Yesterday, New York City Mayor Michael Bloomberg announced a ban on sales of sugary drinks larger than 16 ounces in restaurants, delis, sports arenas, and movie theaters.
The reactions have been ferocious, and not only from the soda industry, which placed an ad in the Times (see below).
The New York Times also weighed in with an editorial arguing that the mayor has now gone too far and should be sticking to educational strategies.
Alas. If only educational strategies worked. But they do not.
We know this from what it took to discourage people from smoking cigarettes. We also know this from research on eating behavior. This shows that it doesn’t take much to get people to eat too much.
Just barrage us with advertising, put food within arm’s reach, make food available 24/7, make it cheap, and serve it in enormous portions.
Faced with this kind of food environment, education doesn’t stand a chance.
That’s the point the Mayor’s proposal is trying to address, however clumsily. After all, a 16-ounce soda is two servings.
Sugary drinks—especially large ones—make sense as a target for a portion size intervention.
- They have calories but no nutrients (“liquid candy”).
- The larger the serving size, the more calories they contain.
- They are widely consumed, often to the extent of hundreds and sometimes thousands of calories a day.
- Research links them to obesity (people who habitually consume sugary drinks tend to have worse diets and weigh more than those who don’t).
- People tend to drink the amount that is in the container.
The sugary drink industries have much to answer for their role in obesity promotion.
- They put billions of dollars into advertising, much of it directed to children and minority groups.
- They lobby Congress and federal agencies to prevent laws and regulations that might affect sales.
- They co-opt health organizations to neutralize criticism (hence: the Academy of Nutrition and Dietetics’ advice to focus on “education and moderation”)
- They attack public health professionals who advise “don’t drink your calories.”
- They attack the science and make it appear confusing (see the ad below, which does not mention studies that show otherwise).
- They price drinks to favor the largest size servings; an 8-ounce soft drink costs much more per ounce than a 2-liter bottle.
If the Beverage Association really wanted to help Americans eat more healthfully, it could change all of those practices.
The Mayor is committed to improving the health of New Yorkers and is trying to figure out ways to do that.
Beverage companies are interested in one thing and one thing only: the financial health of beverage companies. And they have convinced many Americans that the financial health of beverage companies trumps public health.
Education? I’m for it if it’s focused on educating the public how beverage companies really operate.
Addition: The New York City Health Department has been collecting endorsements from public officials and health advocates and is posting them online. I’m in good company.
Marion Nestle is the author of What To Eat and is the Paulette Goddard Professor of Nutrition, Food Studies, and Public Health at New York University. Nestle blogs regularly at Food Politics.
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christina, me and YOU may be in control but we are paying for the people not in control. People should be in control of the amount and place they drink alcohol but given the DUI enforcement and taxes necessary to control those not in control it is just naive to think the answer is “just say no”. Taxing sugar does not prevent people from consuming it, it just pays for societal costs of the irresponsible.
“YOU are in control.”
Yes, I am but for every one of me (or you) there are 1000’s of people not in control and we’re all paying for them. Do you suggest we legalize drugs because people “should” be in control? We should stop taxing alcohol and road side DUI enforcement because, “you are in control”? The fact is we should all be responsible, but that’s why we have laws and cops and courts and jails because too many people are not, and they effect us all.
The junk food industry is no better than your local drug cartel in the harm they cause over time to people’s health. Difference is drug cartels don’t get a stock symbol.
“Do you care that the junk food industry and irresponsible people are driving up your health care costs, both private and tax supported?”
No food industry drives up your health care cost – YOU are in control. Your need for additional health cares depends on your genes, what you eat, how much you exercise, what you smoke, what your life style issues are, etc.
Then incentivize the good choices. There is a chasm of difference between good regulation and bad; between personal responsibility in choice and banning products that are not, inherently, “bad” (at least not compared to plenty of carcinogenic substances, chemicals, or weapons). Your mention of “personal responsibility” is a red herring; outright bans remove the consequences of choice entirely from the conversation. You’re right – we cannot have it both ways – but bans like this ignore the obvious choices to the greatest extent.
The intention is good but I think personal responsibility is absolutely critical in how a society operates. Taking away this personal responsibility sends the wrong message that obesity is cause by others and the obese. I know some people became obese out of something beyond their control but most people that are obese just eat too much food. If you stop the large soda, are you going to stop them from eating double portion food servings.
“let’s license, tax and insure every bike rider, just as I, as a car owner, am.”
Nanny State?
“And when they get injured in accidents (which is near inevitable), or cause accidents, I wind up paying their healthcare costs too.”
