Berkeley Talks: How the tobacco industry drove the rise of ultra-processed foods

(Music: “No One Is Perfect” by HoliznaCC0)

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Isabel Madzorera: Thank you. So welcome everyone. Thank you for joining this webinar. Really interesting discussion and really excited to see all of you on this Zoom call. So we have about 140-plus people joining the webinar, so really good group. And we are really excited to talk about “The New Tobacco? A Discussion About Ultra-Processed Foods.” My name is Isabel Madzorera. I’m an assistant professor in food, nutrition and population health with the Berkeley School of Public Health. I’m also a co-faculty director at the Berkeley Food, sorry, at the Berkeley Food Institute, BFI for short. I’m pleased to be the moderator for today’s session on this webinar. The webinar is co-sponsored by the School of Public Health.

Today’s webinar is part of BFI’s Spring Lunch and Learn Webinar Series where we share and highlight food and farm systems research, particularly research that addresses current food policy issues and helps us to advance just and sustainable farm and food systems. Before we dive into today’s webinar, some housekeeping items. Firstly, audience members are encouraged to submit their questions in the Q&A at the bottom of your screen. So if you look at the bottom of your screen, you will see a Q&A section. If you could type your questions there and we’ll be looking through throughout the presentation and reading through your questions at the end. Also, feel free to drop in your questions throughout the presentation.

There’s no need to wait until the very end. Following today’s presentation and discussion, we’ll also have time for you to … We’ll also have time to discuss your questions that you would’ve raised throughout the webinar. As a reminder, all BFI webinars are uploaded into the BFI website under the events page. So if you want to go back and look at them later, you’ll be able to do that. You can also find webinar recordings on our YouTube channel. Today’s discussion will focus on the latest research on ultra-processed foods. A topic of increasing public health interest in policy circles and in the media as a rising concerns about ultra-processed food impacts on health.

Ultra-processed foods are chemically formulated foods that typically rely on high levels of fat, sugar, sodium, and/or carbohydrates to trigger the brain’s reward system. They encourage excessive eating, making them hyper-palatable, or we call them HPF foods. A growing body of health research suggests that ultra-processed may be the new tobacco when looking at health impacts in the United States, including increased of diabetes, cancer risk and diet-related disease outcomes. Our speaker from the California Department of Public Health will not be able to join us today as the state’s recommendations on ultra-processed foods are still under review.

However, we will likely have a second webinar on this topic, including a discussion of the state’s policy efforts in this space later in the fall. So keep your eyes and your ears ready to hear about that as things progress. We’ll announce those details in the forthcoming BFI newsletter. 

Today I’m pleased to introduce Dr. Laura Schmidt, who is a professor of health policy in the School of Medicine at the University of California at San Francisco. She’s the presenter for today’s webinar. She holds a joint appointment in the Philip R. Lee Institute of Health for Health Policy Studies and the Department of Humanities and Social Sciences.

Dr. Schmidt seeks to understand how changing lifestyles are contributing to the rising rates of chronic diseases across the globe and what to do about it. Her work explores the growing pressures of globalizing economies, rising inequities, and marketization of products that undermine our health. She works directly with policymakers to craft and implement evidence-based policies that reduce the consumption of ultra-processed foods. I’ll start briefly by having a quick introduction to this topic and then I’ll hand over to Dr. Schmidt to proceed with the presentation. So I will talk very briefly about ultra-processed foods and their definitions as part of my introduction.

Isabel Madzorera: My apologies for the multiple slides. Can you all see my slides?

Laura Schmidt: Yes.

Isabel Madzorera: Thank you. Sorry for that. It’s not full. So briefly, ultra-processed foods are under the category of processed food. So processing itself is not a new phenomenon, but has been occurring over time. But this is just an example of the extent of processing and how it can vary from food to food. So there are commonly, when we think about ways to classify ultra-processed foods, there’s several that are currently available. We just wanted to give you an example of one such guideline or one such classification, which is the NOVA classification for ultra-processed food. This is based off of research developed by Dr. Carlos Monteiro at the University of Sao Paulo in Brazil.

So basically this classifies foods into four food groups. The first group is unprocessed or minimally processed foods. These are foods that are just minimally processed in terms of maybe grinding, crushing, things like that and the natural foods like beans, rice and others like that. And then the second group is the processed culinary ingredients that are added to foods, but are rarely consumed by themselves. So the salt, the sugars and the oils that are added to food. The third category is the processed foods, this is where processing is done by adding salt, sugar or other substances from group two to group one foods.

