Alimentos Ultraprocesados Articulo

G.
Pérez
Ultra-processed foods
as a topic of study
in global bioethics
Los alimentos ultraprocesados

como un tema de estudio
de la bioética global
Gustavo Pérez Berlanga*5

Grupo Restaurantero Gigante,
Mexico City, Mexico
https://doi.org/10.36105/mye.2023v34n4.02
Let your food be your medicine and your medicine be your food.
Hippocrates (1)
Abstract
This article proposes to consider food in general and ultra-processed

foods and sugar-sweetened beverages in particular, as an issue that
concerns global bioethics. The first section explains the relationship
between the consumption of ultra-processed foods and health, the sec-
ond section relates the so-called non-communicable diseases and
* Director of Social Responsibility at Grupo Restaurantero Gigante. Writer, lecturer,

and professor in sustainability at several universities and business schools. Mexico
City, Mexico. E-mail: [email protected]
https://orcid.org/0009-0004-6542-8080
Reception: 10/05/2023 Acceptance: 22/06/2023
968 Medicina y Ética - October-December 2023 - Vol. 34 - No. 4

Ultra-processed foods as a topic of study in global bioethics
mental health with food, and the third section argues the role that bio-
ethics, especially global bioethics, should play around food.
Keywords: food and health, non-communicable diseases, bioethics.
1. Introduction
Food plays a fundamental role in people’s health, and there is evidence

of the damage caused in people by the consumption of ultra-pro-
cessed foods (2), which is manifested in the so-called non-commu-
nicable diseases such as overweight, obesity, diabetes, hypertension,
some respiratory diseases and even cancer (3). In addition, some
authors also relate mental health problems, such as depression and
anxiety, to the consumption of ultra-processed foods (4).
On the other hand, bioethics is the systematic study of the mor-
al dimensions, including moral visions, decisions, behaviors and pol-
icies of life sciences and health care, in an interdisciplinary context
(5), and global bioethics transcends national and cultural boundaries,
addressing ethical challenges related to health and science that im-
pact the world.
In recent years, globalization has modified economic, cultural,
and social aspects that make bioethics global in scope (4), which has
also influenced the way humanity feeds itself.
The food we eat has an impact on our health, both physical
and mental, and it is essential to have a diet that provides the nu-
trients necessary for our development. The World Health Orga-
nization (who) states that “nutrition is a critical part of health...
an adequate diet reduces the risks of acquiring non-communicable
diseases, such as diabetes or cardiovascular disease” (6). Therefore,
ultra-processed foods and sugary drinks should be part of the glob-
al bioethics’ agenda, while recognizing that there are other factors
that also influence health, such as physical activity, rest or a healthy
lifestyle.
Medicina y Ética - October-December 2023 - Vol. 34 - No. 4 969

G. Pérez
Faced with this scenario, it is essential to become aware as a so-

ciety and act as a company, government and consumer to reverse the
unfavorable future that awaits us if we fail to act.
Food must be placed as a central theme of global bioethics, to
initiate reflection and then action in favor of human health.
2. Ultra-processed foods and sugar-sweetened

beverages and their relationship to health
There is evidence of the damage to health caused by the consump-

tion of ultra-processed foods and sugar-sweetened beverages, prod-
ucts that have flooded the consumer in the prevailing market econo-
mies around the world.
According to Monteiro, an ultra-processed food is a food that
“contains formulations of various ingredients that, in addition to salt,
sugar and fats, include food substances not used in culinary prepara-
tions, in particular, flavorings, colorings, sweeteners, emulsifiers and
other additives used to mimic the sensory qualities of unprocessed or
minimally processed foods and their culinary preparations, or to mask
undesirable qualities of the final product” (7). Some examples of
these foods are sweetened cereals, carbonated beverages, processed
fruit juices, instant soups, margarines or fried foods (8).
According to the who (9), ultra-processed products contain a
careful combination of sugar, salt, fat and additives, concluding that
they cause obesity, diabetes, cardiovascular diseases and some types
of cancer. The consumption of these products has displaced tradi-
tional diets based on healthier foods.
The relationship between sugar, salt, fats and additives on peo-
ple’s health is mentioned below. We begin with sugar.
2.1. Sugar and health

