Banning large sugar sweetened drinks is a start

In an effort to combat obesity and all the health problems that are associated with it, New York mayor Michael Bloomberg recently announced a plan to ban the sale of sugar-sweetened drinks to 16 ounces or less. It also includes a $200 fine to vendors who violate it. If passed, the ban could take place as early as next March. The ban would not include diet drinks, juice-based drinks, or alcoholic beverages. It would also not include drinks sold at convenience or grocery stores.

So, my first reaction was, “Um, what’s the point? If I can’t get a large soda at the movie theater or the drive-thru, what’s stopping me from swinging by my local 7-Eleven to get my fill?”

It didn’t make sense to me.  But the more I think about it, I applaud the effort. I mean, you have to start somewhere, right? And who needs 32 ounces of soda at the movie theater? It just disrupts the movie with bathroom breaks. Seriously, though, Mr. Bloomberg should be recognized for his public health efforts. He banned both smoking and trans fats at restaurants, in addition to requiring restaurants to post their health grades in their windows. For a city in which at least half of the people are overweight or obese, I think it’s a fair start.

The New York City Beverage Association is speaking out against the ban; its members feel that the beverage industry is being singled out. Beverage companies say that drinks alone are not the cause of the obesity problem in the US. Are they correct? Obesity is a huge problem (forgive the pun) in this country. It’s outright scary. But it’s multi-factorial. People don’t exercise enough. Physical education programs are being cut from school curricula. Fast food is cheap and convenient. Healthy food is more expensive and doesn’t come from a drive-thru. And yes, portion sizes are huge. Think about a regular cheeseburger at McDonald’s versus the size of a burger at your local sports bar. When was the last time you saw a burger on a menu that was made of less than 1/3 lb of beef? The size of a bagel has increased three fold in the last 20 years. I’m also pretty sure that when I went to the movies as a kid, the “small” drink wasn’t as big as my head.

Another common argument against such policies is in reference to personal freedom. Let’s be honest – people aren’t exactly making the best choices with their “personal freedom” these days. The obesity rate is rising at an alarming rate, and so is the percentage of Americans without insurance or depending on government programs for healthcare. It is clear that obesity leads to multiple health problems. Should we encourage “personal freedoms” that can, and do, exacerbate these conditions? Especially if our tax money is funding them?

It’s a touchy area, I know. But as a taxpaying citizen and a physician who sees obesity and its consequences on a daily basis, I know that we have to start somewhere. And if it makes people a little angry, then so be it.

Mandy Huggins is a sports medicine physician who blogs on her self-titled site, Dr. Mandy Huggins.

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  • John C. Key MD

    Unfortunately your first impression was correct. Stupid, pointless idea. Bloomberg does indeed deserve recognition…but only as the hyper-nanny that he is, not as a visionary.

    • ChuloDO

      For being an MD, you sure are short on solutions.

      Unless you benefit financially from obese patients (which wouldn’t be particularly sound medicine), how about proposing alternatives instead of being a highly educated whiner?

      You don’t really know if the ban will work or not, but you’d prefer to wail about the paternalism. Kudos to Bloomberg for actually trying something.

      Reality is that as long as health care providers (or at least emergency departments) have a duty–or convention–to care for everyone, at least for initial diagnosis, a majority of people ought to be clamoring for such restrictions (or other solutions) in order to reduce their own insurance or health care costs. And currently, the social cost (i.e., health cost) of sugary drinks isn’t incorporated in the price, so limiting quantity is one way to mitigate the negative impact.

      But hey, Dr. Key cares more about freedom without responsibility. Please sign me up as a patient; he seems like a class act.

  • http://twitter.com/MakeThisLookAwe MakeThisLookAwesome

    Banning sugary drinks IS as start! But why stop there?

    Why not just give everyone government prescribed meals? In order to save health care costs, we could eliminate consumer choice altogether! Everyone will check in with their state-provided doctor, prescribed what foods we can and cannot eat. Then groceries would be dispensed by a pharmacy, and everyone would be eating healthy!!!

    I know this plan will absolutely guarantee that children eat their vegetables. Yup. We will force people to be healthy whether they like it or not! And of course the state won’t be influenced by lobbying groups to promote one food over another, regardless of actual health benefits. Nah… that will *never* happen. *cough*

    Isn’t it wonderful how complete strangers know how to run your life?

