New evidence on ultra-processed foods is hard to ignore. In February 2024, The BMJ published one of the most ambitious summaries ever assembled on food processing and health: an umbrella review led by researchers at Deakin University’s Food & Mood Centre in Australia, pooling the results of 45 meta-analyses covering nearly 10 million people. It found direct associations between ultra-processed foods and 32 different health parameters, from cardiovascular death and type 2 diabetes to anxiety, depression and poor sleep. The findings do not prove that every packaged snack is dangerous, but they are the strongest signal yet that ultra-processed foods deserve a hard look in the typical weekly diet.
What exactly counts as an ultra-processed food?
The review used the NOVA system, the framework researchers use to group foods by their degree of industrial processing rather than by their nutritional content. At the base sit unprocessed or minimally processed foods: fruit, vegetables, eggs, rice, beans, fresh meat and milk. Next come processed culinary ingredients such as olive oil, butter, sugar and salt, and then processed foods such as freshly baked bread, cheese and canned vegetables. The fourth group is ultra-processed foods: industrial formulations made mostly from substances extracted from foods or synthesised in factories.
Soft drinks, packaged snacks, sweetened breakfast cereals, instant noodles, mass-produced packaged bread and reconstituted meat products typically belong here. The easiest way to recognise them is not by their packaging claims — words like “natural” and “source of fibre” appear frequently on ultra-processed products — but by an ingredient list full of items rarely found in a home kitchen: emulsifiers, artificial flavourings, colourings, protein hydrolysates and hydrogenated oils.
What the BMJ review found about ultra-processed foods
The review assessed the credibility of 45 unique pooled analyses — 13 dose-response associations and 32 other associations — drawn from studies totalling 9,888,373 participants. Direct associations emerged between ultra-processed food exposure and 32, or 71%, of the health parameters examined, spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal and metabolic health outcomes.
The strongest, “convincing” (class I) evidence pointed to four outcomes: a 50% higher risk of dying from cardiovascular disease (risk ratio 1.50, 95% confidence interval 1.37 to 1.63), a 12% higher risk of type 2 diabetes per increment of exposure (dose-response risk ratio 1.12, 1.11 to 1.13), 48% higher odds of anxiety outcomes (odds ratio 1.48, 1.37 to 1.59), and 53% higher odds of combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63). A second tier of “highly suggestive” (class II) evidence linked greater exposure to a 21% higher risk of death from any cause (risk ratio 1.21, 1.15 to 1.27), a 66% higher hazard of heart-disease-related death (hazard ratio 1.66, 1.51 to 1.84), a 22% higher hazard of depressive outcomes, 55% higher odds of obesity, and 41% higher odds of adverse sleep-related outcomes.
A 10-year global cohort with Gulf participation
The BMJ umbrella review is not the only large-scale evidence in this field. The Prospective Urban and Rural Epidemiology (PURE) study, published in the American Journal of Clinical Nutrition in 2023, is one of the biggest cohort studies on the topic ever conducted. PURE followed 138,076 adults aged 35 to 70 with no history of cardiovascular disease, living on five continents — including Saudi Arabia, where the King Fahad Cardiac Center at King Saud University in Riyadh, and Hatta Hospital in Dubai, contributed to the collaboration.
Over a median follow-up of 10.2 years, 9,227 participants died and 7,934 suffered major cardiovascular events. Eating two or more servings of ultra-processed foods a day, compared with none, was associated with a 28% higher risk of total death (hazard ratio 1.28, 95% confidence interval 1.15 to 1.42), a 17% higher risk of cardiovascular death, and a 32% higher risk of death from non-cardiovascular causes. Notably, the association with major cardiovascular events themselves did not reach statistical significance — an important nuance often lost in sensational headlines.
Why this matters in Saudi Arabia and the Gulf
Ultra-processed foods and ready-to-eat meals have become an entrenched part of daily eating across the Gulf, where long working hours, hot climates and rapid urbanisation push many people towards delivery apps and packaged products. Saudi-specific research is starting to catch up with the question: a 2025 study from King Abdulaziz University in Jeddah, published in Frontiers in Nutrition, examined 190 Saudi adults aged 18 to 25 and classified their diets using the same NOVA system.
Higher ultra-processed food intake was associated with higher body mass index and waist circumference, with odds of overweight more than nearly tripled (odds ratio 2.966, 95% CI 1.86 to 4.21) and odds of abdominal obesity more than 2.5 times higher (odds ratio 2.610, 95% CI 1.46 to 3.97). The sample was small and limited to one university community, so the figures should be read cautiously — but the direction of the association matches the wider literature, and the review authors argue the evidence supports population-level measures to reduce dietary exposure to ultra-processed foods.
What the evidence cannot prove — yet
For all the striking numbers, an honest reading of the research needs several caveats. First, every study included in the review was observational: it can reveal associations, but it cannot prove that ultra-processed foods cause any specific disease. People who eat more ultra-processed foods also tend to differ in other ways — income, sleep, smoking, physical activity — and although the underlying studies adjusted for known confounders, residual confounding can never be fully excluded. Second, the authors’ own GRADE quality assessments were sobering: of the 45 pooled analyses, 22 were rated low quality and 19 very low, with only four reaching moderate quality. Most of the dramatic risk ratios therefore rest on evidence the authors themselves grade as limited. Third, 13 of the 45 associations were graded as having no supporting evidence at all. The researchers call for urgent mechanistic research and properly designed trials — a reminder that this field is still maturing.
How to cut back without overhauling your diet
If the science still carries uncertainty, the practical response does not have to be complicated. Read ingredient lists: a short list of ingredients you would recognise from your own kitchen usually signals a less processed product, while long lists featuring emulsifiers, flavourings, colourings and protein isolates are the hallmark of ultra-processing. Swap rather than eliminate: dates and nuts instead of packaged biscuits, plain yoghurt with fruit instead of a sweet dessert, freshly grilled chicken instead of processed meat.
Keep in mind that not all processing is harmful: canned beans, frozen vegetables and plain yoghurt are convenient, affordable and minimally processed. Soft drinks deserve special attention, because liquid calories are one of the most common ultra-processed habits in the region. And traditional Saudi and Gulf cuisine — rice, grilled meats, lentil soups, salads and dates — is built mostly on whole ingredients, a genuine advantage worth keeping at the centre of the week. For more practical guides, see related articles, or browse more reads.
Key takeaways
- A BMJ umbrella review of 45 meta-analyses covering nearly 10 million people found direct associations between ultra-processed foods and 32 health parameters.
- The strongest evidence linked them to cardiovascular death, type 2 diabetes, anxiety and combined common mental disorders.
- In the PURE cohort of 138,076 adults across five continents, two or more servings a day was associated with a 28% higher risk of death over roughly 10 years.
- A Saudi study in young adults linked higher ultra-processed food intake to sharply higher odds of overweight and abdominal obesity.
- Most of the evidence is observational and graded low quality, so associations are not proof of causation.
- Practical steps: read ingredient lists, swap packaged snacks for whole foods, and keep traditional home-cooked meals at the centre of the week.
Sources
- Lane MM et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses — The BMJ, 2024
- Dehghan M et al. Ultra-processed foods and mortality: analysis from the Prospective Urban and Rural Epidemiology (PURE) study — American Journal of Clinical Nutrition, 2023
- Alomari WD, Almoraie NM. Ultra-processed food intake and its association with obesity risk factors in Saudi adults — Frontiers in Nutrition, 2025
The information in this article is for educational purposes only and does not substitute professional medical advice. Consult a physician or a registered dietitian before making significant changes to your diet.
