In announcing the Decade of Action on Nutrition on April 1st 2016, The United Nations acknowledged a stark polarisation which is becoming even more marked as the years progress. Although there are 800 million people who remain chronically undernourished at one end of the spectrum, at the other end, there are another 600 million who are now obese. And those at both ends are suffering from forms of malnutrition.
The UN resolution placed nutrition firmly at the heart of sustainable development, and importantly, discussed at length just how malnutrition affects both ends of this spectrum. In the words of WHO Director-General Dr Margaret Chan: “Part of the world has too little to eat, leaving millions vulnerable to death or disease caused by nutrient deficiencies. Another part overeats, with widespread obesity pushing life-expectancy figures backwards and pushing the costs of health care to astronomical heights."
In my words: ‘Mal’-nutrition now refers to both those who have insufficient food and to those who eat too much poor quality food. Too much junk food?
The original Rome Declaration dated November 19th 2014 which kicked off this initiative attacked the usual macro and micro-nutrient suspects. “Governments” it says in the declaration, “should encourage a reduction in trans-fats, saturated fats, sugars and salt in foods and drinks, and improve the nutrient content of foods through regulatory and voluntary instruments”. No surprises there, but the proceedings then took a dramatic turn.
Drawing on a paper first published in Obesity Reviews and dated October 23rd 2013 entitled “Ultra-processed products are becoming dominant in the global food system”, the UN decided to adopt a definition of ultra-processed foods (UPPs) which effectively short-circuited the macro/micronutrient conversation. By declaring that these ‘UPPs’ have an impact on both ends of the food availability spectrum, they became the core focus for future policies and programs.
The problems of ultra-processed food were first raised by Carlos Monteiro (Professor at the Department of Nutrition of the School of Public Health at the University of São Paulo) in a 2009 paper entitled “Nutrition and health. The issue is not food, nor nutrients, so much as processing”. But potential progress using these considerations has really only come to life with the widespread adoption of the NOVA food classification system by bodies such as the Pan American Health Organization and the UN Food and Agriculture Organization.
The UN resolution placed nutrition firmly at the heart of sustainable development, and importantly, discussed at length just how malnutrition affects both ends of this spectrum. In the words of WHO Director-General Dr Margaret Chan: “Part of the world has too little to eat, leaving millions vulnerable to death or disease caused by nutrient deficiencies. Another part overeats, with widespread obesity pushing life-expectancy figures backwards and pushing the costs of health care to astronomical heights."
In my words: ‘Mal’-nutrition now refers to both those who have insufficient food and to those who eat too much poor quality food. Too much junk food?
The original Rome Declaration dated November 19th 2014 which kicked off this initiative attacked the usual macro and micro-nutrient suspects. “Governments” it says in the declaration, “should encourage a reduction in trans-fats, saturated fats, sugars and salt in foods and drinks, and improve the nutrient content of foods through regulatory and voluntary instruments”. No surprises there, but the proceedings then took a dramatic turn.
Drawing on a paper first published in Obesity Reviews and dated October 23rd 2013 entitled “Ultra-processed products are becoming dominant in the global food system”, the UN decided to adopt a definition of ultra-processed foods (UPPs) which effectively short-circuited the macro/micronutrient conversation. By declaring that these ‘UPPs’ have an impact on both ends of the food availability spectrum, they became the core focus for future policies and programs.
The problems of ultra-processed food were first raised by Carlos Monteiro (Professor at the Department of Nutrition of the School of Public Health at the University of São Paulo) in a 2009 paper entitled “Nutrition and health. The issue is not food, nor nutrients, so much as processing”. But potential progress using these considerations has really only come to life with the widespread adoption of the NOVA food classification system by bodies such as the Pan American Health Organization and the UN Food and Agriculture Organization.
In their paper, “The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing”, the authors show that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases (my bold).
Anna Lartey, Director of the Nutrition Division of The Food and Agriculture Organization of the United Nations (FAO), provided guidance in 2015 to countries and researchers on how to incorporate the collection of information on processed foods into their food consumption surveys. Contributors to these guidelines included some heavyweights such as Walter Willett of the Harvard School of Public Health in Boston and the resulting NOVA classification now effectively divides food and drink into four categories.
It turns out that what Ms Elver actually made reference to was ‘cheap, nutrient-poor foods’ when she raised the topic of the basic ‘human right to adequate food’. Those newspaper references to junk food were courtesy of the Associated Press reporter covering the press conference, who I imagine was probably just trying to simplify things for us lay people.
Yet according to the Washington Post, most people - roughly six in 10 - acknowledge that they only ever read the news headlines, not the specifics. So anyone reading the headlines probably did think that the UN was finally getting tough on purveyors of junk food. And therein lies the problem. Junk food means quite different things to different people. And Big Food is desperate to to keep the focus away from the topic of ultra-processing. It is after all, by far their most profitable ‘added-value’ segment.
Anna Lartey, Director of the Nutrition Division of The Food and Agriculture Organization of the United Nations (FAO), provided guidance in 2015 to countries and researchers on how to incorporate the collection of information on processed foods into their food consumption surveys. Contributors to these guidelines included some heavyweights such as Walter Willett of the Harvard School of Public Health in Boston and the resulting NOVA classification now effectively divides food and drink into four categories.
- Unprocessed or minimally processed foods
- Processed culinary ingredients
- Processed foods
- Ultra-processed food and drink products
It turns out that what Ms Elver actually made reference to was ‘cheap, nutrient-poor foods’ when she raised the topic of the basic ‘human right to adequate food’. Those newspaper references to junk food were courtesy of the Associated Press reporter covering the press conference, who I imagine was probably just trying to simplify things for us lay people.
Yet according to the Washington Post, most people - roughly six in 10 - acknowledge that they only ever read the news headlines, not the specifics. So anyone reading the headlines probably did think that the UN was finally getting tough on purveyors of junk food. And therein lies the problem. Junk food means quite different things to different people. And Big Food is desperate to to keep the focus away from the topic of ultra-processing. It is after all, by far their most profitable ‘added-value’ segment.
So exactly what is junk food?
There’s a popular parlour game which involves someone giving you a word and you are then asked to say the first thing that comes to mind; the next person continues and so on.
Let’s play: Imagine for a moment that you are looking at a cake shop window, or maybe the Starbucks counter full of buns, biscuits and chocolate cake. Someone says the word ‘junk food’. Is your immediate response ‘blueberry scone’ or do you perhaps mention a favourite slice of cake? Or would you mentally leave the cake shop window and jump straight to a more mainstream understanding of junk food and say ‘pizza’ or perhaps, ‘burger’?