The ACA wants a health insurance mandate to make sure there are no free riders. Would that be, “nanny state”?
“What a bunch of Health Fascists here! Not a single mention of all that can be done to have positive reinforcement of good behaviors and health habits.”
Education never worked for smoking and education is easily out gunned by corporate advertising. Applying a visible sugar tax would remind the buyer every time they buy about the harmful effects sugar consumption. It would also be the ultimate conservative personal responsibility solution, paying for your own bad habit to compensate society for the cost.
Deetelecare –
Sorry but education programs are unlikely to work. Most overweight people from high school dropouts to PhD’s already know that if they want to lose weight, they need to eat less and exercise more. They know that fruits and vegetables are healthy while soda, cake, pie, ice cream, chocolate, etc. aren’t. Plenty of doctors here have commented that even when you bring up the need to lose weight in a tactful and non-judgmental manner and explain the health benefits from doing so, patients tend to get defensive.
Exercise such as walking on a treadmill or using a stationary bike or elliptical machine is both boring and time consuming. If you’re not athletic or are somewhat uncoordinated, just about any sport is frustrating and not fun. When I spend 40 minutes on my stationary bike at a respectable speed, I burn all of about 500 calories. It doesn’t take a big piece of cake or pie or bowl of ice cream to consume that amount of calories or more in just a few minutes and doing so is pleasurable.
Some obese people don’t get the signal from their brain that they’ve had enough to eat until they’ve eaten way too much. Others go to Weight Watchers to no avail. People with low incomes may live in unsafe neighborhoods and don’t have a safe place to exercise even if they want to while healthy foods can be expensive if they’re available at all nearby.
I think taxation is the best approach to encourage people to consume less unhealthy food. The problem, aside from the power of affected interest groups in the food industry, is that it’s hard to design a tax that can be fairly applied and efficiently administered. Taxing sugar and high fructose corn syrup would be a start but what about foods with lots of fat and / or sodium? They’re pretty unhealthy too.
High taxes have dramatically reduced cigarette consumption and, to a lesser degree, alcohol as well. In Europe, high gasoline taxes cause people to drive tiny cars or mopeds or even bicycles and to use public transportation where feasible. If there are certain products that we should encourage people to consume less of, the best way to do that is to impose a tax that would have a big enough impact on prices of goods that contain those products to get people’s attention.
What a bunch of Health Fascists here! Not a single mention of all that can be done to have positive reinforcement of good behaviors and health habits. Just tax it, prohibit it and otherwise Nanny State it–and develop a nice underground economy of prohibited, overtaxed foods. And none of this prevents children especially from developing bad habits.
Positive reinforcement can be downright old-fashioned. If insurers and healthcare organizations are concerned about cost, then they should work to bring costs down. What about insurers sending speakers to schools on ‘food ed’ and street teams out into communities to encourage consumption of healthy foods…to Rotaries and Chambers of Commerce to ask that store owners curb their own merchandising of sodas and snack foods, and to put out healthier items (and smaller sized snacks)–offering lower business insurance premiums in return for performance. Insurers could do the same with snack food mfgs. and bakers–less sugar and corn syrup, lower premiums. Insurers and health organizations could sponsor sports teams and walking clubs for all ages…social networks for health….and celebrities of all ages to advocate healthy lifestyles and ‘don’t do this, do this’ as role models? Video game and computer manufacturers (two leading causes of sedentary behavior) could also advocate and sponsor sports and activities. Add social gaming and networking to this–where’s the Farmville for weight loss, eating and exercise? The problem ain’t just soda….and we should stop Federal/state subsidizing of the production of corn syrup and sugar cane.
@ Peter1–you haven’t seen erratic, ‘I own the road and the hell with the lights and pedestrians’ bike riders like here in NYC. I’ve seen pedestrians hit and nearly been so myself crossing the street on a green light. Speaking of taxes, let’s license, tax and insure every bike rider, just as I, as a car owner, am. They use the roads, gulp the air and otherwise create a traffic nuisance for cars and pedestrians. Why should they have a free ride? And when they get injured in accidents (which is near inevitable), or cause accidents, I wind up paying their healthcare costs too.
@David MD Where do the taxes on soda go? To increased general government spending, just like tobacco taxes. And why stop there? Let’s tax doughnuts (with which Bloomberg stuffed his face on National Donut Day), cake, cupcakes and ‘vitamin water’! Haven’t a clue why Pepsi even stays in Purchase NY in this failed state.
