Brazil's Hospitals Lead the Fight Against Ultra-Processed Foods
Every month, dozens of staff from leading hospitals in São Paulo take time from their busy schedules to visit food fairs where over 50 local farmers display their produce. Their goal: to strike deals that supply hospitals with organic vegetables, homemade bread, and other locally made foods. This initiative, launched in October 2023, is part of a revolutionary scheme to phase out ultra-processed foods (UPFs) from hospital menus.
Weruska Davi Barrios, a hospital nutrition specialist at the University of São Paulo, explains that the fairs are attended not only by cooks and nutritionists but also by nurses and doctors. These events allow hospitals to order vegetables, fruits, herbs, and spices, and to sample artisanal delicacies made from unique plant species native to Brazil's diverse ecosystems. Many of these plants have been threatened by deforestation but are now being preserved by local farmers.
While Brazilian hospitals have always tried to use fresh vegetables, UPFs have increasingly infiltrated menus despite evidence of their harmful health effects. A 2019 study estimated that 57,000 premature deaths in Brazil each year are linked to UPFs. Ana Duran, an epidemiologist at the University of Campinas, finds this troubling: "We're using our national health system funds to buy ultra-processed foods. That should not be acceptable."
Transitioning to fresh food requires building hospital kitchens, investing in cold storage, creating transport networks, and educating staff and patients. "Change is gradual," says Barrios. "As more local foods enter the purchasing plan, fewer UPFs will be needed." The idea has gained political backing. Daniel Soranz, Rio de Janeiro's health secretary, announced at a recent conference that the city aims to eliminate processed foods from all hospitals within eight years. "In two years, 30% of our hospitals will no longer use ultra-processed food," he stated.
A federal bill prohibiting UPFs in hospital meals is also progressing through the senate. If passed, Brazil would become one of the first countries to implement such a policy nationally. However, this requires overcoming logistical challenges, industry opposition, and public skepticism.
Brazil has already succeeded in reshaping children's nutrition in schools. Since 2020, restrictions on UPFs in schools have tightened. A new law requires 45% of school funding to buy food from local farmers, and by 2026, UPFs must make up no more than 10% of school menus. In Rio de Janeiro and Ceará, they are completely banned. At EDI Gabriela Mistral primary school, meals now include rice, beans, fruit, oatmeal, and homemade bread, replacing packaged cookies and chocolate milk.
The transition faced resistance. School principals worried about costs and storage, while cooks feared children would reject healthier options. Surprisingly, parents opposed the changes, concerned that healthy school meals would create expectations at home. "We heard mothers saying, 'I don't have time to cook,'" says Duran. Some parents also view being overweight as healthy, a legacy of past hunger and malnutrition.
Despite pushback, positive signs emerge. Duran's research shows children in compliant schools consume fewer UPFs overall, even at home. Officials in Rio will begin an initial assessment of health impacts later this year. Carlos Monteiro, the nutrition professor who coined the term ultra-processed foods, notes that Brazil's approach arose from necessity: rates of overweight five- to nine-year-olds rose from 13.4% in 1989 to 33.4% in 2008.
Paula Johns, co-founder of ACT Health Promotion, advocates restricting UPF marketing, but this faces political hurdles due to the influence of food advertising on media and industries. Instead, her organization aims to limit children's exposure to UPFs through other means, such as a proposed law in Niterói to ban UPFs from supermarket shelves below 1.5 meters. "They are always at children's eye level," she says. "To create a healthy food environment, we must push back against manipulation."
Starting small, Couto's Desiderata Institute hopes to set a precedent. "We're starting in Niterói, a small city," she says. "If approved, we can move to Rio and ask why the capital hasn't adopted it. Politicians have pride; they want to keep up with latest policies. Vanity is something we have to use."
