Ultra-processed food staples dominate mainstream U.S. supermarkets. Americans more than Europeans forced to choose between health and cost.

Abstract BACKGROUND The United States (U.S.) is the leading country in ultra-processed food (UPF) consumption, accounting for 60% of caloric intake, compared to a range of 14 to 44% in Europe. Given the increasingly evident health risks of UPF consumption, this is a major health problem. Common UPFs include soft drinks, snacks, processed meats, cookies, and candy. We hypothesized that even basic staple foods in the United States are ultra-processed and aimed to study the UPF prevalence in food staples from popular U.S. supermarkets compared with European countries. METHODOLOGY We analyzed staple food products (bread, canned goods, cereals, eggs, milk, vegetables, and yogurt) stocked in U.S. supermarket chains (Walmart, Target, and Whole Foods), France (Carrefour), and Spain (Mercadona). Using an algorithm that identifies UPF values based on the NOVA and Food and Agriculture Organization of the United Nations guidelines, we identified the UPF prevalence and average number of UPF markers (cosmetic ingredients/additives). RESULTS The prevalence of UPFs in budget-friendly supermarkets, Walmart, and Target, is 41-42% higher than Whole Foods, a store focused on quality. Furthermore, UPFs in Walmart and Target have 75% and 57% more UPF markers, respectively, than UPFs in Whole Foods. Around 58% of staples in U.S. leading supermarkets are ultra-processed, which is 41% more than supermarkets in Europe. Furthermore, the U.S. UPFs contain 41% more UPF markers than their EU counterparts. CONCLUSION Most of the staple food products at mainstream U.S. budget-friendly retailers are ultra-processed, which is not the case at a more premium, quality focused store. Compared to supermarkets in Europe, the U.S. mainstream supermarkets have more UPFs, and those foods also have more UPF markers. Making healthy food choices in the United States is a challenge that is compromised by the high availability and accessibility of UPFs, even among everyday products that constitute the dominant part of the diet of a population. The European model shows the possibility of decreasing the UPF availability in large supermarkets. American consumers need more tools and guidance to identify UPFs along with greater regulation of UPF products to prioritize healthy choices and reduce UPF availability.