Escaping the Ultra-Processed Food Trap

How to Eat in a Way That Actually Lasts

You know, it kind of sneaks up on people. It happens so slowly that almost nobody notices. One birthday, then the next. One annual physical onto the next. That pair of pants that fits a little tighter.

Then, yep, another year goes by.

The average American adult gains about 1 to 2 pounds per year.[1]

Twenty years later, you’re carrying an extra 20 or 30 pounds thinking:

Wow. How did this happen?

Here’s the peculiar part: almost everybody knows what healthy food looks like.

If you give most people two dinner plates, one with grilled salmon, roasted vegees, olive oil, and a side of strawberries, the other with pepperoni pizza, soda, and a couple of cookies, just about everyone can identify the healthy choice.

So…why do we keep choosing the other?

Most people assume the answer is simple: Willpower. Eat less. Move more. “Just Say ‘no’ to cookies. But, really, if it were just about discipline, why would so many intelligent, motivated people end up in the exact same place?

I hear “I’ve tried everything” almost every week in my office. Keto. Weight Watchers. Low carb. Intermittent fasting. You name it. Folks lose weight then gain it back. Even the word “diet” means something temporary.No wonder people fail. A “diet” implies there’s an end point. After enough iterations, patients start blaming themselves and they really shouldn’t. The diets failed them.

So the real question isn’t willpower. It’s the food environment.

But here’s the thing…

What if there really is a way of eating that doesn’t lead to weight gain?

What if it isn’t a “diet” at all?

What if it’s actually delicious? And you could eat it forever?

Turns out we have already have clues…and they come from one of the most well-controlled nutrition studies we have.

In a carefully controlled inpatient trial, researchers assigned 20 adults to either an ultra‑processed diet or an unprocessed diet for two weeks each. Because it was inpatient, the diets were matched for total calories offered, macronutrient content, as well as fiber, sugar, and sodium.[2] Yet, despite this, people eating the ultra-processed “diet” consumed about 500 extra calories per day.[3]

The crazy thing is that both diets had the same calories available. It is just that, unrestricted, people just ate more from the ultra-processed menu than the other. Voluntarily. The engineered combinations of sugar, fat, salt, and additives actually drive overeating in ways that calorie counts alone just don’t fully capture.

Whole foods, fruits, vegetables, and whole grains are associated with

better weight maintenance.[1]

The actual type of food processing matters as much as the macronutrient content.

That’s not a willpower issue. That’s a physiological response to food that was specifically designed to override our own satiety signals.

While just knowing that doesn’t make it easier to walk past the snack aisle, it does help to understand why our behavior changes.

It’s Not Just the Calories

The Nova classification defines ultra-processed foods as industrial formulations made primarily from chemically modified substances, with additives to enhance taste, texture, and shelf life, and minimal whole food content.[4]

In the United States, these processed foods account for about 58% of total dietary energy![5] That is not a snack.

That is most of the calories for most people.

These foods tend to be: calorie-dense, high in salt, sugar, and saturated fat, and low in fiber and micronutrients.[4] And the harm goes beyond just the nutrient profile. Every 10% increase in the share of ultra-processed food in the diet is associated with about 35 additional calories consumed per day.[3]

That doesn’t sound like much, but it adds up to over 1,000 extra calories every month and about 12,700 extra calories per year. Let’s do the math:

12,700 kcal/year ÷ ~3,500 kcal per pound ≈ 3.6 lb/year

This is not too far off the literature’s report of 1 to 2 points per year. It adds up to real weight gain, and real cardiometabolic risk.

There’s also the displacement effect: The foods that protect you get crowded out by the foods that don’t. When ultra-processed foods represent 75% of total energy intake, the dietary share of fruits, vegetables, and legumes drops to only 4%. When ultra-processed foods are only 15% of energy, fruits, veggies and legumes go up to 12.4%.[3]

Then there’s what’s happening in the gut. Additives found in ultra-processed foods disrupt the gut microbiome and fuel inflammation.[4] This is called ‘leaky gut.” In studies, there were higher urinary concentrations of PFAS (those “forever chemicals”), in people with higher ultra-processed food intake.[3] During pregnancy, higher ultra-processed food intake was linked to both greater maternal concentrations of phthalates and higher umbilical cord PFAS numbers. Nothing like starting off on the wrong foot.

The association between processed foods and disease is jaw-dropping. A recent Lancet review of 104 prospective studies found high ultra-processed food intake was associated with increased risk across 12 distinct outcomes, including:

• Type 2 diabetes
• Hypertension
• Cardiovascular disease
• Coronary heart disease
• Cerebrovascular disease
• Chronic kidney disease
• Crohn’s disease
• Depression, and
• All-cause mortality

Of those 104 studies, 92 reported increased risk for at least one outcome.[3] That’s practically the entire literature. And, like so many other things that are bad for you, there is a dose response: Each additional daily serving of ultra-processed food is associated with a 7% increase in risk of major cardiovascular events and a 9% increase in cardiovascular mortality.[5]

This unhealthy relationship extends beyond cardiometabolic conditions. One finding that surprised me was a 90% increased risk of Crohn’s disease (HR 1.90, 95% CI 1.40–2.59).[3] I did not intuitively connect a bag of chips or packaged snacks to Crohn’s. But, the gut microbiome disruption hypothesis may partly explain this link.[4] The mechanisms are not fully worked out, but this degree of correlation is difficult to blow off.

