Guidance from Health Canada to limit highly processed foods (HPF) seeks to ensure that Canadians remain within intake recommendations for nutrients of concern. However, HPF can contribute to dietary requirements of specific populations. The Canadian Nutrition Society and Institute for the Advancement of Food and Nutritional Sciences convened speakers for a Food for Health workshop in 2021 to provide evidence and perspectives from government, industry, and healthcare on reasons for advocating limits and potential unintended consequences of limiting HPF, and implications and necessity of HPF in clinical settings. This paper discusses advantages and disadvantages of HPF explored at this workshop.


Les directives de Santé Canada invitant à limiter les aliments hautement transformés (« HPF ») visent à garantir que les Canadiennes et les Canadiens respectent les recommandations d'apport pour les nutriments préoccupants. Cependant, les HPF peuvent contribuer aux besoins alimentaires de populations spécifiques. La Société canadienne de nutrition et l'Institut pour l'avancement des sciences de l'alimentation et de la nutrition ont organisé un atelier sur l'alimentation pour la santé en 2021. Cet atelier visait à fournir des données probantes et des points de vue du gouvernement, de l'industrie et des soins de santé sur les raisons de préconiser des limites et les conséquences potentielles imprévues de la limitation des HPF. Il était aussi question de présenter les implications et la nécessité des HPF en milieu clinique. Cet article traite des avantages et des inconvénients des HPF explorés lors de cet atelier. [Traduit par la Rédaction]


Canada's dietary guidance (Health Canada 2019) is based on the most current and available evidence linking excess consumption of sodium, saturated fat, and added sugars to negative health outcomes such as obesity, type 2 diabetes, and cardiovascular disease (Mozaffarian 2016). Major contributors of these nutrients of concern are highly processed foods (HPF) (MacDonald and Reitmeier 2017). Processing of food, however, has been performed for centuries (2016) and serves important functions including preservation, ensuring food safety (e.g., pasteurization), reducing food preparation time, and promoting taste or health qualities (MacDonald and Reitmeier 2017). Although an increase in HPF consumption has prompted some to advocate limits, not all processed foods present the same concerns. Food processing is important to ensure a safe, affordable, and palatable food system and includes adding ingredients and approved food additives (Fardet 2018). Processing also helps food meet the nutritional requirements of specific populations (e.g., those in hospitals or long-term care). To explore the multiple aspects of HPF, the Canadian Nutrition Society (CNS) and Institute for the Advancement of Food and Nutritional Sciences (IAFNS) convened a panel of speakers for a one-day Food for Health workshop in 2021. This workshop examined food processing with evidence and perspectives from government, industry, and healthcare. Topics explored included the basis for processed foods, rationale for advocating limits on consumption of HPF, potential unintended consequences of limiting HPF, plant-based processed foods, and the necessity of some processed foods for clinical settings. The objective of this paper is to discuss the advantages and disadvantages of HPF explored at the 2021 Food for Health workshop.

Overview of food processing

Definitions and classifications of processed foods

Foods have been subject to various processing methods that alter it from their original state (Dwyer et al. 2012). The term “highly processed foods” refers to prepared and readily available foods and drinks that add excess sodium, sugars, or saturated fat to the diet and although not well defined, it is used by Health Canada instead of the term “ultra-processed foods” (UPF). UPF is defined and used in the NOVA classification. It is notable that the definition of HPF is not identical to the definition of UPF. The NOVA food classification system categorizes all foods into four groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and UPF (Monteiro et al. 2018). UPF are processed or prepared foods and beverages, such as sugar-sweetened beverages, baked goods, and desserts that contribute to excess sodium, sugars, saturated fat, antioxidants, stabilizers or preservatives to the diet. UPFs are food and beverage products obtained from the extraction, refinement, and transformation of raw foods with little or no whole food. They are frequently produced with additives including those that imitate or enhance the sensory qualities of culinary preparations made from foods.
In Canada's Food Guide (CFG), the number and types of ingredients are important in defining the processing level. The highest number of calories per serving is in HPF. Total and free sugars are high in both HPF and some minimally processed foods due to the natural sugars. Saturated fats can be high in processed foods and relatively lower in minimally or unprocessed foods, with the exception of certain animal-based whole foods such as beef and high-fat dairy products. Sodium is also higher in processed foods and HPF. However, minimal differences in protein levels are observed between the minimally processed, processed, and HPF groups (Vergeer et al. 2019). Overall, HPF are highest in these nutrients of concern and should not be consumed regularly.

