In this episode of Diabetes Care Conversations, we explore the science behind ultra-processed foods and what the evidence really says about their role in diabetes care. Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDCES, is joined by Melissa Joy Dobbins, MS, RDN, CDCES, to separate fact from fear, discuss practical nutrition strategies, and share how clinicians can help people with diabetes make informed, balanced food choices without getting caught up in the latest nutrition buzzwords.
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Amy Hess-Fischl
Ultra-processed foods seem to be everywhere in news headlines, social media feeds, and conversations with patients. But what exactly makes a food ultra-processed? Is the term helping people make better choices or creating more confusion? Research has linked ultra-processed foods to weight gain and chronic disease.
Yet experts still debate how these foods should be defined and whether all ultra-processed foods belong in the same category. So, what does the science actually tell us? And what does it mean for people living with diabetes? Welcome to ADCES's podcast, Diabetes Care Conversations. I'm your host, Amy Hess Fischel, and in this episode, we'll explore the evidence behind ultra-processed foods.
Discuss how different foods affect blood glucose, and examine why some processed foods may still have a place in a healthy eating pattern. We'll also talk about practical strategies for navigating today's food environment. Joining us today is registered dietitian and nutrition communications expert, Amy Hess-Fischl, who will help us cut through the noise and focus on what matters most.
Helping people make choices that support their health, preferences, and long-term goals. Melissa, as dieticians, we have known each other quite some time. But you have used your nutrition expertise in such a cool way. Before we dive into our ultra-processed food conversation, can you just give us kind of your origin story, so to speak, and how you landed on your current gig?
Melissa Joy Dobbins
Well, sure. It's so great to be with you, Amy. yes, we are both in the Chicago area. So yeah, we we go way back. But I'm just so thrilled to be reconnected with you. So in addition to being a registered dietitian for over 30 years, I've been a certified diabetes care and education specialist for I think twenty-eight years now. So I started off in clinical and then I was an outpatient dietitian and did a lot of diabetes education. And then I became a supermarket dietitian. I worked for the dairy council for a while and started my own business about 15 years ago, nutrition communications business. And even in my second job, my outpatient job, I did a lot of media. The first day on that job, the Chicago TV station came to the hospital. So I I just sort of leveraged that experience, the trainings. I was a state media rep for Illinois. I was an academy spokesperson, a National Dairy Council spokesperson. So yeah, I've had a lot of opportunity to get training and experience in the Chicago area and nationally. And so one of the things that I love to do is help other dietitians and diabetes educators and other credible experts improve their communication skills as well. And 11 years ago, I started my own podcast, the Sound Bites Podcast, where I interview experts on a variety of topics. I was really tempted in the beginning to just focus on diabetes because that's how passionate I am about it. But I decided to stay with a variety of topics and that has resonated well with my audiences. A lot of my listeners are dietitians and diabetes educators. And a shameless plug here, people can get free continuing education from some of my podcast episodes. So wanted to share that.
Amy Hess-Fischl
Well, thank you. I know I and I believe that some of them are usually on the ADCES emails that come out. So again, people take a look because again, you'll see which of those that you can get CE for. But we all thank you for everything that you do, Melissa, because you do a lot of research and you're digging into everything about all of these topics. And for that, we are so grateful because you're kind of keeping us at the top of our game as well. And with that.
You're keeping us at the top of our game with our current topic today too, when we talk about ultraprocessed foods themselves. What does that buzz term really mean? And why is it really sticking or or gaining traction in the world when patients come to us and say, I can't eat ultra processed foods? What kind of things are kind of swirling around in your head when you hear that?
Melissa Joy Dobbins
Yes, this has been a buzzword for quite a while now. I have done several episodes on it and learned from several experts. And the more I learn, the more interested I get and the more nuanced there is. Technically, there's no specific definition for ultra-processed foods. And, you know, there's actually a newer term. I think it's highly processed foods is kind of being thrown around now. And prior to that, we would just talk about processed foods or packaged foods, right?