For example, pickles and jams would fall into this category. The fourth category is what really term ultra-processed foods according to this classification. And it really includes foods that are formulations of ingredients, mostly exclusive, sorry, industrial use and typically created by a number of industrial techniques and processes. So really undergoing a lot of processes to get at what we term ultra-processed foods. So just a quick example of some foods that are classified under this group four of ultra-processed foods. As you can see there, foods that include sugar sweetened beverages, some of the cereal grains, and some of the fast foods that we are used to.

Just to give a brief overview in terms of the two sides of the coin, there are some pros and cons, but some of the issues around consumption of ultra-processed foods are really driven by demand, rising incomes particularly globally, as well as supply side issues related to media advertising and so forth. This is just to highlight some of the key ingredients of ultra-processed foods that we think might be related to poor health outcomes. And I will hand over to the main speaker for today. I’ll stop sharing my slides and allow her to commence today’s presentation. Thank you.

Laura Schmidt: Thanks Isabel. Let me try to pull up my slides. So great to be here and to tell you a little bit about what we’re finding around the ties between the tobacco and the ultra-processed food industries. I want to challenge you to think about ultra-processed foods through the lens of tobacco executives today, and I think it gives us a really new perspective on what’s going on with ultra-processed foods in our market today.

First of all, the question of the topic of today: The New Tobacco? Are ultra-processed foods actually a new tobacco? I’m going to argue that they’re actually a legacy of the tobacco industry. And the second thing I want to talk about is the relationships between the tobacco, alcohol and ultra-processed food industries.

We tend to treat these product lines as very distinct, and I’m going to argue that at least from the standpoint of the people who make this stuff, they would be arguing that they’re all in one big industry best described as the consumer packaged good industry. And then finally, I’m going to put out in a hypothesis that is driving a lot of my work these days. And the hypothesis is that when tobacco and alcohol and ultra-processed food companies come together and work together in the same firms, they tend to wind up making products that are more harmful to people. And so just keep that in your mind as I flip through my slides today. So I also want to call attention to the main source of data for the work that I’m going to present today.

It comes out of the UCSF industry documents library. Originally, you’ll see here in the upper left-hand corner, we’re really driving the conversation around commercial determinants of health at UCSF, and we’re doing that through this archive. The tobacco documents, we have about 16 million tobacco documents from the largest producers of cigarettes, Philip Morris and R.J. Reynolds in particular, but also British American Tobacco. And that comes to us through major litigation that happened in the 1990s. We’re currently ingesting the opioid litigation documents from the recent lawsuits. So this is the source of data that I’m going to be presenting from.

So just before getting into the role of the tobacco companies and ultra-processed food. I want to assert a few things in addition to what Isabel said about what we currently know. There are a lot of things we don’t know about these products, but there’s some things we do know. And the first is we now have three randomized clinical trials. These are extremely expensive to conduct and very challenging to do well. This is one that was conducted at NIH and published in 2019. And what we know from this trial is that ultra-processed foods make people overeat and not by a little bit, by a lot. By about 500 calories per day, which probably for the average person would be adding up to about a pound a week.

And so these are products that definitely people overeat on. We don’t understand all of the mechanisms. There are also changes in body weight observed in this trial in some biometrics. Another thing we know is that Americans are eating a lot of processed food, in fact, more than pretty much any other country. This is a comparison across different countries. You can see the penetration of UPFs into the food supply in these various countries. You have countries like Brazil, which is where Dr. Monteiro designed the whole concept of NOVA while he was watching people experience health problems as people in his country were eating more and more ultra-processed foods.

And out here, in the U.S. actually our rates are a little higher now. We eat about 60% of our diet in ultra-processed foods, 70% for kids. The other thing we know is that the introduction of ultra-processed foods into the market coincides pretty well with the rapid rise of obesity. So UPFs come into the marketplace somewhere in the mid-’60s and the firms are operating at scale by the 1980s as the obesity rates in America start to tick up and they keep going up, up, up as ultra-processed foods continue to penetrate our food supply. So those are some things we know about what’s going on with ultra-processed foods. I want to tell you a little bit about what I’ve been learning about the role of the tobacco industry in this food industry.

