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[Series] Towards unified global action on ultra-processed foods: understanding commercial determinants, countering corporate power, and mobilising a public health response

The rise of ultra-processed foods (UPFs) in human diets is harming global public health. However, policy responses are still emerging—much like tobacco control efforts decades ago—indicating the need to understand root causes and accelerate global action. This paper, the third in a three-part Lancet Series, takes several steps to advance knowledge of these causes, and to inform a global public health response. First, we show that the UPF industry is a key driver of the problem, as its leading corporations and co-dependent actors have expanded and restructured food systems almost everywhere, in favour of ultra-processed diets.

[Series] Policies to halt and reverse the rise in ultra-processed food production, marketing, and consumption

Dietary patterns high in ultra-processed foods (UPFs) have been associated with poor diet quality and health outcomes, and are displacing healthier dietary patterns—meals and dishes prepared with fresh and minimally processed foods—in most parts of the world. In the second paper of this Series, we propose a set of government policies aimed at halting and reversing the rise of UPFs worldwide. To date, policies have mainly focused on reducing consumption of foods high in added fats, sugar, and sodium, many of which are UPFs.

[Series] Ultra-processed foods and human health: the main thesis and the evidence

This first paper in a three-part Lancet Series combines narrative and systematic reviews with original analyses and meta-analyses to assess three hypotheses concerning a dietary pattern based on ultra-processed foods. The first hypothesis—that this pattern is globally displacing long-established diets centred on whole foods and their culinary preparation as dishes and meals—is supported by decades of national food intake and purchase surveys, and recent global sales data. The second—that this pattern results in deterioration of diet quality, especially in relation to chronic disease prevention—is confirmed by national food intake surveys, large cohorts, and interventional studies showing gross nutrient imbalances; overeating driven by high energy density, hyper-palatability, soft texture, and disrupted food matrices; reduced intake of health-protective phytochemicals; and increased intake of toxic compounds, endocrine disruptors, and potentially harmful classes and mixtures of food additives.

[Department of Error] Department of Error

Gevaert P, Desrosiers M, Cornet M, et al. Efficacy and safety of twice per year depemokimab in chronic rhinosinusitis with nasal polyps (ANCHOR-1 and ANCHOR-2): phase 3, randomised, double-blind, parallel trials. Lancet 2025; 405: 911–26—In this Article, in the Results section, sentence 2 of paragraph 8 should have read, “One participant (who received depemokimab)”; in Appendix 1, in the Sensitivity Analyses section, line 5 and 6 of paragraph 3 should have read “(–3 to 3 by increments of 1 for mean NPS; and –1·5 to 1·5 by increments of 0·5 for mean nasal obstruction VRS score)”, and figure S12 has been updated accordingly.

[Department of Error] Department of Error

Zannad F, O’Connor CM, Butler J, et al. Vericiguat for patients with heart failure and reduced ejection fraction across the risk spectrum: an individual participant data analysis of the VICTORIA and VICTOR trials. Lancet 2025; 406: 1351–62—In this Article, Prof Giuseppe M C Rosano's affiliations should have read San Raffaele Open University of Rome, Rome, Italy, and IRCCS San Raffaele Roma, Rome, Italy. Additionally, support to Prof Rosano from the Italian Ministry of Health (Ricerca Corrente) 20/1819 should have been stated in the Acknowledgments.

[Department of Error] Department of Error

Butler J, McMullan CJ, Anstrom KJ, et al. Vericiguat in patients with chronic heart failure and reduced ejection fraction (VICTOR): a double-blind, placebo-controlled, randomised, phase 3 trial. Lancet 2025; 406: 1341–50—In figure 1 of this Article, the intention-to-treat population for the placebo group should have read “3052” patients. In the Geographical region section of figure 3, alignment of the dots and lines has been corrected. Additionally, support to Prof Giuseppe M C Rosano from the Italian Ministry of Health (Ricerca Corrente) 20/1819 should have been stated in the Acknowledgments.