But there is one classification system that's most commonly used in research, and that's called NOVA, the NOVA scale. What's important about the lack of the definition and knowing that the most commonly one used in research is NOVA, is that when we look at the research, which we'll talk about more in detail, if one research study is using one definition and another research study is using a different definition, then it's harder to kind of compare and contrast what the body of research shows. And this Nova scale that's most commonly used, they grade foods on a one-to-four scale from unprocessed or minimally processed to ultra processed. And the criticism of this classification system is it's really focused on the level of processing, and it really isn't including or appreciating the amount of nutrients in a food, or what we like to say a nutrient-dense or nutrient-rich food. And so one of the most important things I like to share with people, some of the nutrient-dense foods that Nova considers ultra-processed include some foods that we commonly recommend to our patients and clients. And that's fruit-flavored yogurt, soy milk, canned vegetables, peanut butter, tofu. And an expert that I talked to recently pointed out,
If you're vegan or vegetarian, you are likely getting a higher proportion of ultra-processed foods in your diet. Plant-based burgers are a good example. You know, as dieticians, we're always talking about what nutrition are you getting from a particular food? So it's kind of like nails on a chalkboard if that's not something being considered. And we'll talk more about the nuances of ultra processed, but I wanted to start off with
Amy Hess-Fischl
Thank you. Because I I think to your point, so we're using this Nova scale, but it is only focusing on a very small piece of when we look at the big picture of nutrition. How do we kind of deconstruct that? I mean, because of course, when we're talking with patients, you know, again, they're having this misconception, you know, like ultra-processed foods, you know, and most individuals don't really know what that truly means. So, to your point, like all right, we're talking about foods that are healthful but are still in this category. Yeah, how do we kind of navigate that conflicting information with patients when so many things about nutrition are confusing?
Melissa Joy Dobbins
Absolutely. And I think it's important to realize, I guess, you know, ultra processed foods are the villain of the day. It's always something, right? You know, it w it was fat for a while, then it was sugar. Sugar's still in the hot seat. And, you know, that's something we talk about with our patients with diabetes and prediabetes a lot is okay, sugar's one thing, but let's look at total carb, let's look at fiber, let's look at the quality of the carbohydrate and what those foods are bringing along with them as far as other nutrients. So I think it's important to put that into perspective.
And I think a lot of people when they're thinking about processed foods, ultra processed foods, they think of again as packaged foods. Right. And I think maybe they don't know that yogurt and tofu are being categorized as ultra processed, which could be a good thing, because we don't want them to get super confused about this. But if they are hearing some of that and they're questioning some of that, I think a good message is that not all ultra processed foods are created equal and that we do want to look at the nutrition. I mean, that's what we've been doing for decades in our field. We can't just throw that out. It can't just be like, well, now we're just looking at processed. And one of the things that I think about is we used to use the term junk food. Okay, let's call it indulgent foods or packaged foods. There's a difference between, you know, like frosted flakes and raisin bran, right? And the reason I'm bringing up cereal is because it's packaged, it's in a box. It gets a lot of hate these days. And I'm not I'm personally not sure, why. I mean, I understand yeah, you you wanna look at how much fiber, how much sugar, all of those things. But cereal it's usually served with milk or yogurt, sometimes with fruit. So I think that in some ways we just wanna reassure people and let them know that they can use common sense, but some of this stuff isn't common sense, so it can get confusing.
Amy Hess-Fischl
And we know that as you said, it's the hot, it's the buzz, it's the sexy topic to talk about these days. Whereas how do we get people to not fixate on just one thing? It's about the entire eating pattern. And you know, I think that's a bigger point too. So I I thank you for that. You know, I know that you commented on some of the research. I'd love for you to kind of delve into that a little bit more, if you don't mind. You know, what does the research show about ultra processed foods and weight and diabetes and just general health.
Melissa Joy Dobbins
There's a lot of research out there on ultra-processed foods, but it's mostly observational or epidemiology. There aren't very many randomized control trials, and the ones that are out there, some of them are pretty short. Some of them have been criticized for comparing like an unprocessed or minimally processed diet to an ultra-processed diet, but they weren't matching up the calories. So you're kind of thinking, okay, well, if they're showing that the processed diet, you know, increased calorie intake and weight, if it was higher in calories, we would expect to see that. So there's just a lot of different nuances there. I think one of the most interesting studies is a paper that came out in 2023 in the Journal of Nutrition. Julie Hess was the primary author. This was through the USDA Research Center. It was a proof-of-concept study. They wanted to see: is it possible to build a sample?