And I want to start by showing you the two major U.S. producers of cigarettes, Philip Morris, back in the ‘60s to 2010 when this timeline is showing here. They were the largest tobacco company in the world. R.J. Reynolds was a very large tobacco company. And starting about 1960, they start buying up food companies. The first one is Hawaiian Punch. This is the R.J. Reynolds acquisitions at the top of the timeline. They buy Del Monte, and eventually Nabisco, which is a very large company. They’re also getting into the alcohol business in the 1980s. And by about the mid-’90s, R.J.R. has spun off most of its food subsidiaries. Here on the bottom, we see Philip Morris, they get into the alcohol business starting in 1970.

They buy up 7 Up in 1978. Then in the mid-’80s, ‘85 to ‘88, they buy General Foods and then they buy Kraft and they merged them. And at the time, at various points in this window, Kraft General Foods is the largest food company in the world. Sometimes it’s second to Nestle. So we’re talking a large food company there. And then eventually, interestingly, they buy Nabisco from R.J.R. They do it in a funny sort of way through PepsiCo, which people can ask me about. But basically the take home message of this slide is that at the point when UPFs were really, really scaling up in the mid-’80s and we were starting to see more and more of them in the U.S. food supply, tobacco companies own some of the largest food in the world.

Everyone always wants to know why did they get into the market and companies don’t usually just make these big decisions for one reason, they had several. They wanted to grow and they thought that they saw … A lot of the tobacco executives were seeing the food companies as not as profitable as they could be. And they thought if they acquired them, they could grow faster, diversify, and make those subsidiaries more profitable. Particularly in the case of R.J.R., they were very interested in chemical patents, all the colors and flavors that we are so familiar with. There’s a lot of debate now about regulating these things. The tobacco companies, particularly R.J.R., bought the food companies because they owned patents on chemicals that they wanted.

Now, sometimes they were thinking, “We can take these chemicals that we already put into cigarettes like menthol and we can use them in food.” And in other cases, they were thinking the reverse way. They were thinking, “Well, we’ve got food additives, maybe we can try them out in cigarettes.” What I’m describing here is what executives at the time talked about as synergies. Synergies across different lines, alcohol, tobacco, food. For example, when Philip Morris bought Kraft, they bought a lot of packaging technologies. R.J.R. developed the aseptic box, the little juice box that kids run around with in their hands. And these technologies could transfer across alcohol, food, and tobacco lines.

And I’ll talk a little bit more about the synergies initiative in Philip Morris because it’s very important to understanding what these companies were up to in the mid-’80s. Here is a slide that gives you the story of what happened to the food brands that the tobacco-owned companies owned for decades and nurtured. In the middle, we’ve got R.J.R. and Philip Morris, sorry, it’s complicated because this is the way business works. There are a lot of mergers and acquisitions that go on all the time, but essentially take home message is the big food companies here along the edge, these are the companies that currently own many product lines that were nurtured and developed by the tobacco companies between 1960 and 2008.

Again, the first tobacco acquisition of a food company happened in 1963. And by 2008, they were all spun off into food companies. What’s important about this picture is to notice that a lot of these food companies, these are very large companies and many are international. So at the time that ultra-processed foods were coming into the U.S. food supply, they were also going across the sea to other countries, and they were part of an emerging market strategy of getting these food product lines into developing low and middle income countries and so forth. So as you can see, a lot of the tobacco owned food brands wound up in international, very large companies like Mondelez.

So that’s a story generally about the significant imprint that the tobacco companies had on the food market. And now I want to talk a little bit about how in these companies were thinking about product lines that were diversified across food, alcohol, and tobacco. And so this is a document from the archive, 1989 investor. This is when the executives get trotted out and they make the investors excited about the company. And in ’89, this was a speech by Geoff Bible who was the head of Philip Morris, and he said, “We are the largest publicly held cigarette company, second-largest food company, second-largest beer company in the world. Therefore, we are together the largest consumer packaged good company. Marketing products to millions of people every day.

Our products,” here’s the interesting part, “have shared common characteristics. They’re low-priced, packaged consumer goods with huge retail markets. Most of our products are sold around the world using common marketing approaches.” Synergies is what he’s talking about there. “And similar retail outlets. Most products are agriculturally based and are resistant to economic change.” So as you can see, it’s pretty clear, and there are many, many documents like this where the executives are explaining how similar food, alcohol, and ultra-processed foods are to their marketing and to their product development strategies. This is a document from 1995.

It was in 1995 that Kraft General Foods got renamed Kraft. And at this point, Kraft is the second-largest food company in the world. And you can see here in the reorganization of Philip Morris, here’s the U.S. cigarette company, here’s the international cigarette company, here’s the food, here’s the alcohol. And so you can see they’re fully integrated. And other organization charts at the time you can see common research and development, common marketing branches that are serving all their subsidiaries across cigarettes, food, tobacco and alcohol. Now, just to give you a couple of examples of what the tobacco companies did when they acquired familiar brands in the ultra-processed food market.

