WASHINGTON — Though grain-based foods remain an anchor of US nutrition, the White House’s Make America Healthy Again Commission report singles out ultra-processed grains as among the foods contributing to chronic disease in American children.

The report, released May 22, stems from a February executive order by President Donald Trump that created the MAHA Commission, a group of top administration officials charged with addressing what Department of Health and Human Services Secretary Robert F. Kennedy Jr. has described as a “childhood chronic disease crisis” in the United States. Plans call for the assessment to be followed up within 180 days of the order by a “make our children healthy again” strategy based on the report’s findings.

Ultra-processed foods (UPFs) are identified by the commission as a chief factor behind poor health outcomes in US children. The report cited ultra-processed grains, sugars and fats as driving nutrient depletion, higher caloric intake and food additive consumption, with children “increasingly neglecting the whole foods essential for their health.”

“Most American children’s diets are dominated by UPFs high in added sugars, chemical additives and saturated fats, while lacking sufficient intakes of fruits and vegetables,” the MAHA report said. “This modern diet has been linked to a range of chronic diseases, including obesity, type 2 diabetes, cardiovascular disease and certain cancers. The excessive consumption of UPFs has led to a depletion of essential micronutrients and dietary fiber, while increasing the consumption of sugars and carbohydrates, which negatively affects overall health.”

The report pointed to research finding that UPFs account for about 70% of the 300,000-plus branded food products in grocery stores, half of the calories consumed by Americans (and nearly 70% for children) and more than half of the diets of pregnant and postpartum women.

“The rise in UPF consumption has led to the dominance of three key ingredients in American children’s diets: ultra-processed grains, sugars and fats,” according to the report. “These engineered components, virtually nonexistent a century ago, now account for over two-thirds of all calories consumed by American children. The ultra-processing of these ingredients displaces nutrient-dense whole foods, resulting in a reduction of essential vitamins, minerals, fiber and phytonutrients needed for optimal biological function.”

In ultra-processed grains, cakes, cookies, refined bread, candy and snacks are described in the report as drivers of empty calories and, in turn, weight gain and obesity.

“These grains make up a large portion of the UPF calories that dominate daily intake,” the report said. “Processing grains involves the removal of the bran and germ, which strips away essential vitamins, minerals and fiber. The stripping of these components can lead to blood sugar spikes, increasing the risk of type 2 diabetes while also displacing healthier, nutrient-rich whole grains from the diet.”

The commission also spotlighted ultra-processed grains, sugars and fats for “industrial processing inherent in UPF production,” which the report said leads to “significant changes in fiber, protein, caloric density and digestibility” that foster the incidence of chronic disease.

“Research suggests that these alterations could interfere with brain reward pathways and satiety hormones, promote faster eating and compromise gut fullness signals,” the report said. “The refined ingredients in these foods can rapidly spike blood sugar and insulin levels as well as damage the gut microbiome.”

Enriched, fortified grains absent

Not mentioned in the MAHA Commission report were enriched and fortified refined grains, core contributors to US diet quality and nutrition. Enrichment involves replenishing nutrients naturally found in a food that were lost or reduced during processing, while fortification adds nutrients not naturally found in a food to meet a specific health need.

In a white paper earlier this year, the Grain Foods Research Institute (GFRI) noted that enriched and fortified grains historically have played an integral role in reducing micronutrient deficiency diseases and related health risks while providing an affordable, effective way to raise the intake of underconsumed nutrients and improve diet.

“There continues to be a great deal of misunderstanding — and even lack of informed awareness — about the public health impacts of enrichment and fortification,” Erin Ball, executive director of the Grain Foods Foundation (GFF), GFRI’s sister organization, said in comments on the MAHA Commission report. “We know that food pattern modeling exercises completed by USDA have shown that it is difficult or impossible for some population subgroups to meet targets for certain nutrients without enriched grains in the diet. It’s a missed opportunity that the report does not reflect the important work already being done at USDA.”

Citing National Health and Nutrition Examination Survey (NHANES) analyses, the GFRI paper said enriched and fortified grain-based foods supply a “substantial amount” of the daily intake for micronutrients like thiamin (45%), riboflavin (25%), niacin (28%), iron (38%) and folate (50%). These grains also remain a core source of fiber and are one of the most inexpensive, widely consumed food groups, including staples like bread, rolls, tortillas, pasta, rice and ready-to-eat cereals.

“There’s a significant disconnect between the MAHA report and the progress food manufacturers, especially in the grain category, have made to improve nutrition, including increasing whole grain offerings to support fiber and nutrient intake,” Ball said. “The report overlooks these efforts and doesn’t reflect a strong understanding of the industry or the science guiding product innovation.”