2,000 calorie menu for seven days that aligns with the dietary guidelines. And these would have been the 2020 dietary guidelines because this was published in 2023. When they were looking at like the healthy US style eating pattern that has 80% or more of its calories coming from ultra-processed foods according to the Nova scale. That's what they did. They aimed to develop a menu that was like commonly consumed foods, not weird stuff that just isn't what's food modeling. It's not real life, comprised of commonly consumed.
Consumed foods, they were aiming for a healthy eating index score of above 90. Now, just a reminder, the average American adult healthy eating index score is 59. We are getting a failing grade. Right. So they were saying, okay, we're going to aim for 90 or above. They wanted to meet acceptable macronutrient distribution ranges, meet recommendations for most micronutrients, you know, have it be as nutrient-rich as possible. And having 80% of the calories or more coming from those ultra-processed foods. They were able to put together a menu and they analyzed it, and they were able to get the healthy eating score for that to 86. And that's out of a possible 100. So that's much higher than the average. It was adequate in most micronutrients, vitamin D, vitamin E, choline was a little short. I had 37 grams of fiber.
Melissa Joy Dobbins
In that menu. It was adequate. That never, ever, ever happens, right? It had calcium, fiber, potassium. It did not meet sodium. Sodium was high, but we know, especially clinicians, how hard it is to limit sodium in the diet. It's super, super difficult. But yeah, so it was a very successful study showing that you can include a large amount of ultra-processed foods in your diet and still have adequate nutrition and technically better nutrition than the average diet. One of their conclusions was that the Nova scale cannot be used as a proxy determinant for diet healthfulness or really isn't indicative of diet quality.
Amy Hess-Fischl
And that makes sense. Do we see that there is some movement towards standardizing ultra-processed food definitions? Because I think that's really the sticking point here is that sure, the HUS study said, yeah, look at this. I mean, these foods, while they're considered ultra-processed, they're still healthful. And I think that's really the the point that when we look at some of that research that that gets the standard consumer saying, this is but it's ultra processed. Why can't we have that when it's in this diet? What kind of arguments have you heard kind of for and against ultra processed foods in the research?
Melissa Joy Dobbins
There is actually a paper just recently, I got an email from iFans and the Academy in May of 2026. There was a paper published in Nutrition Today, and that was the first time I kind of saw a nice little outlining of arguments for and arguments against. And I'm sure we can have a link available for for people for this. It kind of summed up some of the things that I've heard. And I think the main approach actually one thing that they pointed out was.
The different perspectives or thoughts on ultraprocessed foods are in part due to different philosophies about food systems and approaches to research. So, you know, I we talked about this already, observational versus randomized control trials. Now, to be fair, most nutrition research is observational and epidemiological by nature. It's hard to do randomized control trials, it's costly, all the things.
And observational research is important, but it cannot determine a cause and effect. Right. It determines an association and a correlation. So we just need to keep that in mind when we're looking at this. The other thing that comes out is there has been no mechanism identified. And I interviewed Dr. Rick Mattis, who is a researcher who's been dedicating his entire career, 30 years or so, to appetite regulation, food cues, sensory aspects of our diet and our intake. And he talks about palatability or hyperpalatability, which was kind of one of those terms I hadn't heard, but when I heard it, I was like, maybe this is the smoking gun. Maybe this is what is causing the ultra-processed foods to be associated with increased weight and different negative health outcomes.
At first when I heard about hyperpalatability, my understanding was it was how fast can you eat something? And the faster you can eat something, obviously the more of it you're going to consume and that could increase the calories, sugar, salt, everything. Right. But you can't drink a glass of soy milk faster than you can drink a glass of regular milk. You can't eat a plant-based burger faster than you can eat a regular burger. So the other aspect of palatability is the desirability of the food.