Reasons for food processing: the nexus of COVID-19, nutrition, and food security

Food processing allows for the transformation of agricultural products into food for consumption by humans or animals. It extends the shelf-life of foods by inactivating pathogens, improving nutritional value, and increasing palatability. One aim of food processing is preservation focused on the reduction or elimination of microorganisms in food by thermal processing, chemical preservation techniques, sanitation practices, or sterilization of food packaging. Another form of food preservation relates to food quality. Some of the strategies include slowing down food deterioration by freezing with blanching or dehydration and food packaging to protect food from light and moisture. Strategies such as food fortification enhance the nutritional value of food, whereas thermal processing enhances food digestibility. Additionally, food processing may add value to products (e.g., methods that modify texture, flavour, and colour of products, and smoking/curing). Use of functional additives such as colouring or flavouring agents can also make food more appealing.
Food processing can also help fulfill the gaps in food supplies. The global food system experienced challenges in 2020 due to the COVID-19 pandemic (Jafri et al. 2021). This emphasized some of the food security issues including food shortages (e.g., dry yeast, buckwheat, garlic, nonperishable foods) (Boyaciota-Gunduz et al. 2021). Food insecurity increased due to disruption in food supply chains, loss of migrant labourers, and closure of production facilities and markets; these changes marked a shift towards shelf-stable foods.

Innovations in food processing: the plant protein challenge

The CFG recommends protein foods, including plant-based protein foods, as an important part of healthy eating. Given the broad interest in processed plant-based meat substitutes, many novel techniques are in development. For example, muscle-based proteins are “springy” while plant proteins are “rigid” and inflexible. When making plant-based proteins appear and taste like meat, appearance, flavour and texture are important (Kyriakopoulou et al. 2021). In addition, proteins should be blended to balance the different types of amino acids from both functional and nutritional standpoints. The use of dry textured plant-based proteins (e.g., peas) is common due to the number of different sizes and colours. However, many extraction methods include sodium, which is sometimes left behind in food. Therefore, while attempting to make plant-based proteins more acceptable to the Canadian population, the sodium content must be managed as well. The challenge is to balance industry's interest in supporting consumer demands around sensory, economic, environmental, and nutritional properties with public health priorities.

Perspectives from Health Canada on processed foods

The CFG has evolved over the past 80 years. It suggests that preparing foods with healthy ingredients and choosing healthier menu options (i.e., fresh or minimally processed foods) on a daily basis are ways to limit HPF consumption (Government of Canada 2019). The 2019 CFG was developed from the Evidence Review for Dietary Guidance 2015 (Health Canada 2016) and the Food, Nutrients and Health: Interim Evidence Update 2018 (Health Canada 2018a). These documents provide evidence that intakes of processed meats, sodium, added sugars, and saturated fats are strongly associated with adverse health outcomes (Health Canada 2018a). In Canada, intakes of saturated fats and added sugars in all age groups exceed recommendations (Kirkpatrick et al. 2019). Primary sources of saturated fats include cheese, red meat, butter, milk, baked products, processed meat, poultry, confectionary and frozen desserts, and margarines and oils. Primary sources of added sugars include sugar beverages, syrups, baked products, desserts, and sweetened yogurt. High sodium intakes result from consumption of bakery products, mixed dishes and processed foods (Kirkpatrick et al. 2019). According to Guideline 2, “processed or prepared foods and beverages that contribute to excess sodium, free sugars, or saturated fat undermine healthy eating and should not be consumed regularly” (Government of Canada 2019). However, Health Canada also recognizes that food processing has benefits. For example, processed foods may be healthy options if they contain little to no added sodium, saturated fat or free sugars. They are also convenient options, especially when fresh food is out of season, costly, or unavailable. Although there is convincing evidence that links excess consumption of sodium, saturated fat, and free sugars to negative health outcomes (Chen et al. 2020), Health Canada recognizes that not all processed foods are created equally and that the focus should be on reducing and limiting HPF in the general population.