GFRI’s paper noted that refined grains often are misclassified and/or grouped with red and processed meat, sugar-sweetened foods and beverages, fried foods and high-fat dairy products identified as part of an “unhealthy” or “Western” dietary pattern. But when analyzed individually, refined grain intake wasn’t linked to a higher risk of all-cause mortality, type 2 diabetes, cardiovascular disease, coronary heart disease, stroke, hypertension or cancer.

One reason for such misconceptions, the paper said, is that the refined grains category covers a wide range of products, from “staple” grain foods (such as bread, cereal and pasta) that are enriched and fortified — with limited to no saturated fat or added sugar — to “indulgent” grain foods (such as cakes and other baked treats) with higher fat and sugar content.

In addition, observational studies and the Dietary Guidelines for Americans typically haven’t made a distinction between these types of grain-based foods, although most refined grains consumed by Americans are staple grain foods, the GFRI paper said. Less than a quarter are indulgent grain foods, such as flour-based desserts (9.6% of that subgroup), stuffing/breading (5%), quick bread (3.9%), biscuits (2%), pie and pastry crusts (1.9%) and croissants (0.6%). Also, consumption data show that most people are eating indulgent grain foods in moderation.

“Public health folks often use the term ‘refined grains’ to mean what we in the industry understand to be indulgent foods,” Ball said. “GFF has advocated for the use of the terms ‘staples’ and ‘indulgences’ to delineate the roles of each in a healthy diet. And we do — along with our Scientific Advisory Board — believe that there are roles for both staples and ‘treats’ in a healthy dietary pattern. Making this distinction helps support more practical, evidence-based dietary guidance that reflects how people actually eat.”

In response to the MAHA Commission report, the North American Millers’ Association (NAMA) noted the importance of grain-based foods and how the milling process transforms raw grain into flour, cereals and other ingredients used to make a range of nutritious, safe food options available year-round.

“Grain foods are affordable staples that create the foundation for a healthy and balanced diet; both whole and vitamin-enriched refined grain foods are crucial to public health,” said Jane DeMarchi, president of NAMA. “Processing is not a reliable indicator of nutritional value. Instead, we should consider the nutritional profile of individual foods, as well as their specific role in the diet. NAMA continues to partner with the Grain Foods Foundation to better understand the nutritional benefits of our products.”

Science and UPFs

Upon its release, the MAHA Commission report drew broad scrutiny over its interpretations of science and the validity of its supporting research, including sourcing. News media cited instances in the report of non-functioning online links to studies and purported study authors saying they didn’t participate in any such research, leading to claims that the MAHA report was cobbled together using artificial intelligence.

Still, food industry groups said the report provides a basis for further discussion with federal officials.

“We believe the MAHA Commission’s initial assessment serves as a formal invitation for a conversation with the administration,” said Jennifer Hatcher, chief public policy officer at FMI-The Food Industry Association. “It’s a conversation that recognizes the power of public-private partnerships in helping consumers make informed food choices from among the 32,000 options available to them when shopping in the average grocery store. FMI members have always been part of the solution, and we will advocate for realistic policies that are grounded in science, nutrition and consumer needs.”

NAMA’s DeMarchi called for more industry collaboration following the MAHA report.

“As the MAHA Commission’s work moves to the recommendation and implementation stage, NAMA seeks opportunities for food and agricultural stakeholders to engage in support of science- and risk-based decision making, which have been the hallmarks of the US regulatory system,” she said.

Informing and educating policymakers “remains critical,” GFF’s Ball said.

“There may be wisdom in having these conversations with members of Congress and their staff who influence national nutrition policy, rather than going directly to HHS at this time,” she said. “Groups like ABA (American Bakers Association) and NAMA are wisely and carefully navigating a politically complex and evolving conversation about food ingredients.”

Indeed, the MAHA report’s focus on UPFs could further inflame the negative dialogue around processed foods already impacting large packaged food companies, said TD Cowen food analyst Robert Moskow.

“The negative news flow from the administration reinforces the concerns we have expressed about consumers losing trust in the quality of big processed food brands,” Moskow said in a May 27 research note. “The increasingly mainstream use of the term UPF is particularly damaging, because it targets the industrial manufacturing process itself rather than just the ingredients. This will make it significantly more difficult for food companies to improve their reputation through ingredient reformulation alone.”

UPF remains a nebulous term at present, Ball said.

“There is a great deal of imprecision in the use of the term ‘ultra-processed,’ and the science in this area is not yet mature enough to responsibly describe the category, if that is even possible,” she said, adding, “Work must continue to further define — or debunk — the category of ‘ultra-processed foods.’”