Having tried this little game with a number of willing participants, you probably did initially think of something fatty as opposed to choosing from what you might have seen in the café window. You may have considered those sweet goods as representing a treat, even a welcome break in the middle of a busy day, not really summing up your idea of ‘junk food’ at all. Yet I would argue that almost everything that’s for sale in the café or cake shop counter is junk food; heavy in processed carbohydrates and cheap oils.
What’s conjured up in your mind when considering those two short words is often very different from person to person. Most of us probably do associate junk food with pizzas, hamburgers and hot dogs and we might also refer to them as fast-food. Related thought patterns could see us considering the possible damage we are doing to our arteries by eating all that saturated fat and processed meat. After all, that’s what we’ve been told haven’t we?
Of course, we might be considering just how tasty junk food can be - that’s what it’s designed to be after all, with the appropriate flavour additives and emulsifiers guaranteeing a perfect consistency. Even then, we would probably be thinking of different food categories to cakes and buns… chocolate bars for example? Are they junk food? Is Nutella which has a 57 per cent sugar content junk food or is it dependent on what you eat it with?
I would like to suggest that all ultra-processed food and drink be renamed junk food. It has a memorable ring to it that UPPs certainly don’t have. But then we need to define UPP’s quite precisely and thankfully, that’s already been done. All that remains is to convince opinion leaders in this area that the two are equivalent.
Let’s play: Imagine for a moment that you are looking at a cake shop window, or maybe the Starbucks counter full of buns, biscuits and chocolate cake. Someone says the word ‘junk food’. Is your immediate response ‘blueberry scone’ or do you perhaps mention a favourite slice of cake? Or would you mentally leave the cake shop window and jump straight to a more mainstream understanding of junk food and say ‘pizza’ or perhaps, ‘burger’?
Having tried this little game with a number of willing participants, you probably did initially think of something fatty as opposed to choosing from what you might have seen in the café window. You may have considered those sweet goods as representing a treat, even a welcome break in the middle of a busy day, not really summing up your idea of ‘junk food’ at all. Yet I would argue that almost everything that’s for sale in the café or cake shop counter is junk food; heavy in processed carbohydrates and cheap oils.
What’s conjured up in your mind when considering those two short words is often very different from person to person. Most of us probably do associate junk food with pizzas, hamburgers and hot dogs and we might also refer to them as fast-food. Related thought patterns could see us considering the possible damage we are doing to our arteries by eating all that saturated fat and processed meat. After all, that’s what we’ve been told haven’t we?
Of course, we might be considering just how tasty junk food can be - that’s what it’s designed to be after all, with the appropriate flavour additives and emulsifiers guaranteeing a perfect consistency. Even then, we would probably be thinking of different food categories to cakes and buns… chocolate bars for example? Are they junk food? Is Nutella which has a 57 per cent sugar content junk food or is it dependent on what you eat it with?
I would like to suggest that all ultra-processed food and drink be renamed junk food. It has a memorable ring to it that UPPs certainly don’t have. But then we need to define UPP’s quite precisely and thankfully, that’s already been done. All that remains is to convince opinion leaders in this area that the two are equivalent.
A few years back, Dr Carlos Monteiro of Sao Paulo University in Brazil together with researchers from the University of North Carolina set out to investigate changes in the annual per capita sales of selected ultra-processed products. They did this for 79 countries between 1998 and 2012 and to get them started, they developed with this working definition for UPP’s:
“Ultra-processed products are made from processed substances extracted or refined from whole foods – e.g. oils, hydrogenated oils and fats, flours and starches, variants of sugar, and cheap parts or remnants of animal foods – with little or no whole foods. Products include burgers, frozen pasta, pizza and pasta dishes, nuggets and sticks, crisps, biscuits, confectionery, cereal bars, carbonated and other sugared drinks, and various snack products. Most are made, advertised, and sold by large or transnational corporations and are very durable, palatable, and ready to consume, which is an enormous commercial advantage over fresh and perishable whole or minimally processed foods … [They] are typically energy dense; have a high glycaemic load; are low in dietary fibre, micronutrients, and phytochemicals; and are high in unhealthy types of dietary fat, free sugars, and sodium.”
Now, that’s a bit of a mouthful I admit, but in essence, isn’t this more or less what we mean when in conversation, we refer to the catch-all ‘junk food’? Do we need more precision?
“Ultra-processed products are made from processed substances extracted or refined from whole foods – e.g. oils, hydrogenated oils and fats, flours and starches, variants of sugar, and cheap parts or remnants of animal foods – with little or no whole foods. Products include burgers, frozen pasta, pizza and pasta dishes, nuggets and sticks, crisps, biscuits, confectionery, cereal bars, carbonated and other sugared drinks, and various snack products. Most are made, advertised, and sold by large or transnational corporations and are very durable, palatable, and ready to consume, which is an enormous commercial advantage over fresh and perishable whole or minimally processed foods … [They] are typically energy dense; have a high glycaemic load; are low in dietary fibre, micronutrients, and phytochemicals; and are high in unhealthy types of dietary fat, free sugars, and sodium.”
Now, that’s a bit of a mouthful I admit, but in essence, isn’t this more or less what we mean when in conversation, we refer to the catch-all ‘junk food’? Do we need more precision?
Definition and Communication
The words junk and food, separately or sometimes joined up are regularly found in newspaper headlines or on the lips of newsreaders and social commentators. Let’s go back a few years to the issue of the British Daily Telegraph published on December 28th 2008 for a typical example.
The headline read as follows: “Parents are killing obese children with kindness, says UK Government”; the kindness in question being the encouragement of unhealthy lifestyles such as “eating junk food and playing video games”. In the same context, the more populist Daily Mail wrote that “junk food such as burgers and chips could harm children in the long run”. They quoted Tam Fry, of the Childhood Growth Foundation, which monitors children's weight, saying: "We're really concerned that parents are using sweets, chocolates and fizzy drinks to reward their children.”
Meanwhile, the actual report to which they referred was issued by the Department of Health and said: “Kids who eat the wrong sorts of food and sit around all day are more likely to get heart disease, cancer, diabetes and die young.”
Is junk food the ‘wrong sort of food? Do they mean ‘burgers and fries’, ‘sweets, chocolate and fizzy drinks’ or simply take-aways in general. Some Chinese take-aways contain very high levels of sugar indeed.
Not surprisingly, in the health and nutrition community, no-one seems to endorse junk food. Negative comments often condemn the ingredients or the calorific value but precise category interpretations vary and appear to be situational.