While this may sound like hyperbole, some commonly consumed ultra-processed foods may even be considered addictive substances by standards used for tobacco products: compulsive use and reinforcement driven by rapid delivery of rewarding, hyper-palatable ingredients.[3]

Unfortunately, this is by design. “Bet you can’t eat just one!” Where have I heard that before?

The Good News Is Wonderfully Simple

The American Heart Association (AHA) in Circulation in 2021 published dietary guidance to improve cardiovascular health. These recommendations are probably just like your grandmother’s advice: Eat plenty of fruits and vegetables. Choose whole grains. Choose healthy proteins with an emphasis on plants, fish, and seafood.

Use plant oils liquid at room temperature over tropical oils. Minimize ultra-processed foods and cut back on added sugars.[6] This is not a fad diet or one with a doctor’s name in it. It’s an eating style.

If those principles sound oddly familiar, they should. They describe, more or less, how people eat in the Mediterranean. A 2023 review and analysis of 40 RCTs with over 35,000 participants found that Mediterranean dietary patterns reduced cardiovascular mortality by a whopping 45% versus minimal intervention. All-cause mortality dropped by 28%.[7] Non-fatal heart attack risk down 52% . Stroke risk down over a third!

To put those numbers in concrete terms: for patients at high cardiovascular risk, Mediterranean “diets” prevented 36 fewer deaths per 1,000 patients over five years compared to no intervention.

Worth mentioning: very low fat, modified fat, Ornish, and Pritikin dietary programs generally showed little or no benefit in the exact same analysis.

The Mediterranean “diet” wins the game. The others not so much, even with an MD’s name.

Plant-forward eating patterns have demonstrated consistent evidence too. A meta-analysis of 11 RCTs found that vegan diets reduced body weight by about 9 pounds (4.1 kg) and BMI by 1.38 kg/m² compared with control diets over at least 12 weeks. Vegan diets also reduced HbA1c, total cholesterol, and LDL cholesterol.[8] Vegetarian diets drop fasting blood glucose numbers by over 6 points and LDL cholesterol by 10 points in RCTs, with higher glucose reductions in those with chronic disease when the intervention lasted more than 12 weeks.[9] You don’t have to go fully vegan to benefit. Shifting just a bit toward more plants and fewer processed foods consistently moves biomarkers in the right direction. If all of this seems like a lift, you could consider going all vegetarian one day a per week. Or maybe two.

For those with high blood pressure, the DASH diet has some of the best RCT randomized trial evidence in dietary/lifestyle medicine. A meta-analysis of 30 randomized RCTs with over 5,500 people found that the DASH diet reduced systolic blood pressure by 3.2 mm Hg and diastolic by 2.5 mm Hg.[10] That effect was seen in adults both with and without hypertension. That effect size may not sound dramatic, but across a whole population that translates to meaningful reductions in stroke and heart attack risk. And, look, the DASH diet isn’t exotic. Fruits, vegetables, whole grains, fish, nuts, and low-fat dairy. Reduced red meat, sweets, and sugar-containing beverages.[11] DASH overlaps substantially with the Mediterranean pattern and with the AHA guidance.

The Grocery Store Is Trying to Tell You Something

When you walk into the grocery store, shop the perimeter. Almost every grocery store is laid out the same way. The outer part is where you find the produce, meat, fish, dairy, and eggs. Real food. The interior aisles are where the ultra-processed products live, stacked floor to ceiling in cardboard boxes, cellophane bags, and plastic packaging.

The food packaging itself is a warning.

It tells you something about what’s inside.

When food needs a box with a list of twenty ingredients to exist, think twice.

Once you have completed the loop, venture into the center aisles last and deliberately: olive oil, canned beans, whole grain pasta, oats. Short ingredient lists you can actually read. Then don’t browse. Check out and leave.

One thing I tell patients: look at the color of your food. Just notice it. Ultra-processed foods tend to cluster in a very narrow part of the color spectrum. White, light tan, beige, pale yellow. Rice, pasta, chips, pretzels, crackers, cookies. The whole category is basically variations on the same few shades. It’s a reflection of what these foods are made from: refined grains, starches, and fats stripped of most of what made the original food nutritious. The color went with it (with deep apologies to my vegetable friends cauliflower, onions and mushrooms).

The AHA guidance to eat plenty and a variety of fruits and vegetables[6] is sometimes described as “eating the rainbow,” and that framing is a lot more useful than it might sound. A plate with red tomatoes, dark leafy greens, orange sweet potato, and purple cabbage is telling you something about its own nutritional density. A plate that’s mostly beige is telling you something. too.

You don’t need a nutrition label. You can actually see it.

