There is growing public health interest in ultra-processed foods (UPF), but limited research exploring consumers’ perceptions of these foods in the United States. We aimed to characterise consumers’ beliefs about UPF, the association between perceived food processing and perceived food healthfulness and alignment between consumers’ perceptions and objective measures of food processing and healthfulness.

In a cross-sectional survey, participants answered questions regarding their beliefs about UPF. They rated the healthfulness and processing levels of a random selection of ten out of forty possible foods. We used descriptive statistics to examine participant beliefs about UPF. We used linear regression models to test associations between perceived processing and perceived healthfulness and between objective and perceived measures of food healthfulness and processing.

We fielded an online survey in the USA in November 2023.

This study included US adults aged ≥ 18 years (n 4455).

Fifty-four percent of participants correctly identified UPF as ‘Food products submitted to a series of industrial processing’ and 52 % correctly identified UPF as, ‘Food products that contain artificial ingredients’. However, one-third of participants believed UPF were genetically modified products. While foods with higher perceived processing tended to have lower perceived healthfulness and individuals perceived UPF as more processed and less healthful than minimally processed foods, healthfulness perceptions better aligned with Food Compass 2.0, a measure that integrates food processing and nutrient-profile.

Educational and policy efforts (e.g. food labeling) are needed to help consumers distinguish UPF and holistically assess the healthfulness of foods and beverages.