Scholars and publications with financial ties to the industry reinforce their artillery against Carlos Monteiro (in image), a USP professor who showed us that a bag of rice is not the same as a packet of savoury snacks
Carlos Monteiro was watching a debate in the Libertador A Room when he got a text message on his cellphone: “Get over here now. You are under attack.” But the presentation on the role of biodiversity for the improvement of health and nutrition, to which he had been invited, was really interesting. And attacks, anyhow, are not exactly news to the professor of the School of Public Health at the University of São Paulo (USP).
Especially after he devised a proposal that infuriated the ultraprocessed foods industry: giving it a name. It’s not easy to accept a labelling.
That is what happened in 2009, when Monteiro and the Health and Nutrition Epidemiological Research Centre (Nupens) decided to propose a new standard of food grading. Instead of macro (proteins, fats, carbohydrates) and micronutrients (vitamins and minerals), a new entity, the “level of processing”, came onto the scene. The NOVA classification, as it is known, divides foods into four groups. The three first have been the basis of human food consumption for many centuries: non- or minimally processed foods, processed cooking ingredients and processed foods. And the fourth group, comprising industrial formulas of food subproducts and cosmetic additives, called ultraprocessed foods.
Up until then, the ultraprocessed foods industry roamed the streets in relative anonymity. Some called it junk food. Others refer to it as crap or trash – “hey, kid, don’t even think of eating any trash before dinner”. But there wasn’t a consensual scientific term, which in a way, is still the case.
But food grading according to the level of processing was one of the breakthroughs that started to point the finger towards the industry as the main entity responsible for the obesity epidemic that skyrocketed in the last few decades. Various research groups around the world set their sights onto ultraprocessed foods and have not stopped, since then, listing scientific evidence with regard to the link between consumption and chronic non-transmissible diseases (diabetes, high blood pressure, cancer). The National Cancer Institute recently revealed the existence of sound evidence of a correlation between obesity and 13 types of cancer.
“These studies, conducted by researchers from many countries, have confirmed a massive worldwide growth of ultraprocessed foods, such as soft drinks, industrialized snacks and frozen meals, and the systematic negative impact of these foods with regard to the nutritional quality of the human diet and the risk of obesity, high blood pressure, metabolic syndrome, dyslipidaemias and other chronic non-transmissible diseases”, Monteiro wrote recently, defending himself against an attack.
Transnationals have never spared resources creating scientific evidence pointing the finger in all other directions. What Monteiro’s research did was grab hold of the school bully, put him in the middle of the courtyard and show him how uncomfortable it is to be exposed.
A lot of changes took place until October 2017, at the International Nutrition Congress, held in a downtown Buenos Aires hotel.
The debate taking place a few metres away from the room where Monteiro stood was adopting strong tones in an attempt to demean him as a researcher. When the professor travelled Argentina, he was already expecting his work to be subject to praise and criticism. It’s what being in the spotlight is all about. In one of the first debates, however, the level of sparring beyond what is customary for the cautious realm of science started to appear.
“Processed foods: food technology for better nutrition” was the slogan chosen by the Latin American Food Science and Technology Association for one of the mega-event’s opening symposia.
“It’s wrong to believe that growing levels of obesity and chronic diseases are linked to the level of processing”, said Julie Miller Jones, from Saint Catherine University. “Processed foods are already part of the system and are summarily on trial or found guilty of causing obesity, which is not true.”
The fact is that NOVA proposes a very clear distinction between processed and ultraprocessed foods. The detractors, however, usually erase that line, which causes the impression that the classification is anti-industrialization.
“The scientific community around the world questioned the scientific foundation and the benefits brought by NOVA, which additionally implies an unjustified demonization of processed foods and the crucial historical role played by food science and technology”, continued Susana Socolovsky, president of the Argentinian Food Technologist Association.
She showed a slide: “The use of the NOVA classification in public policies is irresponsible.” This was an allusion to an article published shortly before in the American Journal of Clinical Nutrition by a group led by Michael Gibney, from Dublin University, in Ireland.
“Processed foods and human health: a critical review” was a no-holds-barred attack against the NOVA classification standard. The central allegation is that the separation between in natura, processed and ultraprocessed is simplistic and error-inducing. The authors defend that this sistemization is useless in order to deal with the links between diet and diseases.
