Ultra-processed foods in healthcare settings

The food choices offered to patients in hospitals should be a cause of deep concern

According to Lane et al (BMJ, 2024;384: e077310), ultra-processed foods (UPFs) are “characterised as industrial formulations primarily composed of chemically modified substances extracted from foods, along with additives to enhance taste, texture, appearance, and durability, with minimal to no inclusion of whole foods”. With ‘Big Food’ promoting these substances for our consumption, it’s unsurprising that Lane et al’s study ‘Ultra-processed food exposure and adverse health outcomes…’ concluded that greater exposure to UPF “was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes”. Six years previously, in Public Health Nutrition (2018, 21: 5-17) Monteiro et al concluded, in relation to UPFs, “that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked, and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.”

Nobody told the UK’s Hospital Caterers Association (HCA). Take, for example, the Hospital Catering Solutions Guide – produced by Premier Foods – on the HCA’s website. In the guide, the HCA’s then Honorary National Chair Mr Philip Shelley states: “The expertise that Premier Foods brings to the hospital catering industry is invaluable with the knowledge that our healthcare caterers are reaching out for advice and recipes from a supplier that truly bring freshness to food choices.” Emblematic of bringing freshness to food choices are the “top 15 recommended Premier Foods products for hospitals”, whose bill of fare includes flavoured jelly, custard powder, scone mix, soft bap mix, stuffing mix, and instant mashed potato.

Given this bleak prospect, it is encouraging to note that the Report of the Independent Review of NHS Hospital Food (2020) observed that “what we all want to see is safe food that has not been over-processed…”. But hang on; who chaired this review? It was Mr Shelley. And one can also read the November/December 2023 issue of Hospital Food & Service on the HCA’s website, which features an item titled ‘Keep it Sweet’ (page 28), and whose author says that “desserts can also make a vital contribution to the overall nutritional intake for patients…”.

I sent Freedom of Information (FoI) requests to 13 Scottish NHS Boards, asking how much each spent on confectionery and sugar-sweetened beverages for sale to patients and the public in 2022/2023. One Scottish NHS Board spent nothing and eight spent a combined total of £609,206.

The extent to which health sector caterers, administrators, and dietitians appear willing to perpetrate UPF-mediated dietary mayhem in healthcare settings is deeply concerning. There seems to be a reluctance – even a refusal – to endorse and implement a plain three-word food and health policy that would help to begin to address today’s soaring obesity and type 2 diabetes (T2D) rates: Eat Real Food. But instead, a dietary hysteria is encouraging people to follow dietary guidelines like the Eat Well plate that has been shown to be unsupported by evidence and that glorifies the one foodstuff that’s both non-essential and fuels T2D: Carbohydrate. In ‘Saturated fats and health: A reassessment and proposal for food-based recommendations: Journal of the American College of Cardiology State-of-the-Art Review’ (JACC, 2020; 76: 844-857), Astrup et al state: “There is no robust evidence that current population-wide arbitrary upper limits on saturated fat consumption in the United States will prevent cardiovascular disease or reduce mortality.” Despite papers like this that champion scientific scrutiny – and common sense – stubbornness abounds.

What of future nutritional standards? I sent FoI requests to Scottish medical schools asking details about time spent teaching medical students about nutrition. Glasgow University replied: “Year 1 – Describe the recommendations for a balanced diet (the Eat Well plate) to provide the nutrients required for the body. Year 2 – There are four hours that directly cover nutrition for the full lecture.” Er… that’s it.

With healthcare settings opening their arms to UPFs and junk food and a lack of education in medical schools on the subject of nutrition, one might usefully look to the past. In his essay ‘On the ignorance of the learned’, William Hazlitt (1778-1830) observes that “…the mass of society have common sense, which the learned in all ages want”, and notes that some of the labourers in the vineyard of learning “seem as if it was their object to confound all common sense… by means of traditional maxims and preconceived notions taken upon trust…”.