Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep105: Understanding ultraprocessed foods in the American diet, with Krista Blackwell, Ph.D.
Transcript
- 0:00 Children, specifically the school aged children between ages six to 11, had the highest amount of ultra processed foods in their diet. Happy 0:18 Thanksgiving and welcome to off the chart, a business in medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the assistant editor in medical economics, and I'd like to thank you for joining us today with food being top of mind for so many. Today's episode features a conversation about Ultra processed foods medical economics. Senior editor Richard payerton sat down with Dr Krista Blackwell, a clinical assistant professor specializing in physiology and the Department of Biomedical Sciences at the USC School of Medicine Greenville, to talk about two recently published reports on ultra processed foods in the American diet, one by the CDC and the other by the American Heart Association. Dr Blackwell walks through what these reports reveal about consumption patterns, especially among children, why Ultra processed foods are so prevalent in American diets, and what physicians need to know about the cardio metabolic risk highlighted in the findings, she also shares practical ways the primary care physicians can approach nutrition counseling, including motivational interviewing and the growing role of culinary medicine. Dr Blackwell, thank you so much for joining us, and now let's get into the episode. 1:30 Thank you for joining us today. Thank you for having me today. We're going to discuss two key reports that were published in August 2025 there was a CDC survey about consumption of ultra processed foods in the American diet, and a day later, the American Heart Association published the science advisory Ultra processed foods and their association with cardio metabolic health to begin with, sort of a big picture question. As an expert in this field, when you saw those two reports, what were your first impressions of the new data? 2:03 I mean, here at School of Medicine Greenville, one of the things that we specialize in is lifestyle medicine, education within our curriculum and as the administrative lead of culinary medicine, our approach is always focused on teaching our students about whole food, plant based diets. And so seeing this, these reports related to ultra processed foods, I feel that it aligns with a lot of the nutrition education that our physicians are receiving that are also allowing them to understand how these ultra processed foods can also lead to the burden of chronic disease here in the United States, 2:43 especially regarding the CDC survey. The title of it was Ultra processed food consumption in youth and adults. United States, August 2021 to August, 2023 what was the most surprising finding in that one? 2:57 Well, I think as a country, we knew that ultra processed foods were not the best option for us. I do feel that the data from children, specifically the school age children between ages six to 11 had the highest amount of ultra processed foods in their diet, I think as a also as a mom of an eight year old, it's actually interesting to see that these numbers are some of the highest numbers in the youth. And I feel like there are multiple factors that result in that. Because our kids are school age. Children often eating school lunch. Many of the options that are available in terms of food options from fast food restaurants, and then many other variables that can come into that environment. And so I feel like it's really interesting to see that they are the highest consumers of ultra processed foods in our youth. 3:56 Okay, because one of the things that I noticed in the report for the CDC data, it was really interesting to me on timing, because there was a review for comparison sake. There was a review from 2013 and 2014 and then data from 2021 and 2023 I know that many of us would love to be able to put the covid 19 pandemic behind us, but of course, that was right in the middle of that review period. And do you think that the covid 19 pandemic had an effect on diet, nutrition and food preferences in our country? 4:28 I think with the covid 19 pandemic, as many individuals were working from home, or they had to shelter in place, being able to, you know, prepare food, became a priority in the households. So being able to it was not easy to be able to go and pick up food from a restaurant, or it was not easy to get food from many fast food sources. So I feel that with everyone being at home, it was easy. There for meals to be prepared, which could increase the the amount of fruits and vegetables that were being consumed by individuals. Now, I think, as a whole, that could be true. But if we were to also think about some of those individuals that were still out and about, that might have been essential workers, they may not have been able to come home and prepare those meals as others who may have been working from home, so their consumption of ultra processed food would be higher. So I really think it depends on the individuals and what environment they were allowed to be a part of during the covid 19 pandemic, because an essential worker's life during that period may have been very different from individuals that were able to work from home and be there with their families, who were also in school and in college, taking classes online, 5:56 and a great segue to a point that you touched on a few moments ago, especially regarding the predominance of ultra processed foods in the diets of youths. Obviously, covid 19, hopefully is less of a factor in our lives now, but there are other factors that come into play. And can you share your thoughts about why Ultra processed foods are such a big part of the diet for young people. 