So this is Hawaiian Punch. These all come from the 1950s before R.J.R. acquired Hawaiian Pacific, which made one thing, Hawaiian Punch in 1963. And at the time, Hawaiian Punch was an adult cocktail mixer, as you can see. It was basically your ‘50s housewife makes the cocktail to greet her husband at the end of the day. And it’s basically vodka and Hawaiian Punch, and it was sold in this big gallon can for adults. Within a couple of years of owning Hawaiian Punch R.J.R. by 1963-’64 has turned Hawaiian Punch into a child focused product line. You can see here, they’ve got toy giveaways. They had expanded the colors and flavors because children like bright colors and fruity flavors. So they had expanded the product line.

They were bringing children and moms into focus groups to figure out how to develop the brand. And they had put this cartoon character as the symbol for the new brand obviously designed to appeal to children with integrated … These are examples of what they called integrated marketing where you put toy giveaways alongside marketing and product development. Here’s a quote out of the archive right around when R.J.R. bought Hawaiian Pacific. “It’s easy to characterize R.J.R. merely as a tobacco company. In a broader, much less restricting sense, however, we’re in the flavor business. Many of the flavorants for tobacco would be useful in food, beverage and other products.”

Now this comes from a document that was sent by the lab manager in R.J.R. Labs to the folks in the C-suite saying … And parts of it explained that they were very interested in certain chemical patents that Hawaiian Pacific owned and therefore they were encouraging the purchase of the company. What’s interesting here is that this is Joe Camel. When R.J.R. was sued for child target marketing of children, they were disallowed from ever using this cartoon character on cigarettes anymore. But the same ad company created the Hawaiian Punch cartoon character. This is from Philip Morris, just to give you a flavor for same strategy, this is 1978. This is the year that Philip Morris bought 7 Up.

And what they say, essentially, “Soft drinks like cigarettes and beer are reasonably priced, relatively low cost consumer items that give pleasure to users, repeat purchases, satisfies their expectations.” So a lot of people like to ask, “Well, were they really trying to addict people like they were to nicotine and that kind of thing?” We don’t usually see that. What we hear about in the archive is they’re much more likely to talk about pleasure and craving and experiences that really drive people to want to buy products. Just to give you a sense of the cigarette strategy, it’s a combination of market segmentation and line extensions.

So essentially what they do is they carve up the population, the consumers, into a bunch of different subpopulations based on gender, ethnicity, age, and then they develop product lines called line extensions specifically for those market segments. So they’ll have particular line extensions for low-income people and various, sometimes … Like cool cigarettes have a lot of menthol and are targeting the Black population. Sometimes they target very narrow segments of Virginia Slims for women and so forth. So this is the basic strategy that cigarette companies had been using for decades, and they applied that very same strategy to developing ultra-processed food and beverage brands.

This is an example of Kool-Aid, which came to Philip Morris in its acquisitions of General Foods and Kraft. And as you can see the before picture, there are only five flavors and colors. By the time we can’t even … We’ve been struggling to get an exhaustive list of all the line extensions that …

Speaker 3: Laura, I’m just going to quickly point out, we can’t see your slides currently. I think you’ll just have to reshare. Great. Thank you.

Laura Schmidt: Working now?

Speaker 3: Wonderful.

Laura Schmidt: So here are the … I don’t know when they stopped. Here’s the picture of the line extensions for cigarette brands. And here you can see a very, very similar strategy where five brands transformed into many, many brands. In some cases, in the product development testing documents that we uncovered, they were talking about little boys like blue. “We’re going to make a blue brand.” So they’re very, very specifically targeting a small, very narrow market segments of children with line extensions. Another similarity here at the time that Philip Morris owned Kraft, they also owned Miller, a beer. And what they did was they put together all of their marketing into one big marketing synergies program.

And they tried to figure out ways to use marketing strategies that they used for years and assets for cigarettes and apply them to food. And so this is an example of their target marketing strategy for minority populations. It’s a combination of sponsorships and partnerships with minority serving organizations, with online purchasing media. So this is integrated marketing strategy. And in some cases, for example, the in-store marketing, they had cigarette listings of consumers. And they basically transferred those over to Kraft General Foods for use in target marketing of consumers, say for foods just like they had for cigarettes.

