Reducing Ultra-Processed Food (UPF) intake: A systematic review of intervention strategies and content

Background: High intake of ultra-processed foods (UPFs) is associated with adverse health outcomes, yet the effectiveness of behavioural interventions aimed at reducing UPF consumption have not been systematically reviewed.Objectives: To evaluate the effectiveness of behavioural interventions targeting UPF intake reduction, identify behaviour change techniques used, describe delivery characteristics, and explore features associated with greater reductions.Methods: A systematic review of behavioural interventions measuring UPF intake using the Nova classification was conducted. Eligible studies included trials and pre-post studies published from 2009 onwards. Six databases were searched to June 2025. Seventeen studies were included (15 with outcome data, 2 protocols), including one pilot randomised controlled trial and three feasibility or pilot studies. Risk of bias was assessed using an adapted Mixed Methods Appraisal Tool. Data were extracted on outcomes, BCTs, and delivery mode.Results: Seven out of fifteen studies reported significant reductions in UPF intake (kcal/day or % energy), fewer UPF servings, or greater adherence to low-UPF diets. Three reported within-group improvements, and five showed mixed or null effects. Six studies reported improved anthropometric outcomes; two showed improvements in metabolic markers. Effective interventions consistently included instruction and health-related information, alongside self-regulatory techniques such as goal setting, self-monitoring, feedback, and action planning. Delivery formats varied (in-person, digital, hybrid), with no consistent association with effectiveness. Risk of bias was generally moderate to high.Limitations: Evidence was limited by study heterogeneity, risk of bias, and incomplete reporting of implementation outcomes.Conclusions: Behavioural interventions show potential to reduce UPF intake, although evidence remains mixed. Future research should improve reporting of implementation processes and assess long-term sustainability.Registration: PROSPERO CRD42024591327.KEYWORDS: Ultra-processed foods, Behaviour change interventions, Dietary behaviour, Diet quality, Behaviour change techniques