Mike Bloomberg’s war on Big Sugar

Since winning office, New York City Mayor Michael R. Bloomberg has banned smoking in public, stopped the use of trans fats in city restaurants and compelled food providers to list the calories served on their menus.

Last Thursday, he publicly exposed the latest bee in his bonnet: he’s angling for a fight against sugary drinks, commonly known as ‘sodas’ in the United States. It’s a war he thinks is worth fighting, even if he losses a couple of battles on the way. And it’s a conflict whose time has surely come, many would argue.

Speaking to NBC News the mayor acknowledged both that the war on obesity is the biggest national health issue in the country and, that it is one war with very few victories to date. And he wants to change all that.

In order to reduce the numbers of Americans that become overweight as well as improve the health of those already super sized, the mayor wants to limit the size of sugary beverages available in sports grounds, cinemas and food courts.

Contrary to his detractors (i.e. the lobbyists and Big Sugar’s marketing geniuses with their toe tapping tunes) but also TV talk show hosts hitching their wagons to what they perceive is the populist view), the mayor this time is not planning a tax on sugar, nor is he outlawing the sale of sodas.

He simply wants to tackle obesity in a new way.

He wants to give consumers cues to be alert to just how much they are drinking and to what exactly it is they are gulping down. He wants to do this by outlawing the sale of bucket like cups of soft drinks.

The sugary drink industry (through its lobbyists) has been downplaying the connection between its products and weight gain for 50 years, even though there is vast data that proves a linkbetween drinking soda pop and expanding waistlines.

While drinking small amounts (say 7 oz or 200 ml) of soda pop shouldn’t make a significant difference to a consumer’s waistline, many quick service restaurants very often supply trough sized 32 oz drinks. That's a whopping 900 mls containing the equivalent of 25 sugar cubes and weighing in at 400 calories or 1,680 kJ. It’s the consumption of such quantities that’s fuelling the epidemic of obesity.

By making consumers cognisant of the harm they are inflicting on their bodies and on the public health care system when they put away large volumes of soda pop, the mayor hopes consumer behaviour will be modified. His aim is for folk to drink smaller quantities or failing that, to drink multiple regular sized drinks rather than a super sized drink. At least that way they will see the error of their ways. And hopefully curb them.

The Mayor is not alone.

New York City’s Commissioner for Health & Mental Hygiene, Dr. Thomas Farley is convinced that sugar results in weight gain and that action is needed to arrest this scourge.

Last Thursday the Commissioner outlined plans to cap serving sizes of sugary drinks at 16 ounces (473 ml), which will be in force next March. The rule would cover sodas, sweetened teas and so-called (feel free to guffaw) “vitamin” waters.

The size limit would apply only in restaurants, cinemas, delis and street side food vendors. Even so, Big Sugar is already wheeling out the heavy artillery.

Sadly for Big Sugar the mayor has both the facts and history on his side.  And most of all he’s rich enough not to be swayed by soft money.

Sodas do contribute to the obesity epidemic because of the way our bodies process such drinks. And we’re gulping down more and more of that stuff. According to the Centre for Disease Control and Prevention in Atlanta, Georgia, the average size of a quick service restaurant soda is stunning sixtimes larger than a soda in the 1950s. These drinks are empty calories, free of nutrition and fail to create a sensation of fullness, adding over a thousand kilojoules each day.

Americans slowly grew chubbier from 1960 to the early 1980s. But in the 25 years since the mid 1980s, Americans, like pigs on hormone supplementation, have fattened up at twice that rate. The Annual Review of Public Health in 2005 showed that a rapid rise in obesity rates began in the 1980s.

In 2002, Flegal, Carroll, Ogden and Johnson, in the Journal of the American Medical Association pointed out that during the late 1980s and early 1990s, obesity prevalence climbed to 23% and reached 31% by 2000. While Grade 3 obesity (where the Body Mass Index is at least 40) grew even more rapidly, rising from 1.3% in the late 1970s to 4.7% in 2000. The depressing evidence is that while Australians are not quite as fat as Americans, we’re catching up real quick, don’t you worry. Numerous studies, including that of Fontaine, Redden, Wang, West and Allison in 2003have linked sugary drink consumption with long-term weight gain as well as an increased risk of heart disease and diabetes.

In this fight the soda industry will be clutching at straws.

