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BackgroundChildren and adolescents in the USA consume large amounts of daily calories from ultraprocessed foods (UPFs). Recent evidence links UPF consumption to increased body fat in youth. We aimed to estimate the potential impact of reducing UPF consumption on childhood obesity rate in the USA.MethodsWe developed a microsimulation model to project the effect of reducing UPF consumption in children’s diet on reducing the prevalence of overweight or obesity among US youth. The model incorporated nationally representative data on body mass index (BMI) percentile and dietary intake of 5804 children and adolescents aged 7–18 years from the National Health and Nutrition Examination Survey 2011–2016, and the effect of reducing UPF consumption on calorie intake from a recent randomised controlled trial. Uncertainties of model inputs were incorporated using probabilistic sensitivity analysis with 1000 simulations.ResultsReducing UPFs in children’s diet was estimated to result in a median of −2.09 kg/m2 (95% uncertainty interval −3.21 to –0.80) reduction in BMI among children and adolescents aged 7–18 years. The median prevalence of overweight (BMI percentile ≥85th) and obesity (BMI percentile ≥95th percentile) was reduced from 37.0% (35.9%, 38.1%) to 20.9% (15.1%, 29.9%) and from 20.1% (19.2%, 21.0%) to 11.0% (7.86%, 15.8%), respectively. Larger BMI and weight reductions were seen among boys than girls, adolescents than children, non-Hispanic black and Hispanic youth than non-Hispanic white youth, and those with lower levels of parental education and family income.ConclusionsReducing UPF consumption in children’s diet has the potential to substantially reduce childhood obesity rate among children and adolescents in the USA.

OBJECTIVES: With the rise in production and consumption of ultra-processed foods (UPF), children in the US consume a significant amount of total daily calories from UPF. High UPF consumption can contribute to obesity among US children through excessive calorie intake from UPF.(1) We aimed to estimate the potential impact of reducing UPF consumption on childhood obesity in the US. METHODS: We modelled a nationally representative cohort of 5804 US children ages 7–18 years with weight, height, body mass index (BMI) percentile, and UPF consumption estimated from the National Health and Nutrition Examination Survey (NHANES) 2013–2016. From the reported difference in ad libitum calorie intake between individuals consuming a UPF vs. non-UPF diet in a randomized controlled trial, we estimated that children reduce their proportion of calories from UPF by 17% when switching to a non-UPF diet. Under this assumption, we projected weight loss based on estimated weight reduction due to calorie reduction in children accounting for potential changes in energy expenditure and appetite.(2) We compared the current and modelled BMI distribution and prevalence of overweight and obesity by age (7–11 and 12–18 years) and sex (boys and girls). NHANES survey weights were used to estimate the mean BMI and prevalence of overweight and obesity among US children. Uncertainty of model inputs were incorporated using probabilistic sensitivity analysis with 1000 simulations. RESULTS: Under this scenario, the median (95% UI) of weight-adjusted BMI among US children ages 7–18 years old was 20.2 kg/m(2) (19.7, 20.8), corresponding to a −1.74 kg/m(2) (–2.67, −0.67) reduction in BMI. The median (95% UI) prevalence of overweight (BMI percentile ≥85(th)) and obesity (BMI percentile ≥95(th) percentile) was reduced from 37.2% (36.1%, 38.3%) to 23.3% (17.8%, 31.4%) and from 20.2% (19.3%, 21.1%) to 12.3% (9.3%,16.9%), respectively. Adolescent boys (–1.87 kg/m(2): −2.42, −1.32) experienced the largest reduction in BMI, followed by adolescent girls (–1.73 kg/m(2): −2.24, −1.22), boys ages 7–11 years (–1.66 kg/m(2): −2.15, −1.17), and girls ages 7–11 years (–1.62 kg/m(2): −2.10, - 1.15). CONCLUSIONS: Reducing current levels of UPF consumption among US children has the potential to reduce the childhood obesity rate in the US to a great extent, especially among adolescents. FUNDING SOURCES: NIH/NIMHD.