    • ChuloDO

      Why stop there? Because MakeThisLookEmbarrassing is proposing a straw man argument that doesn’t exist. Your mention of eating vegetables, MTLA, is ridiculous. Meanwhile, outside the world of MTLA’s baseless rant, sugary drinks are a gigantic health problem. I’d prefer a tax (where the proceeds are earmarked for health care prevention and maybe treatment), which was highly effective for reducing smoking (eventually), but this is a step in the right direction.

      Your waning credibility, MakeThisLookRidiculous, just about disappeared with the lobbying mention, because it’s the lobbyists for the agriculture and beverage industries that keep the diabetogenic drinks flowing for cheap–or even subsidized by the American people (in the case of the sugar industry). The soft-drink lobbyists might make taxation difficult, but in the meantime, they are the ones with the freedom, dispensing beverages without bearing the social costs.

      As someone who is tired of expensive insurance, I’m all for initiatives to bring the cost of my insurance down by making others’ health costs less expensive. I guess that laws could be put into place that people who ruin their health on their own don’t get treated, and as soon as you lead the charge, MTLA, for such legislation to be passed, I’ll consider complying. In the meantime, my duty as a provider doesn’t allow it.

      • NewMexicoRam

        Looks to me like you are the one throwing the straw man up there.

        • ChuloDO

          Just because you say it doesn’t mean it’s true. Unlike you (and MakeThisLookIgnorant before you), I provided analysis. And alternatives.

          And no straw man.

          But nice try.

  • Brad White

    Why not mandate physical fitness? Or mandate how many hours a TV can be on? If the only good way to use freedom is to always make the best health decision then freedom is an illusion.

    • ChuloDO

      Nice ideas, and good to suggest to parents and kids alike (we already do it), but feel free to explain how such initiatives are going to be enforced.

      Meanwhile, the consumption of supersized beverages is a gigantic health problem for diabetes and obesity alike.

      • Brad White

        Chulo, please let me know where you’d like me to ship you my excess freedom – as I reflect on my weekend I realize that I did not make the optimal health choice at every juncture so I obviously need people like you to dictate my actions.

        • ChuloDO

          You mean the loss of excess freedom in the form of extra health costs borne by society and/or fellow insurers? So you’re saying that you are now prepared to assume the costs personally of your actions (and/or require others to do the same)? Excellent.

          That’s the irony of YOUR weak straw man here. If you do make healthy decisions, then you benefit from the law. And if you don’t, then it reduces your ability to shove it on the rest of us who do. That actually sounds like a conservative principle that you seem to embrace–personal responsibility. Whether your hypothetical really implies a suboptimal health choice that affects others is in your mind and isn’t really relevant to my argument.

          BTW, your silly hyperbole about physical fitness is not so farfetched anyway, as a paying insurance holder and taxpayer toward those who are not being responsible for their health care so that my health care costs (and yours) are kept down. Too bad you got mixed up in your own argument about freedom, given that limiting people who are irresponsible about their health helps the freedom (including economic freedom) of those of us who do.

          • Brad White

            At the risk of feeding the troll…

            Here is the definition of a straw man argument: http://en.wikipedia.org/wiki/Straw_man Twisting your opponents words to defeat them rather than deal with the substance of their position falls in this category. You, my friend, are the one using the straw men.

            Instead, let’s look at the substance of our positions. I say that the government does not have the right to force people to do things that are good for them. I think that is a loss of freedom. Your position (I think, please correct if I am wrong) is that since society pays for the lack of responsibility, then the government does have a right to strip that freedom from everyone.

            I think the solution is contained in your problem statement – simply eliminate the government subsidies in health care and let people be responsible for themselves. Another approach would be to only control the lifestyle of those receiving public assistance. I think this is what you mean by your second question in the first paragraph.

  • http://www.facebook.com/profile.php?id=100000652119019 Dave Comstock

    “…the state or any other social body has NO right to coerce or restrict the individual unless the individual causes harm to others, crucially, the individual’s own physical or moral harm is not justification for constriction of their liberty.” – John Stuart Mill (1869).

    I take particular issue with your comment, “people aren’t exactly making the best choices with their “personal freedom” … which clearly misses the essence and meaning of “personal freedom.”

    • ChuloDO

      Glad you brought up the notion that restricting the individual is justified when it causes harm to others. Since medical costs of others (including big soda drinkers) boost insurance costs for you and me, Dave, then this initiative seeks to mitigate those costs. Thanks, Dave, and Mr. Bloomberg.