Clarity of communication is always helpful but I would suggest that it becomes vital when we are facing up to the twin worldwide epidemics of obesity and type-2 diabetes. In spite of the recent alarm at the dreadful, ‘new’ famines in Africa, there are actually more obese than undernourished citizens in the world today. And as we read earlier, most of those obese people also suffer from a form of malnutrition according to WHO and UN representatives.
The headline read as follows: “Parents are killing obese children with kindness, says UK Government”; the kindness in question being the encouragement of unhealthy lifestyles such as “eating junk food and playing video games”. In the same context, the more populist Daily Mail wrote that “junk food such as burgers and chips could harm children in the long run”. They quoted Tam Fry, of the Childhood Growth Foundation, which monitors children's weight, saying: "We're really concerned that parents are using sweets, chocolates and fizzy drinks to reward their children.”
Meanwhile, the actual report to which they referred was issued by the Department of Health and said: “Kids who eat the wrong sorts of food and sit around all day are more likely to get heart disease, cancer, diabetes and die young.”
Is junk food the ‘wrong sort of food? Do they mean ‘burgers and fries’, ‘sweets, chocolate and fizzy drinks’ or simply take-aways in general. Some Chinese take-aways contain very high levels of sugar indeed.
Not surprisingly, in the health and nutrition community, no-one seems to endorse junk food. Negative comments often condemn the ingredients or the calorific value but precise category interpretations vary and appear to be situational.
Clarity of communication is always helpful but I would suggest that it becomes vital when we are facing up to the twin worldwide epidemics of obesity and type-2 diabetes. In spite of the recent alarm at the dreadful, ‘new’ famines in Africa, there are actually more obese than undernourished citizens in the world today. And as we read earlier, most of those obese people also suffer from a form of malnutrition according to WHO and UN representatives.
Precision matters, words matter, even punctuation matters. As the website Grammarly notes, the sentences “I love my parents, Lady Gaga and Humpty Dumpty” and “I love my parents, Lady Gaga, and Humpty Dumpty” are a little different. Without a comma, it looks like the parents in question are, in fact, Lady Gaga and Humpty Dumpty.
Your life can literally depend on the correct and clear communication of what’s important to you; as a 19 year old, Derek Bentley found this out to his cost when on trial in London in 1953. Bentley had shouted to his co-defendant (who was carrying a gun), ''Let him have it!'', and the legal case depended on whether he was instructing his younger accomplice to hand over the pistol or to fire it. Unfortunately for Bentley, the court decided it was the latter, so the gallows awaited him.
Words such as "fish" and "bread" seldom lead to communication difficulties but ‘junk food’ can be grouped with ‘balanced diet’, ‘healthy eating’ and other such phrases, all being too easily open to misinterpretation. Using them in a conversation can prove to be just as difficult as getting into a discussion about really tricky topics like "fundamental human rights", if and when you dive beneath the veneer of agreement which lies on the surface. Catchy phrases like ‘healthy Mediterranean diet’ mean different things to different people and if you incorporate them into your viewpoint, it can quite easily end in disagreement.
Michael Joseph who runs the informative Nutritionadvance.com website has pointed out that most large food manufacturers regularly use such trite phrases, when declaring their support for a healthy diet and lifestyle. Coca Cola chooses to advocate an ‘active, balanced lifestyle’, Mars goes for ‘a well-balanced lifestyle’ and General Mills touts the advantages of ’a balanced and healthy lifestyle’. No-one can disagree with these statements, although most of us take issue with the processed, packaged food and drinks that form an important part of that ‘lifestyle’.
Your life can literally depend on the correct and clear communication of what’s important to you; as a 19 year old, Derek Bentley found this out to his cost when on trial in London in 1953. Bentley had shouted to his co-defendant (who was carrying a gun), ''Let him have it!'', and the legal case depended on whether he was instructing his younger accomplice to hand over the pistol or to fire it. Unfortunately for Bentley, the court decided it was the latter, so the gallows awaited him.
Words such as "fish" and "bread" seldom lead to communication difficulties but ‘junk food’ can be grouped with ‘balanced diet’, ‘healthy eating’ and other such phrases, all being too easily open to misinterpretation. Using them in a conversation can prove to be just as difficult as getting into a discussion about really tricky topics like "fundamental human rights", if and when you dive beneath the veneer of agreement which lies on the surface. Catchy phrases like ‘healthy Mediterranean diet’ mean different things to different people and if you incorporate them into your viewpoint, it can quite easily end in disagreement.
Michael Joseph who runs the informative Nutritionadvance.com website has pointed out that most large food manufacturers regularly use such trite phrases, when declaring their support for a healthy diet and lifestyle. Coca Cola chooses to advocate an ‘active, balanced lifestyle’, Mars goes for ‘a well-balanced lifestyle’ and General Mills touts the advantages of ’a balanced and healthy lifestyle’. No-one can disagree with these statements, although most of us take issue with the processed, packaged food and drinks that form an important part of that ‘lifestyle’.
Who coined the term, junk food?
The phrase junk food has only been around since 1972, having been coined by Michael Jacobson, the Director of the American Center for Science in the Public Interest. He called soda (sweet, fizzy drinks), the ‘quintessential junk food’ containing sugar and no nutrients, so it’s interesting how today, most people think first and foremost of fattier foods. Mr Jacobson was also famous for other colourful phrases, calling fettuccine alfredo a "heart attack on a plate”. But he never precisely defined junk food, using that and other choice phrases for their symbolic impact, which is why today, interpretations can still vary wildly.
Another British news headline from 2006 illustrates the situation - “MPs call for junk food ad ban during shows such as The X Factor”. The article that followed cited Dr Sarah Wollaston MP, chair of the health committee: “One third of children leaving primary school are overweight or obese, and the most deprived children are twice as likely to be obese than the least deprived”.
But after parliamentary committee meetings, they could not reach agreement on what constituted ‘junk-food’, so they fell back on the prevailing low-fat (pretty much unchanged today) dietary guidelines, calling for TV ad restrictions on products high in fat, sugar and salt (HFSS) to be extended to a complete ban before 9pm. Ironically, that meant many boxed breakfast cereals could still be advertised before 9pm as could much of the food on sale at coffee chains for example.
Another British news headline from 2006 illustrates the situation - “MPs call for junk food ad ban during shows such as The X Factor”. The article that followed cited Dr Sarah Wollaston MP, chair of the health committee: “One third of children leaving primary school are overweight or obese, and the most deprived children are twice as likely to be obese than the least deprived”.
But after parliamentary committee meetings, they could not reach agreement on what constituted ‘junk-food’, so they fell back on the prevailing low-fat (pretty much unchanged today) dietary guidelines, calling for TV ad restrictions on products high in fat, sugar and salt (HFSS) to be extended to a complete ban before 9pm. Ironically, that meant many boxed breakfast cereals could still be advertised before 9pm as could much of the food on sale at coffee chains for example.
