Policy Update

So Long Supersize By Lainey Younkin, RD

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Mayor Michael Bloomberg’s at it again. He has banned smoking in restaurants and public parks, banned the use of artificial trans fats in restaurants, and mandated that chain restaurants post calories on menus. Public health and nutrition are top priorities for the New York City (NYC) mayor who caused an uproar with his most recent proposal to ban sugar-sweetened beverages.

Restaurants, delis, and entertainment venues such as sports arenas in NYC will not be able to sell certain sugary beverages in containers over 16 ounces. No bottled sugary beverages over 16 ounces can be sold at these locations either. Vending machines and grocery stores are exempt from the mandate.

Bloomberg’s proposal excludes drinks that have fewer than 25 calories per 8-ounce serving such as diet drinks and zero-calorie Vitamin Water. Fruit juice (at least 70 percent juice), dairy-based drinks (including milkshakes), and alcoholic beverages are also exempt from the ban, which could become effective in March 2013.

So what’s all the fuss about? Is the proposal too extreme, as many in the media and public have argued? It depends on whom you ask.

The Bloomberg administration views the proposed ban as an effort to combat rising rates of obesity and diabetes. Less than 20% of U.S. adults were obese 20 years ago. Now over 1/3 of U.S. adults are obese. Similarly, since 1990 there has been a 61% increase in new cases of type 2 diabetes. Consumption and size of sugary beverages has also increased. In the 1950s the average size of a soda was 6.5 ounces. Now it’s between 12 and 20 ounces. Soda was once viewed as a treat. Now over half of Americans consume sugary drinks daily, accounting for 7% of calories in the average American diet. While the relationship between rising soda consumption and rising obesity may not be causal, many scientists agree that sugary beverages contribute a significant number of non-nutritive, or empty, calories to Americans’ diets.

Some opponents of the ban are the American Beverage Association and soft drink companies, who say that the mayor cannot single out sugar as the sole cause of obesity. They have a point. Obesity is a multi-factorial condition related to diet, activity, genetics, and the environment. While Mayor Bloomberg acknowledges these factors, he claims he is about doing something. He wants to take proactive steps that will lead to positive behavior change. His track record proves this to be true (banning trans fats in restaurants and mandating calories be posted on menus at chain restaurants).

However, Coca-Cola says the ban is not needed because they, like other companies, already post calories on the front of their products. “New Yorkers expect and deserve better than this. They can make their own choices about the beverages they purchase,” Coca-Cola said in a statement responding to the ban. Many consumers agree.

Much of the public backlash has been from people who claim the ban takes away the freedom to choose. They suggest that an alternative and more successful approach would be to educate the public to make healthful choices. The Academy of Nutrition and Dietetics takes this stance stating that the evidence supporting the effectiveness of such bans is not strong enough. Academy President Sylvia Escott-Stump says, “To date, most bans and taxations like the New York proposal are based on theoretical models. There is conflicting research on whether these programs actually result in behavior change that leads to positive health outcomes.” The Academy has developed a working group that will study how such bans and taxes affect consumers’ purchases and health behaviors.

But, is education alone enough to reduce obesity? Nutrition education gives people nutrition knowledge and empowers them to make decisions based on that knowledge. However, often people know what they are supposed to do but they don’t do it. This is when people begin to argue that education is not enough to lead to behavior change. People argued that education was not enough to significantly reduce smoking in the U.S. and claimed it was not until strict regulations were enacted that the number of smokers declined. Is the country moving in a similar direction to target the rising rates and costs of obesity? Either way, bans might be a unique and effective way of educating the public. Dr. Alice Lichtenstein, professor at the Friedman School, says, “One benefit of all the hype caused by the caloric beverage size limit is that it is raising awareness.” Perhaps increasing the public’s awareness will lead people to make healthier choices. Through the hype, people might learn about the number of empty calories in sugary beverages, appropriate portion sizes, or less sugary alternatives.

In contrast to a ban, Dr. Brian Wansink, professor at Cornell University, suggests rewarding people for healthy choices instead of punishing them for unhealthy ones. He says, “By working with these [soft drink] companies, New York City could discover new ways to better promote lower-calorie options—while consumers deride bans, they love promotions. Encouraging greater sales of healthier beverages—using a carrot instead of a stick—would be welcomed by struggling retailers and manufacturers alike.”

There is no one answer to the obesity epidemic, Dr. Lichtenstein reiterates, but she says the ban could be a small step in the right direction, “The etiology is different for different people. For some, they will consume the entire amount of whatever is available at any one time and not really think about portion size. For those individuals, even if a ban on large size caloric beverages cuts 50 kcal/day, it will add up to a significant amount in the long run.” For people who want to drink more than 16 ounces in one sitting, they still could. There will still be the option of buying another beverage or, depending on the place, getting a refill because currently the proposal does not prohibit refills.

Interestingly, Mayor Bloomberg’s past policies received similar hype when they were proposed. Then they spread beyond NYC. In 2010, the federal government required all chain restaurants of 20 or more locations to post calories on their menus. Many restaurants began voluntarily cutting trans fats from their kitchens – either because consumers no longer wanted them or because the restaurants anticipated a national ban down the road.

Mayor Bloomberg’s proposal to ban sugar-sweetened beverages is beginning to expand past NYC as well. Mayor Henrietta Davis of Cambridge, Massachusetts, announced on June 19 that the city is considering a similar ban. However, due to the current backlash from beverage associations, businesses, and the public, the council will wait to see how the situation unfolds in New York.

The proposed ban in New York City has the obesity epidemic in the spotlight once again. For some, it has been frustrating and frightening that the government could start dictating what they eat and drink, much as they have regulated tobacco and alcohol in the past. For others, the ban represents a step in the right direction towards cutting calories in Americans’ diets. It is important that nutrition and public health professionals be sensitive to the public reaction to such interventions and that they quickly establish good public relations to dampen backlash. Maintaining good relations between public health professionals and the public will ensure that effective interventions can be enacted in the future. Time and more scientific studies will give insight into the most effective approaches to reducing obesity. It’s likely the answer will not be one (education) or the other (bans) but instead an integration of the two. In the meantime, as Mayor Bloomberg said, someone is going to do something about it.

*Sources available upon request

Lainey Younkin, RD just finished her first year in Nutrition Communication at the Friedman School.  She is enjoying a summer in Europe working for the European Food Information Council (www.eufic.org) and traveling to many countries. 

The Friedman Sprout is a monthly student run newspaper that aims to serve the student population at the Friedman School of Nutrition Science and Policy, prospective students, and alumni. Our mission is to report on newsworthy information that affects the Friedman community including nutrition research, food policy, internship and volunteer opportunities, as well as school events. Our editorial slant is that of sustainability in food and nutrition.

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