«Many scientists in the food industry admit that they design food so that we cannot stop eating it»

Dr Chris van Tulleken calls for greater regulation of ultra-processed foods.
Doctor and writer Chris van Tulleken argues that, in the interest of public health, ultra-processed foods should be treated in the same way as cigarettes.

An infectious disease specialist at the Hospital for Tropical Diseases in London, a professor at University College and presenter of several BBC programmes, he is also the author of the book “Ultra-processed People: Why we eat things that aren't food, and why we can't stop eating them” (Editorial Elefante).

The work became a best-seller and won several awards.

The British doctor admits that he initially doubted the concept of ultra-processed foods and thought that the dangers pointed out in studies on these foods were related only to the excess fat, sugar and salt present in many of these products.

To put the idea to the test, she decided to conduct research in which she radicalized her own diet and began eating mostly ultra-processed foods.

Among many other details and information contained in his book, he details everything he experienced during the experience.

In an interview with BBC News Brazil, Van Tulleken calls for countries and governments to take stronger measures to reduce the consumption of ultra-processed foods among the population.

In his view, big food companies will destroy traditional cuisines in the next 50 years, and there is not much that individual people can do to change this scenario (or their own diet).

Below are the main excerpts from the interview.

You have a background in infectious diseases and molecular virology. Where did your academic and scientific interest in food come from?

As a doctor in my youth, I worked in low- and middle-income countries, specifically in Central Africa and Southeast Asia. And, as an infectious disease specialist, I witnessed children dying from infectious diseases.

Many of these children died because their parents were persuaded to buy infant formula, often without the financial means, and they did not have access to clean water to prepare it. Often, they did not even know how to prepare the formula.

That was my first contact with the food industry, which I would do research on in the future.

A few years later, I participated in some BBC programmes in which I began to focus on how commercial interests affect our health or how some corporations, mainly food manufacturing companies, affect us all.

Do you remember the first time you heard the term “ultra-processed food”?

Yes, that happened in 2009, when a BBC producer sent me a scientific article while we were producing a documentary on childhood obesity.

This article was written half in Portuguese, half in English, and had been published in a Brazilian health magazine. For me, at the time, it didn't seem very important and I ignored it for a long time.

When I finally read the article, I felt that there was the explanation for everything. That was my instinct.

I then did a lot of further reading and turned this topic into my research as a scientist. After a few years, I can say that my initial instinct was correct and the concept of ultra-processed foods really explains how these foods harm us.

In the book, you say that you were skeptical about the concept of ultra-processed foods, because you thought that the damage associated with many foods could be caused by excess salt, fat and sugar. What were the reasons that raised that suspicion?

As I mentioned, my first instinct was that this concept explained everything. But then I thought: is it really true? Or is it the salt, sugar and fat that are so bad in these foods?

It's hard to explain the excitement I felt at that moment, but it was a mix of curiosity and skepticism.

In her book, Van Tulleken details everything she experienced when she followed a diet based almost entirely on ultra-processed foods.

After all these years of research, what do you think is the simplest way to explain what an ultra-processed food is?

If you eat a food and need to read the list of ingredients, you are probably looking at an ultra-processed food.

And if that list includes ingredients that you can't find in any kitchen or pantry, it's definitely an ultra-processed food.

This concept describes most products manufactured by transnational food corporations.

There are some exceptions. Nestlé, for example, makes a wheat cereal that is not technically ultra-processed.

But most of the products that make money for Nestlé, Danone, Pepsico, Kraft Heinz, Coca-Cola, Mondelez and other companies are ultra-processed.

I'm talking to you from a hotel room and here in front of me is a basket with a nut bar, a chocolate bar, chewing gum and a packet of seasoned nuts. All of this is ultra-processed.

In the book, you make comparisons between the food industry and the tobacco industry, and also between ultra-processed foods and cigarettes. In your opinion, what are the similarities and differences between these two sectors and products?

Well, these industries are not only similar, they are the same thing.

In the mid-1980s, one of the world's largest cigarette companies, RJ Reynolds, bought Nabisco, a huge food company.

At the same time, Philip Morris (tobacco company) bought General Foods (food company).

We are talking about the same conglomerates, even if these companies have been broken up and changed hands in the decades since. They use the same laboratory-tested molecules for cigarettes as flavourings in food. They use the same marketing techniques and distribution networks to sell addictive and harmful foods, just as they did with cigarettes.

Therefore, this comparison is completely legitimate.

Today, these companies are controlled by the same institutional investors and continue to behave in a similar manner.

For me, it is important that people understand that the tobacco industry is not exceptional or unique.

Food, cigarettes, alcohol, gambling, fossil fuels and medicines are all governed by the same group. And they all need some form of regulation, with some nuances for specific cases.