I know it when I see it
‘Junkfood’ as one word or written separately is never referred to by established food manufacturers but it comes up over 153 million times if you conduct a Google search; so you would be forgiven for thinking that ‘junk-food’ falls into the “I know it when I see it” category. And for that one reason alone, you might still question whether it even needs a precise definition?
Well… as you will know by now, my opinion is; yes it does. The phrase, “I know it when I see it” usually describes something which is subjective or lacking in clear definition and is famously attributed to US Supreme Court Justice Potter Stewart. He came up with it back in the 1960’s when defining his ‘threshold test’ for pornography, although in that particular case, while judging Louis Malle’s film, ‘The Lovers’; he decided that ‘he didn’t see it’. So, just as beauty is often described as being in the eye of the beholder, the official interpretation of watching porn is too!
Is that then how we should remain with ‘junk food’? Is it OK that everyone has their own view of it? How easy it would be to reach agreement on a shared point of view if we all just nodded heads and spoke convincingly about the evils of junk food, but each had in mind our own unique definition! (As we have observed when committees reach agreement on the importance of a ‘balanced diet’).
Well… as you will know by now, my opinion is; yes it does. The phrase, “I know it when I see it” usually describes something which is subjective or lacking in clear definition and is famously attributed to US Supreme Court Justice Potter Stewart. He came up with it back in the 1960’s when defining his ‘threshold test’ for pornography, although in that particular case, while judging Louis Malle’s film, ‘The Lovers’; he decided that ‘he didn’t see it’. So, just as beauty is often described as being in the eye of the beholder, the official interpretation of watching porn is too!
Is that then how we should remain with ‘junk food’? Is it OK that everyone has their own view of it? How easy it would be to reach agreement on a shared point of view if we all just nodded heads and spoke convincingly about the evils of junk food, but each had in mind our own unique definition! (As we have observed when committees reach agreement on the importance of a ‘balanced diet’).
Therein lies the crux of the matter because, we do not all share a similar idea of what ‘junk food’ represents and so it does need more precise definition. The simple fact is; we do not recognise junk food when we see it, and many of us see it in places where others do not.
If, like me, you support the blood/insulin principle, meaning that carbohydrates, particularly refined carbohydrates are the main cause of Insulin Resistance, then any food or drink with a high proportion of processed carbs should probably be labelled as junk food. But that is currently a minority view. Most people do not even associate carbs (aka starchy foods) with junk food, unless they remember that sugar in all its forms is a form of carbohydrate. They have been taught to blame the burger rather than the bun, as do law-makers. An increasing number of local councils talk of establishing ‘no-fry zones’ when they set out to keep junk food outlets away from schools, presumably associating junk food with too much fat?
After former First Lady Michelle Obama said: “Our classrooms should be healthy places where kids aren’t bombarded with ads for junk food,” in connection with her “Let’s Move” campaign, she went on to enjoy a certain measure of success. Implementation of her initiatives in 2014 saw the USDA limiting snacks in High Schools to 200 calories per item, and sodas and sports drinks reduced to 60 calories or less per 12-ounce serving. The new regulations also restricted vending machines in Elementary and Middle schools to the sale of water, 100% fruit or vegetable juice and low-fat or fat-free milk. Was that because they seriously thought that the fat in milk moved it into the junk food category? I wonder?
VISUAL school vending machine?
By now, you may be thinking that reaching agreement on a definition for junk food will be impossible, why bother? But stay with me, there is some agreement. Google takes you straight to the following description “pre-prepared or packaged food that has low nutritional value” and Wikipedia refers to junk food as a “pejorative term for cheap food containing high levels of calories from sugar or fat with little fiber, protein, vitamins or minerals”. The UK’s NHS system avoids the words, except when citing newspaper stories, as do the U.S. Food and Drug Administration (FDA) and the American Heart Association (AHA). At WebMD, they kind of avoid the issue by saying that ‘it depends who you ask’ and the UK’s Eatwell policy guide simply avoids the phrase completely. It’s as if ‘junk food’ is the Voldemort of the eating authorities. Can it be that junk food is really the type of food that must not be named? Are they (whoever ‘they’ is) scared to define it? Is there someone we might offend?
If, like me, you support the blood/insulin principle, meaning that carbohydrates, particularly refined carbohydrates are the main cause of Insulin Resistance, then any food or drink with a high proportion of processed carbs should probably be labelled as junk food. But that is currently a minority view. Most people do not even associate carbs (aka starchy foods) with junk food, unless they remember that sugar in all its forms is a form of carbohydrate. They have been taught to blame the burger rather than the bun, as do law-makers. An increasing number of local councils talk of establishing ‘no-fry zones’ when they set out to keep junk food outlets away from schools, presumably associating junk food with too much fat?
After former First Lady Michelle Obama said: “Our classrooms should be healthy places where kids aren’t bombarded with ads for junk food,” in connection with her “Let’s Move” campaign, she went on to enjoy a certain measure of success. Implementation of her initiatives in 2014 saw the USDA limiting snacks in High Schools to 200 calories per item, and sodas and sports drinks reduced to 60 calories or less per 12-ounce serving. The new regulations also restricted vending machines in Elementary and Middle schools to the sale of water, 100% fruit or vegetable juice and low-fat or fat-free milk. Was that because they seriously thought that the fat in milk moved it into the junk food category? I wonder?
VISUAL school vending machine?
By now, you may be thinking that reaching agreement on a definition for junk food will be impossible, why bother? But stay with me, there is some agreement. Google takes you straight to the following description “pre-prepared or packaged food that has low nutritional value” and Wikipedia refers to junk food as a “pejorative term for cheap food containing high levels of calories from sugar or fat with little fiber, protein, vitamins or minerals”. The UK’s NHS system avoids the words, except when citing newspaper stories, as do the U.S. Food and Drug Administration (FDA) and the American Heart Association (AHA). At WebMD, they kind of avoid the issue by saying that ‘it depends who you ask’ and the UK’s Eatwell policy guide simply avoids the phrase completely. It’s as if ‘junk food’ is the Voldemort of the eating authorities. Can it be that junk food is really the type of food that must not be named? Are they (whoever ‘they’ is) scared to define it? Is there someone we might offend?
Empty Calories... ?
What would happen for example if junk food were defined as all food that’s made up of empty calories – food and drink that is, with lots of energy but few nutrients? The online resource, WebMD tells us that "Convenience foods like packaged snacks, chips and sodas, are common sources of empty calories”. Well such a definition could well also include all highly processed food and anything manufactured with lots of cheap vegetable oil, sugar (or substitutes) and other refined carbohydrates, such as wheat, rice and corn. After all, such foods are mostly made from nutrient poor, denatured ingredients with diverse additives, flavouring, emulsifiers etc.
