Image Source: Pexels
Non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), diabetes, cancers, and chronic respiratory conditions, account for nearly three-quarters of global mortality and pose a significant threat to health systems and economic development. Among the key modifiable risk factors, unhealthy diets have emerged as a central driver, with growing evidence implicating ultra-processed foods (UPFs) as a major contributor to the rising NCD burden.
UPFs are industrial formulations typically made using refined food substances, additives, and preservatives, with minimal or no whole-food content. These products are generally high in saturated fats, free sugars, and sodium, while being low in dietary fibre, protein, and essential micronutrients. The global rise in UPF consumption is closely linked to the nutrition transition, a shift from traditional, minimally processed diets toward energy-dense, convenience-oriented foods. This transition is driven by urbanisation, income growth, globalisation of food systems, aggressive marketing, and changing lifestyles. In low- and middle-income countries (LMICs) — including India — this transition has occurred rapidly, often without parallel regulatory safeguards, exacerbating the double burden of malnutrition, where undernutrition coexists with diet-related NCDs.
Among the key modifiable risk factors, unhealthy diets have emerged as a central driver, with growing evidence implicating ultra-processed foods (UPFs) as a major contributor to the rising NCD burden.
India provides a compelling case study of the health consequences of dietary transition. According to the Global Burden of Disease (GBD), dietary risks are among the leading contributors to NCD-related mortality in the country, particularly CVDs and diabetes. Cardiovascular diseases alone accounted for over a quarter of total deaths in India in 2016, while premature deaths from NCDs doubled between 1990 and 2019. National surveys further demonstrate a sharp rise in overweight and obesity across both urban and rural populations. Between 2005–06 and 2019–20, adult overweight and obesity increased by more than 10 percentage points, with worrying trends also observed among children and adolescents. Early onset of obesity substantially increases the lifetime risk of diabetes and CVDs. Dietary pattern analyses in India consistently show that diets high in sweets, salty snacks, and refined carbohydrates are associated with a higher risk of type-2 diabetes and cardiometabolic disorders. These dietary shifts closely mirror increased availability, affordability, and marketing of UPFs.
Market analyses indicate that UPFs are growing faster than staple or minimally processed foods, driven by convenience, long shelf life, and aggressive promotion. Globally, multinational food corporations are increasingly targeting emerging markets, capitalising on weak regulatory environments and rising consumer demand. Multiple studies have demonstrated that exposure to unhealthy food advertising, particularly through digital and social media, significantly influences preferences, purchase intentions, and consumption patterns, especially among children and adolescents. Early-life exposure to UPFs is associated with a higher risk of obesity and metabolic disease later in life.
Early-life exposure to UPFs is associated with a higher risk of obesity and metabolic disease later in life.
A robust body of epidemiological evidence links high UPF consumption with adverse health outcomes. Prospective cohort studies across Europe and America have also shown that higher intake of UPFs is associated with increased risk of cardiovascular disease, coronary heart disease, and cerebrovascular events. Similar associations have been observed for all-cause mortality. An inpatient randomised controlled trial demonstrated that participants consuming ultra-processed diets consumed significantly more calories and gained more weight than those consuming minimally processed diets, even when meals were matched for macronutrients, sugar, salt, and fibre. This suggests that factors beyond nutrient composition, such as food texture, palatability, eating rate, and food matrix, also play a role in driving excess energy intake. Systematic reviews further confirm associations between UPF consumption and obesity, metabolic syndrome, type-2 diabetes, and hypertension. Emerging evidence also links UPFs to multimorbidity, underscoring their role in cumulative NCD risk over the life course.
Despite strong evidence, policy responses to UPFs remain inadequate in many countries. Fragmented regulatory frameworks, voluntary rather than mandatory measures, and a lack of fiscal disincentives have limited progress in reducing the consumption of unhealthy foods. Research indicates that clear front-of-pack warning labels, restrictions on marketing to children, and fiscal policies such as taxes on sugar-sweetened beverages can effectively reduce purchases of UPFs and improve dietary choices. Experiences from countries such as Chile demonstrate that comprehensive regulatory approaches, including mandatory warning labels and advertising restrictions, can shift consumer behaviour and incentivise product reformulation. Countries like Canada amended their existing food legislation, and the United Kingdom (UK) revised its communications legislation to implement a comprehensive package of restrictions.
Addressing the UPF-NCD nexus requires a comprehensive food-systems response that combines stringent regulation, fiscal measures, consumer education, effective use of advertising and marketing, and industry accountability.
Ultra-processed foods have emerged as a central driver of the global NCD epidemic, with converging evidence from epidemiology, clinical trials, and food systems research linking their dominance in modern diets to rising rates of obesity, diabetes, cardiovascular disease, and premature mortality. Addressing the UPF-NCD nexus requires a comprehensive food-systems response that combines stringent regulation, fiscal measures, consumer education, effective use of advertising and marketing, and industry accountability. Ensuring the procurement of healthy foods and beverages within processed-food guidelines by the government is necessary to establish a uniform procurement process across diverse institutions, including hospitals, schools, government offices, and universities. Reducing reliance on ultra-processed foods and promoting minimally processed, nutrient-rich diets is not only a public health imperative but also essential for achieving sustainable development and long-term population health.
Shoba Suri is a Senior Fellow with the Observer Research Foundation’s Health Initiative.
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.