From traditional dietary patterns to highly processed foods

Rationale for advocating limits on processed food consumption

Dietary patterns have shifted due to a changing food system from less processed foods (i.e., legumes, fruits, leafy vegetables, and animal-sourced foods) to foods that are high in caloric sweeteners, salt, and saturated fat (High Level Panel of Experts Steering Committee 2017). Globalization increased availability of processed foods and a convergence to a “Western” diet; for example, store-bought food constitutes the majority of the diets of First Nations (Batal et al. 2018). Most research on the intake of HPF is based on the examination of dietary patterns. Data from the 2015 Canadian Community Health Survey (CCHS) indicate that intake of UPF, according to the NOVA classification, contributed to approximately 24% and 73% of total daily energy intake in the lowest and highest UPF intake quartiles, respectively, in adults over 19 years of age (Nardocci et al. 2021). Higher consumption of UPF was associated with a 31%, 37%, and 60% higher odds of obesity, diabetes, and hypertension, respectively, adjusting for a range of covariates (Nardocci et al. 2021). Furthermore, a study of 265 Syilx Okanagan Nation adults who completed a 24-h dietary recall found that those who reported consuming traditional foods consumed less UPF and had a higher diet quality (Blanchet et al. 2020). Also, providing evidence is a randomized, controlled, crossover study that compared energy intake and body weight changes between 2-week diets high in UPF or unprocessed foods in 20 weight-stable adults (Hall et al. 2019). Results showed that ad libitum energy intake was significantly higher with the UPF diet, during which participants gained body weight compared to the unprocessed food diet, where participants lost body weight. In 2020, at least six systematic reviews and meta-analyses of current evidence concluded that diets high in HPF or UPF increase the risk of a range of diet-related health outcomes including obesity and cardiometabolic outcomes (Askari et al. 2020; Chen et al. 2020; Santos et al. 2020; Silva Meneguelli et al. 2020; Costa de Miranda et al. 2021; Pagliai et al. 2021) demonstrating the negative impact of shifting from less processed foods to diets high in HPF or UPF.

Examining the healthfulness of processed foods using a branded food database

Nutritious foods should not contribute to excess intakes of sodium, saturated fat, or free sugars. For example, there has been very little progress in reducing levels of sodium in the food supply and although the food industry has been making headway, there is more that can be done (Health Canada 2020). One useful tool is the Food Label Information Program (FLIP) database of Canadian prepackaged food and beverage package labels that provides the opportunity to explore whether the majority of packaged food products in Canada could be considered as HPF (Vergeer et al. 2019). In addition, other tools such as front-of-package (FOP) labeling are important to provide guidance to the public and consumers about the status of our food supply, particularly, nutrients of concern. FOP labeling provides a simplified summary of the healthiness of food products using symbols, logos, or designs. These systems are prevalent in the Canadian marketplace and approximately 158 unique FOP systems have been identified, and there are no specific regulations governing their use (Schermel et al. 2013). To reduce intakes of nutrients of public health concern among consumers, using only a message of “limiting intake of HPF” may be helpful, but may not be the best approach. Health Canada recently proposed to add mandatory FOP symbols that highlight products with high levels of nutrients of public health concern such as sodium, saturated fat, or added sugars (Health Canada 2018b; Government of Canada 2022). The new FOP symbols, which include nutrient-specific systems, provide information based on the presence of a food group or ingredient, to help consumers identify the healthier options (Schermel et al. 2013; Government of Canada 2022).

