Isocaloric replacement of ultraprocessed foods was associated with greater weight loss in the POUNDS Lost trial

Objective

Higher intake of ultraprocessed foods (UPFs) is associated with obesity. We examined whether replacing UPFs (NOVA 4) with minimally processed foods and culinary ingredients (NOVA 1 + 2) was associated with differential weight change in this secondary prospective analysis of the Preventing Overweight Using Novel Dietary Strategies (POUNDS) Lost trial.

Methods

We estimated percent energy intake (%kcal) from the four NOVA groups using 24-h dietary recalls in a subset of 356 participants. Multivariable-adjusted substitution models examined whether replacing %kcal from UPFs with NOVA 1 + 2 was associated with greater weight, body fat percentage, trunk fat, and waist circumference reduction at 6 months; changes in parameters were compared among NOVA 1 + 2 tertiles (T).

Results

Participants were on average 52.3 years of age, 85% White, 55% female, and 58.2% nonsmoking, with a mean BMI of 32.7 kg/m². Replacing 10%kcal of UPFs with NOVA 1 + 2 was associated with greater 6-month weight (ß = 0.51, 95% CI: −0.93 to −0.09, p = 0.02), body fat percentage (ß = 2.7, 95% CI: −5.10 to −0.43, p = 0.02), and trunk fat reduction (ß = 3.9, 95% CI: −7.01 to −0.70, p = 0.02), but not waist circumference reduction. Participants in T3 (−8.33 kg) versus T1 (−5.32 kg) of NOVA 1 + 2 had greater weight loss (p < 0.001).

Conclusions

Isocaloric substitution of UPFs with NOVA 1 + 2 was associated with marginally greater weight loss under energy restriction. These modest findings support more research exploring the mechanisms linking UPFs with body weight regulation beyond energy intake.