Sensory Integration Education

Ultra-processed foods (UPFs) have received a lot of attention in the media recently, accompanied by a growing body of research that shows that UPF is harmful to health. This has led to an interest in reducing the amount of UPF in our families' diets, but how do we manage these changes for family members who are selective eaters and have strict preferences on food types and brands? This article looks at how to introduce new foods to selective eaters, sensitively and taking into account practical considerations.

What Are Ultra-Processed Foods?

So what are ultra-processed foods? The official definition is long but can be summarised as foods made with ingredients that are industrially processed to be cheap to manufacture, convenient to eat and hyperpalatable (encouraging excess consumption). Ultra-processed foods will contain ingredients not typically found in a domestic kitchen, often include a long list of ingredients and may have a lot of salt and sugar added to make them more appealing. 

Why Is There Concern About UPFs?

Ultra-processed food significantly raises the risk of high blood pressure, heart disease, heart attacks and strokes, according to two recent large studies, says Dr Chris van Tulleken, an infectious diseases doctor at the Hospital for Tropical Diseases in London and Associate Professor at University College London. He also cites research showing that high consumption of UPF is linked to obesity, cancer, type 2 diabetes, depression, dementia and tooth decay. According to epidemiologist Prof Tim Spector*, UPFs are not only harmful to our health but also provide less nourishment. UPF food dominates many people's diets: this study found that ultra-processed foods account for 57% of total energy intake in the UK diet. 

How Can I Identify Ultra-Processed Foods?

One of the team who classified and researched the impact of UPF, Carlos Monteiro, a professor of nutrition and public health at the University of São Paulo, notes that a practical way to identify if a product is UPF is to see if its ingredients include "either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents)." In his book, Ultra-Processed People*, Chris van Tulleken notes that health claims on packaging, such as "high in fibre", "source of protein" or "sugar-free", can be another warning that the product might be UPF. 

UPF and "Picky Eaters"

It is estimated that the prevalence of selective eating is between 15 and 35% of the population. The same study notes that selective eating is characterised by an unwillingness to eat familiar foods or to try new foods, as well as strong food preferences. The consequences may include poor dietary variety during early childhood.

If you want to manage the proportion of UPF in your diet, but you or a family member are a selective eater (in previous years, perhaps referred to as a "picky eater" or a "fussy eater"), introducing alternative foods can be distressing. One of the aspects of ultra-processed foods is the consistency in taste, texture, smell and appearance, and it's this consistency which many selective eaters value as it feels safe and familiar. Think of breakfast cereals, processed meats, frozen pizzas and chicken nuggets, supermarket bread, shop-bought biscuits, bars and cakes - these will all be reassuringly the same every time they are consumed as opposed to less-processed foods. This preference for consistency may mean that for many selective eaters their diet contains a very high proportion of UPFs.

Gentle Ways to Introduce New Foods

Whilst there are legitimate concerns about high UPF consumption, no one wants to raise the anxiety of selective eaters and their parents. It is important to be kind to ourselves and also realistic. For all individuals, it is important to aim for as much balance, variety and fresh food as we can within our means and for selective eaters, this balance might look different.

According to Healthline, it is important to consider an individual's nutritional preferences when addressing eating in selective eaters. For example, if individuals prefer beige foods, an idea is to introduce nutrient-rich beige foods like skinless apples, white whole-wheat bread, and cauliflower rice. Many selective eaters also dislike the texture of mushy food, so look out for dry, crispy alternatives as an alternative to UPF snacks. Have a look at this article; it contains lots of helpful suggestions.

Laura Osman is a Highly Specialist Speech and Language Therapist, Advanced Sensory Integration Therapist, Feeding Therapist and Teacher. Louisa Hargett is a Highly Specialist Occupational Therapist, Advanced Sensory Integration Therapist, Feeding Therapist and Teacher. Both Laura and Louisa have presented training courses for Sensory Integration Education feeding and eating difficulties. Here, they suggest the following tips to increase the intake of healthier options alongside familiar UPFs: 

• Start with offering very small amounts of a wide range of foods at each snack/meal. 
• Deconstruct meals. 
• Present a familiar food alongside the same food presented in different ways.
• Cook foods for varying temperatures. 
• Know what types of food they can manage from a skill or sensory perspective and always offer it alongside a variety of foods.
• Allow a child to break up the food on their plate and empower them to make changes to their own food; don't do it for them. 

It is important to remember that this takes time, and whilst we should take notice of the health risks of UPFs, accepting healthier options is a gradual process. The old maxim, everything in moderation, comes to mind.

If you are a parent or carer, you might like to explore SIE's service Sensory Help Now for information and support on sensory processing difficulties. It includes the short online course 6 Sensory Strategies to Introduce a New Food.

You might also be interested in this article 3 Things Impacting Eating Skills, Apart From Food Preferences.

References:

‌Chatpol Samuthpongtorn, Nguyen, L. H., Okereke, O. I., Wang, D. D., Song, M., Chan, A. T., & Mehta, R. S. (2023). Consumption of Ultraprocessed Food and Risk of Depression. JAMA Network Open, 6(9), e2334770–e2334770. https://doi.org/10.1001/jamanetworkopen.2023.34770

Creating Healthy Meals for Picky Eaters: Kids and Adults. (2022, April 19). Healthline. https://www.healthline.com/nutrition/healthy-meals-for-picky-eaters#bottom-line

‌LDN, K. D. M., MS, RD. (2020, January 9). What are ultra-processed foods and are they bad for our health? Harvard Health Blog. https://www.health.harvard.edu/blog/what-are-ultra-processed-foods-and-are-they-bad-for-our-health-2020010918605

Monteiro, C. A. (2019). Ultra-processed foods: what they are and how to identify them. Public Health Nutrition, 22(5), 936–941. https://doi.org/10.1017/S1368980018003762

Monteiro, C., Cannon, G., Lawrence, M., Laura Da Costa Louzada, M., & Machado, P. (2019). Ultra-processed foods, diet quality, and health using the NOVA classification system Prepared by. https://www.fao.org/3/ca5644en/ca5644en.pdf

‌Rauber, F., Louzada, M. L. da C., Martinez Steele, E., Rezende, L. F. M. de, Millett, C., Monteiro, C. A., & Levy, R. B. (2019). Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study. BMJ Open, 9(10), e027546. https://doi.org/10.1136/bmjopen-2018-027546

‌Samuthpongtorn (2023) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809727

Spector, T. (2024). Food for Life. Jonathan Cape.

‌Taylor, C. M., Wernimont, S. M., Northstone, K., & Emmett, P. M. (2015). Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite, 95, 349–359. https://doi.org/10.1016/j.appet.2015.07.026

‌Touvier, M., Louzada, M. L. da C., Mozaffarian, D., Baker, P., Juul, F., & Srour, B. (2023). Ultra-processed foods and cardiometabolic health: public health policies to reduce consumption cannot wait. BMJ, 383, e075294. https://doi.org/10.1136/bmj-2023-075294

‌Tulleken, C. (2023). Ultra-Processed People. Random House.

‌*Amazon Affiliate links: Sensory Integration Education may earn a commission (at zero cost to you) when you purchase by clicking on an affiliate link. SIE is a not-for-profit organisation providing sensory integration training, supporting research and working to raise awareness of sensory processing and integration challenges.