Are ultra-processed foods following Big Tobacco’s old strategy? What doctors should know

By MDLinxFact-checked by Davi ShermanPublished July 2, 2026

Industry Buzz

People will say: ‘I feel addicted to this’; ‘I feel out of control’; ‘I have these irresistible cravings, I can’t stop, even though I know it’s killing me.’ Real whole food did not trigger addictive responses. No one says: ‘Oh, apple slices, you can’t stop once you start.’

—Ashley Gearhardt, PhD

The ultra-processed food (UPF) debate can sound, at first, like old advice in new packaging: Eat fewer packaged snacks, drink less soda, cook more whole foods. Reasonable enough, but hardly news.

The latest issue of the American Journal of Public Health focuses on UPFs and pushes the conversation into sharper territory. ^[]^[] The question is no longer whether many UPFs are nutritionally poor. It’s whether parts of the modern food supply are engineered, marketed, and defended using strategies borrowed directly from Big Tobacco.

This moves the conversation away from a familiar, often unhelpful script—“patients should make better choices”—and toward a more systems-level view of exposure, risk, and commercial design.

Researchers and public health experts are drawing detailed parallels between tobacco and UPFs, including product formulation, child-focused marketing, “light” or “reduced-fat” positioning, and the use of consumer psychology to drive repeat purchasing. ^[]

One example receiving particular attention is Lunchables, which launched nationally after Philip Morris acquired Kraft. Experts argue that the product was designed not only around taste and convenience but also around children’s desire for autonomy, play, and independence. ^[]

That may sound less like a lunchbox problem and more like a pediatric public health problem.

The tobacco link is not just metaphorical

The comparison between cigarettes and UPFs can be overplayed if it implies that food and tobacco are identical. They are not. Food is necessary; cigarettes are not. Nutrition science also has a messier evidence base than tobacco epidemiology, partly because diet is harder to isolate, randomize, and follow over decades.

Still, the industry history is hard to ignore. Tobacco companies did not merely diversify into food as passive investors. They brought with them a set of business practices already refined in cigarettes: optimize the dose, maximize the reward, market aggressively, normalize constant availability, and defend the product category by emphasizing personal responsibility. ^[]

The clinical translation is straightforward: Many UPFs are better understood as engineered exposure environments than as isolated dietary indiscretions. A patient eating more than they intended is not always displaying a willpower deficit. They may be responding exactly as the product was designed to make them respond.

“I’m a clinical psychologist. I’ve treated people in the clinic for many years, and people will say: ‘I feel addicted to this’; ‘I feel out of control’; ‘I have these irresistible cravings, I can’t stop, even though I know it’s killing me.’ Real whole food did not trigger addictive responses. No one says: ‘Oh, apple slices, you can’t stop once you start,’” Ashley Gearhardt, PhD, professor of psychology at the University of Michigan, told Health Policy Watch. ^[]

The ‘light’ strategy

One of the more striking parallels with the tobacco industry is the “light” product strategy. In cigarettes, “light” branding helped reassure smokers who were worried about health harms. Similar tactics later appeared in food: reduced-fat, low-calorie, sugar-free, or otherwise health-coded products that preserved the broader consumption pattern.

Physicians see this constantly. A patient may replace regular soda with diet soda, full-fat cookies with reduced-fat cookies, or a snack food with a protein-enriched version that still functions as a hyperpalatable packaged dessert.

This does not mean every reduced-sugar or lower-sodium product is harmful. For some patients, substitutions can reduce risk. But the clinical question should be: Did the change improve the dietary pattern, or did it simply rebrand the same pattern?

A useful patient-facing line might be, “The front of the package is marketing. The ingredient list is the most important thing to pay attention to.”

Why this is especially relevant in primary care

Doctors are often asked to manage the downstream consequences of the food environment: obesity, metabolic syndrome, MASLD, hypertension, dyslipidemia, osteoarthritis, sleep apnea, CKD risk, and cardiovascular disease. Counseling patients to “eat healthier” may be technically correct but operationally weak.

A more useful approach is to identify the highest-yield UPF exposures in that patient’s actual day. For many, the first targets are sugar-sweetened beverages, processed meats, packaged snack foods, fast-food meals, and sweetened breakfast products. The goal does not have to be purity. It can be substitution.

For a busy parent, that may mean replacing a packaged lunch kit with a simple assembled lunch: cheese, whole-grain crackers, fruit, yogurt, nuts if age-appropriate, or leftovers. For a patient with hypertension, it may mean identifying sodium-heavy frozen meals and processed meats as the first move.

Clinicians can also reduce shame by naming the design problem. “These foods are made to be easy to overeat” lands very differently from “You need more discipline.”

Why this is especially relevant in primary care

Patients need a way to spot the foods most likely to work against their goals and a plan that fits their life. A simple way to frame it is, “We are not aiming for a perfect diet. We are looking for the foods that are doing the most damage most often.”

Start with the pattern. Ask patients what they eat or drink on a typical workday, not an ideal day. Then look for the big UPF drivers: soda or sweetened coffee drinks, packaged snacks, fast-food meals, processed meats, frozen entrées, sweetened cereals, candy, pastries, and ready-to-eat lunch kits. For many patients, one or two of these categories account for a large share of excess calories, sodium, added sugar, and refined starch.

It may help to give patients a quick label-reading rule: “If the ingredient list is long, includes several items you would not keep in a home kitchen, and the food is easy to eat quickly, treat it as an occasional food.” This is not perfect, but it is practical.

For patients with obesity, diabetes, hypertension, dyslipidemia, MASLD, or cardiovascular risk, make the advice diagnosis-specific:

For diabetes or prediabetes: “The biggest win is usually cutting liquid sugar and refined snack foods first.”
For hypertension or CKD risk: “Watch the sodium in frozen meals, deli meats, packaged soups, fast food, and savory snacks.”
For dyslipidemia or ASCVD risk: “Focus on replacing processed meats, fried fast foods, packaged pastries, and snack foods with higher-fiber, less processed options.”
For parents: “Packaged lunch kits and snack packs are marketed as convenient and kid-friendly, but they are often built around refined grains, sodium, processed meats, and sweets. A simple lunch does not have to be fancy: fruit, yogurt, leftovers, whole-grain bread, nut butter if allowed, cheese, beans, eggs, or hummus can all work.”

The tone matters. Patients should not leave feeling blamed. A useful line may be, “These foods are designed to be convenient, cheap, tasty, and hard to stop eating. So the strategy is to change the default, not rely on willpower every day.”

Offer swaps rather than bans. Replace soda with seltzer or unsweetened iced tea. Replace chips with nuts, popcorn, fruit, or yogurt. Replace processed-meat lunches with leftovers, tuna, eggs, beans, hummus, or rotisserie chicken. Replace sweetened breakfast cereal with oats, plain yogurt with fruit, or eggs and whole-grain toast.

For patients with limited time or budget, emphasize realistic options: Frozen vegetables, canned beans, eggs, plain oatmeal, peanut butter, canned fish, store-brand yogurt, microwavable brown rice, bagged salad, and rotisserie chicken can all support a lower-UPF pattern without requiring elaborate cooking.

A good closing message may be, “Pick one ultra-processed food you have most days and replace it for 2 weeks. We will build from there.”

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