They go on to propose that the nutrient-based approach be maintained. This approach was predominant during the second half of the last century. Nowadays there are dozens, hundreds, even thousands of specialists for each of these nutrients (sodium, zinc, vitamin A etc etc etc). And the scientific community doesn’t seem to be striding towards a consensus. The International Nutrition Congress itself proves this: the same nutrient comes up as a villain or a hero depending on who is organizing the symposium.
Gyorgy Scrinis, a Melbourne University professor, coined an expression for this: “nutritionism”. “Reductionism towards the single nutrient frequently ignores or simplifies the interactions between nutrients, with foods and with the body”, criticizes Scrinis in his book, Nutritionism, where he accusingly states the existence of a deterministic approach that indicates nutrient X or Y as being responsible for a certain disease. To him, this system led the scientific community to divert from the existing complexity in people’s diets, ignoring the changes in eating standards that occurred during the last decades, with the introduction of products with high salt, sugar and fat contents.
In the article in which they criticize the NOVA classification, the authors get ultraprocessed and packaged mixed up – rice is packaged, but not ultraprocessed. And at certain points they tend to generalize, giving the impression that Monteiro’s group is against all types of processing – wheat flour is processed.
Gibney’s group goes on to say that there are “ethical problems” in adopting NOVA. A dangerous approach, because by supposedly discouraging the consumption of processed foods, the role of these products concerning nutrient intake would not be taken into account. “To our knowledge, no argument was offered with respect to how, or if, food processing in any form would pose a health risk to the consumer”, they wrote.
In the last few months, we have seen many similar approaches.
“They want us to keep a cow on the balcony of our apartment”, a professor said. “Do you want to go back to eating beans and woodworm?”
“They want to take us back to the Middle Ages. Do you know what the life expectancy was in the Middle Ages?”, I was asked by a doctor.
“There is this romantic idea nowadays about eating as in our grandparents’ days. Do you have any idea what the food was like back then? People used to die from food poisoning”, threatened another researcher.
Once in a while there are more subtle approaches, but generally speaking, those attempting to undermine the standard according to the level of processing prefer to embrace exaggeration and ignore the obvious difference that exists between a bag of rice and a packet of Fandangos.
Following the publication of Gibney’s article, a Brazilian website produced a text which highlighted that “Crossing processed foods off the menu doesn’t make you healthier”. As well as quoting passages from the original paper, the article opened up for comments by a nutritionist. At that point, things began to unravel.
The nutritionist in point is a consultant for Nestlé. The editor of the Brazilian website decided to remove the contents off the air, admitting a clear conflict of interest.
Gibney also holds a contract with Nestlé. Monteiro warned that two other authors of the article concealed their conflicts of interest. One of them, between 2010 and 2014, worked for a transnational research centre. And another was consultant for a company who lists McDonalds as one of their clients.
“We hope this episode can generate productive talks about the conflicting and growing infiltration by the ultraprocessed foods industry into academic institutions, professional societies and scientific publications”, demanded the group led by Monteiro.
Researching this topic since April, we have seen a deluge of criticism against NOVA. Practically all of them have come from scientists with financial ties to the ultraprocessed foods industry.
There are some food engineers who consider that from their viewpoint, processed foods are processed, period. It makes no sense to make a distinction according to the level of processing. Even so, some admit that from a nutrition and public health point of view the NOVA classification standard could be important.
The Argentinian Food Technician Association lists Coca Cola and Danone as sponsors. The same goes for their peers in other Latin American countries.
American Journal, who published the article by the group led by Gibney, is well known in academic circles. It is one of the publications of the American Society for Nutrition, who currently has 28 partners – Coca Cola, Kellogg, Pepsi, Nestlé, Monsanto and so on. The organization is a champion of these corporations. They once oversaw the issuing of a positive stamp which decorated the packages of cereals with a very high sugar content, among other ultraprocessed foods.
In 2015, researcher Michele Simon, a food industry specialist, published an article where she talks about the luxury surrounding American Society events. Out of 34 scientific panels in that year’s edition, 14 were sponsored by companies or enterprise associations – not to mention front companies.
“It is exactly because the food industry has vastly different objectives from the health organizations that these relationships are problematic”, she wrote. “In order to assure their credibility, to reflect the objective science the public has in mind and keep the food industry under observation, it is essential that the American Society for Nutrition review its financial ties.”
