Household availability of ultra-processed foods and obesity in nineteen European countries

<jats:title>Abstract</jats:title><jats:sec id="S1368980017001379_abs1" sec-type="general"><jats:title>Objective</jats:title><jats:p>To assess household availability of NOVA food groups in nineteen European countries and to analyse the association between availability of ultra-processed foods and prevalence of obesity.</jats:p></jats:sec><jats:sec id="S1368980017001379_abs2" sec-type="general"><jats:title>Design</jats:title><jats:p>Ecological, cross-sectional study.</jats:p></jats:sec><jats:sec id="S1368980017001379_abs3" sec-type="general"><jats:title>Setting</jats:title><jats:p>Europe.</jats:p></jats:sec><jats:sec id="S1368980017001379_abs4" sec-type="subjects"><jats:title>Subjects</jats:title><jats:p>Estimates of ultra-processed foods calculated from national household budget surveys conducted between 1991 and 2008. Estimates of obesity prevalence obtained from national surveys undertaken near the budget survey time.</jats:p></jats:sec><jats:sec id="S1368980017001379_abs5" sec-type="results"><jats:title>Results</jats:title><jats:p>Across the nineteen countries, median average household availability amounted to 33·9 % of total purchased dietary energy for unprocessed or minimally processed foods, 20·3 % for processed culinary ingredients, 19·6 % for processed foods and 26·4 % for ultra-processed foods. The average household availability of ultra-processed foods ranged from 10·2 % in Portugal and 13·4 % in Italy to 46·2 % in Germany and 50·4 % in the UK. A significant positive association was found between national household availability of ultra-processed foods and national prevalence of obesity among adults. After adjustment for national income, prevalence of physical inactivity, prevalence of smoking, measured or self-reported prevalence of obesity, and time lag between estimates on household food availability and obesity, each percentage point increase in the household availability of ultra-processed foods resulted in an increase of 0·25 percentage points in obesity prevalence.</jats:p></jats:sec><jats:sec id="S1368980017001379_abs6" sec-type="conclusions"><jats:title>Conclusions</jats:title><jats:p>The study contributes to a growing literature showing that the consumption of ultra-processed foods is associated with an increased risk of diet-related non-communicable diseases. Its findings reinforce the need for public policies and actions that promote consumption of unprocessed or minimally processed foods and make ultra-processed foods less available and affordable.</jats:p></jats:sec>