Take the farmer’s market: a different experience entirely. No cellophane bags or cardboard boxes. No ingredient lists, because the ingredient is the food. A tomato. A bunch of kale. Corn that was picked yesterday. It almost automatically steers you toward the minimally processed foods all of the evidence consistently supports.[6]

The ultra-processed food problem in America is in no small part a food environment problem.[4] Products are designed to be hyperpalatable in ways that override our normal satiety signals.[2] It helps to understand what we are up against. Shop with a list. Eat before you go. Start at the produce section. Work the perimeter.

If You’re Taking a GLP-1, Food Quality Matters Even More

When I start a patient on a GLP-1, one of the first things I tell them is this: processed food has a way of making these treatments feel punishing. The nausea, the bloating, the constipation is directly related to what you eat while you’re on them. In my clinical experience, processed foods make the side effects far worse.

GLP-1 medications slow gastric emptying. Food sits in your stomach longer than it used to. When that food is high in fat, sugar, or heavily processed, the combination amplifies every GI side effect that these drugs already tend to cause. I’ve seen patients who were miserable on a GLP-1 and then got dramatically better once they changed how they ate. Same dose. Different foods. Different experience.

There’s another reason this matters: These medications substantially reduce appetite and overall calorie intake. Every bite nutritionally actually counts more than it used to. If most of your bites are coming from ultra-processed foods, you’re filling a smaller tank with lower-quality fuel. And the color test still applies. If everything on the plate is white or beige, something is not right. The AHA guidance applies here just as much as it does for anyone else, maybe even more so.[6]The GLP can help with the food quantity. But, the quality is still up to you.

Diets are Oxymoronic with Sustainability

It should surprise no one that “diets”, for the most part, fail. Diets tend to fail for the same reason: they all have an end date. You never hear about a diet that continues forever. Diets are designed (implicitly or explicitly) to be completed rather than lived. And no wonder they don’t last: diets just feel like something you’re enduring.

What the literature actually supports is an eating style: More whole foods. More plants. Less processing. Less added sugar. Less cardboard boxes.

Not a name-branded program. Not a fad.

Look, the Mediterranean diet has been eaten by people in southern Europe literally for generations. Not because they were following a “diet”. That’s just how they ate. The food was good. The outcomes, as the data now shows, stand for themselves. Perhaps we evolved from the Mediterranean diet.

And yet the contrast with ultra-processed food patterns couldn’t be more striking. The Lancet review showed that the risk estimates for high versus low ultra-processed food intake were similar in magnitude, but in reverse, to the protective effects from the Mediterranean diet.[3] The same body of evidence that shows what harms us also shows what protects us. They point in opposite directions, and the gap between them is huge.

What is sustainable? An eating style that’s durable. A way of eating that includes salmon and olive oil and a bowl of lentil soup on a cold New England night. One that leaves room for imperfection, because imperfection is how real life works. One that people have been eating for a very long time without even giving it a name.

And one that, when you look at the plate, has some actual color in it. Food is medicine. Those bright colors are an invitation.

I’m a physician who reads medical research daily and wants to share what I’m learning with you. My goal is to translate complex medical literature into practical insights you can discuss with your own healthcare team. This article is educational — it’s me sharing interesting findings from the medical literature, not medical advice for your specific situation. Every person’s health is different, and what works in a research study might not be right for you. Always talk with your doctor or healthcare provider before making changes to your health routine.

References

1. Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men Mozaffarian D, Hao T, Rimm EB et al. The England Journal of Medicine (2011)
2. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake Hall KD, Ayuketah A, Brychta R et al. Cell Metabolism (2019)
3. Ultra-processed foods and human health: the main thesis and the evidence. Monteiro CA, Louzada ML, Steele-Martinez E et al. Lancet (London, England) (2025)
4. Ultra-Processed Food Exposure and Adverse Health Outcomes: Umbrella Review of Epidemiological Meta-Analyses Lane MM, Gamage E, Du S et al. BMJ (2024)
5. Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study Juul F, Vaidean G, Lin Y et al. Journal of the American College of Cardiology (2021)
6. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association Lichtenstein AH, Appel LJ, Vadiveloo M et al. Circulation (2021)
7. Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis. Karam G, Agarwal A, Sadeghirad B et al. BMJ (Clinical research ed.) (2023)
8. Effects of Vegan Diets on Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Termannsen AD, Clemmensen KKB, Thomsen JM et al. Obesity Reviews : An Official Journal of the International Association for the Study of Obesity (2022)
9. Effects of Vegetarian Diets on Blood Lipids, Blood Glucose, and Blood Pressure: A Systematic Review and Meta-Analysis Xia X, Zhang J, Wang X et al. Food & Function (2024)
10. Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults With and Without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Filippou CD, Tsioufis CP, Thomopoulos CG et al. Advances in Nutrition (2020)
11. Effects of Sodium Reduction and The DASH Diet in Relation to Baseline Blood Pressure Juraschek SP, Miller ER, Weaver CM et al. Journal of the American College of Cardiology (2017)