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Ultra‐processed foods cause weight gain and increased energy intake associated with reduced chewing frequency: A randomized, open‐label, crossover study
Abstract
Aim: To elucidate the effects of ultra‐processed foods (UPFs) on body weight and ad libitum energy intake compared with non‐UPFs. Materials and Methods: In this randomized, open‐label crossover study conducted at the University of Tokyo Hospital, overweight/obese Japanese male participants were randomly assigned (1:1) to start the study with consumption of either UPFs or non‐UPFs for 1 week, followed by a 2‐week washout period, before crossing over to the alternate food diet for 1 week. Individuals with diabetes, hypertension or any other medical conditions who visited a hospital regularly were excluded. The meals were designed to be matched for the total energy and macronutrient levels. The primary outcome was the difference in the body weight change between the UPF and non‐UPF periods. The differences in the average daily energy intake and chewing frequency were assessed as one of the prespecified secondary outcomes. Results: Nine eligible participants were randomly assigned to start the study with either UPFs or non‐UPFs. All participants completed the study. During the UPF period, participants gained 1.1 kg more weight (95% confidence interval 0.2 to 2.0; P = .021) and consumed 813.5 kcal more per day (342.4 to 1284.7; P = .0041) compared with during the non‐UPF period. Regarding the chewing frequency, the number of chews per calorie was significantly lower during the UPF period ( P = .016). Conclusions: Consumption of UPFs causes significant weight gain. Medical nutritional therapy focused on reducing the consumption of UPFs could be an effective strategy for preventing obesity.
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The two crossover RCTs on ad libitum UPF and non-UPF diets matched for presented calories and macronutrients and the pilot behavioural intervention study found significant effects of the ultra-processed dietary pattern on weight changes.
“However, the two crossover RCTs on ad libitum UPF and non-UPF diets matched for presented calories and macronutrients and the pilot behavioural intervention study aforementioned found significant effects of the ultra-processed dietary pattern on weight changes.”
From Ultra-processed foods and human health: the main thesis and the evidence (2025) · cites this paper as [58]
Other plausible factors linking UPF consumption to harm include hyper-palatability, high nonbeverage energy density, disrupted food structures, soft texture, low content of health-protective phytochemicals, toxic contaminants created during processing or released from packaging materials, and potentially harmful classes and mixtures of additives.
“As discussed in hypothesis 2, other plausible factors include hyper-palatability, high nonbeverage energy density, disrupted food structures, soft texture, low content of health-protective phytochemicals, toxic contaminants created during processing or released from packaging materials, and potentially harmful classes and mixtures of additives.[57][58][59][60][61][62]”
From Ultra-processed foods and human health: the main thesis and the evidence (2025) · cites this paper as [58]
The finding that 64 of 66 associations remained significant after adjusting for diet quality aligns with the NIH and Tokyo trials.
“This finding aligns with the NIH and Tokyo trials.56,58”
From Ultra-processed foods and human health: the main thesis and the evidence (2025) · cites this paper as [58]
In the 1-week Tokyo trial with 9 participants, the UPF diet led to a gain of 2•2 kg (1•8-2•6) in bodyweight and 0•7 kg (0•3-1•1) in fat mass, while the non-UPF diet led to a gain of 1•1 kg (0•5-1•6) in bodyweight and a reduction of 0•4 kg (0•0-0•8) in fat mass.
“In the 1-week Tokyo trial with 9 participants, the UPF diet led to a gain of 2•2 kg (1•8-2•6) in bodyweight and 0•7 kg (0•3-1•1) in fat mass, while the non-UPF diet led to a gain of of 1•1 kg (0•5-1•6) in bodyweight and a reduction of 0•4 kg (0•0-0•8) in fat mass.58”
From Ultra-processed foods and human health: the main thesis and the evidence (2025) · cites this paper as [58]
Short-term RCTs have shown consistent and biologically plausible effects of ultra-processed diets on precursors of obesity, including excessive total energy intake and increases in bodyweight and fat mass.
“Short-term RCTs (eg, those by the US NIH 56 and Tokyo Hospital 58 ) have shown consistent and biologically plausible effects of ultra-processed diets on precursors of obesity, including excessive total energy intake and increases in bodyweight and fat mass.”
From Ultra-processed foods and human health: the main thesis and the evidence (2025) · cites this paper as [58]
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Cites
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Ultra-processed foods: What they are and how to identify them
Monteiro, C. A., Cannon, G., Levy, R. B., Moubarac, J.-C., Louzada, M. L., Rauber, F., Khandpur, N., Cediel, G., Neri, D., Martinez-Steele, E., et al. (2019) · Public Health Nutrition · doi:10.1017/s1368980018003762 · Cited by 2,964
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“16 This finding suggested that the protein leverage hypothesis could explain, at least in part, the increased energy intake associated with the consumption of UPFs as an effort to maintain a consistent protein intake.”
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Slow food, fast food and the control of food intake
de Graaf, C., & Kok, F. J. (2010) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2010.41 · Cited by 152
Ultra-processed foods, protein leverage and energy intake in the USA
Martínez Steele, E., Raubenheimer, D., Simpson, S. J., Baraldi, L. G., & Monteiro, C. A. (2018) · Public Health Nutrition · doi:10.1017/s1368980017001574 · Cited by 144
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“11 Further investigations are warranted to clarify the biological mechanisms by which UPFs may impact satiety signalling and obesity.”
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Ultra-processed foods and human health: the main thesis and the evidence
Monteiro, C. A., Louzada, M. L., Steele-Martinez, E., Cannon, G., Andrade, G. C., Baker, P., Bes-Rastrollo, M., Bonaccio, M., Gearhardt, A. N., Khandpur, N., et al. (2025) · The Lancet · doi:10.1016/s0140-6736(25)01565-x · Cited by 339
Metadata
- Authors
- Hamano, S., Sawada, M., Aihara, M., Sakurai, Y., Sekine, R., Usami, S., Kubota, N., & Yamauchi, T.
- Affiliations
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine The University of Tokyo Tokyo Japan
- Department of Clinical Nutrition Therapy The University of Tokyo Hospital Tokyo Japan
- Graduate School of Education The University of Tokyo Tokyo Japan
- Department of Metabolic Medicine, Faculty of Life Sciences Kumamoto University Kumamoto Japan
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2024-09-12
- Volume
- 26
- Issue
- 11
- Pages
- 5431-5443
- ISSN
- 1462-8902
- 1463-1326
- Cited by
- 124
- References
- 8
- Language
- en
- Funders
- Ministry of Education, Culture, Sports, Science and Technology (Grant‐in Aid for Scientific Research (B) (21H02976)
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