So they were using, again, all of the same marketing infrastructure for these different product lines. This is an example of an integrated marketing campaign that came out of Kool-Aid. They were very proud of this campaign in the ‘80s called the Kool-Aid Wacky Wild Warehouse. And kids would save up coupons and things and then be able to mail them in and get toys that were Kool-Aid branded. And it turned out that the very same model for this came out of the Marlboro Country Store, which is a similar integrated campaign for cigarettes. And the Wild Warehouse for children in Kool-Aid was actually developed by the same ad firm and same people.

And so as you can see, the strategies that they had developed and made worked for cigarettes, they were very easily applied to ultra-processed food products. Finally, I just want to share a little taste of what we find when we look in the laboratory research. Of course, tobacco companies are very big companies and they have really large laboratory facilities. They do defensive research to think about what could we be sued on in terms of product liability. They’re looking at … They’re interested in the health effects of the products they’re selling. And Philip Morris had an extensive laboratory search program focused on human pleasure.

And in this document, this is from ’83, they’re talking about being in the business of selling pleasure. And as I mentioned, this is the way that they talk about things, as cigarettes, beer, and carbonated beverages are designed to affect sensual gratifications. Now, Frank Gulotta was a scientist in a lab in Germany. He worked for Philip Morris studying nicotine. And he was actually brought over and worked with Kraft in developing products in Kraft. An example of a very lengthy laboratory research project at Philip Morris, it’s called Project 1620. It went on from 1977 to 1999.

And what they were doing, Gulotta was one of the scientists involved here, was developing electrophysiological kind of EEG type measures to very swiftly be able to measure the human response to flavors and colors and additives in cigarettes. Once they owned Kraft and General Foods, this technology was then very easily applied to study the same colors and flavor additives that you would find in ultra-processed foods. Kraft had a lot of technology around low fat, fat-free food additives. They were very proud of that technology. And some of that was subjected to some of this testing under Project 1620. There’s a lot more that I could say about this, but I’m just giving you a flavor for what we see in the archive.

I do want to point out that Tera Fazzino a couple of years ago published a very interesting study where she used the tobacco archive to code ultra-processed food brands on the basis of whether they had ever been owned and developed by tobacco companies or not. And what she demonstrated was that the tobacco owned brands were more likely to fit her definition of hyperpalatable, which means to have unnaturally high amounts of sugar, salt, and/or fat in them. You need too much sugar, too much salt in the product to qualify as hyperpalatable. And she found that while the tobacco companies own these brands, they were significantly more likely to be hyperpalatable, which is somewhat consistent with what we see in the archive around product development strategies.

What was really interesting about her research is that she also did a contemporary 2018 data point to show that by the time we get to 2018, all the other food companies in the food system are making food as hyperpalatable as the tobacco companies were back in the 1980s and ‘90s. So it may very well be that some of what happened was that the tobacco owned brands, when they were spun off and owned by new food companies, some of that technology was adopted in our current food brands. So just to … 

Isabel Madzorera: Quick, sorry to interject. I think we’ve got three minutes left for the presentation. That’s okay? Thank you.

Laura Schmidt: I’m on the final slide. I think we’ll have a few extra minutes, which is great.

Isabel Madzorera: Thank you.

Laura Schmidt: So just to conclude, first off, it’s important to understand when we look at our ultra-processed system today, once again, Americans are eating about 60% of the calories in their diet are from ultra-processed foods. That many of these brands were owned and developed by tobacco companies using very similar technologies to what they use to develop cigarette brands and alcohol brands. And that the scaling up of these companies happened right as ultra-processed foods were hitting the market. So in the mid-’80s when we really see ultra-processed foods starting to scale up in the American food supply, and we also see obesity starting to really rise. That is the moment when some of the largest food companies are owned by tobacco companies.

Second, the more that you read the documents and understand the thinking, it’s very important, I think, when we think about ultra-processed foods today to understand that to companies, they’re very similar to cigarettes and alcohol. And particularly that the same product formulation, strategies, the same chemical colors and flavors and additives, the same marketing strategies, even down to the lists of consumers to target are all the same for these companies. And I think there’s a real disconnect here between the way the public health and regulatory world kind of thinks about this and the way that actual companies think about this.

I currently follow a lot of industry trade publications and I can tell you, people are always talking about CPG lines. They are not necessarily thinking about alcohol, tobacco, and food as separate categories of products. And then finally to my hypothesis that when these companies get together, they may be able to create more harmful products and this should be a concern for public health. What we see going on with the tobacco owned food brands was that when those companies got those brands, the cigarette companies, they quickly turn the products into child-focused products because this makes a ton of sense from a marketing standpoint. If you can develop brand loyalty in children, you have that consumer for life.

