It’s my privilege to be asked to write a continuous column here on the website of NUPENS (the University of São Paulo Centre for Epidemiological Studies in Nutrition and Health, at its School of Public Health).
So who am I, and what am I doing here? You can find some information about me elsewhere on the site. As I say there, I am English, and came to live and work in Brazil in 2000 because I had realised that the future for public health and nutrition is in the global South. The work led by Carlos Monteiro and shared by colleagues at NUPENS and many other centres and countries, in creating, developing and establishing the NOVA project, with its advocacy of freshly prepared meals and its identification and definition of ultra-processing, shows that I was right. For me, NOVA expresses what the originally ancient natural philosophy of dietetics stands for – the good life well led, within which everything associated with the enjoyment of good food is a central part (1). What goes round, comes round.
Carlos and I first met at an Institute of Nutrition of Central America and Panama (INCAP) conference in Guatemala in 1999, and I started formally to work with NUPENS in 2012. Before then between 2000 and 2002 I worked in Brazil at the federal Ministry of Health, Brasília with Denise Costa Coitinho and many other colleagues. I was a member of the official Brazilian government delegation to the World Health Organisation Executive Board meeting in 2001, and led the drafting group on Infant and Young Child Feeding, ensuring that the Brazilian Resolution became the basis of the UN Global Strategy, which it is (2). I also wrote the initial draft of the first ever official federal Brazilian dietary guidelines (Guia), eventually published in 2005 and reissued in 2006 and 2008 (3). This first Guia is food-based,stresses Brazilian foods and food culture, customs and realities, plant foods, and freshly prepared meals. It isbased on explicit stated principles including on environmental sustainability. It includes recommendations for government and industry, and health professionals, as well as for family members. Work on the Guia by Elisabetta Recine, with Janine Pasquim, Gracy Heijblom, Janine Coutinho and Patricia Radaelli, continued after I left the Ministry.
In 2003 I moved to Juiz de Fora in Minas Gerais with Raquel Bittar de Oliveira and her son Tauá (‘red earth’ in Tupi-Guarani) near to Maõs Mineiras, the women’s community Raquel founded in Manejo, close to Lima Duarte, which still flourishes (4). Raquel and I were married and our son Gabriel is now 15 and at high school.
Good food goes bad
In the UK in the 1980s and 1990s when working as a journalist, author and campaigner, I always felt uneasy about the nutrient-based expert consensus on food, nutrition, obesity and diseases, though I tried hard to suppress my doubts. Why? Well, for a start, I was more interested in good health and well-being than in quasi-medical matters. Also, one of my principles is to avoid food that tastes disgusting, such as any type of margarine whether or not packed with polyunsaturates. But what I came to call the chemical theory of nutrition seemed to me to be narrow and selective, which indeed it is (5). Also, while sugar is conventionally grouped as a food, it is also an additive, as a preservative and to make the ingredients of what we now call ultra-processed food products palatable and desirable.
Conventional nutritionists, who are untrained in food science, ignored food additives, being content to be told that they were toxicologically safe. But it seemed obvious to my co-author Caroline Walker and me that the main issue with additives were not as contaminants but as adulterants. Caroline said that many products made attractive with cosmetic additives were “legalised consumer fraud” (6). I joked that my next book on nutrition would be titled “All you need to know about food” and would contain just four words: “Good food goes bad”. We invented two other phrases: “Never eat anything you would not feed to a dog” and “Long shelf life leads to short human life”. This made the manufacturers of what was known by vague terms like “highly” or “heavily” processed food or “fast food” or by slang like “junk food” and their trade and front organisations, unhappy.
A star is born
Ten years ago I was columnist for and a deputy editor of the international journal Public Health Nutrition, in charge of invited commentaries. For the May 2009 issue Carlos offered a piece for which we agreed a memorable title: “Nutrition and health. The issue is not food, nor nutrients, so much as processing”(7). In my column that month I explained that “Carlos Monteiro… has tracked changes in patterns of food, diet and disease since the mid-1970s, and for a number of years has been increasingly aware that the conventional classifications of food and drink on which epidemiologists depend, obscure the key nutritional drivers of disease risk. His classification is based on one principle, that the issue is not food, nor nutrients, so much as processing”; and I concluded “This is an idea whose time has come” (8).
What Carlos and his colleagues Inês Castro, Renata Bertazzi-Levy and Rafael Claro had devised, was a whole new classification of food based on the nature, purpose and extent of processing. They had also specified which foods fitted into which group, and why. They sharply distinguished what they termed “ultra-processed food” from the other groups which include whole foods modified by processing, whereas ultra-processed foods are completely different. They are not modified whole foods, but formulations of industrial ingredients and additives containing little or no whole food. This was the conceptual breakthrough. This was new. For the first time, a system was being created which could the basis for epidemiological and experimental studies to be undertaken anywhere in the world. So it has proved.
Carlos is one of the two leading nutritional epidemiologists in Brazil. So when in 2012 the federal Ministry of Health decided to commission the second official national dietary guidelines, it was natural that Carlos was commissioned with his NUPENS team to undertake the technical work, subject once drafted to extensive public consultation (9). This is when I joined the team, which included Jean-Claude Moubarac now at the University of Montreal, who later proposed NOVA as the name for the project. So a star was born and shines brightly (10). The rest is a story to be continued…
- Cannon G. The rise and fall of dietetics and of nutrition science, 4000 BCE–2000 CE. Public Health Nutr 2005, 8, 6A, 701-705. doi: 10.1079/PHN2005766
- Serra J. Ampliando o Possível. A Política de Saúde do Brasil. Rio de Janeiro: Campos, 2002. ISBN 85-352-1078-4
- Ministry of Health, Brazil. Guia Alimentar para a Populaçāo Brasileira. Brasília: Ministério da Saúde, 2005. http://www.actbr.org.br/uploads/arquivo/943_05_1109_M.pdf
- Santos di Filippo M. Mulher, Desenvolvimento e Meio Ambiente; a Experiência da Associaçāo Māos Mineiras. Thesis. Federal University of Lavras, Minas Gerais, Brazil, 2002. Brazilhttps://www.scribd.com/document/386631798/dissertacao-Mulher-Desenvolvimento-e-Meio-Ambiente-a-Experiencia-Da-Associacao-Maos-Mineiras
- Cannon G. The Fate of Nations. Food and Nutrition Policy in the New World. London: Caroline Walker Trust, 2003. ISBN 1 897820 17 8
- Walker C. Legalised consumer fraud. In: Lawrence F (ed) Additives. Your Complete Survival Guide. London: Century, 1986. ISBN 0 71 26 1 269 6
- Monteiro C. Nutrition and health. The issue is not food, nor nutrients, so much as processing.Public Health Nutr 2010, 12, 5, 729-731. doi:10.1017/S1368980009005291
- Cannon G. Forget food and nutrients, think processing Public Health Nutr 2010, 12, 5, 732–734. doi:10.1017/S1368980009005370
- Ministry of Health, Brazil. Dietary Guidelines for the Brazilian Population (English version) Brasília: Ministério da Saúde, 2014. http://www.fao.org/nutrition/education/food-based-dietary-guidelines/regions/ countries/brazil/en/
- Monteiro C, Geoffrey G, Levy R, Moubarac J-C, Jaime P, Martins AP, Canella D, Louzada M, Parra D. NOVA. The star shines bright. World Nutrition 2016, 7, 1-3, 28-38. https://worldnutritionjournal.org/index.php/wn/article/view/5
Tags: NOVA. Guia Alimentar.