Sadly for them, Bloomberg’s proposal only needs the approval of the New York City Board of Health, a board appointed by the Mayor. It does not require the approval of elected politicians in the state capital, Albany (as would be the case in an Australian Commonwealth or state parliament), where soft money contributions may sway a vote. You see, all but one member of the New York City Board of Health, are appointees of the Mayor and must answer to the Mayor, and not to donors. And the real kicker is that the sole non-appointee, the big cheese himself, the Commissioner, is very, very much on board.

It looks very much like Check Mate for Big Sugar.

It is expected that lobbyists will go to the airwaves, print and online media decrying the “assault on freedom of choice” which they will claim the city’s #1 Nanny wants to impose. Many others, with shallower pockets, of course will argue they too want freedom of choice: the freedom to choose not to pay for health care of others where it is clear that a patient’s dietary behaviour directly related to his/her hospitalisation.

According to Nancy Huehnegarth of the Huffington Post, two years ago the American Beverage Association spend nearly US$13 million in lobbying against a proposed cent-per-ounce New York state soda tax. No expense was spared. Big Sugar hit both the electronic and print mediums as well as dangled the sword of possible bottling plant relocations out of the state, if the tax saw light of day.

The lobbyists won that day. Lawmakers folded like paper napkins. With their nightmare of a countrywide bad food tax, Big Sugar’s fear campaign trumped popular pro health advertisements.

This time it’s different. Mayor Bloomberg is not proposing a tax, but a cap. And this makes it much harder for opponents to kill. As does the way he wants to introduce it. The idea has captured the imagination of many and has jump-started a national discussion on sugary drinks portion sizes, obesity and how far government should go to protect the health of its citizens from Big Sugar.

And that’s precisely Mr Bloomberg’s point. A debate is way overdue.

Cutting portion sizes to reduce food or drink consumption makes sense because research has consistently shown it works far better than education or depending on "personal responsibility." High up in this list is the 2005 study in the Journal of Nutrition Education and Behavior that demonstrates that cinema patrons who were given a large, rather than a medium-sized container of stale popcorn, ate much more popcorn, than those given a medium container. Even though it was stale.

While referring to food, but easily transferable to the issue of beverages, Chair & Director of Cornell University’s Food & Brand Lab in Ithaca, NY, Brian Wansink, PhD, has suggested that the reason Americans are getting fatter is that they have been conditioned to eat more. He breaks up this insidious misinformation by industry as follows:

• Drivers of Large Portion Size – larger portions in supermarket freezers; larger servings in restaurant (which to a lay observer, like the writer, would include the nefarious “free refill” of sodas in quick service restaurants regardless of the size of the cup) and larger crockery on sale in department stores;
• Increased Perceived Portion Size – as “recommended” by the manufacturer and emblazoned on the packaging; and
• Increases in the volume of food or drink consumed in a single session - which after all, is a multiple of portion sizes, which too are increasing over time.

Echoing earlier studies, Wansink admits that educating the public to eat better and eat less is not the magic bullet. How folk are influenced to change behaviour is what makes the difference.

He cites his study of 65 highly educated graduate students indoctrinated for 90 minutes on healthy eating only to find most of them soon fail a test of healthy eating. He wanted to see if those presented with one 1 gallon container of snacks would eat more than those presented with two half gallon containers. He found that those served with larger containers ate a whopping 53% more snacks and to boot, argued that the serving container had absolutely nothing to do with their larger consumption!

Wansink strongly believes that the answer to weight control is not to pester consumers with messages about not overeating from large packages of food or drink, or from the relatively recent phenomenon of large crockery. The answer is to replace large servings, large “recommended” portions and large crockery from their lives with smaller servings, smaller “recommended” portions and smaller crockery.

Wansik contends that changing people’s environments is far, far easier than changing their thinking, And this is vital in the case of a foodstuff like sugar whose deleterious health effects are documented.

Changing environments can be done very easily by modifying serving sizes in both restaurants and quick service food sellers. As well as by focussing consumers’ attention on better foods to eat. Not by brow beating consumers, instead by slowly and methodically marketing them a new (slimmed down, healthier) reality.

It’s bound to succeed.

This type of approach has form. After all, changing our environment slowly and methodically with respect to portion sizes since the 1950s is precisely what made us obese in the first place.

Kudos Mr Mayor, kudos.