6:21 Interestingly, many of the ultra processed foods are marketed towards youth, and so some of the commercials for some of those less healthy Ultra processed food options are targeting those individuals, and they are, in fact, consuming more of those ultra processed foods to 6:40 get into some very specific health effects. The American Heart Association had published the science advisory Ultra processed foods and their association with cardio metabolic health evidence, gaps and opportunities. You know, kind of a sweeping scientific advisory. It really covered a lot of ground. What would you like to point out in that survey that was really telling to you or that might have been misunderstood or under reported. 7:06 One of the things that I actually found from that article, and if I can quote it, it says what we don't know is if certain ingredients or processing techniques make the food unhealthy, above and beyond their poor nutritional composition. And I this stood out to me, because the one thing that we do know is when we talk about those ultra processed foods, many times we're talking about foods that are high in saturated fat, foods that are high in sugar, and foods that are high in salt. And so we know that those factors alone, those food ingredients are are low in nutrition, can be low in nutritional value, and having those ingredients in many of the ultra processed foods are what can lead to weight gain and increase risk of cardio metabolic disease. But also adding to that, the discussion of whether or not the some of the additives that are in the foods, as well as the processing techniques, can actually make that food worse. And I think that's an area that could definitely be looked at, because that's something that we know very little about in terms of how these variables can also impact those unhealthy Ultra processed foods that are have already been identified. 8:26 You know, I think that's another great segue to something I wanted to ask about, and I'll also quote from the American Heart Association. It noted that it is estimated that 70% of grocery store products in the US contain at least one Ultra processed ingredient. Does that mean 70% of American food products are inherently bad? 8:47 I will say no, that does not mean that all the 70% of American foods are bad. We know that many foods will contain Ultra processed ingredients, but we know that again, when we're looking at those ultra processed foods, we're thinking about those foods that are specifically high in those saturated fats, high in sodium and high in sugar. And so when an individual is trying to figure out whether Ultra processed foods, which ones may be better options. They can use the nutrition labels to try to identify what percentage of saturated fat, what amount, the amount of sugar and sodium that is present in the foods that they are considering purchasing. And we give our students here in our culinary medicine course a quick way to think about sodium, we say that there should be a one to one ratio with the calories to the amount of sodium in the foods that that are being consumed. And so this is a quick piece of information that can be shared with patients or others in the community to help them make healthier food choices, even when. They're consuming Ultra processed foods. So again, looking at those ultra processed foods that are higher in saturated fat, sugar and salt, but you can have some things like whole grain bread. You can have some yogurts that are low in sugar, that are ultra processed foods, but are actually not considered bad. 10:24 You know what I was going to say you, you touched on so many good points that we can go in a couple different directions here, because I do have some follow up questions on on some of the thoughts you shared, and maybe to continue on that train of thought. And I'm really glad that you touched on the medical school element, because this is something you know, medical economics, we still try to cater to independent physicians, especially those in smaller and medium sized practices, whether it be in medical education or for a practicing physician you know, who's out in exam rooms, even right now as we speak, what advice would you give to them about the Best ways to approach diet and nutrition with their 11:02 patients. Here at School of Medicine Greenville, as we teach our students about lifestyle medicine and interact with them through our culinary medicine courses, one of the practices that our students learn is motivational interviewing, where they're focusing on helping the patient. You know, if there's a food dietary recall, helping the patient identify a place that they can make small changes in their diet that can also improve their health. And I could give you an example, if a person was to have soda with their breakfast, lunch and dinner, we know that soda is not healthy, but if that is in that person's diet. You know, we could, individuals could make recommendations of, you know, replacing the soda with a healthy average option, and then allowing that patient to continue, you know, as they see changes, you know, whether it's their hemoglobin, a 1c or other clinical values, allowing them to see how these changes have improved their quality of health, but also allow them to continue to make those small changes that will lead to a better quality of life and reducing risk of disease, or possibly better management of a chronic disease. 12:20 This may be a little far afield, but I'm hoping you may have gotten some good feedback from some of the students who have gone on to become physicians. When doctors take that approach, how do patients respond? 12:31 I think in general, with what our students have seen and observed is that motivational interviewing allows individuals to take small steps, but if you walk into a room, and I've even had this conversation myself, is if you have a conversation this might have says, Well, you need to consider a vegetarian diet, or you need to consider this diet or that diet without any solutions or suggestions, it may be harder for that individual to figure out what steps to take. So sort of meeting people where they are figuring out how to make those small changes, or things that I think have been very successful with you two are working or individuals that are trying to help their patients make change. 