In those UN reports referred to earlier, highly processed and packaged foods are increasingly blamed for their negative impact on our bodies and more specifically, the lack of diversity in our gut microbiome, not to speak of the harmful hormonal impact they have on our body’s fat storage systems.
That ‘empty calorie’ definition could equates to all ultra-processed food, even when vitamins and other nutrients are added to restore a healthier look to what’s being sold. It would include almost all breakfast cereals, the entire content of cake shops and most bakers, as well as about half of what’s on sale in supermarkets in terms of floor space… not to mention practically all the food sold in fast-food chains. Step forward a few years. Can you picture a world where to protect the young, McDonald’s burgers are sold in plain paper packaging just as cigarettes are today? Stranger things have happened… and maybe it’s not such a strange idea at all.
In those UN reports referred to earlier, highly processed and packaged foods are increasingly blamed for their negative impact on our bodies and more specifically, the lack of diversity in our gut microbiome, not to speak of the harmful hormonal impact they have on our body’s fat storage systems.
That ‘empty calorie’ definition could equates to all ultra-processed food, even when vitamins and other nutrients are added to restore a healthier look to what’s being sold. It would include almost all breakfast cereals, the entire content of cake shops and most bakers, as well as about half of what’s on sale in supermarkets in terms of floor space… not to mention practically all the food sold in fast-food chains. Step forward a few years. Can you picture a world where to protect the young, McDonald’s burgers are sold in plain paper packaging just as cigarettes are today? Stranger things have happened… and maybe it’s not such a strange idea at all.
or just... Low Nutritional Value?
Let’s lower our sights just a bit. What if junk food were defined as being any food with a low nutritional value. What would that mean? How would we interpret that? And whose definition of nutritional value would we choose?
Junk food, as it is generally referred to today, is often construed as being any food that’s high in fat, sugar and salt. That’s after years of a low-fat, salt is bad for you message, but it’s only in recent years that sugar has been given joint billing, finally becoming our dietary public enemy number one. And the ‘fat’ message is changing.
There is more and more evidence, combined with a number of re-evaluations of earlier studies that suggest fat is not the demon it was once thought to be. This ‘new wisdom’ is crossing over into our consumer buying habits and after 20 plus years of decline, sales of butter and regular milk (vs skim or low-fat) are on the rise. Meanwhile, the leading cardiovascular research scientist James di Nicolantonio has just published a book entitled ‘The Salt Fix’ where he explains how eating more salt can actually save lives.
So if salt, like fat may have been unfairly targeted, that brings us back to sugar. At least we all seem to agree there. Too much sugar is bad for us. Any opponents to that statement? I doubt it, but can junk food be just a synonym for sugary food. Surely in terms of poor nutritional value, the category must be broader than that?
One way to consider how such issues play out in the real world is to ask the question, which definition is most advantageous for Big Food? On the one hand, they do not really like any such nutrient controls, but on the other, it’s comparatively easy for them to adjust and lower the levels of that ‘deadly trio’, salt, sugar and fat. That is especially the case if it’s done in tiny increments. Then, they can spin out the story for years. Just look at Nestlé’s recent announcement that the amount of sugar in Kit Kat bars will be reduced by 10%. That will bring the amount of sugar down by 5 grams per 100g, from making up just-over half the contents of a Kit Kat bar to just-under half of the contents; a further 10% reduction in 5 years’ time would bring the sugar content down to 45%, then 5 years later to 40%... and so on.
But are such incremental steps of any use? I doubt it. Unless you subscribe to the theory that weaning mankind off the sweet stuff should be done incrementally over two to three generations? Aren’t we facing a health crisis? Isn’t this a much more urgent communications issue?
Junk food, as it is generally referred to today, is often construed as being any food that’s high in fat, sugar and salt. That’s after years of a low-fat, salt is bad for you message, but it’s only in recent years that sugar has been given joint billing, finally becoming our dietary public enemy number one. And the ‘fat’ message is changing.
There is more and more evidence, combined with a number of re-evaluations of earlier studies that suggest fat is not the demon it was once thought to be. This ‘new wisdom’ is crossing over into our consumer buying habits and after 20 plus years of decline, sales of butter and regular milk (vs skim or low-fat) are on the rise. Meanwhile, the leading cardiovascular research scientist James di Nicolantonio has just published a book entitled ‘The Salt Fix’ where he explains how eating more salt can actually save lives.
So if salt, like fat may have been unfairly targeted, that brings us back to sugar. At least we all seem to agree there. Too much sugar is bad for us. Any opponents to that statement? I doubt it, but can junk food be just a synonym for sugary food. Surely in terms of poor nutritional value, the category must be broader than that?
One way to consider how such issues play out in the real world is to ask the question, which definition is most advantageous for Big Food? On the one hand, they do not really like any such nutrient controls, but on the other, it’s comparatively easy for them to adjust and lower the levels of that ‘deadly trio’, salt, sugar and fat. That is especially the case if it’s done in tiny increments. Then, they can spin out the story for years. Just look at Nestlé’s recent announcement that the amount of sugar in Kit Kat bars will be reduced by 10%. That will bring the amount of sugar down by 5 grams per 100g, from making up just-over half the contents of a Kit Kat bar to just-under half of the contents; a further 10% reduction in 5 years’ time would bring the sugar content down to 45%, then 5 years later to 40%... and so on.
But are such incremental steps of any use? I doubt it. Unless you subscribe to the theory that weaning mankind off the sweet stuff should be done incrementally over two to three generations? Aren’t we facing a health crisis? Isn’t this a much more urgent communications issue?
All Junk Food is Highly Processed. But is all highly-processed food junk food?
Taking a big step further, I’d like to suggest that all highly processed foods and the cohort of food colourings, texturisers, emulsifiers and flavour enhancers that accompany them in packaged goods form be declared members of the ‘junk food’ family. That broad definition would of course be much more difficult for food manufacturers to swallow. It is after all, the long shelf dates, cheaper ingredients and supply chain enhancements which have driven down supplier costs and increased profit margins over the years.
Take a look at the main ingredient in Oreo cookies – No, it is not (relatively expensive) chocolate. It is refined carbs in the form of wheat flour, cornstarch and sugar, brought together with some palm and canola oil. That, to my way of thinking makes Oreo Cookies a perfect example of junk food. Right? Should Oreos carry a government health warning then? Well I certainly think so. My suggestion is that they add a label reading: “This is junk food. It is not good for you and should only be eaten in small quantities”. Food companies would then not have to reformulate their manufacturing recipes to fit new guidelines, they would just need to carry a simple junk food health warning.