Unintended consequences of avoiding highly processed foods

Although there are recommendations that HPF should not be consumed regularly (Health Canada 2019), it is also important to consider the unintended consequences of avoiding them. Since there is no clear consensus on the definition of HPF, consumers may not know which foods to avoid. For example, Health Canada suggests including whole grains (e.g., quinoa, whole grain pasta, and bread) as an important component of healthy eating. However, under the NOVA classification 91% of Canadian grain-based foods meet the definition of ultra-processed (Gupta et al. 2019). Avoiding grain products may result in other health challenges such as inadequate intakes of dietary fibre and folic acid. In one study, individuals who consumed no grains had the lowest fibre intakes, whereas those who consumed whole or mixed grains had the highest fibre intakes (Hosseini et al. 2019). The goal of reducing HPF is to reduce risk of chronic disease; however, the question remains whether eliminating them entirely will improve nutrition and health or whether there will be unintended consequences. In the Physicians Health Study (Bazzano et al. 2005), those who consumed ≥ 1 serving/day of ready-to-eat cereals with whole or refined grains had significantly lower body weight than those who rarely consumed these foods. Furthermore, ready-to-eat cereals have been inversely associated with risks of obesity, cardiovascular disease, type 2 diabetes, and certain cancers (Cho et al. 2013; Xu et al. 2016). Total breads, total grains, cereals, refined grains, and white or total rice (both minimally processed foods) (Jones et al. 2020) have been found to be associated with increased risk of cardiovascular disease or all-cause mortality. Another example is sweetened yogurt, which under the NOVA classification is an UPF, but has been associated with a lower risk of several health outcomes such as obesity and type 2 diabetes (Mozaffarian et al. 2011; Mozaffarian 2016). However, although these benefits are only half of that of plain yogurt, sweetened yogurt still contributes to higher calcium intakes and has not been shown to negatively impact body weight (Mozaffarian et al. 2011). In addition, there are HPF that meet a health need such as gluten-free crackers for those with celiac disease and lactose-free milk for those lactose intolerance. Finally, while reducing HPF intake could theoretically be favourable towards preventing obesity and chronic diseases, the reality is more complex. Therefore, it is important to focus on dietary patterns rather than specific foods.
Additionally, HPF serve an important role today as food preparation must fit a consumer's time, skill, budget, and other resources. Historically, in the 1900s, women spent approximately 6 hours/day in food preparation. In the present context, the pressure of time is difficult and a return to minimally processed foods will result in greater food preparation time in the home, which is not currently available in most Canadian households. Certainly, homes with more children have also been shown to use more HPF dinner products (including fast food) than households with fewer children, potentially due to the decreased cost of some processed foods, but also less time for food preparation (Djupegot et al. 2017). There is also evidence that as a parent's cooking skills decrease, intake of processed foods increases (Martins et al. 2020). Over the past several decades, food skills have been on the decline (Government of Canada 2010). Men's cooking skills, specifically, may be limited compared with women, and men tend to consume more HPF and fast food than women (Djupegot et al. 2017). These factors may have an important impact on healthy eating and the health of Canadians. However, with current initiatives in communities and schools to address food literacy and culinary skills, there may be room for improvement (Doustmohammadian et al. 2020).

From bench to bedside: necessity of processed foods in hospitals and long-term care

HPF have application in the clinical setting. There are several challenges to food provision in both hospital and long-term care and meeting the nutritional needs of individuals in these settings. Food is not prioritized in many hospitals and patients have experienced organizational mealtime and eating environment barriers (Keller et al. 2015). In a study of 16 hospitals, the most important attributes to patients were found to be taste, freshness, if the food meets dietary needs, right temperature, sufficient amount, and easy to eat (Trinca et al. 2022). Patients who eat less than 50% of offered food in their first week in hospital are more likely to deteriorate and stay in the hospital longer due to the dislike of foods or reduced intake due to illness (Allard et al. 2015). There is also a potential disconnect between clinical care and food service, resulting in dietitians not being as involved in the planning of menus. This can result in disparities between patient needs and food offered, further negatively affecting dietary intake. Due to these challenges, there is a place for caloric and nutrient dense foods, some of which are HPF to prevent malnutrition and support recovery.
With respect to food intake, in long-term care, one-third of nutrients are inadequately consumed with high proportions of residents consuming below the Estimated Average Requirement for the nutrient (Keller et al. 2018). As malnutrition is common at 44% (Keller et al. 2020, identifying ways to improve intake is important. Although there is variety and the food may be appealing in terms of visual acceptability, many long-term care residents have reported not recognizing the food or disliking the taste (Pizzola et al. 2013). The CFG is traditionally used for menu planning in long-term care (Duizer and Keller 2020); however, there is provincial variation in nutritional quality of menus due to funding for food and food services (Vucea et al. 2017). Drivers of menu planning in long-term care include ministry standards (Duizer and Keller 2020; Lagace et al. 2020), funding, time, and labour capacity. Ready prepared foods are labour-saving, but the average sodium content may be as high as 3000–3500 mg/serving in some dishes. This creates a public health challenge wherein, nutrient and caloric dense products are needed by those with poor appetite, chewing, and swallowing problems—but these same foods may have excess sodium that impact other health conditions of residents. To limit sodium intake for the day to <3000 mg may lead to significant malnutrition in these residents. Commercially-sourced food, which would be defined as HFP, are often needed to mitigate malnutrition in clinical settings, and careful selection of products to consider sodium content is needed.
In long-term care, food is as much about quality of life as it is about nutrition. In 2020, the Dietitians of Canada, Canadian Malnutrition Task Force, Canadian Nutrition Society, and Ordre professionnel des diététistes du Québec developed a document for menu planning in long-term care including policy recommendations on commercial and prepared foods (Armstrong et al. 2020). As these foods may promote quality of life and satisfaction, their inclusion on the menu is based on resident consultation. Although select items are high in sodium, these preferred foods are commonly offered in Canadian long-term care homes. These prepared foods may also be useful in this setting to support malnourished residents, those with dysphagia, poor appetite, and dementia.
Innovative and nutrient-dense enhanced products are needed for some clinical populations and food producers are responding. For example, there are high protein milk powders, plant-based protein powders and products, protein-enhanced cereals and soups, and protein-enhanced eggs and egg products. Food in healthcare settings requires improvement in nutritional content and sensory quality and the food industry is responding with what would be considered by NOVA as UPF and by CFG as HPF.

