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By Jocelyn C. Zuckerman
As an infectious-disease doctor working in Central Africa and South Asia in the early 2000s, Chris van Tulleken saw more than his share of children suffering from acute malnutrition. That was probably to be expected, given the impoverished areas in which he served and his patients’ painfully limited diets. But van Tulleken eventually became aware of a more insidious factor at work.
A professor at University College London and a host of popular programs on BBC radio and television, van Tulleken isn’t the first person to point out that remote villagers across the Global South, while unable to access essential medicines, can easily buy a bottle of Coke. But in Ultra-Processed People: The Science Behind Food that Isn’t Food, he goes farther than anyone I’ve encountered in unequivocally characterizing the global obesity epidemic as a “commerciogenic” problem (like smoking) and sounding the alarm about our collective ignorance of its long-term impacts. It isn’t until chapter 19 that van Tulleken references the infant-formula scandal of the 1970s—when it was discovered that Nestlé’s aggressive marketing to impoverished mothers in the developing world had led to tens of thousands of infant deaths — but that corporate villainy hovers over his book like a malevolent spirit.
Over the last several decades, writes van Tulleken, the food industry has learned how to reduce whole foods to their basic molecular constituents and to modify and re-assemble them into food-like shapes and textures — salting, sweetening, coloring, and flavoring them to become entirely new “edible substances.”
“Our calories increasingly come from modified starches,” he explains, “from invert sugars, hydrolyzed protein isolates and seed oils that have been refined, bleached, deodorized, hydrogenated — and interesterified. And these calories have been assembled into concoctions using other molecules that our senses have never been exposed to either.”
The ultra-processed food (UPF) that results now accounts for some 60 percent of the average diet in the United States and in the United Kingdom, where van Tulleken lives with his wife and young children. He tracks the processes invented to cut costs and extend the shelf life of food products (including the development of margarine by a member of the Nazi party and its testing on some 6,000 concentration-camp prisoners), and he provides evidence that the chemicals in today’s ubiquitous UPF actually disrupt our bodies’ ability to regulate appetite and digestion, interfering with the brain’s reward system, much as alcohol, nicotine, and morphine do. A food’s unique smell and taste signal to the body that particular nutrients are on the way, for instance. But when we eat ultra-processed versions of those foods, our bodies never get the nutrients their flavorings have promised to deliver. Craving nutrition that doesn’t come, we end up eating more and more. And because ultra-processing also strips out many of the molecules naturally present in whole foods — molecules like vitamins, heme iron, and polyphenols that may protect us against cancers, heart disease, dementia, and more — we are left with high-caloric diets increasingly void of nutrition.
Van Tulleken provides a formal, scientific definition for UPF, but in keeping with his appealingly conversational tone, he simplifies for us: If something is wrapped in plastic and contains one ingredient that you wouldn’t find in a home kitchen, it is ultra-processed. UPF’s hallmark qualities are convenience, hyper-palatability and, crucially, low cost. (UPF’s affordability comes thanks in part to its reliance on high-yield, industrially farmed crops such as palm oil, soy, sugar, and corn, and the fact that the externalities involved in their cultivation — a warming climate, growing antibiotic resistance, declining biodiversity — don’t get factored into their costs.)
While acknowledging that obesity is a complicated issue involving genetic, social, cultural, and behavioral factors — he’s careful throughout not to overstate his case — van Tulleken systematically swats away such Big Food scapegoats as excess sugar, insufficient exercise, and lack of willpower. As an example of how easy it is to fall prey to the wiles of the industry, he offers the example of his identical twin, Alexander (“Xand”), who — homesick in the U.S., stressed out, and surrounded by McDonald’s, Burger King, and KFC — proceeded to gain 45 pounds within mere months. In the name of research, van Tulleken subjects himself to a similar UFP-heavy diet for a month. He likewise packs on the pounds — and finds himself suffering from constipation, hemorrhoids, sleeplessness, and more. A post-UPF-diet MRI revealed that the connectivity between regions of his brain, particularly those involved in the hormonal control of food intake and in desire and reward, had changed considerably.
In breaking new ground in the ongoing debate about diet and health, and doing so in a way that’s both authoritative and entertaining, Ultra-Processed People could sit on the bookshelf alongside such classics as Michael Pollan’s The Omnivore’s Dilemma and Eric Schlosser’s Fast Food Nation. Van Tulleken goes out of his way not to preach or offer dietary advice, though he does suggest that if you want to clean up your diet you might try his UPF immersion plan while reading the book. (He and Xand have since sworn off UPF for good.)
Nor does he have any illusions about the Nestlés, PepsiCos, and Unilevers of the world changing the way they expand their markets. Getting a handle on the global obesity epidemic will mean overhauling regulatory agencies and reining in marketing machines aimed at convincing us we need products that we don’t — whether formulas to replace breast milk or UPF fortified with probiotics meant to replace the very ones stripped from those products. He knows, too, that barring those responsible for making and informing food policy from taking industry money will be as challenging as cracking down on deceptive marketing.
In 2020, van Tulleken traveled to Brazil and was only marginally surprised to come upon an updated version of Nestlé’s half-century-old baby-formula campaign. The company had enlisted door-to-door sales teams to hawk its packaged foods in urban slums and had launched a boat to sell them to communities dwelling along tributaries of the Amazon. One boat manager told van Tulleken how “enchanted” he’d been to steward the floating supermarket for seven years — until he began to see friends and family succumbing to tooth decay and stomach disease. Among the hundreds of products he’d offered on the boat, said the manager — products including yogurt and powdered milk — it was always the ice cream and Kit Kat bars that sold out first. “Once you’ve had ice cream and Kit Kats,” writes van Tulleken, invoking the image of a Trojan Horse, “you can’t go back.”
Which, of course, is exactly the way it’s designed to be.