How about this? Let’s turn it back to something like influencing individual choices. Let obese people pay their fair share of their own healthcare directly through higher premiums. Let’s find other ways of changing behavior, such as encouraging moderation in consumption of all food and increasing exercise, which are the CORE PROBLEMS, not specific foods. At the end of the day, we may have fewer obese people, and a more healthy general population.
“Filling potholes, snow clearance and road paving is more important than bike lanes.”
Only if you’re a car driver. Each bicycle is one less car to clog the road and damage pavement. Probably not many bike riders are obese as are more large soda drinkers. Cities are there to serve a varied population and trying to keep all the taxpayers wanting services happy is a juggling act.
“People might drink less if it were the latter”
It would certainly increase the price (same as tax?) also given that domestic sugar is tariff protected. The Aussies call Florida sugar cane growers the “Sugar Mafia”.
@deetelecare, taxing and regulating the use of sugar added beverages (as we have raised the cost of cigarettes through taxes) is the only pragmatic, workable way to implement reform to reduce obesity, a bill that we all must pay. As I pointed out earlier, the current Bloomberg (really NYC Dept of Health) efforts to limit sugar-added-water drink size was taken because Pepsi, whose HQ is in NY State, threatened to move their HQ outside of the state when taxes on sugar-added beverages was proposed.
The “sugar-added water” tax should not be a political problem to pass in any state but NY State and George (Atlanta is the HQ of Coca Cola).
@ DavidMD, I have a very workable cure for high healthcare costs: 100% individual purchase and get employers, the Feds and the states out of it. Individuals can join buying groups, but everyone gets a bill. Plans are national and not state based. AND costs are based on individual history, not state set rates, just like home and car insurance are. You will find that people suddenly become savvier shoppers, have the incentive to improve behaviors, better their health and thus lower their bills. What we have in place now is NOT WORKING and fiddling with it won’t fix it.
Bloomberg, as he is on most things such as bike lanes, has no concept of the proper functions of government or how best to use a shrinking budget, now that Wall Street is fleeing his Luxury City. That is, fixing things like water mains and supply pipes that waste thousands of gallons a day maybe is more important to public health than the size of soda servings. Filling potholes, snow clearance and road paving is more important than bike lanes. Most of all, crime is increasing in small but measured ways all across the city. But stuff like this, which is critical to quality of life, unglamorous, and he is a bored short man, in more ways than one.
@Barry Carol, the sugar used in drinks is all high fructose corn syrup, not sugar cane. People might drink less if it were the latter because it metabolizes better, and satisfies with one serving.
Mayor Bloomberg is a very smart guy and he’s done a lot of good things for New York City. However, he can be a bit too sanctimonious at times. His sugary drink proposal falls into that category, in my opinion.
Anti-tax conservatives are fond of saying that if you tax something you get less of it and if you tax it more you get even less. I think that’s exactly what we want or at least should want when it comes to sugar consumption. Cigarette consumption is way down from what it was 30 to 40 years ago, in large part, because of higher cigarette taxes. We should pursue the same approach with sugar, ideally at the federal level.
Ironically, the U.S. sugar growing lobby has succeeded in keeping sugar prices artificially high by convincing our government to impose tariffs on lower cost foreign sugar. From a health standpoint, that’s a good thing. Let’s tax sugar to mitigate obesity driven healthcare costs and to allow the price of products that contain sugar to reflect the full social cost of producing them.
Partnership for Quality Care Endorses Mayor Bloomberg’s Initiative on Sugary Drinks http://www.pqc-usa.org/news?id=0061 #healthychoices
No one asked government to take on healthcare finance. It is little more than political pork. Get government out of healthcare finance and leave people to their own devices.
People complain about high health care costs yet much of these costs are from obesity.
Average caloric intake has increased by 300 calories — 150 of that from sugar added beverages. One in three adult New Yorkers consume at least one sugar-added beverage per day.
20 years ago 10 oz bottles were the norm in vending machines amounting to 26 lbs of sugar a year if one bottle was consumed daily. Today there are 20 oz bottles amounting to 52 lbs of sugar (one per week) if consumed daily.
CDC Director Tom Frieden, MD, MPH recommends a tax for sugar-added beverages.
http://www.nejm.org/doi/full/10.1056/NEJMp0902392
Such a tax failed in the NY State legislature because Pepsi, headquartered in NY State (White Plains) threatened to move their HQ elsewhere if the tax was imposed.
Don’t think “nanny state” rather think, “those people who through behavior increase their health care costs should not shift those costs onto others.”
“I’d much rather target specific at-risk populations for intervention/education (let’s go borough by borough, medical history, BMI and so forth) and get help to the people that need it directly.”
