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March 2026 (Volume 104)
Quarterly Article
Ashley N. Gearhardt
Kelly D. Brownell
Allan M. Brandt
June 2026
September 2025
June 2025
Back to The Milbank Quarterly
Policy Points:
Context: Ultraprocessed foods (UPFs) now dominate the global food supply and are strongly associated with risks for heart disease, cancers, metabolic disease, diabetes, and obesity. UPFs are likely associated with rates of neurologic issues such as dementia and Parkinson’s disease and predict premature death. Drawing on the history of tobacco regulation, we examine how the design, marketing, and distribution of UPFs mirror those of industrial tobacco products. Such information speaks to the sophistication and aims of food product manipulation and its consequences.
Methods: This review synthesizes findings from addiction science, nutrition, and public-health history to identify structural and sensory features that increase the reinforcing potential of both cigarettes and UPFs. We focus on five key areas: dose optimization, delivery speed, hedonic engineering, environmental ubiquity, and deceptive reformulation.
Findings: Cigarettes and UPFs are not simply natural products but highly engineered de-livery systems designed specifically to maximize biological and psychological reinforcement and habitual overuse. Both industries have used similar strategies to increase product appeal, evade regulation, and shape public perception, including adding sensory additives, accelerating reward delivery, expanding contextual access, and deploying health-washing claims. These design features collectively hijack human biology, undermine individual agency, and contribute heavily to disease and health care costs.
Conclusions: UPFs should be evaluated not only through a nutritional lens but also as addictive, industrially engineered substances. Lessons from tobacco regulation, including litigation, marketing restrictions, and structural interventions, offer a roadmap for reducing UPF-related harm. Public-health efforts must shift from individual responsibility to food industry accountability, recognizing UPFs as potent drivers of preventable disease.