The who (10) also details that the consumption of sugars raises
the overall caloric density, without constituting an adequate sum of

the necessary calories from a nutritional perspective. In addition,

constant movements in the levels of sugars ingested cause abrupt
changes in body weight and body mechanisms.
Among other notes and research, it has been found that free
sugars provide energy devoid of specific nutrients, so it is recom-
mended that the more vulnerable the daily diet is, the more care
should be taken with the intake of free sugars, recommending that
the intake of free sugars should constitute less than 10% of the total
caloric intake, so that any other circumstances and alterations in the
diet do not significantly impact the health status of the person (11).
According to the National Confectioners Association (nca),
41% of Americans consume at least one confectionery per day; in
the Mexican case, it has been reported that 90% of confectionery
products are oriented to children. These already high figures are
increasing in other countries. In Colombia, it is estimated that 75%
and 80% of the population consumes sweets and soft drinks every
day (12).
Thus, it can be outlined that sugar is necessary in low quantities
for specific functions of the organism. However, its use in food pro-
cessing has increased its consumption among the population, mak-
ing it a factor of high impact and attention, since it is also related to
various diseases, such as obesity.
2.2. Fat and health
Fats are useful in some functions of the organism. However, the

current diet of the population also includes trans-fatty acids (TFA),
which come from hydrogenated foods and do not supply any of the
body’s functions (13), making them fats that affect people’s health,
regardless of age, gender or socioeconomic level.
In addition to constituting an energy reserve for the body and its
functioning, they are responsible for transporting fat-soluble vita-
mins so that they can be correctly used. However, their high and
diverse presence in many foods and preparations makes them a risky

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element for health. For example, high consumption of saturated fatty

acids (SFA) is associated with increased cardiovascular risk (14). In
turn, TFA are related to elevated LDL cholesterol and decreased
HDL cholesterol. In addition to these data, the who estimates that
excess consumption of TFA causes more than half a million deaths
annually around the world, as it generates coronary heart disease (15).
In an article written by the Director General of the who, Tedros
Adhanom Ghebreyesus, he states that: “food should not be a cause
of disease, but a source of health. The time has come to throw trans
fats into the dustbin of history” (16). He also states that, in 2018,
who called for “the complete elimination of industrially produced
trans fats from the global food supply by the end of 2023” (16).
2.3. Salt and health
Common salt is an important substance for the proper functioning

of the body in normal doses. It has the function of providing the
body with sodium, which is responsible for fluid retention in cells
and blood, as well as for the regulation of blood pH. It also contrib-
utes to the correct functioning of transmissions between neurons,
allowing the activity of the central nervous system that sustains the
entire human organism (17).
In contemporary industrialized societies, a large part of the diet
is nourished by processed products, which frequently contain added
salt or other sodium-based substances, which has led to an excessive
consumption of this ingredient in modern populations (18). Ac-
cording to the Pan American Health Organization (paho), most of
the world’s population consumes 9 to 12 grams of salt per day, which
is more than twice the recommended amount (19).
Several medical studies have demonstrated and reaffirmed the
relationship between excessive salt consumption and the propensity
to develop various diseases, mainly arterial hypertension, which can
lead, among other consequences, to cardiovascular or cerebrovascu-
lar events (17).

2.4. Additives and health
Food additives are substances that are added to foods to improve

their taste, appearance, texture, preservation, or safety. Additives can
be of natural or synthetic origin and are used in a wide variety of
processed foods, including canned goods, frozen foods, baked
goods, dairy products, meats, beverages, snacks, and more.
The most common food additives are:
1. Preservatives (they seek to prolong the shelf life of foods).

2. Colorants (used to improve the color of food).
3. Sweeteners (sweeten foods without adding calories).
4. Flavor enhancers (intensify or improve the flavor of foods).
5. Emulsifiers (used to mix ingredients that would not normally
mix, such as water and oil).
6. Antioxidants (which prevent oxidation of foods while main-
taining their freshness and quality).
It is important to note that food additives are subject to regulations

and safety controls by health authorities in most countries to ensure
that they are safe for human consumption and do not pose a health
risk. However, some people may be sensitive or allergic to certain
additives, so it is advisable to read food labels and consult a health
professional if you have concerns about their consumption.
The who mentions that “food additives are substances that
are added to foods to maintain or improve their safety, freshness,
taste, texture or appearance. It is necessary to check that these
substances cannot cause adverse effects on human health before
using them” (20).
Facing the adverse effects of the consumption of food additives
on health, little notice has been taken of ultra-processed foods and
sugar-sweetened beverages. According to Grimm (21), several physi-
cians have come to suspect that these chemical products added to
food are the cause of aortic valve calcification. Moreover, additives

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are present in most ultra-processed foods and sugary beverages. Be-

cause they appear harmless and are used legally, consumers are not
aware of their harmful effects. In this regard Grimm argues that:
Colorants go so far as to cause learning disorders. Migraines and
hyperactivity can be triggered by certain additives. As far as cancer is
concerned, sweeteners are often under suspicion. Preservatives can
damage the intestine and disrupt the immune system (21).
Some possible harms caused by the consumption of additives are

