low in nutrients.

Critics say UPF is a poorly defined category and that existing health policies, such as those aimed at reducing sugar and salt consumption, are sufficient to address the potential threat.

Monteiro acknowledges that some foods fall somewhere between “ultra-processed” and “processed,” which poses a problem for regulators.

“A whole loaf of bread with emulsifiers and added fiber is technically ultra-processed by definition, but it is clearly not the worst product,” he says.

“I think the solution is to forget the technical definition of ultra-processed foods and focus on all the food groups that are most likely ultra-processed,” says Monteiro.

Products that are clearly UPF, he says, include reconstituted meat products, instant noodles and soft drinks. He adds: “If you take ice cream for example. Probably 99% of the ice cream on the UK market is ultra-processed. And then you have maybe 1% that isn’t, which is probably very expensive. So if you put a tax on all ice cream? Great.”

The hard sell of ultra-processed foods in developing countries and among poorer communities in particular, Activists say this is creating a non-communicable disease crisis.

Earlier this year, Monteiro spoke at the International Congress on Obesity in São Paulo, where research was presented showing that obesity rates in the country are rising rapidly. Brazil is on track to have 68% of adults overweight or obese by 2030, up from 62% today.

He argued that multinational food companies that produce UPF should be treated in the same way as tobacco companies, requiring them to display warnings on the front of their packages, pay taxes and conduct public health campaigns.

Monteiro says he’s been surprised by the amount – and consistency – of evidence that’s been collected in the past five years. He recently counted 70 cohort studies that followed large groups of people over long periods of time to look at the impact of diet on their health, and says 62 found that UPFs were linked to health problems.

The studies are observational – they can’t conclusively prove that UPFs cause the health problems – but Monteiro points out that it was the same kind of evidence that linked smoking and lung cancer.

“It’s really strong, and not just in obesity or diabetes, but in cardiovascular disease, mental health, kidney, liver, gastrointestinal disease. So we’re talking about exposure (to UPF) that’s damaging to most body systems.”

He believes it is time for a global treaty on ultra-processed foods, similar to the one imposed on the tobacco industry: an international treaty aimed at curbing supply and demand and preventing tobacco companies from lobbying the UN and the World Health Organization and sponsoring scientific conferences.

There are clear differences, he says, between UPFs and tobacco, not least that the relationship between diet and health is more complex than that between smoking and disease. But, he says, both “increase the risk of many serious diseases” and are “produced by huge transnational corporations with immense power”.

Monteiro says national dietary guidelines should tell people to avoid UPFs as much as possible, pointing to evidence that even a relatively high-quality diet can be disrupted by an increase in such foods.

“You lose the protection,” he argues. “That means you can’t say, ‘Well, I’ve already eaten fruit and vegetables today, I can have three cans of Coke.’ No, you can’t.”

Directive changes should be followed by taxes and marketing restrictions, Monteiro adds. In Brazil, he has advised on tax reforms that will lead to zero or low taxes on minimally processed foods and high taxes on UPFs.

He disagrees with the idea that extreme processing can make food healthier, arguing that reformulation too often simply means making food tastier, so that consumers buy and eat more.

“UPFs are produced to replace non-ultra-processed foods, so they are new products: new bread, new yoghurts, new soups, new pizzas that replace traditional pizzas, traditional yoghurts, traditional cheese, traditional bread, etc.”

They are ‘made extremely palatable so that they reach our brains very quickly and provide enormous pleasure’.

While flavored yogurt (an example of UPF) is “obviously better than soda – you have some calcium and some protein – what if I compare the flavored ultra-processed yogurt to the regular yogurt and fruit?”

Moreira has little time for the argument that extra taxes hit the poorest hardest, because UPFs are generally cheaper. This can be countered with targeted policies and social support, he says.

This could mean working to improve the supply of fresh fruit and vegetables in “food deserts” such as the slums of Brazil, he says. But it is “ridiculous” to use that as “a reason not to promote healthy food or healthy diets”.

“Nobody is saying that ultra-processed foods should be banned,” he says, adding: “We are not banning tobacco or alcohol.”

Countries are in one of two situations, he says. In Western states such as the US, Britain, Australia and Canada, traditional food cultures have been “destroyed” and UPF already makes up the majority of the population’s energy intake (about 66% for adolescents in the UK), a figure he says is stabilising.

In other countries, particularly in ‘low- and middle-income countries’, UPF consumption is lower but ‘increasing very rapidly’.

In less affluent countries, chronic diseases linked to UPF can mean decades of suffering for patients, and health care costs that are “simply unaffordable,” he says.

For him, eating UPF is “an exception.” On a recent trip to Europe, he couldn’t find chocolate in a supermarket without emulsifiers, flavors or dyes, he says, adding, “I bought whatever I could find.”