We commonly think of obesity as being related to a mathematical calculation involving calorie consumption through food and calorie expenditure through physical activity. Does that equation make sense?

When we think of extreme cases, such as a cyclist participating in the Tour de France or an Olympic swimmer, it is clear that they burn more calories than an average person.

But being more active doesn't significantly alter the number of calories you burn.

What does this mean? Well, if a Brazilian leaves his sedentary job in Rio de Janeiro as a doctor or journalist and decides to live in the forest, with an ancestral lifestyle, he probably won't burn many more calories.

This observation seems counterintuitive, I know, but it comes from very high-quality studies.

What recent evidence shows us is that a person like me will burn 3,000 calories a day, regardless of whether he lives as a hunter-gatherer or invests in his career as a doctor and writer.

And this explains why exercise is so beneficial for us. When we exercise, we “steal” those calories from other parts of the body.

That is, I have to take energy that would normally be used for other things, such as anxiety, inflammation, and producing high levels of reproductive hormones.

Exercise is good because we spend less energy on things like anxiety or inflammation. But it doesn't significantly change the amount of calories we burn.

In my favorite chapter of the book, I explain that most of the studies saying the opposite—that we burn more calories when we exercise—were sponsored by the sugary drink industry.

We have good, independent evidence showing that exercise does not burn more calories, and a host of studies claiming the opposite, but which were funded by the sugary drinks industry.

On this subject, in recent years we have seen the rise in popularity of drugs to treat obesity. From your point of view, are the increase in the consumption of ultra-processed foods, the growth of obesity and the appearance of new drugs for excess weight interrelated?

Private companies don't make money by solving the obesity crisis. Sure, there would be a huge benefit in terms of public health and the economy, but that doesn't benefit corporations.

The food industry sells us fattening foods because it has to. It's the only way they can make a profit. They need to sell foods that lead to overconsumption, to exaggeration, so they can make more and more money.

Imagine a food company that sold food that satiates people. That is, consumers would not need to buy large quantities, only what they need. How could this company compete?

I think the food industry needs to sell these products in order to continue to exist.

In this context, it makes perfect sense for pharmaceutical companies to offer and sell solutions to this problem in the form of new drugs.

The comparison I make is between cigarettes, chemotherapy and lung cancer.

It's not like the tobacco industry and the pharmaceutical companies got together one day and agreed: "Look, I cause cancer and you create the cure for this disease."

It is very important to celebrate the existence of chemotherapy, which helps many patients, that is excellent, just as it is important to have medications for obesity, because they can help many people.

But chemotherapy should not distract us from the terrible health tragedy caused by cigarettes, which goes far beyond cancer.

The same goes for drugs that treat obesity. These work relatively well, but they are not the solution to all problems related to what we eat. These drugs do not cure anxiety, depression, cancer, inflammation, intestinal diseases or cardiovascular problems.

We should never let people get sick and then treat them. It would be much cheaper and more effective to improve children's diets, regulate the food industry and encourage everyone to live a healthy life.

This is feasible, all that is needed is to limit the power of the food industry.

Dr Van Tulleken is a lecturer at University College London and has presented programmes on the BBC.

In the book you say that you don't want to give dietary recommendations or change anyone's diet. Why did you make that decision?

The book reflects on the subject, but does not claim to offer practical advice for everyday life. The first reason is that there are no individual solutions.

In fact, I encourage people to read the book while eating ultra-processed foods. In the end, many readers told me they no longer wanted to consume them.

The truth is that there is still no solution. Even if someone feels disgusted by this type of food, it is practically impossible to avoid it on a daily basis.

You work in a BBC office in London, and the food sold there is ultra-processed. Even if you leave the building and decide to eat somewhere nearby, the vast majority of these establishments only offer ultra-processed foods.

These foods are at gas stations, airports, and pretty much everywhere. They're all around us, no matter where we go. And often, ultra-processed foods are the only food people can afford at supermarkets. So, it seems a bit cruel to suggest that you stop eating them.

Part of my decision not to recommend dietary changes comes from that lack of hope, from not thinking it's very kind to tell people to change.

I'm really interested in the food system. And I hope the book reduces the shame and stigma people feel around food.

I have spoken to many scientists who work in the food industry, and they are very clear in saying that they design and alter food so that we cannot stop eating it.

So the point of my book is to point out that the problem is not with individuals, but with the entire system. By this I mean that if you can't stop consuming these products, you don't need to punish yourself.

Is there anywhere in the world where this regulation on ultra-processed products works? In your opinion, what are the ways to change this system?

Chile, Mexico and Argentina have very good public policies in this regard. Brazil is also developing interesting things.

Recently, I gave a lecture at Harvard University in the United States, and a Mexican colleague who was in the audience commented that, despite all the warnings on packaging and taxes on ultra-processed foods in his country, people still suffer from obesity.