the following: increased intake of phenolic antioxidants is correlated
with increased frequency of allergic diseases (22); synthetic dyes
have been associated with mild hypersensitivity reactions to chronic
urticaria, angioedema, asthma and atopic dermatitis. They can also
cause weight gain, as in the case of curcumin, which inhibits the re-
lease of leptin, a slimming hormone that serves to curb appetite, and
which, in low concentrations, causes obesity; some preservatives,
such as sulfites and benzoates, have been associated with allergic
reactions. Regarding sulfites, hypersensitivity has been found in asth-
matic patients. On the other hand, hypersensitivity reactions to ben-
zoates have been reported, such as orofacial granulomatosis, chronic
urticaria and bronchial asthma. In addition, it is argued that sodium
benzoate promotes diabetes, hyperactivity and growth disorders; it is
also attributed with the ability to damage cells, to the extent of caus-
ing neurodegenerative diseases such as Parkinson’s disease (21).
Flavorings are used to add or intensify the flavor or aroma of
products. Monosodium glutamate has been associated with several
clinical pathologies: neck numbness, headache, nausea, vomiting, di-
aphoresis, palpitations, flushing.
Emulsifiers are used to form or maintain a uniform emulsion of
a product. Their use has been related to cases of occupational asth-
ma, contact dermatitis, exacerbation of atopic dermatitis and chron-
ic urticaria (21).
According to Trasande (23), at least in the United States, more
than ten thousand chemicals have been allowed to be used in foods

designated as “generally safe” (GRAS) due to failures within the

food safety system, which has led to substantial gaps in the data on
the potential health effects of food additives. In addition, there are
studies that suggest that colorings, flavorings, added chemicals, as
well as those substances in the materials that come into contact with
food, can contribute to illness in the population, with children being
particularly susceptible to their effects. The above reinforces the
point that food additives added to food imply a health risk for con-
sumers.
As we have seen in this section, some of the substances con-
tained in ultra-processed foods, such as added sugars, salt, fats and
additives, are closely related to human health. In the following, we
will briefly review how food contributes to the so-called non-com-
municable diseases, as well as mental health.
3. Non-communicable diseases associated with diet
Eating disorders are associated with a variety of noncommunicable

diseases (NCDs) that significantly affect the quality of life of people
and represent a health problem of social character, attended as such
by health institutions. Among the diseases associated with eating dis-
orders are overweight, obesity, type 2 diabetes mellitus, various car-
diovascular and respiratory diseases, and cancer. Therefore, these
NCDs are the subject of study in this section, where they are ana-
lyzed in greater depth.
3.1. Overweight and obesity
Overweight and obesity have been defined by the who as: “an ab-
normal or excessive accumulation of fat that can be harmful to
health” (24). This excessive accumulation is due to an imbalance be-
tween a person’s energy intake and expenditure, since by consuming
more fat than a person can process and convert it into energy, it

G. Pérez
begins to accumulate in the body. These types of conditions are

closely linked to the type of diet of the people who suffer from
them, placing individuals at the center of the problem rather than
those factors that surround them, such as the “correlation between
the increase in chronic diseases and globalization [...]”(25).
In 2016, more than 1.9 billion adults aged 18 years and older
were overweight, of whom more than 650 million were obese. And
since 1975, obesity has nearly tripled worldwide. In 2016, 39% of
adults aged 18 or older were overweight, and 13% were obese (26).
According to the World Obesity Atlas (woa) (26), global levels of
overweight and obesity in 2023 are estimated to affect about 4 billion
people, up from 2.6 billion in 2020.
Both overweight and obesity are associated with a variety of co-
morbidities that significantly affect the quality of life of the person,
also reducing their life expectancy by exposing them to various com-
plications that can even lead to death. Amelia Martí (27) conducted
a systematic review to evaluate the possible association between the
consumption of ultra-processed foods and the development of obe-
sity. They selected a total of 12 papers that they separated according
to the classification system by type of processing (called NOVA), as
the first group, and other systems, as the second group. Under the
criteria of the first group, the papers concluded with the existence
of a relationship between the consumption of Ultraprocessed Foods
and industrially produced sugar-sweetened beverages (UPAs) and
weight gain in the seven studies that were conducted between 2015
and 2019 in 19 European countries, in addition to the United States
and Brazil. Regarding the second group, there were five studies, three
of which found a direct relationship between consumption of UPAs
and two that found no conclusive evidence of association.
Among the physical-motor comorbidities, resulting from the ex-
tra effort made by the skeletal-muscular system generated by the
additional weight, osteoarthrosis, hypoventilation and sleep apnea
stand out. Some studies also point to overweight and obesity as the
cause of cardiomyopathies and a higher incidence of varicose veins
and abdominal hernias (28).