Melissa Joy Dobbins
And you hear all this stuff, like the food industry, it's like a evil scientist, and they're creating this food that you know we are addicted to, and all of those scary sounding, conspiracy-sounding things, right? Dr. Rick Mattis, the expert in this topic, said palatability and this desirability of the food is not a characteristic of the food itself. It's actually a characteristic of the person. I think most people can enjoy ice cream, cookies, chips, things like that. But a food that you find extremely desirable may not be something that I find extremely desirable. I think that makes a lot of sense. Yeah. I mean, again, we're looking at indulgent foods. Foods that don't have a lot of fiber, that don't fill up your belly. Yeah, that's what I want people to think about. If it's an indulgent food, are there some nutrients that come along with it? Maybe it's got more protein in it, or maybe it does have fiber.
You can compare two different indulgent foods and say, okay, which one tastes the best? Which one do I like better? I use this example a lot in my house. All of my family members love ice cream. I mean, they really love ice cream. I love ice cream, but I don't love ice cream. Like, you know, we each pick out our own flavors. Mine will get freezer burned because I will forget about it. But if M&Ms come into this house.
Maybe I shouldn't say brand names, but you know, chocolate. If chocolate comes into this house, I will hunt it down and it will be gone. We all have different preferences and we can all relate different family members really love something and that's not really my thing. Cool. I can have that around. It's not gonna be too tempting for me. And we talk about that with our patients and clients. Try not to have those tempting foods around. Don't put yourself through all this, you know, set up your environment to support success. But I think it's just really important to again, just take a step back and
Tease out some of that nuance and reassure our patients and clients at the end of the day.
Amy Hess-Fischl
And I appreciate that because I mean, certainly, while as dieticians, we do a very thorough nutrition assessment. But I think for the diabetes care and education specialists that are listening to us, what are one or two questions that they should be assessing for? I mean, I think to your point, you know, I mean we we should be digging a little bit deeper of what are those foods that you have in the house you will not only eat two, like me and Oreos.
Yes, if I have Oreos in the house, just like you with sorry, I know I just called out a a a brand name as well, but we do need to really dig in a little bit more to those preferences of our patients to help them to navigate some of these sticking points that may cause their outcomes to diminish.
Melissa Joy Dobbins
Yes. And I often think, okay, there's so many things to do and focus on. Our role is to kind of help people zero in on what is going to make the biggest impact for them. And these things over here, you might hear a lot about this in the media or social media, but this not really an issue for you. Don't worry about that. You're good with this. We're looking at your diet. You don't need to worry about this. This is where you could really focus and make a difference. And I think that's what we do is Diabetes educators. And I think that we want to think about what's meaningful and what's helpful. And maybe we ask our patients, what are your concerns? You know, with the whole motivational interviewing style with like the open ended questions. And if they bring up the topic, ask them what are their thoughts, what are their concerns? What are they hearing? What are their questions? And if they're not maybe necessarily using that word, but you're kind of getting into the area of with those types of, you know, foods.
Maybe asking them, have you heard anything about ultra processed foods? Do you have any concerns? And then you can address that. But this paper in Nutrition Today just had some really great takeaways that I circled that I wanted to share.
Amy Hess-Fischl
Please. Yeah, if you don't mind, because I was just gonna ask, you've gone through some of that. We look at observational studies, you know, again, and that's not as helpful. You know, again, we have to dig into that. So I mean, what what are some of the things that we can really bring to our patients and say, What's worthwhile? Let's cut through that and don't worry about the term processed or alter processed. These are some healthy options for you.
Melissa Joy Dobbins
Yes. And you had asked about the arguments for or against, and I'm gonna share a little bit, but I wanna preface this by saying if your patients and clients are not concerned about additives and foods or any of those things, I wouldn't launch into that conversation. We don't need to bring up anything that's not already on their radar. There's plenty of things to focus on that they already are concerned about. But we would say as diabetes educators, we talked about the mechanism. There's no set mechanism. The the mechanism's still elusive. If there is one. The other side would say that the precautionary principle dictates that action is needed. They're not, you know, hung up on the fact that there's no mechanism. We would say one of the issues is if additives are a concern, they're approved by regional authorities. It's not a national thing. So that's there's a whole ball of wax there with this different additives in different foods. The people against the ultra-processed foods would say that additives serve as a marker of processing. And I would argue, again, the amount of processing should be considered, but it doesn't necessarily equate to nutrition. And yes, if the more something is processed, perhaps the quicker you can eat it, perhaps the less it will fill you up. These are things that we can easily determine, you know, in our own homes, in our own settings.