So you want to single out and discriminate against people with high BMI? I get your point, but your suggestion may be as bad as Bloomberg’s … heavy people might just circle the wagons, many of them are doing it right now (e.g. a lot of individuals who get very defensive if not testy when the subject is just raised in a supportive, nonjudgmental manner and environment.
One part of a multifaceted approach that IMHO would be very effective and easy to defend is to single out a couple of modifiable risk factors proven to bring up HC costs (smoking, obesity, ? maybe also severe repeated noncompliance with diabetes and hypertension care) and to let people share the increased cost they incur. We would be doing sthg similar to what car insurances do.
I get the idea here and support the sentiment, but pretty sure the Bloomberg proposal is likely to do more harm than good. Opponents will trundle out the “nanny state”/”you’re taking away my cheeseburger” line. The slippery slope argument clearly applies.
What’s to stop Mayor B from taking away the toppings on my pizza? Regulating the size of my beer? Mandating that I get enough sleep at night?
Limiting my overuse of gadgets?
I’d much rather target specific at-risk populations for intervention/education (let’s go borough by borough, medical history, BMI and so forth) and get help to the people that need it directly.
I’m not sure that we have the will needed to do that, though. And more’s the pity.
John Irvine
Its easy to argue that Gov’t should not play a role in “choice”, I’m in agreement….but….there must be a reciprocal response for personal responsibility. We don’t want anyone telling us what to buy or eat or drink or smoke, fine, but don’t call foul to the same Gov’t for regulations when you are denied a job due to obesity or diabetes (too expensive for the company) or have to pay more out of pocket for health care. The fundamental flaw in the Gov’t control argument in healthcare revolves around the fact that almost everyone benefits from Gov’t regulation and support. You can’t have it both ways.
EMTALA either needs to be repealed or it needs to be FUNDED!!
There’s a fine line to draw when we talk about government telling us what we can and cannot do. While I agree with you that the junk food industry and irresponsible people are driving up health care costs, I don’t think introducing a ban is the solution.
Yes, education doesn’t work and yes, people don’t listen. The penalties and regulations should be focused on industry, not on the consumer that, many times, is forced to eat crap food.
I fully agree with you on taxing sugar! Perhaps federal bans on sales of soda in public schools is another alternative.
“I do care about my government dictating what is good for me. The nanny state is getting way out of hand.”
Do you care that the junk food industry and irresponsible people are driving up your health care costs, both private and tax supported?
I applaud the Mayor for an attempt but feel it’s like banning king size cigarette packs – pretty useless. Looking back who was the first community to ban smoking in public places and what was the reaction to that.
What we should really be doing is taxing sugar. That way you can indulge but pay for irresponsible behavior.
I find the Bloomberg proposal silly and likely to be ineffective (although I would be pleased to see it succeed) … but I have to say that every kind of discussion about how to change detrimental dietary and lifestyle habits in the US is a blessing. Everyone working in healthcare and keeping their eyes open realize that we are in the late beginning of a disastrous diabetes epidemic … either medicare will become unsustainable within decades (even if we prevail making HC more efficient, like it is in other industralized nations) … or it will be the libertarian scenario: there will be individuals who can afford HC/insurance, and a majority of those who cannot … and those who cannot will be divided into healthy people who maintain reasonable diets and lifestyles (as well as being blessed with good genes) who will have a reasonable life expectancy … and on the other hand a lot of folks who fail on one of these 3 counts and who will do poorly. EMTALA will be repealed or circumvented (as it apparently already happens in some places) and people with untreated type 2 diabetes will die on the streets. Despite the efforts of some randian heroes, the US industry would be no longer competitive and our society would be doomed.
One small case … that’s all it takes to set precedent. Again … I’m not concerned about the beverage industry. I would rather see incentives to not buy the larger drives than to pass yet another law to make it illegal. It’s like Prohibition, in a way, all over again.
I get the nanny argument. But looking at this one small case … why not consider health policies that, at worst, have absolutely no effect on public health and, at best, improve it?
I don’t think this one law in NYC is going to take any beverage company down.
I do think it might be a cool opportunity for a public health experiment in a microcosm of a city.
Frankly, I don’t care how the beverage industry operates. I don’t buy or drink their sugary products. I do care about my government dictating what is good for me. People consume foods, drinks and smokes for all kinds of reasons, many not even considered by Marion Nestle. People hear the public service announcements and survive the health and hygiene classes, but they all make their own decisions, as it should be. The nanny state is getting way out of hand.