There was one more interesting point in Simon’s article. She drew our attention to the emphatic defence by the entity for food processing. And here we can go back to Gibney’s text.
“In relation to the use of the NOVA classification in the development of food guideline documents, we have shown that the broad definition of ultraprocessed foods makes that impossible”, defends the article.
In actual fact, it is highly possible, so much so that it is already included in two documents of the kind, in Brazil and in Uruguay. Here at home, the Ministry of Health published the Dietary Guidelines for the Brazilian Population, in 2014. The project was developed by none other than the group led by Monteiro. And it came out with a clear recommendation: avoid the consumption of ultraprocessed foods. The industry did everything it could to obstruct the document’s publication, to no avail.
The Brazilian project was hailed by leading high reputation members in the nutrition sector. FAO considers it one of the top food guide documents. The ultraprocessed foods concept is frequently applied scientifically. “During the Guide’s public consultation phase, a sector that was totally engaged with the industry language use said that the term wouldn’t work”, says Patrícia Jaime, professor at the USP Public Health College and the ministry’s Food and Nutrition coordinator at the time. “It’s amazing to see how it is currently being used by people outside the technical field of nutrition. We see it in the media. The concept is appropriate because it makes sense to people.”
Some Ministry of Health and Ministry for Social Development documents have adopted NOVA. Health Minister Ricardo Barros instituted a ban on the sale of ultraprocessed foods on Ministry premises — and nobody who works there understood that to mean they could no longer eat rice or products containing wheat flour.
The Pan American Health Organization (PAHO) adopted NOVA to define the nutritional profile model launched last year, which proposes that if you only consume foods that fit into acceptable standards of salt, fat, sugar and calorie content, at the end of the day you will probably have followed a healthy diet. The document is the basis for the Front-Of-Package labelling for processed and ultraprocessed foods in Uruguay, a measure that is one signature away from being adopted.
Carlos Monteiro is respected by his peers. We notice that not only by walking through the congress in Buenos Aires, but also in the interviews we held with Brazilian researchers whose line of thought opposes his. Everyone recognizes the scientific thoroughness with which he acts and the relevance of his work.
That is why, as a rule, criticism was concentrated on the Guide and the classification. Following the publication of the Brazilian document, the American Society for Nutrition came to the defense of processed foods, ignoring the fine line with the ultraprocessed foods, one of the first indications regarding the direction of the debate. It was a clear and quick reaction to the praise for the work in the media and in the U.S. academic sector.
The Brazilian Guide is a pioneer not only for touching on the subject of processing level, but for proposing a language accessible to the public and for thinking of food beyond nutrient content, praising cultural issues and eating as a group.
The emphatic defense by American Society of the industry once again raised a reaction from Michele Simon: “At a time when Americans are recognizing more and more that processed foods are not exactly healthy, the position is remarkably deaf eared.” To her, the only explanation for that is the connection with the sponsors.
In the early 21st century, Monteiro showed that the ceiling for the ultraprocessed foods market is achieved when it corresponds to 60% of the daily energy intake, a level reached in some Northern countries. Brazil, who jumped from 20% to 28% in the last decade, is therefore a promising growing market for expansion. Or a nation that can step on the brakes while they’re still halfway gone.
This year, Monteiro’s group released an article in Public Health Nutrition showing a direct correlation between ultraprocessed foods and obesity: each energy point coming from ultraprocessed foods raises the obesity rate by 0,25 points. Countries with lower consumption show lower obesity rates.
For that reason, when Gibney stated there was no evidence of this correlation, Monteiro hit back, accusing his colleague of ignoring many scientific projects. “Indeed, all studies except the one quoted in the ‘critique’ show ultraprocessed foods associated to negative health effects”, says the professor. The researcher from Ireland left out two studies resulting from a high quality survey carried out in Spain, which followed a population group for nine years, showing the correlation between ultraprocessed food consumption and obesity and high blood pressure .
“The NOVA classification system challenges a much older and more dominant system, based on nutritional contents. Of course it has to be criticized. But scientific progress comes from the exchange of reasonable and well founded arguments, as well as a balanced debate”, regretted the Brazilian group, in a comment that came out on the 11th in Public Health Nutrition, after the editor of American Journal refused to open space for the Brazilian researchers’ answers.
Nor was he willing to publish a letter written by the professor from USP. And so far, he has provided no answers with regard to omitting the ties between researchers and companies.