This pattern of thought takes us back to the idea that junk food should simply be defined as everything found within the ultra-processed produce (UPP) NOVA food category, or at least become the major subset of all those ultra-processed foods and drinks. Yet reality gets in the way. We need to acknowledge just how far we are away from there… And there’s a lot of back-history.
Take a look at the main ingredient in Oreo cookies – No, it is not (relatively expensive) chocolate. It is refined carbs in the form of wheat flour, cornstarch and sugar, brought together with some palm and canola oil. That, to my way of thinking makes Oreo Cookies a perfect example of junk food. Right? Should Oreos carry a government health warning then? Well I certainly think so. My suggestion is that they add a label reading: “This is junk food. It is not good for you and should only be eaten in small quantities”. Food companies would then not have to reformulate their manufacturing recipes to fit new guidelines, they would just need to carry a simple junk food health warning.
This pattern of thought takes us back to the idea that junk food should simply be defined as everything found within the ultra-processed produce (UPP) NOVA food category, or at least become the major subset of all those ultra-processed foods and drinks. Yet reality gets in the way. We need to acknowledge just how far we are away from there… And there’s a lot of back-history.
McDonald’s sell junk food? Don't they?
Consider the situation of McDonald’s in Israel. The company is currently involved in a spat with the Minister of Health because he had the audacity to refer to the burgers, chicken nuggets and everything else they sell as ‘junk food’. McDonald’s rebuke to this detailed the way the company had implemented every little change in the food regulations over many years including, switching the cooking oil (ironically away from natural fats to canola oil), reducing total fat and sugar content, and playing a leading role in improving hygiene and safety standards etc. In national newspaper ads last April, they challenged the Minister, Yakov Litzman to explain why the food they sell is ‘junk’. And as far as I am aware, they are still waiting on an answer.
The Israeli Health Ministry has however cited its position paper on ‘fast food’ in which the ministry defines fast food as “food that is eaten in 7-10 minutes without fork and knife, needs little chewing, and makes the eater feel satiated only after 20 minutes, pushing the eater to consume more.” But that does not necessarily make it ‘junk food’, or does it? I mean, what about sushi? Most people would think “no-way” and yet typical take-away sushi is carb-loaded with boiled rice, salt and sugar rich sauces, and also much more calorific than most people expect. So most sushi is junk food. Right?
The Israeli Health Ministry has however cited its position paper on ‘fast food’ in which the ministry defines fast food as “food that is eaten in 7-10 minutes without fork and knife, needs little chewing, and makes the eater feel satiated only after 20 minutes, pushing the eater to consume more.” But that does not necessarily make it ‘junk food’, or does it? I mean, what about sushi? Most people would think “no-way” and yet typical take-away sushi is carb-loaded with boiled rice, salt and sugar rich sauces, and also much more calorific than most people expect. So most sushi is junk food. Right?
Back to Israel: Einav Shimron Greenbaum, a spokeswoman for the health ministry, confirmed that no country's nutritional board has ever issued a scientific definition of junk food. And therein lies the real dilemma. It is currently just too politically sensitive. Think of the enormous number of people employed in the ‘junk food’ industry; however you define it. Consider the impact of sweeping changes. This is potentially much, much bigger than what Big Tobacco faced all those years ago.
You see, I do (personally) believe that McDonald’s is a purveyor of junk food, but it’s not because of their beef patties. It’s because of the 70 plus ingredients that go to make up one single ‘ultra-processed’ Big Mac. They need about 25 ingredients just to provide long shelf life to their hamburger buns (on those rare occasions I cook bread at home, I use just 4 ingredients) and another 30 for their special sauce. Oh - and as for that bun, sugar and other refined carbohydrates make up 75% of the calorific impact.
You see, I do (personally) believe that McDonald’s is a purveyor of junk food, but it’s not because of their beef patties. It’s because of the 70 plus ingredients that go to make up one single ‘ultra-processed’ Big Mac. They need about 25 ingredients just to provide long shelf life to their hamburger buns (on those rare occasions I cook bread at home, I use just 4 ingredients) and another 30 for their special sauce. Oh - and as for that bun, sugar and other refined carbohydrates make up 75% of the calorific impact.
That UN stand against junk food
When on September 25th 2016, The Daily Mail, Fox News and others reprinted parts of the AP story which featured the headline - “A U.N. expert says junk food is a human rights concern”, without checking any further details, they may have inadvertently illuminated the biggest problem.
In keeping with the unwritten law (that being not to offend Big Food directly), Ms Elver referred to “cheap, nutrient-poor foods”, not junk-food, and at the press conference, she did not answer any specific questions on the subject. Her personal Twitter feed, @HilalElver re-tweeted some of those news stories which condemned junk food (which leads me to think that she may approve personally of condemning junk food) but she did not use the term ‘on the record’. By extending the UN definition of malnutrition to include “undernutrition, micronutrient deficiency and conditions associated with excess intake and nutritional imbalance” , Ms Elver implied that eating too much junk food leads to a form of malnutrition… but there again, she didn’t quite say that. The fact is, it’s too politically incorrect for someone involved in nutrition and food supply at a senior level to say ‘junk food’ without getting into trouble.
I can imagine Ms Elver quoting the words of Francis Urquhart from House of Cards; "You might very well think that; I couldn't possibly comment" and when questioned by me on the subject (via Twitter, although we are connected), she not surprisingly declined to answer.
OK; I have to admit that some words and phrases are just very difficult to define and ‘junk food’ is currently one of them. Even at the United Nations, certain terms fall into that ‘indefinable’ category too, ‘terrorism’ being another of them. There is no universal agreement on the definition of ‘terrorism’ with governments being reluctant to seek out a legally binding definition, presumably because the word is so emotionally potent. As is the term ‘junk food’ which together with many other nutritional words and phrases such as my personal favourite, “eat a healthy, balanced diet”, are at best, still subject to a great degree of interpretation.
I can imagine Ms Elver quoting the words of Francis Urquhart from House of Cards; "You might very well think that; I couldn't possibly comment" and when questioned by me on the subject (via Twitter, although we are connected), she not surprisingly declined to answer.
OK; I have to admit that some words and phrases are just very difficult to define and ‘junk food’ is currently one of them. Even at the United Nations, certain terms fall into that ‘indefinable’ category too, ‘terrorism’ being another of them. There is no universal agreement on the definition of ‘terrorism’ with governments being reluctant to seek out a legally binding definition, presumably because the word is so emotionally potent. As is the term ‘junk food’ which together with many other nutritional words and phrases such as my personal favourite, “eat a healthy, balanced diet”, are at best, still subject to a great degree of interpretation.
