Van Tulleken’s work here is an outstanding compilation and explanation of dozens of research studies, historical events, and personal observations tying the state of the current obesity epidemic to the growth of the ultra-processed food industry.

His conclusions are well supported with research making his commentary poignant and powerful. Unfortunately, while he tries to provide some hope with a few methods for change, the reality of our world, our government, and capitalism make it clear that we’ll likely never have any systemic change, so any change to how we eat must be ultimately personal.

Van Tulleken puts UPF on a spectrum. While avoiding all UPF is desirable, some are worse than others simply based on the quantity of non-kitchen ingredients. And, identifying UPF is difficult. Trying to follow the simple rule that an ingredient one would not find in a normal household kitchen denotes UPF is a nice start, but it isn’t always that simple.

I really like his stance, that we shouldn’t judge people for what they eat, and we should just do our best to eat real food. And, don’t nag.

At the beginning of chapter 18, Van Tulleken summarizes the findings outlined previously in the book before moving into the ideas for moving forward. I’ve tried to record those conclusions below.

Summary from Chapter 18 -- The processing makes UPF soft, which means it is eaten quickly and a person consumes more calories per minute and don’t feel full until long after finished. ---- Can reduce facial bone size and bone density, which can lead to dental issues. -- UPF typically has a very high calorie density because it is dry and high in fat and sugar, providing more calories per mouthful. -- UPF displaces diverse whole foods from the diet, especially among low income groups. ---- UPF is often micro-nutrient deficient, which also contributes to excess consumption -- Mismatches between taste signals in the mouth and the nutrition content arriving in the gut alters metabolism and alters appetite in ways we are just beginning to understand, but seem to drive excess consumption. -- Ultra-processed food is addictive, meaning for some people binges are unavoidable. -- The emulsifiers, preservatives, modified starches and other additives damage our microbiomes, allowing inflammatory bacteria to flourish and causing our guts to leak. -- The convenience, marketing, and price of UPF urges us to eat constantly and without thought. -- The additives and physical processing mean that UPF affects our satiety system, and other additives may affect brain and endocrine functions, and plastic from the packaging might affect fertility. -- Production methods used to make UPF require expensive subsidies and drive environmental destruction, carbon emissions, and plastic pollution, which harms us all.