And so that becomes a very important incentive to make child-focused brands. The brands were target marketed to vulnerable groups as I shared a little bit about the craft marketing strategy to minority communities. And as I showed towards the end, they were more likely to be hyperpalatable, higher in sugar, fat, and salt. And so I think with that, I will finish up and let’s have some questions.

Isabel Madzorera:

Great, thank you. Thank you so much, Laura. What a fascinating presentation. We already have a couple of questions in the chat, so I’ll be reading aloud and then you can address them as you see fit. The first question is from Ernest and he says, “What is the evidence that over and above the contribution of salt, sugar, saturated and trans fats that ultra-processed foods have an additional adverse effect? Suppose I just consumed raw sugar, salt, butter.” He gives us an example. “Mixed together, this is not even processed, but will this be as unhealthy if the same ingredients and amounts were blended together in an ultra-processed food?” Loaded question there.

Laura Schmidt: So I think what’s different about what’s going on in these companies is the chemical additives. And what the way I understand it from talking with psychologists who study food and addictive behavior is that when we eat carbohydrates in particular, starches and sugars, we get a dopamine rush in the brain right away and we get a secondary rush when those carbs hit our gut. And that dopamine rush, which is quite similar to dopamine changes in the brain resulting from addictive substances, which has been the subject of some FMRI research, that drives us to crave next time. And what the colors, the flavors, the marketing, the packaging may be doing with all of the color, flavor additives is to cue us to crave particular products.

And particular in the same way that in some of the original fMRI studies, they would put, say someone who was addicted to a drug like an opioid drug in the fMRI machine. And simply by showing them the works, the syringe and all of the stuff that you use before you actually get high, you would see that dopamine rush. And so it may be that what they’re trying to do is to engineer an anticipatory response and to connect our brains between the product and the benefits that we experience when we feel that dopamine rush. I’ve talked to a number of experts in this area who are very interested in what exactly is going on with the chemical colors and flavors.

What I can tell you is someone who spends a lot of time reading from inside these companies and trying to understand their strategy is that they were really, really obsessed with chemical additives. It was in some cases the whole reason they bought certain subsidiaries. They really wanted those patents and they felt that a lot of their product testing had to do with which colors and flavors and additives were going to develop the most response in consumers and be the most attractive particularly to children. And I think part of that goes back to that cigarette marketing model, which is to do with line extensions.

So if you have a factory that’s set up to just make cigarettes, it’s pretty easy to swap out the colors and flavors and slight packaging changes to make all these line extensions and say one line extension isn’t doing so well in the market, you can pull it back and introduce a new one, get a lot of consumers excited about your brand again. And so it may be that part of what was going on here with the chemical colors and flavors had to do with that, and they understood that they needed those additives to produce line extensions. But I do see a lot of interest in that.

And that is the difference I think between what you can do in your home kitchen cooking and what you can do in a factory is that it’s not just the sugar, fat, and salt, but it’s also the way they’re combined with all of the chemical additives. And there’s a very interesting line of research right now into the actual processing itself and whether foods are less satiating, for example, and easier to overeat simply because they’ve used these chemical additives to manipulate the texture of the food to make it a little less satiating. So I think the chemical additives, the more I look, the more interesting they become.

Isabel Madzorera: Great, thank you. So we’ve got a ton of questions. I’m going to try and group them so that we can try and get an answer for everyone. I don’t know if you’ll be able to do it. The next questions, I’ll read the four questions. The first one is, why do people tend to consume ultra-processed foods more than the minimally processed foods, despite the known health risks? What is the role of urbanization and stress? That’s the first question. The second question is developed countries have the knowledge, financial resources, and infrastructure to support optimal health. So why is ultra-processed food consumption and related diseases are still poorly controlled in these settings? Third question.

Laura Schmidt: Wait, I get it.

Isabel Madzorera: It’s a four plus. Third question is: In developing countries, agro-processing industries such as those focusing on soda, noodles and sugar production are growing rapidly. As ultra-processed food consumption increases, what health or policy recommendations would you suggest to protect public health? And the last question from this attendee is, food processing plays an important role in preservation, food security convenience, and meeting consumer sensory preferences. Where should the balance line between food processing, consumer acceptability, and the need to protect public health? These are great questions.