Finally, the psychosocial consequences stand out, since obesity

and overweight confront the person with self-rejection, discrimina-
tion (particularly in the adolescent population with overweight and
obesity) and aversion based on a cultural structure that elevates the
slim figure as an aesthetic ideal.
3.2. Type II diabetes
Diabetes mellitus is a group of metabolic diseases with different

etiologies, whose basic characteristic is the presence of chronic hy-
perglycemia. Type 2 diabetes (DM2) accounts for more than 90% of
all cases, and genetic and environmental factors are involved in its
pathogenesis. Two of the risk factors are obesity and poor diet, a
diet rich in sugar, dairy products and meat, and low in fruits and
vegetables (29).
It can be inferred that foods high in fatty acids and diets with
non-recommended amounts of carbohydrates may increase the risk
of obesity and thus the development of insulin resistance. For this
reason, people with type 2 diabetes can prevent or treat the disease
with a healthy diet and regular physical activity.
This is supported by the research conducted by María Alcántara
(30) in which she carried out a systematic review of 53 studies on the
relationship between high fructose intake and the metabolic dysreg-
ulation it caused. Among their findings, they found that one of the
conditions caused by fructose, linked to prediabetes and type 2 dia-
betes mellitus, is insulin resistance and the basic alterations induced
by its consumption are increased oxidative stress and protein glyco-
sylation. On the other hand, they found that fructose promotes in-
flammation and reduces intestinal permeability, which affects the
liver and the digestive system. The authors concluded that the evi-
dence suggests that consuming this substance on a regular basis cre-
ates dependence and, therefore, compromises health.
As can be seen in this section, the development of type 2 di-
abetes is linked to the consumption of ultra-processed foods and

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sugar-sweetened beverages, products that, because they contain el-

ements such as fructose, create dependence and contribute to the
development of NCDs.
3.3. Cardiovascular diseases
According to the woa (31), cardiovascular diseases (CVD) are the

leading cause of death in the world and, among its factors, is inade-
quate nutrition and it is known that its growth was favored by the
modernization of agriculture, food processing and formulations in
the last century (32). In general, it can be said that energy-dense di-
ets, with high intakes of added sugar, salt and fat, are a determining
factor in the increase of NCDs, specifically CVD (33).
To demonstrate the degree to which diet is affected in relation to
CVD, the example of the consumption of sugar-sweetened soft
drinks is given. It is known that its consumption increases the risk of
adiposity and has been associated with a higher incidence of hyper-
tension and coronary heart disease. These determinants are those
that associate the risk of CVD with the consumption of this type of
beverage due to increased adiposity and the accumulation of viscer-
al fat or the production of uric acid (34).
In addition to those mentioned above, several studies have shown
the correlation between CVD and a diet based on ultra-processed
foods, excessive in additives, sugars and trans fats.
3.4. Respiratory diseases
Asthma, a respiratory disease, is associated with various exogenous

factors such as exposure to tobacco smoke, environmental pollution
and diet. Regarding the latter, it has been shown to have protective
effects on the risk of recurrent wheezing and asthma. On the other
hand, asthma is a non-communicable disease of greater impact in
adolescence. Despite this, there are few studies on UPA consump-
tion and its connection with respiratory diseases in childhood (35).

According to a study conducted by the Spanish Association of

Pediatrics (AEP), the most frequent diseases in the pediatric age
group are respiratory diseases, with asthma being the most prevalent
chronic disease in childhood in developed countries. In a cross-sec-
tional study carried out by the AEP, within the Child Follow-up for
Optimal Development project, on 513 Spanish children, the con-
sumption of UPAs was calculated, classifying foods according to the
NOVA system, which classifies foods by their degree of process-
ing, to estimate daily consumption and the percentage of kilocalo-
ries from UPAs. The study concluded that a higher consumption of
UPAs had an impact on the probability of wheezing respiratory dis-
eases in the pediatric age, recurrent bronchitis/wheezing and asthma,
which allowed determining that there is a direct association between
UPA consumption and wheezing diseases in childhood (36).
Grimm (25) conducted a research on food additives used in the
manufacture of ultra-processed foods and their relationship with re-
spiratory disorders. According to his research, tartrazine, a colorant
used in the production of mustard, pudding and pastry products,
can cause respiratory difficulties or asthma-like episodes in sensitive
asthmatics. Carmine, another colorant used in the manufacture of
jams, candies and alcoholic beverages, can in rare cases cause allergic
reactions such as asthma-like episodes in sensitive individuals.
Azorubin, used to color fruit ice cream, as well as candies and fruits,
is also associated with asthma episodes. Amaranth, used in certain
alcoholic beverages; cochineal red A, added to certain deli foods,
such as chorizo; glossy black BN, artificially manufactured from pe-
troleum derivatives and used to blacken candy; all of these additives
are linked to breathing difficulties or asthma-like episodes. Accord-
ing to Grimm, carotene, a colorant considered healthy and used in
the manufacture of creams, desserts and ice cream, is supported by
several studies that its daily intake could increase the risk of lung
cancer and heart attacks in smokers and people with cardiovascular
conditions. Sulfur dioxide and sulfites can trigger induced asthma in
hypersensitive people, adding to bronchial narrowing and airway in-
flammation.

