Research Review: Ultra-Processed Doesn’t Always Mean Unhealthy: Why Reform, Not Removal, Should Guide Food Policy—Especially for Fortified Plant Milks, Clinical Meal Replacements, and Frozen Vegetables

By Jackson Mann

BLUF (Bottom Line Up Front)

This narrative review examines the controversial role of ultra-processed foods (UPFs) in modern diets. It presents evidence both for their potential harms—such as high levels of salt, sugar, oil, and additives—and for their possible utility if significantly reformulated and regulated to support health and sustainability goals. The authors argue that the health impact of UPFs depends less on processing alone and more on their nutrient composition, processing techniques, and additive profiles. Citing examples like fortified plant-based milks and nutrient-retaining frozen vegetables, the review highlights that some UPFs may contribute positively to public health when thoughtfully designed.

Purpose of the Study

The purpose of the focal narrative review is to evaluate the evolving role of ultra-processed foods (UPFs) in modern food systems and public health policy. The authors aim to examine how current food classification systems—particularly the NOVA framework—categorize UPFs and influence global dietary guidelines. They also analyze the mechanisms by which UPFs may contribute to non-communicable diseases (NCDs), including obesity, metabolic syndrome, and cardiovascular disease. Rather than accepting the generalized assumption that all UPFs are nutritionally harmful, the authors challenge this view by highlighting variability within the category. They propose a more targeted public health approach that emphasizes reformulation and regulatory oversight over outright elimination. Ultimately, the paper advocates for a shift in strategy—from condemning processing itself to evaluating foods based on nutrient density, ingredient profiles, and their functional or social utility in diverse populations.

Methods

This article uses a narrative review methodology, synthesizing a wide array of scientific and policy literature without conducting a systematic review or meta-analysis. The authors incorporate findings from epidemiological studies that link UPF consumption to health outcomes, along with mechanistic research on additives, hyper-palatability, and metabolic signaling. They also examine national dietary guidelines from countries such as Brazil, France, and Canada, which have either adopted or critiqued the NOVA classification system which categorizes foods based on the extent and purpose of their processing. In addition, the review draws from regulatory reports and models related to food industry reformulation strategies. Based on this body of literature, the authors introduce a conceptual framework for assessing UPFs according to nutrient quality, additive content, and intended social use. Although this framework is not tested empirically, it is offered as a potential guide for future food policy development and reformulation initiatives.

Key Findings

Ultra-processed foods currently account for up to 60% of total daily energy intake in many Western populations, contributing significantly to modern dietary patterns. Their widespread availability, low cost, and convenience have been accompanied by rising concerns about their association with chronic health conditions. The review highlights several plausible mechanisms linking UPF consumption to adverse health outcomes, including nutrient dilution, high energy density, excessive added sugars and sodium, and the presence of emulsifiers, non-nutritive sweeteners, and flavor enhancers that may disrupt appetite regulation, metabolic signaling, or gut microbiota.

Importantly, the authors stress that not all UPFs are equally harmful. Some products, such as fortified unsweetened plant-based milks, provide valuable nutrients like calcium and vitamin D and serve as critical dairy alternatives for lactose-intolerant or vegan populations. As highlighted by Mialon et al. (2021), these beverages—though classified as ultra-processed—are often nutritionally adequate and support dietary diversity when unsweetened and fortified appropriately.

Similarly, products like plain frozen vegetables, which may contain minor preservatives or packaging agents, are sometimes grouped under UPFs. However, research such as Madormo (2024) confirms that frozen vegetables retain most of their fiber and micronutrients, making them practical and long-lasting sources of nutrition. These cases underscore the need to distinguish between UPFs with excessive additives and those that remain nutrient-rich despite light industrial processing.

Rather than banning UPFs outright, the authors advocate for targeted reformulation efforts that focus on improving the nutritional quality of the most commonly consumed UPFs through ingredient and additive optimization.

Interpretation & Significance

This review underscores the need for a more nuanced public health strategy in addressing the role of ultra-processed foods. The authors argue that relying solely on processing level as a proxy for nutritional value can be misleading, particularly when some minimally processed foods are energy-dense and nutrient-poor, while some UPFs—like fortified plant-based milks or engineered clinical meal replacements—can be nutritionally robust, shelf-stable, and affordable.

They call for a policy shift toward intelligent reformulation, which involves modifying the nutrient and additive profile of UPFs rather than attempting to eliminate them from the food system entirely. This approach aligns with public health priorities while also accounting for economic accessibility, supply chain realities, and global dietary needs. The authors suggest that food classification systems should be refined to include considerations of nutrient density and sensory additives, thereby improving the relevance and utility of these systems in shaping health policy. The authors propose reformulation as a potential tool, but caution that it must be paired with strong regulation, transparent classification systems, and structural food system reform.

Conclusions

The authors conclude that ultra-processed foods, while often linked to negative health outcomes, should not be treated as a monolithic category. Rather than advocating for blanket avoidance, they propose a refined strategy that emphasizes reformulation, nutrient enhancement, and additive reduction in the most commonly consumed UPF categories. Examples such as fortified plant-based milks and minimally altered frozen vegetables challenge the notion that all UPFs are nutritionally inferior.

This approach supports the development of more practical, evidence-based food policies that can improve population health while maintaining dietary accessibility and flexibility. Future research should focus on interventional studies, policy evaluations, and consumer behavior to better understand how re-engineered UPFs can function as allies rather than foes in modern diets.

Sources

1. Monteiro, C. A., Cannon, G., & Lawrence, M. (2024). Ultra-Processed Foods—Dietary Foe or Potential Ally? Nutrients, 16(7), 1013. 
2. Mialon, M., et al. (2021). Not all ultra-processed foods are nutritionally poor: the case of fortified plant-based milks.
3. Madormo, C. (2024, June 21). Are fresh or frozen vegetables more nutritious? Verywell Health.