New tactic in war on obesity: Attack portion size

After obesity rates in the United States began soaring in the 1980s, federal, state and local governments started to push back. Calorie counts were mandated for food packages and in many restaurants. School lunches were made healthier. Unhealthy trans fats got phased out.
Yet American waistlines continued to swell, with two-thirds of adults and one-third of children now overweight or obese — a major factor in the country’s health-care crisis, as obesity triggers expensive chronic illnesses, including diabetes and heart disease.
By the early 2000s, policymakers began focusing their energies on a new target: soft drinks. High in calories and with no nutritional value, sodas are a huge source of added sugar in the American diet. Study after study shows that people who drink the most non-diet soda are at the highest risk for obesity.
But in the face of intense lobbying from drink makers, efforts to tax and regulate soft drinks have foundered.
This past week, New York Mayor Michael Bloomberg — amidst a multi-front war on obesity — tried a new tactic. He proposed limiting sugary drinks sold by restaurants, cinemas, street vendors and stadiums in his city to 16 ounces. (Grocery stores would be exempt.) “We know that portion size influences consumption. We know that portion sizes have risen dramatically. And we know that sugary drinks have this uniquely strong connection with weight gain,” said Thomas Farley, New York’s health commissioner.
The move intensified the debate over how far government should go to steer individual behavior in the name of health and immediately drew scorn from the $75 billion-per-year soft drink industry.
“Here they go again,” said Chris Gindlesperger, spokesman for the American Beverage Association, an industry group. “The New York City health department has an unhealthy obsession with attacking soft drinks. It’s over the top. It’s overreach. The city is not going to address the obesity problem by attacking soda, because soda is not driving the obesity rate.” A group funded by restaurants began running ads in New York branding Bloomberg — shown in a housedress and scarf — as “the nanny.” “You only thought you lived in the land of the free,” read the newspaper ad bought by the Center for Consumer Freedom, which sourcewatch.org says represents the restaurant, alcohol, tobacco and other industries.
Fast-food giant McDonald’s also weighed in with a tweet to Bloomberg on Friday, “We trust our customers to make the choices that are best for them.” But public-health advocates contend that letting everyone make their own choices has led the country to $192 billion per year in medical bills for obesity-related care. That’s a tab everyone ends up paying via Medicare, Medicaid and soaring rates for private health insurance.
“There is nobody on face of the planet who needs a soda, let alone a 32 ounce soda,” said Robert Lustig, a pediatric-obesity researcher at the University of California at San Francisco who is a vocal proponent of restrictions on sugary drinks.
Advocates of soda regulation point to a long list of government mandates — vaccines to prevent childhood diseases, seat-belt laws and automobile-air-bag rules, and high taxes and age restrictions on cigarettes and alcohol — that they say have improved public health and saved lives. What sets New York’s proposal apart is that it addresses a new aspect of the obesity problem — portion size.
“If New York City’s initiative succeeds, it really opens up a new front,” said Michael Jacobson, executive director for Center for Science in the Public Interest, an advocacy group. “I’m sure it will encourage other cities and states to seek similar measures to reduce portion sizes.” The approach also offers a model for getting around the kind of political warfare that has impeded soda taxes, Farley said.
The battle over sodas raged in 2009, after President Barack Obama floated the idea of a national soda tax to reduce consumption and pay for his proposed health-care reforms. As top academics championed the idea, states and cities rolled out proposed taxes.
But soda makers pushed back hard — upping their lobbying expenditures eight-fold from 2008 to 2009, to $40 million, according to records for the American Beverage Association. The result: Soda taxes were defeated in 30 states and several cities, including Philadelphia.
PepsiCo. threatened to move its headquarters out of New York state if an 18 percent tax passed there (it didn’t). And, despite the president’s rhetoric, a soda tax never even made it into drafts of the health-care bill, which was passed into law in 2010.
Soda makers “have indicated they will spend as much money as it takes to kill a tax because tens of millions [of dollars] is nothing compared to the sales they would lose if a stiff tax were adopted,” said Jacobson.
By contrast, adoption of Bloomberg’s proposal is virtually assured. The only body that must sign off on it is the city’s health board — all Bloomberg appointees with Farley as the chairman.
The beverage industry’s only recourse appears to be a lawsuit, which Gindlesperger said the beverage association is considering.
“New ideas are often more controversial and are more likely to be passed by a group of experts than by a group of people who have to get elected every couple of years,” said Farley.
Gindlesperger countered that regulators could achieve more meaningful results if they “came to the table” and negotiated voluntary changes with the industry.
But the soda industry’s interests are “in complete conflict with public health needs,” said Yale University professor Kelly Brownell, a proponent of soda taxes and restrictions.
That’s because drink makers and retailers reap big profits from giant drinks, Brownell added. For just a few pennies of extra product, soda companies can sell jumbo drinks for a dollar or two more than smaller sizes.
“That’s why you have to regulate,” he said.
Bloomberg’s proposal swims against two federal policies that public-health advocates say encourage soda drinking: Farm subsidies that push down the price of high-fructose corn syrup add about $100 million a year to the bottom line of soda makers, according to a 2009 analysis from Tufts University researchers. Those subsidies make soda cheaper.
And the 42 million Americans receiving federal food stamps use those benefits to buy $4 billion of soda every year, according to the Center for Science in the Public Interest.
Still, overall consumption of sugary drinks has dropped 24 percent since 1998, according to an analysis from the group.
“That’s historic and indicates some progress, probably due to a whole range of factors,” including more consumption of bottled water and diet sodas, the popularity of low-carb diets like Atkins, and increased health consciousness, Jacobson said.
Experts disagree about whether the Bloomberg plan will cut into the city’s obesity problem.
“There’s not a lot of evidence it will work,” said Cornell University professor Brian Wansink, who studies food behaviors. “Because the people who drink it really like it, they’re going to figure out a way around it.” But a slew of research shows larger cups and bottles leads to more soda drinking. “What’s put in front of you, big or small, feels satisfying to people,” said Farley.
Barry Popkin, a prominent public-health researcher at the University of North Carolina, agreed, calling the proposal “gutsy.” “Controlling sugary beverage portions . . . is critical for reducing weight gain and risk of diabetes in the United States,” Popkin said.
Brownell challenged the industry groups accusing Bloomberg of cutting into Americans’ freedom to choose, “It’s not a nanny state to encourage people not to buy a 64-ounce soda at KFC.”