[Correspondence] Global health after USAID cuts – Authors' reply

We thank Daniel Krugman and colleagues and Jayalakshmi Alagar and Ludmila Lobkowicz for their interest in our study1 on the potential consequences of the second Trump administration's abrupt and massive defunding of the United States Agency for International Development (USAID), culminating in its complete dismantling in July, 2025. In this study, we estimated that this decision could result in more than 14 million deaths (95% uncertainty interval [UI]: 8·5–19·7 million) across 133 low-income and middle-income countries by 2030.

[Correspondence] Global health after USAID cuts

Daniella Medeiros Cavalcanti and colleagues1 offer a sobering estimate of the human cost of the United States Agency for International Development (USAID)'s defunding, projecting over 14 million additional deaths globally by 2030, including 4·5 million children younger than 5 years. However, their model likely underestimates the true toll by omitting three crucial factors.

[Correspondence] Global health after USAID cuts

On July 1, 2025, the United States Agency for International Development (USAID) was officially terminated by the second Trump administration. The move prompted widespread condemnation and panic, though largely concentrated in Europe and North America.1 Some have mourned the loss of US jobs,2 while others have lamented the fading influence of US foreign policy and amplified the pragmatic justification that the move is detrimental to US soft power.3

[Correspondence] Population size and vaccination rates for zero-dose estimates – Authors' reply

Neema Kumari and colleagues express concerns about the estimates of zero-dose children in India and, more generally, the use of absolute numbers versus relative metrics in our Article1 for understanding the state of health systems globally. We agree that relative metrics are crucial for understanding successes and gaps in equitable health care, and much of our Article centred on vaccine coverage, rather than numbers of unvaccinated children. In addition to emphasising the importance of addressing relative disparities, however, the Immunization Agenda 2030 (IA2030) also sets a global goal to reduce the number of zero-dose children by 50% by 2030.

[Correspondence] US public health resistance must include Palestine – Author's reply

We are grateful to Sanghyuk S Shin and colleagues for raising the crucial issue of Palestine in their Correspondence regarding our Comment.1 We fully agree that the decimation of public health infrastructures in Gaza, along with other crimes against humanity that invariably affect health, should be denounced by all public health professionals.2 We also agree that given the USA's role in financing and supporting the Israeli Government's genocide,3 under both the Biden and Trump administrations, US public health professionals have a special obligation to hold our own Government to account.

[Correspondence] US public health resistance must include Palestine

We were surprised that Palestine is not mentioned at all in the Comment by Alicia Ely Yamin and colleagues on resisting US attacks on public health.1 This omission is baffling since punishing and silencing Palestine advocacy have been central to the Trump administration's attacks on universities.2 Moreover, the public health crisis in Gaza has reached unprecedented levels, with Palestinians facing widespread starvation and infectious disease outbreaks under a completely dismantled health system.

[Correspondence] Safeguarding research integrity: SAGER guidelines, research ethics, and the politics of evidence

The current sociopolitical climate has made science a contested terrain. Polemical rhetoric and attempts to subordinate science to ideology are not only compromising research integrity, but also eroding public trust.1 Gender is central to these contestations: efforts to erase, ignore, and deny identities or politicise gender scholarship undermine scientific accuracy and accountability. Sex and gender, which defy binaries, shape risk exposure, disease manifestation, health-care access, and outcomes.

[Perspectives] Heart of ice

There's a key moment in The Ice Tower when Jeanne (Clara Pacini), its 15-year-old protagonist, stumbles into a film studio looking for shelter from a winter's night. She wanders around the back of the set, bedding down against a backdrop of plain wooden boards, unaware of the opulent fairy-tale landscape on the other side. It is an apt metaphor for the way director Lucile Hadžihalilović's film presents itself to the viewer. This is a film that infers, rather than displays, its exploration of obsession, addiction, and identity.

[Perspectives] Structural intercompetency: an asylum seeker with abdominal pain in Tijuana, Mexico

Daniel, a 45-year-old asylum seeker from Ghana, presented with severe abdominal pain to a medical clinic in Tijuana, Mexico, which provides free primary care services for migrants requesting asylum in the USA. Daniel tells Dr V, an emergency medicine physician from Los Angeles, CA, USA, who volunteers at the clinic, that he experienced persecution for becoming romantically involved with another man. Although he tried to keep the relationship a secret, a group of young men violently attacked Daniel for being gay.