13:21 Hey, there. Keith Reynolds here and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow. Hack an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at K Reynolds at mjh, life sciences.com with your topic, a quick outline or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute 14:09 to continue on with another point that you had talked about. Can you explain a little bit about your approach to culinary medicine and why that's important now? Where do you think it's going to go in the future? 14:20 Well, with here at School of Medicine Greenville, what we do in our culinary medicine course is we have we focus on different diseases, or we focus on different dietary components, so we can have sessions on carbohydrates or proteins, or even talking about hypertension. And what we will do is use cases as a way to discuss these diseases or these areas that we're focused on. And then from there, we use these patient cases to look at ways to improve the dietary approach of individuals. And then we prepare meals that are intended to be. Healthier options that will allow an individual to enjoy the food that they're eating, but also reduce the consumption of ultra processed foods, you know, prepare meals that have low amounts of added sugar, in order to show them that healthier food options can actually be a very tasty food options, and we know that when we're eating, we want to enjoy our food just as much as we want it to be healthy. So culinary medicine is a very nice blend of this nutritional, Applied Nutrition that is in the kitchen, but also related to patient care. And so our students come out with the ability to share recipes with their patients. They come out with skills on motivational interviewing. They are able to learn things about food insecurity as well. So there are many different nutritional areas that we focus on in this course that are going to be relevant to patient care for our student population that is engaged in the course. 16:09 To go back to a point that you made a few minutes ago regarding the quotation from the American Heart Association report, and you know the amount of knowledge that we have about Ultra processed foods, but there's still plenty to learn in terms of future research, what would you like to see for further study about the health effects of ultra processed 16:29 foods? Well, I mean, just with that, what that quote stated is that they don't know if the processing itself actually worsens the the ultra processed the risk that is associated with Ultra processed foods. So looking at the processing, the the actual types of processing related to those foods, but then also the additives that are associated with those ultra processed foods, the additives, I think, is a much bigger discussion, because we know that there are 1000s of food additives that can be found in Ultra processed foods, and understanding more about them in terms of their influence on disease, the development of disease, whether it's cardio metabolic disease or any all any other type of health risk or mortality. I think it's important to understand as well. So looking at those two areas, I think a way to try and find out more about what is increasing this cardio metabolic risk for these ultra processed foods. 17:41 I was just really curious also about your perspectives, because one of the things that has really another issue that has exploded across medicine has been around the GLP one drugs, and regarding those drugs, there have been numerous, numerous reports about beneficial health effects from them. How do you think that's going to start to fit into future research and understanding kind of big picture scientifically about the gut brain axis, and then what do you think that's going to mean for doctors who are again out in the exam rooms working with actual patients? 18:14 I mean, I think one the gut brain axis is a very complicated conversation. I feel like one of the benefits that has come from this research and growth in this space is these GOP one drugs. And so I feel that this has definitely been a drug that has been useful for reducing reducing for diabetes management. It's also been helpful for individuals that are obese and losing weight. But I do think that you know, as with patient care at all times, it's about a personalized approach. It's about having a conversation with your physician, because many of these drugs are not they may not be as effective in certain individuals. So I do feel that that is a conversation that should always be had with the physician to figure out what is the best approach, whether it's management of obesity, type two diabetes or other health risks. And so I feel that the gut, brain access, there has been a lot of work on other other hormones related to that, but the GOP one drugs are one of the largest developments that has come from this field, 19:29 another issue that has been in the news in recent you know, recent days, recent months, really is sort of a new level of attention to ultra processed foods, especially even up to and including the White House and the Department of Health and Human Services with the initiative to make America healthy again, with this type research from the CDC and American Heart Association. Do you think that will add to the movement? 