  • http://www.facebook.com/profile.php?id=100000652119019 Dave Comstock

    Human liberty has three components that apply to the individual:

    1) The freedom to think as one wishes, and to feel as one does. This includes the freedom to opinion, and includes the freedom to publish opinions known as the freedom of speech,

    2) The freedom to pursue tastes and pursuits, even if they are deemed “immoral,” and only so long as they do not cause harm to others,

    3) The “freedom to unite” or meet with others, often known as the freedom of assembly.

    Without all of these freedoms, in Mill’s view, one cannot be considered to be truly free.

  • http://www.facebook.com/profile.php?id=662132748 Lata Potturi Schaedler

    Personal freedom has led to a country where 67% of its population is overweight, 30+% are obese, and healthcare costs are skyrocketing out of control. Does no one care to notice that when given free will to choose people are making BAD decisions and killing themselves? I may be in the minority, but I think government involvement is overdue. Control portion sizes for people (because obviously they cannot). Stop subsidizing corn prices and start subsidizing fruits and vegetables. Start initiating changes that will lead Americans to make healthy choices.

  • http://twitter.com/danceswithfat Ragen Chastain

    Actually, the scientists upon whose work Bloomberg claims his ban is
    based have written an article explaining that he misunderstood their
    research and why the ban won’t work and will likely make things worse.
    http://m.theatlantic.com/health/archive/2012/06/how-bloombergs-soft-drink-ban-will-backfire-on-nyc-public-health/258501/

    The “Tax Dollars” argument is a thin veil for bigotry. Unless you have a list of all the things your tax dollars pay for divided up between what you do and don’t want to pay for, and a list of the interventions that you are taking on each thing you don’t want to pay for, then you are just using this as an excuse to stereotype fat people. Research including Matheson et. al, Wei et. al, and the Cooper Institute studies show that obese people who practice healthy habits have the same hazard ratio of thin people who practice healthy habits and a dramatically better hazard ratio than thin people who don’t practice healthy habits. The only thing you can tell by someone’s body size is what size they are and what your stereotypes about people that size are.

    The idea that you should take away people’s freedoms because you don’t like the way that they are using them is abhorrent. Should vegetarians be allowed to take away everyone’s right to eat meat because they disagree with it. Should raw foodists be able to take away everyone else’s right to cook their food. I don’t drink – do I get to take away everyone else’s right to drink because I think it’s a bad choice and I don’t want my tax dollars to go toward the ensuing costs?

    Public health should be about providing access – to food options, safe movement options, correct information and affordable evidence-based healthcare. Then people get to prioritize their health in whatever way they wish and make choices for their bodies and mind their own business.

    Ragen Chastain
    http://www.danceswithfat.org

  • EmilyAnon

    Personally, I don’t care how other people abuse their bodies (except for my family where I reserve the ‘right’ to nag), just don’t make me pay for it.

    • ChuloDO

      Excellent, Emily! Glad that you support efforts such as this ban that reduce your need to pay for it!

    • ChuloDO

      Terrific, Emily; glad you’re in support of initiatives such as this one that reduce the amount that you have to pay for the poor health decisions of others via insurance, taxes, poor work productivity, and possibly infection. This is a tiny sacrifice of unlimited freedom with the goal of boosting societal health and lower health costs. Whether it has an impact is yet to be determined. If it doesn’t (after a sufficient time of testing), then it should be scrapped.

  • 123Anne

    I really don’t think limiting the size of drinks is going to help reduce the rates of obesity. People who want to drink 32 oz will just order 2 drinks. What will help is giving people access to healthier food options, making fun exercise more available, and making good health the goal-not weight loss. Fat people are not necessarily unhealthy and neither are thin people automatically healthy. Good health is not something you can tell by looking at a person. It is something that people of all shapes can hope to improve.

  • Ginger

    I think it’s a good idea. I’m a member of the “clean plate club” meaning I’ll eat whatever is put in front of me. If you order a meal someplace and it comes with a drink then that’s what you drink.
    Portion sizes are way of out line with what people actually need to sustain themselves and soda is not a foodstuff that’s essential. It’s a nudge towards more reasonable portion sizes that isn’t a tax, so why not try it. Many people will adjust and most likely not die from thirst or hunger.