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3.5. Cancer
Cancer is a term that the who refers to as: “a group of diseases that
can originate in almost any organ or tissue of the body when abnor-
mal cells grow in an uncontrolled manner, exceeding their usual lim-
its and invading adjacent parts of the body or spreading to other
organs” (37). Among the risk factors, diet and sedentary lifestyle are
among those responsible for its development (38).
The industrial development of food can also be considered as
another determinant factor of cancer due to the treatments they re-
ceive to be consumed. In this regard, Emilia Mora comments:
The way food is preserved, the additives, the type of packaging used
for preservation and storage, as well as the methods used and the
amount ingested, have also been related to an increased risk of can-
cer (39).
Some authors have attempted to explain how body fat increases the
risk of cancer. First, excess fat causes insulin resistance, causing the
pancreas to increase. These factors are what stimulate cell growth
that favors the proliferation of cancer cells. On the other hand, in
relation to adipose tissue, with a higher body mass index there is a
higher concentration of estrogen and testosterone levels, which is
associated with an increased risk of tumors (39).
Regarding fats, the so-called bad fats include saturated fats and
trans fats from industrial processes. Although the role of fats in can-
cer risk does not yet allow firm conclusions to be drawn, some results
have suggested that the consumption of total fats could increase the
risk of lung cancer; foods rich in saturated fatty acids could increase
the risk of pancreatic cancer; and animal fats could develop tumors
of the colon and rectum (39).
On the other hand, who experts classified processed meat as
carcinogenic for humans, based on evidence that showed that its
consumption caused colorectal cancer, and concluded that for each

50g portion of processed meat consumed daily, the risk of develop-

ing this cancer increases by 18% (40).
Fiolet (41) conducted a population-based cohort study to evalu-
ate prospective associations between consumption of ultra-pro-
cessed foods and cancer risk. During his study, 2,228 incident cases
of cancer, including breast, prostate, and colorectal cancers, were
diagnosed and validated. According to their analysis, the intake of
these products was associated with an increased risk of general can-
cer and breast cancer. Specifically, ultra-processed fats and sauces,
sugary products, and beverages were associated with an increased
risk of overall cancer; in addition, ultra-processed sugary products
were associated with breast cancer risk. The authors concluded that
their study was the first to investigate and highlight an increased
overall cancer risk associated with the intake of ultra-processed
foods and highlighted the need for further studies to better under-
stand the effects related to nutritional composition, food additives,
contact materials, and related contaminants.
From the data discussed in this section, it can be inferred that
there is a strong positive correlation between cancer development
and diet, specifically in the consumption of processed foods.
3.6. Mental health
The WHO defines mental health as “a state of well-being in which

a person is aware of his or her own capacities, can cope with the
normal stresses of life, can work productively and fruitfully, and is
able to make a contribution to his or her community” (42). This
definition coincides fundamentally with that given by the American
Psychological Association (APA) (43). The definition of the Spanish
Association of Neuropsychiatry (AEN) is: “mental health is the bal-
ance between the individual and his environment that allows him to
adapt and develop in his life according to his potential, satisfying his
emotional, cognitive and relational needs.” (44). As can be seen, both
definitions refer to a person’s capacity to develop individually and

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socially and to achieve well-being. The who considers that one in

eight people in the world suffers from some type of mental disorder,
with anxiety and depression being the most frequent (45).
Some authors mention the relationship between NCDs and
mental health, where people with emotional alterations may devel-
op some NCDs (overweight, obesity, type 2 diabetes, cardiovascular
diseases, respiratory diseases and even some types of cancer) (46).
Conversely, people with NCDs may develop mental disorders due
to stress, anxiety or chronic pain associated with the disease. Some
authors even affirm that mental health should be part of NCDs, as
well as the role played by the consumption of ultra-processed foods
and sugar-sweetened beverages in some behaviors of people that
can be considered emotionally affected, such as anxiety or depres-
sion (46).
The who has published some reports on the relationship be-
tween mental health and chronic diseases, including diabetes, cardio-
vascular diseases and cancer (47).
On the other hand, the United States Center for Disease Control
and Prevention (CDC) states that the state of mental health influ-
ences how we think, feel and act and that aspects of depression are
associated with physical problems, such as diabetes and heart disease
and, similarly, the presence of NCDs can lead to a deterioration of
mental health. The CDC mentions that more than 50% of Ameri-
cans will have some mental disorder in their lifetime, one of the
causes being some brain chemical imbalance (48).
There are several studies that reaffirm the relationship between
the consumption of ultra-processed foods and mental health, such
as the following: 1. A study of 1,046 women between 20 and 93
years of age, randomly selected in Australia (49); 2. Another study
showed that the study group substantially improved their symptoms
of depression when they changed their diet to a Mediterranean style
(50); 3. Some studies conducted on consumers of UPA show brain
damage in areas related to spatial memory, learning and memories
(51); and 4. Jacques (52) conducted an analysis of more than 300

research studies on the relationship between sugar consumption and

some emotional aspects, such as anxiety and depression, and con-
cluded that there is “overwhelming evidence” of some brain chang-
es that led to pathological behaviors resulting from the consumption
of sugars in excess of the recommendations of the competent au-
thorities.
Lopresti (53) affirms that depression should be considered a
non-communicable disease and that diet, sleep and physical activity
influence the prevalence levels of some mental health alterations in
people. This author proposes that mental health should be part of
the spectrum of so-called non-communicable diseases.
This reaffirms the argument that ultra-processed foods and sug-
ar-sweetened beverages not only contribute to the so-called non-com-
municable diseases, but also to the affectation of people’s mental
health.
Table 1 lists some of the risks to human health of overconsump-
tion of some ingredients present in industrially processed foods:

Table 1. Process food consumption risks
Recommended daily Risks associated

Risks associated
Product consumption according with noncommunicable
with mental illness
to the who diseases
Sugar Not to exceed 10% of total Obesity, type 2 diabetes, heart Depression and other mood
caloric intake and suggests a disease, increased triglyceride disorders (42,46)
reduction to less than 5% for levels, stroke and fatty liver
additional health benefits (54) (29,30,55,56,57,58,59)
Salt Less than 5 grams of salt per Arterial hypertension, cardio- High salt intake can contrib-
day (60) vascular disease, renal disease,
ute to the development of
osteoporosis, gastric cancer physical diseases that, in turn,
and fluid retention can have a negative impact on
(33,61,62,63,64) mental health. For example,
high blood pressure, which
can be caused by excessive salt
consumption, has been linked
to an increased risk of
depression, anxiety, and
dementia (45) (46)
Saturated fats Less than 10% of total daily Cardiovascular disease, type 2 Studies suggest that a diet
above who calories. (65) diabetes, obesity and certain high in saturated fats and low
recommenda- types of cancer (colon) in healthy fats may negatively
tions (33,36,66,67,68,69) affect mental health through
its effects on the nervous and
cardiovascular systems (46)
Trans fats Not to exceed 1% of daily Cardiovascular disease, type 2 A diet high in trans-fat can
above who energy intake (70) diabetes, cancer, increased have a negative impact on
recommen- LDL (“bad”) cholesterol, overall health, which may
dation breast cancer contribute to mental health
(36,71,72,73,74,75) problems. For example,
obesity and type 2 diabetes,
which can be caused by a diet
high in trans-fat, have been
linked to an increased risk of
depression and other mental
disorders (46)
Food additives None Some food additives, such as Some studies have suggested
monosodium glutamate, have that certain food additives,
been linked to headaches, such as artificial colors, may
nausea, sweating, palpitations be associated with the
and other symptoms in some development of hyperactivity
people. Other additives, such symptoms in children and
as artificial colors, have been adolescents. A 2007 study
linked to an increased risk of found an association between
hyperactivity and attention consumption of artificial
deficit disorder in children. In food dyes and increased
addition, some additives, such hyperactivity symptoms in
as preservatives, can be toxic children aged three and a half
if consumed in large to nine years. Another 2012
amounts. In addition, some study suggested that food
additives have been linked to additives, including dyes,
specific diseases. For example, preservatives, and sweeteners,
it has been suggested may be associated with
that excessive consumption an increased risk of mood
of nitrites and nitrates, which and behavioral disorders in
are used as preservatives in children and adolescents
processed meats, may increase (78,79)
the risk of colorectal cancer.
It has also been suggested
that excessive consumption
of benzoic acid, which is used
as a preservative in some
foods and beverages, may
increase the risk of asthma
and other respiratory prob-
lems (21,39,41,76,77,78)
Source: prepared by the author.
4. The role of bioethics in the field of nutrition
The definition of bioethics contained in the first volume of the En-

cyclopedia of Bioethics published in 1978 is: “the systematic study
of human behavior in the area of life sciences and health care, ex-
amined in the light of human principles and values” (80). In the sec-
ond volume published in 1995, the modified definition is as follows:
“Bioethics is a compound term derived from the Greek words bios
(life) and ethike (ethics) and is defined as the systematic study of
the moral dimensions, including moral views, decisions, behaviors,
and policies of the life sciences and health care, employing a vari-
ety of ethical methodologies in an interdisciplinary context” (81).
The following is an analysis of the most updated definition from
a bioethical perspective applied to ultra-processed foods and their
relationship with people’s health:
1. Systematic study: understood as a rigorous approach to re-

search or analysis that follows a structured process seeking
valid results. It includes an exhaustive and critical review of
the existing literature about the relationship between ul-
tra-processed foods and their negative contribution to peo-
ple’s health.
2. Moral dimensions: refer to the different social, ethical, or
moral aspects that may be present in a situation, a problem,
an action or a decision, morality being those principles, val-
ues, norms and beliefs that guide human behavior and ethical
choices in decision making, highlighting the following:
a) The individual dimension: these are the beliefs, values
and ethical principles that guide a person’s behavior in his
or her decision making and actions. It involves internal
reflection and consideration of what is right or wrong in
moral terms, in this case in relation to food and its effects
on the individual.