19:53 I do. I think that a lot of this work has been done. Your research. Researchers have been. Looking at the effects of ultra processed foods for many years, and I feel that bringing it to the forefront through these nationally led organizations will only continue to move the needle forward in understanding the impact of ultra processed foods in our diets. And I think that continuing to have these discussions finding ways to have a better understanding of the effects of ultra processed foods, considering you know what the nutritional guidelines may look like in terms of how we can improve the cardio metabolic health of individuals, but also reducing the amount of ultra processed foods, I think is also something that can look at in the future. But I do think it's been great for them to be able to bring these conversations to the forefront. As you know, we can now have more conversations about what that looks like, not only in you know, not only in the US itself, but even in the world of medicine. I was 21:03 going to say with regarding the nutritional guidelines, is, my understanding is that there's not necessarily a single preferred definition of ultra processed foods. And so I'm kind of wondering about, I wanted to ask about your thoughts, about, like, defining Ultra processed foods, and then how those might fit in the US nutritional guidelines, and so, 21:22 yeah, I mean, there's a lot of I feel like that's a that's an area that still has a potential for a large amount of growth, because we typically talk about what the nutritional guidelines are, what you can what you should consume daily, but does that necessarily relate to the things that are readily available that would allow people to have sort of that optimal health and optimal well being from a nutritional standpoint. And I think that's sort of, you know, it's, it's a it's an area that is like has a large depth of discussion, because the nutritional guidelines are definitely impacted by the ultra processed foods. But how, how can we include that in the actual guidelines themselves? And I feel like that's sort of the I'm not really sure how to put them together, because I feel like they are somewhat separate, but they they definitely have an impact on each other, if I 22:23 may, like I said, this is a question we like to ask in every interview as well. Our main audience is primary care physicians, and they are a busy bunch of folks. I don't have to, I don't have to necessarily tell anybody, anybody anything new that's not breaking ground to make that statement here. But what I want to the point I want to make, though, is that because of the importance of primary care, but also the shortage of primary care and doctors and doctors overall, germane to our audience, I guess, if they want to learn more, what's the best way 22:54 so culinary medicine In itself, it is a so individuals can become certified in that space. So there is a culinary medicine certification that exists for physicians. I can say that we've also had the pleasure of having some physicians in specialties that are very heavily food related, that are working to become certified here, or have become certified here at School of Medicine Greenville, because that conversation about diet, ultra processed foods, you know, and overall health and well being is necessary in primary care, I feel that, you know, there are opportunities for individuals who may be more interested in that to integrate that into their their practice. So I do feel that there is a way for those to intersect. I feel like we're still very new in that space, but there are many physicians that are working to integrate that culinary medicine piece into their actual patient practice and into patient care 24:01 given the scope and scale of these two reports, the CDC survey and the American Heart Association, what did I not ask about that you would like our audience to know? 24:12 I mean, I think you know, as I was thinking about this topic and looking at the articles, something that I thought was interesting is looking at what is being done worldwide. I feel like they're Australia and the European Union. They've looked at labeling, classifying foods, and they actually give a health score, or a healthy, healthy food scores, and many of those food items, so in their labeling, they may have a merit score that indicates the quality of those foods, and so it uses many different variables. But if we could integrate something like that with foods that are ultra processed, that would be a great way of individuals knowing that if they are consuming Ultra processed foods, if it has a higher. Score that indicates that it's a healthier food option, then they could choose those relative to some of those things that you know may be at zero or one, if that food is unhealthy and it is a very poor, ultra processed food option. So I feel that things like that can make it easier. Because, you know, just in looking at food science and Ultra and food processing, there's just so much information out there and for individuals to be able to think about, you know, how to make better choices utilizing some type of system, you know, in that way, could also be helpful in making those healthier food choices on a day to day basis. 25:47 I'm Richard payer and reporting for medical economics. My guest today has been Dr Krista Blackwell at School of Medicine Greenville at the University of South Carolina. It's been a great conversation, and thank you so much for 25:59 joining us. Thank you so much for having me once again. That was 26:12 the conversation between medical economics senior editor Richard payer chin and Dr crystal Blackwell, a clinical assistant professor specializing in physiology at the Department of Biomedical Sciences at the USC School of Medicine Greenville. My name is Austin Luttrell, and on behalf of the whole medical economics and physicians practice team, I'd like to thank you for listening to the show, and again, I'd like to wish you a happy Thanksgiving. As always, don't forget to subscribe so you don't miss the next episode. Be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you like the best stories that medical economics and physicians practice published delivered straight to your email six days of the week, subscribe to our newsletters at medical economics.com and physicians practice.com off the chart, a business of medicine. Podcast is executive produced by Chris mazzolini and Keith Reynolds and Keith Reynolds and produced by Austin Latrell. Medical economics and physicians practice are both members of the mjh the life sciences family. Thank you. You.