Laura Schmidt: Great questions. Hopefully we’ll be able to digest them and when we come back in the fall, be able to answer them a little more. I think one thing that’s really clear even in markets in low- and middle-income countries where there’s adequate food and it’s delicious and traditional diets are great. A lot of it comes down to branding and the appeal of the branded American products and they have a certain kind of status, it’s modern and this has been true for alcohol and tobacco forever. That becomes part of their appeal. And then the other part is the price point.

And if you can make them shelf stable and cheap enough, then they become accessible to pretty much anybody and start to displace traditional diets. I can’t remember all of the other great questions, but as you were reading them off, I thought, “These are good.”

Isabel Madzorera: I’ll repeat, the other question was if we know that ultra-processed foods are harmful in high-income contexts, like the U.S., why are we not doing enough? Why is that not controlled?

Laura Schmidt: Well, that’s a pretty easy thing to answer, which is the food industry has been blocking any evidence-based policies forever. I mean everything from the gross loophole that allows us to have all these chemical flavors that are not regulated at all. There’s industry self-regulation for all of the chemical flavors and colors. The colors are a little bit more regulated, but there’s that. And then down to opposition to soda taxes and warning labels. And pretty much the best health … Food policy in America would probably be campaign finance reform so that we don’t have the industry in such a position that it can capture federal agencies, and state agencies as well, and oppose any regulations.

I mean, it’s a shame. We’ve got 117 countries and territories taxing soda all around the world, but America, we have a couple of them in the Bay Area and the industry, American Beverage Association comes in and slaps state preemption on us and we can’t have a tax. And we know these things work. I mean, at this point, the train has left the station. We know they work because they work all around the world. Other countries wouldn’t adopt them if they didn’t work. And so it’s a real shame that this is the way our system works.

Isabel Madzorera: Great, thank you, Laura. I’m going to group a couple of questions just to make it a little bit easier for you. So there’s a question. How do fast-casual, fast-food restaurants feed into your research about ultra-processed foods if they do? And then another question is, are there any studies, research that highlights the impacts on consumers of U.S. ultra-processed foods in other countries?

Laura Schmidt: So on the fast-food front, some of the food companies owned by tobacco companies were, in fact, fast-food companies. Kentucky Fried Chicken is a good example. It was acquired by R.J. Reynolds and it was spun off to PepsiCo and now it’s owned by a different company. It’s in the map that I showed earlier with the spin-offs. The restaurant and industry trusting one more and more restaurant chains are basically doing a fast-food strategy where you have flash frozen meat and things that are popped into a fryer quickly reheated to feed the consumer even in sit-down restaurants. And so there is overlap and there are food brands that were never owned by tobacco companies. So this isn’t everything.

The second question around consumer …

Isabel Madzorera: Impacts on consumers of U.S. ultra-processed foods in other countries. In fact, does this translate to impacts in other nations outside the U.S., the products that are developed here?

Laura Schmidt: Yes. So the products are developed here specifically to sell in emerging markets all around the world. And that’s been a strategy for a long time. In fact, the period that I am researching when the tobacco companies owned a lot of food subsidiaries was precisely when they were globalizing. And so over that period, they were pushing more and more into markets around the world so that by today it’s hard to go anywhere that hasn’t been penetrated to some degree by American food corporations and by ultra-processed food companies. And we have a lot of the tobacco-owned brands, as I pointed out, wound up in European food companies. So this is a worldwide phenomenon.

The penetration rates in the American food supply are much higher than in some other countries. And that is, I think, very important for one reason because the health indicators track right alongside, as Isabel mentioned at the outset, premature death, diabetes rates, heart disease tracks to those. There are a lot of epidemiological studies now demonstrating that health worsens, chronic disease worsens when ultra-processed food consumption goes up. And so at this point, it’s a warning call to countries around the world and many are responding to regulate your markets so that the penetration of these harmful products, that consumers still have choice, but they’re not just being bombarded by marketing and distribution.

Part of the way these companies compete today is on distribution. They just want more outlets in more places in your life. So you can’t go to the movie theater without seeing a food court or the airport, you can’t buy gas without being confronted with food marketing. And so basically, it’s a surround sound kind of approach saturation to make it easy to constantly be buying these products and they’re using that strategy internationally and countries can fight back against that.

Isabel Madzorera: Great, thanks. Just because we’ve got a couple of questions, I think Jeannie is answering one question on if there are any changes that will happen under the new administration as far as regulation of food processing ultra-processed foods. There’s also a question on whether we think the increase in unhealthy additives and hyper-palliability in these extremely large conglomerates is a type of consumer harm that should be considered seriously in antitrust cases against mergers and anticompetitive behaviors. It seems that this is problematic and the innovations are not coming from minor players and inevitably, sorry, should crowd out the smaller businesses.

