Researchers warn that ultraprocessed food has left a lasting imprint on older Americans, especially women, linking addictive eating to poorer physical and mental health.
Study: Ultra-processed food addiction in a nationally representative sample of older adults in the USA. Image credit: Nina Firsova/Shutterstock.com
Ultraprocessed foods (UPF) represent a significant part of the American food market and have spread widely worldwide. Often made to be hyper-rewarding, these foods contribute 60% of American adults' energy intake. A recent study in Addiction examines the prevalence of UPF addiction among older adults in the USA as well as the associated health outcomes.
Introduction
In the US, the spread of UPFs began in the 1970s, as tobacco companies diversified into developing and selling these products. UPFs are typically industrially manufactured foods high in refined carbohydrates and added fats, with limited nutritional value. They are also designed to be highly rewarding through added flavors, textures, and palatable components, which may contribute to addictive-like intake patterns.
These foods may activate brain reward pathways in ways similar to other addictive substances. The results include compulsive and uncontrolled eating, intense craving, and the inability to stop using these foods despite experiencing or knowing about the harmful effects.
These UPF consumption patterns fit the recognized criteria for a diagnosis of substance use disorder, or addiction. In previous research, the adult prevalence has been estimated at ~14%, similar to alcohol and smoking. In this study of older adults, the rate was 12%.
People who are addicted to UPFs eat unhealthy diets with a lot of UPF but very little fruit and vegetables. They also tend to be obese or overweight, with a higher risk of diet-related conditions. Previous research has also linked UPF addiction with mental health challenges, such as depression, anxiety, and traumatic stress disorders.
Today's adults between 50 and 64 grew up while UPFs entered the market and were actively promoted. Adolescence and early adult life are characterized by impulsive and emotional behavior, driven by an increased urge to experience rewards, setting up an ideal environment for addiction. Early exposure to UPFs may have played a significant part in forming the food habits of these children of the 1960s and 1970s.
The effects of lifelong eating habits often become visible in older age. Although tobacco companies have largely sold off their food industry holdings, the impact of decades of UPF marketing still lingers.
There is only one prior study on UPF addiction in older adults, based on a large sample of female nurses. This revealed a UPF-associated strong statistical association (up to 18-fold higher likelihood) of obesity in women aged 62-88 years, and higher chances of high blood cholesterol levels and of depression. No mention was made of social isolation, despite its rising prevalence among older people and its role in addiction and mental disease.
Unlike previous studies, which primarily focused on early adulthood and middle age, the current study investigated adults aged 50-80 who were children or young adults during the crucial period when UPFs were being actively introduced and took over the market. It included 2,038 adults, mostly White (about 70%), with a mean age of ~64.
The study was conducted via telephone and online surveys in July 2022. The investigators used the University of Michigan National Poll on Healthy Aging (NPHA) to assess UPF addiction in adults aged at least 50. The presence of addiction was measured using the modified Yale Food Addiction Scale 2.0.
Study findings
About 12% of the survey participants fulfilled the criteria for addiction to UPF. Women showed a 17% UPF addiction rate vs 7.5% in men. Surprisingly, 21% of women aged 50-64 years were addicted vs 12% in women aged 65-80.
Women with annual incomes below $30,000 were more likely to have UPF addiction than wealthier women, though this pattern was not seen in men. These figures are higher than those of the earlier study, probably due to a more accurate condition estimation.
Social norms ensured that most addiction behaviors were less prevalent among women, but this is changing with the current culture. In contrast to other addictions, UPF marketing not only targets both sexes equally but may even have targeted girls and young women specifically through supposed diet-friendly UPF options like low-fat cookies and microwave meals. The highly refined carbohydrate content in these foods, offered as weight-loss aids, contributed to their addictive potential. The predominance of UPFs in the food market continues to pose a threat to girls growing up today.
UPF addiction among adults aged 50-64 years is several times as prevalent as alcoholism or tobacco addiction in older adults overall (about 1.5% and 4%, respectively). All addictions were less common among adults aged 65-80 years. This may reflect the habits of the younger cohort who grew up during the UPF boom.
Conversely, the older subgroup was in their 20s and 30s. Addiction is much less likely when people are first exposed to the substance at 25 years or later. This finding suggests the need to identify critical developmental windows when UPF exposure should be avoided.
The 50-64-year cohort is the first American cohort to have lived most of their lives surrounded by a food environment that predominantly offers UPFs. This suggests the alarming possibility that future generations will be at even greater risk of UPF addiction.
The investigators examined other predictors for possible association with UPF addiction. They demonstrated a nearly 20-fold increase in UPF addiction among overweight men, and 11-fold among overweight women, similar to prior findings in the nurse study.
Men and women in poor health were two- to threefold more likely to be addicted to UPF. However, the study only measured self-rated health, and further work is required to uncover which specific medical conditions may be linked. Poor mental health increased the risk of UPF addiction three- to four-fold, with social isolation being another strong predictor. Because the study design was cross-sectional, the direction of these associations cannot yet be confirmed.
Conclusions
This is the first nationally representative study to demonstrate the widespread prevalence of UPF addiction among older Americans. UPF addiction is associated with poor mental and physical health and social isolation.
Over one in five women aged 50-64 years met addiction criteria. These individuals may have been targeted by active UPF marketing in their teens and early adulthood. Further research should examine these associations to shape future public health and food policy.
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