For one consumer, eating doughnuts is an obsessive habit.
"I can't even be in the same vicinity as ... any type of doughnuts because I will finish a dozen all by myself. I'm a type 2 diabetic, so that could kill me … but for some reason I just can't stop eating them.”
The American diet features an overabundance of processed foods, “raising concerns about their impact on health,” said AMA President Bobby Mukkamala, MD, who joined nutrition experts for an AMA webinar to explore the etiology of these foods, and why it’s difficult for patients to avoid overconsumption.
In 2025, the AMA House of Delegates directed AMA to promote public awareness of the health risks of ultraprocessed foods. Additionally, the new Dietary Guidelines for Americans, 2025–2030, advises consumers to avoid highly processed, ready-to-eat products. Nevertheless, it’s a topic that continues to confound health experts.
While most people have an idea of what ultraprocessed foods are, what does the term actually mean?
Is all processing bad? “What do we know about these products and how they affect health,” asked Dr. Mukkamala, an otolaryngologist who also is board certified in lifestyle medicine.
The webinar, “Understanding Processed Foods,” is available to watch on demand at the AMA Ed Hub™. The AMA has designated this blended live and enduring material for a maximum of 1 AMA PRA Category 1 Credit™.
It was the second of four AMA Ed Hub “Healthy Diet and Dietary Patterns” webinars, all of which are hosted by Dr. Mukkamala. The last one to air is “Reducing Risk of Chronic Disease Through Diet,” June 23, 2 p.m. CDT. Learn more and register now.
Why broad classifications don’t work
While concerns about ultraprocessed foods have grown in both research and public health policy, David Ludwig, MD, PhD, said the category may be too broad and imprecise to serve as a useful foundation for nutrition guidance.
The term “ultraprocessed foods” is so imprecise, even the Food and Drug Administration doesn’t know what it means, said Dr. Ludwig. He is a pediatric endocrinologist and researcher at Boston Children's Hospital, a professor of pediatrics at Harvard Medical School and professor of nutrition at Harvard School of Public Health.
Observational studies have linked ultraprocessed foods to a wide range of adverse health outcomes such as obesity, diabetes, cardiovascular disease, cancer, cognitive decline, psychiatric and behavioral disorders, and total mortality. However, the quality of this evidence is graded low to very low, he said, citing concerns about confounding and inconsistency.
Dr. Ludwig also challenged Brazil’s Nova classification system, which groups foods into several categories: minimally processed or whole foods; culinary ingredients like butter, olive oil, salt, sugar; combinations of group one and group two, and ultraprocessed foods.
Nova’s platform isn’t anchored to health effects, but rather to whether ingredients or additives are traditionally used in home cooking. That can lead to what he described as “nonsensical distinctions,” allowing homemade sugary cornflakes while discouraging some high-fiber packaged cereals, or favoring artisanal white bread over some commercial whole-grain breads.
Rather than relying on a broad ultraprocessed label, Dr. Ludwig called for a more nuanced approach that evaluates how specific types of processing affect health, especially the refining of carbohydrates and the effects of certain additives. The new dietary guidelines may be controversial, but they got one thing right. “They don’t use the term ultraprocessed. They use highly processed specifically as it relates to carbohydrates,” he said.
Consumers should prioritize certain foods
Moving beyond definitions, other webinar speakers talked about making informed food choices.
Instead of broadly avoiding anything labeled ultraprocessed, consumers should prioritize whole plant foods and avoid processed meats and sugar-sweetened beverages, said Neal Barnard, MD, an adjunct professor of medicine at George Washington University School of Medicine and president of the Physicians Committee for Responsible Medicine.
Sugar, for example. is not always a bad thing. “It’s your body’s favorite fuel,” he said, noting modest amounts added to foods are different from sugar in beverages. His bigger concern was soda and similar drinks, where large amounts of sugar can be consumed quickly and contribute to weight gain and diabetes risk. High-fat diets can impair insulin sensitivity rapidly, while excess sodium contributes to hypertension and stroke risk.
Dr. Barnard singled out processed meats as especially concerning, calling them “really the biggest drivers between ultraprocessed foods as a category and health risks,” including cancer, diabetes and cardiovascular disease.
Consumers should check packaged labels to see the total fat and saturated fat content of foods that they buy, he advised.
How foods are processed makes a difference
Dr. Barnard also challenged the idea that all packaged or industrially processed foods are inherently problematic. Drawing on cohort studies, he noted some foods classified as ultraprocessed—such as certain breakfast cereals, yogurt and plant-based meat alternatives—have been associated with neutral or even favorable health outcomes, while processed meats and sugary beverages consistently show harm.
He used soy milk as an example to question simplistic distinctions between “natural” and “processed,” arguing that some plant-based alternatives can improve low-density lipoprotein (LDL) cholesterol, blood pressure and inflammation compared with animal-based counterparts.
Not all processing has the same health effects, noted Dr. Ludwig. “Processing of carbohydrates is consistently unhealthful,” he said, pointing to refined grains and rapidly digested carbohydrates as major concerns. But processing fats and proteins often has far less impact, citing examples such as olive oil, peanut butter and tofu, which may have “very little different metabolic effects” than less processed counterparts.
When processing leads to addiction
But some ultraprocessed foods do lead to addictive-like patterns of eating, noted Ashley Gearhardt, PhD, a professor of psychology in the clinical science area at the University of Michigan.
The products engage the brain’s reward systems in ways that resemble addiction, said Dr. Gearhardt, who researches how food advertising drives eating behavior and food preferences in infants. Drawing on machine learning research, she said “high glycemic load” is a strong predictor of foods people consume in addictive-like ways, while fat can amplify reward when paired with refined carbohydrates.
This combination differs from minimally processed foods because industrial processing can “destroy the food matrix,” speed absorption, weaken satiety signals and allow for “flavor engineering” designed to intensify reward. “They are pulling every single lever at their disposal,” she said of the food industry, describing a system focused on maximizing craving and consumption.
Sensory engineering, product formulation and ubiquitous availability as part of what makes some ultraprocessed foods irresistible, she said, comparing aspects of their design to strategies once used by the tobacco industry.
Such foods aren’t designed to be consumed in moderation, she added. Instead, they produce cue-triggered cravings linked to bright, colorful heavily marketed logo or catchy jingle. This leads to loss of control, repeated overconsumption despite negative consequences and cycles of temporary relief followed by renewed craving.
A tool Gearhardt helped develop, the Yale Food Addiction Scale, can identify people who may need additional support managing cravings and related behaviors.
“We need systematic solutions that identify the corporate engineering of harm that has essentially figured out how to hack our limbic system for overwhelming corporate gain,” she said.