Laura Schmidt: Absolutely and supply chains. So that is a crucial point that the mergers and consolidations make it possible for the very large industrially produced companies to dominate the market. And that is, again, something that is within our power to address. The first question, I remember it was a very good one.

Isabel Madzorera: I can just rehash that. I think it’s been answered by Jeannie in the chat. But the second question was on thinking about combined efforts to really address this coming, I guess mergers, that sort of push.

Laura Schmidt: I mean essentially what’s going on is the smaller producers, as you’re pointing out, are getting crowded out of the market. And so at some point we don’t have consumer choice anymore. We just have … I mean, if you go down the cereal aisle, it’s pretty obvious it looks like choice until you turn the package around on the box of cereal and see that it’s all the same refined ingredients. Just they’ve swapped out the colors and flavors and the packaging and marketing to make it seem like it’s a choice. But in fact, they’re just line extensions of the same basic products. And so I think the more that we allow these consolidations to happen, the harder it becomes for the smaller producers to provide meaningful alternatives to UPFs.

And then the question about the new administration, and I think many of us are very excited about the fact that they’re doing a lot of talking about this issue. So far all that we’ve seen in terms of meaningful kind of action is focused on colors and food dyes, which are a problem. But when you really look at the scope of cosmetic additives, there’s a wide range that really have many of them well-documented health harms like aspartame, there’s a WHO advisory to not be using that artificial sweetener. There’s a lot of low-hanging fruit emulsifiers. And so I would love to see the current effort.

Isabel Madzorera: Sorry. Laura. Sorry to cut you off.

Laura Schmidt: [Inaudible] … food dyes.

Isabel Madzorera: Two minutes to wrap up and we have a hard stop at 1 p.m. Really interesting conversation. I’ll just pick maybe one more question in the interest of time. The question is are schools of public health addressing the commercial determinants of health? How can we as public health professionals continue addressing the commercial determinants of health while also focusing on the social determinants of health? You can’t have one without the other. And then I think maybe just to combine two other questions and then you can give whatever answer you can.

There’s a question whether there are some studies, for example, from Walter Willey that show only certain categories or subcategories of ultra-processed foods are more harmful than others. It is something that might encumber regulation of ultra-processed foods. And the last question is that given that people view food systems or challenging them as paternalistic, despite government intervention in response to market failure or negative externalities, how can we change the narrative around ultra-processed foods? I’ll stop there and then we’ll end exactly at one. Thanks.

Laura Schmidt: So those are three very deep questions. The first one on schools of public health, I’m with you. And we’re building a commercial determinants program. We have a center to end corporate harm at UCSF. And I encourage anyone who’s interested to email me or reach out through social media or whatever to align. The WHO has a branch now on commercial determinants. If you look at the top threats to human health on the WHO website, eight out of 10 of them have to do with commercial industries. So I think it’s absolutely incumbent upon us in public health to develop really good research strategies and build the field of commercial determinants research. And I’m committed to doing that.

On the issue of the boundaries around UPFs, the NOVA classification was developed by a scientist for scientists, but fortunately, there are really good published, peer-reviewed demonstrations that that classification system can be adapted to work for policymakers. And so there’s a lot of industry-funded efforts to undermine the NOVA classification. There were a number of scientists worldwide that had to create an open letter to ask the Novo Nordisk Foundation to stop funding research deliberately to undermine the NOVA classification.

And so the boundary issue is largely determined by, it’s a scientific classification, but there are many public health models for how that can be managed in reliable, defensible, valid ways to work for policy. And so that’s where the work is. And Barry Popkin’s team has a really great publication on precisely how to do that. In terms of changing the narrative …

Isabel Madzorera: Sorry, Laura. We are right at time.

Laura Schmidt: We’re going to talk about changing the narrative in the fall because what that discussion will be about.

Isabel Madzorera: Yes. Thank you all so much. This has been such a lively and interesting discussion. Really great questions. I do apologize that we didn’t get to each and every question, but please feel free to reach out to Laura independently or BFI or myself if you’ve got any lingering questions. But thank you again and looking forward to the second presentation in this series on ultra-processed food consumption and policy. Thank you so much, Dr. Schmidt, for an amazing presentation. Thank you everyone. Take care. Bye.

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