G. Pérez
b) The social dimension: these are the ethical norms, values

and beliefs that govern interactions and relationships be-
tween individuals and groups in a society. It involves con-
siderations on how individual actions may affect others
and how they should behave in the context of the com-
munity, in this case, how society influences the eating be-
haviors of its members.
c) The cultural dimension: has to do with the norms, values
and ethical beliefs that are shared by a particular commu-
nity or society and that influence the behavior and deci-
sion making of its members, in this case, feeding through
ultra-processed foods.
d) The professional dimension: refers to the ethical stan-
dards and codes of conduct that guide the practice of a
specific profession or field, in this case, food science as
applied to ultra-processed products and sugar-sweetened
beverages. Professionals have specific ethical responsibil-
ities in their practice and must consider the moral impli-
cations of their decisions and actions and,
e) The global dimension points to the ethical implications
of actions and decisions in a global context, consider-
ing how they affect people, communities and the envi-
ronment worldwide. It involves considerations of social
justice, global responsibility, sustainability and equity in a
global context.
3. Life sciences: Food sciences fit into this section by virtue of
being a multidisciplinary discipline that studies the scientific,
technological and safety aspects related to the production,
processing, preservation, quality, safety and nutritional value
of food.
4. Health care: which refers to the maintenance, improvement
or restoration of people’s health. It can address a wide range
of health needs, including disease prevention (through ade-
quate nutrition), promotion of healthy lifestyles (eliminating

the consumption of ultra-processed foods and sugar-sweet-

ened beverages), management of chronic diseases (under-
standing the main causes of such diseases, being inadequate
nutrition one of the main ones) and mental health (where
there is evidence of the affectation that the consumption of
ultra-processed foods and sugar-sweetened beverages cause
in people’s mental health), among others.
5. Ethical methodologies: these are approaches used to address
ethical issues and dilemmas in different contexts and situ-
ations, providing a structured and reflective framework to
address ethical problems and make informed and justified
decisions. For the case referred to in this article, they apply
ethical analysis (which analyzes the ethical aspects in the ac-
tors involved in the ultra-processed food industry covering
governments, companies, consumers and the community),
principled ethics (which is the foundation of my doctoral
thesis called “The application of the principles of global bio-
ethics in the commercial determinants of health within the
ultra-processed food and sugar-sweetened beverages sector
contributing to non-communicable diseases” and encom-
passes the principles of justice, responsibility, prevention,
solidarity, precaution, autonomy, informed consent through
conscious consumption and freedom, all of which pertain to
global bioethics).
6. Interdisciplinary context: since the issue of ultra-processed
food is a complex problem that addresses different fields of
knowledge or disciplines that seek collaboration among all
of them to reach the best possible solution. These disciplines
include business activities (production processes covering
raw materials, processing, marketing, distribution, sale, con-
sumption and post-consumption), legal regulations and their
effective application, social norms accepted in the commu-
nity, all health-related disciplines such as medicine, biotech-
nology, food science, nutrition, etc., specialized community

G. Pérez
ranging from civil society organizations to national and inter-

national agencies.
a) The above has a worldwide scope, hence it is the subject
of study of global bioethics. Ultra processed foods are
present in those countries based on a market economy,
the capitalist model being the predominant one at present
in practically the whole world. Global bioethics refers to
the ethics of life and health with a worldwide scope, tran-
scending national and cultural boundaries, addressing
ethical challenges related to health and science. Henk ten
Have (4), describes the criteria necessary to consider a
problem to be in the sphere of global bioethics:
b) Global scale: ultra-processed foods are wreaking havoc
on the health of populations worldwide,
c) Interconnectivity: consumers of such products are affect-
ed at the individual level by situations created at the mac-
ro level,
d) Persistence: this issue is of indefinite validity, i.e., it has no
defined temporality since it persists over time,
e) Interdisciplinarity: this problem involves billions of peo-
ple around the world belonging to a wide range of disci-
plines that need to work in a coordinated manner, and
f) Global action is needed: here it is framed that this prob-
lem needs the major world bodies, such as the United
Nations (un) and its agencies, to align interests among all
actors with a focus on global health.
5. Conclusion
This article reviewed the topics related to food and health: food sci-
ence and noncommunicable diseases associated with food intake.
After analysis, the following conclusions were reached:

1. Excessive consumption of sugar present in ultra-processed

foods and sugar-sweetened beverages is related to obesity
and other NCDs. In addition, the problem seems to affect
mostly children exposed to aggressive advertising of this type
of products.
2. Also, excessive fat consumption increases the risk of obesity,
overweight, cardiovascular problems and cancer.
3. The consumption of salt also present in these products is
intrinsically related to heart disease and hypertension risks,
among other ailments. This is in consideration of the fact
that there are warnings issued by national and international
health institutions on the effects of consuming these prod-
ucts, which do not seem to have any effect on consumers.
4. In addition, excessive consumption of additives is related to
respiratory diseases and carcinogenic agents, among others.
5. Mental disorders: depression and anxiety are aspects of hu-
man behavior that have been related, among other causes, to
ultra-processed foods.
Therefore, the consumption of ultra-processed foods and sug-