In my opinion, we need to use the same means that were used for tobacco control. We need a system of warnings on packaging that are larger than the logos of companies or products. We need to impose aggressive taxes on the worst foods. We need to ban all advertising and also ban their sale to children.

Ultimately, we need to think of ways to limit the power of these corporations, because the current system is bad for everyone. It's bad for business and the economy. It's bad for those who are healthy or sick. It's bad for small and medium-sized businesses that produce good food.

Oh, and we also need to get rid of conflicts of interest.

In the UK, the British Medical Journal has just published an analysis of the Scientific Advisory Committee on Nutrition (a group that provides recommendations for the country's public food policies).

Data shows that 65% of the committee members have received money from food industries, from companies such as Coca-Cola, Nestlé and Danone.

In addition, in the UK, the Science Media Centre (a group that advises the press on scientific issues) has been or is sponsored by Nestlé and Procter & Gamble.

We have research departments and scientists frequently cited by the press who receive funding from Pepsico, Mars and Nestlé.

There are doctors, influencers and health organisations, such as the British Nutrition Foundation, that are funded by Coca-Cola and other companies.

In other words, until we see this money from the food industry as dirty, we will not end all these conflicts of interest.

Do you see any differences in the way these food companies operate in rich and poor countries?

The problem is global, it happens everywhere. Let me give you a practical example. In 2016, the pizza chain Domino's opened 1,281 new stores, or one every seven hours, most of them outside the United States. India currently has around 1,500 Domino's branches.

In West Africa, we see the growth of Kentucky Fried Chicken (KFC) and other large fast food chains. The same is happening in China.

Everywhere, young children are increasingly consuming infant formulas, which are worse for their health compared to breastfeeding.

The ultra-processed food industry's project seems destined to destroy all traditional diets. In Italy, coffee shops have become Starbucks and pizzerias have become Pizza Hut. The same is happening in Brazil, the United Kingdom, the United States...

Even places with very strong food cultures, such as Italy, France and Spain, are becoming increasingly vulnerable.

Either we limit the power of these corporations in the same way we did with the tobacco industry, or all traditional diets will be destroyed in the next 50 years.

Ultra-processed foods account for 60% of the British diet, Van Tulleken estimates.

Why did you decide to undergo an ultra-processed food consumption experience?

Well, I wanted to be the first patient in the study we are conducting on the subject. Honestly, I didn't think that increasing the consumption of ultra-processed foods would change anything in my life. But in practice, I experienced very significant effects on my health, which is totally in line with the scientific literature published on the subject.

You detail all of these effects in the book, but could you mention what emotions you felt during the experience?

The first week was quite fun. But from the second week onwards, I started to feel more tired, because ultra-processed foods are very salty. This causes dehydration and constipation, since they are low in fibre.

That is, I would wake up, eat more than I needed, and go back to sleep. Then, I would wake up in the night wanting to go to the bathroom, urinate, and drink water. But I stopped having regular bowel movements. So my butt hurt and my sleep got worse and worse.

Because you eat more throughout the day, you feel like you have no control over your diet. I felt terrible in that second week of the experience.

But I only realized this when I stopped eating ultra-processed foods.

We see this behavior in children. When they are hungry, they don't verbalize it. They just get more nervous, angry and irritated with everyone.

And I felt the same way. I was angry with my family and became a difficult person to live with. But I thought that the problem was always other people, never me.

But halfway through the experience, a Brazilian scientist said something that changed everything. She told me: “That’s not real food you’re eating.”

That phrase lit a spark in my brain. From that moment on, I no longer wanted to eat ultra-processed foods.

This was, in fact, another reason to invite readers to continue eating ultra-processed foods while reading the book.

But at the end of the experiment, did you really manage to stop eating ultra-processed foods?

I stopped eating them almost completely. In the end, I even lost weight, but I can't promise that will happen to everyone.

However, if you can eliminate ultra-processed foods, there is some evidence that this may be helpful in the weight loss process.

But in my opinion, the only way to eliminate them from our diets is to hate them.

That's why the book is written in a way that makes you hate this food system, instead of hating yourself.

How was the reaction to the book's publication in the UK? How did the companies mentioned respond?

The book became popular in the UK, and I am very grateful for that. The industry reacted in two different ways.

The first contact I received was from McDonald's. They sent me an email that I thought was a demand or an order to remove the books from the stores.

But actually, I was invited to become a brand ambassador.

Afterwards, all the food companies offered me huge sums of money to give talks, something like US$$50,000 to speak to them for an hour.

Obviously, I declined all those invitations.

Shortly after, lawsuits and complaints began to emerge against the publisher that published the book.

Fortunately, the book was written with great care and was reviewed by several lawyers before publication. So none of those lawsuits were successful.

But it is still stressful to deal with these complaints and spend hours responding to them.

Note taken from BBC NEWS WORLD

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