Background: Ultra-processed food consumption is linked to adverse health outcomes, including cardiovascular disease, obesity, and certain cancers. These negative effects disproportionately impact marginalized communities, particularly those with lower socioeconomic status, where access to healthier alternatives is often limited. Yet, there is limited research on consumer perceptions of the relationship between food processing and healthfulness. This study aimed to assess consumer perceptions, evaluate their accuracy against objective classification systems, and examine how perceived food processing influences purchasing decisions, with a focus on understanding how socioeconomic and demographic factors shape these perceptions.

Methods: A cross-sectional study was conducted among low-socioeconomic status consumers (n = 101) in Washington DC. Participants rated 18 food products on a 100-point scale for perceived healthiness and processing level. Spearman’s correlation compared subjective ratings with objective measures from the Nutri-Score and Nova classification systems.

Results: Positive correlations were found between objective scores and participant ratings for healthiness (r_s = 0.63, p < 0.001) and processing level (r_s = 0.71, p < 0.001). Cost, taste/flavor, and healthiness were key factors in purchasing decisions. Ingredients, nutrition facts, and price were crucial in healthiness assessments.

Conclusions: Participants generally perceived more highly processed foods as less healthy, though inconsistencies existed in distinguishing between processed and ultra-processed foods. Cost was reported to have significant influence both purchasing decisions and healthiness assessments. The findings suggest that interventions could focus both on raising awareness about processing levels and promoting affordable, minimally processed alternatives, particularly in food-insecure communities. This approach may help support healthier food choices.