ary beverages is closely linked to the development of non-commu-
nicable diseases (overweight and obesity, type II diabetes, cardiovas-
cular diseases, respiratory diseases and cancer), as well as mental
disorders. Since there is sufficient scientific information, it is possi-
ble to affirm that non-communicable diseases are promoted by the
consumption of these products, so it can also be affirmed that the food
industry in charge of manufacturing them contributes to the promo-
tion of these diseases.
Addressing these problems requires deep bioethical reflection
and the adoption of policies and actions that promote a healthier and
more sustainable diet for the world’s population. To achieve this goal,
a comprehensive and holistic vision involving various stakeholders,
such as governments, companies, consumers and the specialized
community, is needed. It is essential to consider an interdisciplinary

G. Pérez
perspective that encompasses anthropological, legal, philosophical,

health and economic aspects.
Within this context, ultra-processed foods and sugar-sweetened
beverages are a crucial issue for global bioethics due to their impacts
on health and social justice. On the one hand, unbiased studies have
demonstrated the relationship between the consumption of these
products and non-communicable diseases, which underlines the im-
portance of addressing this problem from an ethical perspective.
On the other hand, health inequality is also a relevant aspect, as
these foods are often cheaper and more accessible, encouraging their
consumption in communities with fewer economic resources. In ad-
dition, the food industry often involves business practices that are
questionable from a global bioethical perspective, such as legislative
lobbying to protect its economic interests or marketing that pro-
motes the consumption of unhealthy products.
Global bioethics can play a catalytic role in promoting greater
responsibility in the food industry, without detracting from the au-
tonomy and responsibility of the individual in his or her consump-
tion choices.
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Los alimentos ultraprocesados

Gustavo Pérez Berlanga*5

This article proposes to consider food in general and ultra-processed

* Director of Social Responsibility at Grupo Restaurantero Gigante. Writer, lecturer,

968 Medicina y Ética - October-December 2023 - Vol. 34 - No. 4

Keywords: food and health, non-communicable diseases, bioethics.

Food plays a fundamental role in people’s health, and there is evidence

Medicina y Ética - October-December 2023 - Vol. 34 - No. 4 969

Faced with this scenario, it is essential to become aware as a so-

2. Ultra-processed foods and sugar-sweetened

There is evidence of the damage to health caused by the consump-

2.1. Sugar and health

970 Medicina y Ética - October-December 2023 - Vol. 34 - No. 4

the necessary calories from a nutritional perspective. In addition,

2.2. Fat and health

Fats are useful in some functions of the organism. However, the

Medicina y Ética - October-December 2023 - Vol. 34 - No. 4 971

element for health. For example, high consumption of saturated fatty

2.3. Salt and health

Common salt is an important substance for the proper functioning

972 Medicina y Ética - October-December 2023 - Vol. 34 - No. 4

2.4. Additives and health

Food additives are substances that are added to foods to improve

1. Preservatives (they seek to prolong the shelf life of foods).

It is important to note that food additives are subject to regulations

Medicina y Ética - October-December 2023 - Vol. 34 - No. 4 973

are present in most ultra-processed foods and sugary beverages. Be-

Some possible harms caused by the consumption of additives are

974 Medicina y Ética - October-December 2023 - Vol. 34 - No. 4

designated as “generally safe” (GRAS) due to failures within the

3. Non-communicable diseases associated with diet

Eating disorders are associated with a variety of noncommunicable

3.1. Overweight and obesity

Medicina y Ética - October-December 2023 - Vol. 34 - No. 4 975

begins to accumulate in the body. These types of conditions are

976 Medicina y Ética - October-December 2023 - Vol. 34 - No. 4

Finally, the psychosocial consequences stand out, since obesity

3.2. Type II diabetes

Diabetes mellitus is a group of metabolic diseases with different

Medicina y Ética - October-December 2023 - Vol. 34 - No. 4 977

sugar-sweetened beverages, products that, because they contain el-

3.3. Cardiovascular diseases

According to the woa (31), cardiovascular diseases (CVD) are the

3.4. Respiratory diseases

Asthma, a respiratory disease, is associated with various exogenous

978 Medicina y Ética - October-December 2023 - Vol. 34 - No. 4

According to a study conducted by the Spanish Association of

Medicina y Ética - October-December 2023 - Vol. 34 - No. 4 979

980 Medicina y Ética - October-December 2023 - Vol. 34 - No. 4

50g portion of processed meat consumed daily, the risk of develop-

3.6. Mental health

The WHO defines mental health as “a state of well-being in which

Medicina y Ética - October-December 2023 - Vol. 34 - No. 4 981

socially and to achieve well-being. The who considers that one in

982 Medicina y Ética - October-December 2023 - Vol. 34 - No. 4

research studies on the relationship between sugar consumption and

Medicina y Ética - October-December 2023 - Vol. 34 - No. 4 983

Recommended daily Risks associated