  • http://twitter.com/hugginsmd Mandy Huggins

    I knew this post would trigger much discussion, and I appreciate many of the points made below. At the end of the day, it’s just an opinion, my opinion. You can judge me if you want, but I still think that it’s about time that people start taking action against this epidemic that will affect us on more levels than we care to believe.

  • LissaKay

    The government is promoting unhealthy food by way of subsidies to farms
    at the same time they are trying to dictate what foods we eat, partially
    based on promotion of certain agriculture products. The USDA is not
    interested in our health, nor is it even right about what foods are
    healthy. It is up to the individual to seek out the truth about food,
    and make the choices for themselves. A good place to start is with “Fat
    Head” … you can watch for free on Hulu or Netflix. See also: http://bit.ly/MgrA1l

    • ChuloDO

      Glad you’re in support of removing farm subsidies.

      Your bash on USDA seems ill-founded; while their food recommendations might not be optimal, stating that they are not interested in health appears to go too far.

  • davemills555

    Not to worry! If free-market Tea Party Republicans get their way, any legislation to limit sugar in our diets won’t see the light of day in Congress or in any state legislature. After all, it’s about “freedom and liberty”, right? The “freedom and liberty” for uninsured Americans to get as sick as they possibly can and then force hospitals and force insured individuals to pay to rescue these freeloaders. That’s what Republicans want and they are fighting like crazy to make it happen.

  • http://www.facebook.com/profile.php?id=769935315 Jen Madeline

    The way I understand it is the reason soft drinks, fast food, and highly processed food is over eaten is because its so cheap. The food is so cheap because its largely made from corn syrup. Corn syrup is so cheap because corn is subsidized by the government. I also understand this is a simplistic view of the situation, but what I don’t understand is why anyone would think its a good idea to tax the end consumer (who is likely already lower on the socioeconomic scale)? Fix the root of the problem by decreasing the subsidies. I did a report on Agricultural Policy in med school and found that the current US agricultural supply doesn’t provide nearly enough vegetables and fruits for everyone in the US to be able to eat the USDA recommended daily amounts even if they wanted to. But we sure do have enough corn. Nothing is going to change until the food supply does. If I’m missing something, will someone please explain it to me? Its maddening that what seems so clear to me, is blatantly overlooked by the government and media.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Because the government was sold down the river a long time ago and because we don’t really have objective journalism anymore.
      So we pass laws to measure drinking cups with a ruler or something. Reminds me of the miniskirts monitors in Catholic schools. What are they going to do? Ride around Manhattan in little blue cars checking plastic cup supplies in every dinky store? Handcuff the owners, or shut them down?
      How about giving people small business loans to open little fresh food stores in neighborhoods loaded with fast food and not much else?

  • Dorothygreen

    Subsidies for nhealthy food must be stopped but in such a way that the farmers now getting subsidized to grow corn and wheat and soy can be paid more to grow vegetables and fruits. Big AG/big food is very powerful and do not care about the people who become addicted to their sugary, corn fed animal or high sodium products (salt is very cheap without subsidies. The goal is to make vegetables and low glycemic fruits cheaper than potato chips, ice cream, candy, all processed foods. And make them accessible. Their are pilots with SNAP vouchers for vegetables and fruit. Then the end user is responsible.
    Both should be done simultaneously. It is like the “war on tobacco”. It didn’t come easy but ex-smokers are grateful – hard as it was to quit. And smokers have a choice – it is their RISK and they are paying a good amount up front for this risk of lung cancer or lower respiratory disease.
    We are wired to like sugar, fat and salt. However we now have endless choices to eat as much processed sugar, chemical and heat processed vegetable oils, corn fed animal meat and their fat and salt. When our DNA was formed we didn’t have these.
    It matters because the preventable diseases caused by consumption of high amounts of these processed foods eat up about 2/3 of our health care dollars – many of those dollars from those who pay income tax and choose not to eat unhealthy food.
    When all aspects of the Tobacco model are implemented – limited to adult viewing ads like we have with alcohol, change in the subsidy program, put RISK messages on packages and a RISK tax on the added sugar, refined carbohydrates, chemical processed vegetable oils, corn fed animals and their products and sodium – everything possible will have been done to warn the end uses fo the dangers and collect revenue to help those who unable to control this addiction.

  • http://www.knockoutfoto.com/ Bruce Coe

    Hmmm…..slagging off your patient duties to the government? Good Move. Physicians need to work with their patients (“I won’t see you again until you have lost at least 5 pounds….” is a good start) no matter how weak and disgusting they may seem to them.

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