The future of highly processed foods: where do we need to go?

Dietary recommendations must be clear, affordable and actionable, and applicable to all lifestyles and consumer segments to support public health goals. It is important to be mindful of how consumers interpret the information and guidance from the CFG and how behaviour change is promoted using food labels in terms of what consumers are selecting and eating. Although CFG recommendations are to reduce consumption of HPF and replace them with healthier options (e.g., nuts, fruits and vegetables, protein foods), providing clear directives and understandable ways to decrease consumption of added sugars, sodium, and saturated fat must be provided to consumers so that they do not appear overly restrictive. Food label literacy is an important way to support consumers in choosing processed foods with lower levels of these nutrients to limit. Furthermore, clear definitions of HPF should be considered by Health Canada as we move forward. New nutrition labeling regulations for packaged foods that require a symbol on the front of packages indicating that a food is high in saturated fat, sugars and/or sodium have recently come into effect (Government of Canada 2022). Front-of-pack symbols coupled with the Nutrition Facts Table would also help consumers choose healthier options and focusing more on dietary patterns rather than specific foods is key. Therefore, examining dietary advice with a focus on reducing HPF has merit and environmental impact from a holistic standpoint.


The Food for Health Workshop is a collaboration between the Canadian Nutrition Society (CNS) and Institute for the Advancement of Food and Nutritional Sciences (IAFNS). We thank Dr. Alfred Aziz (Health Canada), Dr. Rickey Yada (University of British Columbia), Dr. Malek Batal (Université de Montréal), Dr. Mary L'Abbé (University of Toronto), Dr. Julie Miller Jones (St. Catherine University), Dr. Heather Keller (University of Waterloo), and Dr. Shannon Hood-Niefer (Saskatchewan Food Industry Development Centre Inc.) for their perspectives and presentations at the virtual workshop, “Guidance On ‘Highly Processed Foods’: Assessing Impacts from Bench to Bedside”, on 22 April 2021.


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cover image Applied Physiology, Nutrition, and Metabolism
Applied Physiology, Nutrition, and Metabolism
Volume 47Number 10October 2022
Pages: 1038 - 1044


Received: 5 April 2022
Accepted: 27 July 2022
Accepted manuscript online: 4 August 2022
Version of record online: 23 September 2022

Data Availability Statement

This article does not report data.

Key Words

  1. highly processed foods
  2. ultra-processed foods
  3. saturated fat
  4. sodium
  5. added sugar
  6. long-term care
  7. clinical setting
  8. plant-based foods


  1. aliments hautement transformés
  2. aliments ultra-transformés
  3. gras saturés
  4. sodium
  5. sucre ajouté
  6. soins de longue durée
  7. milieu clinique
  8. aliments d'origine végétale



Département d’éducation physique, Université Laval, Québec, QC, Canada
Canadian Nutrition Society, Ottawa, ON, Canada
Wendelyn Jones
Institute for the Advancement of Food and Nutritional Sciences, Washington, DC, USA
Alison M. Duncan
Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
Guylaine Ferland
Département de nutrition, Université de Montréal, Montréal, QC, Canada
Heather Keller
Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
Andrea Grantham
Canadian Nutrition Society, Ottawa, ON, Canada
Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
Richardson Centre for Food Science and Technology, University of Manitoba, Winnipeg, MB, Canada

Author Contributions

S.P. coordinated and drafted the current manuscript. W.J. and J.D.H. chaired the workshop. H.K. presented at the workshop. All authors contributed to and reviewed the manuscript.

Competing Interests

S.P. is Program Lead at CNS. W.J. is Executive Director of IAFNS. IAFNS is a nonprofit organization that pools funding from industry and advances science through the in-kind and financial contributions from private and public sector members. A.M.D. is a member of the Board of Directors and current President of CNS. A.G. is the Executive Director of CNS. G.F. was the past President of CNS. H.K. has received research funding from Aramark, Nestlé Health Sciences and Abbott Nutrition in the past 3 years. J.D.H. sits on the Boards of Trustees for IAFNS, is on the CNS Advisory Committee, and was a past President at CNS.

Funding Information

The authors declare no specific funding for this work.

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