One of the interesting things is that this article in Nutrition Today that I got the email from iFans and the Academy, iFANS has guiding principles for classifying foods based on processing and formulation to support health, which I did not know. And perhaps this is new. So they have nine guiding principles. I won't read them all to pretty in depth. There's actually a couple of words in there I need to look up, but it's pretty self-explanatory. But one of the other things that this paper brings up that I've heard from day one concerns about ultra processed foods from a standpoint of a dietitian and a diabetes educator is that cultural appropriateness of food classification should be considered and it's not considered in NOVA. Interestingly, NOVA came out of Brazil. This classification came out of Brazil. So they share an example here. Although tofu is not a common cultural food in Brazil, it's a staple in some Asian cultures. And some forms of tofu would not be recommended according to the NOVA system.
I think that we see things in the media, social media, blah, blah, blah. But we work with real people. Right. And real people sometimes follow traditional cultural foods. Sometimes our food insecure. Grocery prices are going through the roof. And it's really important that we don't demonize not just the level of processing, but entire category of a grocery store. Exactly. Certain aisles and so on. And that we help people build healthful diets that are affordable and accessible.
Melissa Joy Dobbins
And hearkening back to your previous life in the grocery store, I think that is worth kind of expanding on a little bit more because we know that yeah, every time I go to the grocery store, sure, I get, you know, their cute little coupons, but it's expensive for people, you know. And so what do you feel are some of those processed foods that are worthwhile? You know, as you said, we need to be culturally sensitive.
And knowing that the Nova scale does not really apply to a lot of cultures. So it's just a fascinating conversation to have with patients. But you know, to say, here, let's cut through this and say, these are some good options for you. Let's not worry about the term as much.
So several products that come to mind that I will list, but also keeping in mind we don't just eat a single food, you know, we eat a mixed meal. Right. So canned fish, canned tuna, canned salmon, canned beans. I mentioned the cereal. Cereal can provide a lot of vitamins and minerals, different amounts of fiber, you know, aimed towards more fiber. We're always talking to our patients and clients about fiber. It just needs a PR makeover. We know we need we need
We need fiber to be the next protein, not in the way that protein is in everything. You know, we don't want no to you know, we want to do this slowly and gradually and helpfully and to not get into too much trouble with too much fiber at once. But for example, like boxed pasta or rice, sure, or whole grain pasta or brown rice could be more nutritious, but what are you serving with that? Is rice the vehicle to get stir fry veggies and chicken breast?
Is pasta a vehicle to get red sauce with lycopene in it and you know a little olive oil? You know, are you having a side salad with it and all of those things? I think it's how we build our diets. You know, we talk about balance, variety, moderation. Those are boring and too vague, but they're foundational. But I think the guidelines are already there for us to limit saturated and solid fats, to limit sugars.
I have my own opinions about the whole term added sugars we can get into if want. And then limit sodium and salt. You know, we know that those are nutrients of concern to limit, and we know that nutrients of concern to increase calcium, fiber, potassium, vitamin D, we know those tend to be the nutrients that people are lacking. Yeah.
Amy Hess-Fischl
Absolutely. And you hit the nail on the head before is that we need to look at the whole meal. We need to stop focusing on just one thing, you know, because it's confusing enough for people to make these changes to what they're eating. And I think we do need to have a longer conversation about added sugars. But maybe for another day. We'll we'll talk about to ADCS about that. But But w in light of everything that you said, I mean, we we know that people are trying to eat more healthfully and trying to lose weight. What are your thoughts when we think of GLP1 use? And how do people actually choose more healthfully and not worry so much about these ultra-processed foods? I mean, how do we minimize that glycemic variability, that fiber that you're talking about? And how do we maintain that hydration that is so essential for people as they're using these medications that are causing such weight loss, you know, in the grand scheme of things. So what are your thoughts?