So where does this leave us
Let’s be positive and take our lead from the former professor in food technology at India’s Laxminarayan Institute of Technology in India, Pratima Shastri. She provides us with a good potential starting point. She says that: "Wholesome food pleases the palate, satisfies the hunger, supplies necessary nutrients, does not stuff the body with undesirable calories and does not cause illness." I like that.
So, it’s simple then: we could simply define Junk food as being the precise opposite of that statement, which I suppose brings me back to the very start of this article, because let’s face it; that’s unlikely to happen! And sadly, although it may be detrimental to your health, junk food, thanks to the input of many nutritional scientists, often pleases the palate too.
What is most likely to happen is that Big Food in cohorts with the established nutrition establishment will continue to push the reduced salt/sugar/fat agenda until perhaps one day, far away, they agree that what Mrs Elver refers to as ‘cheap, nutrient poor foods’ are leading to a new form of malnutrition in the developed world. Then a move to a definition encompassing a large number of ultra-processed products would be possible with all its implications.
The problem is that a large part of the nutrition industry is sponsored directly or indirectly by Big Food so that’s unlikely to happen any time soon. Just consider the concerns of Marion Nestle, Professor at the Department of Nutrition, Food Studies, and Public Health of New York University. To cite one of her examples; of the 12 members of the editorial board of the influential American Journal of Clinical Nutrition, only 3 disclose no corporate conflicts of interest. The various shenanigans of Coca-Cola’s attempts at influence have been widely reported in recent months: how they paid nutritionists and the media to push their balanced ‘drinks and physical exercise’ agenda, in which they largely dismissed obesity as being due to a lack of exercise. As do Kellogg’s, Nestle and many others. After all, why are McDonald’s and Coca-Cola still two of the biggest sponsors of next year’s FIFA World Cup and the Olympic Games?
So, it’s simple then: we could simply define Junk food as being the precise opposite of that statement, which I suppose brings me back to the very start of this article, because let’s face it; that’s unlikely to happen! And sadly, although it may be detrimental to your health, junk food, thanks to the input of many nutritional scientists, often pleases the palate too.
What is most likely to happen is that Big Food in cohorts with the established nutrition establishment will continue to push the reduced salt/sugar/fat agenda until perhaps one day, far away, they agree that what Mrs Elver refers to as ‘cheap, nutrient poor foods’ are leading to a new form of malnutrition in the developed world. Then a move to a definition encompassing a large number of ultra-processed products would be possible with all its implications.
The problem is that a large part of the nutrition industry is sponsored directly or indirectly by Big Food so that’s unlikely to happen any time soon. Just consider the concerns of Marion Nestle, Professor at the Department of Nutrition, Food Studies, and Public Health of New York University. To cite one of her examples; of the 12 members of the editorial board of the influential American Journal of Clinical Nutrition, only 3 disclose no corporate conflicts of interest. The various shenanigans of Coca-Cola’s attempts at influence have been widely reported in recent months: how they paid nutritionists and the media to push their balanced ‘drinks and physical exercise’ agenda, in which they largely dismissed obesity as being due to a lack of exercise. As do Kellogg’s, Nestle and many others. After all, why are McDonald’s and Coca-Cola still two of the biggest sponsors of next year’s FIFA World Cup and the Olympic Games?
This industry bias is sad, because the form of ‘junk food’ malnutrition that Hilal Elver refers to is progressively invading all westernised countries. This particularly nasty form of malnutrition brings with it Insulin Resistance, before often progressing into various related diseases of civilisation including type-2 diabetes, cardiovascular disease, cancer in many forms and Alzheimer’s disease – plus of course obesity on a pandemic scale.
An attempt to quantify this in the UK was published in February 2015 with the authors first attempting to quantify the degree of consumption of UPP’s and then hypothesising about the impact of a reduction. In their words:
“UPP tend to be more palatable and, crucially, affordable to people. They are highly profitable for the food industry. To promote health, the food industry would need to make and market healthier products so as to shift consumption away from ultra-processed, unhealthy foods. However, such foods are intrinsically less profitable than their processed, unhealthy counterparts. In addition, UPPs contribution to ill health goes beyond the nutrients we considered in this study…
…The contribution of UPP in the diet is set to increase. There is evidence of the progressive industrialization of the food production system increasing the proportion of processed food globally; most notably in lower and middle income countries. Reversing this trend in the UK will not be easy.”
Brazil was cited as one country where the encouragement of traditional family meals and a dietary pattern of traditional food systems act as protective agents. The Brazilian government has also supported legislation to protect and improve traditional food systems.
An attempt to quantify this in the UK was published in February 2015 with the authors first attempting to quantify the degree of consumption of UPP’s and then hypothesising about the impact of a reduction. In their words:
“UPP tend to be more palatable and, crucially, affordable to people. They are highly profitable for the food industry. To promote health, the food industry would need to make and market healthier products so as to shift consumption away from ultra-processed, unhealthy foods. However, such foods are intrinsically less profitable than their processed, unhealthy counterparts. In addition, UPPs contribution to ill health goes beyond the nutrients we considered in this study…
…The contribution of UPP in the diet is set to increase. There is evidence of the progressive industrialization of the food production system increasing the proportion of processed food globally; most notably in lower and middle income countries. Reversing this trend in the UK will not be easy.”
Brazil was cited as one country where the encouragement of traditional family meals and a dietary pattern of traditional food systems act as protective agents. The Brazilian government has also supported legislation to protect and improve traditional food systems.
Junk food should be more of a fact than a feeling
Yes we do, and let’s bring things back to the grass roots level by taking just one illustrative example from the fast-food sector. Well-meaning local councils are reluctant to allow junk food outlets to open when their location is just a few hundred metres from a school. One approach is to declare a local no-fry zone and with the focus having been firmly on low-fat in recent decades, that means they might allow a sandwich shop, but forbid McDonald’s from setting up shop. They could say that it’s OK for a patisserie selling cakes and sticky buns to open their doors but decide against a pizza chain. They might approve KFC over Burger King, arguing that they are ‘healthier’ because they only use lean white meat. They might turn down a café that sells bacon and eggs yet allow a vegetarian sandwich bar selling low-fat options when truth be told, their carb-loaded food is more likely to turn to body-fat than the bacon or eggs sold at the ‘greasy spoon’. Councils need clear guidance on what provides the right basis for such decisions? They need an agreed definition of junk food to help them, not an emotional bundle that means different things to different people.
