Understandings of ultra-processed foods among adults with responsibility for household food activities in the United Kingdom: a qualitative study.

backgroundThere is accumulating evidence that ultra-processed foods (UPFs) are associated with many non-communicable diseases. In the United Kingdom (UK), UPFs account for more than half of mean daily energy intake. There is limited evidence describing how individuals make sense of UPFs in their daily lives. In this study, we aim to explore public perceptions of UPFs and their relationship to health; how these are shaped by different information sources; whether perceptions influence purchasing and consumption; and proposed solutions for reducing UPF consumption.

methodsWe undertook 30 qualitative, one-to-one interviews with people living in the UK, aged 18 years or older, with household responsibility for food activities recruited using social media advertisements. Interviews followed a semi-structured topic guide reflecting the aims. Data were analysed using reflexive thematic analysis. Members of a Public Involvement and Engagement group helped interpret emergent findings.

resultsReflexive thematic analysis identified five interconnected themes: (1) understanding of UPFs, (2) influences on understanding, (3) decision-making around UPFs, (4) barriers and enablers to reducing UPF consumption, and (5) proposed solutions. Food processing often made more sense to participants as a continuum rather than ordinal categories. There was particular confusion regarding the boundary between processed and ultra-processed food. Participants described an overwhelming food-related information environment. Personal and anecdotal experience was particularly powerful. While industry-sponsored information was met with scepticism, the personal testimonies of social media influencers were seen as relatable or helpful. Participants' perceptions of UPFs sometimes influenced their purchasing and consumption. However, cost, convenience, taste, and family practices were often as or more important. Suggestions to help reduce UPF consumption ranged from education to fiscal policies.

conclusionsThese findings suggest that the public may benefit from support in navigating a complex food information landscape, including clearer and more actionable communication about UPFs and related topics. Policy approaches that modify the food environment are also likely to be useful, particularly those that make less processed options more affordable, available, and convenient for people with limited time.