Melissa Joy Dobbins
Yes, GLP ones. I mean, I was just telling somebody the other day, it's obviously the biggest thing that's happened in my career. Prior to this, I think it was vitamin D I was telling everybody. Vitamin D was the biggest thing that's happened. I'm like, whoa, this is really, you know, knocked the vitamin D out of the water as far as how big of an impact this is making. So many people are are taking them and, you know, their decreased appetite, they aren't feeling that they need to drink as often and they're not as hungry. So we have this decreased fluid intake, decreased food intake. And so we need to be even more focused on getting nutrient-rich foods when we do make those choices. And I think what's exciting from a dietitian and diabetes educator standpoint is it completely changes the conversation away. Well, I shouldn't say completely. It really shifts the conversation toward quality of diet, nutrients, and getting those fluids versus trying to help people manage their hunger, manage their cravings, just eat less, things that are really hard to do. Right. I think now it's exciting that we get to talk about, okay, so you typically have, you know, a sandwich for lunch. How can we get more fiber in the bread? How can we get some different vegetables layered into that sandwich or on the side? And just some really nice opportunities to look more at the quality of what people are getting and I always say this too, like, gee, what's good for people on GLP ones is good for all of us. Yes. So I know we see foods in the marketplace that have, you know, GLP one. I'm like, well, what does that mean? Does that mean it's just giving you more nutrition in that smaller package? Does it mean, you know, some people say, this GLP one food acts like a GLP one? Well, that doesn't stay in the body very long. It just that's not a thing really. But yeah, so I think we could all benefit from smaller portion nutrient rich choices and getting more fluids. So it's definitely an interesting development for sure. And and it they're here to stay. And we're gonna learn more as time goes on.
Amy Hess-Fischl
No, absolutely. And hopefully the role of the dietitian and diabetes care and education specialist increases because of it. So I think that that's a beautiful thing. And I know we we've covered a lot of ground and we could probably talk about this for another couple of hours. But what are kind of your top level what should our audience members really kind of focus on these key takeaways based on everything that we've talked about today?
Melissa Joy Dobbins
Want them to consider, are there certain foods in their diet? I'm gonna call them indulgent, you know, that they would think, okay, those are the foods that you know I should keep a bit of an eye on. How often am I having them? How tempting are they? Do I keep them at home or not? And do they provide any nutrition? What nutrients are you trying to get more of? I would like one of those to be fiber for everybody. Maybe you're looking for more protein, maybe you're looking for calcium, vitamin D, and so on.
Keep in mind what you're looking for when you're looking at products in the store. And my supermarket dietitian hat is always like, you can always compare two products and pick the one that that meets your needs and including how it tastes. You know, food should be pleasurable. You know, we get a lot of pleasure from food. There's nothing wrong with that. Consider the speed at which you consume certain foods. Are you getting full? Pay attention to your hunger and always
Consider the amount of total carbs and fiber in your foods, whether you're counting them or not, just you know, trying to get some more of those quality carbs, you know, what nutrients is that particular food bringing along with it? And is it a vehicle for other nutrient rich foods as well?
Amy Hess-Fischl
Melissa, I cannot thank you enough. You know, as a an expert podcaster yourself, I am so grateful that you were so kind to me as being your host. And I so thank you for everything that you have talked about today. And as our audience, you know, again, thank you so much, everyone, for listening to this episode of Diabetes Care Conversations and engaging with ADCES. You can find any of the resources related to this episode in the show notes. And remember, being an ADCES member gets you access to many resources, education, and networking opportunities. Learn about all of those benefits of being a member of ADCES at ADCES.org forward slash join. And please, for our members, look at all the resources that we have. It's amazing what is on that ADCES site.
And then this information in this podcast is for informational purposes only and may not be appropriate or applicable for your individual circumstances. This podcast does not provide medical or professional advice and is not a substitute for consultation with a healthcare professional. Please consult your healthcare professional for any medical questions. And thank you all for joining and have a wonderful day. And until next time.