Junk food is the result of societal needs for quick tasty food on the go, meeting industrial supply chains which worship the Gods of efficiency, cost-savings and an absurdly long shelf-life. It should not be defined in terms of what Ben Goldacre calls ‘nutritionism’ but rather by the absence of fresh, wholesome ingredients. All junk food has been to some extent ultra-processed.
Consider how often UK Members of Parliament, doctors, local councils, US Senators and other opinion leaders around the world refer to junk food as if it’s short-hand for something that’s self-evident. Surely it would help us all if we knew what they really meant? If only they knew. Junk food should be more of a fact than a feeling.
That is why – coming full circle – if we accept the basic premise of this 2017 paper
We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.
Consider how often UK Members of Parliament, doctors, local councils, US Senators and other opinion leaders around the world refer to junk food as if it’s short-hand for something that’s self-evident. Surely it would help us all if we knew what they really meant? If only they knew. Junk food should be more of a fact than a feeling.
That is why – coming full circle – if we accept the basic premise of this 2017 paper
We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.
References
Core Source: The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing: https://www.ncbi.nlm.nih.gov/pubmed/28322183
http://www.npr.org/sections/thesalt/2016/04/22/475271835/israeli-official-denounces-mcdonald-s-as-junk-food-but-chain-fights-back
http://www.timesofisrael.com/we-deserve-a-break-today-mcdonalds-tells-health-minister/
https://www.fatsecret.com/calories-nutrition/mcdonalds/hamburger-bun
http://www.foodmatters.com/article/whats-really-in-a-big-mac
http://timesofindia.indiatimes.com/city/nagpur/definition-of-junk-food-still-not-clear/articleshow/57213461.cms
https://medicalxpress.com/news/2016-10-expert-junk-food-human-rights.html
http://healthland.time.com/2014/02/25/what-food-marketing-changes-means-for-health/
Foods surprisingly high in sugar: http://www.menshealth.com/nutrition/sugar/slide/3
Junk food and the UN: http://www.dailymail.co.uk/health/article-3871928/UN-expert-Junk-food-human-rights-concern.html
On empty calories: http://www.webmd.com/diet/obesity/tc/quick-tips-avoiding-empty-calories-get-started
NHS avoiding the issue: http://www.nhs.uk/Search/?q=junk+food
No mention of junk food at the FDA: https://health.gov/dietaryguidelines/2015/guidelines/search/?query=junk+food
WebMD declaring that pizza is not junk food: http://www.webmd.com/diet/features/junk-food-facts#1
Best places to get junk food near Harvard University: https://college.harvard.edu/admissions/hear-our-students/student-blog/top-10-best-late-night-junk-food-places
World’s biggest nutrition fair: https://www.ideafit.com/fitness-conferences/idea-world-fitness-convention/expo
Marion Nestle’s concerns: http://www.foodpolitics.com/2013/11/conflicts-of-interest-in-nutrition-societies-american-society-of-nutrition/
Killing with kindness: http://www.telegraph.co.uk/news/health/news/3997462/Parents-killing-obese-children-with-kindness-says-Government.html
All photos: iStock with exception of Ms Elver’s UN photo.
NOVA definitions: http://wphna.org/wp-content/uploads/2016/01/WN-2016-7-1-3-28-38-Monteiro-Cannon-Levy-et-al-NOVA.pdf
Ultra Processed foods in UK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334511/
FAO Guidelines on the collection of information on food processing through food consumption surveys: http://www.fao.org/3/a-i4690e.pdf
Who reads more than the headlines? https://www.washingtonpost.com/news/the-fix/wp/2014/03/19/americans-read-headlines-and-not-much-else/?utm_term=.4d08a196c35b
Discussion on no-fry zones in Ireland: http://www.irishtimes.com/news/ireland/irish-news/no-fry-zone-near-schools-opposed-by-council-bosses-1.2660817
Empty calories: http://www.webmd.com/diet/obesity/tc/quick-tips-avoiding-empty-calories-get-started
http://www.npr.org/sections/thesalt/2016/04/22/475271835/israeli-official-denounces-mcdonald-s-as-junk-food-but-chain-fights-back
http://www.timesofisrael.com/we-deserve-a-break-today-mcdonalds-tells-health-minister/
https://www.fatsecret.com/calories-nutrition/mcdonalds/hamburger-bun
http://www.foodmatters.com/article/whats-really-in-a-big-mac
http://timesofindia.indiatimes.com/city/nagpur/definition-of-junk-food-still-not-clear/articleshow/57213461.cms
https://medicalxpress.com/news/2016-10-expert-junk-food-human-rights.html
http://healthland.time.com/2014/02/25/what-food-marketing-changes-means-for-health/
Foods surprisingly high in sugar: http://www.menshealth.com/nutrition/sugar/slide/3
Junk food and the UN: http://www.dailymail.co.uk/health/article-3871928/UN-expert-Junk-food-human-rights-concern.html
On empty calories: http://www.webmd.com/diet/obesity/tc/quick-tips-avoiding-empty-calories-get-started
NHS avoiding the issue: http://www.nhs.uk/Search/?q=junk+food
No mention of junk food at the FDA: https://health.gov/dietaryguidelines/2015/guidelines/search/?query=junk+food
WebMD declaring that pizza is not junk food: http://www.webmd.com/diet/features/junk-food-facts#1
Best places to get junk food near Harvard University: https://college.harvard.edu/admissions/hear-our-students/student-blog/top-10-best-late-night-junk-food-places
World’s biggest nutrition fair: https://www.ideafit.com/fitness-conferences/idea-world-fitness-convention/expo
Marion Nestle’s concerns: http://www.foodpolitics.com/2013/11/conflicts-of-interest-in-nutrition-societies-american-society-of-nutrition/
Killing with kindness: http://www.telegraph.co.uk/news/health/news/3997462/Parents-killing-obese-children-with-kindness-says-Government.html
All photos: iStock with exception of Ms Elver’s UN photo.
NOVA definitions: http://wphna.org/wp-content/uploads/2016/01/WN-2016-7-1-3-28-38-Monteiro-Cannon-Levy-et-al-NOVA.pdf
Ultra Processed foods in UK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334511/
FAO Guidelines on the collection of information on food processing through food consumption surveys: http://www.fao.org/3/a-i4690e.pdf
Who reads more than the headlines? https://www.washingtonpost.com/news/the-fix/wp/2014/03/19/americans-read-headlines-and-not-much-else/?utm_term=.4d08a196c35b
Discussion on no-fry zones in Ireland: http://www.irishtimes.com/news/ireland/irish-news/no-fry-zone-near-schools-opposed-by-council-bosses-1.2660817
Empty calories: http://www.webmd.com/diet/obesity/tc/quick-tips-avoiding-empty-calories-get-started