Household availability of ultra-processed foods and obesity in nineteen European countries

Public Health Nutr. 2018 Jan;21(1):18-26. doi: 10.1017/S1368980017001379. Epub 2017 Jul 17.


Objective: To assess household availability of NOVA food groups in nineteen European countries and to analyse the association between availability of ultra-processed foods and prevalence of obesity.

Design: Ecological, cross-sectional study.

Setting: Europe.

Subjects: Estimates of ultra-processed foods calculated from national household budget surveys conducted between 1991 and 2008. Estimates of obesity prevalence obtained from national surveys undertaken near the budget survey time.

Results: Across the nineteen countries, median average household availability amounted to 33·9 % of total purchased dietary energy for unprocessed or minimally processed foods, 20·3 % for processed culinary ingredients, 19·6 % for processed foods and 26·4 % for ultra-processed foods. The average household availability of ultra-processed foods ranged from 10·2 % in Portugal and 13·4 % in Italy to 46·2 % in Germany and 50·4 % in the UK. A significant positive association was found between national household availability of ultra-processed foods and national prevalence of obesity among adults. After adjustment for national income, prevalence of physical inactivity, prevalence of smoking, measured or self-reported prevalence of obesity, and time lag between estimates on household food availability and obesity, each percentage point increase in the household availability of ultra-processed foods resulted in an increase of 0·25 percentage points in obesity prevalence.

Conclusions: The study contributes to a growing literature showing that the consumption of ultra-processed foods is associated with an increased risk of diet-related non-communicable diseases. Its findings reinforce the need for public policies and actions that promote consumption of unprocessed or minimally processed foods and make ultra-processed foods less available and affordable.

Keywords: DAFNE; European countries; Household budget surveys; Obesity; Ultra-processed foods.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diet
  • Europe / epidemiology
  • Exercise
  • Family Characteristics
  • Fast Foods / adverse effects*
  • Female
  • Food Handling
  • Food Supply*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Nutritive Value
  • Obesity / epidemiology*
  • Obesity / etiology
  • Prevalence
  • Rural Population
  • Sedentary Behavior
  • Young Adult